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Dissociative Fugue

Dissociative Fugue. Formerly Psychogenic Fugue (Presented by Erica Miller and Marisa Rennie). Dissociative Fugue. Dissociation: disturbance in normally integrative functions of identity, memory, or consciousness. (Turkus)

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Dissociative Fugue

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  1. Dissociative Fugue Formerly Psychogenic Fugue (Presented by Erica Miller and Marisa Rennie)

  2. Dissociative Fugue • Dissociation: disturbance in normally integrative functions of identity, memory, or consciousness. (Turkus) • Fugue: sudden onset of wandering with clouding of consciousness and amnesia for the event. (Davidson/Neale) • Dissociative Fugue: disturbance in memory; travel to new location and assumption of new identity. (Turkus) • Brief; new identity less crystallized • typically follows severe stress • upon recovery, individual has no memory of events of fugue

  3. Historical Background • Originally referred to as psychogenic fugue • DSM-I: dissociative reaction • represents wide variety of symptoms that reflect personality disorganization • DSM-II: dissociative symptoms a subtype of hysterical neurosis • DSM-III: separate category • DSM-IIIR: criteria for fugue listed in Table I

  4. Specific Culture Features • “Running” syndromes in various cultures • characterized by sudden onset of high level of activity, trancelike state, potentially dangerous behavior in form of running or fleeing, exhaustion, and amnesia for the episode • pibloktoq: Arctic • grisi siknis: Miskito of Honduras and Nicaragua • Navajo “frenzy” witchcraft • amok: Western Pacific

  5. Diagnosis • DSM-IV Criteria • 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 new identity • doesn’t occur exclusively during the course of DID and isn’t due to direct physiological effects of a substance or a general medical condition • symptoms cause clinically significant stress or impairment in social, occupational, or other areas of functioning

  6. Diagnosis • Dissociative disorders in general: (Turkus) • clinical interview • awareness of existence of childhood trauma • high prevalence of physiological symptoms (Berkowitz et al) • gastrointestinal • pain • cardiopulmonary • conversion

  7. Etiology • Most clinicians describe dissociation on a continuum of severity • Studies focus on adolescents and adults. • prevelance rate of .2% in general population • prevelance of dissociation in children unknown • evidence supports onset of dissociative disorders in childhood • Abuse/trauma (Richardson)

  8. Etiology • Fugue often associated with circumstances that raise suspicion of malingering (Hales et al) • Fugue states occur in a wide variety of psychiatric disorders • highly suggestible traits • capacity to use major repression and escape as coping style (Ford)

  9. Treatment • Psychodynamic/cognitive psychotherapy facilitated by hypnotherapy • Stage one: assessment • history (what happened to you?) • sense of self (how do you feel about yourself?) • symptoms (e.g. depression, anxiety, etc.) • safety (of self, to and from others) • relationships/social support system • family history • medical status (Turkus)

  10. Treatment • Stage two: Therapist and client develop plan for stabilization • contracts to ensure physical & emotional safety • developing cognitive framework • undoing damaging self-concepts • learning about what is “normal” (Turkus)

  11. Treatment • Stage three: Revisiting/reworking trauma • abreactions: reexperiencing traumatic event along with release of related emotion and recovery of repressed aspects of that event • hypnosis • contains abreactions • releases painful emotions more quickly (Turkus)

  12. Treatment • Stage four: Further processing of traumatic event • creative energy released • claim self-worth and personal power (Turkus) • Psychotherapy - anamnesis • talk about that which is remembered • memory association fills in gaps (Ford)

  13. Ethical Considerations • A lack of control groups of untreated children creates difficulties in allowing treatment of children, but treatment can not be denied them. • Confidentiality issues arise when etiology of disorder is suspected to be related to abuse. (Richardson)

  14. Prognosis • Onset usually related to trauma • Episodes may last from hours to months • 1/2 of all fugues last less than 24 hours(Pies) • Fugue may be accompanied by depression, dysphoria, psychological stress, suicidal and aggressive impulses. • Extent and duration of fugue may determine degree of other problems • loss of employment • disruption of personal/family relationships references

  15. (Braun)

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