Editing Dissociative fugue (section)

==Diagnosis==
{{More citations needed|section|date=November 2021}}
Before dissociative fugue can be diagnosed, either [[dissociative amnesia]] or [[dissociative identity disorder]] must be diagnosed.<ref>{{Cite web |title=Dissociative Fugue: What It Is, Causes, Symptoms & Treatment |url=https://my.clevelandclinic.org/health/symptoms/22836-dissociative-fugue |access-date=2023-11-07 |website=Cleveland Clinic |language=en}}</ref> The only difference between dissociative amnesia, dissociative identity disorder and dissociative ''fugue'' is that the person affected by the latter travels or wanders. This traveling or wandering is typically associated with the amnesia-induced identity or the person's physical surroundings.<ref>{{Cite book |title=Diagnostic And Statistical Manual of Mental Disorders |publisher=American Psychiatric Association |year=2013 |isbn=978-0-89042-555-8 |edition=5th |pages=290–298}}</ref>

Sometimes dissociative fugue cannot be diagnosed until the patient returns to their pre-fugue identity and is distressed to find themselves in unfamiliar circumstances, sometimes with awareness of "lost time". The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before the patient left home, the travel itself, and the establishment of an alternative life.<ref>[https://www.anxietyfoundation.com/unveiling-the-mystery-of-dissociative-fugue-insights-into-a-rare-disorder/ Dissociative fugue]</ref>

Functional amnesia can also be situation-specific, varying from all forms and variations of trauma or generally violent experiences, with the person experiencing severe memory loss for a particular trauma. Committing homicide, experiencing or committing a violent crime such as [[rape]] or torture, experiencing combat violence, attempting suicide, and being in automobile accidents and natural disasters have all induced cases of situation-specific amnesia.<ref name=":0">{{Cite journal |last=Kopelman |first=M. D. |date=2002-10-01 |title=Disorders of memory |journal=Brain |volume=125 |issue=10 |pages=2152–2190 |doi=10.1093/brain/awf229|doi-access=free |pmid=12244076 }}</ref><ref>{{Cite journal |last1=Arrigo |first1=Jean Maria |last2=Pezdek |first2=Kathy |date=October 1997 |title=Lessons From the Study of Psychogenic Amnesia |url=http://journals.sagepub.com/doi/10.1111/1467-8721.ep10772916 |journal=Current Directions in Psychological Science |language=en |volume=6 |issue=5 |pages=148–152 |doi=10.1111/1467-8721.ep10772916 |issn=0963-7214}}</ref> In these unusual cases, care must be exercised in interpreting cases of [[psychogenic amnesia]] when there are compelling motives to feign memory deficits for legal or financial reasons.<ref name=":0" /> However, although some fraction of psychogenic amnesia cases can be explained in this fashion, it is generally acknowledged that true cases are not uncommon. Both global and situationally specific amnesia are often distinguished from the organic amnesic syndrome, in that the capacity to store new memories and experiences remains intact. Given the very delicate and oftentimes dramatic nature of memory loss in such cases, there usually is a concerted effort to help the person recover their identity and history. This will sometimes allow the subject to recover spontaneously, when particular cues are encountered.

===Definition===
The cause of the fugue state is related to [[Psychogenic amnesia|dissociative amnesia]] (code 300.12 of the [[DSM-IV codes]]<ref>{{cite web |url=http://www.psychiatryonline.com/content.aspx?aID=9708 |archive-url=https://web.archive.org/web/20070928075634/http://www.psychiatryonline.com/content.aspx?aID=9708 |url-status=dead |archive-date=2007-09-28 |title=Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ) |publisher=Psychiatryonline.com |access-date=2011-11-28 }}</ref>), which has several other subtypes:<ref>[http://www.psychnet-uk.com/dsm_iv/dissociative_amnesia.htm Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com )] {{webarchive |url=https://web.archive.org/web/20101128192837/http://www.psychnet-uk.com/dsm_iv/dissociative_amnesia.htm |date=November 28, 2010 }}</ref> [[selective amnesia]], [[generalized amnesia]], [[continuous amnesia]], and [[systematized amnesia]], in addition to the subtype "dissociative fugue".<ref name="DSM-IV_300.13"/>

Unlike [[retrograde amnesia]] (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), dissociative amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., amnestic disorder due to a head trauma, DSM-IV Code 294.0).<ref name="PsychNet-UK.com">[http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm Complete List of DSM-IV Codes ( PsychNet-UK.com )] {{webarchive |url=https://web.archive.org/web/20110106174809/http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm |date=January 6, 2011 }}</ref> It is a complex neuropsychological process.<ref>{{cite web |url=http://www.dissociation.co.uk/background.asp |title=Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma ) |publisher=Dissociation.co.uk |access-date=2011-11-28 |url-status=dead |archive-url=https://web.archive.org/web/20120114165147/http://www.dissociation.co.uk/background.asp |archive-date=2012-01-14 }}</ref>

As the person experiencing a dissociative fugue may have recently experienced the reappearance of an event or person representing an earlier trauma, the emergence of an armoring or defensive personality seems to be for some, a logical defense strategy in the situation.<ref>{{Cite journal |last1=Raval |first1=Chintan Madhusudan |last2=Upadhyaya |first2=Sunnetkumar |last3=Panchal |first3=Bharat Navinchandra |date=2015 |title=Dissociative fugue: Recurrent episodes in a young adult |journal=Industrial Psychiatry Journal |language=en |volume=24 |issue=1 |pages=88–90 |doi=10.4103/0972-6748.160944 |doi-access=free |issn=0972-6748 |pmc=4525440 |pmid=26257491}}</ref><ref>Angothu, H., & Pabbathi, L. (2016). Recurrent episodes of dissociative fugue. ''Indian Journal of Psychological Medicine, 38''(2), 160-162. <nowiki>https://doi.org/10.4103/0253-7176.178815</nowiki></ref>

Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "[[dissociation (psychology)|dissociative]] fugue", the former implying a greater degree of "motion".<ref>{{Cite web |title=Amnesia Concepts In Psychology |url=https://scales.arabpsychology.com/2022/11/19/amnesia-2/ |access-date=2023-02-21 |language=en-US}}</ref> For the purposes of this article, then, a "fugue state" occurs while one is "acting out" a "dissociative fugue".

The ''[[DSM-IV|DSM-IV{{Hair space}}]]''<ref name="DSM-IV_300.13"/> defines "dissociative fugue" as:

*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 the assumption of a new identity
*significant distress or impairment

The ''[[Merck Manual|Merck Manual{{Hair space}}]]''<ref name="Merck">[[Merck Manual]] 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)</ref> defines "dissociative fugue" as:

: 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.

In support of this definition, the ''Merck Manual{{Hair space}}''<ref name="Merck"/> further defines dissociative amnesia as:

: An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.