Dissociative Fugue Disorder

Dissociative fugue is an exceptionally rare psychiatric condition that involves the person’s loss of memories and personal identity.

People with dissociative fugue disorder, formerly called psychogenic fugue, experience sudden, unexpected travel away from their home or work, suffer an inability to recall their past, assume a new identity, and cannot remember important personal details about their past.

Mostly, the person with this curious disorder just takes off and loses the ability to recall his or her entire previous identity. While in a fugue state, the person does not remember his or her prior life—after the fugue, the episode may or may not be remembered.

The stimulus for a fugue state usually involves the individual leaving behind some kind of difficult and troubling situation that (on some level) he or she finds intolerable. For example, traumatic memories, financial crises, and/or marital problems have triggered fugue states. In some cases, the individual assumes an entirely new identity along with traveling to another geographical location.

Prevailing Pattern

Fugue states usually do not appear until early adolescence, and more commonly occur in adulthood. Symptoms rarely appear for the first time after the age of 50 but once they do appear, they usually continue well into old age (Barlow & Durand, 2012). The duration of the fugue state may range from a few hours to several days, and it usually ends abruptly. Once the person returns home, he or she may recall some of what happened during the fugue.

Differential Assessment

Dissociative fugue is far more common in movies and television programs than in clinical practice. The person with this disorder usually comes to the practitioner’s attention as a John or Jane Doe who is lost or confused about who he or she is and where he or she comes from.

A competency-based assessment helps practitioners avoid being vigorous in assigning pathology and looks to strengths and coping mechanisms. This orientation to the assessment helps the practitioner to discern the more serious conditions with similar symptoms (such as dissociative identity disorderOpens in new window, dementiaOpens in new window, substance-related disorders, or schizophreniaOpens in new window).

The symptoms associated with dissociative fugue are the same as those for dissociative amnesia except for the sudden travel component.

Other diagnostic categories to consider are manic or schizophrenic episodes accompanied by traveling; organic, nonepileptic factors such as brain tumors; and alcohol- and drug-related memory loss accompanied by wandering. Before making an assessment of dissociative fugue, the practitioner should also consider assessments for delirium, dementia, malingering, factitious disorder, and dissociative identity disorder.

The following case illustrates someone who experiences a dissociative fugue.

The Case of “Elvis Garfield Lancaster Smith”
“I’ll tell you boys once again, my name is Elvis Garfield Lancaster Smith, but my friends call me Elvis. Now that we’ve gotten through that, I’d like to get back to the shelter and get something to eat. That is, if y’all don’t mind.” Mr. Smith was brought to the emergency room after getting into a physical scuffle with another man also seeking a meal and a shower at the Salvation Army Shelter. The police brought Mr. Smith (who appeared to be middle-aged) to the hospital because he sustained a head wound during the physical altercation. When the emergency room physician asked Mr. Smith for some identification or proof of insurance, the staff quickly determined that he carried no personal papers or identification of any kind on him. On physical examination, the physician noted, “The patient has very recently sustained severe body trauma, and shows evidence of multiple slash-type wounds.” Mr. Smith commented when viewing his injuries, “Man, sure looks like somebody beat me up pretty good—I just don’t remember nothing about it.” As the interview progressed, Mr. Smith offered that he was new to the Miami area, and he could not recall where he had worked or lived before he came here. He was unable to provide the names of friends or family members who could be contacted to help. The police began an investigation to see if they could find out anything further about Mr. Smith, who was kept overnight for observation. During the night, the police were able to piece together his identity and what had happened to him. Mr. Smith, as it turned out, was really Mr. Edgar Edelstein, who lived in Orlando. Three days before the physical altercation at the homeless shelter, Mr. Edelstein was involved in an automobile accident that killed his wife, Margie, and his mother-in-law, Sheila. The Orlando police had been looking for Mr. Edelstein, who apparently wandered away from the scene of the accident.

The Case of “Elvis Garfield Lancaster Smith”

“I’ll tell you boys once again, my name is Elvis Garfield Lancaster Smith, but my friends call me Elvis. Now that we’ve gotten through that, I’d like to get back to the shelter and get something to eat. That is, if y’all don’t mind.”

Mr. Smith was brought to the emergency room after getting into a physical scuffle with another man also seeking a meal and a shower at the Salvation Army Shelter.

The police brought Mr. Smith (who appeared to be middle-aged) to the hospital because he sustained a head wound during the physical altercation. When the emergency room physician asked Mr. Smith for some identification or proof of insurance, the staff quickly determined that he carried no personal papers or identification of any kind on him.

On physical examination, the physician noted, “The patient has very recently sustained severe body trauma, and shows evidence of multiple slash-type wounds.” Mr. Smith commented when viewing his injuries, “Man, sure looks like somebody beat me up pretty good—I just don’t remember nothing about it.”

As the interview progressed, Mr. Smith offered that he was new to the Miami area, and he could not recall where he had worked or lived before he came here. He was unable to provide the names of friends or family members who could be contacted to help. The police began an investigation to see if they could find out anything further about Mr. Smith, who was kept overnight for observation.

During the night, the police were able to piece together his identity and what had happened to him. Mr. Smith, as it turned out, was really Mr. Edgar Edelstein, who lived in Orlando. Three days before the physical altercation at the homeless shelter, Mr. Edelstein was involved in an automobile accident that killed his wife, Margie, and his mother-in-law, Sheila. The Orlando police had been looking for Mr. Edelstein, who apparently wandered away from the scene of the accident.

Assessment Summary

The competency-based assessment serves as a tool to organize the data collected. This case is a classic example of dissociative fugue in that “Mr. Smith” Edelstein was unable to provide any biological facts about his identity. He traveled away from home and set about seeking shelter. There is no evidence that Mr. Edelstein’s history of a cognitive disorder (other than the obvious amnesia) that would support an assessment of dementia.

Specialties

Dissociative Fugue Disorder

Prevailing Pattern

Differential Assessment

Assessment Summary

See also: