An Overview of Dissociative Fugue

An Overview of Dissociative Fugue September 30, 2019 Getty / Tamboly More in PTSD Related Conditions Causes Symptoms Diagnosis Treatment Coping PTSD and the Military In This Article Table of Contents Expand Overview Symptoms Diagnosis Causes Treatment Coping 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. What Is Dissociative Fugue? 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 ones 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. Symptoms of Dissociative Fugue What are the symptoms of dissociative fugue? They potentially include all of the following depending on the case: During the Fugue State If youre in the midst of a fugue state, you may exhibit the following symptoms: confusion about your identityappearing to be unsure about your pastfeeling confronted if challenged about your identity However, its 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. After the Fugue State Ends Once a dissociative fugue state has passed, you may experience symptoms like: feelings of depressionperiods of grieffeelings of shamediscomfort or angerfeelings of distress about being in an unfamiliar placefeeling as though you have lost time It should also be noted that a person can experience multiple instances of dissociative fugue, particularly if the underlying cause of the fugue is never addressed. Diagnosis of Dissociative Fugue How is dissociative fugue diagnosed? Diagnosis In the DSM-IV 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 ones home or workthe inability to remember your past experiencesconfusion about your identity and taking on a new onesignificant distress and impairment about these issues However, its 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. Diagnosis In the DSM-5 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 amnesiageneralized amnesiacontinuous amnesiasystematized amnesia Diagnostic Exclusions Dissociative fugue will not be diagnosed if the fugue state is directly related to any of the following conditions or situations: ingestion of psychotropic substancesexperience of physical traumaa general medication conditiondissociative identity disorderdiagnosis of deliriumdiagnosis of dementiahead traumaingestion of drugs or alcohola period of sleep deprivationdiagnosis of epilepsy In this way, its 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. Methods of Diagnosis 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. Prevalence Dissociative fugue is rare with the rate being around 0.2 percent of the population. It is more common in adults than in children, and also more common in people already diagnosed with dissociative identity disorder. Causes of Dissociative Fugue 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 abuseexperience of violence (e.g., rape, torture)combat violencesuicide attemptautomobile accidentnatural disasterscommitting a homicidesevere 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 persons with dissociative fugue may also be more likely to experience the condition. The Link Between Trauma and Dissociative Disorders Treatment of Dissociative Fugue 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: To help recover your identity and develop coping strategies to prevent the same thing from happening again.To help you come to terms and cope with the original trauma that triggered the episode. Treatment 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 patternsMedication for related depression and anxietyFamily therapy to ensure you receive supportArt therapy to explore feelings in a safe wayClinical hypnosis to explore the original traumaEye movement desensitization and reprocessing (EMDR) to treat nightmares, flashbacks, and symptoms of post-traumatic stressDialectical behavior therapy (DBT) to help with personality disturbances, dissociative symptoms, after abuse and/or traumaMeditation 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 Online Therapy Programs Prevention The best prevention involves treating the underlying problem and/or removing the threat that caused the episode. Coping With Dissociative Fugue Its difficult to make recommendations for coping with dissociative fugue since most people with the condition do not know that they have it. However, if youve experienced it in the past, there are things you can do to prevent recurrence: Receive therapy to cope with symptoms related to the fugueDeal with the underlying issue that caused the fugue through therapyObtain the support of family members to help you notice when you are at risk of fugueTry to reduce or eliminate potential triggers of a dissociative fuguePractice meditation or other techniques to help manage bad feelingsFind 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. Helping Someone With Dissociative Fugue 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. What to Do If Someone Seems Confused 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 someones well-being or safety, it is best to notify the relevant authorities in your area so that they can investigate the situation further. A Word From Verywell 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. Why Some Disorders Are Not Found in the DSM-5