We woke up in a place that is not familiar to us. We wander the streets, but we’re not at home, not even in our town. Where am I and what am I doing here? We ask a local, who seems to recognize us and calls us by a name that is not ours. Apparently we have been in the town for a month. How is this possible?

One of the possible answers to this question is that we have experienced a disorder called dissociative leakage .

Dissociative leakage: definition and characteristic symptoms

Dissociative fugue is defined as an associative disorder characterized by the realization of unexpected journeys away from the subject’s usual environment in which the individual is unable to remember his past. This journey is made with apparent normality, not drawing attention to the subject’s behaviour and without the appearance of symptoms of mental disorder or cognitive impairment. It is also frequent, although it may not occur, that the individual has doubts about his own identity, either by losing it or by assuming a new one.

In a large majority of cases the person ends up recovering his previous identity and memory . However, there are cases in which parts of the past are not remembered, and in some cases the patient has not even remembered his past before the escape. In most cases, when the identity is recovered, amnesia may occur after the episode, in which the patient forgets what happened during it.

After recovering memory, the individual usually feels discomfort , derived both from the confusion caused by what has happened and from the deterioration in different vital domains such as work or partner. The individual may experience guilt, depression, anxiety, irritability, impulsiveness, and even suicide attempts.

Currently, dissociative leakage is no longer considered a disorder in itself, being a specifier of dissociative or psychogenic amnesia because with the exception of the presence of the leak in question it shares most of the characteristics of the latter.

Leakage subtypes

Although most of the symptoms of dissociative leakage are similar , this disorder can manifest itself in different ways and have different repercussions. Specifically, three major subtypes of dissociative leakage can be considered.

Classic leakage

In this subtype of dissociative flight, a journey or flight to an unknown place occurs, presenting autobiographical amnesia and the partial or total loss of one’s identity and the assumption of a new one. The subject may come to settle in the new place with a new identity , without knowing his previous history until he recovers his memory.

Amnesia of personal identity

This type of leak implies that the individual has a loss of autobiographical memory along with his identity , although in this case there is no change in the latter. The individual does not believe he is another person, but knows that he does not know who he is.

Return to previous period of one’s life

This type of dissociative escape refers to the return to a previous period of one’s life on a psychic level, presenting amnesia with respect to the period of time that has elapsed since the period in question and the present. However, the personal identity remains intact.

Causes

The causes of dissociative leakage are associated with the experience of very stressful and traumatic events . For example, it is not uncommon for subjects to have suffered sexual abuse or lived through misfortunes such as wars or natural disasters during childhood or throughout their lives, so that their psyche splits up to avoid the pain generated by the event in question.

It also appears to predispose them to intoxication or substance abuse, head trauma and certain disorders such as epilepsy.

At the biological level, it is considered that the noradrenergic and serotoninergic systems , as well as the opioids, can have an influence. Brain changes in the limbic system and its connection with the neocortex seem to be observed.

Treatment

Dissociative leakage is a disorder whose treatment is primarily focused on recovery and symptom control. It should be noted that although usually only a single episode occurs, new leaks are possible, so prevention is another consideration.

It is necessary to work with the patient on the causes of this amnesia, the situation that generated the escape and what this situation means for the subject. Cognitive restructuring or work on emotional expression and stress management can be of great help to this type of patient. Hypnosis and suggestion have also been used to try to unblock the blocked contents of the subject’s mind, as well as the performance of interviews facilitated by hypnotic substances.

It is essential to work not only with the subject but also with the family and environment . Providing them with information about the disorder and what has happened is reassuring and can help to take into account and control factors that may have triggered the episode. Couple or family therapy to help manage conflicts that may have been triggered or may have occurred by the escape is also recommended.

Bibliographic references:

  • American Psychiatric Association (2002). DSM-IV-TR. Diagnostic and Statistical Manual of Mental Disorders. Spanish edition. Barcelona: Masson. (Original in English, 2000).
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • De Rezende, L.; Ramos, A. & González, J.C. (2011). The dissociative escape. About a case and a brief bibliographic review. Journal of the Spanish Association of Neuropsychiatry. 31 (112), 725-731.
  • Caballero, L. (2010). Dissociative and Conversational Disorders. In: Vallejo, J. and Leal, C. (eds.) Tratado de Psiquiatría. Barcelona: Ars Medica. p. 1311-1335