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Dissociative fugue

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

Dissociative fugue, formerly fugue state or psychogenic fugue, is a dissociative disorder.[1] It is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality. The state can last days, months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. 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 fugue, previous memories usually return intact. Because of this, there is not normally any treatment necessary for people who have been in fugue states. Additionally, 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.[2] Fugues are precipitated by a series of long-term traumatic episodes. It is most commonly associated with childhood victims of sexual abuse who learn over time to dissociate memory of the abuse (dissociative amnesia).

Signs and symptoms

Symptoms of a dissociative fugue include mild confusion, and once the fugue ends, possible depression, grief, shame and discomfort. People have also experienced a post-fugue anger.[3]

Diagnosis

A doctor may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one. The doctor carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychological examination is also done.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternative life.

Definition

The cause of the fugue state is related to dissociative amnesia, (DSM-IV Codes 300.12[4]) which has several other subtypes:[5] selective amnesia, generalised amnesia, continuous amnesia, and systematised 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 Codes 294.0).[6] It is a complex neuropsychological process.[7]

As the person experiencing a dissociative fugue may have recently suffered the reappearance of an event or person representing an earlier life trauma, the emergence of an armoring or defensive personality seems to be for some, a logical apprehension of 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.[citation needed] For the purposes of this article then, a fugue state occurs while one is acting out a dissociative fugue.

The DSM-IV defines[1] 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[8] 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[8] 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

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. An individual usually has only one episode.

Cases

  • Shirley Ardell Mason also known as "Sybil" would disappear and then reappear with no recollection of what happened during the time span. She recalls "being here and then not here" and having no identity of herself; it should be noted that it is claimed she also suffered from what was formerly called "multiple personality disorder."
  • 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 suffered a protracted fugue state.[9]
  • David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Five's television series Extraordinary People. He entered a fugue state on December 4, 2005, and is still working on regaining his entire life's memories.[10]
  • Hannah Upp, a teacher originally from Salem, Oregon,[11] who was living in New York at the time of her disappearance, disappeared on August 28, 2008. She was rescued after she jumped into the New York Harbor on September 16. She underwent a psychiatric evaluation and refused to speak to detectives.[11] Upp was seen checking her email four times at Apple Stores while she was missing.[12][13][14][15] She later claimed to have no recollection of the time in between. Upp claimed that the episode was diagnosed as dissociative fugue.[16] On September 3, 2013, she disappeared from her new job as a teacher's assistant[17] at Crossway Community Montessori in Kensington, Maryland. She was found unharmed September 5, 2013 in Wheaton, Maryland.[18][19] As of September 14, 2017, she is missing again; she was last seen near Sapphire Beach in St. Thomas.[20]
  • 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 Penny called Denver police identifying him. The episode was diagnosed as dissociative fugue. Ingram has experienced three incidents of amnesia: in 1994, 2006, and 2007.[21]
  • 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
  • Benjaman Kyle

See also

References

  1. ^ a b c Dissociative Fugue (formerly Psychogenic Fugue) (DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  2. ^ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. ISBN 9780890425541.
  3. ^ The Merck Manual
  4. ^ "Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )". Psychiatryonline.com. Retrieved 2011-11-28.
  5. ^ Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com ) Archived November 28, 2010, at the Wayback Machine
  6. ^ Complete List of DSM-IV Codes ( PsychNet-UK.com ) Archived January 6, 2011, at the Wayback Machine
  7. ^ "Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )". Dissociation.co.uk. Retrieved 2011-11-28.
  8. ^ a b Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
  9. ^ "Experts say that Roberts may indeed have amnesia | Juneau Empire - Alaska's Capital City Online Newspaper". Juneau Empire. 1997-07-17. Retrieved 2011-11-28.
  10. ^ "Shows". Five.
  11. ^ a b The Associated Press (2008-09-16). "Update: Missing Oregon teacher rescued from Long Island Sound". OregonLive.com. Retrieved 2013-11-16.
  12. ^ "Hannah Upp Updates Her Status, Remembers Little". Gothamist.
  13. ^ "A Life, Interrupted". The New York Times. 2009-03-01.
  14. ^ "Missing New York City School Teacher Spotted in Apple Store". Fox News. 2008-09-09.
  15. ^ "Everyone is drawn to the Apple Store, including a missing teacher". TechCrunch. AOL. 10 September 2008.
  16. ^ Rovzar, Chris. "Hannah Upp Mystery Still Deepening - Daily Intelligencer". Nymag.com. Retrieved 2013-11-16.
  17. ^ Mimica, Mila (2013-09-05). "Md. Woman With Rare Form of Amnesia Located". NBC4 Washington. Retrieved 2013-11-16.
  18. ^ "Hannah Upp of Kensington found in Wheaton, Md". wusa9.com. 2013-09-05. Retrieved 2013-11-16.
  19. ^ "A Life, Interrupted". The New York Times. 2009-03-01.
  20. ^ "Community asked to help search for missing teacher Hannah Upp". Virgin Island Daily News. September 19, 2017.
  21. ^ "For Man With Amnesia, Love Repeats Itself". NPR. 2012-12-13. Retrieved 2013-11-16.
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