Fugue (FYOOG) refers to a psychiatric condition in which people wander or travel and may appear to be functioning normally, but they are unable to remember their identity or details about their past.
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Sigmund Freud, one of the fathers of modern psychiatry, believed that the mind has defense mechanisms, or built-in ways of experiencing reality, that prevent it from being overwhelmed by worry or depression * . In fact, Freud believed that people are not even aware of the way their minds take care of them. Dissociation (di-so-see-AY-shun) is a defense mechanism that allows people to separate or "go away from" thoughts, memories, emotions, or events that are highly stressful. This separation helps people successfully cope with situations that would otherwise be intolerable. With dissociation, people can "daydream" themselves away from their troubles or even develop a separate personality to cope with terrible life events.
Fugue, sometimes called dissociative (dis-SO-see-a-tiv) or psychogenic (sy-ko-JEN-ic) fugue, is an uncommon dissociative disorder. Fugue is thought to be caused by the inability to cope with a severe long-lasting stress or conflict. People with dissociative fugue not only mentally "go away from" an intolerable situation through a dissociation defense mechanism, they actually remove themselves physically from the situation by wandering away from home and either partially or completely assuming a new identity. To be diagnosed with fugue, the wandering and memory changes must not be caused by substance abuse, medications, or other psychiatric disorders such as dissociative identity disorder * .
* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, an d discouragement.
* dissociative identity disorder(DID), formerly known as multiple personality disorder (MPD), is a severe psychiatric condition in which a person has two or more distinct sub-personalities that periodically take control of his or her behavior. The sub-personalities are thought to be caused by repeated episodes of an extreme form of dissociation.
How Do People with Fugue Function?
People diagnosed with fugue unexpectedly travel or wander away from home, work, or familiar places. They may take on new identities, enter new occupations, or develop new interests and hobbies. The degree of fugue can vary from mild to severe and may last anywhere from several hours to years. One study suggests that about half of all fugues last less than 24 hours.
People diagnosed with fugue are often able to perform complex activities and appear to be normal. People with fugue appear to be oriented and to have intact mental functions. However, when questioned, people with fugue are confused about their identity and their past. Some people experience fugue along with other psychiatric disorders such as schizophrenia * , which makes the diagnosis of fugue more difficult.
Do Other Conditions Resemble Fugue?
People with Alzheimer disease * also may wander away from home and lose touch with who they are. This condition, which is believed to be caused by a physical breakdown in the functioning of the brain, is different from dissociative fugue.
Some people who have temporal lobe epilepsy * may have periods of undirected wandering. Neurologists (doctors who study the brain and nervous system) can generally distinguish symptoms that are caused by damage to the brain from those caused by psychological trauma. Drug abuse can also cause fugue-like periods, but these are not considered true dissociative fugue.
* schizophrenia (skitz-o-FREE-nee-ah) is a serious mental disorder that causes people to experience hallucinations, delusions, and other confusing thoughts and behaviors, which distort their view of reality.
* Alzheimer disease (ALZ-hy-mer)is a condition that leads to a gradually worsening loss of mental abilities, including memory, judgment, and abstract thinking, as well as changes in personality.
* temporal lobe epilepsy (EP-i-lep-see), also called complex partial epilepsy, is a form of epilepsy that affects the part of the brain that is located underneath the sides of the head, near the ears. Epilepsy is a condition of the nervous system characterized by recurrent seizures that temporarily affect a person's awareness, movements, or sensations. Seizures occur when powerful, rapid bursts of electrical energy interrupt the normal electrical patterns of the brain.
* psychotherapy (sy-ko-THER-a-pea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
Some psychiatrists believe that fugue is a symptom of other psychiatric disorders, rather than a unique, separate disorder. Treatment, as for other dissociative disorders, generally involves psychotherapy * and the treatment of any other psychiatric disorders the person might have.