Dissociative Fugue

What Causes Dissociative Fugue?

Dissociative fugue and dissociative amnesia are thought to be reactions to traumatic experiences or circumstances in the sufferer’s life. Dissociation offers the only way to escape from the trauma.

Some common triggers for dissociative fugue and dissociative amnesia include:

• Physical abuse
• Sexual abuse and rape
• Violent crime
• Combat
• Death of a loved one
• Financial stress
• Interpersonal conflict

Dissociative fugue can occur when someone experiences one or more of these triggers directly, or it may happen even to witnesses of traumatic events. In addition, a fugue state or dissociative episode sometimes may be triggered by the memory of past trauma.

Is Dissociative Fugue Hereditary?

Most types of amnesia, both neurological and dissociative, are caused by injury, disease, or external factors. Because the memory loss stems from some external event acting upon the brain’s memory centers, it would seem there is no apparent link between family history and the risk of developing amnesia. However, there is evidence that some people may inherit a tendency to develop dissociative amnesia when exposed to traumatic experiences.

Researchers have identified a particular gene variation that appears to make people more susceptible to post-traumatic stress disorder (PTSD) or depression after experiencing a traumatic event. The results of one study also suggested the gene may also increase the risk of trauma-associated memory loss.

How Is Dissociative Fugue Detected?

People in a dissociative fugue state often do not give external clues that they are experiencing a dissociative episode. Warning signs that someone might have entered a dissociative fugue include:

• Confusion
• Loss of memory about their past
• Inability to recognize familiar people
• Absence of emotion
• Wandering
• Missing work, school, or other commitments

How Is Dissociative Fugue Diagnosed?

The diagnostic process for dissociative fugue includes identifying or ruling out neurological problems that might be causing memory loss.  This process includes the following:

• Medical history. The doctor will ask questions about the nature of the memory loss, including when it began, whether it has changed over time, and whether other cognitive symptoms have coincided. In addition, they will look for signs of neurological or psychological triggers and a possible family history of related conditions.
• Physical exam. The physical exam will include neurological function tests, including reflexes, balance, strength, vision, and hearing.
• Cognitive exam. This exam will include logic, reasoning, judgment, and short- and long-term memory tests.
• Laboratory tests. Blood tests will look for signs of infection, vitamin deficiencies, drug abuse, and other blood chemistry abnormalities.
• Electroencephalogram (EEG). This test monitors your brain’s electrical activity and can help detect abnormalities in brain function.
• Imaging tests. Magnetic resonance imaging (MRI) and computed tomography (CT) scans can detect problems such as brain tumors, bleeding, swelling, and brain damage.

If the problem seems to be dissociative amnesia, the doctor will compare symptoms to the diagnostic requirements for that disorder:

• The memory loss affects the recall of important information and is more severe than typical forgetfulness.
• The memory loss interferes with daily functioning and/or causes significant distress to the patient.
• Other neurological or psychiatric disorders can’t explain the memory loss.

How Is Dissociative Fugue Treated?

Treatment for dissociative fugue can include:

• Psychotherapy. Sessions with a professional therapist can help the sufferer address the traumatic source of the amnesia and learn to cope with its effects.
• Cognitive Behavioral Therapy (CBT). This type of psychotherapy helps the sufferer develop strategies to counter harmful thoughts and behaviors.
• Hypnosis. Clinical hypnosis aims to help the sufferer, through relaxation techniques, possibly recover lost memories and stop ongoing memory loss.
• Meditation and alternative therapies.
• Medication. Medications may be used to treat depression or anxiety if they are present in conjunction with amnesia.

How Does Dissociative Fugue Progress?

Dissociative fugue can sometimes resolve quickly, and the sufferer can regain lost memories. In other cases, the memory loss may be permanent. The likelihood of a good outcome often depends on whether or not the sufferer can successfully deal with the traumatic circumstances that triggered the amnesia.

How Is Dissociative Fugue Prevented?

There is no known way to prevent the onset of dissociative fugue directly. The best strategy for preventing the condition is to seek treatment from a mental health professional to address traumatic experiences before the disorder emerges.

Dissociative Fugue Caregiver Tips

If your loved one suffers from dissociative fugue or dissociative amnesia, coping with the disorder’s effects can lead to frustration, confusion, and even depression. Keep these tips in mind to best support your loved one and maintain your own mental health.

• Accompany your loved one to all medical appointments. Because of the very nature of amnesia, you might be better equipped than your loved one to answer questions and retain medical advice.
• Provide a safe, secure, stress-free environment where your loved one will have the best chance of recovery.
• Take advantage of other family members, friends, and your community to care for your loved one. Don’t try to take on the entire responsibility for caregiving by yourself.
• Seek out a support group. It can be beneficial to talk to others who are in your situation.

Many people with dissociative amnesia also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with dissociative amnesia:

• People with amnesia often suffer from depression or anxiety.
• Dissociative amnesia is sometimes comorbid with obsessive-compulsive disorder.
• Many people with dissociative amnesia also have personality disorders, particularly cluster B disorders such as borderline personality disorder or cluster C disorders like avoidant personality disorder.

Dissociative Fugue Brain Science

Dissociative fugue is considered a disorder with a psychological origin (psychogenic) because there is no physical cause (injury, illness, or neurological disease) for the symptoms. However, that does not mean that there is no neurological explanation for what is going on in the brains of people in a dissociative fugue.

Scientists are looking for patterns in brain function or structure that might help explain the neurological mechanism of dissociation. Areas of research include:

• Dissociation may be a product of disrupted communication between the parts of the brain that process emotional responses (amygdala, hippocampus, and other parts of the limbic system) and the region involved in our rational thought (the prefrontal cortex).
• People who are susceptible to dissociation may “over-regulate” their emotions. In these cases, parts of the brain responsible for emotion, such as the amygdala, are suppressed in favor of the less-emotional prefrontal cortex.
• The brains of some people with dissociative disorders may have reduced volume in the amygdala and hippocampus and increased volume in structures such as the prefrontal cortex.

Dissociative Fugue Research

Title: fMRI in Posttraumatic Stress Disorder (PTSD) During Working Memory Updating (METRAPI)

Stage: Completed

Principal Investigator: Wissam El Hage, MD, PhD   

University Hospital

Tours, France

Neuropsychological studies investigating trauma-exposed and post-traumatic stress disorder (PTSD) subjects have generally underlined the significantly poorer performance of tasks requiring attention, concentration, verbal memory, and difficulty regulating memories surrounding the traumatic event. A previous study (El Hage et al. Cognitive Neuropsychiatry, 2006) revealed that the trauma-exposed subjects scored higher on anxiety/depression scales and lower on processing speed tests. Moreover, the study showed significant impairment in working memory partially mediated by speed processing but not by anxiety or depression. These results suggest that processing speed makes a major contribution to trauma-related working memory decline and needs to be investigated in further studies. The present study aims to explore the correlation between hippocampus volume, frontal dysfunction, and cognitive slowing in trauma-exposed subjects while examining brain activation during the performance of working memory tasks using functional magnetic resonance.

Working memory performance will be assessed using the “3-back test”, and processing speed evaluated with the “words comparison test.” The study will be conducted in 2 years. The study should include 18 right-handed female victims of sexual abuse and suffering from PTSD, and 18 controls right-handed females without any history of abuse ad not suffering from PTSD. Brain activation will be measured during the performance of working memory tasks (3-back test) and processing speed test using functional magnetic resonance.

Title: Mechanistic Interventions and Neuroscience of Dissociation (MIND)

Stage: Recruiting

Principal Investigator: Negar Fani, PhD   

Grady Hospital

Atlanta, GA

The purpose of this study is to test the neurophysiological mechanisms of an intervention to reduce symptoms of dissociation in traumatized people. The intervention will be tested in dissociative traumatized people at Emory University and the University of Pittsburgh. The researchers are interested in whether neural networks associated with attentional control and interoceptive awareness can be enhanced in this population. The researchers propose to evaluate whether different body-focused and non-body-focused interventions can change these mechanisms.

People exposed to chronic trauma face devastating effects on the brain and body. Chronically traumatized people become highly distressed when attending to emotional stimuli, leading to feelings of detachment from their bodies and environment. It is difficult to engage highly dissociative traumatized patients in trauma-focused treatment; however, these patients benefit from acquiring basic emotion regulation skills, including present-centeredness and body awareness. Various practices that involve present-centeredness and body awareness (including mindfulness-based interventions) have been shown to demonstrate short-term and long-term improvement in cognition, emotion regulation, and clinical symptoms in dissociative people with trauma exposure.

The researchers will evaluate the effectiveness of interventions that engage present-centered awareness and/or body focus to address this issue.

Title: Dissociation Investigation Study in Sex Offenders (DISSO)

Stage: Recruiting

Principal Investigator: Mouchet-Mages Sabine, PH   

Centre Hospitalier Le Vinatier

Bron, France

Adverse childhood experiences have been described in sexual offenders, but the link with the offense needs further investigation. Investigators postulate that one of the clinical moderating factors could be dissociative experience, a consequence of these early adverse experiences reactivated during the offense. The purpose of the study is to estimate the prevalence of clinical dissociation during the offense in a male adult population referred to our center for a sexual offense and to explore its correlations with epidemiological and clinical data (personal, legal history, psychiatric co-morbidities), clinical trauma and dissociation, prognosis estimates.

The study will be proposed to the subjects after their usual clinical evaluation in the center for a sexual offense and extend this evaluation by focusing on childhood abuse and neglect trauma and dissociative history. After receiving complete information, the participants will sign the consent form and be referred to a unique on-site visit of approximately 2 hours long. During this visit, the participants will benefit from a psychiatric examination in search for clinical features of dissociation during the offense, lifetime dissociative experience, lifetime post-traumatic stress disorder; they will have to complete bio-evaluation forms for dissociation (Dissociative Experience Scale) and childhood abuse and neglect (Childhood Experience of Care and Abuse). After this completion, they will benefit from a second part of the psychiatric examination to complete the assessment and answer their questions.