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Background <p>To our knowledge, no detailed dissociative fugue cases have been reported from any Arab nation in the indexed literature, despite comprehensive searches across international databases and regional Arabic-language sources. Applied to the Arab world’s 492-million population, even conservative prevalence estimates suggest substantial numbers of undiagnosed cases, indicating systematic underrecognition rather than genuine rarity.</p> Case presentation <p>We report a 30-year-old North African woman in the United Arab Emirates who presented four months postpartum with recurrent dissociative fugue episodes characterised by 20–45-kilometre travel with complete amnesia and stereotyped reversion to her suppressed childhood identity. At age 8, following maternal death, she was forced to assume her deceased half-sister’s legal identity, creating a 10-year age discrepancy. Initial emergency assessment diagnosed postpartum psychosis based on cultural references to qareen (spiritual companion), interpreted as delusions. Comprehensive reassessment revealed no psychotic symptoms: ‘voices’ were ego-dystonic intrusive thoughts, and cultural references were idioms of distress rather than delusions. Structured assessment documented severe postpartum depression, dissociative amnesia with fugue (SCID-D severity 18/20), and three personality disorders. Brain magnetic resonance imaging was unremarkable. Treatment comprised escitalopram 10&#xa0;mg daily for depression and suicidal ideation, quetiapine 25&#xa0;mg and melatonin 3&#xa0;mg nightly for sleep restoration, combined with comprehensive psychosocial interventions including psychoeducation for patient and husband, individual trauma-focused cognitive behavioural therapy, couples therapy, and household stressor reduction. This multimodal approach produced complete cessation of fugue episodes sustained over five-month follow-up.</p> Conclusion <p>This case, the first detailed clinical case report from the Arab world to our knowledge, highlights systematic regional underdiagnosis and illustrates critical challenges in differentiating dissociative from psychotic presentations when cultural idioms are misinterpreted. Enhanced training, routine dissociative screening in trauma-exposed populations, and culturally adapted assessment tools represent urgent priorities.</p>

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Dissociative fugue following forced identity change in childhood: the first detailed case report from the Arab world

  • 期刊论文

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  • 发表日期：

    2026年3月30日

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  • Mostafa Abulmagd,
  • Syed Ali Bokhari,
  • Muhanad Elnoor

摘要

Background

To our knowledge, no detailed dissociative fugue cases have been reported from any Arab nation in the indexed literature, despite comprehensive searches across international databases and regional Arabic-language sources. Applied to the Arab world’s 492-million population, even conservative prevalence estimates suggest substantial numbers of undiagnosed cases, indicating systematic underrecognition rather than genuine rarity.

Case presentation

We report a 30-year-old North African woman in the United Arab Emirates who presented four months postpartum with recurrent dissociative fugue episodes characterised by 20–45-kilometre travel with complete amnesia and stereotyped reversion to her suppressed childhood identity. At age 8, following maternal death, she was forced to assume her deceased half-sister’s legal identity, creating a 10-year age discrepancy. Initial emergency assessment diagnosed postpartum psychosis based on cultural references to qareen (spiritual companion), interpreted as delusions. Comprehensive reassessment revealed no psychotic symptoms: ‘voices’ were ego-dystonic intrusive thoughts, and cultural references were idioms of distress rather than delusions. Structured assessment documented severe postpartum depression, dissociative amnesia with fugue (SCID-D severity 18/20), and three personality disorders. Brain magnetic resonance imaging was unremarkable. Treatment comprised escitalopram 10 mg daily for depression and suicidal ideation, quetiapine 25 mg and melatonin 3 mg nightly for sleep restoration, combined with comprehensive psychosocial interventions including psychoeducation for patient and husband, individual trauma-focused cognitive behavioural therapy, couples therapy, and household stressor reduction. This multimodal approach produced complete cessation of fugue episodes sustained over five-month follow-up.

Conclusion

This case, the first detailed clinical case report from the Arab world to our knowledge, highlights systematic regional underdiagnosis and illustrates critical challenges in differentiating dissociative from psychotic presentations when cultural idioms are misinterpreted. Enhanced training, routine dissociative screening in trauma-exposed populations, and culturally adapted assessment tools represent urgent priorities.