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Dissociative fugue: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Dissociative fugue is one or more episodes of amnesia with an inability to remember part or all of the past, combined with a loss of one's own personal identity or the formation of a new one. These episodes, called fugues, develop as a result of trauma or stress. Dissociative fugue often manifests itself as sudden, unpredictable, aimless travel away from home. Diagnosis is based on the patient's history and the exclusion of other possible causes of amnesia. Treatment consists of psychotherapy, sometimes combined with hypnosis or drug-assisted interviews, but its effectiveness is low.
The prevalence of dissociative fugue is estimated at 0.2%, but may increase during periods of war, natural disasters, and accidents.
[ Causes of dissociative fugue
The causes are similar to those of dissociative amnesia, with some additional factors. Fugues are often mistakenly considered simulations, since they relieve the person of responsibility for his actions, reducing his exposure to dangerous situations. On the other hand, fugues are spontaneous, unplanned, and genuine. Many fugues are manifested by the masking of what is desired. For example, an executive with financial problems may leave his hectic life and live in the country as a farmer's assistant. A fugue may remove the patient from a painful situation or intolerable stress, or may be associated with the consequences of rejection by a loved one or separation. For example, a fugue may imply the thought: "I am not the man who will find out that his wife is cheating on him." Some fugues may protect a person from suicidal and homicidal tendencies.
Symptoms of dissociative fugue
The fugue may last from a few hours to months, rarely longer. During the fugue, the person may appear and act normally or be only slightly confused. They may acquire a new name and engage in complex social interactions. On the other hand, confusion about the new identity or the return to the original identity may lead to an understanding of the amnesia or the cause of the disorder. When the fugue ends, shame, discomfort, depression, intense conflict, suicidal and aggressive behavior may occur as the patient copes with what has been lost. The inability to remember events that occurred during the fugue may cause confusion, anxiety, and even terror.
Developmental fugue is rarely recognized. It may be suspected if the person is confused about his or her personal identity, his or her past, or if the person is antagonistic when the new identity is challenged. Often, fugue is not recognized until the person suddenly returns to the original identity and experiences discomfort in the unfamiliar situation. Diagnosis is usually made retrospectively based on information about the circumstances before the trip, during the trip, and the arrangement of the alternate life. If the fugue is suspected of being falsified, cross-referencing of information from multiple sources may reveal inconsistencies that contradict the diagnosis.
Prognosis and treatment of dissociative fugue
Most fugues are short-lived and resolve spontaneously. The disturbances after the fugue are usually minor and short-lived. On the other hand, if the fugue has been prolonged and there have been significant difficulties with behavior before or during the fugue, the patient may have serious problems returning to the original personality: for example, a soldier who returns after a fugue may be accused of desertion, or a man who marries during a fugue may inadvertently become a polygamist.
In rarer cases, when the patient continues to identify with the personality that existed during the fugue, information (possibly through legal pressure and social workers) about the true personality that existed before the fugue and assistance in its restoration are important.
Treatment after the fugue ends includes psychotherapy, sometimes combined with hypnosis or interviews using medications (methohexital). However, attempts to restore memory for the period of the fugue are often unsuccessful. A psychiatrist can help the patient analyze the situations, conflicts, mood swings that led to the development of the fugue, in order to avoid its recurrence.