Dissociative Fugue (Psychogenic Fugue): What is a fugue? Why is it “dissociative”? Why does a dissociative fugue imply multiple personality?

A classic fugue is when a person travels from where he is known to where he is unknown, and has amnesia for where he came from and who he is.

If such a person appears confused and is taken to the hospital emergency room, the doctor will round up the usual suspects: head trauma, drugs, epilepsy, dementia, malingering. If none of these is found, the condition will be diagnosed as having a psychological cause and called “dissociative fugue.”

If such a person had not appeared confused, because he had adopted a new identity, and if he is not found by people who know who he really is, he may start a new life under the new identity.

The fugue may or may not be precipitated by a known trauma or crisis. It may be brief or lengthy.

The old name for dissociative fugue was psychogenic fugue. It is now called “dissociative” fugue, because it is found in the chapter on Dissociative Disorders in the DSM, the psychiatric diagnostic manual.

The word “dissociative” refers to altered states of consciousness (like the trance state that novelists get into when they are writing) and/or mental dividedness and compartmentalization.

In the latest edition of the manual, dissociative fugue is considered a subtype of dissociative amnesia; that is, when a person with psychogenic amnesia travels. Another dissociative disorder is dissociative identity disorder, commonly known as multiple personality disorder.

Now, persons with multiple personality disorder frequently have fugues. It is a common symptom. To screen someone for multiple personality disorder, you might ask if they ever find themselves somewhere and not remember how they got there. This happens when personality A switches to personality B; B travels somewhere; B switches back to A; and A doesn’t know how he got there. A classic fugue might occur when B fails to switch back to A in a timely fashion.

So I suspect that many cases of so-called dissociative amnesia or dissociative fugue are the result of an incomplete diagnostic process. The doctor may have found a symptom of multiple personality without realizing it. Such a mistake is easy to make, because, as previously discussed, multiple personality is naturally hidden and secretive.

Added March 27, 2020: The reason that "Have you had memory gaps?" is a good screening question for multiple personality, is that people with multiple personality may commonly have mini-fugues. "Mini," because significant traveling is not a major feature. They just have a gap in memory for the time that an alternate personality took over. Indeed, they may not even have noticed the gap in their memory unless some embarrassment or comment by someone else brings it to their attention. Other people will usually not know when this is happening, because alternate personalities, in a person who has not been diagnosed, almost always go about their business incognito. Since such gaps usually have not caused a problem and have been going on since childhood, the person usually ignores them, may assume everyone has them, and will not raise the issue unless specifically asked. In short, a dissociative fugue is just one of multiple personality's routine memory gaps, but with major traveling.