Dissociative disorder From Wikipedia, the free encyclopedia
Dissociative fugue (/fjuːɡ/ FYOOG), previously referred to as a fugue state or psychogenic fugue,[1] is a rare psychiatric condition characterized by reversible amnesia regarding one’s identity, often accompanied by unexpected travel or wandering. In some cases, individuals may assume a new identity and be unable to recall personal information from before the onset of symptoms.[2] It is classified as a mental and behavioral disorder[3] and is variously categorized as a dissociative disorder,[1] a conversion disorder,[3] or a somatic symptom disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dissociative fugue is a subset of dissociative amnesia.
| Dissociative fugue | |
|---|---|
| Other names | Fugue state, psychogenic fugue |
| |
| Specialty | Psychiatry, neurology |
Recovery from a fugue state typically results in the restoration of prior memories, and additional treatment is generally unnecessary. Episodes are not considered dissociative fugue if attributable to psychotropic substances, physical trauma, general medical conditions, or disorders such as dissociative identity disorder,[clarification needed] delirium, or dementia.[4] Dissociative fugue is often triggered by prolonged traumatic experiences and is most frequently associated with individuals who experienced childhood sexual abuse, during which they developed dissociative amnesia to suppress memories of the abuse.
Symptoms of dissociative fugue include mild confusion during the episode and, following recovery, possible feelings of depression, grief, shame, discomfort, or post-fugue anger.[5] A key feature of the condition is the loss of one’s identity.[6]
 | This section needs additional citations for verification. (November 2021) |
Before dissociative fugue can be diagnosed, either dissociative amnesia or dissociative identity disorder must be diagnosed.[7] The only difference between dissociative amnesia, dissociative identity disorder and dissociative fugue is that the person affected by the latter travels or wanders. This traveling or wandering is typically associated with the amnesia-induced identity or the person's physical surroundings.[8]
Sometimes dissociative fugue cannot be diagnosed until the patient returns to their pre-fugue identity and is distressed to find themselves in unfamiliar circumstances, sometimes with awareness of "lost time". The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before the patient left home, the travel itself, and the establishment of an alternative life.[9]
Functional amnesia can also be situation-specific, varying from all forms and variations of trauma or generally violent experiences, with the person experiencing severe memory loss for a particular trauma. Committing homicide, experiencing or committing a violent crime such as rape or torture, experiencing combat violence, attempting suicide, and being in automobile accidents and natural disasters have all induced cases of situation-specific amnesia.[10][11] In these unusual cases, care must be exercised in interpreting cases of psychogenic amnesia when there are compelling motives to feign memory deficits for legal or financial reasons.[10] However, although some fraction of psychogenic amnesia cases can be explained in this fashion, it is generally acknowledged that true cases are not uncommon. Both global and situationally specific amnesia are often distinguished from the organic amnesic syndrome, in that the capacity to store new memories and experiences remains intact. Given the very delicate and oftentimes dramatic nature of memory loss in such cases, there usually is a concerted effort to help the person recover their identity and history. This will sometimes allow the subject to recover spontaneously, when particular cues are encountered.
The cause of the fugue state is related to dissociative amnesia (code 300.12 of the DSM-IV codes[12]), which has several other subtypes:[13] selective amnesia, generalized amnesia, continuous amnesia, and systematized amnesia, in addition to the subtype "dissociative fugue".[1]
Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), dissociative amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., amnestic disorder due to a head trauma, DSM-IV Code 294.0).[14] It is a complex neuropsychological process.[15]
As the person experiencing a dissociative fugue may have recently experienced the reappearance of an event or person representing an earlier trauma, the emergence of an armoring or defensive personality seems to be for some, a logical defense strategy in the situation.[citation needed][16]
Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "dissociative fugue", the former implying a greater degree of "motion".[17] For the purposes of this article, then, a "fugue state" occurs while one is "acting out" a "dissociative fugue".
The DSM-IV [1] defines "dissociative fugue" as:
The Merck Manual [18] defines "dissociative fugue" as:
In support of this definition, the Merck Manual [18] further defines dissociative amnesia as:
The DSM-IV-TR states that the fugue may have a duration from days to months, and recovery is usually rapid. However, some cases may be refractory and resist treatment. An individual usually has only one episode.
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