Dissociative Fugue - Definition, Description

Dissociative fugue is a rare condition in which a person suddenly, without planning or warning, travels far from home or work and leaves behind a past life. Patients show signs of amnesia and have no conscious understanding or knowledge of the reason for the flight.

The condition is usually associated with severe stress or trauma. Because persons cannot remember all or part of their past, at some point they become confused about their identity and the situations in which they find themselves. In rare cases, they may take on new identities. The American Psychiatric Association (APA) classifies disassociative fugue as one of four dissociative disorders, along with dissociative amnesia, dissociative identity disorder, and depersonalization disorder.

Causes

Dissociative fugue is usually triggered by severe trauma, such as wars, accidents, natural disasters, or sexual abuse during childhood.

Dissociative fugue is often mistaken for malingering because both conditions may give people an excuse to avoid their responsibilities (as in an intolerable marriage), to avoid accountability for their actions, or to reduce their exposure to a known hazard, such as a battle. However, dissociative fugue, unlike malingering, occurs spontaneously and is not faked.

Many fugues seem to represent 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 develop as an alternative to suicidal or homicidal impulses

Symptoms

A person in the midst of a dissociative fugue episode may appear to have no psychiatric symptoms at all or to be only slightly confused. Therefore, for a time, it may be very difficult to spot someone experiencing a fugue. After a while, however, the patient shows significant signs of confusion or distress because he or she cannot remember recent events, or realizes a complete sense of identity is missing. This amnesia is a characteristic symptom of the disorder.

How is dissociative fugue treated?

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 — 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.

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