Dissociative Fugue

1
Dissociative Fugue
Formerly Psychogenic Fugue (Presented by Erica
Miller and Marisa Rennie)
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Dissociative Fugue

• Dissociation disturbance in normally integrative
  functions of identity, memory, or consciousness.
  (Turkus)
• Fugue sudden onset of wandering with clouding of
  consciousness and amnesia for the event.
  (Davidson/Neale)
• Dissociative Fugue disturbance in memory travel
  to new location and assumption of new identity.
  (Turkus)
• Brief new identity less crystallized
• typically follows severe stress
• upon recovery, individual has no memory of events
  of fugue

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Historical Background

• Originally referred to as psychogenic fugue
• DSM-I dissociative reaction
• represents wide variety of symptoms that reflect
  personality disorganization
• DSM-II dissociative symptoms a subtype of
  hysterical neurosis
• DSM-III separate category
• DSM-IIIR criteria for fugue listed in Table I

4
Specific Culture Features

• Running syndromes in various cultures
• characterized by sudden onset of high level of
  activity, trancelike state, potentially dangerous
  behavior in form of running or fleeing,
  exhaustion, and amnesia for the episode
• pibloktoq Arctic
• grisi siknis Miskito of Honduras and Nicaragua
• Navajo frenzy witchcraft
• amok Western Pacific

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Diagnosis

• DSM-IV Criteria
• sudden, unexpected travel away from home or ones
  customary place of work, with inability to recall
  ones past
• confusion about personal identity or assumption
  of new identity
• doesnt occur exclusively during the course of
  DID and isnt due to direct physiological effects
  of a substance or a general medical condition
• symptoms cause clinically significant stress or
  impairment in social, occupational, or other
  areas of functioning

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Diagnosis

• Dissociative disorders in general (Turkus)
• clinical interview
• awareness of existence of childhood trauma
• high prevalence of physiological symptoms
  (Berkowitz et al)
• gastrointestinal
• pain
• cardiopulmonary
• conversion

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Etiology

• Most clinicians describe dissociation on a
  continuum of severity
• Studies focus on adolescents and adults.
• prevelance rate of .2 in general population
• prevelance of dissociation in children unknown
• evidence supports onset of dissociative disorders
  in childhood
• Abuse/trauma
• (Richardson)

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Etiology

• Fugue often associated with circumstances that
  raise suspicion of malingering (Hales et al)
• Fugue states occur in a wide variety of
  psychiatric disorders
• highly suggestible traits
• capacity to use major repression and escape as
  coping style (Ford)

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Treatment

• Psychodynamic/cognitive psychotherapy facilitated
  by hypnotherapy
• Stage one assessment
• history (what happened to you?)
• sense of self (how do you feel about yourself?)
• symptoms (e.g. depression, anxiety, etc.)
• safety (of self, to and from others)
• relationships/social support system
• family history
• medical status (Turkus)

10
Treatment

• Stage two Therapist and client develop plan for
  stabilization
• contracts to ensure physical emotional safety
• developing cognitive framework
• undoing damaging self-concepts
• learning about what is normal
• (Turkus)

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Treatment

• Stage three Revisiting/reworking trauma
• abreactions reexperiencing traumatic event along
  with release of related emotion and recovery of
  repressed aspects of that event
• hypnosis
• contains abreactions
• releases painful emotions more quickly
• (Turkus)

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Treatment

• Stage four Further processing of traumatic event
• creative energy released
• claim self-worth and personal power (Turkus)
• Psychotherapy - anamnesis
• talk about that which is remembered
• memory association fills in gaps (Ford)

13
Ethical Considerations

• A lack of control groups of untreated children
  creates difficulties in allowing treatment of
  children, but treatment can not be denied them.
• Confidentiality issues arise when etiology of
  disorder is suspected to be related to abuse.
  (Richardson)

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Prognosis

• Onset usually related to trauma
• Episodes may last from hours to months
• 1/2 of all fugues last less than 24 hours (Pies)
• Fugue may be accompanied by depression,
  dysphoria, psychological stress, suicidal and
  aggressive impulses.
• Extent and duration of fugue may determine degree
  of other problems
• loss of employment
• disruption of personal/family relationships

references
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(Braun)