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A fugue reaction or fugue state is a state of mind characterized by abandonment of personal identity, along with the memories, personality and other identifying characteristics of individuality. The Fugue state is a condition of dissociative fugue (formerly Psychogenic Fugue) (DSM-IV Dissociative Disorders 300.13[1]).

Clinical definition[edit | edit source]

The etiology of the fugue state is related to Dissociative Amnesia, (DSM-IV Codes 300.12[2]) which has several other subtypes[3]: Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.[1]

Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone completely forgets who they are), 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 Codes 294.0).[4] It is a complex neuropsychological process.[5]

As the person experiencing a Dissociative fugue may have recently suffered the reappearance of an event or person representing an earlier life trauma, the emergence of an armoring or defensive personality seems to be for some, a logical apprehension of the situation.

Therefore, the terminology fugue state may carry a slight linguistic distinction from Dissociative Fugue, the former implying a greater degree of motion. For the purposes of this article then, a fugue state would occur while one is acting out a Dissociative Fugue.

The DSM-IV defines [1] 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, or
  • significant distress or impairment.

The Merck Manual [6] 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, the Merck Manual [6] 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.

Prevalence and onset[edit | edit source]

It has been estimated that approximately 0.2 percent of the population experiences Dissociative Fugue, although prevalence increases significantly following a stressful life event, such as wartime experience or some other disaster.[6] Other life stressors may trigger a Dissociative Fugue, such as financial difficulties, personal problems or legal issues. The causes of Dissociative Fugue are similar to those of Dissociative Amnesia and Dissociative Identity Disorder. Dissociative fugue is often mistaken for malingering, because both conditions may occur under circumstances that a person might understandably wish to evade. However, Dissociative Fugue occurs spontaneously and is not faked. Malingering is a state in which a person feigns illness because it removes them from accountability for their actions, gives them an excuse to avoid responsibilities, or reduces their exposure to a known hazard, such as a dangerous job assignment. Many fugues seem to represent a disguised wish fulfillment (for example, an escape from overwhelming stresses, such as divorce or financial ruin). Other fugues are related to feelings of rejection or separation, or they may protect the person from suicidal or homicidal impulses.

Similar to Dissociative Amnesia, the Dissociative Fugue usually affects personal memories from the past, rather than encyclopedic or abstract knowledge. A Dissociative Fugue, therefore, does not imply any overt seeming or "crazy" behaviour.

Diagnosis[edit | edit source]

Some disorders have similar symptoms. The clinician, therefore, in his or her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis: dementia, head trauma, substance intoxication, early symptoms of neurological disorders (e.g. multiple sclerosis) may resemble conversion symptoms.[4] Similarly, other psychological disorders may manifest symptoms similar to Dissocative Fugues. These include bipolar disorder, schizophrenia and major depressive disorder.[How to reference and link to summary or text]

Treatment and prognosis[edit | edit source]

Most Dissociative Fugues last for hours or days or months, unresolved and may return. Dissociative Fugue is treated much the same as Dissociative Amnesia and Dissociative Identity Disorder, and treatment is therapy aimed at helping the person restore lost memories as soon as possible.[4] Most people who suffer Dissociative Fugues regain most or all of their prior memories; however, efforts to restore memories of the fugue period usually are unsuccessful.

The goal of treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of his or her symptoms, but most likely will include some combination of the following treatment methods:

  • Psychotherapy[7][8] — Psychotherapy, a type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems.
  • Cognitive therapy — This type of therapy focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
  • Medication — There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
  • Family therapy — This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
  • Creative therapies (art therapy, music therapy) — These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.
  • Clinical hypnosis — This is a treatment method that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

See also[edit | edit source]

References[edit | edit source]

  • Akhtar, S., & Brenner, I. (1979). Differential diagnosis of fugue-like states: Journal of Clinical Psychiatry Vol 40(9) Sep 1979, 381-385.
*Attolini, L., Berti, A., Maberino, C., & Rossi, R. (2003). The mystery of Agatha Christie: Notes to the dissociative fugue: Rivista di Psichiatria Vol 38(4) Jul-Aug 2003, 196-201.
*Braude, S. E. (2004). Memory: The nature and significance of dissociation: Radden, Jennifer (Ed).
*Caroli, F., & Masse, G. (1981). The notion of the pathological journey: Annales Medico-Psychologiques Vol 139(7) Jul 1981, 828-832.
*Coons, P. M. (1999). Psychogenic or dissociative fugue: A clinical investigation of five cases: Psychological Reports Vol 84(3, Pt 1) Jun 1999, 881-886.
*Degun-Mather, M. (2001). The value of hypnosis in the treatment of chronic PTSD with dissociative fugues in a war veteran: Contemporary Hypnosis Vol 18(1) 2001, 4-13.
*Gifford, S., Murawski, B. J., Kline, N. S., & Sachar, E. J. (1976). An unusual adverse reaction to self-medication with Prednisone: An irrational crime during a fugue-state: International Journal of Psychiatry in Medicine Vol 7(2) 1976-1977, 97-122.
*Glisky, E. L., Ryan, L., Reminger, S., Hardt, O., Hayes, S. M., & Hupbach, A. (2004). A case of psychogenic fugue: I understand, aber ich verstehe nichts: Neuropsychologia Vol 42(8) 2004, 1132-1147.
*Gow, K. (2005). Secret wishes, hidden instincts: PsycCRITIQUES Vol 50 (11), 2005.
*Hacking, I. (1996). Les alienes voyageurs: How fugue became a medical entity: History of Psychiatry Vol 7(27, Pt 3) Sep 1996, 425-449.
*Hacking, I. (1998). Mad travelers: Reflections on the reality of transient mental illnesses. Charlottesville, VA: University Press of Virginia.
*Howley, J., & Ross, C. A. (2003). The Structure of Dissociative Fugue: A Case Report: Journal of Trauma & Dissociation Vol 4(4) 2003, 109-124.
*Kapur, N. (1991). Amnesia in relation to fugue states: Distinguishing a neurological from a psychogenic basis: British Journal of Psychiatry Vol 159 Dec 1991, 872-877.
*Keller, R., & Shaywitz, B. A. (1986). Amnesia or fugue state: A diagnostic dilemma: Journal of Developmental & Behavioral Pediatrics Vol 7(2) Apr 1986, 131-132.
*Kopelman, M. D. (1995). The assessment of psychogenic amnesia. Oxford, England: John Wiley & Sons.
*Kopelman, M. D., Christensen, H., Puffett, A., & Stanhope, N. (1994). The great escape: A neuropsychological study of psychogenic amnesia: Neuropsychologia Vol 32(6) Jun 1994, 675-691.
*Kopelman, M. D., Green, R. E. A., Guinan, E. M., Lewis, P. D. R., & et al. (1994). The case of the amnesic intelligence officer: Psychological Medicine Vol 24(4) Nov 1994, 1037-1045.
*Kopelman, M. D., Panayiotopoulos, C. P., & Lewis, P. (1994). Transient epileptic amnesia differentiated from psychogenic "fugue": Neuropsychological, EEG, and PET findings: Journal of Neurology, Neurosurgery & Psychiatry Vol 57(8) Aug 1994, 1002-1004.
*Leucht, S., Mirisch, S., Etgen, T., & Conrad, B. (2003). Fugue and suicide: Nervenarzt Vol 74(7) 2003, 587-590.
*Loewenstein, R. J. (1991). Psychogenic amnesia and psychogenic fugue: A comprehensive review. Washington, DC: American Psychiatric Association.
*Loewenstein, R. J. (1993). Psychogenic amnesia and psychogenic fugue: A comprehensive review. Baltimore, MD: The Sidran Press.
*Loewenstein, R. J. (1996). Dissociative amnesia and dissociative fugue: Michelson, Larry K (Ed); Ray, William J (Ed).
*MacHovek, F. J. (1981). Hypnosis to facilitate recall in psychogenic amnesia and fugue states: Treatment variables: American Journal of Clinical Hypnosis Vol 24(1) Jul 1981, 7-13.
*Macleod, A. D. (1999). Posttraumatic stress disorder, dissociative fugue and a locator beacon: Australian and New Zealand Journal of Psychiatry Vol 33(1) Feb 1999, 102-104.
*McKinney, K. A., & Lange, M. M. (1983). Familial fugue: A case report: The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie Vol 28(8) Dec 1983, 654-656.
*Menninger, K. A. (1919). Cyclothymic Fugues: Fugues associated with manic-depressive psychosis: A case report: The Journal of Abnormal Psychology Vol 14(1-2) Apr-Jun 1919, 54-63.
*Mohan, K. J., Salo, M. W., & Nagaswami, S. (1975). A case of limbic system dysfunction with hypersexuality and fugue state: Diseases of the Nervous System Vol 36(11) Nov 1975, 621-624.
*Otto, H. A. (1977). The family value fugue incident: Initial exploration of a neglected area: The Family Coordinator Vol 26(1) Jan 1977, 13-17.
*Porter, G., Shaw, T., & Ryan, C. J. (2007). Fugue associated with migraine: Journal of Neurology, Neurosurgery & Psychiatry Vol 78(1) Jan 2007, 104-105.
*Rice, E., & Fisher, C. (1976). Fugue states in sleep and wakefulness: A psychophysiological study: Journal of Nervous and Mental Disease Vol 163(2) Aug 1976, 79-87.
*Siciliani, O., Tansella, M., Garzotto, N., & Zimmermann Tansella, C. (1973). The study of a case of dissociative reaction with alternating fugue and general amnesia: Rivista di Psichiatria Vol 8(3) May 1973, 288-326.
*Van der Hart, O. (1985). Metaphoric and symbolic imagery in the hypnotic treatment of an urge to wander: A case report: Australian Journal of Clinical & Experimental Hypnosis Vol 13(2) Nov 1985, 83-95.
*Venn, J. (1984). Family etiology and remission in a case of psychogenic fugue: Family Process Vol 23(3) Sep 1984, 429-435.
*Wagner, E. E. (1978). A theoretical explanation of the dissociative reaction and a confirmatory case presentation: Journal of Personality Assessment Vol 42(3) Jun 1978, 312-316.

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