The patient suffering from dissociative fugue wanders or travels while mentally blocking out a traumatic event. During the fugue state, he usually assumes a different personality; later he can't recall what happened. The degree of impairment varies, depending on the duration of the fugue and the nature of the personality state it invokes. Dissociative fugue may be related to dissociative identity disorder, narcissistic personality disorder, and sleepwalking.
The age of onset varies. Although the fugue state usually is brief (hours to days), it can last for many months and carry the patient far from home. The prognosis for complete recovery is good, and recurrences are rare.
Dissociative fugue typically follows an extremely stressful event, such as combat experience, a natural disaster, a violent or abusive confrontation, or personal rejection. Heavy alcohol use may constitute a predisposing factor.
A person in the midst of a dissociative fugue episode may appear to have no psychiatric symptoms at all or to be only slightly confused. Therefore, for a time, it may be very difficult to spot someone experiencing a fugue. After a while, however, the patient shows significant signs of confusion or distress because he or she cannot remember recent events, or realizes a complete sense of identity is missing. This amnesia is a characteristic symptom of the disorder.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. The doctor makes the diagnosis by carefully reviewing the person's symptoms and performing a physical examination to exclude physical disorders that might be contributing to or causing memory loss. A psychologic examination is also performed.
Sometimes dissociative fugue cannot be diagnosed until the person abruptly returns to his pre-fugue identity and is distressed to find himself in unfamiliar circumstances. The diagnosis is usually made retroactively by a doctor reviewing the person's history and collecting information that documents the circumstances before the person left home, the travel itself, and the establishment of an alternate life.
Psychotherapy aims to help the patient recognize the traumatic event that triggered the fugue state and to develop reality-based strategies for coping with anxiety. A trusting, therapeutic relationship is essential for successful therapy.
Although it might not be possible to prevent dissociative fugue, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Further, quick intervention following a traumatic event or emotionally distressing experience might help reduce the risk of developing dissociative disorders.
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