Definition and Diagnosis
Dissociative fugue involves apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or other important autobiographical information; in DSM-5-TR it is classified as a specifier of dissociative amnesia rather than a fully separate diagnosis, reflecting its close relationship to that condition.
Epidemiology
Dissociative fugue is rare, typically arising in the context of severe stress, trauma, or, in some cases, a natural disaster or combat exposure, and precise prevalence is difficult to establish given its infrequency.
Risk Factors
Risk factors include exposure to overwhelming trauma or stress (such as combat, disaster, or personal crisis), a history of prior dissociative episodes, and, in some cases, co-occurring mood or substance use disorders.
Symptoms and Subtypes
The individual may travel unexpectedly away from home or work, sometimes assuming a new identity, with amnesia for their prior identity or the period of the fugue itself; the episode is often followed by distress or confusion once it resolves.
Diagnosis
Diagnosis is based on clinical history documenting sudden travel or wandering associated with identity or memory disturbance, with careful exclusion of substance use, seizure disorders, or other medical or neurological causes of the episode.
Treatment
Treatment focuses on ensuring safety, gradual reorientation and stabilization, and subsequent trauma-focused psychotherapy addressing the underlying stress or trauma once the acute episode has resolved.
Prognosis
Most fugue episodes are brief, resolving over hours to days, though some can last longer; prognosis for the underlying dissociative vulnerability depends on adequate treatment of the associated trauma and stressors.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).