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Dissociative Fugue

by Daphne Simeon, MD

Dissociative fugue involves one or more episodes of sudden, unexpected, but purposeful travel from home during which people cannot remember some or all of their past life, including who they are (their identity). These episodes are called fugues.

  • Unbearable stress or a traumatic event may trigger dissociative fugue.

  • When in a fugue, people disappear from their usual routine and may assume a new identity, forgetting all or some of their usual life.

  • Usually, doctors make the diagnosis by reviewing the history and collecting information about the circumstances before travel, the travel itself, and the establishment of an alternate life.

  • Usually, fugues last only hours or days, then resolve on their own.

  • Memory retrieval techniques, including hypnosis and drug-facilitated interviews, may be tried but may be unsuccessful.

Dissociative fugue affects about 2 of 1,000 people in the United States. It is much more common among people who have been in wars, accidents, or natural disasters.

Causes

Dissociative fugue is usually triggered by severe trauma, such as wars, accidents, natural disasters, or sexual abuse during childhood.

Dissociative fugue is often mistaken for malingering because both conditions may give people an excuse to avoid their responsibilities (as in an intolerable marriage), to avoid accountability for their actions, or to reduce their exposure to a known hazard, such as a battle. However, dissociative fugue, unlike malingering, occurs spontaneously and is not faked.

Many fugues seem to represent disguised wish fulfillment (for example, an escape from overwhelming stresses, such as divorce or financial ruin). Other fugues are related to feelings of rejection or separation, or they may develop as an alternative to suicidal or homicidal impulses.

Symptoms

A fugue may last from hours to weeks, months, or occasionally even longer. People in a fugue state, having lost their customary identity, usually disappear from their usual haunts, leaving their family and job. If the fugue is brief, they may appear simply to have missed some work or come home late. If the fugue lasts several days or longer, people may travel far from home and begin a new job with a new identity, unaware of any change in their life.

During the fugue, they may appear normal and attract no attention. However, at some point, they may become aware of the memory loss or confused about their identity. If they are confused, they may come to the attention of medical or legal authorities. During the fugue, people often have no symptoms or are only mildly confused. However, when the fugue ends, they may experience depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses.

Diagnosis

A doctor may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one. The doctor carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychologic examination is also done.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternate life.

Did You Know...

  • Dissociative fugue is often mistaken for malingering because it enables people to escape their responsibilities or undesirable or dangerous situations, such as a bad marriage or a battle.

Treatment

Most fugues last for hours or days, then disappear on their own.

Treatment, when needed, may include hypnosis or drug-facilitated interviews (interviews conducted after a sedative is given intravenously to relax people). However, efforts to restore memories of what happened during the fugue itself are usually unsuccessful.

A therapist may help people explore their patterns of handling the types of situations, conflicts, and moods that triggered the fugue to prevent subsequent fugues.

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