Pathology of perception occurs when, for various reasons, the identification of the subjective image of perception with the perceived image is disrupted, and occurs against the background of a violation of the automation of various mental processes. Perceptual disorders are very diverse and are studied by both psychologists and psychiatrists. In the domestic school of neuropsychology, created by A.R. Luria, perception disturbances in various lesions of the cerebral cortex and nearby subcortical structures that cause agnosia have been identified and studied. Agnosia called difficulty recognizing objects and sounds. With agnosia, perception is disrupted in its specifically human characteristics as a process that has the function of generalization and conditionality. Thus, with damage to the secondary sections of the cerebral cortex, elementary sensitivity is preserved, but at the same time the ability to analyze and synthesize incoming information is lost, which causes disturbances of various types perception with relative preservation of elementary visual functions. Depending on the location of the brain lesion, different types of agnosia occur: visual, auditory and tactile,

There are disturbances of perception in the form of a disorder of the body diagram, in which there is a distortion of the usual ideas about the size and shape of one’s body or its individual parts, their location or the position of the entire body. For example, it seems to the patient that his head has grown to enormous size, his legs are growing right out of his head, and his torso has disappeared. Nevertheless, a critical attitude towards this remains, and under the control of vision, these altered ideas, as a rule, disappear, the patient perceives his body in its usual, familiar form. But as soon as he closes his eyes, his head again becomes prohibitively large, etc.

Disorders of the body diagram are often accompanied by metamorphopsia - a distorted perception of one or more objects in the external world. In addition, a distorted perception of surrounding objects is expressed in the fact that they seem to the patient to be smaller or larger than their natural size (micropsia, macropsia), their number increases (polyopsia), they move (optical allesthesia), fall on the patient, are pressed into him, are in violent motion (optical storm). Sometimes not only the size and shape of objects, but also spatial relationships are perceived in a grossly altered form: it seems to the patient that the walls of the room are moving closer together, collapsing, falling on him or, on the contrary, moving apart, the floor becomes wavy, the space seems to be torn apart.

· Agnosia is difficulty recognizing objects and sounds.

Illusion is a disorder of perception in which real phenomena or objects are perceived by a person in a changed, erroneous form.

Hallucination is a disorder of perception in which a person sees, hears, feels something that does not exist in reality, i.e. it is perception without an object.

Derealization is a disorder of perception in which the objects, people, and animals surrounding the patient are perceived as altered, which is accompanied by a feeling of their alienness, unnaturalness, and unreality.

Illusions- disorders of perception in which real phenomena or objects are perceived by a person in an altered, erroneous form. Illusory perception can also arise against the background of complete mental health, when distorted perception is associated either with a deficiency of one or another sense organ, or with the manifestation of one of the laws of physics, for example, a spoon in a glass of tea seems to be refracted. Illusions associated with mental disorders are most often divided into affective, or affectogenic, verbal and pareidolic.

Affective (affectogenic) illusions arise under the influence of intense emotions. A person gripped by horror or in a state of excessive nervous tension mistakenly perceives a tree branch outside the window as a swinging skeleton, etc.

Verbal illusions are an erroneous perception of the meaning of words, the speech of others; instead of neutral speech, the patient hears speech of a different content, usually addressed to him (usually threats, curses, accusations).

Pareidolic illusions are visual illusions when truly existing images (play of chiaroscuro, frosty patterns, clusters of clouds, etc.) are replaced by fantastic images. Pareidolia occurs regardless of the desire and will of the patient, but as an exception, pareidolic illusions occur in healthy people, especially gifted artists. For example, Leonardo da Vinci strengthened this “ability to imagine” through training and encouraged other artists to do the same (“Treatise on Painting”).

Hallucinations- these are perception disorders in which a person sees, hears, feels something that does not exist in reality, i.e. it is perception without an object. Hallucinations do not include mirages, since the vision of mirages is based on physical laws. Just like illusions, hallucinations are divided according to the senses: auditory, visual, olfactory, gustatory, tactile and the so-called hallucinations of the general sense, which most often include visceral and muscular hallucinations. There may also be combined hallucinations (for example, the patient sees a snake, hears its hissing and feels its cold touch).

The most significant and diagnostically important is the division of hallucinations into true and false (pseudohallucinations).

True hallucinations are always projected outward, associated with a real, actually existing situation (“a voice” is heard from behind a real wall; a “witch” sits on a real chair, leaning on a broom, etc.), patients have no doubts about their In actual existence, hallucinatory images are as vivid and natural for the hallucinating person as real things and are sometimes perceived by patients even more vividly and clearly than actually existing objects and phenomena.

False hallucinations, or pseudohallucinations, are most often projected inside the patient’s body; hallucinatory images are usually located in his head (for example, voices are heard inside the head). Pseudohallucinations resemble ideas, but unlike them they do not depend on the will of a person, are intrusive in nature and have the formality of pseudohallucinatory images.

In some rather rare cases, pseudohallucinatory images are projected outward, and then they, unlike true hallucinations, are completely unrelated to the real situation. Moreover, at the moment of hallucination, this environment seems to disappear somewhere, the patient at this time perceives only his hallucinatory image. The moment of appearance of pseudohallucinations, which do not cause the patient any doubts about their reality, is always accompanied by a feeling of being done, arranged, induced by these voices or visions.

Hallucinations are also classified according to analyzers. Auditory hallucinations are the pathological perception of certain words, speeches, conversations, as well as individual sounds or noises. Verbal (verbal) hallucinations can be very different in content: the patient is “called out”, he “hears” a voice calling his name or surname, he can hear entire phrases or even long speeches pronounced by one or more voices.

Imperative hallucinations, the content of which is imperative in nature, are very dangerous for the patient himself, as well as for those around him, for example, the patient hears orders: to hit or kill someone or himself, to harm himself. Such patients require special supervision and care. Auditory hallucinations are sometimes commentary in nature, when the patient “hears speeches” about everything he thinks or does.

Visual hallucinations are either elementary (zigzags, sparks, fire), or objective, when various pictures appear before the patient’s gaze: scary, unusual animals, frightening figures and objects or parts of the human body, etc. Sometimes these are whole scenes, the patient can see , for example, a panorama of a field, etc. In some cases, the patient may have a hallucination of a double, that is, he sees his own image.

Olfactory hallucinations are also observed; most often the patient feels unpleasant odors - rotting meat, burning, smoldering. An unfamiliar smell occurs much less often, and even less often a pleasant one, so patients with olfactory hallucinations often refuse to eat, as they are sure that they are being fed poisoned or spoiled food. Hallucinations can be tactile - false sensations of touching the body, burning or cold; the patient sometimes feels that he is being bitten or scratched, that some kind of liquid appears on the body, or that insects are crawling on it.

Visceral hallucinations are a feeling of the presence of some objects, animals, worms in one’s own body (“a frog is sitting in the stomach,” “tadpoles have multiplied in the bladder,” “a wedge has been driven into the heart”).

Hypnagogic hallucinations are visual illusions of perception that usually appear in the evening before falling asleep, with the eyes closed, which makes them more related to pseudohallucinations than to true hallucinations (there is no connection with the real situation). These hallucinations can be single, multiple, scene-like, sometimes kaleidoscopic (“there is some kind of kaleidoscope in my eyes,” “I now have my own TV”). The patient sees some grimacing faces, sticking out their tongues, winking faces, monsters, bizarre plants. Much less often, such hallucinations can occur during another transitional state - upon awakening. Such hallucinations, also occurring when the eyes are closed, are called hypnopompic. Both of these types of hallucinations are often one of the first harbingers of delirium tremens or some other intoxicating psychosis.

Functional hallucinations occur against the background of a real stimulus acting on the senses, and only during its action. A classic example described by V. A. Gilyarovsky: the patient, as soon as water began to flow from the tap, heard the words: “Go home, Nadenka.” The auditory hallucinations immediately disappeared when the tap was closed. In the same way, visual, tactile and other hallucinations can occur. Functional hallucinations differ from true hallucinations by the presence of a real stimulus, although they have a completely different content, and from illusions by the fact that they are perceived in parallel with the real stimulus (it is not transformed into some kind of “voices,” “visions,” etc.).

During a hypnosis session, inspired hallucinations may occur when a person smells, for example, a rose, and throws off the rope that is “twisting” around him. With a certain readiness to hallucinate, hallucinations may appear even when these deceptions of the senses no longer appear spontaneously (for example, if a person has just suffered from delirium, especially alcoholic delirium). There are also various induced hallucinations. Lipman's symptom is the induction of visual hallucinations by lightly pressing on the patient's eyeballs (sometimes a corresponding suggestion should be added to the pressure). The blank sheet symptom (Reichardt's symptom) is that if the patient is given a blank sheet of paper and asked to read, he will see the text on the sheet and read it. Similarly, if a patient is given a telephone receiver in his hand, he will begin to talk on the phone (Aschaffenburg symptom).

Derealization is a disorder of perception in which the objects, people, and animals surrounding the patient are perceived as altered, which is accompanied by a feeling of their alienness, unnaturalness, and unreality. At the same time, it is most often difficult for patients to even determine what and how has changed, therefore, describing their unusual experiences, they say that “the trees and houses seem to be drawn, even though I know that they are real,” “everything around is somehow inanimate,” “everything is somehow different, as if I were seeing all this in a dream,” etc. Perceptual disturbances during derealization are manifested by an altered reflection of spatial relationships (“as if everything has moved away somewhere and looks somehow flat, drawn") and altered perception of time (“time flows slowly, as if it has stopped” or, conversely, “everything flies by too quickly”). In a state of derealization, a violation of the perception of the surrounding reality can affect both several analyzers simultaneously (changes in visual, auditory, tactile, taste and other images), and one of them (mainly visual or auditory). A pronounced degree of derealization is sometimes accompanied by the disappearance of sensations of the present moment, and patients cannot say what they did today, who they saw, etc.

Derealization is often combined with depersonalization, especially in the form of autodepersonalization, when the patient’s awareness of his image changes and his own face in the mirror seems unfamiliar to him.

Similar to the state of derealization are symptoms such as what has already been seen ( deja vu), already experienced ( deja weight), already tested ( deja eprouve), already heard ( deja entendu). The content of these symptoms is that an unfamiliar, completely new environment for some very short moment seems familiar, already seen once, and the words spoken by the people around them seem once heard. In contrast to these experiences, it happens that a well-known situation is perceived, also for a very short time, as completely alien, unfamiliar, never seen ( jamais vu). These phenomena are quite common in healthy people, especially in states of fatigue, lack of sleep and overexertion. In these states, a feeling of derealization may also appear.

Features of the pathology of sensory cognition depend not only on the nature of the disease, its clinical form, severity and stage, but also on the age of the patient (Fig. 27-1). The most thorough study of disturbances of sensation and perception in childhood and adolescence was carried out by G. E. Sukhareva. Senestopathies can appear in children aged 5-7 years, most often they are projected in the area of ​​the abdominal organs. In adolescence, perception disorders are practically no different from those in adulthood.

Attention disorders

In psychiatry, individual symptoms of attention impairment, as a rule, are not identified, although during a clinical examination, the inability to concentrate and absent-mindedness of the patient is always noted as part of the definition of psychopathological syndromes. Special studies of attention disorders as an important characteristic of mental activity are carried out by psychologists, for which there are specially developed psychological techniques. It is known that the indicators of attention of an individual can vary significantly depending on fatigue and the general state of the body, on environmental conditions, as well as on the person’s attitude to the relevant activity. Attention disturbances are usually observed in psychogenically and somatogenically caused asthenic conditions and manifest themselves in a very unique way with lesions of various brain structures. There are two main types of attention disorders:

1. Modally non-specific attention disorders apply to any forms and levels of attention. The patient cannot concentrate on stimuli of any modality (visual, auditory, tactile, etc.). This kind of disturbance is typical for patients with organic lesions of the brain, especially its nonspecific midline structures at different levels.

2. Modality-specific disturbances of attention are manifested in only one area, for example, only in the visual, auditory, tactile area or in the area of ​​movement. This is a special type of attention disorder, which in the clinic of local brain lesions was described as a phenomenon of ignoring certain stimuli.

Memory disorders

The manifestations of memory disorders are extremely diverse, and for the purpose of their classification, two main types of memory pathology are distinguished. The first is dysmnesia, which includes hypermnesia, hypomnesia and amnesia.

Hypermnesia called enhanced recall, which is combined with weakened memorization of current information. In this case, voluntary memorization especially suffers. In patients with hypermnesia, an involuntary “revival” of memory occurs; long-forgotten events are remembered that are of little relevance to him in the present.

Hypomnesia manifests itself in a violation of the ability to remember, retain, reproduce individual events and facts or their individual parts. This is the so-called “perforating” memory, when the patient remembers only the most vivid and important impressions for him. A mild degree of hypomnesia is a weakened ability to reproduce names, numbers, dates, etc.

Amnesia- this is a complete loss from memory of events, facts and situations that took place in a certain time period of life. There are several types of amnesia.

Retrograde amnesia is a loss from memory of events preceding the acute period of the illness, especially if loss of consciousness occurs, for example due to brain injury, poisoning, etc. Retrograde amnesia can cover a different period of time (from several minutes to several days, weeks , months, years).

Anterograde amnesia is a loss from memory, complete or partial, of events that occurred immediately after a period of impaired consciousness or a painful mental state. The duration of anterograde amnesia over time can also vary. A combination of these two types of amnesia is often found, in which case they speak of retroanterograde amnesia.

Fixation amnesia is the loss of the ability to remember, to record current events - everything that happened at the moment is immediately forgotten by the patient. Patients with this memory disorder forget where their bed is, cannot remember the name of their attending physician, etc.

Progressive amnesia is the decay of memory in accordance with Ribot's law; The memory of the most recently imprinted events and facts disappears first, while the earlier ones disappear last. According to this law, the so-called physiological aging of memory occurs.

In addition to these variants of amnesia, affectogenic, or psychogenic, amnesia is also distinguished, when, under the influence of an unpleasant affect, events that coincided with it in time are not remembered.

The second variant of memory pathology is paramnesia- erroneous, false, false memories. A person can remember events that actually took place, only attributing them to a completely different time. This phenomenon is called pseudoreminiscences - false memories. Confabulations are another type of paramnesia - fictitious memories that are completely untrue, when the patient reports something that never really happened. There is often an element of fantasy in confabulations. Cryptomnesia is a kind of paramnesia when a person cannot remember when this or that event happened, in a dream or in reality, whether he wrote a poem or simply remembered something he once read, whether he was at a concert of a famous musician or only heard it recorded and etc.

The so-called photographic memory is very rare, when a person, having just read several pages of unfamiliar text, can immediately repeat everything he read from memory almost without errors.

Close to photographic memory is the phenomenon called eidetism, which generally relates not only to memory, but also to the field of ideas. Eidetism is a phenomenon in which a representation mirrors a perception. Memory is also involved here in its vivid figurative form: an object or phenomenon, after disappearing, retains its living visual image in the human mind. Eidetism, as a normal phenomenon, occurs in young children with their ability to vividly perceive images and is extremely rare in adults. For example, a child, looking at a photograph and turning it over, can accurately describe what he saw.

Perception- This visual-figurative reflection existing at the moment to the sense organs of things, objects, and not their individual properties and signs.

Basic properties of perception:

1.) objectivity - the ability to perceive the world in the form of separate objects that have certain properties;

2) integrity- the ability to mentally complete a perceived object to a complete form if it is represented by an incomplete set of elements;

3) constancy- the ability to perceive objects as constant in shape, color, consistency and size, regardless of the conditions of perception;

Basic types of perception are distinguished depending on the sense organ (as well as sensations):

1) visual;

2) auditory;

3) taste;

4) tactile;

5) olfactory.

One of the most significant types of perception in clinical psychology is a person’s perception of time (it can change significantly under the influence of various diseases). Great importance is also attached to disturbances in the perception of one’s own body and its parts.

Basic principles of perception:

Principle of proximity ( the closer they are to each other elements are located in the visual field, the more likely they are to be combined into a single image).

Principle of similarity ( similar elements strive to unification).

The principle of “natural continuation” (elements acting as parts of familiar figures more likely to unite exactly in these figures).

The principle of closure - elements of the visual field tend to create a closed image).

MAIN TYPES OF PERCEPTION DISORDERS

The main perception disorders include:

I) Illusions - this is a distorted perception of a real object.

1. Physical (mirage).

2. Physiological (passenger’s feeling of movement on the train).

3. Mental (pareidolic illusions - a scream on the street is like a call by name; noise outside the door is like a doorbell ringing).

The first 2 types also occur in healthy people. There are illusions visual(distortion of the visual image - “the patient perceives a coat hanging in the closet as a person based on the similarity of contours”), taste(modification of taste, appearance of “taste”), olfactory(change in smell) and auditory.

There is also a special type of visual illusion in which the perception of objects changes significantly.

· Metamorphopsia:

· macropsia - a disorder of perception, which is characterized by an increase in the size of surrounding objects;

· micropsia - ... reducing the size of surrounding objects;

· dysmegalopsia - a disorder that is characterized by expansion, elongation or twisting of surrounding objects around their own axis;

· porropsia - a disorder characterized by a change in distance (the object seems to move away from the patient while the size of the object itself remains unchanged).

II) Hallucinations - disturbances of perception arising without the presence of a real object and accompanied by confidence that a given object at a given time and place really exists.

Visual and auditory galls are usually divided into two groups: simple and complex.

Simple: A) photopsia- perception of bright flashes of light, circles, stars; b) acoasms- perception of sounds, noise, crackling, whistling, crying.

Complex hallucinations- auditory hallucinations that have the appearance of articulate phrasal speech and are usually of a commanding or threatening nature.

In addition, according to the mechanism of occurrence, hallucinations are divided into 2 groups: true and pseudohallucinations(can be differentiated only with visual and auditory illusions of perception):

· true hallucinations(images are projected outward; they are bright, loud, intense, sonorous);

· false hallucinations or pseudohallucinations(the images are “inside the patient’s head”; they are “made”, imposed, dull, blurry, muffled; you can “shield yourself” from them for a while; the image has an imperative or commentary character; patients are aware of their false nature, they are in the imagination of the patients themselves) .

III) Eidetism - a disorder of perception in which the “trace” of the just ended excitation in some analyzer remains in the form of a clear and vivid image. This is the reproduction in all details of the images of objects that are not currently acting on the analyzers (a person continues to perceive the object in its absence). From a physiological point of view, this is residual excitation of the analyzer.

IV) Depersonalization disturbances of perception .

Under the term "recognition" imply recognition of the perceived object as already known from past experience.

Depersonalization- this is a distorted perception of how self(the perception of one’s own personality is distorted, which is manifested by a feeling of loss, splitting of the “I”, alienation of the “I”), and individual qualities and parts of the body(there are no crazy ideas and criticism is fully or partially preserved). There are partial (part of the body) and total (the whole body).

Disorders of perception (recognition) of one's own body include somatoagnosia- recognition disorder own body (with lesions of the brain, neurological diseases). This is the inability to recognize and show fingers on the hand (digital autotopagnosia), posture (autotopagnosia of posture), half of the body (autotopagnosia of half the body), disorientation in “right” and “left”; body diagram disturbances- enlargement or reduction of the body, individual parts, painful perception of the location of individual parts of the body - “ears on the back of the head”).

V) Derealization - distorted perception of the surrounding world, “everything is frozen, glazed over,” “the world is like a decoration”). In the context of derealization, one should consider time perception disorders: a person has a feeling of stopping, stretching, slowing down, accelerating, “reverse” flow, loss of the sense of time (if the right hemisphere of the brain is damaged).

VI) Agnosia - impaired recognition of objects, as well as parts of one’s own body, while maintaining consciousness and self-awareness. These are disturbances of visual, auditory and kinesthetic perceptions due to local lesions of the brain of various origins (for example, tumor, inflammation, vascular damage). There may be a violation of the generalized perception of objects (they do not recognize a table, a chair), they do not recognize familiar, previously seen, space - they can’t find their room, the doctor’s office, or the toilet.

The following types of agnosia are distinguished:

· Visual agnosia- disorders of recognition of objects and their images with sufficient acuity. They occur with lesions of the occipital and inferior posterior parts of the parietal lobes of the brain.

· Tactile (tactile) agnosia- failure to recognize an object by feeling it while maintaining tactile sensitivity. appear astereognosis - With their eyes closed, when feeling an object (a comb, a pencil), patients do not recognize, do not feel the shape and size, but when they see an object, they recognize it.

· Auditory agnosia- impaired ability to recognize speech sounds in the absence of hearing impairment. Characteristic of damage to the temporal lobes of the brain (patients do not recognize the sound of an airplane, wind, or car).

Psychiatry classifies perceptual disorder as a mental pathology. Perception is a complex of sensations through which we receive information about the world around us. Sensation consists of five senses: sight, hearing, smell, touch and taste. The result of the perception process is an integral image of the world, the interaction of objects and an understanding of their qualities and properties. A disturbance in the functioning of one or more sense organs is a disorder of perception.

Perception disorders are represented by the following disorders:

• illusion
• agnosia
• hallucination
• psychosensory disorders

With an illusion, a real object is perceived as something else. For example, a robe hanging on a hanger is mistaken for a human figure. There are three types of illusions: physical, physiological and mental. Physiological ones arise due to external factors, often due to the laws of physics. Thus, a cup in a glass of liquid appears to be broken, whereas this is an optical illusion. Physiological illusions are associated with the characteristics of receptors. For example, after a heavy load, a light load seems heavy. Mental illusions arise due to a person’s emotional state. A constantly worried person always hears the footsteps of the pursuer. A person who is intoxicated sees an object in a distorted form. In the same state, people often see pareidolic illusions, when existing objects are replaced by erroneous images. For example, whole pictures or actions similar to theatrical ones are created from wallpaper patterns. They also classify illusions according to the senses. May be visual, auditory, olfactory,gustatory and tactile. However, it should be remembered. That the presence of illusions does not always indicate illness, because they can also occur in mentally healthy people due to objective reasons.

Psychiatry calls the perception of an object that does not exist at the moment a hallucination. Patients perceive such objects as really existing and, for their part, treat them critically. Attempts to convince the patient that an object is missing can only cause irritation, since the person is sure of the opposite. Hallucinations are subject to classification according to certain criteria: content, complexity, interest, etc. In terms of complexity, hallucinations are elementary (photopsia - formless images and acoasms - unclear noises and calls), simple (any one analyzer is involved) and complex (several ones are involved). analyzers). The most common cases are visual and auditory hallucinations. Visual symptoms manifest themselves in the vision of single or multiple images that differ from each other in behavior towards the patient seeing them, mobility or immobility, etc. The image can be perceived by peripheral vision. In this case, it is called extracampal, and if a person sees his double, then this is an autoscopic hallucination. During auditory hallucinations, the patient hears the sound of the howling wind and the rustling of trees. Most often, auditory hallucinations consist of verbal hallucinations, for example, the voices of both acquaintances and strangers, both of one person and of a group of people. These voices are divided into neutral, indifferent or threatening to the patient. Voices manifest themselves in different ways; they can scold, ask questions, order, comment on a person’s actions, threaten, offer to improve. The most dangerous for the patient (for those around him too) are commanding voices (imperative hallucinations). They can be harmless, for example, an order to go on a visit, drink tea, or dangerous, for example, an order to kill or commit suicide. Most often, the patient cannot resist these orders and follows them. It happens that a patient asks someone to restrain him so as not to do something terrible.

With tactile hallucinations, there is a sensation of insects crawling on the surface of the skin or under it, and the person can describe these insects in detail. Olfactory and tactile hallucinations are rare. Olfactory is manifested in the sensation of an unpleasant odor, and gustatory - in the sensation of an unpleasant taste, regardless of the taste of the food taken.

There are a number of other types of hallucinations. Real hallucinations fit very harmoniously into the world around them and have signs of reality. Patients are sure that people around them also perceive these objects, but for some reason they hide it. Hallucinogenic images influence the patient’s behavior, which becomes consistent with their content.

Psychiatry is a disorder that differs from true hallucinations in that it does not fit into the environment and does not bear signs of reality, is projected inside a person, for example, a voice is not heard from the outside, but as if it was built into the head, is called pseudohallucination. Often pseudohallucinations do not affect human behavior, so people often do not realize that a hallucinating person exists next to them.

Psychosensory disorders (sensory synthesis disorders) differ from illusions and hallucinations in that a really existing object is perceived as it should, but in a distorted form. There are two forms of psychosensory disorders: derealization and depersonalization. Derealization consists of a distorted perception of the world. The patient feels that the world has become somehow different, its properties and qualities have changed. This perception is typical of depressed people who say that the world has lost its color. Derealization can manifest itself in a distorted perception of the properties of a separate object, for example, size, shape, etc. With micropsia, the object appears reduced, and with macropsia, enlarged; with metamorphopsia, the object is distorted.

There are two types of depersonalization - somatopsychic and autopsychic. With somatopsychic depersonalization, an experience occurs, a change in the size and shape of the human body. The patient may feel that he has grown significantly or become heavier. With autopsychic depersonalization, changes in one’s “I” are experienced. Patients claim that their personal qualities have changed, their character has deteriorated.

An abnormal perception of the world around you and yourself, when everything seems unreal, and your own thoughts, emotions, sensations seem to be observed from the outside, is called depersonalization in psychiatry. Often it occurs along with derealization, characterized by the remoteness of everything around, the absence of colors in it, and memory impairment. Due to the similarity of symptoms, in the 10th revision of the International Classification of Diseases, depersonalization-derealization syndrome is designated by one code F 48.1.

Perception disorder affects more than 70% of people worldwide from time to time. It seems to them that their consciousness is divided into two parts and one of them, having lost control over their mind and body, panics, and the second indifferently watches this from the side. It's like a bad dream and therefore very frightening. A person sees everything in a fog, in muted colors, and cannot move either an arm or a leg. He feels extreme discomfort and feels like he is going crazy.

Experts do not consider this disorder a serious mental pathology. The human psyche can react this way to stress, fear, severe emotional shock, and even overwork in the physical sense. The brain “turns on” the defense, reducing a person’s sensory sensitivity and emotionality, so objects seem strange, unusual to the touch, and colors seem faded. That is, the perception of the world becomes unusual and strange, unfamiliar. This condition usually goes away on its own and quickly, without treatment.

But, if such a syndrome manifests itself frequently and lasts for a long time, and the symptoms intensify, then it is already dangerous: the individual can harm himself and others with his inappropriate behavior, or commit suicide. Therefore, in this case, the help of doctors is necessary.

You need to know that depersonalization can also accompany clinical depression, panic attacks, anxiety and bipolar disorders, and schizophrenia. Similar sensations are caused by narcotic drugs, sedatives and antihistamines and a number of other medications, as well as caffeine and alcohol.

Causes of perception disorder

Depersonalization occurs in people of all ages and genders, but most often it affects young women. As already mentioned, it is caused by a stressful situation. The psyche that resists it reduces the strong emotional load of a person, switching his attention to outside observation. Thus, the individual turns his consciousness inward, his senses become dulled, but logical thinking remains the same.

The process of development of the syndrome in the body looks like this: under the influence of stress, a large amount of endorphins begins to be produced. As a result of their large-scale chaotic attack on receptors, the limbic system responsible for emotions is unable to cope with such pressure and is forced to partially shut down.

But the above mechanism can also be triggered by other physical factors:

• stroke;
• hypertension;
• brain tumor;
• neurological disease;
• head injury;
• epileptic seizure;
• neurosurgical operation;
• severe infectious disease in childhood;
• birth trauma.

Very rarely, depersonalization is inherited or is a consequence of negative changes in the nervous system.

It has already been said that taking drugs or other intoxication of the body can also cause a disorder of perception, as this provokes increased production of “hormones of happiness” - endorphins. Therefore, in the United States, an organization on drug addiction issues is studying depersonalization at the state level.

It should be noted that in schizophrenia, split personality has other causes and this is a symptom of a serious mental disorder, the approach to which is special and requires complex treatment.

Symptoms

There are 3 conditional groups of signs characterizing depersonalization syndrome:

1. Emotional coldness, indifference in the perception of the surrounding world, detachment, indifference to people::

• indifference to the suffering of others;
• lack of joy when communicating with family and friends;
• insensitivity to music;
• loss of sense of humor;
• maintaining equanimity in situations that previously aroused any feelings, both negative and positive.

Fear is experienced only from the loss of control of one's body and loss of orientation in space. The feeling of confusion from not understanding the location, the history of getting here and further actions is depressing.

2. Violation of physical sensations:

• Loss of sensitivity to hot and cold;
• colors become dull, color blindness may appear;
• taste sensations change;
• objects seem blurry and have no boundaries;
• sounds seem muffled, as in water;
• There is no pain with minor wounds;
• coordination of movements is impaired;
• There is no feeling of hunger, and with it the appetite disappears.

3. Mental immunity:

• a person forgets his preferences - what he likes and dislikes;
• lack of incentives and motives - reluctance to take care of yourself, cook food, do laundry, work, go shopping;
• temporary disorientation - an individual can sit without doing anything for several hours and not understand how much time has passed;
• the feeling of participating as an actor in a boring, drawn-out play;
• contemplation from the outside of your life, as if it were a dream.

The main sign of a perception disorder is a person’s deep self-absorption. At first he realizes that he perceives his personality incorrectly, this depresses him and causes strong emotional disturbance.

When trying to understand what is happening, the feeling of unreality becomes stronger, and the absurdity of the situation forces the individual to avoid communication with other people. The individual, however, is aware of the painfulness of his condition.

In general, the clinical picture of depersonalization can be described as follows:

1. The perception of the world is disrupted - it seems unreal, fantastic.
2. Complete detachment from what is happening around.
3. Loss of satisfaction from natural physiological needs - sleep, food, defects, sex, etc.
4. Closedness.
5. Impaired perception of the structure of one's body - arms and legs seem artificial, of unknown configuration or size.
6. Inability to control your body.
7. Decreased intellectual abilities.
8. Feeling of loneliness, abandoned by everyone.
9. Absence of any emotional manifestations.
10. Changes in physiological sensations.
11. Split personality.
12. The feeling of watching yourself from the outside.

These symptoms of perceptual disorder may have varying degrees of severity for different types of depersonalization, which will be discussed below.

Varieties

Modern psychology shares several forms of depersonalization syndrome, differing in the uniqueness of their perception of the world around them and themselves:

1. Autopsychic depersonalization is a heightened sense of one’s “I”, an increase in the feeling of its loss. It seems to a person that some stranger lives in him, feels at ease and acts in his own way. Such a split makes you suffer and experience discomfort, and reject yourself. Social contacts are difficult.
2. Allopsychic depersonalization – derealization. The surroundings are perceived as a dream, the world is seen as through a cloudy glass. Everything seems alien and hostile: sounds are booming, objects are fuzzy, people look the same. Automatic thoughts and movements, disorientation, deja vu.
3. Anesthetic depersonalization - increased internal vulnerability with complete external insensitivity.
4. Somatopsychic depersonalization, characterized by a pathological perception of one’s body and its functions. It is the most unusual: it seems to a person that he has no hair or clothes, parts of the body have changed and live their own separate lives. Eating is difficult - the throat “does not want” to push food through, there is no desire to eat. Taste sensations change, sensitivity to air and water temperature decreases.

Diagnostics

To identify a perceptual disorder, a thorough interview of the patient and his relatives is required - they will describe the patient’s behavior. Special testing is also carried out.

Blood tests and examination of the patient will not yield anything - he does not look sick, he has no chronic or hidden somatic diseases, his immunity is not satisfactory, and his physical condition is quite normal. But an MRI will show changes in certain areas of the brain. There are also special laboratory studies confirming changes in protein receptors and disturbances in the functioning of the endocrine gland - the pituitary gland.

Now there are clear criteria to confirm the diagnosis:

1. Critical thinking of a patient who is aware of his problem.
2. Maintaining clarity of consciousness, the absence of so-called twilight episodes, confusion of thought.
3. Complaints that the mind exists separately from the body, the latter exists independently and its perception is impaired.
4. A feeling of changing terrain, unreality, misrecognition of familiar objects.

The specialist should distinguish depersonalization from schizophrenia, which has similar symptoms. These pathologies are distinguished as follows: schizophrenia manifests itself with the same symptoms of the same intensity every day, and with a perceptual disorder they are much more varied.

Therapy for depersonalization disorder

Since this disorder is individual for each patient, treatment is selected for each patient separately.

As already mentioned, short-term cases of depersonalization do not require treatment, but psychoanalysis will help eliminate the discomfort.

If the culprit of depersonalization is the use of narcotic substances, then detoxification of the body is carried out. Hormonal treatment will be needed if the cause of the disorder is endocrine pathology.

Depersonalization due to depression, panic attacks, schizophrenia, the psychiatrist prescribes a complex of tranquilizers, antidepressants, and antipsychotics. The following drugs are indicated:

• "Decorten";
• Seroquel in combination with Anafranil;
• "Cytoflamin";
• "Cavinton";
• "Naloxone";
• vitamin C with drugs such as Amitriptyline, Sonapax, Clopiramine, Quetiapine.

Some patients have to take psychotropic medications for life, since the syndrome cannot be completely cured. Medications allow them to relieve the severity of the feelings caused by the disorder.

When symptomatic manifestations subside, it is time for psychotherapy. The specialist conducts a series of sessions with the patient, during which he identifies the causes of the perception disorder, switches the patient’s attention to other people, and teaches him to subsequently cope with emerging attacks of duality.

An effective method for getting rid of depersonalization is to remember strange feelings and then tell them to a psychologist. The latter, in turn, teaches the patient not to be afraid of such cases, and they gradually fade away.

Auto-training and hypnosis are also successfully used; they are most effective together with explanatory therapy.

Additional measures may be prescribed:

• acupuncture;
• soothing massage;
• phytotherapy;
• taking antidepressants;
• physiotherapy;
• homeopathy.

Psychotherapeutic techniques are supported by social rehabilitation: the patient is advised to be in public more often, go to museums, theaters, etc. This gives tangible results in treatment and recovery.

It happens that people with a severe degree of depersonalization have a negative attitude towards the rehabilitation program and are passive. In this case, they resort to the help of the patient’s relatives, who literally drag the relative “out into the world.”