Dissociative fugue - causes, symptoms, treatment

Dissociative fugue
(from Latin fuga - “flight”) is a disease characterized by a sudden but purposeful move to an unfamiliar place, after which the patient completely forgets all information about himself, even his name. Memory for universal information (literature, science, etc.) is preserved. The ability to remember new things is also preserved. In all other respects, except for amnesia, the patient behaves normally.

Patients in a fugue state may come up with a different name and biography for themselves and not know that they are sick. They can find another job (usually unrelated to the previous one) and lead an outwardly normal life.

The cause of dissociative fugue is mental trauma or an unbearable situation in which the patient finds himself. A fugue is protective because it gives the patient the opportunity to take a break from his problems.

A dissociative fugue lasts from several hours to several months, sometimes longer. Then the patient remembers his biography (usually suddenly), but at the same time he may forget everything that happened during the fugue. Coming out of a fugue is often accompanied by sharp negative emotions: the patient again returns to an unpleasant situation.

A famous case of fugue was described by William James in 1890[1]:

Under hypnosis, James restored the personality of Brown, who told everything that happened during that period, but knew nothing about Brown. James was the first to describe this condition and call it “fugue.”

A possible fugue patient could be the main participant in the scandalous Bruner-Kanella case. Despite the forensic and medical evidence provided, the man's identity remains a mystery.

Patients suffering from multiple personality disorder may experience dissociative fugue repeatedly. Usually, a dissociative fugue does not repeat itself.

Treatment: Often, under hypnosis, the patient remembers some details of his past life that help establish his identity. In addition, after memory restoration, a psychiatrist can help the patient cope with the problems that led to the dissociative fugue or change his attitude towards them.

Fugue is one of the dissociative disorders - disorders in which memory is selectively lost (usually due to mental trauma).

Symptoms

To make a diagnosis, in addition to the general signs of dissociative disorders, additional criteria must be met:

• an attempt was made to unexpectedly leave and distance oneself from the usual social environment;
• forgetting the episode, which corresponds to 2 dissociative amnesia.

If an organic brain disorder is the cause of the disease, behavior is not determined by a stress factor and is not as complex and socially adaptive as it is in psychogenic fugue. The situation is similar with fugue during temporal lobe epilepsy.

Causes

Predisposing factors are severe alcohol abuse, the presence of an emotionally unstable, hysterical or schizoid personality type, as well as concomitant affective pathology. It is based on a psychological factor associated with the desire to escape from painfully perceived circumstances. The etiopathogenetic mechanism is close to that described for dissociative amnesia. In addition to catastrophic circumstances, fugue occurs in the context of everyday psychosocial stress (insult, emotionally significant loss, failure, family conflict, financial problems).

Less commonly, the cause is shocks associated with external events that happened directly to the patient himself. It could be:

• long-term physical or psychological abuse from parents or spouse;
• severe incurable illness reported by doctors;
• unsolvable financial problems;
• dismissal from work, which entails a drastic change in lifestyle.

In any case, the basis of the disease is a serious intrapersonal conflict, a reluctance to accept events occurring in life, and the need to avoid a situation that traumatizes the psyche.

Reasons for the development of dissociative fugue

Experts believe that dissociative fugue is a protective mental mechanism designed to protect patients from unbearable experiences and extreme stress. Patients literally feel the need to escape from the current situation, and the psyche realizes this need in a way that is accessible to it. Most often, the disorder occurs when there is an immediate threat to physical existence or the loss of important close relationships: when participating in hostilities, staying in a territory where hostilities are taking place, natural and man-made disasters, or multiple deaths of loved ones.

Less often, less global experiences become the impetus for the development of the disease: severe financial problems, conflicts in the family, dismissal, professional collapse, personal insults, etc. In all cases, the basis of the disorder is a powerful intrapersonal conflict, the inability to accept reality and the desire to avoid emotionally traumatic situation. The likelihood of developing this condition increases with chronic alcoholism, increased anxiety, phobias, hysterical personality type and violent choleric temperament. In people with multiple personality disorder, fugue may occur repeatedly. In other cases, this condition does not recur.

Diagnostics

For a reliable diagnosis there must be:

• signs of dissociative amnesia;
• purposeful travel outside the bounds of ordinary everyday life (the differentiation between traveling and wandering must be made taking into account local specifics);
• maintaining personal care (eating, washing, etc.) and simple social interaction with strangers (for example, patients buy tickets or gasoline, ask for directions, order food).

The diagnosis is usually made retrospectively by asking about the circumstances leading up to leaving home, traveling and starting a “new” life. If dissociative fugues recur repeatedly, a diagnosis of multiple personality disorder (MPD) is usually made.

Dissociative fugue - I’m running away from myself, but I don’t know where

Mental disorders, whatever form they take, have a significant impact on the individual. People suffering from such pathologies are not able to adapt to regularly changing conditions of reality, as well as to adequately solve everyday problems.

One type of mental disorder that has a direct impact on a person’s actions and behavior is dissociative fugue.

The essence of the problem and features of the condition

The term “dissociative fugue” refers to a mental disorder that manifests itself in unexpected actions performed by the patient.

At the same time, the latter loses the idea of ​​himself as a person and, committing actions uncharacteristic for him, does not realize that significant changes are taking place in his life. Along with this, the patient’s intelligence does not suffer.

A fugue state is described as one or more episodes of amnesia, following one after another, in which the patient is unable to remember all or a significant part of his past. After some time, his memory returns, after which he forgets everything he did during the fugue period.

The classic picture of such a phenomenon, indicating a mental personality disorder, is characterized by a sudden trip, leaving home, which is usually not preceded by any traumatic events. The person does not plan the trip, does not talk about it in advance.

During the period of psychofugue, he invents a new life and behaves like a completely different person. In this case, the patient can engage in any type of activity, take part in social life, without performing any actions that could attract attention. Outbursts of anger are extremely rare.

The duration of a dissociative fugue, in most cases, does not exceed several hours or days, but can last for several months.

Reasons influencing the development of the disorder

Experts identify the following factors due to which a fugue state may develop:

• being under conditions of extreme stress, strong feelings and anxiety - all this negatively affects the human psyche, he develops a strong desire to escape from the current situation, and the psyche responds to this need in exactly this way;
• Often the beginning of the disorder can be an immediate threat to physical existence (military action, environmental and other types of disasters), as well as the loss of a loved one;
• the likelihood of breaking up a relationship with a loved one;
• problems at work, worries due to lack of money;
• problems in the social sphere: personal insult, tense family relationships.

In some cases, dissociative amnesia acts as a defense mechanism in response to a person's suicidal thoughts.

The risk of developing such a disorder increases if the patient suffers from chronic alcoholism, has phobias, and is hypersensitive to everything that happens to him. Those who have had multiple dissociative identity disorders are also at risk.

Features of the patient's behavior

The disorder in all cases begins suddenly and acutely. According to observations, the onset of the fugue occurs in the morning. A man wakes up, packs his things and leaves without saying goodbye to anyone. At this moment, the personality is controlled by the “new self”; there are no memories of the previous life.

After moving, a person begins to live a new life, his behavior is not marked by aggression, anger, and there are no suicidal tendencies. He doesn't want to hurt or hurt anyone.

During the period of being in a state of dissociative fugue, the patient builds a completely new life, changing not only his social circle, but also choosing a completely different type of professional activity.

The exit from this state, like the beginning of psychofugue, is acute and sudden. On the eve of the “insight,” a person feels that something strange is happening that does not correspond to reality. The way out comes after awakening: the patient, waking up in an unfamiliar place, is lost and feels shock, because he forgets everything that happened to him during the period of amnesia, just as he had previously forgotten his real life.

If the period of oblivion was short-lived, then the return of the individual to his real life will not be too painful, but if the amnesia was long-term, then patients cannot come to terms with the return for a long time and adapt to the changes that occurred during their absence.

Diagnosis and treatment approach

Difficulties in diagnosing the disorder arise because “fugists” extremely rarely turn to psychotherapists and psychiatrists for help. However, there are two signs that make it possible to diagnose such a disorder:

• leaving home at the beginning of the amnestic period;
• complete or partial loss of memories of the first personality.

Reconciling a person with reality and returning him to the present are the tasks of restorative therapy. It assumes the following:

• the help of a psychiatrist together with a psychologist, specialists help a person overcome the factor that had a traumatic effect on him and provoked amnesia. Resentments and disappointments arising after a long fugue should also be discussed with a psychiatrist;
• conducting hypnosis sessions;
• teaching the patient relaxation methods and ways to relieve acute stress;
• patient support and understanding from family and friends;
• taking tranquilizers and antidepressants in case of severe anxiety of the patient.

Such a psychodisorder has a favorable prognosis. In case of adequate therapy and the patient follows all the specialist’s recommendations, as well as in the absence of other mental disorders, complete recovery occurs.

If the traumatic factor was too pronounced, the person may experience residual effects in the form of memory loss and stressful situations. To return the patient to real life, significant efforts must be made not only by the psychologist, but also by the family of the person who has suffered temporary amnesia - only by being in an environment of goodwill, care and trust can he recover.

Source: //med-anketa.ru/dissociativnaya-fuga-begu-ot-sebya-no-ne-znayu-kuda/

Treatment

Such a disorder, as a rule, occurs to a person only once. Therapy for this condition is to help the patient survive the stress or change his attitude towards the events that caused the dissociative fugue. Depending on the cause of the disease and the general condition of the patient, the following methods are used:

• psychotherapy;
• hypnosis;
• Medication treatment for anxiety and depression.

The following psychotherapeutic techniques are used as the main method:

• rational;
• positive;
• person-oriented;
• psychoanalysis;
• music or art therapy;
• group classes;
• family therapy;
• hypnotic effect.

The use of medications in this case does not play a special role. But they are used when there is a mood disorder or severe anxiety develops (stress treatment). The psychiatrist recommends and selects the method of administration, dosage and duration of administration.

Symptoms of dissociative fugue

Dissociative fugue begins suddenly, usually after a night's sleep. The patient wakes up, performs targeted actions to prepare for departure (gets dressed, packs a suitcase, buys a ticket), and then leaves. The literature describes cases where people withdrew large sums of money from the bank before leaving. As a rule, all these actions go unnoticed by loved ones; from their point of view, the situation looks like “the person left and did not return.”

Hemorrhoids kill the patient in 79% of cases

The patient behaves calmly and adequately; often in a new place, those around him do not even suspect that something is wrong. During prolonged fugue (lasting several months or more), some patients create a new identity, get a job, enter into new intimate relationships, and even have children. At the same time, they usually choose a different field of activity and become more sociable than before the fugue began. Memories of a general nature (geographical information, multiplication tables) are completely preserved. The degree of plausibility of a new personality can vary - from a holistic, consistent picture to fragmentary information.

Sometimes the discrepancy between the patient’s personality and his stories is discovered when trying to take out a loan from a bank, after criminal incidents, traffic accidents and other situations related to document verification. In other cases, the patient lives happily for some time in a new reality and a new personality. Individual memories of life before the dissociative fugue may appear in the form of dreams or be perceived as the plots of books once read.

The return to the old personality usually occurs suddenly, after a night's sleep. The patient wakes up in a state of pronounced anxiety, realizing himself as the same person. He is disoriented, does not understand where he is and does not know what is happening. Memories of life during the fugue period are usually completely lost; less often, individual fragments of events that took place during the period of disorder emerge in memory. After this, the patient returns to his previous life. At the same time, it can be difficult for him to adapt to the changes that have occurred during his absence.

With prolonged fugues, a gradual transition to the previous personality is sometimes observed. At first, the patient begins to feel inner restlessness; he has the feeling that something is wrong, that he has lost something important. Then episodes from his past life gradually emerge in his memory. The main personality “manifests” and takes its rightful place, displacing the old one. The last stage may be accompanied by severe anxiety, decreased mood, vague fears and social disorientation.

With short fugues (lasting from several hours to several days), large-scale changes, as a rule, do not have time to occur. The patient leaves somewhere, and then comes to his senses in a new place, also completely losing memories of the period of illness. Intellectual abilities, professional knowledge and character traits are fully preserved regardless of the duration of the disorder. There are no organic brain damages.

Forecast

Predisposing factors are severe alcohol abuse, the presence of an emotionally unstable, hysterical or schizoid personality type, as well as concomitant affective pathology. It is based on a psychological factor associated with the desire to escape from painfully perceived circumstances. The etiopathogenetic mechanism is close to that described for dissociative amnesia. In addition to catastrophic circumstances, fugue occurs in the context of everyday psychosocial stress (insult, emotionally significant loss, failure, family conflict, financial problems).

With a dissociative fugue, this is a fugue in which a favorable prognosis is given. If the disease does not cause the development of other mental disorders, then at the end of the fugue a full restoration of health is observed.

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Dissociative fugue

Dissociative fugue is a mental disorder accompanied by a sudden move and a complete loss of memory of one’s own personality. General information remains in the patient’s memory, the intellect does not suffer, and no disturbances of consciousness occur. After some time, patients return to their previous personality, completely losing memories of the events that occurred during the fugue period. The disorder occurs in 0.2% of the population.

This pathology is well known to the general public and is one of the popular plots of American action films and psychological thrillers (the most famous example is “The Long Kiss Goodnight”). It is assumed that in reality this disorder occurred in Agatha Christie during her famous 11-day absence. Descriptions of this pathology appeared in the specialized literature in the 19th century, the most famous example being the case of the priest Ansel Bourne, recorded by the American psychologist William James in 1890. Treatment is carried out by specialists in the field of psychiatry, psychotherapy and clinical psychology.