Fugue state

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Fugue state
Classification and external resources
ICD-10F44.1
ICD-9300.13
 
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For the New York City-based publisher, see Fugue State Press.
Fugue state
Classification and external resources
ICD-10F44.1
ICD-9300.13

A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13[1]), 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.

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 psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (dissociative amnesia).

Clinical definition[edit]

The etiology of the fugue state is related to dissociative amnesia, (DSM-IV Codes 300.12[2]) which has several other subtypes:[3] 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).[4] It is a complex neuropsychological process.[5]

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:

The Merck Manual[6] 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[6] 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.

Diagnosis[edit]

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 psychologic 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.

Symptoms[edit]

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.[7]

Prognosis[edit]

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 only has a single episode.

Media examples[edit]

In popular culture[edit]

Television[edit]

In the TV show Archer, season 4, episode 1, Archer experiences amnesia and works at Bob's Burgers.

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 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. This occurs in the second episode of a five-episode plot arc; she loses the Wanda Detroit identity at the end of the third episode, but she does not fully recover her own true identity, personality, and memory until late in the fifth episode. (This arc was not popular with the audience and may have permanently damaged the show's ratings. In the teaser of an early fourth season episode, the show joked about this by having Lois hit her head on a kitchen cabinet door and then pretend to have amnesia, with Clark Kent responding, in a tone of desperate frustration, "No, no, no!", before she said to him, "Just kidding!")

Books[edit]

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

Short stories[edit]

In the Norwegian folktale "Gidske", 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 aliens.

Film[edit]

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

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.

Video games[edit]

In the game Assassin's Creed 3 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.

See also[edit]

References[edit]

  1. ^ a b c Dissociative Fugue (formerly Psychogenic Fugue) ( DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  2. ^ "Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )". Psychiatryonline.com. Retrieved 2011-11-28. 
  3. ^ Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com )[dead link]
  4. ^ Complete List of DSM-IV Codes ( PsychNet-UK.com )[dead link]
  5. ^ "Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )". Dissociation.co.uk. Retrieved 2011-11-28. 
  6. ^ a b Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
  7. ^ The Merck Manual
  8. ^ Adams, Cecil, Why did mystery writer Agatha Christie mysteriously disappear? The Chicago Reader, 4/2/82. [1] Accessed 5/19/08.
  9. ^ "Real 'Sybil' Admits Multiple Personalities Were Fake". NPR. 2011-10-20. 
  10. ^ "Experts say that Roberts may indeed have amnesia | Juneau Empire - Alaska's Capital City Online Newspaper". Juneau Empire. 1997-07-17. Retrieved 2011-11-28. 
  11. ^ The Man With No Past
  12. ^ a b The Associated Press (2008-09-16). "Update: Missing Oregon teacher rescued from Long Island Sound". OregonLive.com. Retrieved 2013-11-16. 
  13. ^ http://gothamist.com/2008/10/05/hannah_upp_updates_her_status_remem.php
  14. ^ "A Life, Interrupted". The New York Times. 2009-03-01. 
  15. ^ "Missing New York City School Teacher Spotted in Apple Store". Fox News. 2008-09-09. 
  16. ^ http://techcrunch.com/2008/09/10/everyone-is-drawn-to-the-apple-store-including-a-missing-teacher/
  17. ^ Rovzar, Chris. "Hannah Upp Mystery Still Deepening - Daily Intelligencer". Nymag.com. Retrieved 2013-11-16. 
  18. ^ Mimica, Mila (2013-09-05). "Md. Woman With Rare Form of Amnesia Located". NBC4 Washington. Retrieved 2013-11-16. 
  19. ^ "Hannah Upp of Kensington found in Wheaton, Md.". wusa9.com. 2013-09-05. Retrieved 2013-11-16. 
  20. ^ "A Life, Interrupted". The New York Times. 2009-03-01. 
  21. ^ "For Man With Amnesia, Love Repeats Itself". NPR. 2012-12-13. Retrieved 2013-11-16. 

External links[edit]