197 Dissociative Fugue (300.13)
Dissociative Fugue is characterized by sudden, unplanned trips from the home or workplace without the ability to remember some or all of the individual’s past. Some of these patients take on new characteristics or aspects not related to their original identity. They tend to be running away from something of which they are unaware. After a fugue episode resolves, patients are unable to remember the events of the state. Although moving occurs in other disorders, in fugue it is purposeful and it is not enacted in a confused or dazed state. In a typical case, the fugue is brief, with purposeful travel, and limited contact with others. About 0.2% of the general population is afflicted with this type of dissociative disorder. (American Psychiatric Association, 2000).
Mental Status
- The mental status exam varies widely.
- Patient may present alert and oriented only to oneself.
- Eye contact and relatedness are limited to fair at best.
- Psychomotor activity is characterized by normal activity.
- Thought processes are intact, although thought content may vary widely from preoccupations to preservations to obsessive fixations to none.
- Reasoning and judgment are lacking, and insight is poor.
- An increased finding of violent or homocidal ideation is present, but suicidal ideation is lacking.
The DSM-IV-TR criteria according to the American Psychiatric Association (2000) includes the following:
- A. “The predominant disturbance is sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past” (p. 526).
- B. “Confusion about personal identity or assumption of a new identity (partial or complete)” (p. 526).
- C. “The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g.., temporal lobe epilepsy)” (p. 526).
- D. “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (p. 526).
Associated features
Dissociative Fugue was formerly known as Psychogenic Fugue. It is comorbid with Bipolar Disorder, Major Depressive Disorder, and Schizophrenia, as well as PTSD, Substance Related disorders, Panic and Anxiety Disorders, Eating Disorders, and Somatoform Disorders. Note: Dissociative Fugue is often mistaken for malingering. This happens because the disorder enables people to escape their responsibilities or undesirable or dangerous situations; therefore it is seen as if a person is taking the ‘easy-way-out’. A person in the midst of a Dissociative Fugue episode may appear only slightly confused or they may appear to have no symptoms at all and attract no attention. Eventually, however, the person will begin to show significant signs of confusion or distress as they become aware of memory loss or confusion about their identity. This amnesia