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Dissociative Fugue

by David Spiegel, MD

In dissociative fugue, people lose some or all memories of their past, and they usually disappear from their usual haunts, leaving their family and job. ("Fugue" comes from the Latin words for "flight" and "to flee.")

Dissociative fugue is a form of dissociative amnesia. A dissociative fugue may last from hours to months, occasionally longer. If the fugue is brief, people 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, form a new identity, and begin a new job, unaware of any change in their life.

Many fugues appear to represent disguised wish fulfillment or the only permissible way to escape from severe distress or embarrassment. For example, a financially distressed executive leaves a hectic life and lives as a farm hand in the country.

Thus, dissociative fugue is often mistaken for malingering because both conditions can 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. Doctors can usually distinguish the two because malingerers typically exaggerate and dramatize their symptoms and because they have obvious financial, legal, or personal reasons (such as avoiding work) for faking memory loss.

Symptoms of Dissociative Fugue

During the fugue, people may appear and act normal or appear only mildly confused and attract no attention. However, when the fugue ends, people suddenly find themselves in a new situation with no memory of how they came to be there or what they have been doing. At this point, many people feel ashamed or upset that they cannot remember what happened. Some people are frightened. If they are confused, they may come to the attention of medical or legal authorities.

After the fugue ends, many people remember their past identity and life up to when the fugue began. However, for others, remembering takes longer and occurs more gradually. Some people never remember parts of their past. A very few people remember nothing or almost nothing about their past for the rest of their life.

Diagnosis of Dissociative Fugue

  • A doctor's evaluation

Doctors 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.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances.

Usually, the diagnosis is made after the fact, 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.

Treatment of Dissociative Fugue

  • Psychotherapy

  • Sometimes hypnosis or drug-facilitated interviews

If people have had dissociative fugues, psychotherapy, sometimes combined with hypnosis or drug-facilitated interviews (interviews conducted after a sedative is given intravenously), may be used to try to help people remember the events of the fugue period. However, these efforts are often unsuccessful.

Regardless, a therapist can help people explore how they handle the types of situations, conflicts, and emotions that triggered the fugue and help them find better ways to respond in the future. This approach can help prevent fugues from recurring.