Dissociative Fugue (DF)

What is a Dissociative Fugue?

The word fugue derives from the Latin word for flight— fugere.^[1]

A dissociative fuguepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as dissociative amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. Dissociative amnesia (DA) was previously called psychogenic amnesia is a form of temporary amnesia that presents often in traumatic situations; for example in car accidents or victim or witness of a violent crime. Dissociative Amnesia is described in the DSM as a disorder that causes significant distress or impairment in functioning, such as when a person cannot remember significant events that happened to them. 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 amnesiaMemory loss. {{See also| 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.^[1] The travelling associated with the fugue condition can last from a few hours or up to several months.^[1] Accurate diagnosis are often not made until the fugue is over, and the person is in contact with mental health professionals. ^[1]

Listen to Jeff Ingram talking about his Dissociative Fugues For Man With Amnesia, Love Repeats Itself[2]

Dissociative fuguepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as dissociative amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. is a rare condition; it has a prevalence of around 0.2%^[1], 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 (DIDDissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. {{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}}) or other specified dissociative disorder (formerly known as DDNOS). Fugues are common in DID.^[1]

Diagnostic criteria in the DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. {{Rp|384}}-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.^[3]:431 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"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" , a medication) or a general medical condition (e.g., temporal lobe epilepsyTemporal lobe epilepsy is a seizure disorder which can cause personality change. As many as 40% of people with temporal lobe epilepsy also have psychosis; often involving religious delusions and olfactory hallucinations (unusual tastes or smells). {{Rp|72,66, 181}}Temporal lope epilepsy is a medical condition which can cause symptoms similar to dissociative disorders and schizophrenia. A dissociative disorder cannot be diagnosed if temporal lobe epilepsy is present and may account for the symptoms. ).

D. The symptoms cause clinically cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. ^[4]

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."^[5]

Dissociative fugue cannot be diagnosed in the case of a postictal fugue which occurs in epilepsy.^[5]

Possible Causes of Dissociative Fugue

Dissociative fugue is rare as a separate diagnosis,^[3]:xxx and usually only occurs within dissociative identity disorder.^[3]:774

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 statepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as dissociative amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. ". Modern studies are limited because dissociative fugues most commonly occur as a symptom of DID or Dissociative Disorder Not Elsewhere Specified.^[3] Paul Dell writes that:

"Dissociative Fugues are common in dissociative patients, but cases of "pure" Dissociative Fugue are quite rare".^[3]

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.^[6] 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.^[1]

First and Tasman (2011) write about general treatment approaches, and state that dissociative fugue often occurs after a traumatic experience or bereavement.^[7] Kaplan gives more detail on causes, which include family, sexual occupational and legal problems. ^[8]. 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.^[7] 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"Memory is not a static thing, but an active set of processes." {{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." {{Rp|11}} will return, but typically there will be amnesia for the period of the fugue.^[3]:431

References

1. ^ a b c d e f g Santos, M.; Gago, E. (2010). European Psychiatry, volume 25 Supplement 1. (doi:10.1016/S0924-9338(10)70610-6)
2. ^ For Man With Amnesia, Love Repeats Itself, NPR (December 13, 2012). Retrieved May 20, 2013 from http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=167187734&m=167230697
3. ^ a b c d e f Dell, Paul F. (ed) (2009) (coauthors: O'Neil, John A.). . New York: Routledge..
4. ^ American Psychiatric Association, ed. (2000). . American Psychiatric Pub..
5. ^ a b World Health Organisation, (2010). ICD-10 Classification of Mental and Behavioural Reaction to severe stress, and adjustment disorders.
6. ^ Glisky, Elizabeth L., et al. "A case of psychogenic fugue: I understand, aber ich verstehe nichts." Neuropsychologia 42.8 (2004): 1132-1147.
7. ^ a b First, Michael B. (2011) (coauthors: Tasman,Allan). . Wiley.
8. ^ Sadock, Benjamin James (2008) (coauthors: Sadock, Virginia Alcott). . Lippincott Williams & Wilkins..

Cite error: Reference "Mamarde2013" "$2" "$3" is not used in prior text.