Dissociative Fugue: Symptoms, Types, Causes And Treatment

A strange mental alteration in which the person goes away and forgets his past, literally.

We wake up in a place that is not familiar to us. We roam the streets, but we are not at home, not even in our city. Where am I and what am I doing here? We ask a local, who seems to recognize us and calls us by a name other than ours. Apparently we’ve been in town for a month. How is this possible?

One of the possible answers to this question is that we have experienced a disorder called dissociative fugue.

Dissociative fugue: definition and characteristic symptoms

Dissociative fugue is defined as an associative disorder characterized by making unexpected trips away from the subject’s usual environment in which the individual is unable to remember their past. This trip is made with apparent normality, the subject’s behavior does not draw attention and without symptoms of a mental disorder or cognitive alterations appearing. It is also frequent, although it may not happen, that the individual has doubts about her own identity, either losing it or assuming a new one.

In a vast majority of cases, the person ends up regaining their previous identity and memory. However, there are cases in which parts of the past are not remembered and it has even happened on some occasion that the patient has not come to remember his past prior to the escape. In most cases, when recovering the identity, an amnesia can occur after the episode in which what has happened during the episode is forgotten.

After recovering the memory, the individual usually feels discomfort, derived both from confusion about what happened and from deterioration in different vital domains such as work or partner. You may experience guilt, depression, anxiety, irritability, impulsivity, and even suicide attempts.

At present, dissociative fugue is no longer considered as a disorder by itself, being a specifier of dissociative or psychogenic amnesia because, with the exception of the presence of the fugue in question, it shares most of its characteristics.

Subtypes of leakage

Although most of the symptoms of dissociative fugue are similar, this disorder can manifest itself in different ways and have different repercussions. Specifically, three major subtypes of dissociative fugue can be considered.

Classic fugue

In this subtype of dissociative fugue there is a trip or flight to an unknown place, presenting autobiographical amnesia and partial or total loss of one’s own identity and the assumption of a new one. The subject can settle in the new place with a new identity, without knowing his previous history until he recovers his memory.

Personal identity amnesia

This type of escape supposes that the individual has a loss of autobiographical memory along with his identity, although in this case there is no change in it. The individual does not believe another person, but knows that he does not know who he is.

Return to the previous period of one’s life

This type of dissociative fugue refers to the return on a psychic level to a previous period of one’s life, presenting amnesia with respect to the period of time that has elapsed since the period in question and today. However, the personal identity remains intact.

Causes

The causes of dissociative fugue are associated with the experience of very stressful and traumatic events. For example, it is not uncommon for subjects to have suffered sexual abuse or suffered misfortunes such as wars or natural disasters during childhood or throughout their lives, so that their psyche is split to avoid the pain generated by the event in question.

It also seems to predispose poisoning or substance abuse, head trauma and certain disorders such as epilepsy to their suffering.

At the biological level, it is considered that the noradrenergic and serotonergic systems, as well as opioids, may have an influence . Cerebrally, the presence of changes in the limbic system and its connection with the neocortex appears to be observed  .

Treatment

Dissociative fugue is a disorder whose treatment is mainly focused on the recovery and control of symptoms. It must be taken into account that, although generally only a single episode occurs, new leaks may appear, so prevention is another aspect to take into account.

It is necessary to work with the patient on the causes of this amnesia, the situation that generated the flight and what this situation means for the subject. Cognitive restructuring or work on emotional expression and stress management can be of great help for these types of patients. Hypnosis and suggestion have also been used  to try to unblock the blocked contents of the subject’s mind, as well as conducting interviews facilitated by hypnotic substances.

It is essential to work not only with the subject but also with the family and environment. Giving them information about the disorder and what has happened is reassuring and can help to take into account and control factors that may have triggered the episode. Likewise, couple or family therapy in order to help manage the conflicts that may have triggered or may have been produced by the escape is also recommended.

Bibliographic references:

  • American Psychiatric Association (2002). DSM-IV-TR. Diagnostic and Statistical Manual of Mental Disorders. Spanish edition. Barcelona: Masson. (Original in English from 2000).
  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • De Rezende, L .; Ramos, A. & González, JC (2011). The dissociative fugue. On the subject of a case and a brief bibliographic review. Journal of the Spanish Association of Neuropsychiatry. 31 (112), 725-731.
  • Caballero, L. (2010). Dissociative and conversion disorders. In: Vallejo, J. and Leal, C. (eds.) Treaty of Psychiatry. Barcelona: Ars Medica. p. 1311-1335
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