seen in NREM sleep arousal disorders.
Dissociative amnesia, with dissociative fugue. Dissociative fugue may be extremely
difficult to distinguish from sleepwalking. Unlike all other parasomnias, nocturnal disso-
ciative fugue arises from a period of wakefu lness during sleep, rather than precipitously
from sleep without intervening wakefulness. A history of recurrent childhood physical or
sexual abuse is usually present (b ut may be difficult to obtain).
Malingering or other voluntary behavior occurring during wakefulness. As with disso-
ciative fugue, malingering or  other voluntary behavior o ccurring during wakefulness
arises from wakefulness.
Panic disorder. Panic attacks may also cause abrupt awakenings from deep NREM sleep
accompanied by fearfulness, but these episode s produce rapid and complete awakening with-
out the confusion, amnesia, or motor activity typical of NREM sleep arousal disorders. 
Medication-induced complex behaviors. Behaviors similar to those in NREM sleep
arousal disorders can be induced by use of, or withdrawal from, substances or medica-
tions (e.g., benzodiazepines, nonbenzodiazepine  sedative-hypnotics, opiates, cocaine, nic-
otine, antipsychotics, tricyclic antidepressant s, chloral hydrate). Such behaviors may arise
from the sleep period and may be extremel y complex. The underlying pathophysiology
appears to be a relatively isolated amnesia. In such cases, substance/medication-induced
sleep disorder, parasomnia type, should be diagnosed (see “Substance/Medication-
Induced Sleep Disorder” la ter in this chapter).
Night eating syndrome. The sleep-related eating disorder form of sleepwalking is to be