Dissociative fugue: symptoms, types, causes and treatment

We wake up in a place that is not familiar to us. We wander the streets, but we are not at home, not even in our city. Where am I and what am I doing here? We ask a local, who seems to recognize us and calls us by a name that is not ours. Apparently we've been in the town for a month. How is this possible?

One of the possible answers to this question is that we have experienced a disorder called dissociative fugue.

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Dissociative Fugue: Definition and Characteristic Symptoms

Dissociative fugue is defined as an associative disorder characterized by the performance of unexpected trips away from the subject's usual environment in which the individual is unable to remember her past. Said trip is carried out with apparent normality, the subject's behavior does not attract attention and without the appearance of symptoms of a mental disorder or cognitive alterations. It is also frequent, although it may not happen, that the individual has doubts about his own identity, either losing it or assuming a new one.

In the vast majority of cases, the person ends up recovering his previous identity and his memory. However, there are cases in which parts of the past are not remembered and on some occasions it has even happened that the patient has not been able to remember his past prior to the escape. In most cases, when recovering the identity, amnesia can occur after the episode in which what happened during the episode is forgotten.

After recovering the memory, the individual usually feels discomfort, derived both from the confusion about what happened and from the deterioration in different vital domains such as work or partner. You may experience guilt, depression, anxiety, irritability, impulsiveness, and even suicide attempts.

At present, dissociative fugue is no longer considered a disorder by itself, being a specifier of dissociative or psychogenic amnesia because with the exception of the presence of the leak in question it shares most of its characteristics.

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Fugue subtypes

Yes ok most of the symptoms of dissociative fugue are similar, this disorder can manifest itself in different ways and have different repercussions. Specifically, three large subtypes of dissociative fugue can be considered.

classical fugue

In this subtype of dissociative flight, a trip or flight to an unknown place occurs, presenting autobiographical amnesia and partial or total loss of one's own identity and the assumption of a new one. The subject can reach settle in the new place with a new identity, without knowing his previous history until he regained his memory.

personal identity amnesia

This type of fugue assumes that the individual has a autobiographical memory loss along with your identity, although in this case there is no change in it. The individual does not believe another person, but knows that he does not know who he is.

Return to a previous period of one's life

This type of dissociative fugue refers to a return on a psychic level to a previous period of one's own life, presenting amnesia regarding the period of time elapsed since the period in question and the present. However, the personal identity remains intact.

Causes

The causes of dissociative fugue are associated with the experience of very stressful and traumatic events. For example, it is not uncommon for subjects to have suffered sexual abuse or experienced misfortunes such as wars or natural disasters. during childhood or throughout his life, so that his psyche splits to avoid the pain generated by the event in question.

It also seems to predispose to its suffering from intoxication or abusive consumption of substances, head injuries and certain disorders such as epilepsy.

At a biological level, it is considered that they may influence noradrenergic and serotonergic systemsas well as opioids. Cerebral seems to observe the presence of changes in the limbic system and its connection to the neocortex.

Treatment

Dissociative fugue is a disorder whose treatment is primarily focused on recovery and symptom control. It must be taken into account that, although there is usually only one episode, it is possible that new leaks appear, so prevention is another aspect to take into account.

It is necessary to work with the patient on the causes of this amnesia, the situation that caused the flight and what this situation implies for the subject. Cognitive restructuring or work on emotional expression and stress management can be of great help for this type of patient. It has also been used hypnosis and the suggestion to try to unlock the blocked contents of the subject's mind, as well as conducting interviews facilitated by hypnotic substances.

It is essential to work not only with the subject but also also with family and environment. Providing them with information about the disorder and what has happened is reassuring and can help them take into account and control factors that may have triggered the episode. Likewise, couples or family therapy in order to help manage conflicts that may have triggered or may have been caused by the escape is also recommended.

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