Dissociative Fugue: Definition, Symptoms & Treatment

What is Dissociative Fugue?

Dissociative fugue, previously called psychogenic fugue, is a state in which individuals travel away from home, experience an inability to recall important personal information, and may create a new identity. This can last from a few hours to several months. Individuals have no recollection of what happened during the fugue state after they come out of it, though this memory can be recovered. Onset is sudden and is usually related to trauma or stress.³ Dissociative fugue falls under the category of dissociative disorders, which are a group of disorders that involve disturbances in the integration of consciousness, memory, identity and emotion.

In the DSM-5, dissociative fugue is a subtype of dissociative amnesia, though it was previously diagnosed as a disorder in itself. Dissociative amnesia is the most common of the dissociative disorders, though the occurrence of dissociative amnesia with fugue (going away from home) is rare.¹ Other dissociative disorders include dissociative identity disorder and depersonalization/derealization disorder.

How Long Does a Dissociative Fugue Episode Last?

The word fugue is Latin for “flight.” During dissociative fugue, individuals engage in “purposeful travel or bewildered wandering” that can last for hours, days, weeks, or months. Additionally, they experience reparable memory loss during the fugue state.^{1, 2} Though some people realize they have “lost time” right away, individuals are typically unaware of their memory loss until it is brought to their attention, described as “amnesia for their amnesia”.¹

Dissociative Fugue Symptoms

Symptoms during a dissociative fugue state may vary, but common trends are present both during and after the episode.

Common symptoms that may occur during a dissociative fugue episode:

• Loss of personal identity: Individuals will not recall important autobiographical information, including their name, job, or address
• Inability to recognize people: Individuals will not recognize family, friends, or pets who they would normally know well.
• Wandering or traveling: Individuals may wander aimlessly down the street, or travel purposefully for thousands of miles.⁴
• Loss of memory: Individuals won’t remember what happened during the fugue state once it is over. Memory for what happened during that time may be retrieved with psychotherapy.

Symptoms following a dissociative fugue episode may include:

• Feelings of sadness: After returning to a pre-dissociative state, individuals may have to face the stress or trauma that precipitated the dissociative fugue in the first place. This is likely to bring up a range of emotions including sadness.
• Feelings of shame: individuals who cannot remember how they have behaved for the past few hours, days, weeks, or even months may feel shame and worry about not being able to recall their actions.
• Feelings of anxiety: A person may feel anxious for having neglected their responsibilities, such as going to work.
• Feeling as if you have “lost time”: Some people may realize immediately that there is a gap in their memories. Others may not realize this until they discover proof that events have happened which they cannot recall.¹
• Confusion: Individuals who have traveled away from home with no memory of how they got to their new location may feel confused, unsettled, and even frightened when they emerge from dissociative fugue

What Causes Dissociative Fugue?

Dissociative fugue often takes place after a traumatic or stressful event. A history of child abuse is often associated with dissociative amnesia and dissociative fugue.⁴ Predisposing factors for dissociative reactions may also include “neuropsychological cognitive dysfunctions and genetic factors”.⁴

Possible events related to dissociative fugue include:

• Sexual assault
• Extreme financial distress
• Threats to personal safety, e.g., homelessness
• Childhood sexual abuse
• Witnessing violence, e.g., war or combat
• Extreme emotional distress, e.g., life-threatening illness of a loved one

Related Disorders

Dissociative fugue can be diagnosed as a subtype of dissociative amnesia, and is common in dissociative identity disorder. Additionally, dissociative fugue can present comorbidly with other disorders, including Post-Traumatic Stress Disorder.

Dissociative fugue may be present in:

Dissociative Amnesia

Dissociative amnesia involves the inability to recall information about oneself, typically related to trauma or stress. It does not occur due to normal forgetfulness, substance use, or neurological conditions.¹ Amnesia may be localized (to a period of time), selective (to a particular event) or, in rare cases, generalized (to one’s identity or history). Memory loss is retrograde and does not affect the ability to make new memories.³ Individuals may experience dissociative fugues when diagnosed with this condition.

Dissociative Identity Disorder

Dissociative identity disorder relates to the disruption of identity, marked by the presence of two or more distinct personality states. Dissociative fugues occur more frequently in dissociative identity disorder than in dissociative amnesia, with individuals frequently ending up in situations or places with no recollection of how they got there.¹ For example, an individual may end up at the mall or at work with no memory of how she got there.

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) may present with comorbidities of dissociative amnesia and dissociative fugue.² PTSD is a trauma-related disorder characterized by intrusive memories, avoidance, changes in thinking or mood, and changes in arousal or reactivity.

How is Dissociative Fugue Diagnosed?

Diagnosis of dissociative fugue typically occurs after the event, as many don’t realize they’re experiencing it until it ends. However, before dissociative fugue is diagnosed, medical and neurological evaluations are done to rule out other possibilities. Substance use, head injuries, dementia, schizophrenia, brain tumors, or seizures may cause similar signs to dissociative fugue and must be ruled out.⁴ To do so, magnetic resonance imaging (MRI) or computed axial tomography (CAT) may be performed, as well as a electroencephalogram (EEG) to rule out seizure activity.

Dissociative Fugue Treatment

A combination of therapeutic methods may be used to address the underlying trauma/causes of a dissociative fugue episode. Additionally, psychiatric medications may be used to treat comorbid conditions such as depression and anxiety.

Therapy methods for treating dissociative fugue may include:

• Family therapy: Family therapy can help bolster an individual’s support network, and can also help with retrieving memories². Family members can learn how to help reduce the patient’s overall stress, so that future episodes are less likely.
• Group therapy: Group therapy can help individuals learn skills to manage symptoms, and can create a feeling of community for clients.
• Hypnosis: Hypnosis can be helpful with retrieving memories.²
• Trauma informed therapy: When individuals are ready to address trauma that precipitated dissociative fugue, trauma informed therapy can be beneficial.
• Individual psychotherapy: Individual therapy can help clients process the stress leading up to dissociative fugue and the symptoms that emerge afterwards, as long as clinicians are mindful of potential re-traumatization.²

How to Cope With Dissociative Fugue

If you have experienced dissociative fugue, some self-coping strategies can help manage the symptoms that follow an episode.

Strategies for recovering from a dissociative fugue episode, and managing stress to prevent future episodes, include:

• Journaling: Journaling can help you process some of the emotions you may experience, and overcome them, rather than get stuck and allow them to become overwhelming.
• Practicing self-care: Taking care of yourself by getting enough sleep, exercising and spending time with friends and family can help decrease your vulnerability to experiencing difficult emotions that are long-lasting and intense.
• Joining a support group: Joining a support group, like the National Alliance on Mental Illness, can help you feel less alone in your journey in understanding your mental health.
• Mindfulness: Using mindfulness practices, such as breathwork; counting colors or objects; practicing a daily loving kindness meditation; or focusing on your five senses can help ground you in the present moment when your mind is worried.
• Seeking out positives: Taking time to schedule activities that you enjoy in the short and long term can help you start to cultivate more positive emotions. Using mindfulness to be fully present during these experiences will make them even more beneficial.

How to Help Someone Experiencing Dissociative Fugue

If a loved one has experienced dissociative fugue, you can help them by offering open-ended support, attending therapy with them, and connecting them to resources. Assisting them with managing stress can help prevent a future episode.⁴

You can help your loved one who has experienced dissociative fugue by:

• Offering support: Rather than making assumptions, asking your loved one what they need from you and how you can help is often a great first step.
• Attending therapy sessions with them: If they agree to it, attending family therapy with a loved one can make them feel supported and less alone.
• Connecting them to resources: If they request it, helping a loved one find a support group, or a trauma-informed therapist can be a great way to assist them if they are feeling overwhelmed.

Final Thoughts

Whether individuals seek out psychotherapy to address the trauma and/or stressors that precipitated dissociative fugue, or medication to alleviate symptoms following it, relief is possible. Enlisting the help of supportive friends and family members can be especially beneficial in restoring a sense-of-self and lost memories. In addition, self-coping strategies can be used to assist in recovering from a dissociative fugue and preventing future episodes.