Poriomania represents a disorder of impulse control characterized by unfounded compulsive running away. The running away here is always associated with at least partial amnesia. Poriomania can have a variety of causes.
What is poriomania?
Poriomania is not a disease in its own right, but represents a symptom of a mental disorder. It is manifested by compulsive and uncontrolled running away in conjunction with complete or partial amnesia. Poriomania was first described by the French neurologist Jean-Martin Charcot in 1888. He examined a 37-year-old letter carrier who wandered around three times and could not remember anything during this time. The cause of this behavior was assumed to be status epilepticus. Poriomania is also known as dromomania or fugue and is a special form of impulse control disorder. When impulse control is lost, certain behaviors can no longer be performed in a controlled manner. The actions simply take place without the affected person having a chance to influence them at will. Poriomania also belongs to the dissociative disorders. In psychology, dissociation is understood as the destruction of the connection between the functions of consciousness, perception, memory, motor function and identity. For the patient, the connection between the functioning motor function and the reason for the action is lost. Actually, every person goes through this phase under special conditions. However, these disorders occur in clusters in psychological disorders. In addition to poriomania, dissociative disorders include, among others, such behaviors as gambling, eating, buying, masturbation, or even self-injury, which are performed uncontrollably by the corresponding patients.
Causes
There are several causes of poriomania. It occurs as a symptom in several psychological disorders. For example, poriomania is observed in depression, neurosis, schizophrenia, delusional states, epilepsy, mental retardation, or dementia, among other forms of impulse control disorder. This phenomenon is particularly well known in Alzheimer’s disease. Why these escape reflexes occur is not yet clearly understood. In certain attempts at explanation, this behavior is considered an unconscious defense mechanism to avoid conflict or responsibility. In very difficult life situations, therefore, even healthy persons may sometimes develop an affect action that manifests itself, among other things, in running away. In the context of mental illnesses, however, such spontaneous uncontrolled actions occur much more often. In this case, the control over certain actions is lost due to the illness. In the case of the letter carrier described by Jean-Martin Charcot, the state of status epilepticus could have led to the loss of control. Status epilepticus is characterized by many small successive epileptic seizures without the patient regaining full consciousness in between. However, despite amnesia, motor functions remain active in this state. However, the same is true in other mental disorders.
Symptoms, complaints, and signs
Poriomania manifests itself, as mentioned, by unexpected and sudden running away. This may be from home or from work. In the process, the patient forgets all or part of his or her own past. One’s own identity may have been lost. The sufferer may then have adopted a different identity. Poriomania occurs both in the context of dissociative identity disorder and independently of it. The symptoms lead to considerable impairment in the private, professional and social fields. While in some cases poriomania is the main symptom, in other cases it tends to fade into the background alongside the other symptoms. Often, affected individuals are inconspicuous during poriomania until asked about their identity. Their excursions can be both short and long in space and time. Thus, some affected individuals disappear for months or years and even assume a new identity during this time. They may then integrate so well in their new environment that the mental disorder is no longer recognized.In various other conditions, such as dementia, the adoption of a new identity is obviously not possible because any possibility of self-direction is absent.
Diagnosis and course of the disease
Poriomania can be diagnosed by its typical features. The most important feature is the sudden running away in connection with amnesia, which affects one’s own identity. In most cases, a mental disorder already exists. If the symptoms occur in otherwise psychologically healthy persons, it may be a temporary phenomenon caused by a particular stressful life situation. Of course, in this context, feigned poriomania cannot be ruled out in order to assume a new identity.
Complications
The complications to be expected in poriomania are not only medical, but also social or legal. Provided that the acute attacks last only a short time, possible consequences usually remain manageable. However, patients are often unable to pursue a profession or manage their lives on their own. Patients who suffer from seizures that last for months or years may face significant legal complications. In particular, when people simply disappear over a period of years, they run the risk of being declared dead and inherited. Victims then regularly lose all their assets and recover them only after lengthy legal battles, if at all. In the elderly, poriomania often accompanies Alzheimer’s disease. Mentally confused seniors often injure themselves while wandering around or cause traffic accidents in the process. These individuals often pose a danger to themselves and others, even though they are rarely aggressive. Alzheimer’s patients are on the run and usually also unable to take care of themselves and their physical needs. They do not eat or drink and therefore dehydrate quickly. Severe hypothermia can also be life-threatening if patients are not found promptly and spend the night outdoors.
When should you go to the doctor?
Poriomania must always be treated by a physician. As a rule, this disease does not heal itself and often causes serious psychological discomfort that negatively affects the patient’s life. The doctor should be consulted if the patient suffers from a compulsion to run away. In this case, the running away can be either from work, school or even home. Sufferers are also often unable to remember their name and assume a different identity. If these symptoms occur, a doctor must be consulted immediately. In some cases, the affected person’s relatives or friends may need to persuade the person to seek treatment. Treatment for poriomania is usually provided by a psychologist. Whether a cure will occur cannot be predicted.
Treatment and therapy
To treat poriomania, its cause is crucial. If it is a symptom within the context of dementia, schizophrenia, or epilepsy, treatment of the underlying disease takes priority. In cases of mild cognitive impairment, neurosis, depression, or adolescent puberty, cognitive behavioral therapy may be used. Within this therapy, the impulse to flee should be avoided. The impulse control disorder is treated in this therapy by consciously directing attention. The affected person should also learn a reality-based and goal-oriented self-control. The success of the therapy depends on the severity of the loss of control and the patient’s ability to establish goal-directed action.
Prevention
To prevent poriomania, it is important to work through internal conflicts that arise early. This can only be done in stable family, social and societal conditions. Furthermore, a healthy lifestyle with a balanced diet and plenty of exercise can also help prevent severe mental illness and senile dementia.
Follow-up
Recovery from mental illness is lengthy. In most cases, symptoms remain attenuated even after therapy. The affected person has nevertheless learned to integrate the illness into his or her everyday life. In order to stabilize the healing success, aftercare must be scheduled. This takes place in a psychotherapeutic or behavioral therapy setting.A combination of both approaches is also common. Aftercare behavioral therapy is recommended for poriomania. The patient’s impulse control is in the foreground. A pathological urge to escape usually does not represent an independent clinical picture. Underlying the mania are depressions, a schizophrenic disorder or delusions. In follow-up care, the cause is already known from the therapy. A recurrence of the symptoms is to be prevented. The affected person learns mindfulness and self-control during aftercare therapy. He must become aware of which situations cause him to have flight reflexes. In everyday life, he should know these triggers precisely and avoid them. Appropriate exercises with the therapist will help him to do this. The patient should always carry the address of the specialist with him as a note. If the flight reflex starts unexpectedly and the patient has lost his orientation, he can reach the therapist by phone or visit him directly. The physician will provide crisis intervention and reassure the sufferer. A cab should be ordered to take him home safely.
What you can do yourself
Poriomania is a serious mental disorder that must be treated primarily with medication and therapy. Affected individuals can support treatment by taking behavioral therapy measures. By consciously directing attention, it is possible to reduce seizures and thereby improve quality of life in the long term. In addition, measures must be taken to survive a seizure without risks. First and foremost, emergency medication must always be carried and taken in the event of a seizure. In addition, sufferers should always carry a cell phone and a note informing any first responders of the condition. Further measures depend on the severity of the condition and whether the underlying psychological symptoms have already been adequately treated. For example, the emergency physician should always be called in the event of a first seizure. Chronic conditions may require inpatient treatment. This must be accompanied by a healthy lifestyle with a balanced diet and sufficient exercise to prevent the development of further mental complaints. Comprehensive treatment prevents serious sequelae such as depression or dementia in old age.
