Question:medium
A patient is brought in by a social worker after a recent earthquake. He has been living in a town different from his place of origin and is unaware of how he traveled 110 km away from home. He cannot recall his identity. There is no substance abuse history. What is the most likely diagnosis?
A patient is brought in by a social worker after a recent earthquake. He has been living in a town different from his place of origin and is unaware of how he traveled 110 km away from home. He cannot recall his identity. There is no substance abuse history. What is the most likely diagnosis?
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Unexpected travel away from home + amnesia for identity or past = dissociative fugue.
Updated On: May 14, 2026
- Dissociative amnesia
- Dissociative fugue
- Dissociative Identity Disorder
- Selective amnesia
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The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
The scenario describes a patient who has experienced a traumatic event (earthquake), traveled a significant distance, lost their personal identity, and has no memory of the travel. This is a classic presentation of a dissociative state involving "flight."
Step 2: Detailed Explanation:
Dissociative Fugue: According to DSM-5, this is now a specifier under Dissociative Amnesia. It is defined as purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.
Triggering Factors: Fugue states are almost always precipitated by severe psychosocial stress, such as natural disasters (earthquakes), war, or intense personal conflict. The "fugue" acts as a psychological defense mechanism to escape an intolerable situation.
Key Features: The patient often adopts a new identity, though it is usually incomplete. Once the fugue state ends, the patient typically regains their original identity but has total amnesia for the events that occurred during the fugue.
Differential Diagnosis: Simple Dissociative Amnesia involves memory loss for specific events or periods but does not include the physical travel or loss of identity. Dissociative Identity Disorder (DID) involves the presence of two or more distinct personality states.
Management: Treatment focuses on resolving the underlying trauma. Hypnotherapy or drug-facilitated interviews (amobarbital interview) may be used to help recover memories once the patient is stable.
Step 3: Final Answer:
The combination of sudden, unexpected travel away from home and the inability to recall one's past or identity following a disaster is diagnostic of Dissociative Fugue.
The scenario describes a patient who has experienced a traumatic event (earthquake), traveled a significant distance, lost their personal identity, and has no memory of the travel. This is a classic presentation of a dissociative state involving "flight."
Step 2: Detailed Explanation:
Dissociative Fugue: According to DSM-5, this is now a specifier under Dissociative Amnesia. It is defined as purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information.
Triggering Factors: Fugue states are almost always precipitated by severe psychosocial stress, such as natural disasters (earthquakes), war, or intense personal conflict. The "fugue" acts as a psychological defense mechanism to escape an intolerable situation.
Key Features: The patient often adopts a new identity, though it is usually incomplete. Once the fugue state ends, the patient typically regains their original identity but has total amnesia for the events that occurred during the fugue.
Differential Diagnosis: Simple Dissociative Amnesia involves memory loss for specific events or periods but does not include the physical travel or loss of identity. Dissociative Identity Disorder (DID) involves the presence of two or more distinct personality states.
Management: Treatment focuses on resolving the underlying trauma. Hypnotherapy or drug-facilitated interviews (amobarbital interview) may be used to help recover memories once the patient is stable.
Step 3: Final Answer:
The combination of sudden, unexpected travel away from home and the inability to recall one's past or identity following a disaster is diagnostic of Dissociative Fugue.
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