Diagnosis: F44.0 – Dissociative Amnesia with Dissociative Fugue Specifier
Z63.0: Problems in relationship with spouse or partner
Explanation of the Diagnosis:
Based on the presenting symptoms, Annie is diagnosed with dissociative amnesia with dissociative fugue syndrome. This diagnosis is supported by the fact that Annie has forgotten her identity, including her name, family, and personal history, and cannot recall these memories, which has caused her significant distress. Additionally, she experienced a seemingly traumatic event before the onset of her symptoms. The dissociative fugue specifier is added as Annie has left her usual environment, has taken on a new identity, and may be traveling away from her home location.
According to the DSM-5 criteria, the diagnosis of Dissociative Amnesia is appropriate when there is an inability to recall important personal information, which is usually of a traumatic or stressful nature that cannot be explained by ordinary forgetfulness or organic memory impairment. This includes situations where the person has taken on a new identity or wandered away from their usual surroundings (APA, 2022). Annie meets all these criteria, as she cannot remember important personal information, including her name, family, and personal history. Additionally, she has taken on a new identity and cannot recall her previous identity or surroundings.
Differential Diagnosis
Other differential diagnoses that were considered include Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), and Psychogenic Amnesia. However, these were excluded because there is no evidence of traumatic exposure or significant emotional disturbance. Additionally, there is no evidence of organic brain dysfunction, ruling out the possibility of amnesia caused by medical conditions such as dementia or brain injury. While Annie has experienced a seemingly traumatic event, her amnesia appears selective to her identity and unrelated to specific traumatic memories. Therefore, dissociative amnesia with dissociative fugue specifier is the most fitting diagnosis.
Cultural Factors
Culture plays a significant role in diagnosing and treating mental health disorders. In Annie’s case, her cultural background and experiences could impact her response to the diagnosis and treatment. As a white female from an affluent family, Annie may have grown up with societal expectations and norms that could affect her response to her role as a wife and mother. Additionally, her family’s disapproval of her marriage to a Black man may have caused her emotional distress and impacted her relationships with her family.
Z-code
I chose the Z63.0 code for this client because of her difficulty adjusting to the role of a wife and mother, and her distress about not remembering her past may be related to problems in her relationship with her spouse. The code refers to problems within a marital relationship, including difficulties in communication, intimacy, and trust (WHO, 2022). In this case, the client’s inability to remember her husband and children suggests that there may be a disconnect or unresolved issues in their relationship that are impacting her memory and emotional well-being. Her distress may also be related to other psychosocial factors, such as her strained relationship with her family of origin. Still, given the information provided in the case, the Z63.0 code seems most appropriate to describe the impact of her current relationship issues on her mental health.
References
American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders. (DSM-5-TR). (5th ed)
WHO. (2022). ICD-10 Version:2019. Icd.who.int. https://icd.who.int/browse10/2019/en#/Z63.7