diagnostic and statistical manual of mental disorders fourth edition dsmiv criteria for fugue require that the predominant disturbance is sudden , with unexpected travel away from home or one 's workplace , coupled with the inability to recall one 's past . the symptoms must also cause clinically significant distress or impairment in or other important areas of functioning . fugue differs from other mental disorders in that the flight behavior is organized and purposeful . the prevalence of dissociative fugue has been estimated at 0.2% , but it is much more common in connection with wars , accidents , and natural disasters . the differential diagnosis includes other dissociative disorders , seizures disorder , amnesic disorder , schizophrenia , mania , dementia ( alzheimer 's type ) , malingering , and factitious disorder . fugue was previously known as functional retrograde amnesia refers to a complete or partial loss of remote memories with a primacy of psychological factors in the absence of corresponding structural brain pathology . fugue is often associated with physical or mental trauma , depression , problems with the legal system , or some other personal difficulty . the length of the fugue may last for several hours , days , and weeks or even several months . fugue was previously known as functional retrograde amnesia refers to a complete or partial loss of remote memories with a primacy of psychological factors in the absence of corresponding structural brain pathology . fugue is often associated with physical or mental trauma , depression , problems with the legal system , or some other personal difficulty . the length of the fugue may last for several hours , days , and weeks or even several months . a 32-year - old , right handed , hindi speaking male was brought by police during emergency hours to mental hospital to get him admitted . he was produced before the court by the police who had taken him in their custody because he was found wandering aimlessly and could not give proper history on being probed . he had no identity card , cell phone or diary at the time of admission . he was conscious , cooperative , and communicative but appears dazed and had difficulty to maintain eye contact during examination . he spoke very little about himself and express his difficulty to recollect events , details of personal whereabouts , specifically of recent past . all investigations including electroencephalogram and magnetic resonance imaging ( mri ) brain scan was found to be normal . gradually he started socializing with other inmates , took interest in ward work and then started going to occupational department . he was by then diagnosed with dissociative fugue according to dsmiv tr text revision and managed with supportive psychotherapy . after obtaining consent from the patient , pentothal interview was done during which he had hazy memory of his children . he remains unchanged until about 2 month when pentothal interview was again repeated when he spoke about his wife who eloped with neighbor about 6 months back leaving behind two children . patient identified himself as rajesh ( name changed ) who earns livelihood by selling bangles , he expressed concern about his children as well his identity of being unfair father who can not sustain his children because of poverty . social worker then informed his brother at his village near chhattisgarh , who informed that it , was his 3 episode of fugue state . in the last 5 years he similarly lost his way and found in haridwar and jaipur in same way . it may be an altered state , out of traumatic experiences , where the consciousness dominated by a wish to flee . the traumatic experiences include combat , rape recurrent childhood sexual abuse , massive social dislocation , and natural disasters . in most other cases , there has been a similar antecedent history , although a psychological trauma was not present at the onset of the fugue episode . in these cases , instead of or in addition to , external dangers or trauma , the patients were usually struggling with extreme emotions or impulses , such as overwhelming fear , guilt , shame , or intense incestuous , sexual suicidal or violent urge or a combination of these that were in conflict with the patient 's conscience or ego ideals . dissociative phenomena may have strong biological roots , with genetic influences , accounting for about 50% of the variance in twin studies . the presence of smaller hippocampal and amygdala volumes in patients with dissociative identity disorder has been reported . neurobiological theories postulate that n - methyl - d - aspartic acid ( nmda ) blockade decreases the inhibitory tone , leading to increased glutamate release and subsequent dissociative symptoms , which also accounts for the structural brain changes in the hippocampus found in mri studies . dissociative disorders continue to remain under diagnosed , undertreated , and insufficiently respected , more so ever the cases of recurrent fugue . recurrent fugue is least reported and so this case is the first to be reported .
dissociative fugue is a rarely reported diagnostic entity . 
 it is one of the least understood and yet clinically one of the most fascinating disorders in mental health . here 
 , we describe a case of fugue in a 32-year - old man who was brought to mental hospital with complete loss of memory for events pertaining to identity of self . 
 this case illustrates the nature of presentation in hospital setting like mental hospital and effort taken to reintegrate his identity and reunite with his family .