What Is A Disassociative Fugue?

Many comedies, particularly those with more elderly actors and actresses, have depicted a scene where for one reason or another, the main character claims to have suffered some sort of loss of memory and identity in order to hide or conceal some behavior or episode that could be potentially harmful or misunderstood by others. This ‘fugue state’ as portrayed allows the main character to get away with their actions without harsh judgment and sometimes with more attention and concern from family members. While a comical and entertaining means to add to the storyline of any movie, the concept displayed is a very serious condition.

What is a disassociative fugue?

The term disassociative fugue refers to a mental state where a person has not only lost their short term memory of the events but often experiences the loss of unique and personal information. For example, an individual may forget who he or she is and wander into a stranger’s home or they may simply not remember anything about their lives and travel to a strange place.

The Diagnostic and Statistical Manual for Mental Disorder, 5th edition, (DSM-V) uses the phrase ‘bewildered wandering’ to describe the experiences of a disassociative fugue state. In other words, the person’s memory is wiped clean for a brief period of time in which their actions and other events also fail to be converted into the short term memory.

A disassociate fugue state can vary in length, lasting from as little as a few minutes to much longer periods like months or even years. They may begin by being small increments of ‘missing time’ and gradually progress into much longer periods. This is one of the most difficult components of diagnosis as many times, the earlier stages of the fugue state are not recognized as problematic.

What are the symptoms of a disassociative fugue?

Disassociative fugues can vary in their presentation of symptoms. In many cases, it is only when the fugue states become more severe that the symptoms become more evident. These symptoms can include:

  • The complete loss of memory of oneself, family, life experiences, work history, abilities, or any other personal or unique identifying information.
  • The impulse to travel or wander, unplanned and unprepared, far from home or familiar places.
  • Frustration at simple and basic questions such as “How old are you?” or “What is your name?”
  • Difficulty in managing daily life due to episodes of “missing time”

Who experiences disassociative fugues?

Like all medical conditions, there are common factors and conditions with which the disassociative fugue state is most commonly associated with. This condition or episode most frequently occurs in elderly individuals, particularly those already suffering from some type of neurological or medical impairment which affects memory, such as dementia or Alzheimer’s disease.

Other individuals may experience disassociative fugue states after periods of extreme trauma or stress, such as soldiers returning from a brutal war deployment or being the victim of a violent home invasion. Additionally, genetic factors can play a component into a person’s susceptibility to experiencing these types of episodes at some point in their life. However, overall, disassociative fugue states are most often seen in older individuals rather than younger individuals.

What causes these disassociative fugue states?

For some individuals, the simple process of aging and cognitive decline overall can introduce simple and very brief disassociate fugue states. For example, when an elderly lady forgets her grandchildren she rarely sees or forgets that she had children. However, in this case, there is often an underlying medical condition which contributes to the inability to properly recall memories, thus leading to periods of confusion.

For other scenarios, these fugue states can be brought on triggers to the specific trauma which created the fugue state initially. For example, a soldier suffering from PTSD from experiencing the loss of a battle buddy during an explosion may initially enter a disassociate fugue state from a gunshot, fireworks, or even a car backfiring. In this case, the sound triggers the part of the brain which most remembers the trauma and the brain seeks to protect itself by simply shutting down memory.

For those without medical or genetic conditions, the trigger which brings on the disassociative fugue state is highly dependent on what trauma exists and the factors and components which are associated directly with the trauma the individual experienced. There are also incidents where these fugue states are brought on by the use of alcohol or illicit drugs.

What do to if you or someone you love is experiencing disassociative fugues?

One thing which makes these states of mind dangerous is that the individual in the midst of the experience can forget very large portions of their own identity and memory. In some cases, there have been reports of individuals forgetting how to drive while being in the vehicle during the onset of a disassociative fugue.

Additionally, one of the most common symptoms of a disassociative fugue state is that the individual almost compulsively travels or wanders far from their home. For individuals reliant on medications and assistance for daily activities, this wandering can introduce a number of serious medical and physical complications and problems.

If you suspect that you or someone you know is experiencing a disassociative fugue state, it is important to seek the advice and guidance of a medical professional. A true diagnosis can only occur from a medical professional. The doctor can run a number of medical tests to determine, what if any, condition or illness is present that could contribute to these fugue states. If no medical condition is identified, he or she may recommend and refer you to seek the assistance of a psychology professional or psychiatrist.

For those elderly individuals, this can mean life adjustments to cope with declining health such as medications, cognitive therapies, and assisted living options. For those whose fugues are associated with trauma, treatment options can include medications, cognitive behavioral therapies, or even hypnosis. However, despite the cause of the fugue state, it is highly important to seek the advice of a doctor as soon as possible.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

https://www.merckmanuals.com/home/mental-health-disorders/dissociative-disorders/dissociative-fugue

https://www.webmd.com/mental-health/dissociative-fugue#1

https://www.psychologytoday.com/us/conditions/dissociative-fugue-psychogenic-fugue

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