Dissociative Fugue

Dissociative Fugue is a confusion about or loss of one’s personal identity and purposeful travel away from ones home. This includes inability to recall portions of one’s past. Dissociative Fugue generally occurs with rapid onset after a traumatic experience or bereavement. Occasionally you will find with this disorder that the person takes on a new identity. This generally occurs for short periods away from home. However, there are situations in which the fugue has lasted for weeks or months. Individuals with Dissociative Fugue may develop complex personalities and function in complex roles. However, they generally lead simple lives and remain relatively reclusive. There is often a single episode and remission may spontaneously occur without treatment. This disorder is more common in alcohol abusers.

Theoretical approaches applied to this disorder are psychodynamic, cognitive, behavioral, hypnosis, and family therapy. Hypnosis is often used to recover aspects of the person’s memory but there is no single approach that is most effective. Hypnotic age regression is a useful framework for making information accessible from an earlier time period. Demonstrating that information may be made available to consciousness can facilitate the working through of emotionally laden components.

It is important to differentiate Dissociative Fugue from organic conditions and Malingering. Occasionally, severe depressive or anxiety states may include states of amnesia. Somnambulism may include amnestic states but this is generally accompanied by clouding of consciousness. PTSD, somatoform disorders, and other dissociative states often include amnesia.

With Dissociative Fugue Disorder, You will need to conduct an assessment and establish a working relationship with the patient. The assessment should include a thorough clinical history, psychosocial, and physical exam to rule out organic conditions. A neurological exam, including CAT scan and sleep deprived EEG may be a necessary step for further evaluation. The assessment should look for any possible mental health disorder as well as substance abuse. Establish safety and stabilize the patient, making sure the patient is not a danger to him/her self or others. While you are establishing your rapport, you should emphasize safety and make the client feel that they have control over their own treatment.

In sorting out organic conditions, it is important to establish if old skills are preserved during the attack. This is uncommon in the presence of organic brain damage or other organic conditions. Establish if there is any obvious secondary gain. However, secondary gain does not necessarily indicate Malingering. It is likely that all dissociative states include some form of secondary gain. It is also important to determine if there are any other reasons that the patient may have for intentionally and consciously changing their identity.

Patients may be quite motivated to maintain their amnesia if it serves the purpose of avoiding highly charged emotions or life situations. Allowing the patient to free associate to fragments of memories that have returned can often be effective. Working with the patient to change environmental conditions or teaching coping skills may make dissociative mechanisms less important. However, the goals of treatment may be simply to return the patient to their previous level of functioning (recover lost memories). However, it may be difficult to plan the course of treatment until the patient’s memories are fully recovered.