Examine individual changes

'{{Short description|Dissociative disorder}} {{For|the New York City–based publisher|Fugue State Press}} {{Infobox medical condition (new) | name = Fugue state | synonyms = Fugue state, psychogenic fugue | image = Headscratcher.png | caption = | field = [[Psychiatry]] | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Dissociative fugue''' ({{IPAc-en|f|juː|ɡ}}), formerly called a '''fugue state''' or '''psychogenic fugue''',<ref name="DSM-IV_300.13"/> is a [[mental disorder|mental]] and [[Abnormal behavior|behavioral]] [[Disorder (medicine)|disorder]]<ref name=Sartorius>Drs; {{cite web |url=https://www.who.int/classifications/icd/en/bluebook.pdf |title= The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines |first1=Norman|last1= Sartorius|author-link=Norman Sartorius|last2= Henderson|first2=A.S.|last3= Strotzka|first3=H.|last4= Lipowski|first4=Z. |last5= Yu-cun|first5=Shen|last6=You-xin|first6=Xu |last7=Strömgren|first7=E. |last8= Glatzel|first8=J. |last9= Kühne|first9=G.-E.|last10= Misès|first10=R.|last11=Soldatos|first11=C.R. |last12= Pull|first12=C.B.|last13= Giel|first13=R.|last14= Jegede|first14=R.|last15=Malt|first15=U. |last16= Nadzharov|first16=R.A.|last17= Smulevitch|first17=A.B.|last18= Hagberg|first18=B.|last19= Perris|first19=C.|last20= Scharfetter|first20=C. |last21= Clare|first21=A. |last22= Cooper|first22=J.E. |last23= Corbett|first23=J.A. |last24=Griffith Edwards |first24=J. |last25= Gelder|first25=M.|last26= Goldberg|first26=D.|last27= Gossop|first27=M.|last28= Graham|first28=P.|last29=Kendell|first29=R.E. |last30= Marks|first30=I.|last31= Russell|first31=G.|last32= Rutter|first32=M.|last33= Shepherd|first33=M.|last34= West |first34=D.J.|last35= Wing |first35=J. |last36= Wing|first36=L.|last37= Neki|first37=J.S. |last38= Benson|first38=F.|last39= Cantwell|first39=D. |last40=Guze|first40=S. |last41= Helzer|first41=J.|last42= Holzman|first42=P.|last43= Kleinman|first43=A.|last44=Kupfer|first44=D.J.|last45= Mezzich|first45=J. |last46= Spitzer|first46=R. |last47=Lokar |first47=J. |website=www.who.int [[World Health Organization]] |publisher=[[Microsoft Word]] |agency=bluebook.doc |pages=111|access-date=3 July 2021 |url-status=live|via=[[Microsoft Bing]]}}</ref> that is [[nosology|classified variously]] as a [[dissociative disorder]],<ref name="DSM-IV_300.13">Dissociative Fugue (formerly Psychogenic Fugue) ''([https://web.archive.org/web/20070928080517/http://www.psychiatryonline.com/content.aspx?aID=9744 DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition])''</ref> a [[conversion disorder]],<ref name=Sartorius/> and a [[somatic symptom disorder]]. The disorder is a rare psychiatric abnormality characterized by reversible [[amnesia]] for one's own personal identity, including the [[memories]], [[Personality psychology|personality]], and other identifying characteristics of [[individuality]]. The state can last days, months or longer. Dissociative fugue usually involves unplanned travel or wandering and is sometimes accompanied by the establishment of a new identity. It is a facet of [[dissociative amnesia]], according to the fifth edition of the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' ([[DSM-5]]). After recovery from a fugue state, previous memories usually return intact, and further treatment is typically unnecessary, although some patients have been known to experience multiple consecutive fugue episodes over the course of several years. 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 [[dissociative identity disorder]],{{clarify|reason=Confusing. Is disassociative identity disorder not a psychiatric disorder? Is there a difference between a psychiatric condition and a psychiatric disorder?|date=May 2017}} [[delirium]], or [[dementia]].<ref name=DSM5>{{cite book | author = American Psychiatric Association | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 9780890425541 | url-access = registration | url = https://archive.org/details/diagnosticstatis0005unse }}</ref> Fugues are precipitated by a series of long-term traumatic episodes. It is most commonly associated with [[Child sexual abuse|childhood victims of sexual abuse]] who learn over time to dissociate memory of the abuse (dissociative amnesia). ==Signs and symptoms== The defining symptom of a fugue state consists of the loss of a subject's identity,<ref>{{Cite web|url=https://www.webmd.com/mental-health/dissociative-fugue|title=What Is Dissociative Fugue?|website=WebMD|language=en|access-date=2019-11-08}}</ref> often resulting in confusion and the abandonment of the subject's possessions and place of residence as they suddenly dissociate from their previous life. Possible symptoms arising after the end of a dissociative fugue can include [[Major depressive disorder|depression]], grief, shame, and discomfort. People have also experienced a post-fugue [[anger]].<ref>The Merck Manual</ref> ==Diagnosis== {{More citations needed|section|date=November 2021}} A doctor might 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 reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. Sometimes dissociative fugue cannot be diagnosed until people return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances, sometimes with awareness of "lost time". 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. Functional amnesia can also be situation-specific, varying from all forms and variations of traumas or generally violent experiences, with the person experiencing severe memory loss for a particular trauma. Committing homicide; experiencing or committing a violent crime such as [[rape]] or torture; experiencing combat violence; attempting suicide; and being in automobile accidents and natural disasters have all induced cases of situation-specific amnesia (Arrigo & Pezdek, 1997; Kopelman, 2002a). As Kopelman (2002a) notes, however, care must be exercised in interpreting cases of [[psychogenic amnesia]] when there are compelling motives to feign memory deficits for legal or financial reasons. However, although some fraction of psychogenic amnesia cases can be explained in this fashion, it is generally acknowledged that true cases are not uncommon. Both global and situationally specific amnesia are often distinguished from the organic amnesic syndrome, in that the capacity to store new memories and experiences remains intact. Given the very delicate and oftentimes dramatic nature of memory loss in such cases, there usually is a concerted effort to help the person recover their identity and history. This will allow the subject to be recovered sometimes spontaneously when particular cues are encountered. ===Definition=== The cause of the fugue state is related to [[Psychogenic amnesia|dissociative amnesia]], (Code 300.12 of the [[DSM-IV codes]]<ref>{{cite web |url=http://www.psychiatryonline.com/content.aspx?aID=9708 |archive-url=https://web.archive.org/web/20070928075634/http://www.psychiatryonline.com/content.aspx?aID=9708 |url-status=dead |archive-date=2007-09-28 |title=Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ) |publisher=Psychiatryonline.com |access-date=2011-11-28 }}</ref>) which has several other subtypes:<ref>[http://www.psychnet-uk.com/dsm_iv/dissociative_amnesia.htm Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com )] {{webarchive |url=https://web.archive.org/web/20101128192837/http://www.psychnet-uk.com/dsm_iv/dissociative_amnesia.htm |date=November 28, 2010 }}</ref> [[selective amnesia]], [[generalized amnesia]], [[continuous amnesia]], and [[systematized amnesia]], in addition to the subtype "dissociative fugue".<ref name="DSM-IV_300.13"/> 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 Code 294.0).<ref name="PsychNet-UK.com">[http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm Complete List of DSM-IV Codes ( PsychNet-UK.com )] {{webarchive |url=https://web.archive.org/web/20110106174809/http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm |date=January 6, 2011 }}</ref> It is a complex neuropsychological process.<ref>{{cite web |url=http://www.dissociation.co.uk/background.asp |title=Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma ) |publisher=Dissociation.co.uk |access-date=2011-11-28 |url-status=dead |archive-url=https://web.archive.org/web/20120114165147/http://www.dissociation.co.uk/background.asp |archive-date=2012-01-14 }}</ref> 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.{{citation needed|date=October 2014}} Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "[[dissociation (psychology)|dissociative]] fugue", the former implying a greater degree of "motion".{{citation needed|date=October 2014}} For the purposes of this article, then, a "fugue state" occurs while one is "acting out" a "dissociative fugue". The ''[[DSM-IV|DSM-IV{{Hair space}}]]''<ref name="DSM-IV_300.13"/> defines "dissociative fugue" 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 *significant distress or impairment The ''[[Merck Manual|Merck Manual{{Hair space}}]]''<ref name="Merck">[[Merck Manual]] 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)</ref> 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{{Hair space}}''<ref name="Merck"/> 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. == Prognosis == The [[DSM-IV-TR]] states that the fugue may have a duration from days to months, and recovery is usually rapid. However, some cases may be refractory. An individual usually has only one episode. ==Cases== *[[Shirley Ardell Mason]] (1923–1998), also known as "Sybil", would disappear and then reappear with no recollection of what happened during the time span. She recalled "being here and then not here" and having no identity of herself; it was claimed by her psychiatrist, [[Cornelia Wilbur]], that she also had [[dissociative identity disorder]]. Wilbur's diagnosis of DID was disputed by Wilbur's contemporary [[Herbert Spiegel]]. *Jody Roberts, a reporter for the ''[[Tacoma News Tribune]]'', disappeared 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 experienced a protracted fugue state.<ref>{{cite web |url=http://www.juneauempire.com/stories/071797/amnesia.html |title=Experts say that Roberts may indeed have amnesia |publisher=Juneau Empire |date=1997-07-17 |access-date=2011-11-28 |archive-url=https://web.archive.org/web/20111120191115/http://juneauempire.com/stories/071797/amnesia.html |archive-date=2011-11-20 |url-status=dead }}</ref> *David Fitzpatrick, who had dissociative fugue disorder, was profiled in the UK on [[Channel 5 (UK)|Five]]'s television series ''[[Extraordinary People (2005 TV series)|Extraordinary People]]''. He entered a fugue state on December 4, 2005, and was working on regaining his entire life's memories at the time of his appearance in his episode of the documentary series.<ref>{{cite web|url=http://five.tv/programmes/extraordinarypeople/manwithnopast/|title=Shows|work=Five}}</ref> *Hannah Upp, a teacher originally from [[Salem, Oregon]],<ref name="oregonlive1">{{cite news|author=The Associated Press |url=http://www.oregonlive.com/news/index.ssf/2008/09/missing_oregon_teacher_rescued.html |title=Update: Missing Oregon teacher rescued from Long Island Sound |publisher=OregonLive.com |date= 2008-09-16|access-date=2013-11-16}}</ref> was given a diagnosis of dissociative fugue<ref name="Aviv">{{Cite news|url=https://www.newyorker.com/magazine/2018/04/02/how-a-young-woman-lost-her-identity|title=How a Young Woman Lost Her Identity|last=Aviv|first=Rachel|date=2018-03-26|work=The New Yorker|access-date=2018-03-30|language=en|issn=0028-792X}}</ref> after she had disappeared from her [[New York City|New York]] home in August 2008 and was rescued from the [[New York Harbor]] 20 days later. News coverage at the time focused on her refusal to speak to detectives right after she was found <ref name="oregonlive1"/> and the fact that she was seen checking her email at [[Apple Store]]s while she was missing.<ref>{{cite web|url=http://gothamist.com/2008/10/05/hannah_upp_updates_her_status_remem.php|title=Hannah Upp Updates Her Status, Remembers Little|work=Gothamist|url-status=dead|archive-url=https://web.archive.org/web/20150322192925/http://gothamist.com/2008/10/05/hannah_upp_updates_her_status_remem.php|archive-date=2015-03-22}}</ref><ref>{{Cite news|last=Marx|first=Rebecca Flint|last2=Didziulis|first2=Vytenis|date=2009-02-27|title=A Life, Interrupted|language=en-US|work=The New York Times|url=https://www.nytimes.com/2009/03/01/nyregion/thecity/01miss.html|access-date=2021-11-19|issn=0362-4331}}</ref><ref>{{cite news | url=http://www.foxnews.com/story/2008/09/09/missing-new-york-city-school-teacher-spotted-in-apple-store/ | work=Fox News | title=Missing New York City School Teacher Spotted in Apple Store | date=2008-09-09 | access-date=2018-12-05 | archive-url=https://web.archive.org/web/20131222090229/http://www.foxnews.com/story/2008/09/09/missing-new-york-city-school-teacher-spotted-in-apple-store/ | archive-date=2013-12-22 | url-status=dead }}</ref> This coverage has since led to criticism of the often "condemning and discrediting"<ref name="Aviv"/> attitude toward dissociative conditions. On September 3, 2013, she went into another fugue, disappearing from her new job as a teacher's assistant{{Hair space}}<ref>{{cite web|last=Mimica |first=Mila |url=http://www.nbcwashington.com/news/local/Montgomery-Co-Woman-Reported-Missing-222271051.html |title=Md. Woman With Rare Form of Amnesia Located |publisher=NBC4 Washington |date=2013-09-05 |access-date=2013-11-16}}</ref> at Crossway Community Montessori in [[Kensington, Maryland]]. She was found unharmed September 5, 2013, in [[Wheaton, Maryland]].<ref>{{cite web |url=http://www.wusa9.com/news/article/273588/158/Missing-woman-found-in-Wheaton |title=Hannah Upp of Kensington found in Wheaton, Md. |publisher=wusa9.com |date=2013-09-05 |access-date=2013-11-16 |url-status=dead |archive-url=https://web.archive.org/web/20131213132119/http://www.wusa9.com/news/article/273588/158/Missing-woman-found-in-Wheaton |archive-date=2013-12-13 }}</ref> As of September 14, 2017, she was missing again; she was last seen near Sapphire Beach in her home in [[Saint Thomas, U.S. Virgin Islands|St. Thomas]] right before Hurricane Maria.<ref>{{cite news| url=http://www.virginislandsdailynews.com/news/community-asked-to-help-search-for-missing-teacher-hannah-upp/article_7dfc62df-1c0b-5e8c-95d3-19b4b5a5fe7b.html | work=Virgin Island Daily News | title=Community asked to help search for missing teacher Hannah Upp | date=September 19, 2017}}</ref> Three months later her mother and a group of friends were searching for her in the Virgin Islands and surrounding areas.<ref>{{Cite news|url=http://www.virginislandsdailynews.com/news/hannah-upp-s-mother-asks-for-help-in-the-search/article_c0341432-d2bd-5fa7-a4a2-1ee6e6301261.html|title=Hannah Upp's mother asks for help in the search for her missing daughter|first=Suzanne |last=Carlson|work=The Virgin Islands Daily News|access-date=2018-03-30|language=en}}</ref> *Jeff Ingram appeared in [[Denver]] in 2006 with no memory of his name or where he was from. After his appearance on national television, to appeal for help identifying himself, his fiancée called Denver police identifying him. The episode was diagnosed as dissociative fugue. As of December 2012, Ingram had experienced three incidents of amnesia: in 1994, 2006, and 2007.<ref>{{cite web|url=https://www.npr.org/2012/12/14/167187734/for-man-with-amnesia-love-repeats-itself |title=For Man With Amnesia, Love Repeats Itself |publisher=NPR |date=2012-12-13 |access-date=2013-11-16}}</ref> *[[Doug Bruce]] "came to" on a subway train claiming to have no memory of his name or where he was from, nor any identification documents. *[[Bruneri-Canella case]] (alleged reappearance of a man who had gone missing in World War I) *[[Benjaman Kyle]] *[[Agatha Christie]] is alleged to have experienced a fugue in 1926, when she went missing for a period of eleven days following a heated quarrel with her husband and was eventually found at a hotel 296 kilometers away from her home. Many have attributed this to some sort of mental breakdown, although psychologists have disagreed on whether or not Christie experienced a genuine dissociative amnesia characteristic of a fugue state. ==See also== {{Portal|Psychology}} *[[Depersonalization|Depersonalization disorder]] ([[DSM-IV Codes#Dissociative disorders|DSM-IV Dissociative Disorders]] 300.6) *[[Dissociation (psychology)|Dissociation ''(psychology)'']] *[[Dissociative disorders]] ([[DSM-IV Codes#Dissociative disorders|DSM-IV Dissociative Disorders]]) *[[Dissociative identity disorder]] (''formerly'' multiple personality disorder) ([[DSM-IV Codes#Dissociative disorders|DSM-IV Dissociative Disorders]] 300.14) *[[Dromomania]], a similar historical diagnosis *[[Psychogenic amnesia]]; dissociative amnesia (''formerly'' psychogenic amnesia) ([[DSM-IV Codes#Dissociative disorders|DSM-IV Dissociative Disorders]] 300.12) *[[Structured Clinical Interview for DSM-IV]] *''[[Lost Highway (film)|Lost Highway]]'', a film by [[David Lynch]] that explores the disorder *''[[Paris, Texas (film)|Paris, Texas]]'', a film by [[Wim Wenders]] where the protagonist ([[Harry Dean Stanton]]) portrays and must cope with the disorder ==References== {{Reflist}} == External links == {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|F|44|1|f|40}} | ICD9 = {{ICD9|300.13}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }} *"[http://www.merck.com/mmhe/sec07/ch106/ch106c.html Dissociative Fugue]" from the [[Merck & Co.]] website. {{Mental and behavioral disorders|selected = neurotic}} {{Authority control}} [[Category:Dissociative disorders]] [[Category:Memory disorders]] [[Category:Symptoms and signs of mental disorders]]'