Fugue state

Overview
A Fugue state is a state of mind characterized by abandonment of personal identity, along with the memories, personality and other identifying characteristics of individuality. The Fugue state is a condition of Dissociative Fugue (formerly Psychogenic Fugue) (DSM-IV Dissociative Disorders 300.13 ).

Clinical definition
The etiology of the fugue state is related to Dissociative Amnesia, (DSM-IV Codes 300.12 ) which has several other subtypes : Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.

Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone completely forgets who they are), 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). It is a complex neuropsychological process.

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.

Therefore, the terminology fugue state may carry a slight linguistic distinction from Dissociative Fugue, the former implying a greater degree of motion. For the purposes of this article then, a fugue state would occur while one is acting out a Dissociative Fugue.

The DSM-IV defines 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, or
 * significant distress or impairment.

The Merck Manual 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 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.

Prevalence and onset
It has been estimated that approximately 0.2 percent of the population experiences Dissociative Fugue, although prevalence increases significantly following a stressful life event, such as wartime experience or some other disaster. Other life stressors may trigger a Dissociative Fugue, such as financial difficulties, personal problems or legal issues. The causes of Dissociative Fugue are similar to those of Dissociative Amnesia and Dissociative Identity Disorder. Dissociative fugue is often mistaken for malingering, because both conditions may occur under circumstances that a person might understandably wish to evade. However, Dissociative Fugue occurs spontaneously and is not faked. Malingering is a state in which a person feigns illness because it removes them from accountability for their actions, gives them an excuse to avoid responsibilities, or reduces their exposure to a known hazard, such as a dangerous job assignment. Many fugues seem to represent a disguised wish fulfillment (for example, an escape from overwhelming stresses, such as divorce or financial ruin). Other fugues are related to feelings of rejection or separation, or they may protect the person from suicidal or homicidal impulses.

Similar to Dissociative Amnesia, the Dissociative Fugue usually affects personal memories from the past, rather than encyclopedic or abstract knowledge. A Dissociative Fugue therefore does not imply any overt seeming or "crazy" behaviour.

Diagnosis
Some disorders have similar symptoms. The clinician, therefore, in his or her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis: dementia, head trauma, substance intoxication, early symptoms of neurological disorders (eg multiple sclerosis) may resemble conversion symptoms. Similarly, other psychological disorders may manifest symptoms similar to Dissocative Fugues. These include bipolar disorder, schizophrenia and major depressive disorder.

Treatment and prognosis
Most Dissociative Fugues last for hours or days or months, unresolved and may return. Dissociative Fugue is treated much the same as Dissociative Amnesia and Dissociative Identity Disorder, and treatment is therapy aimed at helping the person restore lost memories as soon as possible. Most people who suffer Dissociative Fugues regain most or all of their prior memories; however, efforts to restore memories of the fugue period usually are unsuccessful.

The goal of treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of his or her symptoms, but most likely will include some combination of the following treatment methods:


 * Psychotherapy — Psychotherapy, a type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems.
 * Cognitive therapy — This type of therapy focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
 * Medication — There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
 * Family therapy — This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
 * Creative therapies (art therapy, music therapy) — These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.
 * Clinical hypnosis — This is a treatment method that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

Case studies
David Fitzpatrick, a sufferer of dissociative identity disorder from the United Kingdom, was profiled on Five's television series Extraordinary People. He entered a fugue state on December 22, 2005.