Dissociative fugue

For the New York City-based publisher, see Fugue State Press.
Fugue state
Classification and external resources
ICD-10 9 300.13

A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13[1]), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality. The state is usually short-lived (ranging from hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity.

After recovery from fugue, previous memories usually return intact, but there is typically amnesia for the fugue episode. Additionally, an episode of fugue is not characterized as attributable to a psychiatric disorder if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (dissociative amnesia).

Clinical definition

The etiology of the fugue state is related to dissociative amnesia, (DSM-IV Codes 300.12[2]) which has several other subtypes:[3] Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.[1]

Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), 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).[4] It is a complex neuropsychological process.[5]

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.

Therefore, the terminology fugue state may carry a slight linguistic distinction from 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.

The DSM-IV defines[1] as:

  • sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past,
  • confusion about personal identity, or the assumption of a new identity, or
  • significant distress or impairment.

The Merck Manual[6] defines Dissociative Fugue as:

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.

In support of this definition, the Merck Manual[6] further defines dissociative amnesia as:

An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.

Diagnosis

A doctor may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one. The doctor carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychologic examination is also done.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternative life.

Prognosis

The DSM-IV-TR states that the fugue may have a duration from hours to months and recovery is usually rapid. However, some cases may be refractory. An individual usually only has a single episode.

Case studies

  • Agatha Christie disappeared on 3 December 1926 only to reappear eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span.[7]
  • Shirley Ardell Mason also known as "Sybil" would disappear and then reappear with no recollection of what happened during the time span. She recalls "being here and then not here" and having no identity of herself; it should be noted that it is claimed she also suffered from what was formerly called "Multiple Personality Disorder." However, Mason's diagnosis has been challenged as a hoax.[8]
  • Jody Roberts, a reporter for the Tacoma News Tribune, went missing in 1985, only to be found 12 years later in Sitka, Alaska, living under the name of "Jane Dee Williams." While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely suffered a protracted fugue state.[9]
  • David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Five's television series Extraordinary People. He entered a fugue state on December 4, 2005, and is still working on regaining his entire life's memories.[10]
  • Hannah Upp, a teacher originally from Salem, Oregon,[11]who was living in New York at the time of her disappearance, went missing on August 28, 2008. She was rescued after she jumped into the New York Harbor on September 16. She underwent a psychiatric evaluation and refused to speak to detectives.[12] She later claimed to have no recollection of the time in between. Upp claimed that the episode was diagnosed as dissociative fugue.[13] On September 3rd, 2013, she went missing from her new job as a teacher's assistant[14] at Crossway Community Montessori in Kensington, Maryland. She was found unharmed September 5, 2013 in Wheaton, Maryland.[15][16]
  • Jeff Ingram, appeared in Denver in 2006 with no memory of his name or where he was from. After appearing on national television to appeal for help identifying himself, his fiancée Penny called Denver police identifying him. The episode was diagnosed as dissociative fugue. Jeff has experienced three incidents of amnesia: in 1994, 2006, and 2007.[17]

In fiction

In the Norwegian folktale "Asbjørnsen and Moe, the eponymous heroine goes into what appears to be a fugue state after a humiliating experience of rejection by her master, for whom she has had romantic feelings.

In the TV series Scandal (TV series), the character Quinn allegedly is in a dissociative fugue state in season two following the establishment of her new identity.

In the TV series One Tree Hill, the character Clay suffers a fugue state in season nine.

In the TV series Breaking Bad, the character Walter White fakes a fugue state to cover up his kidnapping.

In the TV series Teen Wolf, the character Lydia suffers a fugue state in season two following being bitten by a werewolf.

In the TV series Doctor Who, the character in the 2009 Christmas special, "The Next Doctor," Jackson Lake suffers a fugue state after witnessing the death of his wife by a Cyberman attack.

In the TV series Bates Motel, the character Norman Bates suffers fugue state episodes in which he can react violently to a stressor including attempt to kill but has no memory of it when he recovers from it.

In the TV series The Mentalist, the character Patrick Jane suffers a fugue state after nearly drowning.

In the short story The Shadow Out of Time by H. P. Lovecraft, the character Nathaniel Wingate Peaslee awakens after years of being the victim of an "identity swap" with a member of an ancient race of aliens.

In the third season of the TV series Lois and Clark: The New Adventures of Superman, Lois Lane goes into a dissociative fugue as a result of suffering a blow to the head while escaping from Lex Luthor, who had kidnapped her. Initially, in her fugue state she takes on the personality of Wanda Detroit, a fictional lounge singer from her novel. This occurs in the second episode of a five-episode plot arc; she loses the Wanda Detroit identity at the end of the third episode, but she does not fully recover her own true identity, personality, and memory until late in the fifth episode. (This arc was not popular with the audience and may have permanently damaged the show's ratings. In the teaser of an early fourth season episode, the show joked about this by having Lois hit her head on a kitchen cabinet door and then pretend to have amnesia, with Clark Kent responding, in a tone of desperate frustration, "No, no, no!", before she said to him, "Just kidding!")

Dissociative fugue affects many characters in David Lynch films with the most explicit example being the protagonist of Lost Highway.

In the year 2000 film Nurse Betty, Renée Zellweger's character Betty witnesses the murder of her husband and experiences a fugue state.

In the game Assassin's Creed 3 the character Desmond Miles experiences a fugue state upon first entering the Animus.

See also

Psychology portal

References

External links

  • "Dissociative Fugue" from the Mental Health Matters website.
  • "Dissociative Fugue" from the Merck & Co. website.
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.