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Can a Dissociate Fugue Disorder Lead to Drug Addiction?

Dissociative fugue is a mental health condition in which a person loses their memories and sense of identity, journeys or wanders to a new location, and assumes a new identity. It is a rare disorder most commonly encountered in people who have experienced trauma, abuse, or other significant stressors.
lonely depressed sick woman sitting alone
The disorder is sometimes seen in connection with substance abuse, and it can be difficult to distinguish between substance-induced memory loss and dissociative fugue.

What Is Dissociative Fugue?

Dissociative fugue is a mental disorder characterized by memory loss, loss of identity, and, often, travel to another location.1,2 It is most commonly seen in people who are dealing with a physical or mental trauma, depression, problems with the legal system, or some other personal difficulty.2 People who experience a fugue episode are not able to remember some or all of their past. The individual may suddenly not be able to remember their identity or may create an entirely new one. Fugue states may occur just once or multiple times, and they can last anywhere from a few hours to weeks or months or longer.1

Dissociative fugue is rare, occurring in 0.2% of the general population. The onset is usually in adolescence or early adulthood. The disorder typically comes on suddenly and, in addition to a history of trauma or personal distress, may also be linked to cognitive dysfunctions and genetic factors.3

It can co-occur with bipolar disorder, major depressive disorder, schizophrenia, post-traumatic stress disorder (PTSD), substance abuse, panic disorder, anxiety disorders, eating disorders, and somatoform disorders (physical symptoms that have no apparent medical origin).3

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not classify dissociative fugue as its own disorder. Instead, it is listed as a feature seen in conjunction with dissociative disorders in general. It is more commonly seen in those with another dissociative condition known as dissociative identity disorder (DID) but also appears as a diagnostic specifier for dissociative amnesia.4

What Are the Symptoms?

People who experience a fugue state usually exhibit some of the following behaviors:1,3,5

  • Sudden unexpected travel
  • Sudden absence from work and/or home
  • No memory of the past
  • Confusion about new identity
  • Inability to recognize friends and family
  • Unkempt appearance
  • Fatigue
  • Impaired concentration and attention

It can be difficult to recognize when someone is in a fugue state because there are very few observable symptoms. The person may seem completely normal or slightly confused.1

Short- and Long-Term Effects

Because of the unexpected travel away from work, home, and friends, dissociative fugue can cause significant distress in many areas of life. People often have trouble at work and with personal relationships, since their employer and family may have no idea where they are until they are found.

When the fugue is over, people are usually able to remember their past life up until the fugue began. They often cannot remember what occurred during the fugue. For some people, it can take a long time to recall past events. A small portion of people who have fugue states are not able to recall their past or remember very little of it for the rest of their lives.1,3,5

Many people who have had a fugue episode feel ashamed, frightened, or upset that they are unable to remember the episode. They may become depressed or anxious.1,3

How Is Dissociative Fugue Related to Substance Abuse?

The DSM-V states that an episode of dissociative amnesia (of which dissociative fugue is a subtype) cannot be due to the effects of a substance or medication.4

It can be difficult to differentiate “black-out” periods from drinking or using drugs from dissociative amnesia.

However, substance abuse and dissociative amnesia can co-occur. When they do, it can be difficult to differentiate “black-out” periods from drinking or using drugs from dissociative amnesia, especially if the person with dissociative amnesia uses drugs or alcohol to cope with stressful situations.4

People who have an addiction and dissociative amnesia will often attribute their amnesia to their substance abuse. Some people also develop cognitive problems as a result of their substance abuse, which can lead to memory issues. However, a mental health or healthcare professional can often distinguish between substance-induced memory problems and dissociative amnesia based on a history of the person’s substance abuse and subsequent cognitive deficits.4

A key difference between substance-induced amnesia and dissociative amnesia is that people who experience dissociative amnesia can often regain the ability to recall parts of their past. People with substance abuse problems who forget events can rarely recall them.6

How Is It Treated?

mental health assessment
Most often, fugues are diagnosed after they have occurred. The person usually has to return to their pre-fugue identity and become distressed or confused about who they are and how they came to be in their new environment.1

To form a diagnosis, a doctor will collect information about the person’s history and the circumstances of their life before they left home, their travels, and their creation of a new life.1

Treatment may include psychotherapy, hypnosis, or drug-facilitated interviews (in which a sedative is administered prior to the session) to try to help the person remember the events of the fugue. But these interventions do not always work. In addition to these techniques, a therapist can help the person handle conflicts or emotions that may have triggered the fugue and potentially avoid another one.1

As mentioned above, people who have experienced a fugue may also feel shame or fear. Some people become angry or even suicidal. They may develop depression or PTSD as the source of their fugue is brought to light.4 These related conditions will also need treatment.

If a substance abuse issue and dissociative fugue disorder are co-occurring, it is important to seek comprehensive treatment that addresses both conditions at the same time. Treating one without the other could lead to a relapse if the symptoms re-emerge that caused the person to use drugs or alcohol in the first place.

Many treatment centers across the country offer an integrated approach to treatment that is tailored to co-occurring disorders. Following a thorough intake, diagnoses can be made and a proper treatment plan can be put into place. A medically supervised detox can help ensure a safe withdrawal period, and individual, group, and family therapies can address any trauma or stressful events that may have led to substance abuse and dissociative fugue.

Sources

[1]. Spiegel, D. (2017). Dissociative Fugue. Merck Manual.

[2]. Kihlstrom, J. (2010). Dissociative Disorders. University of California, Berkeley.

[3]. Igwe, M. (2013). Dissociative fugue symptoms in a 28-year-old male Nigerian medical student: a case report. Journal of Medical Case Reports, 7, 143.

[4]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[5]. Raval, C., Upadhyaya, S., and Panchal, B. (2015). Dissociative fugue: Recurrent episodes in a young adult. Industrial Psychiatry Journal, 24(1), 88-90.

[6]. Sharon, I. (2018). Dissociative Disorders. Medscape.

 

Last Updated on May 24, 2019
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