Fugue

Fugue, more accurately termed fugue state, is a rare psychiatric disorder in which individuals temporarily lose their memory and sense of identity. The English term comes from the Latin word for fleeing or escape.

Fugue episodes were formerly considered a distinctive dissociative disorder but were reclassified by Diagnostic and Statistical Manual of Mental Disorders: DSM-5 in 2013 as a subtype or aspect of dissociative amnesia. Dissociative disorders in general are syndromes in which individuals experience a disruption in memory, consciousness, and/or identity. A fugue state may last from less than a day to several months and is sometimes, but not always, brought on by severe stress or trauma. Fugue states are usually triggered by traumatic and stressful events, such as military combat, abuse, rape, accidents, natural disasters, and extreme violence, although fugue states may not occur immediately after the stressor.

Individuals experiencing a fugue state may exhibit the following symptoms:

The use and abuse of certain medications and such illegal drugs as LSD can also prompt fugue-like episodes. For example, alcohol-dependent patients frequently report alcohol-induced blackouts that mimic the memory loss of the fugue state and sometimes involve unplanned travel. The distinction between a blackout and a fugue state can usually be clarified by taking a thorough history of substance use and abuse.

Dissociative fugue is relatively rare, with a prevalence rate of 0.2% in the general population. The length of a fugue episode is thought to be related to the severity of the stressor or trauma that caused it. The majority of cases appear as single episodes with no recurrence, although there are several cases reported of individuals in the United Kingdom, Australia, and the United States who had recurrent episodes of fugue. In some cases, the individual does not remember events that occurred during the fugue state. In other cases, amnesia related to the traumatic event that triggered the fugue may persist to some degree after the fugue episode has concluded.

Treatment for dissociative fugue should focus on helping the patient come to terms with the traumatic event or stressor that caused the disorder. This can be accomplished through various kinds of interactive therapies that explore the trauma and work on building the patient's coping mechanisms to prevent further recurrence. Some therapists use cognitive therapy, which focuses on changing maladaptive thought patterns. It is based on the principle that maladaptive behavior (in this case, the fugue episode itself) is triggered by inappropriate or irrational thinking patterns. A cognitive therapist will attempt to change these thought patterns (also known as cognitive distortions) by examining the rationality and validity of the assumptions behind them with the patient. In the case of a dissociative fugue brought on by abuse, this may involve therapeutic work that uncovers and invalidates negative self-concepts the patient has (e.g., “I am a bad person, therefore I brought on the abuse myself” ).

In some cases, hypnotherapy or hypnosis, may be useful in helping the patient recover lost memories of trauma. Creative therapies (i.e., art therapy, music therapy) are constructive in allowing patients to express and explore thoughts and emotions in safe ways. They also empower patients by encouraging selfdiscovery and a sense of control. Psychodynamically focused therapy may also be used to uncover traumatic events.

Medication may be a useful adjunct, or complementary, treatment for some of the symptoms that patients may be experiencing in relation to the dissociative episode. In some cases, antidepressant or antianxiety medication may be prescribed.

Group therapy, either therapist/counselor-led or in self-help format, can be helpful in providing an ongoing support network for patients. It also provides patients with opportunities to gain self-confidence and interact with peers in a positive way. Family therapy sessions may also be part of the treatment regime, both in exploring the trauma that caused the fugue episode and in educating the rest of the family about the dissociative disorder and the causes behind it.

See also Abuse; Amnesia ; Post-traumatic stress disorder (PTSD) .