The person may assume a new name, identity, and domicile and may engage in complex social interactions. However, at some point, confusion about his identity or the return of the original identity may make the person aware of amnesia or cause distress. Many fugues appear to represent disguised wish fulfillment. For example, a financially distressed executive leaves his hectic life and lives as a farm hand in the country. The fugue may remove the patient from an embarrassing situation or intolerable stress or may be related to issues of rejection or separation.
Some fugues appear to protect the person from suicidal or homicidal impulses.
The person often has no symptoms or is only mildly confused during the fugue. Failure to remember events of the fugue may cause confusion, distress, or even terror. A fugue in progress is rarely recognized. It is suspected when a person seems confused over his identity, puzzled about his past, or confrontational when his new identity or the absence of an identity is challenged. Sometimes the fugue cannot be diagnosed until the person abruptly returns to his prefugue identity and is distressed to find himself in unfamiliar circumstances.