Fugue state

Dissociative fugue, formerly fugue state or psychogenic fugue, is a DSM-5 Dissociative Disorder.^[1] It is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality. The state is usually short-lived (ranging from hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. It is no longer its own classification or diagnosis as it was in the DSM-IV, but now a facet of Dissociative Amnesia according to the DSM-5.

After recovery from fugue, previous memories usually return intact, but there is typically amnesia for the fugue episode. 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 other psychiatric conditions such as dissociative identity disorder, delirium, or dementia.^[2] Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (dissociative amnesia).

Signs and symptoms

Symptoms of a dissociative fugue include mild confusion, and once the fugue ends, possible depression, grief, shame and discomfort. People have also experienced a post-fugue anger.^[3]

Diagnosis

A doctor may 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 carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychological examination is also done.

Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. 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.

Definition

The cause of the fugue state is related to dissociative amnesia, (DSM-IV Codes 300.12^[4]) which has several other subtypes:^[5] Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.^[1]

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 Codes 294.0).^[6] It is a complex neuropsychological process.^[7]

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.

Therefore, the terminology fugue state may carry a slight linguistic distinction from Dissociative Fugue, the former implying a greater degree of motion. For the purposes of this article then, a fugue state would occur while one is acting out a Dissociative Fugue.

The DSM-IV defines^[1] 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, or
• significant distress or impairment.

The Merck Manual^[8] 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^[8] 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 hours to months, and recovery is usually rapid. However, some cases may be refractory. An individual usually has only one episode.

Society and culture

• Agatha Christie disappeared on 3 December 1926 only to reappear eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span.^[9]
• Shirley Ardell Mason also known as "Sybil" would disappear and then reappear with no recollection of what happened during the time span. She recalls "being here and then not here" and having no identity of herself; it should be noted that it is claimed she also suffered from what was formerly called "Multiple Personality Disorder."
• 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 suffered a protracted fugue state.^[10]
• David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Five's television series Extraordinary People. He entered a fugue state on December 4, 2005, and is still working on regaining his entire life's memories.^[11]
• Hannah Upp, a teacher originally from Salem, Oregon,^[12] who was living in New York at the time of her disappearance, disappeared on August 28, 2008. She was rescued after she jumped into the New York Harbor on September 16. She underwent a psychiatric evaluation and refused to speak to detectives.^[12] Upp was seen checking her email four times at Apple Stores while she was missing.^{[13][14][15][16]} She later claimed to have no recollection of the time in between. Upp claimed that the episode was diagnosed as dissociative fugue.^[17] On September 3, 2013, she disappeared from her new job as a teacher's assistant^[18] at Crossway Community Montessori in Kensington, Maryland. She was found unharmed September 5, 2013 in Wheaton, Maryland.^[19][20]
• 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 Penny called Denver police identifying him. The episode was diagnosed as dissociative fugue. Jeff has experienced three incidents of amnesia: in 1994, 2006, and 2007.^[21]
• Doug Bruce "came to" on a subway train with no memory of his name or where he was from, nor any identification documents.
• Bruneri-Canella case
• Benjaman Kyle

Television

In the TV series Scandal, the character Quinn allegedly is in a dissociative fugue state in season two following the establishment of her new identity.

In the TV series One Tree Hill, the character Clay suffers a fugue state in season nine.

In the TV series Breaking Bad, the character Walter White fakes a fugue state to cover up his kidnapping at the hands of his drug distributor Tuco.

In the TV series Under the Dome, the character Sam mentions that his nephew Junior's mother experienced fugue when Junior admits that he experienced blackouts.

In the TV series Teen Wolf, the character Lydia suffers a fugue state in season two following being bitten by a werewolf.

In the TV series Doctor Who, the character in the 2008 Christmas special, "The Next Doctor," Jackson Lake suffers a fugue state after witnessing the death of his wife by a Cyberman attack.

In the TV series Bates Motel, the character Norman Bates suffers fugue state episodes in which he can react violently to a stressor including attempt to kill but has no memory of it when he recovers from it.

In the TV series The Mentalist, the character Patrick Jane suffers a fugue state after nearly drowning.

In the third season of the TV series Lois and Clark: The New Adventures of Superman, Lois Lane goes into a dissociative fugue as a result of suffering a blow to the head while escaping from Lex Luthor, who had kidnapped her. Initially, in her fugue state she takes on the personality of Wanda Detroit, a fictional lounge singer from her novel.

In the TV show Drop Dead Diva, a client named Daniel Porter experienced a nine-year fugue state after a single engine plane crash and now seeks shared custody of his son, Noah.

In the television series Rizzoli & Isles, a season five episode titled "...Goodbye", has Jane, Maura, and the squad dealing with the case of young woman who has a dissociative fugue episode where she believes she has killed someone. The character named "Jessica" by Maura does not remember anything about the murder but does remember that she likes the Red Sox and who her favorite player is. The character's memory is jogged by the realisation that she did not commit the murder of her significant other.

Books

In Perks of Being a Wallflower, Charlie, the main character, goes into a fugue state after taking LSD.

In John O'Farrell's The Man Who Forgot His Wife (16 March 2012) (2012, Doubleday, ISBN 978-0-385-60610-3 (11 October 2012) Black Swan ISBN 978-0-552-77163-4, Vaughan the main character is in a Fugue State

In Walker Percy's novels The Last Gentleman and The Second Coming, the main character Will Barrett is referred to as suffering repeated fugue states, leading eventually to his diagnosis with the fictional disorder ″Hausmann's Syndrome.″

Short stories

In the Norwegian folktale "Gidske,"^[22] collected by Asbjørnsen and Moe, the eponymous heroine goes into what appears to be a fugue state after a humiliating experience of rejection by her master, for whom she has had romantic feelings.

In the short story The Shadow Out of Time by H. P. Lovecraft, the character Nathaniel Wingate Peaslee awakens after years of being the victim of an "identity swap" with a member of an ancient race of gods.

Film

Dissociative fugue affects many characters in David Lynch films with the most explicit example being the protagonist of Lost Highway.

In the film "Altered States" (1980) William Hurt's character Dr Edward Jessup emerges from a sensory deprivation tank/drug experience bloodied and aphasic and is misdiagnosed as having entered a fugue state post seizure in the tank. Jessup actually experienced a transient de-differentiation of his genetic structure and temporarily regressed into a mute "quasi-simian" creature complete with structural changes to his vocal chords.

In the year 2000 film Nurse Betty, Renée Zellweger's character Betty witnesses the murder of her husband and experiences a fugue state.

In the film (and book) Perks of Being a Wallflower, Charlie, the main character, undergoes a fugue state.

In the film and book Bourne Identity, the protagonist Jason Bourne enters a fugue state after being shot.

In the 2015 film 88 (film), Katharine Isabelle's character, Gwen, enters a fugue state following the death of her lover.

In the 1984 film "Paris, Texas, Travis Henderson, the main character, undergoes a fugue state.

Video games

Cloud Strife from Final Fantasy VII entered a trauma-induced fugue state after witnessing the death of Zack Fair (as shown in the game Crisis Core: Final Fantasy VII). He took on Zack's identity and forgot his own memories and identity until later in the story.

In the video game Assassin's Creed III, the character Desmond Miles experiences a fugue state upon first entering the Animus.

In the prologue of the game Gothic 2 the main character experiences a fugue state after the destruction of the protecting shield of the penal colony.

Music

In 2014, Vulfpeck, a funk instrumental group, released the album "Fugue State."

In 2012, PelleK, a power metal vocalist released the album "Bag of Tricks," which contains the song: "Fugue State"

See also

• Structured Clinical Interview for DSM-IV
• Dissociative Disorders (DSM-IV Dissociative Disorders)
• Dissociative Identity Disorder (formerly Multiple Personality Disorder) (DSM-IV Dissociative Disorders 300.14)
• Psychogenic amnesia; Dissociative Amnesia (formerly Psychogenic Amnesia) (DSM-IV Dissociative Disorders 300.12)
• Depersonalization Disorder (DSM-IV Dissociative Disorders 300.6)
• Dissociation (psychology)

References

External links

• "Dissociative Fugue" from the Merck & Co. website.