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Dissociative Fugue — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersDissociative FugueMRCPsych Paper B

A 20-year-old man disappears shortly after a severe interpersonal crisis and is located 250 miles away three days later. Records show that he bought a train ticket, booked accommodation and interacted coherently with staff while using a newly adopted name. He is alert and attentive and is oriented to time and place, but cannot recall the journey or important autobiographical information, including his usual identity. Collateral information and longitudinal assessment reveal no external incentive, pursuit of the patient role or evidence of conscious symptom production. Toxicology, neurological examination, brain MRI and EEG identify no alternative cause. Which condition is most likely?

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Correct answer: B — Dissociative fugue

Dissociative fugue is the best answer. The discriminating features are dissociative autobiographical amnesia combined with apparently purposeful travel beyond the person’s usual range; coherent behaviour and adoption of another identity may occur during the episode. A severe psychosocial precipitant and exclusion of intoxication, neurological disease and conscious fabrication further support the diagnosis. Malingering requires intentional symptom production for an external incentive, while factitious disorder involves intentional falsification associated with assuming the patient role; neither motivation is present. Functional neurological disorder causes motor, sensory or seizure-like symptoms rather than purposeful travel with autobiographical amnesia. Delirium would produce impaired attention and fluctuating global cognitive disturbance, not isolated loss of autobiographical memory in an otherwise alert, organised person.

Reference: NHS Classifications Service, ICD-10 5th Edition, section F44.1: Dissociative fugue, accessed 2026. https://classbrowser.nhs.uk/ICD-10-5TH-Edition/vol1/block-f40-f48.htm