Fugue state

For the New York City-based publisher, see Fugue State Press.
Fugue state
Classification and external resources
Specialty Psychiatry
ICD-10 F44.1
ICD-9-CM 300.13

Dissociative fugue, formerly fugue state or psychogenic fugue, is a DSM-5 dissociative disorder.[1] It 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. It is no longer its own classification or diagnosis as it was in the DSM-IV, but is now a facet of dissociative amnesia according to the DSM-5.

After recovery from fugue, previous memories usually return intact. Because of this, there is not normally any treatment necessary for people who have been in fugue states. 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 other psychiatric conditions such as dissociative identity disorder, delirium, or dementia.[2] Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (dissociative amnesia).

Signs and symptoms

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.[3]

Diagnosis

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 psychological 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.

Definition

The cause of the fugue state is related to dissociative amnesia, (DSM-IV Codes 300.12[4]) which has several other subtypes:[5] selective amnesia, generalised amnesia, continuous amnesia, and 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).[6] It is a complex neuropsychological process.[7]

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 occurs while one is acting out a dissociative fugue.

The DSM-IV defines[1] as:

The Merck Manual[8] 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[8] 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.

Prognosis

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 has only one episode.

Society and culture

Television

In the TV series Knots Landing, Valene suffers a fugue state in season six and goes by the name of Verna.

In the TV series Falcon Crest, Jordan experiences a fugue state in season five after the suicide of her father and takes the new personality of Monica, a woman who sleeps with several men.

In the TV series Archer, The character Sterling Archer enters from a fugue state two months prior to season four. By the premier of season four Archer is living his life as Bob in a restaurant similar to one seen in 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 Under the Dome, the character Sam mentions that his nephew Junior's mother experienced fugue when Junior admits that he experienced blackouts.

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.

In the TV show Drop Dead Diva, a client named Daniel Porter experienced a nine-year fugue state after a single engine plane crash and now seeks shared custody of his son, Noah.

In the Netflix TV series "Unbreakable Kimmy Schmidt", a psychiatrist, played by Tina Fey, suspects the main character Kimmy suffered from a dissociative fugue state earlier in the day.

In the television series Rizzoli & Isles, a season five episode titled "...Goodbye", has Jane, Maura, and the squad dealing with the case of young woman who has a dissociative fugue episode where she believes she has killed someone. The character named "Jessica" by Maura does not remember anything about the murder but does remember that she likes the Red Sox and who her favorite player is. The character's memory is jogged by the realisation that she did not commit the murder of her significant other.

In the Showtime television series Penny Dreadful, a character, Vanessa Ives, enters a fugue state while hypnotized.

Books

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

In John O'Farrell's The Man Who Forgot His Wife (16 March 2012) (2012, Doubleday, ISBN 978-0-385-60610-3 (11 October 2012) Black Swan ISBN 978-0-552-77163-4, Vaughan the main character is in a fugue state

In Walker Percy's novels The Last Gentleman and The Second Coming, the main character Will Barrett is referred to as suffering repeated fugue states, leading eventually to his diagnosis with the fictional disorder ″Hausmann's syndrome.″

In Kerry Lonsdale's 2016 novel, Everything We Keep, the main character enters a fugue state while being presumed dead.

In Patrick Hamilton's 1941 novel "Hangover Square",the main character repeatedly enters a fugue state which begins with what he describes a clicking/snapping sound like the shutter of a camera.

Short stories

In the Norwegian folktale "Gidske,"[21] 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 gods.

Film

In the film "Altered States" (1980) William Hurt's character Dr Edward Jessup emerges from a sensory deprivation tank/drug experience bloodied and aphasic and is misdiagnosed as having entered a fugue state post seizure in the tank. Jessup actually experienced a transient de-differentiation of his genetic structure and temporarily regressed into a mute "quasi-simian" creature complete with structural changes to his vocal chords.

In the 1984 film Paris, Texas, Travis Henderson, the main character, undergoes a fugue state.

Dissociative fugue affects many characters in David Lynch films with the most explicit example being the protagonist of Lost Highway (1997).

In the 2000 film Nurse Betty, Renée Zellweger's character Betty witnesses the murder of her husband and experiences a fugue state.

In the 2002 film and book Bourne Identity, the protagonist Jason Bourne enters a fugue state after being shot.

In the 2012 film (and book) Perks of Being a Wallflower, Charlie, the main character, undergoes a fugue state.

In the 2015 film 88, Katharine Isabelle's character, Gwen, enters a fugue state following the death of her lover.

In the 2015 film, "Into The Forest", Ellen Page's character, Nell, studies and explains to Eli about fugue state after a power grid failure in the United States.

Video games

Cloud Strife from Final Fantasy VII entered a trauma-induced fugue state after witnessing the death of Zack Fair (as shown in the game Crisis Core: Final Fantasy VII). He took on Zack's identity and forgot his own memories and identity until later in the story.

In the video game Assassin's Creed III, 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.

Music

In 2014, Vulfpeck, a funk instrumental group, released the album "Fugue State."

In 2012, PelleK, a power metal vocalist released the album "Bag of Tricks," which contains the song: "Fugue State"

In 2011, Nero, an electronic artist released the album "Welcome reality," which contains the song: "Fugue State"

See also

References

  1. 1 2 3 Dissociative Fugue (formerly Psychogenic Fugue) (DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
  2. ↑ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. ISBN 9780890425541.
  3. ↑ The Merck Manual
  4. ↑ "Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )". Psychiatryonline.com. Retrieved 2011-11-28.
  5. ↑ Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com ) Archived November 28, 2010, at the Wayback Machine.
  6. ↑ Complete List of DSM-IV Codes ( PsychNet-UK.com ) Archived January 6, 2011, at the Wayback Machine.
  7. ↑ "Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )". Dissociation.co.uk. Retrieved 2011-11-28.
  8. 1 2 Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
  9. ↑ "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.
  10. ↑ "Shows". Five.
  11. 1 2 The Associated Press (2008-09-16). "Update: Missing Oregon teacher rescued from Long Island Sound". OregonLive.com. Retrieved 2013-11-16.
  12. ↑ "Hannah Upp Updates Her Status, Remembers Little". Gothamist.
  13. ↑ "A Life, Interrupted". The New York Times. 2009-03-01.
  14. ↑ "Missing New York City School Teacher Spotted in Apple Store". Fox News. 2008-09-09.
  15. ↑ "Everyone is drawn to the Apple Store, including a missing teacher". TechCrunch. AOL. 10 September 2008.
  16. ↑ Rovzar, Chris. "Hannah Upp Mystery Still Deepening - Daily Intelligencer". Nymag.com. Retrieved 2013-11-16.
  17. ↑ Mimica, Mila (2013-09-05). "Md. Woman With Rare Form of Amnesia Located". NBC4 Washington. Retrieved 2013-11-16.
  18. ↑ "Hannah Upp of Kensington found in Wheaton, Md.". wusa9.com. 2013-09-05. Retrieved 2013-11-16.
  19. ↑ "A Life, Interrupted". The New York Times. 2009-03-01.
  20. ↑ "For Man With Amnesia, Love Repeats Itself". NPR. 2012-12-13. Retrieved 2013-11-16.
  21. ↑ http://www.sacred-texts.com/neu/ptn/ptn43.htm
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