Dissociative fugue

Dissociative Fugue (psychogenic fugue or fugue states) is included now within the category of Dissociative Amnesia (DA) in the DSM-5

What is a Dissociative Fugue?
"The word fugue derives from the Latin word for flight— fugere."

A dissociative fugue occurs when a person unexpectedly travels far from home/work, and has amnesia for their past, including their identity. A fugue involves the person also having amnesia for the reason for the flight, usually accompanied by confusion about personal identity. In rare cases the person may partially or completely assume of a new identity. The travelling associated with the fugue condition can last from a few hours or up to several months. Accurate diagnosis are often not made until the fugue is over, and the person is in contact with mental health professionals.

Dissociative fugue is a rare condition; it has a prevalence of around 0.2%, although it is important to note that it can only be diagnosed if other conditions would not also account for it, for example dissociative identity disorder (DID) or other specified dissociative disorder (formerly known as DDNOS). Fugues are common in DID.

Diagnostic criteria in the DSM-5
The diagnostic criteria for a Dissociative Fugue is now the same as for Dissociative Amnesia, since dissociative fugue was moved from a separate diagnosis to a subtype of Dissociative Amnesia in the DSM-5, in 2013. A fugue involves generalized rather than selective amnesia. People with the complex dissociative disorders may experience dissociative fugues as part of their disorder, but dissociative fugue has been found in people who do not meet the criteria for other dissociative disorders.

Previous diagnostic criteria (DSM-IV)

The text-revision of the DSM-IV manual (produced in 2000) gives the following criteria, only parts A and B were not described in the criteria for dissociative amnesia:

A The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past.

B. Confusion about personal identity or assumption of a new identity (partial or complete).

C. The disturbance does not occur exclusively during the course of dissociative identity disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

D. The symptoms cause clinically cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Diagnostic criteria in the ICD-10
In the ICD-10 dissociative fugue is a separate diagnosis, rather than included in dissociative amnesia.

F44.1 Dissociative Fugue

Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue, the patient's behaviour during this time may appear completely normal to independent observers."

Dissociative fugue cannot be diagnosed in the case of a postictal fugue which occurs in epilepsy.

Possible Causes of Dissociative Fugue
Dissociative fugue is rare as a separate diagnosis, and usually only occurs within dissociative identity disorder.

Santos (2010) states that "Episodes of dissociative fugue are usually associated with severe stress or trauma, such as war, natural disasters, death of a loved one or unbearable pressures at work or home." Mamarde (2013) gives combat, rape, recurrent childhood sexual abuse, massive social dislocation, and natural disasters as possible causes.

Historical and modern studies of people experiencing dissociative fugue
Paul Dell writes that "Clinical literature on dissociative amnesia and dissociative fugue date back to the 19th Century (Ross 1997; Ross & Howley 2004)."

Dissociative fugue was previously known as psychogenic fugue, and is commonly referred to in the media as a "fugue state". Modern studies are limited because dissociative fugues most commonly occur as a symptom of DID or Dissociative Disorder Not Elsewhere Specified. Paul Dell writes that: "'Dissociative Fugues are common in dissociative patients, but cases of 'pure' Dissociative Fugue are quite rare'."

Cases of Dissociative Fugue
Glisky (2004) reports on a case of dissociative fugue in which the individual lost access not only to his autobiographical memories but also to his native German language. Santos (2010) reports on a case caused by stress at work in a 55 year old woman with no psychiatric history. There are descriptions of patients that have traveled thousands of miles from home while in a state of dissociative fugue.

First and Tasman (2011) write about general treatment approaches, and state that dissociative fugue often occurs after a traumatic experience or bereavement. Kaplan gives more detail on causes, which include family, sexual occupational and legal problems. . Mamarde (2013) et al. describe recurrent dissociative fugues as being exceptionally rare, describing the case of a 32 year old man in India whose third fugue occurred several months after his wife eloped with neighbor, leaving behind two children who he felt he was too poor to provide for.

Dissociative fugue evidence
Videos of personal experiences of Dissociative Fugue have broadcast in the media in several countries; news appeals have been used to help identity those experiencing from dissociative fugues, although some regain their memories unaided. If the fugue was caused by a psychosocial stressor then resolving the stressor should allow the fugue to remit. Media interviews of some of those who have experiences Dissociative Fugues refer to the person feeling under "stress" immediately beforehand.

Prognosis
Dissociative fugues often do not get brought to the attention of mental health professionals until the fugue ends, which gives professionals little chance to research or treat the disorder. When the fugue ends a person's identity and memory will return, but typically there will be amnesia for the period of the fugue.