Dissociative Fugue is one or more episodes of amnesia in which the inability to recall some or all of one's past and either the loss of one's identity or the formation of a new identity occur with sudden, unexpected, purposeful travel away from home.
Specific symptoms include:
The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.
Confusion about personal identity or assumption of a new identity (partial or complete).
The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The length of a fugue may range from hours to weeks or months, occasionally longer. During the fugue, the person may appear normal and attract no attention. The person may assume a new name, identity, and domicile and may engage in complex social interactions. However, at some point, confusion about his identity or the return of the original identity may make the person aware of amnesia or cause distress.
The prevalence of dissociative fugue has been estimated at 0.2%, but it is much more common in connection with wars, accidents, and natural disasters. Persons with dissociative identity disorder frequently exhibit fugue behaviors.
The person often has no symptoms or is only mildly confused during the fugue. However, when the fugue ends, depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses may appear--ie, the person must deal with what he fled from. Failure to remember events of the fugue may cause confusion, distress, or even terror.
A fugue in progress is rarely recognized. It is suspected when a person seems confused over his identity, puzzled about his past, or confrontational when his new identity or the absence of an identity is challenged. Sometimes the fugue cannot be diagnosed until the person abruptly returns to his prefugue identity and is distressed to find himself in unfamiliar circumstances. The diagnosis is usually made retroactively based on the history with documentation of the circumstances before travel, the travel itself, and the establishment of an alternate life. Although dissociative fugue can recur, patients with frequent apparent fugues usually have dissociative identity disorder
Most fugues are brief and self-limited. Unless behavior has occurred before or during the fugue that has its own complications, impairment is usually mild and short-lived. If the fugue was prolonged and complications due to behavior before or during the fugue are significant, the person may have considerable difficulties--eg, a soldier may be charged as a deserter, and a person who marries may have inadvertently become a bigamist.
In the rare case in which the person is still in the fugue, recovering information (possibly with help from law enforcement and social services personnel) about his true identity, figuring out why it was abandoned, and facilitating its restoration are important.
Treatment involves methods such as hypnosis or drug-facilitated interviews. However, efforts to restore memory of the fugue period are often unsuccessful. A psychiatrist may help the person explore inner and interpersonal patterns of handling the types of situations, conflicts, and moods that precipitated the fugue to prevent subsequent fugue behavior.
Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 1 Jun 2010
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