Fugue

An episode during which an individual leaves his usual surroundings unexpectedly and forgets essential details about himself and his life.

Causes and symptoms

Fugues are classified as a dissociative disorder, a syndrome in which an individual experiences a disruption in memory, consciousness, and/or identity. This may last anywhere from less than a day to several months, and is sometimes, but not always, brought on by severe stress or trauma. Dissociative fugue (formerly termed psychogenic fugue) is usually triggered by traumatic and stressful events, such as wartime battle, abuse, rape, accidents, natural disasters, and extreme violence, although fugue states may not occur immediately.

Individuals experiencing a fugue exhibit the following symptoms:

• Sudden and unplanned travel away from home together with an inability to recall past events about one's life.
• Confusion or loss of memory about one's identity (amnesia). In some cases, an individual may assume a new identity to compensate for the loss.
• Extreme distress and impaired functioning in day-today life as a result of the fugue episodes.

If the amnesia of fugue occurs without an episode of unexpected travel (fleeing), dissociative amnesia is usually diagnosed.

Diagnosis

Patients who experience fugue states should under-go a thorough physical examination and patient history to rule out an organic cause for the illness (e.g., epilepsy or other seizure disorder). If no organic cause is found, a psychologist or other mental healthcare professional will conduct a patient interview and administer one or more psychological assessments (also called clinical inventories, scales, or tests). These assessments may include the Dissociative Experiences Scale (DES or DES-II), Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), and the Dissociate Disorders Interview Schedule (DDIS).

The use and abuse of certain medications and illegal drugs 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.

Treatment

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. In some cases, the individual will 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 principal 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 also constructive in allowing patients to express and explore thoughts and emotions in "safe" ways. They also empower the patient by encouraging self-discovery and a sense of control.

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

Group therapy, either therapist/counselor-led or in self-help format, can be helpful in providing an on-going support network for the patient. It also provides the patient 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.