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| {{SI}}
| | #REDIRECT:[[Amnesia classification#Dissociative Fugue]] |
| {{CMG}}
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| ==Overview==
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| 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 Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]] 300.13<ref name="DSM-IV_300.13">Dissociative Fugue (''formerly'' Psychogenic Fugue) ( [http://www.psychiatryonline.com/content.aspx?aID=9744 DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition])</ref>)''.
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| ==Clinical definition==
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| The [[etiology]] of the fugue state is related to ''[[Psychogenic amnesia|Dissociative Amnesia]], ([[DSM-IV Codes]] 300.12<ref> [http://www.psychiatryonline.com/content.aspx?aID=9708 Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )]</ref>)'' which has several other subtypes<ref> [http://www.psychnet-uk.com/dsm_iv/dissociative_amnesia.htm Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com )]</ref>: Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype ''Dissociative Fugue''<ref name="DSM-IV_300.13"/>.
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| Unlike [[retrograde amnesia]] (which is popularly referred to simply as "amnesia", the state where someone completely forgets who they are), ''[[Psychogenic amnesia|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'')<ref name="PsychNet-UK.com"> [http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm Complete List of DSM-IV Codes ( PsychNet-UK.com )]</ref>. It is a complex neuropsychological process<ref>[http://www.dissociation.co.uk/background.asp Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )]</ref>.
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| 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.
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| Therefore, the terminology ''fugue state'' may carry a slight linguistic distinction from ''[[dissociation (psychology)|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''.
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| The [[DSM-IV]] defines <ref name="DSM-IV_300.13"/> as:
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| *sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past,
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| *confusion about personal identity, or the assumption of a new identity, or
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| *significant distress or impairment.
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| The ''[[Merck Manual]]'' <ref name="Merck">[[Merck Manual]] [[1999]] section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)</ref> defines ''Dissociative Fugue'' as:
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| : 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.
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| In support of this definition, the ''Merck Manual'' <ref name="Merck"/> further defines ''[[Psychogenic amnesia|Dissociative Amnesia]]'' as:
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| : An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.
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| ==Prevalence and onset==
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| 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<ref name="Merck"/>. 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 ''[[Psychogenic amnesia|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.
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| Similar to ''[[Psychogenic amnesia|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.
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| ==Diagnosis==
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| 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<ref name="PsychNet-UK.com"/>. Similarly, other psychological disorders may manifest symptoms similar to ''Dissocative Fugue''s. These include [[bipolar disorder]], [[schizophrenia]] and [[clinical depression|major depressive disorder]].
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| ==Treatment and prognosis==
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| Most ''Dissociative Fugues'' last for hours or days or months, unresolved and may return. ''Dissociative Fugue'' is treated much the same as ''[[Psychogenic amnesia|Dissociative Amnesia]]'' and ''[[Dissociative Identity Disorder]]'', and treatment is therapy aimed at helping the person restore lost memories as soon as possible<ref name="PsychNet-UK.com"/>. 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.
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| 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:
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| *[[Psychotherapy]]<ref>[http://www.pep-web.org/document.php?id=PI.020.0259A The Psychoanalytic Psychotherapy of Dissociative Identity Disorder in the Context of Trauma Therapy ( Psychoanalytic Inquiry, 2000 )]</ref><ref> [http://www.ipa.org.uk International Psychoanalytical Association (IPA)]</ref> — 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.
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| *[[Cognitive therapy]] — This type of therapy focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
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| *[[Psychiatric medication|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.
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| *[[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.
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| *''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.
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| *[[Hypnotherapy|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.
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| ==Case studies==
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| 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. <ref>[http://five.tv/programmes/extraordinarypeople/manwithnopast/ The Man With No Past]</ref>
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| ==See also==
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| *[[Structured Clinical Interview for DSM-IV]]
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| *'''Dissociative Fugue''' (''formerly'' Psychogenic Fugue) ([[DSM-IV Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]] 300.13)
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| *[[Dissociative disorders|Dissociative Disorders]] ([[DSM-IV Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]])
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| *[[Dissociative Identity Disorder]] (''formerly'' Multiple Personality Disorder) ([[DSM-IV Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]] 300.14)
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| *[[Psychogenic amnesia]]; Dissociative Amnesia (''formerly'' Psychogenic Amnesia) ([[DSM-IV Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]] 300.12)
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| *[[Depersonalization|Depersonalization Disorder]] ([[DSM-IV Codes#Dissociative Disorders|DSM-IV Dissociative Disorders]] 300.6)
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| *[[Dissociation (psychology)|Dissociation]] ''(psychology)''
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| ==References==
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| {{reflist|2}}
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| [[Category:Psychiatry]]
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| [[Category:Dissociative disorders]]
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| [[de:Wandertrieb (Humanmedizin)]]
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| [[nl:Dissociatieve fugue]]
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| [[pl:Fuga (psychiatria)]]
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| [[ru:Диссоциативная фуга]]
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| {{WH}}
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| {{WS}}
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