Dissociative Fugue
Dissociative Fugue
Definition
Dissociative fugue is a rare condition in which a person suddenly, without planning or warning, travels far from home or work and leaves behind a past life. Patients show signs of amnesia and have no conscious understanding or knowledge of the reason for the flight. The condition is usually associated with severe stress or trauma. Because people cannot remember all or part of their past, at some point they become confused about their identity and the situations in which they find themselves. In rare cases, they may take on new identities. The American Psychiatric Association (APA) classifies dissociative fugue as one of four dissociative disorders , along with dissociative amnesia, dissociative identity disorder , and depersonalization disorder.
Description
The key feature of dissociative fugue is “sudden, unexpected travel away from home or one’s customary place of daily activities, with inability to recall some or all of one’s past,” according to the APA. The travels associated with the condition can last for a few hours or as long as several months. Some individuals have traveled thousands of miles from home while in a state of dissociative fugue. (The word fugue stems from the Latin word for flight—fugere.) At first, people experiencing the condition may appear completely normal. With time, however, confusion appears. This confusion may result from the realization that they cannot remember the past. Those affected may suddenly realize that they do not belong where they find themselves.
During an episode of dissociative fugue, those affected may take on new identities, complete with a new name. They may even establish new homes and ties to their communities. More often, however, those affected realize something is wrong not long after fleeing—in a matter of hours or days. In such cases, they may phone home for help, or come to the attention of police after becoming distressed at finding themselves unexplainably in unfamiliar surroundings.
Dissociative fugue is distinct from dissociative identity disorder (DID). In cases of DID, which previously was called multiple personality disorder, those affected lose memory of events that take place when one of several distinct identities takes control of them. If the person with dissociative fugue assumes a new identity, it does not coexist with other identities, as is typical of DID. Repeated instances of apparent dissociative fugue are more likely a symptom of DID, not true dissociative fugue.
Causes and symptoms
Causes
Episodes of dissociative fugue are often associated with very stressful events. Traumatic experiences, such as war or natural disasters, seem to increase the incidence of the disorder. Other, more personal types of stress might also lead to the unplanned travel and amnesia characteristic of dissociative fugue. The shocking death of a loved one or seemingly unbearable pressures at work or home, for example, might cause some people to run away for brief periods and blank out their pasts.
Symptoms
People in the midst of dissociative fugue episodes may appear to have no psychiatric symptoms at all or to be only slightly confused. Therefore, for a time, it may be very difficult to spot someone experiencing a fugue. After a while, however, patients show significant signs of confusion or distress because they cannot remember recent events, or they realize a complete sense of identity is missing. This amnesia is a characteristic symptom of the disorder.
KEY TERMS
Amnesia —A general medical term for loss of memory that is not due to ordinary forgetfulness. Amnesia can be caused by head injuries, brain disease, or epilepsy, as well as by dissociation.
Dissociation —A reaction to trauma in which the mind splits off certain aspects of the traumatic event from conscious awareness. Dissociation can affect the patient’s memory, sense of reality, and sense of identity.
Demographics
Dissociative fugue is a rare disorder estimated to affect just 0.2% of the population, nearly all of them adults. More people may experience dissociative fugue, however, during or in the aftermath of serious accidents, wars, natural disasters, or other highly traumatic or stressful events.
Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders , 4th edition, text revision, also known as the DSM-IV-TR, lists four criteria for diagnosing dissociative fugue:
- unexplained and unexpected travel from a person’s usual place of living and working along with partial or complete amnesia
- uncertainty and confusion about one’s identity, or in rare instances, the adoption of a new identity
- the flight and amnesia that characterize the fugue are not related exclusively to DID, nor is it the result of substance abuse or a physical illness
- an episode must result in distress or impairment severe enough to interfere with the ability of the patient to function in social, work, or home settings
Accurate diagnosis typically must wait until the fugue is over and the person has sought help or has been brought to the attention of mental health care providers. The diagnosis can then be made using the patient’s history and reconstruction of events that occurred before, during, and after the patient’s excursion.
Treatments
Psychotherapy , sometimes involving hypnosis, is often effective in the treatment of dissociative fugue. With support from therapists, patients are encouraged to remember past events by learning to face and cope with the stressful experiences that precipitated the fugue. Because the cause of the fugue is usually a traumatic event, it is often necessary to treat disturbing feelings and emotions that emerge when the patient finally faces the trauma. The troubling events that drove them to run and forget about their past may, when remembered, result in grief, depression , fear, anger, remorse, and other psychological states that require therapy.
Prognosis
The prognosis for dissociative fugue is often good. Not many cases last longer than a few months and many people make quick recoveries. In more serious cases, patients may take longer to recover memories of the past.
See alsoDissociative identity disorder.
Resources
BOOKS
Allen, Thomas E., and others. A Primer on Mental Disorders: A Guide for Educators, Families, and Students. Lantham, MD: Scarecrow Press, 2001.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text rev. Washington, D.C.: American Psychiatric Association, 2000.
Beers, Mark H., and Robert Berkow, eds. “Dissociative Fugue.” The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
ORGANIZATIONS
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax: (202) 682-6850.
International Society for the Study of Dissociation. 60 Revere Drive, Suite 500, Northbrook, IL 60062. <http://www.issd.org/>.
National Alliance for the Mentally Ill. Colonial Place Three, 2107 Wilson Boulevard, Suite 300, Arlington, VA 22021. <http://www.nami.org/index.html>.
New York Online Access to Health (NOAH). “Dissociative Disorders.” 2006. List of online resources at: <http://www.noah-health.org/en/mental/disorders/dissociative.html>.
Dean A. Haycock, PhD
Emily Jane Willingham, PhD