DISOCIATIVE FUGUE
Dissociative fugue was previously called psychogenic fugue. Fugue comes from
the Latin word fugere, which means to escape. Dissociative fugue is the loss of memory
that is accompanied by leaving home and creating a new identity. Memory loss is greater
than dissociative amnesia. The person in question not only experienced total amnesia,
but suddenly left home and worked using a new identity. Sometimes the person has a
new name, a new home, a new job, and even a new set of personality characteristics.
The causes of dissociative fugue are similar to dissociative amnesia. This disorder
appears after the individual experiences severe stress or conflict.
1. Diagnostic Criteria based on DSM-IV
a. The predominant disorder is traveling away from home or work which usually
occurs suddenly, unexpectedly, with an inability to remember his or her past.
b. Confusion about personal identity or wearing a new identity (partially or
completely)
c. The disorder does not occur exclusively during the course of a Dissociative
Identity Disorder, and is not due to the direct physiological effects of a substance
(substance abuse, medication) or a general medical condition (e.g., temporal lobe
epilepsy)
d. Symptoms cause clinically significant suffering or impairment of social,
occupational or other vital functions.
Case Examples :
The man told the police that it was Burt Tate's namany. The 42-year-old white
man was involved in a fight at the restaurant where he worked. When the police arrived,
they found him not carrying an identity card. He told them that he had come to the city
a few weeks ago, but could not remember where he lived or worked before coming to
the city. There must be no charges against him, the police asked him to come to the
emergency room for evaluation. "Burt" knows what the city is and knows what date it
is now and realizes that it feels strange that he doesn't remember his past, but doesn't
seem to care about it.
There was no evidence of physical injury or brain trauma or drug or alcohol
abuse. Police made some inquiries and found that Burt matched the profile of a missing
person, Gene Saunders, who had disappeared a month earlier from a town 2,000 miles
away. Mrs. Saunders called and assured her that Burt was her husband. She reported
that her husband, who had worked at the middle management level at a manufacturing
company, was struggling at work before disappearing. He is not promoted and his
supervisor is very critical of his work.
Work pressure seems to affect his behavior at home. Previously he was easy to
get along with and socialize, then he withdrew and began to criticize his wife and
children. Then shortly before disappearing, he had a heated argument with his 18-year-
old son. His son called him a loser and walked out of the house. Two days later, the man
disappeared. When confronted with his wife again, he admitted that he did not recognize
her but clearly he looked nervous.
2. DEPERSONALIZATION DISORDER
• Depersonalization disorder, is a disorder in which a person's perception or
experience of oneself changes sadly and disturbingly, in the DSM-IV-TR it is listed as
a dissociative disorder. However, there is still controversy in its inclusion because
depersonalization disorder does not include memory impairment, which is a special
feature of other dissociative disorders.
• This depersonalization disorder is generally triggered by stress, the individual
suddenly loses their sense of self. They experience unusual sensory experiences, such
as the size of their hands and feet seemingly changing drastically or their voices
sounding unfamiliar to themselves. They also felt outside their bodies, staring at
themselves from a distance. Sometimes they feel like machines, as if they and other
people are robots or as if they are moving in an unreal world. The same episodes
sometimes occur in several other disorders such as schizophrenia, panic attacks, post-
traumatic stress disorder and borderline personality disorder.
• Depersonalization disorder usually begins in adolescence and the journey is
chronic, that is, it is experienced over a long period of time and there is often
childhood trauma. Comorbidities with personality disorders are common, as are
anxietas and depression disorders. Depersonalization disorder often goes away
without treatment. Treatment is guaranteed only if the disorder is long, recurrent, or
causes a disorder. Psychodynamic psychotherapy, behavioral therapy, and hypnosis
have been effective for some people.
a. Psychological counseling
Psychological counseling will help patients understand why
depersonalization occurs and train patients to stop worrying about the symptoms
that occur. Depersonalization disorder can also improve when counseling helps
with other psychological conditions, such as depression.
b. Medicines
Although there is no specific medication, a number of medications commonly
used to treat depression and anxiety can also help with depersonalization disorder
conditions. Some examples that have been shown to relieve such symptoms
include:
1) Fluoxetine (Prozac)
2) Clomipramine (Anafranil)
3) Clonazepam (Klonopin)
3. DISSOCIATIVE IDENTITY DISORDER
DSM-IV-TR Criteria for Dissociative Identity Disorder
1. The existence of two or more personalities or identities
2. At least two personalities control behavior repeatedly
3. Inability to remember important personal information
• According to the DSM-IV-TR, a diagnosis of Dissociative Identity Disorder
(GID) can be established when a person has at least two separate or altered ego
states (different modes of being, feelings and actions that do not affect each other
and are in control at different times. Sometimes there is one personality and its
treatment is usually reserved for the primary personality.
• Generally, there are two to four personalities at the time of diagnosis, but during
the course of therapy several new personalities often emerge. Memory gaps are
also common and are usually because at least one personality has no contact with
another. The existence of various different personalities must also be chronic
(occurs over a long period of time) and severe (causes the patient's life to be
severely disrupted). These changes are not temporary, for example because of
taking certain medications.
• Each personality can be quite complex, having its own patterns of behavior,
memory and relationships (each determines the individual's character and actions
when in control). Usually each of these personalities is quite different, even
contradicting each other.
• Dissociative identity disorder usually begins in childhood, but is rarely
diagnosed until adulthood. This disorder is more widespread than other
dissociative disorders and the cure is less comprehensive. This disorder is much
more common in women than men. Other diagnosis enforcement, especially
depression, borderline personality disorder and somatization disorder, is
frequent. GID is generally accompanied by headaches, substance abuse, phobias,
hallucinations, suicide attempts, sexual dysfunction, self-injurious behaviors and
also other dissociative symptoms such as amnesia and depersonalization
disorder.
• Prevention or treatment of this disorder can be done using several approaches,
namely:
1. Psychodynamic approach
Traditional psychoanalysis aims to help people with dissociative identity
disorder uncover and learn to cope with early childhood trauma. Wilbur
(1986) offers some variation on the theme in his discussion of psychoanalytic
treatment of people with multiple personalities. First, Wilbur points out that
analysts can work with whatever personality is the rise during therapy
sessions. Any and all personalities can be asked to talk about their memories
and dreams as well as they can. Any and all personalities can be sure the
therapist will help them understand their anxiety and safely "relive" the
traumatic experience so that they can be made aware and they can release the
psychic energy trapped by them. Wilbur instructs therapists to remember that
anxiety experienced during therapy sessions can cause a switch in personality
due to alternative personalities that may be developed as a means to cope
with intense anxiety. Eventually, however, enough early experiences can be
brought to light so that personality reintegration becomes possible
2. Biological approach
No drug has been developed to integrate personality change. However,
people with multiple personalities often suffer from anxiety, depression, and
other problems that can be treated with medications such as antidepressants
and anti-anxiety agents. Some evidence suggests there are selective
serotonin-reuptake inhibitors like Prozac to have some simple benefits in
treating depersonalization disorder. However, more research is needed to
investigate biological approaches that can help doctors encourage the
integration of different personalities.
3. Behavioral approach
Behavioral techniques have been applied to the treatment of people with
multiple personalities. Kohlenberg concluded that dual personality is a
learned response pattern whose performance is linked to reinforcement
contingencies. In the case of multiple personality, as noted by Spanos and his
colleagues (1985), reinforcement can take the form of extra attention from
the therapist who considers the case of multiple personality to be glamorous
and exotic. There is too little evidence to conclude that people with multiple
personalities will generally respond to the selective reinforcement of the most
adaptive personalities. This form of therapy also raises ethical questions
about whether or not the therapist has the right to determine the personality
should be selectively reinforced.
