Dissociation is a mental process, which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his/her ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.
Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with conscious awareness of one’s immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Disorders, which may result in serious impairment or inability to function. Some people with Dissociative Disorders can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service — appearing to function normally to coworkers, neighbors, and others with whom they interact daily.
Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream).
During the depersonalization experience, reality testing remains intact.
The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
Dissociative Fugue is 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.
Specific symptoms include:
- The predominant disturbance is sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past.
- Confusion about personal identity or assumption of a new identity (partial or complete).
- The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The length of a fugue may range from hours to weeks or months, occasionally longer. During the fugue, the person may appear normal and attract no attention. The person may assume a new name, identity, and domicile and may engage in complex social interactions. However, at some point, confusion about his identity or the return of the original identity may make the person aware of amnesia or cause distress.
The prevalence of dissociative fugue has been estimated at 0.2%, but it is much more common in connection with wars, accidents, and natural disasters. Persons with dissociative identity disorder frequently exhibit fugue behaviors.
The person often has no symptoms or is only mildly confused during the fugue. However, when the fugue ends, depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses may appear–ie, the person must deal with what he fled from. Failure to remember events of the fugue may cause confusion, distress, or even terror.
A fugue in progress is rarely recognized. It is suspected when a person seems confused over his identity, puzzled about his past, or confrontational when his new identity or the absence of an identity is challenged. Sometimes the fugue cannot be diagnosed until the person abruptly returns to his prefugue identity and is distressed to find himself in unfamiliar circumstances. The diagnosis is usually made retroactively based on the history with documentation of the circumstances before travel, the travel itself, and the establishment of an alternate life. Although dissociative fugue can recur, patients with frequent apparent fugues usually have dissociative identity disorder
Most fugues are brief and self-limited. Unless behavior has occurred before or during the fugue that has its own complications, impairment is usually mild and short-lived. If the fugue was prolonged and complications due to behavior before or during the fugue are significant, the person may have considerable difficulties–eg, a soldier may be charged as a deserter, and a person who marries may have inadvertently become a bigamist.
In the rare case in which the person is still in the fugue, recovering information (possibly with help from law enforcement and social services personnel) about his true identity, figuring out why it was abandoned, and facilitating its restoration are important.
Treatment involves methods such as hypnosis or drug-facilitated interviews. However, efforts to restore memory of the fugue period are often unsuccessful. A psychiatrist may help the person explore inner and interpersonal patterns of handling the types of situations, conflicts, and moods that precipitated the fugue to prevent subsequent fugue behavior.
The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.
The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Dissociative Identity Disorder
The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
At least two of these identities or personality states recurrently take control of the person’s behavior.
Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
Dissociaitive disorder nos otherwise specified is when a person has some of the symptoms of a dissociaitve disoreder but do not fulfill any of the specific diagnosic criteria.