338 CHAPTER 8
Table 8.4 • Dissociative Fugue
Facts at a GlancePrevalence- This disorder is rare, occurring in approx-
imately 0.2% of Americans. However,
the prevalence may increase after wide-
spread traumatic events such as natural
disasters or wars.
Comorbidity- People with dissociative fugue may also
have a mood disorder, posttraumatic
stress disorder (PTSD), or a substance-
related disorder.
Onset- The fugue state begins after a traumatic
or overwhelming event, although it is not
known how much time typically passes
between the event and the onset of the
fugue state.
Course- Patients usually experience only a single
episode, in response to high levels of
stress, and recover quickly; however,
some people may continue to have am-
nesia for events that transpired during
the fugue state. - Very little is known about the process by
which people recover from dissociative
fugue (Kihlstrom, 2001).
Gender Differences- There does not appear to be any consis-
tent gender difference in the prevalence
of dissociative fugue.
Cultural Differences- Dissociative fugue is not observed
worldwide. Syndromes that are similar
occur in some cultures, but these syn-
dromes involve running or fl eeing and
different kinds of memory problems.
Source: Unless otherwise noted, the source is
American Psychiatric Association, 2000.
EFE/Oscar NavarreteSome cultures have syndromes that are similar
to dissociative fugue, such as grisi siknis, which
shares with dissociative fugue a sudden fl ight
from home and problems with memory. This
photo shows local healers of an indigenous
Miskito community in Nicaragua treating people
with grisi siknis.
CASE 8.2 • FROM THE OUTSIDE: Dissociative Fugue
“Joe” went to work at his usual time [Monday morning, and on Tuesday night he] wandered
into a K-Mart 150 miles from home and said, “Could you please help me? I don’t know who
I am or how I got here. Would you call the police for me?”
The police took his truck keys and located his truck. They discovered his identity, took him
to the emergency room, and called his hometown where his wife had reported him missing.
When he returned, he did not recognize his home, his wife, or his children....
He described returning to his home and his wife as a déjà vu experience. He felt he had
seen this woman before, but he couldn’t quite place her. At work he did not recognize any of
his coworkers. When he read papers that he had written, he indicated that he could under-
stand about 10% of the material. He had some “vague recollection that it was familiar.”
(Jasper, 2003, pp. 311, 313)
Joe’s medical tests were negative, which ruled out a physical cause for his memory
problems. He received treatment using hypnosis, and over time he remembered his
life and the events that led up to his fugue state: He had become extremely angry at
his boss and threatened to harm him physically, then ran out of the offi ce. Apparently,
the level of his anger and capacity for violence frightened Joe so much that he went
into a fugue state.An important fact about dissociative fugue, as noted in Table 8.4, is that it does
not arise in all cultures. This simple observation implies a larger role for social fac-
tors than occurs for many other psychological disorders. For example, in some cul-
tures, instead of the DSM-IV-TR diagnosis of dissociative fugue, people can develop
arunning syndrome. Although this condition has some symptoms that are similar
to those of dissociative fugue, it typically involves a sudden onset of a trancelike
state and dangerous behavior such as running or fl eeing, which leads to exhaus-
tion, sleep, and subsequent amnesia for the experience. Running syndromes include
(American Psychiatric Association, 2000):- pibloktoq among native Arctic people,
- grisi siknis among the Miskito of Nicaragua and Honduras, and
amok• in Western Pacifi c cultures.
These syndromes have in common with dissociative fugue part of Criterion A
(Table 8.3)—unexpected travel—but the amnesia occurs after the running episode is
over, so the individual doesn’t remember that it happened. In contrast, with disso-
ciative fugue, the memory problem arises during the fugue state, and the individual
can’t remember his or her past. In addition, Criteria B, C, and D for dissociative
fugue do not necessarily apply to running syndromes.