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Dissociative fugue

For its use in music, see fugue (music). more...

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The Merck Manual 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 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.

In the field of psychology, a fugue state is usually defined by the term dissociative fugue and from the definitions above it is etiologically related to dissociative amnesia (which in popular culture is usually simply called amnesia, the state where someone completely forgets who they are).

A fugue state is therefore similar in nature to the concept of dissociative identity disorder (DID) (formerly called multiple-personality disorder) although DID is widely understood to have its conception in a long-term life event (such as a traumatic childhood), where sufficient time is given for alternate personality representations to form and take hold. Sudden neurological damage would thus seem to fit more closely the onset of a fugue state.

As the person experiencing a fugue state may have recently suffered an amnesic onset -- perhaps a head trauma, or the reappearance of an event or person representing an earlier life trauma -- the emergence of a "new" personality seems to be for some, a logical apprehension of the situation.

Interestingly, in music the word fugue implies multiple instruments (voices) that introduce the melody (personality traits) sequentially (thus suggesting motion), possibly later playing simultaneously with combinations of counter-melodies (counter-traits). There is almost certainly a linguistic relationship between these ideas (most likely the psychological notion was so named after the musical notion).

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, fugue state would be the situation of acting out a dissociative fugue.

Prevalence and onset

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. Other life stressors may trigger a fugue state, such as financial difficulties, personal problems or legal issues. Unlike a dissociative identity disorder, a fugue is usually considered to be a malingering disorder, resolving to remove the experiencer from responsibility for their actions, or from situations imposed upon them by others. In this sense, fugues seem to be the result of a repressed wish-fulfillment. Similar to dissociative amnesia, the fugue state usually affects personal memories from the past, rather than encyclopedic or abstract knowledge. A fugue state therefore does not imply any overt seeming or "crazy" behaviour.


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Dissociation/Dissociative disorders
From Gale Encyclopedia of Psychology, 4/6/01

Dissociation, or the feeling of being detached from the reality of one's body, can be categorized into two types: depersonalization and derealization. Depersonalization is highlighted by a sense of not knowing who you are, or of questioning long-held beliefs about who you are. In derealization, persons perceive reality in a grossly distorted way. Psychologists have identified several types of disorders based on these feelings. These include depersonalization disorder, dissociative fugue, dissociative amnesia, dissociative trance disorder, and dissociative identity disorder (also known as multiple personality syndrome), among others.

Depersonalization disorder is a condition marked by a persistent feeling of not being real. The DSM-IV describes its symptoms as "persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one's mental processes or body (e.g., feeling like one is in a dream)." While many people have experienced a similar feeling, persons actually suffering from this disorder are so overwhelmed by these feelings that they are unable to function normally in society. It is also critical to point out that in order to be diagnosed as having this disorder, these feelings cannot be caused by some specific drug or event. Depersonalization disorder, by itself, is a rare disorder, and, in fact, many of its symptoms are also symptomatic of other more common disorders, such as acute stress disorder and panic attacks.

Dissociative fugue is a strange phenomena in which persons will be stricken with a sudden memory loss that prompts them to flee their familiar surroundings. These flights are usually caused by some traumatic event. People suffering from this disorder will suddenly find themselves in a new surrounding, hundreds or even thousands of miles from their homes with no memories of the weeks, months, or even years that have elapsed since their flight. Incidence of dissociative fugue rarely appear until after adolescence and usually before the age of 50. Once a person has fallen into the behavior, however, it is more likely that it will recur.

Dissociative amnesia describes the condition of suddenly losing major chunks of memory. There are two types of this disorder: generalized amnesia, in which a person cannot remember anything about their lives, and localized amnesia, a common disorder in which a person forgets pieces of their identity but retains an overall understanding of who they are. Dissociative amnesia is generally caused by some traumatic event, such as a natural disaster, a violent crime, or war. In these instances, it is an adaptive mechanism that allows a person to continue his or her life without having to deal with an utterly horrific memory.

Dissociative trance disorder describes the trance-state that people experience in various kinds of religious ceremonies. Such people generally perform feats that would normally cause injury or severe pain-such as walking on hot coals-but because of their dissociated mental state, they are not harmed. This is a curious subcategory in that the condition is not considered a "disorder" in many cultures of the world. Western psychiatrists are divided as to whether this should really be considered a "disorder," since the word has negative implications. It has been proposed, however, that future editions of the DSM specify a diagnosis of trance and possession disorder as one of several dissociative disorders.

Gale Encyclopedia of Psychology, 2nd ed. Gale Group, 2001.

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