Dissociative Fugue (Psychogenic Fugue)

Definition

Dissociative fugue (formerly called psychogenic fugue) is a psychological state in which a person loses awareness of their identity or other important autobiographical information and also engages in some form of unexpected travel. People who experience a dissociative fugue may suddenly find themselves in a place, such as the beach or at work, with no memory of how they got 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 going 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 commonly seen in adults than in children. 

Symptoms

Dissociative fugue is a subtype of dissociative amnesia, but 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 physically and mentally 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 as long as weeks or 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, with persisting confusion about identity.

Causes

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.

Diagnosis is typically made based on a review of the circumstances before a person left home, the description of the travel (including forgetfulness about the details of travel), and the details of an alternative life that may have been established during a fugue episode.

Treatments

There is no standard treatment for dissociative fugue due to the rarity of this 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. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Coons, P. M. (1999). Psychogenic or dissociative fugue: a clinical investigation of five cases. Psychological reports, 84(3), 881-886.

Jha, M., & Sharma, V. (2015). Dissociative fugue disorder: Identification and psychological intervention. Psychological Studies, 60(1), 17-24.

Sharma, P., Guirguis, M., Nelson, J., & McMahon, T. (2015). A case of dissociative amnesia with dissociative fugue and treatment with psychotherapy. The primary care companion for CNS disorders, 17(3).

Last reviewed 04/17/2018