Dissociative Fugue State: Symptoms, Tests, Treatments, and More

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Dissociative Fugue State: Symptoms, Tests, Treatments, and More

Dissociative Fugue, formerly known as Psychogenic Fugue, is a rare mental health disorder that is a sub-type of the Dissociative Amnesia disorders. From the symptoms to tests to famous case examples and more, learn about the diagnosis and treatments one can receive who suffers from Dissociative Fugue.

Dissociative Fugue Definition (Formerly Known as Psychogenic Fugue)

An unusually uncommon mental health disorder that causes people to act unlike their character and travel away from their place of living, Dissociative Fugue is usually in response to a stressful event or trauma experienced by the person. People with Dissociative Fugue forget who they are and unexpectedly wander away from home or work. At times, they may even create new identities once they reach their new location. You are not able to look at a person and know they have the disorder because there are no obvious signs in their appearance or behavior.

Fugue Definition

Fugue is derived from a Latin word meaning flight.

The disorder is called Dissociative Fugue since the person can suddenly and unexpectedly travel far from home with no recollection of who they are likely in response to an extremely stressful event or trauma. The condition is seen as the person fleeing or taking flight from their usual life and going to an unexpected location.

Dissociative Fugue DSM 5: What Does it Mean for Everyday Life?

The previous DSM-IV criteria is as follows:

  • The predominant disturbance is sudden, unexpected travel away from home or one’s customary place of work, with the inability to recall one’s past.
  • Confusion about personal identity or assumption of a new identity (partial or complete).
  • The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It is important to note that the DSM-5 has incorporated Dissociate Fugue as a specifier of the Dissociative Amnesia diagnosis. It is no longer recognized as its own separate diagnosis.

This should not impact everyday life as this is a short-term disorder that typically lasts a few days to months at the most. The person’s life is only affected during the actual fugue state where they leave their normal life and create a new identity in a new location.

Dissociative Fugue Statistics: How Many Suffer from this Disorder?

A girl standing on a rock on the side of a lake having dissociative fugue

This is typically a rare disorder; it is considered to be the rarest of the Dissociative Amnesia disorders. The prevalence rate is estimated at 0.2% of the population.

Demographics

Some studies suggest Dissociative Fugue is more prevalent among women although the reason for this is unknown. Other studies argue it is equally seen in both men and women. There does not appear to be a cultural pattern with this diagnosis. Due to cultural differences, what one might consider a fugue state in one culture may be considered normal in others.

Dissociative Fugue ICD 10: The 4 Facts You Didn’t Know About Dissociative Fugue

  1. The ICD-10 code for Dissociative Fugue is F44.1. This would be used by providers for billable specific purposes for reimbursement from health insurance companies.
  2. The word fugue is derived from a Latin word meaning flight.
  3. Dissociative Fugue was once considered its own diagnosis and is now considered a subtype of Dissociative Amnesia
  4. Dissociative Fugue is the rarest of the Dissociative disorders and it is extremely rare to find this diagnosis in children

Dissociative Fugue Symptoms: What is a Fugue State?

A fugue state is when a person takes flight unexpectedly and travels very far away from their normal surroundings. Dissociative Fugue is more commonly seen following intense trauma such as war, a natural disaster, or extreme abuse situations. Typically the fugue state is short-lived; the length of time of the fugue is thought to be connected to the severity of the traumatic event that triggered it. The fugue state will often go away on its own.

Common Behaviors/Characteristics

  • Sudden and unplanned travel away from home or work coupled with the inability to remember specifics about their own life
  • Amnesia including loss of memory about one’s identity. In some cases, a new identity will be created to make up for the loss of memory about their real identity.
  • Confusion and distress related to their situation

Causes of Dissociative Fugue

The main cause of a dissociative fugue is trauma or extreme stress.

The person typically has no conscious understanding of the reason for their trip, forgetting who they really are, and unexpectedly traveling far away. Typically the person is running away from something in their own life, but they are not consciously aware of this.

Since the person is not conscious, he or she tends to act normally in their new environment as they are not able to recall their original identity. At some point, they will start to have complications as a partial memory of who they are and will cause confusion and extreme distress.

Dissociative Fugue Test: How is it Diagnosed?

Dissociative Fugue Disorder can be diagnosed by a mental health professional using the Diagnostic and Statistical Manual of Mental Disorders. To be accurately diagnosed, it is best to wait until the fugue is over and the person has returned to their normal level of functioning. The person should receive medical attention from a mental health provider. The mental health professional will go over the details of what led to the fugue and what occurred prior, during and after the fugue state.

Dissociative Fugue Criteria

According to the DSM-5: Dissociative Amenisa code 300.12 has 4 criteria listed:

1. An inability to remember who you are, usually in response to a trauma

2. The symptoms cause significant impairment to the person’s everyday life and overall functioning

3. The symptoms are not caused by a substance or other medical condition

4. The disturbance cannot be explained by another psychological disorder such as PTSD

The defining factor to be considered a Dissociative Fugue, which is code 300.13, is purposeful travel or confused wandering that is associated with amnesia of the person’s identity.

Dissociative Fugue vs Dissociative Amnesia: Define Fugue

As previously discussed, Dissociative Fugue was originally recognized as its own diagnosis through the DSM-IV but now is considered to be part of the Dissociative Amnesia diagnosis in the DSM-V. One must first meet all the criteria for the Dissociative Amnesia Disorder.

Then to be further classified as having Dissociative Fugue, the person must additionally show symptoms to include unexpected travel from work or home and often taking on a new identity as the person forgets who they really are.

Dissociative Fugue State Case Example

One of the more famous cases of Dissociative Fugue is that of Agatha Christie, the famous mystery writer. She had experienced two traumatic events which may have caused the fugue state. Agatha’s mother who she was close with had passed away, and her husband was discovered to be having an affair with another woman.

The novelist vanished on December 3rd, 1926.

The police began searching for her as a missing person. It was later discovered that she had checked herself into a spa hotel under a different name. After being found, she was questioned as to the reason for the disappearance. She had no explanation or memory of what happened during the eleven days she was missing.

Dissociative Fugue in Adults and Children: Which is more Common?

Dissociative Fugue is almost exclusively diagnosed in adults and is not commonly found in children. It can be found in children when the child is a victim of extreme abuse and trauma.

Living in a Fugue State: The Complications and Risk Factors

A person living in a Fugue State will not be conscious of this. They will forget who they are and likely develop a new identity completely. Risk factors include extreme stress or trauma events such as war, natural disasters, or trauma. Once the patient begins to come out of the fugue state the complications expected are confusion, distress, and an inability to function in normal day to day life.

Once the person is no longer in the fugue state, they should seek medical attention, which may include hospitalization depending on the severity. A medical doctor should be consulted to rule out any organic or substance-induced causes for the fugue state. If there are no organic or substance-induced causes found then a referral to a mental health professional should be made.

Dissociative Fugue Leave Policies

Dissociative Fugue is a mental health condition. If a person feels they need to take a leave of absence from work due to a Dissociative Fugue diagnosis, they should speak to their Human Resources department about their employer’s medical leave policies.

Dissociative Fugue Treatment

People who suffer from fugue states should seek treatment to avoid future episodes. Treatment options will include therapy and possibly medication management. Dissociate Fugue should be treated by a mental health professional, and treatment would typically begin after the person has come out of the fugue state and has returned to their baseline functioning.

The mental health provider will explore the events that lead to the fugue and how that event is still affecting them currently. Treatment will focus on processing the trauma and developing coping skills to deal with the trauma to prevent a future fugue state.

Possible Medications for Dissociative Fugue

In addition to therapy, psychotropic medications may be prescribed such as Antidepressants or Anti-anxiety to further treat the patient.

Home Remedies to help Dissociative Fugue

Therapy using Art and Music are helpful tools that can be utilized in the comfort of one’s home to allow the patient to express their emotions and experiences.

Insurance Coverage for Dissociative Fugue

Most health insurance provides coverage for routine outpatient therapy as well as medication management. A person who feels they may have suffered a Dissociative Fugue state should seek treatment and can speak with their insurance company for referrals to in-network mental health providers.

How to Find a Therapist

Therapist listening to her patient with dissociative fugue while writing on a record board

The easiest way to find a therapist would be to search the internet for mental health providers in your area. You can also contact your primary care physician to ask for referrals. Additionally, you can contact your health insurance carrier to request a list of therapists.

What Should I be Looking for in an LMHP?

When looking for an LMHP, it is important to find someone you feel comfortable with. Telephone contact is the first way to see if you have a connection and if you feel comfortable sharing personal information with them. If your telephone contact is successful, the next step would be to make an appointment to have a 1:1 session with them.

Being that Dissociative Fugue is a rare disease, it will be unlikely to find a therapist who has direct experience working with patients with this specific disorder. LMHP’s who have experience working with trauma would be the best fit for a person who experienced a fugue state.

3 Questions to ask for Potential Therapist:

  1. Do you have experience working with Dissociative Disorders?
  2. Do you have experience working with trauma patients?
  3. Do you utilize art therapy, music therapy, and or hypnosis?

Dissociative Fugue Support Helpline

If you feel you have experienced a Dissociative Fugue state and have questions about mental health issues, you may contact NAMI (National Alliance on Mental Illness) helpline.

Call 1-800-950-NAMI (6264) or email [email protected]

The NAMI HelpLine can be reached Monday through Friday, 10 am–6 pm, ET.

If you are in immediate danger or in a psychiatric crisis, please call 911.

About the Author:

Jennifer LoPiano, LCSW, is a New York psychotherapist with extensive experience in clinical psychiatry. She has worked with children, adolescents, adults, and geriatrics in a variety of settings. Jennifer is committed to promoting healthy lifestyles, happiness, and overall well-being.

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