Wikipedia

Dissociative fugue

For the New York City–based publisher, seeFugue State Press.

Dissociative fugue(/fjuːɡ/FYOOG), previously referred to as afugue stateorpsychogenic fugue,[1]is a rare psychiatric condition characterized by reversibleamnesiaregarding one’s identity, often accompanied by unexpected travel or wandering. In some cases, individuals may assume a new identity and be unable to recall personal information from before the onset of symptoms.[2]It is classified as amentalandbehavioraldisorder[3]and isvariously categorizedas adissociative disorder,[1]aconversion disorder,[3]or asomatic symptom disorder.According to theDiagnostic and Statistical Manual of Mental Disorders(DSM-5), dissociative fugue is a subset ofdissociative amnesia.

Dissociative fugue
Other namesFugue state, psychogenic fugue
SpecialtyPsychiatry,neurology

Recovery from a fugue state typically results in the restoration of prior memories, and additional treatment is generally unnecessary. Episodes are not considered dissociative fugue if attributable topsychotropic substances,physical trauma, general medical conditions, or disorders such asdissociative identity disorder,[clarification needed]delirium,ordementia.[4]Dissociative fugue is often triggered by prolonged traumatic experiences and is most frequently associated with individuals who experiencedchildhood sexual abuse,during which they developed dissociative amnesia to suppress memories of the abuse.

Signs and symptoms

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Symptoms of dissociative fugue include mild confusion during the episode and, following recovery, possible feelings ofdepression,grief, shame, discomfort, or post-fugueanger.[5]A key feature of the condition is the loss of one’s identity.[6]

Diagnosis

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Before dissociative fugue can be diagnosed, eitherdissociative amnesiaordissociative identity disordermust be diagnosed.[7]The only difference between dissociative amnesia, dissociative identity disorder and dissociativefugueis that the person affected by the latter travels or wanders. This traveling or wandering is typically associated with the amnesia-induced identity or the person's physical surroundings.[8]

Sometimes dissociative fugue cannot be diagnosed until the patient returns to their pre-fugue identity and is distressed to find themselves in unfamiliar circumstances, sometimes with awareness of "lost time". The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before the patient left home, the travel itself, and the establishment of an alternative life.[9]

Functional amnesia can also be situation-specific, varying from all forms and variations of trauma or generally violent experiences, with the person experiencing severe memory loss for a particular trauma. Committing homicide, experiencing or committing a violent crime such asrapeor torture, experiencing combat violence, attempting suicide, and being in automobile accidents and natural disasters have all induced cases of situation-specific amnesia.[10][11]In these unusual cases, care must be exercised in interpreting cases ofpsychogenic amnesiawhen there are compelling motives to feign memory deficits for legal or financial reasons.[10]However, although some fraction of psychogenic amnesia cases can be explained in this fashion, it is generally acknowledged that true cases are not uncommon. Both global and situationally specific amnesia are often distinguished from the organic amnesic syndrome, in that the capacity to store new memories and experiences remains intact. Given the very delicate and oftentimes dramatic nature of memory loss in such cases, there usually is a concerted effort to help the person recover their identity and history. This will sometimes allow the subject to recover spontaneously, when particular cues are encountered.

Definition

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The cause of the fugue state is related todissociative amnesia(code 300.12 of theDSM-IV codes[12]), which has several other subtypes:[13]selective amnesia,generalized amnesia,continuous amnesia,andsystematized amnesia,in addition to the subtype "dissociative fugue".[1]

Unlikeretrograde amnesia(which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), dissociative amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., amnestic disorder due to a head trauma, DSM-IV Code 294.0).[14]It is a complex neuropsychological process.[15]

As the person experiencing a dissociative fugue may have recently experienced the reappearance of an event or person representing an earlier trauma, the emergence of an armoring or defensive personality seems to be for some, a logical defense strategy in the situation.[citation needed]

Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "dissociativefugue ", the former implying a greater degree of" motion ".[16]For the purposes of this article, then, a "fugue state" occurs while one is "acting out" a "dissociative fugue".

TheDSM-IV [1]defines "dissociative fugue" as:

  • 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 the assumption of a new identity
  • significant distress or impairment

TheMerck Manual [17]defines "dissociative fugue" as:

One or more episodes of amnesia in which the inability to recall some or all of one's past and either the loss of one's identity or the formation of a new identity occur with sudden, unexpected, purposeful travel away from home.

In support of this definition, theMerck Manual [17]further defines dissociative amnesia as:

An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.

Prognosis

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TheDSM-IV-TRstates that the fugue may have a duration from days to months, and recovery is usually rapid. However, some cases may be refractory and resist treatment. An individual usually has only one episode.

Cases

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  • Shirley Ardell Mason(1923–1998), also known as "Sybil", would disappear and then reappear with no recollection of what happened during the time span. She recalled "being here and then not here" and having no identity of herself. It was claimed by her psychiatrist,Cornelia Wilbur,that she also haddissociative identity disorder.Wilbur's diagnosis of DID was disputed by Wilbur's contemporaryHerbert Spiegel.
  • Jody Roberts, a reporter for theTacoma News Tribune,disappeared in 1985, only to be found 12 years later inSitka, Alaska,living under the name of "Jane Dee Williams". While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely experienced a protracted fugue state.[18]
  • David Fitzpatrick, who had dissociative fugue disorder, was profiled in the UK onFive's television seriesExtraordinary People.He entered a fugue state on December 4, 2005, and was working on regaining his entire life's memories at the time of his appearance in his episode of the documentary series.[19]
  • Hannah Upp, a teacher originally fromSalem, Oregon,[20]was given a diagnosis of dissociative fugue[21]after she had disappeared from herNew Yorkhome in August 2008 and was rescued from theNew York Harbor20 days later. News coverage at the time focused on her refusal to speak to detectives right after she was found[20]and the fact that she was seen checking her email atApple Storeswhile she was missing.[22][23][24]This coverage has since led to criticism of the often "condemning and discrediting"[21]attitude toward dissociative conditions. On September 3, 2013, she went into another fugue, disappearing from her new job as a teacher's assistant [25]at Crossway Community Montessori inKensington, Maryland.She was found unharmed two days later on September 5, 2013, inWheaton, Maryland.[26]On September 14, 2017, she went missing again, having last been seen near Sapphire Beach in her home inSt. Thomasright before the arrival ofHurricane Mariathat month.[27]Her mother and a group of friends searched for her in the Virgin Islands and surrounding areas;[28]as of 2025,she remains missing.[29]
  • Jeff Ingram appeared inDenverin 2006 with no memory of his name or where he was from. After his appearance on national television, to appeal for help identifying himself, his fiancée called Denver police identifying him. The episode was diagnosed as dissociative fugue. As of December 2012, Ingram had experienced three incidents of amnesia: in 1994, 2006, and 2007.[30]
  • Doug Bruce"came to" on a subway train claiming to have no memory of his name or where he was from, nor any identification documents.
  • Bruneri-Canella case(alleged reappearance of a man who had gone missing in World War I)
  • Agatha Christie(possibly).[31]Following a spate of traumatic and stressful events, Christie went missing in 1926, and was found at a spa hotel, having checked in under another name; when found, she claimed to be suffering from amnesia. HistorianLucy Worsleyposited[32]that Christie's behaviour could be explained by Christie having experienced a fugue state.
  • Lizzie Borden,who may have murdered her father and stepmother under fugue state

Fictional cases

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See also

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References

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  1. ^abcdDissociative Fugue (formerly Psychogenic Fugue)(DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  2. ^Goldstein, E. Bruce (2019).Cognitive psychology: connecting mind, research, and everyday experience(5E ed.). Boston, MA, USA.ISBN978-1-337-40827-1.OCLC1055681278.{{cite book}}:CS1 maint: location missing publisher (link)
  3. ^abDrs;Sartorius, Norman;Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin, Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Mi sắc s, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.; Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter, C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.; Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West, D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman, P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J."The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines"(PDF).who.intWorld Health Organization.Microsoft Word.bluebook.doc. p. 111.Retrieved3 July2021– viaMicrosoft Bing.
  4. ^American Psychiatric Association (2013).Diagnostic and statistical manual of mental disorders: DSM-5.Washington, D.C.: American Psychiatric Association.ISBN9780890425541.
  5. ^The Merck Manual
  6. ^"What Is Dissociative Fugue?".WebMD.Retrieved2019-11-08.
  7. ^"Dissociative Fugue: What It Is, Causes, Symptoms & Treatment".Cleveland Clinic.Retrieved2023-11-07.
  8. ^Diagnostic And Statistical Manual of Mental Disorders(5th ed.). American Psychiatric Association. 2013. pp.290–298.ISBN978-0-89042-555-8.
  9. ^Dissociative fugue
  10. ^abKopelman, M. D. (2002-10-01)."Disorders of memory".Brain.125(10):2152–2190.doi:10.1093/brain/awf229.PMID12244076.
  11. ^Arrigo, Jean Maria; Pezdek, Kathy (October 1997)."Lessons From the Study of Psychogenic Amnesia".Current Directions in Psychological Science.6(5):148–152.doi:10.1111/1467-8721.ep10772916.ISSN0963-7214.
  12. ^"Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )".Psychiatryonline. Archived fromthe originalon 2007-09-28.Retrieved2011-11-28.
  13. ^Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK )ArchivedNovember 28, 2010, at theWayback Machine
  14. ^Complete List of DSM-IV Codes ( PsychNet-UK )ArchivedJanuary 6, 2011, at theWayback Machine
  15. ^"Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )".Dissociation.co.uk. Archived fromthe originalon 2012-01-14.Retrieved2011-11-28.
  16. ^"Amnesia Concepts In Psychology".Retrieved2023-02-21.
  17. ^abMerck Manual1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
  18. ^"Experts say that Roberts may indeed have amnesia".Juneau Empire. 1997-07-17. Archived fromthe originalon 2011-11-20.Retrieved2011-11-28.
  19. ^"Shows".Five.Archived fromthe originalon 2007-04-03.Retrieved2008-04-03.
  20. ^abThe Associated Press (2008-09-16)."Update: Missing Oregon teacher rescued from Long Island Sound".OregonLive.Retrieved2013-11-16.
  21. ^abAviv, Rachel (2018-03-26)."How a Young Woman Lost Her Identity".The New Yorker.ISSN0028-792X.Retrieved2018-03-30.
  22. ^"Hannah Upp Updates Her Status, Remembers Little".Gothamist.Archived fromthe originalon 2015-03-22.
  23. ^Marx, Rebecca Flint; Didziulis, Vytenis (2009-02-27)."A Life, Interrupted".The New York Times.ISSN0362-4331.Retrieved2021-11-19.
  24. ^"Missing New York City School Teacher Spotted in Apple Store".Fox News.2008-09-09.Archivedfrom the original on 2013-12-22.Retrieved2018-12-05.
  25. ^Mimica, Mila (2013-09-05)."Md. Woman With Rare Form of Amnesia Located".NBC4 Washington.Retrieved2013-11-16.
  26. ^"Hannah Upp of Kensington found in Wheaton, Md".wusa9. 2013-09-05. Archived fromthe originalon 2013-12-13.Retrieved2013-11-16.
  27. ^"Community asked to help search for missing teacher Hannah Upp".Virgin Island Daily News.September 19, 2017.
  28. ^Carlson, Suzanne."Hannah Upp's mother asks for help in the search for her missing daughter".The Virgin Islands Daily News.Retrieved2018-03-30.
  29. ^"What Happened to Hannah Upp? The Mystery Around the Young Woman's Disappearance Continues".
  30. ^"For Man With Amnesia, Love Repeats Itself".NPR. 2012-12-13.Retrieved2013-11-16.
  31. ^"Dissociative Fugue".Psychology Today.17 March 2012.Retrieved17 March2013.
  32. ^"Agatha Christie: Lucy Worsley on the Mystery Queen".
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