An Overview of Dissociative Fugue

Dissociative fugue, formerly called fugue state or psychogenic fugue, is a subtype of dissociative amnesia. It involves loss of memory for personal autobiographical information combined with unexpected and sudden travel and sometimes setting up a new identity.

The word "fugue" comes from the Latin word for "flight," which reflects the nature of dissociative fugue in that involves an element of running away from one's present situation.

Dissociative fugue is a form of reversible amnesia that involves personality, memories, and personal identity. This type of temporary amnesia may last hours, days, weeks, months, or longer. It involves wandering or unplanned travel, in which the person may establish a new identity in a new location very different from their old life.

While dissociative fugue used to be diagnosed as a separate disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), in the new updated DSM-5 it is a subtype of dissociative amnesia instead. In general, the dissociative disorders involve impairment of identity perception, conscious awareness, and memory.

What are the symptoms of dissociative fugue? They potentially include all of the following depending on the case:

If you're in the midst of a fugue state, you may exhibit the following symptoms:

• confusion about your identity
• appearing to be unsure about your past
• feeling confronted if challenged about your identity

However, it's important to note that a person in the middle of dissociative fugue may not show any outward signs that suggest they are experiencing mental illness. That is because, from the perspective of the person, the new identity is their actual identity. It is only when this becomes challenged that issues may present themselves.

Once a dissociative fugue state has passed, you may experience symptoms like:

• feelings of depression
• periods of grief
• feelings of shame
• discomfort or anger
• feelings of distress about being in an unfamiliar place
• feeling as though you have lost time

How is dissociative fugue diagnosed?

When it was originally included as a separate disorder in the DSM-IV, the following criteria needed to be met for diagnosis:

• sudden or unexpected travel away from one's home or work
• the inability to remember your past experiences
• confusion about your identity and taking on a new one
• significant distress and impairment about these issues

However, it's important to know that dissociative fugue is typically only diagnosed retrospectively since a person in the middle of it may not show any outward signs and it might be hard for others to recognize. So, it is only when the fugue ends, either abruptly or gradually, that a diagnosis is usually made.

Since the release of the DSM-5, dissociative fugue is now a subtype of dissociative amnesia (a disorder) and referred to as a state of bewildered wandering.

All of the other subtypes are listed below:

• selective amnesia
• generalized amnesia
• continuous amnesia
• systematized amnesia

Dissociative fugue will not be diagnosed if the fugue state is directly related to any of the following conditions or situations:

• ingestion of psychotropic substances
• experience of physical trauma
• a general medication condition
• dissociative identity disorder
• diagnosis of delirium
• diagnosis of dementia
• head trauma
• ingestion of drugs or alcohol
• a period of sleep deprivation
• diagnosis of epilepsy

In this way, it's important to emphasize that dissociative fugue and dissociative amnesia as the umbrella condition is a neurological impairment rather than due to some physical cause or substance that was taken.

Furthermore, in very rare cases, people may feign dissociative fugue for legal or other reasons. This would be uncovered during a complete physical and mental examination.

An assessment for dissociative fugue would generally start with a physical exam to rule out medical conditions. It could also include neuroimaging, such as an electroencephalogram (EEG), to rule out things like epilepsy, head injury, etc. Once physical causes were ruled out, a psychiatrist or psychologist would administer a series of assessment tools and conduct an interview to assess for mental disorders.

What are the causes of dissociative fugue? Below is a list of some potential related causes. Generally, these situations involve some sort of violence or terrible trauma:

• childhood sexual abuse
• experience of violence (e.g., rape, torture)
• combat violence
• suicide attempt
• automobile accident
• natural disasters
• committing a homicide
• severe stress (e.g., marital or financial)

While you may appear fine after the trauma, triggers of an early trauma could cause dissociative fugue. For example, seeing your abuser later in life or experiencing an event that reminds you of the earlier event (e.g., seeing a small fire after being involved in a tragic fire). In this way, events have the potential to trigger a massive reaction because they somehow make contact with the trauma in your memory.

In addition, there is evidence that there may be a genetic link as family members of person's with dissociative fugue may also be more likely to experience the condition.

The outlook for dissociative fugue is good given that most often people recover their memory with everything intact.

The goal of treatment is therefore twofold:

1. To help recover your identity and develop coping strategies to prevent the same thing from happening again.
2. To help you come to terms and cope with the original trauma that triggered the episode.

There are a number of different types of treatment that can be employed with a person who has experienced dissociative fugue;

• Psychotherapy to gain insight into thinking patterns
• Medication for related depression and anxiety
• Family therapy to ensure you receive support
• Art therapy to explore feelings in a safe way
• Clinical hypnosis to explore the original trauma
• Eye movement desensitization and reprocessing (EMDR) to treat nightmares, flashbacks, and symptoms of post-traumatic stress
• Dialectical behavior therapy (DBT) to help with personality disturbances, dissociative symptoms, after abuse and/or trauma
• Meditation and/or relaxation techniques to manage symptoms and monitor your internal state.

Unfortunately, without treatment of the underlying issue, dissociative fugue can happen multiple times.

The best prevention involves treating the underlying problem and/or removing the threat that caused the episode.

It's difficult to make recommendations for coping with dissociative fugue since most people with the condition do not know that they have it. However, if you've experienced it in the past, there are things you can do to prevent recurrence:

• Receive therapy to cope with symptoms related to the fugue
• Deal with the underlying issue that caused the fugue through therapy
• Obtain the support of family members to help you notice when you are at risk of fugue
• Try to reduce or eliminate potential triggers of a dissociative fugue
• Practice meditation or other techniques to help manage bad feelings
• Find a creative outlet for bad emotions such as painting or drawing.
• If you are prescribed medication for anxiety or depression by your doctor, be sure to take your medication regularly.

How can you help someone who has been diagnosed with dissociative fugue? Below are some suggestions.

• Attend therapy to learn about their issues and how you can offer support.
• Recognize potential triggers and be sensitive to those and how they might influence the person experiencing dissociative fugue.
• Make sure that the person is receiving adequate care and taking all prescribed medications according to the prescription given by the doctor or psychiatrist.

There can be many reasons a person might seem confused about their surroundings or identity, and dissociative fugue is relatively rare. If you have concern for someone's well-being or safety, it is best to notify the relevant authorities in your area so that they can investigate the situation further.

We still really know very little about the treatment of dissociative fugue beyond preventing its recurrence and treating related issues. For this reason, more research is needed to identify how best to handle this psychiatric issue. If you or someone you know has lived with dissociative fugue, know that you are not alone and others have experienced the same thing. If you have not already, ensure you are receiving proper treatment to prevent the same thing from happening again.