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Dissociative fugue: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Dissociative fugue is one or more episodes of amnesia with the inability to recall part of the past or the whole past in combination with the loss of one's own identity or the formation of a new one. These episodes, called fugues, develop as a result of trauma or stress. Dissociative fugue is often manifested by a sudden, unpredictable, aimless journey away from home. The diagnosis is based on anamnestic information, with the exclusion of other possible causes of amnesia. Treatment consists of psychotherapy, sometimes in combination with hypnosis or interview using drugs, but its effectiveness is low.
The prevalence of a dissociative fugue is estimated at 0.2%, but may increase during wars, natural disasters, and accidents.
[Causes of dissociative fugue
The causes are similar to those for dissociative amnesia with some additional factors. Fugues are often mistakenly considered a simulation, as they relieve a person from responsibility for their actions, reduce his being in dangerous situations. On the other hand, the fugues are spontaneous, unplanned and genuine. Many fugues are manifested by masking the desired. For example, a manager with financial problems can leave his turbulent life and live in the village as an assistant farmer. Fugue can remove the patient from a painful situation for him or intolerable stress or may be related to the consequences of rejection of a loved one or separation. For example, a fugue may imply such an idea: "I'm not the man who finds out that his wife is cheating on him." Some fugues can protect a person from suicidal and homicidal tendencies.
Symptoms of dissociative fugue
Fugue can last from a few hours to months, rarely longer. During a fugue a person can look and act normally or be only slightly confused. He can get a new name, get involved in complex social interactions. On the other hand, confusion about a new personality or a return to the original personality can lead to an awareness of amnesia or the cause of the disorder. When the fugue ends, shame, discomfort, depression, severe conflict, suicidal and aggressive behavior may occur - the patient needs to cope with what he has lost. Failure to remember events that occurred during the fugue can cause confusion, anxiety and even horror.
Fugue is rarely recognized during development. It can be suspected if a person is confused about his personal identity, his past or enters into confrontation, if his new identity is disputed. Often the fugue is not recognized until a person suddenly returns to the original person and does not feel any discomfort when he is in an unfamiliar situation. The diagnosis is usually established retrospectively on the basis of information about the circumstances prior to travel, during the journey and about the arrangement of alternative life. If there is a suspicion that the fugue is falsified, cross-gathering information from a variety of sources can reveal inconsistencies that are inconsistent with the diagnosis.
Prognosis and treatment of dissociative fugue
Most fugues are not long and end on their own. Violations after the termination of the fugue are usually small and short-lived. On the other hand, if the fugue was protracted and severe difficulties were observed due to behavior before or during the fugue, the patient may have serious problems in returning to the original personality: for example, a soldier who returned after a fugue can be accused of desertion, or a person who married during a fugue, may inadvertently become a polygamist.
In the more rare cases, when the patient continues to identify himself with the personality that existed during the fugue, information (possibly with the help of legal pressure and social workers) is important about the true identity that existed before the fugue and help in its recovery.
Treatment after the termination of a fugue includes psychotherapy, sometimes in combination with hypnosis or an interview with the use of medications (metohexital). However, attempts to restore memory for the fugue period are often unsuccessful. The psychiatrist can help the patient to analyze the situations, conflicts, mood swings that led to the development of the fugue, in order to avoid its recurrence.