Dissociative fugue: How did I get here?

Dissociative fugue is a phenomenon that is part of dissociative disorders and is characterized by an episode of sudden travel away from home with the inability to remember who one is and how they got there. Thus, the person arrives at a place and is unable to account for their situation, current and past, not remembering basic data about themselves or their environment. It falls within dissociative phenomena, associated with overwhelming or traumatic experiences. In fact, this unusual coping mechanism manifests itself unexpectedly in emergency rooms with people who don’t remember getting there. Wondering: How did I get here? Why don’t I remember anything? 

Generalities of dissociative fugue

Dissociative fugue is part of the spectrum of dissociative phenomena. These psychiatric syndromes are characterized by disruptions of consciousness. In this way, memory, identity, behavior and environmental warning can be affected, that is, the ability to realize what is happening in the environment.

Usually, dissociation is a response to extreme overwhelming situations or traumatic experiences. In the case of dissociative fugue, this is less common than other phenomena of loss of consciousness.

These sudden trips with loss of identity and the notion of space and time can last a few hours or, in some cases, months. When the escape ends, the person usually does not remember what happened to them or how they got there. So the diagnosis is usually provided after someone has suddenly found themselves in unknown circumstances.

What does it mean to dissociate?

Dissociation is a defense mechanism that involves separating certain aspects of personal experience from consciousness. This emotional or cognitive disconnection can arise as a form of protection against traumatic or stressful situations. Thus, dissociation allows people to distance themselves from painful thoughts, emotions or memories, creating a kind of “separation” from reality.

While it may be helpful in the short term, prolonged dissociation can interfere with healthy functioning and integration of experience. This happens by generating feelings of confusion and incomprehensible symptoms for the person and is usually common in dissociative disorders. 

What Are the Symptoms of Dissociative Fugue?

Here are some common symptoms associated with Dissociative Fugue:

• Memory Loss: Sudden inability to recall personal information, including identity, past events, or specific periods of time.
• Confusion about Identity: Feeling detached from one’s sense of self or identity, sometimes assuming a new identity or experiencing confusion about who they are.
• Unexpected Travel: Engaging in unplanned travel or wandering without a clear purpose, often far from home.
• Amnesia: Forgetting significant personal information or details about oneself, family, or events that would typically be remembered.
• Abrupt Change in Behavior: Displaying behaviors or attitudes inconsistent with the person’s usual character or personality.
• Distress or Discomfort: Experiencing anxiety, confusion, or distress upon realizing the memory gaps or unfamiliar surroundings.
• Duration of Episode: Dissociative Fugue episodes can vary in duration, lasting from hours to days, weeks, or even longer periods.
• Triggered by Stressful Events: Often linked to stressful or traumatic events that may act as a trigger for the dissociative state.
• Functional Impairment: Difficulty functioning in daily life, carrying out responsibilities, or maintaining relationships due to memory loss and disorientation.
• Recurrent Episodes: In some cases, individuals may experience recurrent episodes of Dissociative Fugue over time.

What Causes Dissociative Fugue?

Here are some potential causes of Dissociative Fugue presented in bullet points:

• Trauma: Sudden or prolonged traumatic events, such as abuse, combat, accidents, or natural disasters, can trigger dissociative fugue as a defense mechanism to escape overwhelming emotions.

• Stress: Extreme stress, whether due to personal crises, financial issues, or significant life changes, may overwhelm coping mechanisms, leading to dissociative states.

• Genetics: Some evidence suggests a genetic predisposition to dissociative disorders, including fugue states, although specific genes are yet to be identified.

• Neurological Factors: Brain injuries, seizures, or other neurological conditions might contribute to dissociative symptoms by affecting brain function.

• Substance Abuse: Drug or alcohol abuse can increase vulnerability to dissociative states, altering brain chemistry and perception.

• Psychological Vulnerability: Individuals with a history of other dissociative disorders or certain personality traits may be more prone to experiencing dissociative fugue states.

How Is Dissociative Fugue Diagnosed?

 

• Clinical Evaluation: A thorough evaluation of the individual’s medical history and current symptoms is the initial step. The psychiatrist or psychologist conducts interviews to gather information about the individual’s experiences, including episodes of unexpected travel and memory gaps.

• Diagnostic Criteria: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for diagnosing Dissociative Fugue. Professionals assess whether the individual meets these specific criteria, such as sudden travel away from home and an inability to recall one’s past identity.

• Medical and Psychological Tests: To eliminate other potential causes for the symptoms, medical tests might be conducted to rule out neurological conditions or substance-related factors. Psychological assessments and tests may also be used to understand the extent of memory impairment and dissociative experiences.

• Collateral Information: Information from family members, friends, or other individuals who have observed the episodes can be valuable in understanding the person’s behavior during these fugue states.

• Duration and Impact: Evaluation of the duration and impact of the fugue episodes on the individual’s life helps in confirming the diagnosis and planning appropriate treatment.

• Psychiatric Evaluation: A mental health professional performs a comprehensive psychiatric evaluation to explore underlying stressors or triggers that might contribute to the dissociative episodes.

• Follow-up and Monitoring: Continuous monitoring and follow-up assessments are crucial to track changes in symptoms, assess treatment effectiveness, and ensure ongoing support.

How Is Dissociative Fugue Treated?

Dissociative fugue, a rare dissociative disorder characterized by memory loss and wandering, is typically treated through psychotherapy, medication, and support. Therapy, especially psychotherapy like cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), helps individuals understand their condition, triggers, and coping mechanisms. 

The primary aim is to integrate lost memories and manage stressors triggering fugue states. Therapists work on grounding techniques, enhancing awareness, and addressing underlying trauma or stress contributing to the dissociation. Medications might be prescribed to manage associated symptoms like anxiety or depression, although there isn’t a specific drug for dissociative fugue itself.

Support systems play a crucial role, involving family, friends, or support groups to provide a stable environment. Creating routines and structure aids in minimizing triggers and reducing the likelihood of fugue episodes. Additionally, educating both the individual and their support network about the disorder fosters understanding and effective assistance during episodes.

Long-term management involves continuous therapy to prevent relapses and build resilience. While there isn’t a definitive cure, the combination of therapy, medication, and support significantly improves the quality of life for those living with dissociative fugue, helping them manage symptoms and reduce the frequency of fugue episodes.

How Common Is Dissociative Fugue?

Dissociative Fugue, a rare dissociative disorder, affects only a fraction of the population. Estimates suggest it occurs in less than 0.2% of individuals, making it uncommon compared to other mental health conditions. Its transient nature and unique manifestation make diagnosis and prevalence assessment challenging. Often triggered by severe stress or trauma, it causes sudden memory loss and wandering behavior. Due to its fleeting episodes and varying degrees of severity, many cases remain undiagnosed or misinterpreted. Despite its rarity, understanding and recognition are crucial for timely intervention and support, highlighting the importance of mental health awareness and professional intervention for those affected.

Dissociative fugue vs. dissociative amnesia 

Dissociative fugue and dissociative amnesia are related yet distinct psychological conditions. Dissociative fugue involves sudden, unplanned travel and wandering, often with memory loss surrounding one’s identity and past. Individuals experiencing fugue may unexpectedly embark on a journey, adopting a new identity and forgetting previous life details. 

Dissociative amnesia, on the other hand, involves memory loss tied to specific events or periods, often due to trauma or stress. It can affect personal memories or even entire blocks of time. While both involve memory disruption, fugue manifests in sudden travel and a temporary adoption of a new identity, while amnesia primarily pertains to memory loss without the flight response.

Conclusion

Dissociative fugue is a phenomenon within dissociative disorders that is rare and usually affects people who face overwhelming or extremely stressful situations. In this way, its approach must be comprehensive, considering the triggers and factors that perpetuate dissociation phenomena. Through listening, accompaniment and therapeutic approaches, people with dissociative fugue can reduce these episodes. However, we must continue to investigate action, approach and detection protocols, taking into account that these episodes are often difficult to report and diagnose as they are forgotten.