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.

Causes and symptoms

Fugues are classified as a dissociative disorder, a syndrome in which an individual experiences a disruption in memory, consciousness, and/or identity. This may last anywhere from less than a day to several months, and is sometimes, but not always, brought on by severe stress or trauma. Dissociative fugue (formerly termed psychogenic fugue) is usually triggered by traumatic and stressful events, such as wartime battle, abuse, rape, accidents, natural disasters, and extreme violence, although fugue states may not occur immediately.

Individuals experiencing a fugue exhibit the following symptoms:

Sudden and unplanned travel away from home together with an inability to recall past events about one's life.
Confusion or loss of memory about one's identity (amnesia). In some cases, an individual may assume a new identity to compensate for the loss.
Extreme distress and impaired functioning in day-to-day life as a result of the fugue episodes.

If the amnesia of fugue occurs without an episode of unexpected travel (fleeing), dissociative amnesia is usually diagnosed.

Diagnosis

Patients who experience fugue states should undergo a thorough physical examination and patient history to rule out an organic cause for the illness (e.g., epilepsy or other seizure disorder). If no organic cause is found, a psychologist or other mental healthcare professional will conduct a patient interview and administer one or more psychological assessments (also called clinical inventories, scales, or tests). These assessments may include the Dissociative Experiences Scale (DES or DES-II), Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), and the Dissociate Disorders Interview Schedule (DDIS).

The use and abuse of certain medications and illegal drugs can also prompt fugue-like episodes. For example, alcohol-dependent patients frequently report alcohol-induced "blackouts" that mimic the memory loss of the fugue state and sometimes involve unplanned travel.

Treatment

Dissociative fugue is relatively rare, with a prevalence rate of 0.2% in the general population. The length of a fugue episode is thought to be related to the severity of the stressor or trauma that caused it. The majority of cases appear as single episodes with no recurrence. In some cases, the individual will not remember events that occurred during the fugue state. In other cases, amnesia related to the traumatic event that triggered the fugue may persist to some degree after the fugue episode has concluded.

Treatment for dissociative fugue should focus on helping the patient come to terms with the traumatic event or stressor that caused the disorder. This can be accomplished through various kinds of interactive therapies that explore the trauma and work on building the patient's coping mechanisms to prevent further recurrence. Some therapists use cognitive therapy, which focuses on changing maladaptive thought patterns. It is based on the principal that maladaptive behavior (in this case, the fugue episode itself) is triggered by inappropriate or irrational thinking patterns. A cognitive therapist will attempt to change these thought patterns (also known as cognitive distortions) by examining the rationality and validity of the assumptions behind them with the patient. In the case of a dissociative fugue brought on by abuse, this may involve therapeutic work that uncovers and invalidates negative self-concepts the patient has (e.g., "I am a bad person, therefore I brought on the abuse myself").

In some cases, hypnotherapy, or hypnosis, may be useful in helping the patient recover lost memories of trauma. Creative therapies (i.e., art therapy, music therapy) are also constructive in allowing patients to express and explore thoughts and emotions in "safe" ways. They also empower the patient by encouraging self-discovery and a sense of control.

Medication may be a useful adjunct, or complementary, treatment for some of the symptoms that the patient may be experiencing in relation to the dissociative episode. In some cases, antidepressant or anti-anxiety medication may be prescribed.

Group therapy, either therapist/counselor-led or in self-help format, can be helpful in providing an on-going support network for the patient. It also provides the patient with opportunities to gain self-confidence and interact with peers in a positive way. Family therapy sessions may also be part of the treatment regime, both in exploring the trauma that caused the fugue episode and in educating the rest of the family about the dissociative disorder and the causes behind it.

For Your Information

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Further Information
National Alliance for the Mentally Ill (NAMI), 200 North Glebe Road, Suite 1015, Arlington, VA USA 22203-3754; Phone:(800)950-6264; Website: http://www.nami.org

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

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