In dissociative fugue, people lose some or all memories of their past, and they typically disappear from their usual environments, leaving their family and job. ("Fugue" comes from the Latin words for "flight" and "to flee.")
(See also Overview of Dissociative Disorders and Dissociative Amnesia.)
Dissociative fugue is a rare form of dissociative amnesia.
People experiencing dissociative fugue may appear and act normal, but 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.
Usually, dissociative fugue is diagnosed after the fact, when a doctor reviews the history and collects information that establishes an alternate life.
A supportive environment and psychotherapy may help a person who has experienced dissociative fugue.
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 in the city and lives as a farm worker in the country.
Thus, dissociative fugue is often mistaken for malingering (faking physical or psychologic symptoms to obtain a benefit) 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, based on specific diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
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, dissociative fugue is diagnosed 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
A supportive environment
Psychotherapy
Sometimes hypnosis or medication-facilitated interviews
If memory of only a very short time period is lost, providing a supportive environment may be all that is needed. This is especially true when there is no apparent need to recover the memory of some painful event. If the supportive environment is not helpful or there is a need to recover traumatic memories, other treatments are needed.
If people have had dissociative fugues, psychotherapy, sometimes combined with hypnosis or medication-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 psychotherapist 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.
