Dissociative Fugue (Psychogenic Fugue)
Formerly called psychogenic fugue, dissociative fugue, is a psychological state in which a person loses awareness of their identity or other important autobiographical information. This subtype of dissociative amnesia often includes some form of unexpected travel. People who experience a dissociative fugue may suddenly find themselves in a place, such as on the beach or at work, with no memory of traveling there. Similarly, they may find themselves somewhere in their home, such as a closet or in the corner of a room, with no memory of getting there. The DSM-5 refers to dissociative fugue as a state of “bewildered wandering.”
In addition to confusion about identity, people experiencing a dissociative fugue state may also develop a new identity. Dissociative fugue is a rare condition, with prevalence estimates as low as 0.2 percent in the general population. Dissociative fugue states are more common in adults than in children; symptoms usually appear in a person’s 20s and 30s, but sometimes it can show up in kids as young as 8 years of age.
Dissociative fugue is more commonly found in people who experience dissociative identity disorder. Dissociation is generally thought of as a defense against trauma that helps people disconnect from extreme psychological distress. A dissociative fugue state is a condition in which a person may be mentally and physically escaping an environment that is threatening or otherwise intolerable.
The travel that may occur in a dissociative fugue state can last for as little as a few hours or a few weeks, or sometimes even months. In some cases, dissociative fugue can be very difficult to distinguish from sleepwalking. When the fugue state is over, people usually cannot remember what happened during the period of fugue. The fugue state can end suddenly or more gradually. Symptoms include:
- Persisting confusion about identity
- Persisting confusion about the past
- Refuses to be challenged about their beliefs, especially who they are
Dissociative fugue is a subtype of dissociative amnesia. In these two types of dissociation, a person can lose awareness of identity or personal history or other autobiographical information. The person with dissociative fugue may find himself wandering physically to other locations, oftentimes in far-off destinations. Fugue can last longer than dissociative amnesia, sometimes up to months.
These are not the same, though the out-of-body experience is a dissociative state. In the out-of-body experience, the person is awake but views his body from outside his body. Researchers believe that this state involves the brain’s right temporoparietal cortex.
The onset of a dissociative fugue state is usually sudden and follows a traumatic or highly stressful event. Dissociative fugues are associated with difficult events, such as natural disasters and wars, as well as severe marital or financial distress, alcohol abuse, depression, and a history of child abuse. There may also be a genetic link because individuals with dissociative disorders sometimes have family members with the same condition.
There is no specific treatment for dissociative fugue, in part due to the rarity of the condition. The process of recovery may begin when people experiencing dissociative fugue become spontaneously aware of the situation, or when they are unable to appropriately respond to questions about their background during an episode of dissociative fugue.
Effective treatment practices include removing a person from the threats or stressful situations that may have contributed to the development of a dissociative fugue state. An empathic, supportive approach to psychotherapy will help people who have experienced dissociative fugue, feel safe and open to treatment. The treatment process may include developing healthy coping skills that help people manage stress and psychological pain more effectively. Other forms of therapy, such as cognitive-behavioral therapy and dialectical behavioral therapy may also be employed.
There are no drugs for this. However, a health professional may need to address any co-occurring conditions; for example, patients with anxiety or depression may benefit from medications that target those conditions.