Dissociative Fugue

This disorder involves amnesia of past personal experience and an unanticipated absence from home .

Symptoms include:

• A 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.

Travel may range from brief trips over relatively short periods of time (i.e., hours or days) to complex, usually unobtrusive wandering over long time periods (e.g., weeks or months), with some individuals reportedly crossing numerous national borders and traveling thousands of miles. During a fugue, individuals may appear to be without psychopathology and generally do not attract attention. At some point, the individual is brought to clinical attention, usually because of amnesia for recent events or a lack of awareness of personal identity. Once the individual returns to the prefugue state, there may be no memory for the events that occurred during the fugue.

Most fugues do not involve the formation of a new identity. If a new identity is assumed during a fugue, it is usually characterized by more gregarious and uninhibited traits than characterized the former identity. The person may assume a new name, take up a new residence, and engage in complex social activities that are well integrated and that do not suggest the presence of a mental disorder.

Associated Features

After return to the prefugue state, amnesia for traumatic events in the person's past may be noted (e.g., after termination of a long fugue, a soldier remains amnestic for wartime events that occurred several years previously in which the soldier's closest friend was killed). Depression, dysphoria, anxiety, grief, shame, guilt, psychological stress, conflict, and suicidal and aggressive impulses may be present.

Individuals with Dissociative Fugue may have a Mood Disorder, Posttraumatic Stress Disorder, or a Substance-Related Disorder.

Prevalence

A prevalence rate of 0.2% for Dissociative Fugue has been reported in the general population. The prevalence may increase during times of extremely stressful events such as wartime or natural disaster.

Course

The onset of Dissociative Fugue is usually related to traumatic, stressful, or overwhelming life events. Most cases are described in adults. Single episodes are most commonly reported and may last from hours to months. Recovery is usually rapid, but refractory Dissociative Amnesia may persist in some cases.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.