Dissociative Fugue State

A dissociative fugue state is a kind of amnesia and a mental illness that falls under the category of dissociative disorders. These are conditions characterized by a loss of touch with reality and unusual, often distressing changes in memories and perception. During a dissociative fugue a person loses past memories and forgets important and identifying, personal information. This person forgets who she or he is, and may or may not be aware that the information is lost.

Unlike amnesia without fugue, this state causes a person to wander away from their life. Some may create a new personality and identity, traveling somewhere new and starting a new life, while others may become confused and realize that they can’t remember who they are. The fugue may last for only a few minutes, a couple of days, or weeks. In rare cases it lasts for months or longer, which allows the individual to travel far from home. When the fugue state resolves a person often doesn’t remember what happened or how they got where they are.

Types of Dissociative Fugue

Dissociative fugue is a subtype of dissociative amnesia. There are no further subtypes of the dissociative fugue state, but there are ways in which the condition can vary by individual. For instance, the duration may be only a few minutes or it may be months or years and any amount of time in between, although fugue most often lasts a short period of time.

The kind of wandering away from one’s life can also vary by individual. Some people plan and follow through with travel that seems purposeful. Others wander aimlessly and in a bewildered state. In many cases the fugue state ends suddenly, but for some people it takes more time as the memories return only gradually. And finally, some people are aware that they have lost memories, and this can be very distressing. Others don’t realize they used to be someone else and develop a new identity.

Dissociative fugue is a rare condition. It may occur more often than the number of diagnoses suggest because individuals often recover suddenly and the condition doesn’t often last long. A person may travel as fugue sets in and then return recovered so that there is no attempt to seek professional help or get a diagnosis.

• The estimated prevalence of dissociative fugue is just 0.2 percent
• Estimates for the prevalence of dissociative amnesia without a fugue state are between two and seven percent of the population
• Someone in a fugue state may develop a new identity to replace the one that is forgotten
• Most people do not remember what happened during the fugue state after recovering
• Most cases of fugue states are short, a few hours or days, but in some cases they may last for months or years
• Many people in a fugue state are unaware that they have lost their identity or that they have created a new, false one

Dissociative fugue can be hard to identify in someone because a person in this state often behaves normally or only seems a little bit confused. When the fugue ends and the person can’t remember where they are or how they got there, it can be significantly distressing and this is when they are most likely to seek help and get a professional diagnosis. Some people don’t actively seek help, but express fear, confusion, shame, or even anger over the situation, bringing them to the attention of law enforcement, medical professionals, or others who then offer assistance.

A medical or mental health professional may diagnose someone with dissociative amnesia with dissociative fugue if the following criteria are met:

• The person cannot remember, or could not remember if the state has already been resolved, important autobiographical information
• The loss of memories and identity has caused significant distress and impairment in functioning
• The loss of memories is not normal and cannot be attributed to a neurological condition, an injury, or any other medical condition or substance use
• During the state of amnesia the individual wandered away from work or home or purposely traveled, with no warning or explanation

There may be other associated symptoms that occur with a dissociative fugue state. Because the condition is rare, research into its nature has mostly been in the form of individual case studies. From these, researchers have found that fugue may cause depression, confusion, anger, stupor, distress, fear, and suicidal thoughts or behaviors.

Like other dissociative disorders, fugue is caused by trauma. The amnesia is an involuntary response by the brain to painful, disturbing, and traumatic experiences and memories. The fugue may occur shortly after an experience of trauma, or it may occur much later, even multiple times. In these instances the state of fugue may be triggered by a stressful situation or an accumulation of significant amounts of stress.

Why some people who go through trauma develop amnesia and fugue and others do not is not well understood. Trauma is both the cause and the leading risk factor. Experiencing trauma as a child, especially ongoing abuse, is a major risk factor. The longer and more severe the trauma, at any age, the greater the risk that someone will develop fugue states at some point. And, having one fugue puts an individual at risk for having others in the future.

Other types of dissociative disorders may occur with amnesia and dissociative fugue. Dissociative identity disorder in particular commonly occurs along with fugue states. This is the condition that causes a person to develop multiple, distinct identities and personalities. Personality disorders are also more commonly co-occur with dissociative disorders than other mental illnesses.

Other trauma-based conditions, including posttraumatic stress disorder or acute stress disorder can include fugue states. Fugue may also occur with major depression, anxiety disorders, suicidal behaviors, self-harm, eating disorders, sleep disorders, non-epilepsy seizures, and substance misuse or substance use disorders.

If medical conditions and injuries have been ruled out as causes for memory loss, someone who has been through a dissociative fugue state will be treated with therapy largely targeted at facing and processing the underlying trauma. Most people recover memories on their own but still need treatment to face the trauma. Not many people who are in the fugue state get treatment because they are not often identified as suffering from amnesia. Most treatment occurs later.

Cognitive behavioral therapy (CBT) and variations of CBT that focus on trauma are most often used to treat patients with fugue. The goals are to find better ways to cope with traumatic memories and to minimize the risks of experiencing another fugue state. CBT is a therapy that places an emphasis on identifying negative patterns in thoughts, behaviors, and reactions and taking active steps to change them and to set and achieve positive goals.

Dialectical behavior therapy, or DBT, is a variant of CBT that may be particularly useful for patients who need to face and process trauma. It focuses on being mindful and aware of emotions and behaviors in the present moment, accepting traumatic memories and negative feelings, and learning better ways to tolerate painful memories, regulate emotions, and interact with other people.

Another trauma-focused therapy that can help people who have been through a fugue is called eye movement desensitization and reprocessing. This strategy uses the brain stimulation triggered by guided eye movements to help patients face and reprocess traumatic memories. It helps relieve negative emotions and lessens the serious impact of the experience of trauma.

Dissociative fugue state is a distressing experience and an unhealthy, although involuntary way of coping with a traumatic past. Even someone who has recovered memories without professional help needs treatment. Trauma-focused therapy can help people find better ways to cope with trauma, which in turn helps to reduce the chances that a fugue will occur again. Along with professional therapy, learning and practicing stress management techniques and healthy coping strategies, as well as healthy lifestyle changes, can help patients avoid fugue states and wandering and enjoy a better quality of life by facing down past trauma.