Dissociative amnesia with fugue following a suicide attempt: a rare clinical intersection of identity loss and suicidal ambivalence: a case report.

BACKGROUND: Dissociative amnesia with dissociative fugue is a rare dissociative disorder characterized by abrupt loss of autobiographical memory and disruption of personal identity, most often emerging in the context of severe psychological stress. Although dissociative phenomena are increasingly recognized in individuals with suicidal behavior, the development of fugue states in the immediate aftermath of a suicide attempt remains rarely documented and poses significant diagnostic and therapeutic challenges.

CASE PRESENTATION: We report the case of a 50-year-old man with no documented psychiatric or neurological history who was admitted following a suicide attempt by bilateral wrist laceration. After medical stabilization, he exhibited profound retrograde autobiographical amnesia, including inability to recall his name, nationality, or personal life history, while semantic memory, language abilities, and general cognition remained largely preserved, as evidenced by fluent bilingual communication and intact broad factual knowledge. Comprehensive medical and neurological evaluation, including laboratory testing, toxicology screening, neuroimaging, and specialist consultations, excluded organic etiologies. During a three-week psychiatric admission, gradual recovery of selected autobiographical fragments occurred, although full identity restoration was not achieved at discharge. Management included supportive psychotherapy, safety monitoring, pharmacologic treatment for affective stabilization, and multidisciplinary psychosocial interventions.

DISCUSSION: This case illustrates a rare and clinically instructive intersection of suicidality and dissociative identity disruption. The pattern of selective retrograde autobiographical amnesia with intact semantic and procedural memory supports the retrieval inhibition model of dissociative amnesia, in which stress-related prefrontal inhibition functionally blocks access to identity-related memories without structural brain injury. An integrative framework combining neurobiological, cognitive, and psychodynamic perspectives suggests that dissociative fugue in this context may represent an extreme defensive response to overwhelming affective conflict, enabling psychological survival while temporarily disengaging identity from the intolerable internal experiences that precipitated the suicidal crisis.

CONCLUSION: Dissociative amnesia with fugue should be considered when post-self-harm amnesia selectively impairs autobiographical memory despite preserved cognition and normal neurological findings. Accurate diagnosis requires longitudinal psychiatric assessment and exclusion of organic or feigned causes. No post-discharge follow-up data were available, which substantially limits prognostic conclusions. This case provides an educational framework for understanding the interaction between identity, memory, and self-preservation in acute psychiatric emergencies.