Dissociative Fugue: Diagnosis and Symptoms
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Questions and Answers

Which of the following is the MOST accurate description of Dissociative Fugue?

  • A chronic condition marked by consistent memory loss and identity confusion that gradually worsens over time.
  • A long-term pattern of unstable relationships, distorted self-image, and impulsive behavior.
  • A sudden and unexpected departure from one's usual surroundings accompanied by an inability to recall one's past and potential identity confusion. (correct)
  • A condition primarily characterized by auditory and visual hallucinations and a detachment from reality.

What is a key differentiating factor between Dissociative Fugue and malingering?

  • Malingering always involves assumption of a bizarre alternate identity.
  • Malingering involves genuine amnesia, unlike Dissociative Fugue.
  • Dissociative Fugue is easily diagnosed through hypnotic interviews, while malingering is not.
  • Malingering is often associated with an attempt to escape legal, financial, or personal issues, while Dissociative Fugue may arise from overwhelming stressors. (correct)

Which of the following conditions should be ruled out BEFORE diagnosing Dissociative Fugue?

  • Panic Disorder.
  • Social Anxiety Disorder.
  • Obsessive-Compulsive Disorder.
  • Complex partial seizures. (correct)

A patient presents with sudden travel away from home, confusion about their identity, and an inability to recall their past. According to the diagnostic criteria, what other condition MUST be ruled out BEFORE diagnosing Dissociative Fugue?

<p>Dissociative Identity Disorder. (D)</p> Signup and view all the answers

Which of the following is LEAST likely to be associated with Dissociative Fugue?

<p>Grandiose ideas and inappropriate behavior. (D)</p> Signup and view all the answers

A patient is exhibiting symptoms of Dissociative Fugue. What other co-morbid psychological condition might they ALSO be experiencing?

<p>Posttraumatic Stress Disorder (D)</p> Signup and view all the answers

During an evaluation, a patient describes an episode of wandering behavior with subsequent amnesia. What factor would suggest this episode is due to a Manic Episode rather than Dissociative Fugue?

<p>The individual displayed grandiose ideas and inappropriate behavior during the episode. (D)</p> Signup and view all the answers

A forensic examiner is evaluating a defendant claiming Dissociative Fugue after committing a crime. What aspect of the crime would be MORE consistent with a TRUE dissociative disturbance rather than malingering?

<p>The crime was bizarre and yielded little actual gain. (B)</p> Signup and view all the answers

What is the estimated prevalence of Dissociative Fugue in the general population?

<p>0.2% (A)</p> Signup and view all the answers

What factor is MOST likely to increase the prevalence of Dissociative Fugue in a population?

<p>Times of extremely stressful events such as wartime or natural disaster. (D)</p> Signup and view all the answers

Which of the following is NOT included as a 'running syndrome'?

<p>The Jumping disease of Maine (A)</p> Signup and view all the answers

What is the typical duration of a single episode of Dissociative Fugue?

<p>Hours to months (A)</p> Signup and view all the answers

Which condition could be mistaken for Dissociative Fugue due to similar wandering behavior, but involves very different underlying mechanisms?

<p>Epileptic Fugue (A)</p> Signup and view all the answers

If dissociative symptoms are judged to be caused by a general medical condition, what is the appropriate diagnosis?

<p>Mental Disorder Not Otherwise Specified Due to a General Medical Condition (D)</p> Signup and view all the answers

In the context of schizophrenia, how might memory difficulties differ from those seen in Dissociative Fugue?

<p>Memory for events during wandering episodes in individuals with Schizophrenia may be difficult to ascertain due to the individual’s disorganized speech. (B)</p> Signup and view all the answers

What is the primary characteristic of continuous amnesia?

<p>Inability to recall events subsequent to a specific time, up to and including the present. (C)</p> Signup and view all the answers

Which of the following best describes systematized amnesia?

<p>Loss of memory for certain categories of information, like memories related to family. (B)</p> Signup and view all the answers

Individuals exhibiting continuous or systematized amnesia may be diagnosed with what broader condition?

<p>Dissociative Identity Disorder or another complex Dissociative Disorder. (C)</p> Signup and view all the answers

Which of the following is a common symptom associated with Dissociative Amnesia?

<p>Depersonalization. (D)</p> Signup and view all the answers

What is a potential indicator of Dissociative Amnesia that can sometimes be observed?

<p>Answering simple questions with obviously incorrect responses, resembling Ganser syndrome. (C)</p> Signup and view all the answers

Why is Dissociative Amnesia challenging to assess in preadolescent children?

<p>Symptoms can mimic inattention, anxiety, learning disorders, or typical childhood amnesia. (B)</p> Signup and view all the answers

What is a recommended approach for accurately diagnosing Dissociative Amnesia in children?

<p>Serial observation or evaluations by multiple examiners. (C)</p> Signup and view all the answers

What are the differing views on the reported increase in cases of Dissociative Amnesia involving forgotten childhood traumas?

<p>Some attribute it to better diagnosis, while others argue it's overdiagnosed in suggestible individuals. (A)</p> Signup and view all the answers

What is a common pattern in the course of Dissociative Amnesia regarding memory gaps?

<p>The duration of amnesia can range from minutes to years, and individuals may experience single or multiple episodes. (A)</p> Signup and view all the answers

Under what circumstances might acute amnesia associated with Dissociative Amnesia resolve spontaneously?

<p>When the individual is removed from the traumatic circumstances linked to the amnesia. (C)</p> Signup and view all the answers

How is Amnestic Disorder Due to a General Medical Condition distinguished from Dissociative Amnesia?

<p>Amnestic Disorder is linked to a specific medical condition or brain injury, based on medical history or lab findings. (C)</p> Signup and view all the answers

In Amnestic Disorder Due to a Brain Injury, what patterns of amnesia are typically observed?

<p>Both retrograde and anterograde amnesia, with a history of physical trauma or unconsciousness. (D)</p> Signup and view all the answers

What key characteristic helps differentiate Dissociative Amnesia with retrograde amnesia from Amnestic Disorder?

<p>The prompt recovery of lost memories under hypnosis. (B)</p> Signup and view all the answers

How does memory loss in delirium and dementia differ from that in Dissociative Amnesia?

<p>Delirium and dementia involve a broader range of cognitive, affective, and behavioral disturbances alongside memory loss. (C)</p> Signup and view all the answers

What distinguishes Substance-Induced Persisting Amnestic Disorder from Dissociative Amnesia?

<p>In Substance-Induced Amnesia, short-term memory is impaired, whereas Dissociative Amnesia preserves the ability to form new memories. (D)</p> Signup and view all the answers

What is a common characteristic of the primary identity in individuals with Dissociative Identity Disorder?

<p>A passive, dependent, guilty, and depressed demeanor (A)</p> Signup and view all the answers

Which of the following best describes how alternate identities typically interact within an individual with Dissociative Identity Disorder?

<p>They may deny knowledge of one another, be critical, or openly conflict. (B)</p> Signup and view all the answers

What is a key feature of the amnesia experienced by individuals with Dissociative Identity Disorder?

<p>Asymmetrical memory loss, where some identities have more constricted memories than others (A)</p> Signup and view all the answers

What is commonly observed during transitions between different identities in Dissociative Identity Disorder?

<p>Rapid eye blinking, changes in facial expression, voice, or demeanor, and disruptions in thought. (C)</p> Signup and view all the answers

Which of the following is a controversial aspect regarding the reported history of individuals with Dissociative Identity Disorder?

<p>The accuracy of reports of severe physical and sexual abuse during childhood. (D)</p> Signup and view all the answers

What associated feature might lead to a concurrent diagnosis of Borderline Personality Disorder in an individual with Dissociative Identity Disorder?

<p>Self-mutilative behavior, impulsivity, and unstable relationships. (B)</p> Signup and view all the answers

What is a significant cross-cultural consideration in diagnosing Dissociative Identity Disorder?

<p>DID has been found in individuals from a variety of cultures around the world. (C)</p> Signup and view all the answers

Why is diagnosing Dissociative Identity Disorder in preadolescent children particularly challenging?

<p>The manifestations of DID may be less distinctive in children compared to adults. (B)</p> Signup and view all the answers

How does the reported prevalence of Dissociative Identity Disorder differ between adult males and females?

<p>DID is diagnosed three to nine times more frequently in adult females than in adult males. (A)</p> Signup and view all the answers

What might explain the sharp rise in reported cases of Dissociative Identity Disorder in recent years?

<p>Greater awareness of the diagnosis among mental health professionals leading to the identification of previously undiagnosed cases. (C)</p> Signup and view all the answers

An individual with DID is found with items they can't remember purchasing. How does this relate to their condition?

<p>This is an example of the amnesia associated with DID, where an alternate identity may have made the purchase (D)</p> Signup and view all the answers

A therapist notices a patient's voice and demeanor changing rapidly during a session. Which aspect of DID might this indicate?

<p>The transitions between different identities (B)</p> Signup and view all the answers

Which statement reflects a key consideration when evaluating reports of childhood abuse in individuals with DID?

<p>Childhood memories may be subject to distortion, but reports of abuse are often confirmed by objective evidence (D)</p> Signup and view all the answers

An individual with DID consistently scores high on measures of hypnotizability. How is this finding typically interpreted?

<p>It is an expected finding, as individuals with DID often have a high capacity for dissociation (C)</p> Signup and view all the answers

How might the average number of identities differ between males and females diagnosed with Dissociative Identity Disorder?

<p>Females tend to have approximately 15 identities or more, higher than males. (B)</p> Signup and view all the answers

What is the average time frame between the presentation of initial symptoms and a formal diagnosis of Dissociative Identity Disorder (DID)?

<p>6-7 years (C)</p> Signup and view all the answers

How might Dissociative Identity Disorder manifest in individuals as they age beyond their late 40s?

<p>The disorder may become less apparent but can reemerge during stressful events or substance abuse. (C)</p> Signup and view all the answers

Which neurological condition shares overlapping symptoms with Dissociative Identity Disorder, requiring careful differentiation?

<p>Complex Partial Seizures (D)</p> Signup and view all the answers

What characteristics differentiate seizure episodes from the shifts in identity states observed in Dissociative Identity Disorder?

<p>Seizure episodes are generally brief (30 seconds to 5 minutes) and do not involve the complex and enduring structures of identity and behavior. (B)</p> Signup and view all the answers

In the differential diagnosis of Dissociative Identity Disorder, what clinical tool might be used to distinguish it from complex partial seizures?

<p>EEG studies, especially sleep deprived and with nasopharyngeal leads (B)</p> Signup and view all the answers

How can symptoms caused by substance use be differentiated from Dissociative Identity Disorder?

<p>Substance use is known to be etiologically related to the disturbance. (B)</p> Signup and view all the answers

An individual describes feelings of detachment and being an outside observer of themselves, but maintains an awareness that these feelings are not real. Which disorder is most consistent with these symptoms?

<p>Depersonalization Disorder (A)</p> Signup and view all the answers

What criteria must be met for a diagnosis of Depersonalization Disorder, beyond experiencing feelings of detachment?

<p>The symptoms must cause significant distress or impair functioning. (C)</p> Signup and view all the answers

Why is it important to rule out other mental disorders before diagnosing Depersonalization Disorder?

<p>Depersonalization is a feature commonly associated with many other mental disorders. (D)</p> Signup and view all the answers

Which of the following factors supports a diagnosis of Dissociative Identity Disorder rather than another mental disorder with overlapping symptoms?

<p>Sudden shifts in identity states and the persistence of identity-specific demeanors over time (D)</p> Signup and view all the answers

Which condition should be considered when an individual presents with multiple identities, especially if there's potential for financial or legal benefits?

<p>Malingering (D)</p> Signup and view all the answers

According to the diagnostic criteria for Dissociative Identity Disorder, what is a core characteristic of the condition?

<p>The presence of two or more distinct identities or personality states that recurrently take control of the person’s behavior. (D)</p> Signup and view all the answers

What distinguishes pathological trance and possession trance symptoms from Dissociative Identity Disorder?

<p>Individuals with trance symptoms typically describe external spirits or entities that have entered their bodies and taken control. (A)</p> Signup and view all the answers

How might shifts between identity states in Dissociative Identity Disorder be misconstrued, leading to a misdiagnosis?

<p>Mistaken for cyclical mood fluctuations leading to confusion with Bipolar Disorder (D)</p> Signup and view all the answers

What role does memory impairment play in diagnosing Dissociative Identity Disorder, according to the provided diagnostic criteria?

<p>Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. (D)</p> Signup and view all the answers

An individual reports feeling detached from their body and mental processes, describing it as if they are watching themselves in a movie. Reality testing remains intact. To diagnose Depersonalization Disorder, what else must be present?

<p>The depersonalization must cause significant distress or impairment in functioning. (A)</p> Signup and view all the answers

A patient reports symptoms of depersonalization following a traumatic event. How would a clinician differentiate between Depersonalization Disorder and Posttraumatic Stress Disorder (PTSD)?

<p>If the depersonalization symptoms are present only during periods of heightened anxiety related to the traumatic event, PTSD would be the primary diagnosis. (C)</p> Signup and view all the answers

Which of the following is an important distinction between Depersonalization Disorder and Schizophrenia?

<p>Reality testing remains intact in Depersonalization Disorder, whereas it is significantly impaired in Schizophrenia. (A)</p> Signup and view all the answers

A patient is experiencing depersonalization symptoms. What would be the MOST important initial step in differentiating Depersonalization Disorder from depersonalization caused by a general medical condition?

<p>Obtaining a thorough medical history, conducting a physical examination, and ordering appropriate lab tests. (D)</p> Signup and view all the answers

A clinician is evaluating a patient who reports symptoms of detachment and unreality. Which co-occuring mental health condition should the clinician FIRST rule out before diagnosing Depersonalization Disorder?

<p>Panic Disorder (B)</p> Signup and view all the answers

An individual who has a history of heavy alcohol use reports experiencing frequent episodes of depersonalization. What factor should a clinician consider to accurately diagnose Depersonalization Disorder?

<p>Whether the depersonalization symptoms began before or only during the period of heavy alcohol use. (B)</p> Signup and view all the answers

What associated feature might a clinician observe in a patient diagnosed with Depersonalization Disorder?

<p>A disturbance in one's sense of time (D)</p> Signup and view all the answers

During an interview, a client with suspected Depersonalization Disorder expresses concern that their experiences mean they are 'going crazy'. What is the best approach for the interviewer?

<p>Acknowledge the client's fears and provide education about Depersonalization Disorder, emphasizing that intact reality testing is a key feature. (B)</p> Signup and view all the answers

A patient describes instances where objects appear to change size or shape (macropsia or micropsia). If this occurs alongside feelings of unreality, what aspect of Depersonalization Disorder is being described?

<p>Derealization (D)</p> Signup and view all the answers

An individual with Depersonalization Disorder is undergoing psychological testing. Which finding would be MOST consistent with this diagnosis?

<p>High hypnotizability and high dissociative capacity. (C)</p> Signup and view all the answers

In certain cultural contexts, experiences of depersonalization or derealization are voluntarily induced as part of meditative practices. Why are these experiences NOT considered Depersonalization Disorder?

<p>Because these experiences are part of a culturally accepted practice and do not necessarily cause distress or impairment. (A)</p> Signup and view all the answers

What is the typical course of Depersonalization Disorder following a life-threatening event?

<p>It usually develops suddenly upon exposure to the trauma. (C)</p> Signup and view all the answers

A patient with Depersonalization Disorder reports that their symptoms worsen during periods of high stress at work. How would this pattern be described in terms of the disorder's course?

<p>Chronic with exacerbations related to stressors (C)</p> Signup and view all the answers

A patient reports feelings of numbness. How can a clinician distinguish this numbness from that experienced in depression versus Depersonalization Disorder?

<p>In Depersonalization Disorder, numbness is associated with detachment, even when the individual is not depressed. (A)</p> Signup and view all the answers

What is the reported mean age of onset for Depersonalization Disorder?

<p>Around age 16 (D)</p> Signup and view all the answers

How can memory loss due to substance intoxication ("blackouts") be distinguished from Dissociative Amnesia?

<p>Memory loss in substance intoxication is typically associated with heavy substance use. (D)</p> Signup and view all the answers

When should a separate diagnosis of Dissociative Amnesia NOT be made?

<p>When the dissociative amnesia occurs exclusively during Posttraumatic Stress Disorder. (C)</p> Signup and view all the answers

In what context is malingered amnesia most commonly observed?

<p>In individuals presenting with acute symptoms when potential secondary gain is evident. (B)</p> Signup and view all the answers

What factor complicates the evaluation of memories related to reported physical or sexual abuse, especially in early childhood?

<p>The potential for both underreporting and overreporting of such events. (A)</p> Signup and view all the answers

What distinguishes Dissociative Amnesia from normal memory lapses?

<p>The presence of significant distress or impairment due to the inability to recall extensive traumatic memories. (B)</p> Signup and view all the answers

What is the essential feature of Dissociative Fugue?

<p>Sudden, unexpected travel away from home, coupled with amnesia for one's past. (C)</p> Signup and view all the answers

During a Dissociative Fugue, what might an individual exhibit that could make them not attract attention?

<p>Behavior that appears to be without obvious psychopathology. (A)</p> Signup and view all the answers

What commonly triggers clinical attention in individuals experiencing Dissociative Fugue?

<p>Amnesia for recent events or a lack of awareness of personal identity. (D)</p> Signup and view all the answers

What is a common characteristic of a new identity assumed during a Dissociative Fugue, if one is assumed?

<p>It is usually characterized by more gregarious and uninhibited traits than the former identity. (B)</p> Signup and view all the answers

After returning to the prefugue state, what emotional or psychological states might be noted?

<p>Depression, anxiety, guilt or overwhelming stress. (D)</p> Signup and view all the answers

According to diagnostic criteria, which of the following is necessary for a diagnosis of Dissociative Amnesia?

<p>Significant distress or impairment in important areas of functioning. (C)</p> Signup and view all the answers

What is a key difference between Dissociative Amnesia and Age-Related Cognitive Decline?

<p>Dissociative Amnesia is distinguished by the involuntary nature and content of the memory loss (often traumatic). (C)</p> Signup and view all the answers

If depersonalization occurs only during episodes of Dissociative Amnesia, should it be diagnosed separately as Depersonalization Disorder?

<p>No, because depersonalization is an associated feature of Dissociative Amnesia. (A)</p> Signup and view all the answers

What must be ruled out before diagnosing Dissociative Amnesia based on the diagnostic criteria?

<p>Direct physiological effects of a substance or neurological condition. (C)</p> Signup and view all the answers

What is the range of travel seen in Dissociative Fugue?

<p>Ranges from brief trips to complex wandering over long time periods. (B)</p> Signup and view all the answers

Flashcards

Dissociative Amnesia

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

Reversible Memory Impairment

A reversible memory impairment where memories of personal experience cannot be retrieved verbally or fully retained.

Memory Gaps

Gaps in recall for aspects of one's life history, usually related to traumatic events.

Localized Amnesia

Failing to recall events during a specific period, often after a disturbing event.

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Selective Amnesia

Recalling some but not all events during a specific period of time.

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Generalized Amnesia

Failure to recall one's entire life history.

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Acute Dissociative Amnesia

Presents as a florid episode with sudden onset, more likely during wartime or after severe trauma.

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Selective Amnesia

Recalling some, but not all, of the events during a circumscribed period of time.

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Continuous Amnesia

Inability to recall events after a specific time, up to the present.

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Systematized Amnesia

Loss of memory for specific categories of information (e.g., memories about family).

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Associated Features of Dissociative Amnesia

Depressive symptoms, anxiety, depersonalization, trance states, analgesia, and spontaneous age regression.

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Ganser Syndrome

Providing inaccurate answers to questions.

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Hypnotizability in Dissociative Amnesia

High levels of suggestibility.

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Differential Diagnosis in Children

Inattention, anxiety, oppositional behavior, learning disorders, psychotic disturbances.

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Interpretations of Increased Cases

Increased awareness among professionals, or overdiagnosis in suggestible individuals.

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Duration of Amnesia

Minutes to years.

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Resolution of Acute Amnesia

Amnesia resolves after removal from traumatic circumstances.

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Amnestic Disorder

Amnesia due to a medical condition (e.g., head trauma).

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Memory Loss

Usually anterograde (after the trauma).

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Diagnosis

History, lab findings, or physical exam.

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Seizure Disorders

Memory impairment is sudden, motor abnormalities may be present, EEGs show abnormalities.

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Delirium and Dementia

Extensive cognitive, linguistic, affective, attentional, perceptual, and behavioral disturbances.

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Substance-Induced Amnesia

Short-term memory is impaired.

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Intoxication Amnesia

Memory loss linked to substance use, typically not reversible.

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Dissociative Fugue

Sudden, unexpected travel away from home with amnesia and confusion about identity.

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Dissociative Amnesia (Criterion A)

Extensive memory loss, usually of a traumatic nature, beyond normal forgetfulness.

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Dissociative Amnesia (Criterion C)

Symptoms causing significant distress or impairment in functioning.

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Malingered Amnesia

Amnesia or memory loss that is deliberately feigned or exaggerated.

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Dissociative Amnesia Traits

Tendency to score high on hypnotizability and dissociation measures.

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Fugue Amnesia

Inability to recall events during a fugue state after returning to normal.

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Fugue Identity Confusion

Confusion about personal identity during a fugue state.

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Fugue New Identity

Assuming a new identity during a fugue state, often more outgoing.

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Post-Fugue Amnesia

Amnesia for past traumatic events after a fugue state ends.

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Fugue Associated Features

Symptoms include depression, anxiety, stress, and suicidal thoughts.

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Dissociative Amnesia (Criterion B)

Ruling out other disorders and substances (e.g., PTSD, substance abuse).

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Memory Retrieval Evaluation

Evaluates the accuracy of retrieved memories, as it can be contentious.

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Dissociative Fugue (Criterion A)

Sudden, unexpected travel with inability to recall one's past, excluding Dissociative Identity Disorder.

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Dissociative Fugue (Criterion B)

Confusion about personal identity or assumption of a new identity (excluding DID) during a fugue.

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Identity Confusion in Fugue

Confusion about personal identity or assumption of a new identity.

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Fugue Exclusion Criteria

Fugue symptoms not due to DID, substances, or general medical conditions.

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Fugue Impact

Symptoms cause significant distress or impairment in functioning.

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Dissociative Identity Disorder (DID)

Two or more distinct identities or personality states recurrently take control of behavior.

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Memory Loss in DID

Inability to recall important personal information, too great to be explained by forgetfulness.

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DID Exclusion

Symptoms of DID not due to substances or medical conditions; not normal childhood fantasy.

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Approximate Answers

Approximate, inaccurate answers given to questions.

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Fugue Triggers

Onset of Dissociative Fugue often linked to trauma or overwhelming events.

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Fugue Recovery

Rapid, but refractory Dissociative Amnesia may persist.

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Epileptic Fugue Clues

Epileptic fugue includes auras, motor issues, and abnormal EEGs.

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Mania vs. Fugue

Fugue-like behavior during mania includes grandiosity and inappropriate behavior.

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Malingered Fugue

Faking fugue to escape legal, financial, or personal problems.

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Dissociative Fugue Prevalence

Uncommon, occurring in approximately 0.2% of the general population.

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"Running" Syndromes

Conditions with sudden activity, trance-like states, fleeing, and amnesia.

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Primary Identity (in DID)

The identity that usually carries the individual's given name and is often passive and depressed.

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Alternate Identities (in DID)

Identities that have different names and characteristics from the primary identity; may be hostile or controlling.

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Switching (in DID)

The experience of alternate identities taking control in sequence, often without awareness of each other.

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Amnesia (in DID)

Gaps in recall for personal history, both remote and recent, common in DID.

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Asymmetrical Amnesia (in DID)

The tendency for more passive identities to have more constricted memories, while hostile identities have more complete ones.

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Hallucinations (in DID)

Auditory or visual hallucinations experienced by an identity that is not in control.

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Triggers (in DID)

Events or circumstances that trigger transitions among identities.

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Signs of identity switches (in DID)

Rapid blinking, facial changes, and changes in voice or demeanor during identity switches

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Self-Mutilation and Suicidality (in DID)

Self-harm and suicidal thoughts or actions that may occur with DID.

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Conversion Symptoms (in DID)

Physical symptoms without a medical cause that may be experienced by certain identities in DID.

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Hypnotizability (in DID)

A tendency to score higher on measures of hypnotizability and dissociative capacity.

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Common Physical Conditions (in DID)

Migraines, irritable bowel syndrome, and asthma are common physical conditions associated with DID.

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Gender Differences (in DID)

The fact that DID is diagnosed more frequently in adult females than in adult males.

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Controversy (in DID)

Differing interpretations exist; either greater awareness or overdiagnosis due to suggestibility.

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Depersonalization

Feeling detached from one's body or mental processes, as if observing from outside.

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Derealization

The sense that the external world is unreal or strange.

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Macropsia or Micropsia

Alteration in the perceived size/shape of objects.

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Criterion C (Depersonalization Disorder)

Clinically significant distress or impairment due to depersonalization/derealization.

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Criterion D (Depersonalization Disorder)

Depersonalization/derealization must not occur exclusively during another mental disorder.

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Associated features of Depersonalization Disorder

Anxiety, depression, obsessive rumination, somatic concerns, distorted time sense.

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Commonly co-occurring Personality Disorders

Avoidant, Borderline, Obsessive-Compulsive

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Culture-bound depersonalization

Voluntarily induced experiences of depersonalization within cultural practices.

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Gender Prevalence

Diagnosed twice as often in women than men

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Mean age of onset (Depersonalization Disorder)

Around age 16

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Usual presenting complaints (Depersonalization Disorder)

Another symptom such as anxiety, panic or depression.

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Basis of determination (Depersonalization Disorder)

History, laboratory findings, or physical exam.

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Substances causing depersonalization

Alcohol and a variety of other substances.

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Reality testing in Depersonalization Disorder

Maintained.

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Feelings of Numbness

Detachment from self remains there.

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Time to DID Diagnosis

The average duration between the first symptom presentation and an accurate diagnosis of Dissociative Identity Disorder.

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Triggers for DID Relapse

Trauma, stress, or substance abuse that can cause the reemergence of Dissociative Identity Disorder symptoms, especially as individuals age beyond their late 40s.

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Familial Pattern of DID

Dissociative Identity Disorder is reported to occur with higher frequency among first-degree biological relatives of individuals diagnosed with the disorder, compared to the general population.

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Complex Partial Seizures

A neurological condition with brief episodes (30 seconds - 5 minutes) that may resemble dissociative symptoms, but lacks the complex identity structures seen in Dissociative Identity Disorder.

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EEG Studies

A diagnostic tool, especially when sleep-deprived and using nasopharyngeal leads, helpful in differentiating Dissociative Identity Disorder from seizure disorders.

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Substance-Induced Dissociation

Mental disorders must be distinguished from Dissociative Identity Disorder, where a drug or medication directly causes dissociative symptoms.

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DID Diagnostic Hierarchy

A diagnosis that should be prioritized over Dissociative Amnesia, Dissociative Fugue, and Depersonalization Disorder when diagnostic criteria are met.

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Possession Trance

External spirits or entities entering the body and taking control, distinguishing it from DID which involves internal, distinct identity states.

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Mental Disorders Confused with DID

Psychotic Disorders and Bipolar Disorder, where the presence of distinct personality states may be mistaken for delusions/hallucinations or mood fluctuations.

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Indicators Supporting DID Diagnosis

Sudden shifts in identity states, consistent behaviors of specific identities, reversible amnesia, early dissociative behaviors, and high scores on dissociation measures.

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Malingering

Feigning or exaggerating symptoms for financial or forensic gain.

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Factitious Disorder

Falsifying symptoms to assume the sick role.

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Intact Reality Testing

Maintaining an awareness that the feeling of detachment from one's self is not real, and reality testing remains intact.

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Study Notes

Dissociative Amnesia (Formerly Psychogenic Amnesia)

  • Involves the inability to recall important personal information, typically of a traumatic or stressful nature
  • Memory impairment is reversible, preventing verbal retrieval or retention of personal experiences
  • Not due to substance use, neurological conditions, or other medical conditions
  • Causes significant distress or impairment in functioning

Presentation

  • Usually presents as retrospectively reported gaps in recall related to traumatic or stressful events
  • Amnesia can cover episodes of self-mutilation, violent outbursts, or suicide attempts
  • Can manifest as a sudden-onset, florid episode, especially during wartime or after severe trauma

Types of Memory Disturbances

  • Localized amnesia: failure to recall events during a specific time, often after a disturbing event
  • Selective amnesia: recall of some, but not all, events during a specific time
  • Generalized amnesia: encompasses the person’s entire life
  • Continuous amnesia: inability to recall events from a specific time up to the present
  • Systematized amnesia: loss of memory for certain information categories, such as memories of family

Associated Features and Disorders

  • Depressive symptoms, anxiety, depersonalization, trance states, analgesia, and spontaneous age regression
  • Inaccurate answers to questions (Ganser syndrome)
  • Sexual dysfunction, impaired relationships, self-mutilation, aggressive/suicidal impulses
  • May coexist with Conversion Disorder, Mood Disorder, Substance-Related Disorder, or Personality Disorder
  • High hypnotizability is often observed

Age-Specific Features

  • Difficult to assess in preadolescent children due to potential confusion with other conditions
  • Requires serial observation from multiple people to diagnose accurately

Prevalence and Course

  • Reported cases of Dissociative Amnesia, especially those involving forgotten childhood traumas, have increased in recent years
  • It is debated as to whether this is due to better diagnoses or over diagnosing
  • Can occur at any age
  • Typically involves a retrospective memory gap, ranging from minutes to years
  • Episodes can be single or recurrent
  • Acute amnesia may resolve spontaneously when removed from the traumatic circumstances
  • Can develop into a chronic form

Differential Diagnosis

  • Must be distinguished from Amnestic Disorder Due to a General Medical Condition, such as head trauma or epilepsy
  • Substance-Induced Persisting Amnestic Disorder, which impairs short-term memory
  • Dissociative Fugue and Dissociative Identity Disorder (a separate diagnosis of Dissociative Amnesia is not made if it occurs during either of these)
  • Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder (Dissociative Amnesia should not be diagnosed if it occurs exclusively during the course of these disorders)
  • Malingered amnesia, which is more common when secondary gain is evident
  • Memory loss related to Age-Related Cognitive Decline and nonpathological forms of amnesia
  • Extensive and involuntary inability to recall traumatic memories, causing distress or impairment defines dissociative amnesia

Diagnostic Criteria

  • Inability to recall important personal information, usually of a traumatic nature, beyond normal forgetfulness
  • Not due to other disorders or direct physiological effects of a substance/medical condition
  • Causes significant distress/impairment in functioning

Dissociative Fugue (Formerly Psychogenic Fugue)

  • Sudden, unexpected travel away from home or usual activities, with inability to recall one’s past
  • Accompanied by confusion about personal identity or assumption of a new identity
  • Not due to substance use disorder or a general medical condition
  • Causes clinically significant distress or impairment in functioning

Presentation

  • Travel ranges from brief trips to complex wandering over long periods
  • Individuals may appear normal during a fugue, but eventually come to clinical attention
  • Amnesia for events during the fugue is common once the prefugue state is regained
  • A new identity, if assumed, is typically more gregarious than the former one

Associated Features and Disorders

  • Amnesia for past traumatic events may be noted after returning to the prefugue state
  • May involve depression, dysphoria, anxiety, grief, shame, guilt, stress, conflict, suicidal and aggressive impulses
  • May coexist with Mood Disorder, Posttraumatic Stress Disorder, or a Substance-Related Disorder

Culture-Specific Features

  • Culturally defined "running" syndromes may meet criteria for Dissociative Fugue
  • Characterized by sudden onset of high activity, trance-like state, and amnesia

Prevalence and Course

  • Prevalence rate of 0.2% in the general population
  • May increase during times of extreme stress
  • Onset is usually trauma-related and occurs most commonly in adults
  • Episodes can last from hours to months with recovery being rapid
  • Refractory Dissociative Amnesia may persist in some cases

Differential Diagnosis

  • Must be distinguished from symptoms of head injury or other medical conditions
  • Wandering behavior during seizures or postictal states
  • Dissociative symptoms caused by a substance
  • Dissociative Fugue should not be diagnosed separately if it only occurs during the course of Dissociative Identity Disorder
  • Wandering during a Manic Episode, which involves grandiose ideas and inappropriate behavior
  • Peripatetic behavior in Schizophrenia, although individuals with Dissociative Fugue generally do not demonstrate other symptoms of schizophrenia
  • Malingered fugue states in those trying to flee legal, financial, or personal difficulties

Diagnostic Criteria

  • Sudden, unexpected travel away from home or work with inability to recall one’s past
  • Confusion about personal identity or assumption of a new identity
  • Not due to other disorders or direct physiological effects of a substance/medical condition
  • Causes significant distress/impairment in functioning

Dissociative Identity Disorder (Formerly Multiple Personality Disorder)

  • Presence of two or more distinct identities or personality states that recurrently take control of behavior
  • Inability to recall important personal information, beyond ordinary forgetfulness
  • Not due to substance use or a general medical condition
  • In children, symptoms are not attributable to imaginary playmates

Presentation

  • Reflects a failure to inegrate identity, memory, and consciousness
  • Each personality has a distinct history, self-image, and identity and may have different names
  • A primary identity is passive, dependent, guilty, and depressed, while the alternate identities contrast with the primary
  • Identities emerge in specific circumstances and can differ in age, gender, vocabulary, knowledge, or affect
  • Identities deny knowledge, are critical, or fight. Aggressive identities interrupt activities
  • Memory gaps exist for personal history, and amnesia is frequently asymmetrical
  • Identity transitions are triggered by stress, switches are rapid
  • Number of identities vary from 2 to more than 100

Associated Features and Disorders

  • History of severe physical and sexual abuse, especially during childhood
  • Manifest posttraumatic symptoms or Posttraumatic Stress Disorder
  • Self-mutilation and suicidal/aggressive behavior is common
  • Unusual pain tolerance or other physical symptom control
  • Co-occurs with Mood, Substance-Related, Sexual, Eating, or Sleep Disorders
  • Concurrent diagnosis of Borderline Personality Disorder

Lab and Examination Findings

  • High hypnotizability and dissociative capacity
  • Possible variations in physiological functions across identities
  • Scars from self-inflicted injuries or abuse, along with migraines, irritable bowel syndrome, and asthma

Culture, Age, and Gender Features

  • Found across cultures
  • Manifestations in children are less distinctive
  • Diagnosed more frequently in adult females than adult males
  • Females tend to have more identities than males

Prevalence and Course

  • Sharp rise in reported cases may be due to greater awareness or overdiagnosis
  • Fluctuating, chronic, and recurrent clinical course
  • Average time to diagnosis takes 6-7 years
  • The disorder may be less manifest as individuals age, but can reemerge during stress, trauma, or substance abuse

Familial Pattern

  • More common among first-degree biological relatives

Differential Diagnosis

  • Must be distinguished from symptoms caused by a general medical condition or substance use
  • Overrules diagnoses of Dissociative Amnesia, Dissociative Fugue, and Depersonalization Disorder
  • Must be distinguished from trance and possession trance symptoms attributed to an external entity
  • Presence of multiple personality states may be mistaken with delusions or auditory hallucinations. Identity shifts can be confused with mood fluctuations
  • Differentiated from Malingering for financial/forensic gain and Factitious Disorder for help-seeking

Diagnostic Criteria

  • Presence of two or more distinct identities or personality states
  • At least two identities recurrently take control of the person’s behavior
  • Inability to recall important personal information, beyond ordinary forgetfulness
  • Not due to a substance or general medical condition; in children, not due to imaginary play

Depersonalization Disorder

  • Persistent or recurrent episodes of depersonalization, marked by detachment from oneself
  • Intact reality testing during depersonalization
  • Causes significant distress or impairment in functioning
  • Not due to other mental disorders or direct physiological effects of a substance/medical condition

Presentation

  • Feeling like an automaton or living in a dream
  • Sensation of being an outside observer of one's mental processes or body
  • Sensory anesthesia, lack of affective response, and a sensation of lacking control
  • Fear that these feelings mean they are "crazy"
  • Derealization is common, feelings that the external world is strange or unreal
  • An uncanny alteration in the size or shape of objects (macropsia or micropsia)

Associated Features and Disorders

  • Anxiety, depressive symptoms, obsessive rumination, somatic concerns, and time disturbances
  • Coexists with Hypochondriasis, Major Depressive or Dysthymic Disorder, Anxiety Disorders, Personality Disorders, and Substance-Related Disorders
  • Depersonalization and derealization are frequent symptoms of Panic Attacks and after traumatic stress

Lab Findings

  • High hypnotizability and high dissociative capacity

Culture and Gender

  • Voluntarily induced depersonalization/derealization in meditative practices should not be confused with the disorder
  • Diagnosed at least twice as often in women than in men

Prevalence and Course

  • Lifetime prevalence is unknown
  • Half of all adults may have experienced single brief episodes due to trauma
  • Presents in adolescence or adulthood
  • Episodes vary from brief (seconds) to persistent (years) and occurs suddenly on exposure to trauma or life threatening situations
  • Chronic course may wax and wane in intensity, but is also sometimes episodic
  • Often associated with stressful events

Differential Diagnosis

  • Depersonalization due to the direct physiological consequences of a specific general medical condition or substance use
  • Should not be diagnosed separately when symptoms occur only during panic attacks
  • Intact reality testing distinguishes Depersonalization Disorder from Schizophrenia
  • Numbness is associated with a sense of detachment from one’s self and occurs when the individual is not depressed

Diagnostic Criteria

  • Persistent or recurrent experiences of feeling detached from one's mental processes or body
  • Reality testing remains intact
  • Causes clinically significant distress or impairment
  • Not due to other conditions/substances

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Description

Explore the clinical presentation of Dissociative Fugue, including diagnostic criteria and differentiation from similar conditions. Review key features, co-morbidities, and factors to consider during evaluation. Understand the complexities involved in diagnosing and managing this dissociative disorder.

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