Fugue State: Complete Guide to this Disorder

 

You might have heard it called by different names: Dissociative Fugue, Psychogenic Fugue. But the name isn’t as important as the mess it creates: a complete loss of identity, past, and livelihood. While it might be rare to come across a person affected, the fugue state is a serious disorder that requires urgent attention. We will explore what is the fugue state, symptom and causes of the fugue state, diagnosis of the fugue state, is it fact or fiction and what can be done to treat this crisis of identity.

Fugue State: Complete Guide to this Disorder

The fugue state

This morning, I woke up in my familiar bed, reached over to where my phone always lies to check the time. Did a few sit-ups just to shake off the sleepiness. After that, I brushed my teeth, turned on the shower as I opened my work email to look for any last-minute updates and remind myself of the agenda for the day. I waited the appropriate time I knew it took for the water to heat up, then stepped inside so I could get on with my work day. A typical weekday for me. A scheduled routine that I am accustomed to, and a part of my life that I take for granted.

So, it would be pretty unnerving if the next morning, I woke up and not be in my normal bedroom, with no memories or idea of what I am doing. Identity is so important to our lives, and dissociation disorder means losing that life as we know. In studying the fugue state, mental health experts want to learn more about this bizarre condition that has such a mysterious origin and outlook. A fugue state may be something that can affect all of us, so it helps to gain a better grip on what it is.

What is Fugue State?

Fugue comes from the Latin word for “flight.” Pretty fitting, as this disorder leads people to “fly,” drive, or wander away. Those in the fugue state experience a form of amnesia in which they not only forget who they are but suddenly travel-sometimes literally flying miles and miles away. There is no set parameter for how far those in the fugue state will travel, not for how long this episode lasts. In fact, the more one reads up about this disorder, the harder it is to find anything specific about it which can be highly stressful for someone who suffers it.

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So, what we do we know? The “fugue state” was first coined in 1901, from a French publication entitled Mental State Hystericals. Fugue also being a French word for “running away” it was a “fugue” that the publication used to describe a woman who would enter a state of hysterics, running off and acting like a completely different person. The woman would only be able to recall her strange behavior under hypnosis. In time this disorder became part of mental health terminology, first labeled as “psychogenic fugue” and more currently as a fugue state. Still, in popular culture, the term entering a “fugue state” tends to be used more often (like how multiple personality disorder tends to be a misnomer for dissociative identity disorder).

Therefore, a fugue state is a dissociative disorder and a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality.

Fugue state is, in fact, part of a group of dissociative disorders listed in the DSM IV. Dissociative Disorders include Dissociative Identity Disorder, Dissociative amnesia, and Depersonalization Disorder. Fugue is a sub-type of the Dissociative Amnesia.

Fugue State vs Amnesia

Let’s take a step back to better understand why fugue is different from amnesia. In the DSM-V, dissociative disorders are problems with memory, identity, emotion, and sense of self. When we “dissociate” it means we are disconnecting with our normal thoughts, memories, or feelings in life. For a “normal” individual, this can mean simply daydreaming while in traffic, getting so lost in a book or movie that we imagine ourselves in the scenario of the protagonist, or maybe just for a moment losing touch of our surroundings.
With the disorder though, this behavior is so pervasive and severe that it affects daily life.

Fugue State: Complete Guide to this Disorder

Dissociative Fugue can cause a person to wander miles away from home

Countless works of fiction have depicted this: The Strange Case of Dr. Jekyll and Mr. Hyde, Fight Club, the classic animated feature Anastasia. Because of this, it’s easy to accept that these circumstances don’t happen in real life. But psychiatrists would caution that these cases have been documented and while rare, are very real for the people who have suffered from them.

In the case of dissociative amnesia, some sort of stressful event usually provokes the individual to forget large amounts of information about oneself such as name, address, or family ties. A fugue state is a specific form of this amnesia that is usually precipitated my running away from home and making up a new identity. As with the recorded case in 1901, some people may not be able to recall what they were doing during this fugue state until some sort of treatment is provided.

Fugue State: Symptoms and Diagnosis

Some of the symptoms of the fugue state include:

  • Abrupt and unexplained travel from home
  • Inability of remember key events from the past, or important life details (to note, this does not usually affect the person’s factual memory, such as dates, current President, or how to tie shoes.)
  • Confusion about one’s name or identity, sometimes leading to the person adopting a whole new persona.

It is because of this, that people in the fugue state will present an appearance of normalcy until they are especially questioned about their past or previous whereabouts. Clinicians trying to diagnose the disorder will have to ascertain if the symptoms mentioned are present and run brain imaging and blood tests to rule out the possibility of physical illness. From there, patients are referred to a psychologist or psychiatrist to complete mental health assessments specifically tailored to evaluate dissociative disorders.

Causes of the Fugue State

Some popular depictions of characters in fiction with some type of dissociation problem are Dr. Jekyll/Mr. Hyde, Anastasia and the narrator in Fight Club. Interestingly, for these characters, there was a specific underlying cause for their disorder:

  • A special concocted drug caused the identity split for Dr. Jekyll
  • A bump on the head during a traumatic wartime escape for the little Anastasia.
  • Severe insomnia coupled with a need to escape a mundane lifestyle for the Narrator of Fight Club
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So, in the real world, what causes a fugue state? The answer might be a combination of all the popular theories. In general, the fugue state has been linked to severe stress brought on by trauma such as war, abuse, or witnessing extreme violence. And since dissociative Disorders are on the trauma spectrum, conditions brought on by trauma are often co-morbid. Here are a few examples:

PTSD and fugue state

Since the fugue state can be triggered by stress, it would be obvious that the fugue state would be associated with those suffering from a post-traumatic stress disorder. PTSD is well-documented in veterans that have been exposed to the horrors of wartime but can affect any person exposed to a traumatic event that provokes anxiety and troubling memories. One key hallmark of PTSD is an avoidant behavior-the tendency of situations that may trigger bad memories, and it is perhaps this tendency to go to extremes that may provoke behavior related to the fugue state. Severe PTSD has been known to provoke hallucinations and delusions, which may progress to dissociation

Depression and fugue state

Extreme depression has been linked to dissociative disorders. Suicide thoughts can be a risked factor. This is because depression and emotional disturbances can be caused by trauma such as abuse which in turn can provoke the fugue state.

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Sleep disturbances and fugue state

A 2014 study showed that a high level of sleep disturbances was associated with participants who have dissociative disorders. Indeed, those with fugue state symptoms tend to experience waking dreams and extreme nightmares, possibly linked to trauma.

Drug and alcohol abuse and fugue state

Those who abuse drugs and alcohol often experience blackout episodes akin to fugue state, sometimes even resulting in an unexplained travel. Whether such instances constitute an actual fugue state is unclear.

How common is fugue?

The simple answer is not very. Clinicians estimate that 0.2% of the population is affected. But like most rare disorders, there is a lot of attention to case studies of the disorder. Here we can list a few of the most notable cases:

Agatha Christie

The famous writer entered what might have been a fugue state in the winter of 1926. She disappeared without a trace from her house and was eventually found to have checked into a health spa under a false name. She never explained her behavior.

Sybil

Inspired the famous book and film, Shirley Mason, alias Sybil is one of the most famous documented cases of Dissociative Identity Disorder. What is also known through the notes of her therapist, is that during the 50s “Sybil” would experience “waking up” in antique shops or hotel rooms with no idea of how she had gotten there. Such fugue states were noted by Sybil’s therapist to run concurrently with Sybil’s many different personalities breaking out

Benjamin Kyle

In 2004, a man who came to be known Benjamin Kyle was found by the side of a Burger King in Georgia, badly beaten and naked. Waking up in the hospital, he had no memories of his last name, his past, or how he ended up at the Burger King. Interestingly, Ben did exhibit innate knowledge of food preparation techniques- a hint that he may have been in the restaurant business before his memory loss.

Nigerian med student

Probably of the most recent cases. A paper published by Igwe in 2017 documented an extraordinary case of a 28-year-old Nigerian medical student who went missing for 10 days before he had to give a class presentation. He was discovered to have made an eight-hour road trip from his school, with no memory of how he traveled or where he had spent the night before. The investigation into the student’s life prior to his disappearance yielded clues linked to the fugue state: he had been under great academic and financial stress and was exhibiting mood swings and sleep disturbances characteristic of depression. He also reported suicidal ideation because of all the pressure from school.

Is the Fugue fact or fiction?

As you can see from the cases above, people affected by fugue state vary in gender, ethnicity, and just about everything else. What could a 20th-century mystery writer have in common with a present-day Nigerian med student? This is a puzzling question that we have trouble reconciling before we move on to possible treatment. It should be mention that some of the popular cases of fugue state have drawn suspicion as to the validity of the disorder.

Fugue State: Complete Guide to this Disorder

People in the fugue state make a genuine effort to recall their lost memories.

 

Clinicians and non-clinicians have often wondered whether this escape is a concerted effort by some to gain attention or escape responsibility. It probably doesn’t help that the fugue-like behavior is so frequently depicted in media that we may have trouble separate what is a real problem from what someone might be trying to copy from that movie.

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To be clear, a true diagnosis of dissociative amnesia (which fugue state is a subset of) requires the individual to truly lose memory of their identity and are unable to recall details despite their best efforts. Individuals who feign amnesia to escape tax problems, be absolved of a crime, or just gain the attention of the media (it happens) would be classified as maligners.

Fortunately, we have great experts who can administer tests to pinpoint those who may maligner: neuropsychological assessments can often show that a person is deliberately faking impairment in memory. A clinician will also assess the effort that the person is putting in to recall their past, or if they may be other motives for exhibit fugue behavior.

Still, it is a hard case to present when the underlying cause is mental, rather than physical symptoms. Some people want to find neurological correlates that identify those with dissociative amnesia. Some neuroimaging studies have found that the brains of those with dissociative disorders had hyperactivity in the frontal cortex and less activity in the hippocampus. The hippocampus is known to be our storage center storing memories so it would support the idea that the fugue state leads to an observable imbalance in the brain. The more facts we have on fugue, the better it will be to confirm.

Fugue State Treament

If you look through all the noted cases of fugue state, you might realize there is one underlying theme: some exposure to trauma or stress. Therefore, treating the fugue state usually involves helping individuals come to terms with the associated trauma. Below are a few examples of how this is treated:

Hypnotherapy and fugue state

Possibly the most common treatment. In hypnosis, the patient will be put in a deep state of relaxation and focused attention on exploring alternative thoughts and emotions. Patients with dissociative disorders are often put under hypnosis in the hope to recover memories that may be key to explaining how triggered the episode. Such memories might often be painful reminders of abuse suffered or trauma experience, and therefore they become repressed but trigger unusual behavior such as a fugue state. The use of hypnosis is often controversial in science so it may not be used all the time.

Psychotherapy and fugue state

Another common treatment. Practitioners will encourage patients to communicate thoughts and challenge dysfunctional thinking that might trigger the fugue behavior. This is considered a type of cognitive therapy because the emphasis is for the patients to actively look within themselves to understand why they behave the way they do or feel the way they do. Usually a lot less controversial than hypnosis.

Creative Therapy and fugue state

Patients are encouraged to pursue an artistic outlet such as painting or music, particularly after a fugue episode. This often allows fugue patients to express complicated thoughts or stress in a safe and understandable way.

Medication and fugue state

Often, the use of drugs isn’t directly used to treat fugue, but the co-morbidity of depression and anxiety. Because trauma is so linked to dissociative disorders, administering anti-depressants or anti-anxiety medications may help mitigate the problems that trigger fugue episodes.

Fugue state prognosis

While disturbing, the fugue state can usually go away on its own, as suddenly as it first appeared. With the use of treatment, there is usually a good chance that the affected person will recover memories prior to the fugue state. To truly prevent the episode from occurring, it would behoove clinicians to address the actual trauma that most likely triggered the dissociation.

Tips to help a loved one dealing with Fugue

Fugue State: Complete Guide to this Disorder

Family support is essential for helping people overcome Dissociative Fugue

Trauma from is not an easy topic to discuss, let alone deal with. It not only affects the person who experienced it but creates a ripple within the family and friends unit. We must understand that the fugue state is a specific type of dissociative disorder, and most of the time these disorders have root in wanting to escape or forget about very difficult experiences. This might be evident to spot for people who we know were exposed to traumatic events, and so PTSD counseling should always be considered for those exposed to events like war and terrorist attacks.

However, the trauma might have come from abuse from childhood that has been suppressed, or never truly addressed. It is for that reason that intervention is key to helping those who have or at a risk to experience a fugue state. One must be prepared to talk about some potentially unsettling issues, and for that reason, it helps to have a therapist who can foster productive discussion.

Family therapy is an effective tool for an affected person; being surrounded by loved ones who may know the person will help to jog or uncover lost memories. But having a frank discussion, a person who has suffered from the fugue state may feel comfortable enough to discuss a painful past that triggered the episode. Because fugue is can be complicated with other mental health conditions such as depression, anxiety, drug abuse, and suicidal thoughts, you should immediately contact a professional is any such signs are exhibited.

 

References

Brody, J. E. (2007). When a Brain Forgets Where Memory Is – The New York Times. Retrieved September 24, 2018, from https://www.nytimes.com/2007/04/17/health/psychology/17brody.html

Galan, N. (2017). Dissociative fugue: Symptoms, causes, and treatment. Retrieved September 24, 2018, from https://www.medicalnewstoday.com/articles/319024.php

Huskinson, H. (2013). Excuse Me, Who Am I? Retrieved September 24, 2018, from https://news.nationalgeographic.com/news/2013/07/130731-amnesia-fugue-state-brain-disorder-hypnosis/

Igwe, M. N. (2013). Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: A case report. Journal of Medical Case Reports, 7(1), 1. https://doi.org/10.1186/1752-1947-7-143

Kvarnstrom, E. (2016). Finding Effective and Compassionate Dissociative Fugue State Treatment – Bridges to Recovery. Retrieved September 24, 2018, from https://www.bridgestorecovery.com/blog/finding-effective-and-compassionate-dissociative-fugue-state-treatment/

Stewart, A. (2018). Your APA: The First 100 Days. Psychiatric News, 53(17), appi.pn.2018.9a18. https://doi.org/10.1176/appi.pn.2018.9a18

Wynarczyk, N. (2018). Benjaman Kyle: The man with no memory and no identity. Retrieved September 24, 2018, from https://www.lifedeathprizes.com/amazing-stuff/benjaman-kyle-man-with-no-identity-14597

Nana is a new collaborator for CogniFit. When not writing he works as a University research specialist, focusing on clinical assessment of brain injury. He received his BA from Dartmouth College and recently completed his Master of Public Health degree at the University of Ghana. His MPH dissertation was on cognitive impairment in Africans living with HIV. His interests are in neuropsychology, abnormal psychology, and cognitive disorders. Feel free to provide feedback on the articles he shares.