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Dissociative fugue

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For the New York City–based publisher, see Fugue State Press.
Dissociative fugue
Other namesFugue state, psychogenic fugue
SpecialtyPsychiatry, Neurology

Dissociative fugue (/fjuːɡ/ FYOOG), formerly called a fugue state or psychogenic fugue,[1] is a rare psychiatric phenomenon characterized by reversible amnesia for one's identity in conjunction with unexpected wandering or travel. This is sometimes accompanied by the establishment of a new identity and the inability to recall personal information prior to the presentation of symptoms.[2] Dissociative fugue is a mental and behavioral disorder[3] that is classified variously as a dissociative disorder,[1] a conversion disorder,[3] and a somatic symptom disorder. It is a facet of dissociative amnesia, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

After recovery from a fugue state, previous memories usually return intact, and further treatment is unnecessary. An episode of fugue is not characterized as attributable to a psychiatric disorder if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to dissociative identity disorder,[clarification needed] delirium, or dementia.[4] Fugues are precipitated by a series of long-term traumatic episodes. It is most commonly associated with childhood victims of sexual abuse who learn to dissociate memory of the abuse (dissociative amnesia).

Signs and symptoms

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Symptoms of a dissociative fugue include mild confusion and once the fugue ends, possible depression, grief, shame, and discomfort. People have also experienced post-fugue anger.[5] Another symptom of the fugue state can consist of loss of one's identity.[6]

Diagnosis

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Before dissociative fugue can be diagnosed, either dissociative amnesia or dissociative identity disorder must be diagnosed.[7] The only difference between dissociative amnesia, dissociative identity disorder and dissociative fugue is that the person affected by the latter travels or wanders. This traveling or wandering is typically associated with the amnesia-induced identity or the person's physical surroundings.[8]

Sometimes dissociative fugue cannot be diagnosed until the patient returns to their pre-fugue identity and is distressed to find themselves in unfamiliar circumstances, sometimes with awareness of "lost time". The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before the patient left home, the travel itself, and the establishment of an alternative life.[9]

Functional amnesia can also be situation-specific, varying from all forms and variations of trauma or generally violent experiences, with the person experiencing severe memory loss for a particular trauma. Committing homicide, experiencing or committing a violent crime such as rape or torture, experiencing combat violence, attempting suicide, and being in automobile accidents and natural disasters have all induced cases of situation-specific amnesia.[10][11] In these unusual cases, care must be exercised in interpreting cases of psychogenic amnesia when there are compelling motives to feign memory deficits for legal or financial reasons.[10] However, although some fraction of psychogenic amnesia cases can be explained in this fashion, it is generally acknowledged that true cases are not uncommon. Both global and situationally specific amnesia are often distinguished from the organic amnesic syndrome, in that the capacity to store new memories and experiences remains intact. Given the very delicate and oftentimes dramatic nature of memory loss in such cases, there usually is a concerted effort to help the person recover their identity and history. This will sometimes allow the subject to recover spontaneously, when particular cues are encountered.

Definition

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The cause of the fugue state is related to dissociative amnesia (code 300.12 of the DSM-IV codes[12]), which has several other subtypes:[13] selective amnesia, generalized amnesia, continuous amnesia, and systematized amnesia, in addition to the subtype "dissociative fugue".[1]

Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), dissociative amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., amnestic disorder due to a head trauma, DSM-IV Code 294.0).[14] It is a complex neuropsychological process.[15]

As the person experiencing a dissociative fugue may have recently experienced the reappearance of an event or person representing an earlier trauma, the emergence of an armoring or defensive personality seems to be for some, a logical defense strategy in the situation.[citation needed]

Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "dissociative fugue", the former implying a greater degree of "motion".[16] For the purposes of this article, then, a "fugue state" occurs while one is "acting out" a "dissociative fugue".

The DSM-IV [1] defines "dissociative fugue" as:

  • sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past
  • confusion about personal identity, or the assumption of a new identity
  • significant distress or impairment

The Merck Manual [17] 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 [17] 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.

Prognosis

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The DSM-IV-TR states that the fugue may have a duration from days to months, and recovery is usually rapid. However, some cases may be refractory.[clarification needed] An individual usually has only one episode.

Cases

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  • Shirley Ardell Mason (1923–1998), also known as "Sybil", would disappear and then reappear with no recollection of what happened during the time span. She recalled "being here and then not here" and having no identity of herself. It was claimed by her psychiatrist, Cornelia Wilbur, that she also had dissociative identity disorder. Wilbur's diagnosis of DID was disputed by Wilbur's contemporary Herbert Spiegel.
  • Jody Roberts, a reporter for the Tacoma News Tribune, disappeared in 1985, only to be found 12 years later in Sitka, Alaska, living under the name of "Jane Dee Williams". While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely experienced a protracted fugue state.[18]
  • David Fitzpatrick, who had dissociative fugue disorder, was profiled in the UK on Five's television series Extraordinary People. He entered a fugue state on December 4, 2005, and was working on regaining his entire life's memories at the time of his appearance in his episode of the documentary series.[19]
  • Hannah Upp, a teacher originally from Salem, Oregon,[20] was given a diagnosis of dissociative fugue[21] after she had disappeared from her New York home in August 2008 and was rescued from the New York Harbor 20 days later. News coverage at the time focused on her refusal to speak to detectives right after she was found[20] and the fact that she was seen checking her email at Apple Stores while she was missing.[22][23][24] This coverage has since led to criticism of the often "condemning and discrediting"[21] attitude toward dissociative conditions. On September 3, 2013, she went into another fugue, disappearing from her new job as a teacher's assistant [25] at Crossway Community Montessori in Kensington, Maryland. She was found unharmed two days later on September 5, 2013, in Wheaton, Maryland.[26] On September 14, 2017, she went missing again, having last been seen near Sapphire Beach in her home in St. Thomas right before the arrival of Hurricane Maria that month.[27] Her mother and a group of friends searched for her in the Virgin Islands and surrounding areas;[28] as of 2023, she remains missing.[29]
  • Jeff Ingram appeared in Denver in 2006 with no memory of his name or where he was from. After his appearance on national television, to appeal for help identifying himself, his fiancée called Denver police identifying him. The episode was diagnosed as dissociative fugue. As of December 2012, Ingram had experienced three incidents of amnesia: in 1994, 2006, and 2007.[30]
  • Doug Bruce "came to" on a subway train claiming to have no memory of his name or where he was from, nor any identification documents.
  • Bruneri-Canella case (alleged reappearance of a man who had gone missing in World War I)
  • Agatha Christie (possibly)[31]. Following a spate of traumatic and stressful events, Christie went missing in 1926, and was found at a spa hotel, having checked in under another name; when found, she claimed to be suffering from amnesia. Historian Lucy Worsley posited [32] that Christie's behaviour could be explained by Christie having experienced a fugue state.
  • Lizzie Borden, who may have murdered her father and stepmother under fugue state

Fictional cases

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See also

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References

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  1. ^ a b c d Dissociative Fugue (formerly Psychogenic Fugue) (DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  2. ^ Goldstein, E. Bruce (2019). Cognitive psychology : connecting mind, research, and everyday experience (5E ed.). Boston, MA, USA. ISBN 978-1-337-40827-1. OCLC 1055681278.{{cite book}}: CS1 maint: location missing publisher (link)
  3. ^ a b Drs; Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin, Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Misès, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.; Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter, C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.; Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West, D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman, P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). www.who.int World Health Organization. Microsoft Word. bluebook.doc. p. 111. Retrieved 3 July 2021 – via Microsoft Bing.
  4. ^ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C.: American Psychiatric Association. ISBN 9780890425541.
  5. ^ The Merck Manual
  6. ^ "What Is Dissociative Fugue?". WebMD. Retrieved 2019-11-08.
  7. ^ "Dissociative Fugue: What It Is, Causes, Symptoms & Treatment". Cleveland Clinic. Retrieved 2023-11-07.
  8. ^ Diagnostic And Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. 2013. pp. 290–298. ISBN 978-0-89042-555-8.
  9. ^ Dissociative fugue
  10. ^ a b Kopelman, M. D. (2002-10-01). "Disorders of memory". Brain. 125 (10): 2152–2190. doi:10.1093/brain/awf229. PMID 12244076.
  11. ^ Arrigo, Jean Maria; Pezdek, Kathy (October 1997). "Lessons From the Study of Psychogenic Amnesia". Current Directions in Psychological Science. 6 (5): 148–152. doi:10.1111/1467-8721.ep10772916. ISSN 0963-7214.
  12. ^ "Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )". Psychiatryonline.com. Archived from the original on 2007-09-28. Retrieved 2011-11-28.
  13. ^ Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com ) Archived November 28, 2010, at the Wayback Machine
  14. ^ Complete List of DSM-IV Codes ( PsychNet-UK.com ) Archived January 6, 2011, at the Wayback Machine
  15. ^ "Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )". Dissociation.co.uk. Archived from the original on 2012-01-14. Retrieved 2011-11-28.
  16. ^ "Amnesia Concepts In Psychology". Retrieved 2023-02-21.
  17. ^ a b Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
  18. ^ "Experts say that Roberts may indeed have amnesia". Juneau Empire. 1997-07-17. Archived from the original on 2011-11-20. Retrieved 2011-11-28.
  19. ^ "Shows". Five. Archived from the original on 2007-04-03. Retrieved 2008-04-03.
  20. ^ a b The Associated Press (2008-09-16). "Update: Missing Oregon teacher rescued from Long Island Sound". OregonLive.com. Retrieved 2013-11-16.
  21. ^ a b Aviv, Rachel (2018-03-26). "How a Young Woman Lost Her Identity". The New Yorker. ISSN 0028-792X. Retrieved 2018-03-30.
  22. ^ "Hannah Upp Updates Her Status, Remembers Little". Gothamist. Archived from the original on 2015-03-22.
  23. ^ Marx, Rebecca Flint; Didziulis, Vytenis (2009-02-27). "A Life, Interrupted". The New York Times. ISSN 0362-4331. Retrieved 2021-11-19.
  24. ^ "Missing New York City School Teacher Spotted in Apple Store". Fox News. 2008-09-09. Archived from the original on 2013-12-22. Retrieved 2018-12-05.
  25. ^ Mimica, Mila (2013-09-05). "Md. Woman With Rare Form of Amnesia Located". NBC4 Washington. Retrieved 2013-11-16.
  26. ^ "Hannah Upp of Kensington found in Wheaton, Md". wusa9.com. 2013-09-05. Archived from the original on 2013-12-13. Retrieved 2013-11-16.
  27. ^ "Community asked to help search for missing teacher Hannah Upp". Virgin Island Daily News. September 19, 2017.
  28. ^ Carlson, Suzanne. "Hannah Upp's mother asks for help in the search for her missing daughter". The Virgin Islands Daily News. Retrieved 2018-03-30.
  29. ^ "What Happened to Hannah Upp? The Mystery Around the Young Woman's Disappearance Continues".
  30. ^ "For Man With Amnesia, Love Repeats Itself". NPR. 2012-12-13. Retrieved 2013-11-16.
  31. ^ "Dissociative Fugue". Psychology Today. 17 March 2012. Retrieved 17 March 2013.
  32. ^ "Agatha Christie: Lucy Worsley on the Mystery Queen".
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