Fugue disorder definition

Mental Health: Dissociative Fugue

Written by WebMD Editorial Contributors

Dissociative fugue, formerly called psychogenic fugue, is one of a group of conditions called dissociative disorders. The word fugue comes from the Latin word for "flight." People with dissociative fugue temporarily lose their sense of personal identity and impulsively wander or travel away from their homes or places of work. They often become confused about who they are and might even create new identities. Outwardly, people with this disorder show no signs of illness, such as a strange appearance or odd behavior.

Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, conscious awareness, identity, and/or perception. When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with a person's general functioning, including social and work activities, and relationships.

What Are the Symptoms of Dissociative Fugue?

A fugue in progress often is difficult for others to recognize because the person's outward behavior appears normal. Symptoms of dissociative fugue might include the following:

Sudden and unplanned travel away from home
Inability to recall past events or important information from the person's life
Confusion or loss of memory about their identity, possibly assuming a new identity to make up for the loss
Extreme distress and problems with daily functioning (due to the fugue episodes)

What Causes Dissociative Fugue?

Dissociative fugue has been linked to severe stress, which might be the result of traumatic events -- such as war, abuse, accidents, disasters, or extreme violence -- that the person has experienced or witnessed. The use or abuse of alcohol and certain drugs also can cause fugue-like states, such as alcohol-induced "blackouts."

How Common Is Dissociative Fugue?

Dissociative fugue is relatively rare. The frequency of dissociative fugue tends to increase during stressful or traumatic periods, such as during wartime or after a natural disaster.

How Is Dissociative Fugue Diagnosed?

If symptoms of dissociative fugue are present, the doctor will often begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose dissociative disorders, the doctor might sometimes recommend various diagnostic tests, such as neuroimaging studies, electroencephalograms (EEGs), and blood tests, to rule out physical illness or medication side effects if these are suspected as causing the symptoms. Certain conditions -- including brain diseases (such as epilepsy), head injuries, drug and alcohol intoxication, and sleep deprivation -- can lead to symptoms similar to those of dissociative disorders, including amnesia (loss of memory).

If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interviews and assessment tools to evaluate a person for a dissociative disorder.

How Is Dissociative Fugue Treated?

The goal of dissociative fugue treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of their symptoms, but most likely will include some combination of the following treatment methods:

Psychotherapy: Psychotherapy, a type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems. Cognitive therapy is a specific type of psychotherapy that focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
Medication: There is no established medication to treat the dissociative disorders themselves. However, if a person with a dissociative disorder also suffers from depression or anxiety, they might benefit from treatment with a medication such as antidepressant, anti-anxiety, or antipsychotic drugs.
Family therapy: This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
Creative therapies (art therapy, music therapy): These therapies allow the patient to explore and express their thoughts and feelings in a safe and creative way.
Clinical hypnosis: This is a treatment method that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings, and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

What Is the Outlook for People With Dissociative Fugue?

Most dissociative fugues are brief, lasting from less than a day to several months. Often, the disorder goes away on its own. The outlook, therefore, is quite good. However, without treatment to work out the underlying problem, additional fugue episodes can occur.

Can Dissociative Fugue Be Prevented?

Although it might not be possible to prevent dissociative fugue, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Further, quick intervention following a traumatic event or emotionally distressing experience might help reduce the risk of developing dissociative disorders.

Dissociative Fugue: Definition, Symptoms, and Causes

Overview

Dissociative fugue is a type of amnesia that is caused by an extreme psychological trauma instead of physical trauma, illness, or another medical condition. It’s a form of dissociative amnesia that’s severe, and it’s considered rare.

Someone with dissociative fugue won’t have any memory of their past or about themselves personally. The type of memories that they lose are sometimes referred to as autobiographical memories. The condition is a means of escaping a situation of extreme stress that the person can’t cope with.

A dissociative fugue may last only a few hours. The person undergoing it may seem to be confused and forgetful to others during that time, but they’ll return to normal afterward. In cases with such a short duration, the dissociative fugue might even go unnoticed by others.

However, the condition may also last weeks, months, and sometimes even longer than that. A person with dissociative fugue lasting longer than just a few hours may have the following symptoms:

confusion
sudden lack of attendance at work or avoidance of other places they frequent
loss of autobiographical memory (about themselves, other people, events in their lives, etc. )
detachment from their own emotions
severe stress at work or from relationships
confused identity
depression, anxiety, thoughts of suicide, and other mental health issues
inability to recognize loved ones
wandering or going places they usually don’t go

Many times, the person with dissociative fugue will abruptly walk away from their current life and start a new one. Their new life is usually very different from the life they’ve left. For example, a Wall Street executive may leave her high-powered career in a city to become a florist in a rural town if she has dissociative fugue.

Dissociative fugue is caused by a situation that gives the person extreme emotional stress. The dissociative fugue is believed to occur as the person’s means of escape from the stress that they can’t otherwise cope with.

A common cause of dissociative fugue is severe sexual trauma of some sort. Other causes may include:

extreme feelings of shame or embarrassment
trauma caused by war
trauma caused by an accident
trauma caused by a natural disaster
kidnapping
torture
long-term emotional or physical abuse in childhood

These traumas may have actually happened to the person, or they may have witnessed it happening to others and been severely traumatized by what they saw. There is also a possibility that a genetic link may predispose someone to dissociative fugue.

The first step in treatment of dissociative fugue involves ruling out any medical conditions that might cause memory loss. There isn’t a specific test that can diagnose dissociative fugue. However, a medical doctor will want to perform a variety of tests to rule out possible illnesses or injuries that might cause memory loss.

Once all physical or medical conditions have been ruled out, the person will usually be referred to a psychiatrist or another mental health professional. The mental health professional will diagnose dissociative fugue after a series of clinical interviews and assessments. These interviews may include what is called Structured Clinical Interview for Dissociation or SCID-D. Once a diagnosis is made, then the treatment can begin.

The treatment may include the following:

creating a safe environment
help recovering lost memories
help reconnecting to life prior to the trauma
gradually discovering, dealing with, and then managing the trauma that originally caused dissociative fugue
developing coping mechanisms to better handle future stressful situations
regaining normal life functions
strengthening and improving relationships

These goals are accomplished through several types of therapies, which may include:

family therapy
psychotherapy
cognitive behavioral therapy
meditation and relaxation techniques
music or art therapy
clinical hypnosis
dialectical behavior therapy

Currently, there is no medication known to help dissociative behavior. However, you may be prescribed medications to help other symptoms such as depression or anxiety.

A number of complications are associated with dissociative fugue. These can range from mild to serious and should be watched for. They include:

thoughts of suicide
attempting to harm yourself — including cutting, mutilation, etc.
anxiety
depression
post-traumatic stress disorder (PTSD)
personality disorders
eating disorders
relationship and work issues or difficulties
sleep disorders
illegal drug use
alcoholism
seizures (not due to epilepsy)

Some people who experience dissociative fugue may end up missing or may be found wandering in unfamiliar areas.

The sooner dissociative fugue is diagnosed, the better. This is because of the range of complications it can cause.

You should contact a medical professional any time a loved one has experienced or witnessed severe or long-term trauma or stress of any kind and exhibits signs of confusion or memory loss. You should also contact a medical professional if a loved one exhibits odd behavior or stops showing up to their job or places they usually frequent after severe stress or trauma. It’s important to rule out any possible medical conditions that may be causing the symptoms.

Then, if there isn’t a medical cause for the symptoms, get help from a mental health professional as soon as possible. Working with a mental health professional early on will help avoid a worsening of symptoms or a lengthening of the time a dissociative fugue lasts.

The outlook for someone with dissociative fugue is generally good. The outlook improves the sooner treatment and intervention are started. Most people with dissociative fugue will regain most or all of their memories. The memories may return quickly and all at once or gradually over a longer period of time. However, in some cases, people aren’t able to recover their memories completely.

what is a dissociative fugue - T&P

In cinema, there is often a story about "a man without a past.

" The hero suddenly finds himself in an incomprehensible place - without things, satellites and any memories of what happened to him until that moment. By the end of the film, the intrigue is usually revealed, and the memory returns. This kind of story is not a fantasy of screenwriters, but a description of a real psychiatric phenomenon - a dissociative fugue.

On January 17, 1887, the American priest Ansel Bourne got up early in the morning and went to the bank. There he withdrew all his savings and got on a carriage going to another city. This is the last event Bourne remembers. He did not return home that evening, and neither did he the next evening. His relatives filed a missing person's notice in the newspapers. Meanwhile, in one of the neighboring states, an unknown A. J. Brown showed up. The man rented a shop and started selling small goods.

But a couple of months later, the newly minted businessman woke up in a fright and called his housemates. He said that his name was Ansel Bourne, that he had no idea where he was and how he got here, and that just yesterday he took money from the bank, and then there was a blackout. Hearing the story about his own shop, the priest was horrified and admitted that he knew nothing about trade. Moreover, despite all the stories of witnesses, he himself did not remember his adventures.

Some people in the dissociative fugue not only forget the old life, but also create a new personality - with a different name, biography, and even with abilities atypical of the former personality.

It was not only the household that rejoiced at Burnu's return home. William James, an American philosopher and psychologist, became interested in its history. He performed a hypnotic session with the priest, and in a trance, the personality of the mythical A.J. Brown reappeared. The imaginary shopkeeper knew nothing about Bourne, but he spoke in detail about his life during those two months and trade, which he knew well. The story heard under hypnosis helped the psychologist describe this clinical case in detail in his book. It was he who later gave this phenomenon the name "dissociative fugue". Dissociation in psychiatry is a state when the patient feels like anyone but himself. He may look at himself from the outside, or simply feel like someone else. And "fugue" in Latin means "flight".

According to medical statistics, dissociative fugue occurs in 0.2% of the population, that is, approximately two people out of 1,000. In modern psychiatry, this term is used to describe a condition when a patient suddenly and purposefully leaves or goes somewhere, completely forgetting who he is such a. In this state, a person, as a rule, retains basic knowledge such as geography and multiplication tables, but he completely forgets events from his own life, his address and even his name. Therefore, it can be difficult for relatives to find missing patients with fugue.

Something similar, for example, happened to Agatha Christie. In 1926, after her mother's death and her husband's infidelity, Christie left home. Nothing was known about her whereabouts for 11 days. The detective queen's books have already become popular, so the story has caused a lot of buzz. The English police, conducting the search, first found an abandoned car, and a couple of days later, Agatha herself. She didn't remember anything about what had happened. Having collected eyewitness accounts, the investigators learned that the writer checked into the hotel under the name of her husband's mistress, after which she read books for 11 days, underwent healing procedures and played the piano. Later, the British psychologist Andrew Norman called this case a typical example of a dissociative fugue.

Some people in a dissociative fugue not only forget their old life, but also create a new personality — with a different name, biography, and even abilities atypical of the former personality. Quite often, "new people" find work in areas that have nothing to do with their previous field of activity.

A dissociative fugue is usually caused by a traumatic experience. A person cannot cope with it and tries to literally run away from an unpleasant situation and everything connected with it.

Psychiatrists are usually able to interview survivors of a fugue episode after the fact, after returning to the old reality, because the new person will never be able to realize that he is new until he remembers the old one. People experiencing this state are often able to clearly and joyfully tell anyone who wants to make up a biography, easily maintain secular conversation and do not have external signs of mental disorders. It is said that patients with fugue are often much more sociable during an attack than in their life before it.

However, not all stories look so literary. Some of the fugitives simply lose their memory, not replacing their identity with a new one, or confusingly tell fictional biographies in such a way that anyone will notice inconsistencies. The fugue usually lasts from a couple of hours to several months.

In May 1985, the young and ambitious American journalist Jody Roberts left home and never returned. Her parents initially decided that her daughter had gone on vacation or was conducting a journalistic investigation. But months passed, and the girl did not return. The police investigation turned up nothing and Jody was declared dead. But 12 years later, she was suddenly found living in the state of Alaska. True, she was no longer a young journalist: the woman introduced herself as Jane Dee, successfully worked as a web designer, lived with her husband and raised four children. And although there were those among the reporters who covered this story who considered Jodie an amnesia scam, psychiatrists unanimously declared that the woman had a dissociative fugue.

These conditions are usually caused by a traumatic experience. A person cannot cope with it and tries to literally run away from an unpleasant situation and everything connected with it. That is why fugue cases are on the rise in places where there has been a recent natural disaster or financial crisis. It is believed that some teenagers run away from home in a state of dissociative fugue.

This state passes as suddenly as it began. A word, a proper name, a familiar place can bring back lost memories. At this moment, people often forget everything that they experienced during the fugue. A psychotherapist who knows hypnosis can help them remember the days and months they have lived. Unfortunately, psychological help for patients who have experienced a disorder is needed not only in this. After a long dissociative fugue, people actually find themselves in their future, having missed a significant piece of the life of their loved ones. And coming to terms with the changes that have taken place is sometimes not easy.

As a rule, dissociative fugue occurs only once in a lifetime. However, in people with multiple personality disorder, it can also be repeated. Each of the alternative personalities may have their own goals and interests, and it is impossible to predict where they will lead the "owner of the body" in the future.

Planet Ka-Pax

In the first half of the film, the protagonist is trying to cure a patient who came to him, convinced of his alien origin, from a dissociative fugue. And the other half is tormented by doubts whether he is definitely sick or whether Ka-Pex is really his home.

Highway to nowhere

Saxophonist Fred is imprisoned on suspicion of murdering his wife, but behind bars he turns into another man with a new biography - Pete Dayton. Pete does not remember how he ended up in prison, but after a series of strange adventures and symbolic events, he becomes Fred again. The Highway to Nowhere script originally contained no hints of a dissociative fugue. They say that this idea was thrown to Lynch already on the set, and she completely changed the interpretation of the film.

House of Dreams

In this film, the director creatively interprets the dissociative fugue, and the hero, experiencing this disorder, takes on his own personality, simply from a different period of life.

United States of Tara

In the TV series about a versatile woman named Tara, they show what a dissociative fugue looks like in people with multiple personality disorder: four different people “live” in the main character at once.

Fugue state

For the New York publisher, see Fugue State Press.

Dissociative fugue , formerly fugue state or psychogenic fugue , is a dissociative disorder ^[1] and a rare mental disorder characterized by reversible amnesia for personal identity, including memories, personality, and other distinctive characteristics individuality. The condition can last days, months, or longer. The dissociative fugue is usually associated with unplanned travel or wanderings and is sometimes accompanied by the establishment of a new identity. It's a facet of dissociative amnesia, according to fifth edition Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

After leaving the fugue state, previous memories usually return intact and no further treatment is required. In addition, a fugue episode cannot be attributed to a psychiatric disorder if it could be due to the ingestion of a psychotropic substance, to physical trauma, to a general health condition, or to a dissociative identity disorder, ^{[ clarification needed ]} delirium, or dementia. ^[2] Fugues are provoked by a series of prolonged traumatic episodes. It is most commonly associated with childhood victims of sexual abuse who, over time, learn to separate memories of the abuse (dissociative amnesia).

Content

1 Signs and symptoms
2 Diagnostics
- 2.1 Determination
3 Forecast
4 Cases
0042
7 external link

Signs and symptoms

Symptoms of dissociative fugue include mild confusion, and after the end of the fugue, depression, grief, shame, and discomfort may occur. People also experienced postfugu anger. ^[3] Loss of personality can be another symptom of a fugue condition. ^[4]

Diagnosis

A physician may suspect dissociative fugue when people appear confused about their identity or puzzled by their past, or when a confrontation questions their new identity or lack thereof. A doctor reviews symptoms and performs a physical exam to rule out physical disorders that may be contributing to or causing memory loss.

Sometimes a dissociative fugue cannot be diagnosed until people revert to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances, sometimes with a sense of "lost time". The diagnosis is usually made retroactively, when the doctor reviews the medical history and collects information that documents the circumstances before people left home, the journey itself, and the establishment of an alternative life.

Functional amnesia can also be a specific situation, different from all forms and variations of trauma or violent experiences in general, where a person experiences severe memory loss due to a specific trauma. committing a murder; have experienced or committed a violent crime such as rape or torture; experiencing combat violence; suicide attempt; as well as getting into car accidents and natural disasters, all of which caused amnesia cases depending on the specific situation (Arrigo & Pezdek, 1997; Kopelman, 2002a). However, as noted by Kopelman (2002a), care should be taken when interpreting cases of psychogenic amnesia when there are strong motives to feign memory deficits for legal or financial reasons. However, while a proportion of cases of psychogenic amnesia can be explained in this way, it is generally accepted that true cases are not uncommon. Both global and situation-specific amnesia often differ from organic amnesia in that the ability to retain new memories and experiences remains unchanged. Given the very delicate and often dramatic nature of memory loss in such cases, there is usually a concerted effort to help the person recover their identity and history. This will allow the subject to recover, sometimes spontaneously, when certain treatments are encountered.

Definition

The cause of the fugue state is associated with dissociative amnesia, ( DSM-IV codes 300.12 ^[5] ), which has several other subtypes: ^[6] systematized amnesia in addition to the dissociative fugue subtype. ^[1]

Unlike retrograde amnesia (commonly referred to simply as "amnesia", a condition in which someone forgets events prior to brain damage), dissociative amnesia does not occur due to the direct physiological effects of a substance (eg, drug abuse). drug, medicine, DSM-IV codes 291.1 & 292.83 ) or a neurological or other general disorder (eg, amnestic disorder due to head trauma, DSM-IV codes 294.0 ). ^[7] This is a complex neuropsychological process. ^[8]

Because the person experiencing dissociative fugue may have recently suffered a reappearance of an event or person representing an early life trauma, the appearance of a shell or protective personality seems to some to be a logical comprehension of the situation. ^{[ citation needed ]}

Therefore, the term "fugue state" may have a slight linguistic difference from "dissociative fugue", the former implying a greater degree of "movement". ^{[ citation needed ]} Thus, for the purposes of this article, a "fugue state" occurs when a person "enacts" a "dissociative fugue".

In DSM-IV ^[1] defines "dissociative fugue" as:

sudden, unexpected travel away from home or usual place of work, with inability to remember one's past
identity confusion or assumption of a new identity
significant stress or disturbance

B Merck Manual ^[9] defines "dissociative fugue" as:

One or more episodes of amnesia, in which some or all of one's past and either the loss of identity or the formation of a new identity occur during a sudden, unexpected and purposeful journey away from home.

In support of this definition Merck manual ^[9] further defines dissociative amnesia as:

Inability to recall important personal information, usually traumatic or stressful, that is too extensive to be explained by normal forgetfulness.

Prediction

The DSM-IV-TR states that the fugue can last from days to months and recovery is usually rapid. However, some cases may not be susceptible. A person usually has only one episode.

Cases

Shirley Ardell Mason, also known as "Sybil", will disappear and then reappear with no memory of what happened during that time. She recalls "been here and then not here" and had no identity; it was claimed by her psychiatrist, Cornelia Wilbur, that she also had dissociative identity disorder. Wilbur's diagnosis of DID was disputed by a contemporary of Wilbur's. Herbert Spiegel.
Jody Roberts, reporter for Tacoma News Tribune , disappeared at 1985, but was found 12 years later in Sitka, Alaska, living under the name "Jane Dee Williams". While there was initially some suspicion that she was feigning amnesia, some experts concluded that she had indeed experienced a prolonged fugue state. ^[10]
David Fitzpatrick, who suffered from dissociative fugue disorder, was profiled on Five of the television series Extraordinary People . He entered a fugue state on December 4, 2005 and is still working on recovering his lifelong memories. ^[11]
Hannah App, a teacher originally from Salem, Oregon, ^[12] was diagnosed with dissociative fugue ^[13] after she disappeared from her New York home in August 2008 and was rescued off New York Harbor 20 days later. At the time, news coverage focused on her refusal to speak to detectives immediately after she was found. ^[12] and that she checked her email on Apple Stores while she was away. ^[14] ^[15] ^[16] This coverage has since led to a critique of the often "judgmental and discrediting" ^[13] attitude towards dissociative states. On September 3, 2013, she fell into another fugue when she disappeared from her new job as a teacher's assistant. ^[17] at Montessori Crossway Community in Kensington, Maryland. She was found unharmed on September 5, 2013 in Wheaton, Maryland. ^[18] As of September 14, 2017, she was missing again; she was last seen near Sapphire Beach at her St. Thomas home just before Hurricane Maria. ^[19] Her mother and a group of friends are currently looking for her in and around the Virgin Islands. ^[20]
Jeff Ingram arrived in Denver in 2006 with no memory of his name or origin. After appearing on national television to seek help identifying him, his fiancée Penny called the Denver police and identified him. The episode was diagnosed as a dissociative fugue. Ingram has experienced three cases of amnesia: in 1994, 2006 and 2007. ^[21]
Doug Bruce "woke up" on a subway train, claiming to not remember his name, where he was from, or any identification documents.
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