Many people one day come to the conclusion that it is time to change their lives. If the mood is serious, then changes will really come after certain volitional efforts. However, back in the 19th century, a condition was described in which a person is able to immediately cross out the established way of life - name, occupation, acquaintances - and actually become a different person. A similar disorder in psychiatry is defined as dissociative fugue.
- Interpretation of the term
- Why and how does this happen
- Diagnosis of the condition
- Treatment
Interpretation of the term
“It was as if everything was happening not to me”, “It was as if I was watching everything from the outside” - these are typical phrases uttered by people who have experienced short-term dissociations. A person withdraws from certain events. Everyone can experience such states at least once in their life.
If a person strives not only to tune out any events, but to completely erase them from memory, dissociative amnesia occurs. It is important not to confuse this condition with forgetfulness. For example, few people remember poems from the third grade curriculum. But forgetting key moments in life is true dissociative amnesia. In this state, a person does not remember his name, occupation, deeds and actions.
Dissociative fugue is one of the extreme forms of withdrawal combined with memory loss. Human consciousness denies the key parameters of personality, and then the person actually escapes from reality. By the way, that’s why the name of the disease uses the word “fugue” - from Latin “flight”.
Symptoms of dissociative fugue
Before starting treatment for dissociative fugue in Moscow, specialists at Dr. Isaev’s clinic carefully study the history and symptoms of the disease. Usually it manifests quite suddenly, as soon as morning comes. Immediately after waking up, a person purposefully prepares for departure by packing his things and buying a ticket. For an outside observer, his actions are not surprising, since everything happens in an ordinary way.
During the collection, the patient’s behavior is adequate, and for this reason, after his disappearance, relatives describe the situation as “he left and did not return.” At the patient’s new place of stay, his condition does not indicate the presence of pathology. Therefore, with a long-term fugue, he can get a job, start a relationship and even a new family and children. An interesting feature of the manifestation of the disorder is that the type of new human activity is radically different from what it was before the appearance of the dissociative fugue.
Staying in this state is marked by high sociability, the presence of common memories and basic knowledge. A new personality often has a very plausible story, but sometimes the story about one’s life (in a new capacity) consists of separate fragmentary information. A personality discrepancy is discovered in situations where a thorough verification of documents is carried out:
- coming to the bank with the desire to take out a loan;
- getting into a criminal history;
- admission to the hospital after an accident.
If the patient does not face verification of his identity, he can exist for a long time and safely in his new reality. Fragmentary memories of a past life are stored in the form of dreams or perceived as an excerpt from a read text of a book.
Treatment of dissociative fugue in Moscow and other cities is prescribed by a specialist depending on the duration of the disorder and the speed of the patient’s return to the previous state. Restoration of the primary personality also occurs after a night's rest and most often suddenly. At the same time, the person wakes up, remembers all the events preceding the fugue, and feels strong anxiety, since the causal situation returns. Familiar associations - sounds, smells, tastes - can become an impetus for returning, and this further confirms the psychogenic nature of the disease.
Since he is in a new place, he cannot understand how he ended up there. All memories of the past fugue are completely erased from memory, or emerge in the form of fragmentary images. Great difficulties arise for him after returning to his previous place of residence, his family and his old job.
Sometimes the return does not happen immediately, but in parts. At first, the patient begins to feel uneasy and experience a feeling of some kind of loss. Then episodes associated with the previous life gradually form in memory. Thus, the old personality displaces the new one that appears during the fugue. And this development is almost always accompanied by severe anxiety, decreased mood, incomprehensible fears (in which case treatment of phobias will be required), and disorientation in social communication, space and time.
Patients with this disease rarely consult a specialist, and therefore treatment of dissociative fugue is usually carried out after the person returns to his previous life. And for this reason, the diagnosis of the disease is made late. Before starting therapy, this disorder should be differentiated from other mental disorders. For this, the following criteria are taken into account:
- mandatory departure on the day of the fugue manifestation;
- complete or partial amnesia about the previous personality;
- loss of memory of events that occurred during the fugue after exiting it;
- preservation of intelligence, basic knowledge and skills in any period.
Clinic specialists always exclude organic pathology of the central nervous system in this case. This may be a manifestation of amnesia after a traumatic brain injury, against the background of tumor growth, or episodes of loss of memory of events in people suffering from epilepsy. It is important not to miss this pathology, since the treatment method in this case is very different. And with incorrect diagnosis and treatment, serious complications can develop.
To completely exclude the possibility of other problems, a full clinical examination of the patient is carried out, and additional studies are prescribed. An electroencephalogram helps determine the activity of individual areas of brain tissue and the presence (or absence) of pathological arousal. When they are identified, epilepsy is treated; after remission is achieved, the amnesia phenomena disappear.
Toxic substances (if any), including narcotics, are determined in urine and blood. CT or MRI can assess the state of the central nervous system tissues, detect neoplasms, hemorrhages, their location and size.
Why and how does this happen
Doctors consider psychogenic factors to be the main causes of the disorder:
- sudden severe stress (accident, accident);
- long period of painful emotional states;
- threat to health and life (including participation in hostilities);
- natural disasters.
Dissociative amnesia is the result of a conscious or unconscious desire to forget about unpleasant experiences. Events are either erased or perceived as having happened to someone else. The moment when memory loss is combined with purposeful actions is “escape.”
The person becomes a different person. He can call himself by a different name, leave, including from the city, and start a new life. The volume of actions performed depends on the time of the attack. It may last a couple of hours, days or months. The rarest cases are dissociative fugues that last for years.
How to treat acute mental disorder?
Medical statistics say that dissociative fugue is a fairly rare disease. On average, two out of a thousand suffer each year. A person can only be treated after the fact. That is, when he remembers his past life. The doctor’s task in this case is to help completely regain one’s usual self. The danger of a fugue lies in the fact that after the amnesia wears off, a person finds himself in an unusual place. He doesn’t know who he is, how he got to, say, the seashore, and what he should do. It would be good if there was a psychiatrist nearby. Otherwise, coming out of the fugue will be painful.
Doctors rarely have the opportunity to work with patients during such amnesia. Not a single person will seek help because they do not consider themselves sick. Sometimes people with dissociative fugue reveal themselves by pure chance. For example, when they want to take out a loan. Then a lot of inconsistencies suddenly appear in the person’s biography. As a result, he is broken through the base, and it turns out that such a citizen has never existed. The task of the psychotherapist is to understand where the patient came from. Amnesia and moving are the main symptoms of dissociative fugue.
Therapy depends on the duration of amnesia. Long-term memory lapses will require the patient to prepare to accept the changes that have occurred. Sometimes a person is taught self-regulation skills. If a patient has an affective disorder or anxiety, he is prescribed antidepressants or tranquilizers. In principle, this is where work with a person ends. However, the problem that led to the appearance of the fugue also requires treatment. After all, a person changed his personality for a reason. A detailed analysis will help you understand the situation and understand what was the last straw. Severe amnesia - memory lapses that cannot be restored - is observed only when the patient has experienced severe trauma. Under such circumstances, memory may not be fully restored without the intervention of a specialist. But most often psychiatrists do not revive such fragments.
Diagnosis of the condition
The behavior of people with the disorder of memory and consciousness described above differs little from the norm. It is extremely rare that witnesses to dissociative states noted some detachment and absent-mindedness of the patient. Therefore, if dissociative amnesia can still be identified independently or with the help of others, then dissociative fugue, as a rule, is not diagnosed.
Often the attack goes away on its own. With a short-term disorder, the patient seems to wake up with a feeling of memory loss. If the dissociative fugue lasts long enough, the attack may drag on. This often happens in 4 stages:
- the appearance of internal anxiety;
- awareness of the loss of something important;
- gradual memory recovery;
- complete exit from the state.
At the last stage, a person begins to experience depression, anxiety and fears, and social disorientation. If in this state the patient sees a psychiatrist, a retrospective survey will be conducted and a conclusion will be made about the state of dissociative fugue.
Diagnostics
For a reliable diagnosis there must be:
- signs of dissociative amnesia;
- purposeful travel outside the bounds of ordinary everyday life (the differentiation between traveling and wandering must be made taking into account local specifics);
- maintaining personal care (eating, washing, etc.) and simple social interaction with strangers (for example, patients buy tickets or gasoline, ask for directions, order food).
The diagnosis is usually made retrospectively by asking about the circumstances leading up to leaving home, traveling and starting a “new” life. If dissociative fugues recur repeatedly, a diagnosis of multiple personality disorder (MPD) is usually made.
Treatment
Such a disorder, as a rule, occurs to a person only once. Therapy for this condition is to help the patient survive the stress or change his attitude towards the events that caused the dissociative fugue. Depending on the cause of the disease and the general condition of the patient, the following methods are used:
- psychotherapy;
- hypnosis;
- Medication treatment for anxiety and depression.
Most often, the patient fully returns to his previous lifestyle. The exception is cases when the cause of the disease was extremely negative events (attempted rape, murder, severe loss). The decision on further measures is made by the attending physician in each case separately.
Diagnosis and treatment
How to recognize?
Studying a patient during a fugue period is impossible, since a person comes to the hospital after an attack and a return to his previous life .
The specialist determines the diagnosis after the fact.
In order not to be mistaken with the conclusions, the doctor pays attention to the following features that are characteristic only of fugue :
- Dissociative amnesia . The patient loses memory of recent events that are personal in nature. Universal knowledge and skills are preserved, as is the ability to perceive new information.
- Purposeful departure . Man does not wander and is not lost. He arrives at a specific place. The reason for the trip is unknown to the patient himself.
- Social interaction . The patient does not withdraw into himself; he communicates adequately with others. She also doesn’t forget to take care of herself, maintain hygiene, and eat on time.
Apart from these signs, people experiencing a fugue attack are absolutely healthy, both mentally and physiologically.
Therapy methods
The disease is dealt with by psychiatrists, psychotherapists and clinical psychologists. Expert help covers two areas:
- Work on transforming a person’s attitude towards the stressful circumstances that provoked the attack.
- Support in understanding and accepting the changes that occurred during the fugue.
First of all, conversations are held with the patient, the purpose of which is to return him to normal life in the least painful way .
The specialists will also use the following techniques:
- positive therapy;
- person-centered therapy;
- rational therapy;
- psychoanalysis;
- hypnosis.
The prescription of tranquilizers and antidepressants is possible if a person has mood disorders and persistent anxiety.
The prognosis for recovery is favorable . The patient, who has no other mental illnesses, recovers completely.
