Body patterns are disrupted. Body image disorders (images of one's own body) What is a body image disorder?

A violation of the body diagram is a violation of orientation in own body, which is apparently associated with a violation of the higher synthesis of sensory perceptions in the parietal region. The patient may feel that his head is excessively large, his lips are swollen, his nose is pulled forward, his arm is sharply reduced or enlarged and lies somewhere nearby, separate from the body. It is difficult for him to understand “left” and “right”. The disturbance of the body diagram is especially pronounced in a patient with left-sided hemiplegia with simultaneous hemianesthesia and hemianopsia. He cannot find his arm, shows that it starts from the middle of his chest, notes the presence of a third arm, does not recognize his paralysis and is convinced of the ability to get up and walk, but “does not do it” because he “doesn’t want to.” If you show a patient his paralyzed hand, he will not recognize it as his own. These phenomena of anosognosia (lack of awareness of one’s illness) and autotopagnosia (failure to recognize parts of one’s own body, see) in the presence of diffuse atherosclerotic lesions of the vessels of the cerebral cortex are sometimes combined with their delusional interpretation; the patient, for example, claims that the diseased hand is not his, but was thrown to him in bed, that he put his leg in a corner, etc. Various types of paresthesia are painfully transformed into colorful, lush delirium. With right-sided hemiplegia, such disorders of the body diagram are observed less frequently, since the body diagram is more provided by the parietal region of the right hemisphere.

Agnosia. Object agnosia - loss of the ability to recognize familiar objects; with other types of agnosia, individual qualities may not differ: color, sound, smell.

Violation of higher visual functions, the implementation of which is primarily ensured by the occipital regions of the brain, manifests itself in visual agnosia.

With visual agnosia, recognition of an object or its image is impaired, and the idea of ​​the purpose of this object is lost. The patient sees, but does not recognize an object familiar to him from past experience. When feeling this object, the patient can recognize it. And, conversely, with astereognosis the patient does not distinguish objects by touch, but recognizes them by examining them.

Defeat may be limited to failure to recognize only individual details of an object, and the inability to combine individual parts into a whole. Thus, looking at a sequential series of pictures, the patient understands their details, but is not able to grasp the general meaning of the entire series. Facial agnosia may occur ( prosopagnosia), in which the patient does not recognize well-known faces; does not recognize personal photographs or even himself in the mirror.

In addition to object agnosia, spatial visual agnosia may be observed; when there is a violation of the perception of sequential actions, spatial relationships objects, usually with a simultaneous disorder of orientation in the environment. The patient cannot imagine the layout of the rooms that is familiar to him, the location of the house that he has entered hundreds of times, or the placement of the cardinal points on a geographical map.

When a patient without hearing loss loses the ability to recognize objects by their characteristic sounds (for example, water pouring from a tap, a dog barking in the next room, a clock striking), we can talk about auditory agnosia. It is not the perception of sounds that suffers here, but the understanding of their signal meaning.

As already mentioned, both hemispheres of the brain are involved in processing the auditory, visual, somatosensory and motor material entering the brain. But the participation of both hemispheres of the brain in this process is ambiguous. The right hemisphere of the brain is functionally associated with the perception and processing of non-verbal (non-verbal) material. It is characterized not so much by the dissection and logical analysis of reality, which is predominantly the responsibility of the left hemisphere, as by the perception of holistic images, the manipulation of complex associations. The right hemisphere is characterized not by verbal perception, but by sensory-figurative perception. This also leads to the syndromes that are formed when it is damaged. A very large part of the symptoms mentioned above are the result of damage to the right hemisphere. This, for example, is a lack of recognition of faces - proso-pagnosia, impaired perception of the surrounding space, impaired ability to understand images in pictures, impaired ability to understand diagrams and plans, or orientation on a geographical map.

Agnosia for nonwords has also been associated with damage to the right hemisphere.

The connection of the right hemisphere with visual-spatial thinking also determines the appearance of some complex mental phenomena in cases of disorders in the right hemisphere; for example, with a focus of pathological excitation in the right temporal lobe observed in epilepsy visual illusions and the states of “already seen” and “never seen.”

There is reason to believe that this type of visual mental activity, like dreams, is also associated with the right hemisphere of the brain. There are observations that when the right hemisphere is damaged, dreams may stop (In the overwhelming majority of dreams, according to the figurative definition of I.M. Sechenov, they represent an incredible, fantastic transformation of actual, probable, experienced events) or they become meaningless in content, often related to the topic diseases are frightening in nature. A disorder in the body diagram is also considered a sign of damage to the right hemisphere of the brain.

Violation of the body diagram. The concept of a violation of the body diagram includes disorientation in one’s own body, which is associated with a violation of the integration of sensory perceptions and a disorder in the understanding of spatial relationships. The patient in similar cases it may seem that his head is excessively large, his lips are swollen, his nose is pulled forward, his arm is sharply reduced or enlarged and lies somewhere nearby, separate from the body. It is difficult for him to understand “left” and “right”. The disturbance of the body diagram is especially pronounced in a patient with right hemisphere damage with the simultaneous presence of left-sided hemiplegia, hemianesthesia and hemianopsia. This is understandable, since the patient does not see or feel his paralyzed half of the body. He cannot find his arm, shows that it starts from the middle of his chest, notes the presence of a third arm, does not recognize his paralysis and is convinced of the ability to get up and walk, but “does not” do this because he “does not want to.” If such a patient is shown his paralyzed hand, he will not recognize it as his own. This phenomenon anosognosia(from the Greek nosos - illness, gnosis - knowledge, recognition, anosognosis - lack of consciousness of one’s illness, usually paralysis of a limb or blindness) and phenomena autotopagnosia(failure to recognize parts of one's own body). In the presence of diffuse atherosclerotic lesions of the brain vessels, the patient sometimes expresses delusional thoughts, claiming, for example, that the hands of the dead are cut off and thrown into his bed. (“These hands, cold, suffocate, digging their nails into the skin and body”). The patient cries bitterly, asking to stop the merciless treatment of him. To get rid of the annoying “foreign” hand, the patient can grab healthy hand your paralyzed hand, hit the latter with all your strength against the bed or wall. No beliefs work in this case. Various types of paresthesia painfully transform into colorful and lush delirium.

Apraxia, or a disorder of action, consists of a violation of the sequence of complex movements, i.e., the disintegration of the desired set of movements, as a result of which the patient loses the ability to accurately perform habitual actions with complete preservation of muscle strength and preservation of coordination of movements.

All our actions, representing an integrative function different levels nervous system, are provided different departments brain

Voluntary movements will be clearly performed if:

1) preserved afferentation, kinesthesia, which is associated with parts of the posterior central gyrus (test: the patient, without looking at his fingers, must copy the position of the doctor’s fingers);

2) preserved visual-spatial orientation, which is associated with the parieto-occipital regions of the cortex (test: copy the combination hand on hand, fist under fist, make a figure from matches, right - left side);

3) preservation of the kinetic basis of movements, which is associated mainly with the precentral region of the anterior central gyrus (test: copy a quick change of fist with two fingers, knock on the table with different rhythms and intervals);

4) preservation of action programming, its purposefulness, which is associated with the anterior sections frontal lobes(test: performing targeted tasks, for example, beckon or threaten with a finger, carry out this or that order). If one of the listed cortical areas is damaged, one or another type of apraxia will be observed:

2) spatial and constructive apraxia;

3) dynamic apraxia (apraxia of execution);

4)frontal apraxia, i.e. apraxia of design, or, as it is also called, ideatorial apraxia (Fig. 101).

We must, of course, not forget that the clarity of our movements also depends on other parts of the nervous system, as mentioned above. After all, learned by man and entrenched in dynamic stereotype(into a motor image) complex voluntary movements arose and developed with the very effective participation of both afferent and efferent systems. As V.I. Lenin figuratively wrote, “... the practical activity of man billions of times should have led man’s consciousness to the repetition of various logical figures, so that these figures could receive the meaning of axioms.” Failure in the activity of these systems leads to praxial disorders, most pronounced in cases of damage in the premotor or parietal areas of the cortex.

Establishing the nature of apraxia is of great importance in a monolocal process such as a tumor. At vascular lesions We more often see mixed forms of apraxia, for example, postural and constructive or constructive and dynamic. Along with unclear movements, the patient may experience, at first glance, phenomena of absurd behavior. According to the instructions, the patient cannot raise his hand, blow his nose, put on a robe; when asked to light a match, he can take it out of the box and start striking the unsulfurized end against his robe; he may start writing with a spoon, combing his hair through his hat;

the ability to construct a whole from parts, for example a house of matches, to pantomimically depict this or that action, for example, wagging a finger, showing how to sew on a sewing machine, hammering a nail into a wall, etc., is frustrated. With ideation apraxia, the patient may generally find himself completely helpless.

Often with apraxia, perseveration is observed, i.e., “sticking” to a once-performed action, slipping onto the beaten path. Thus, a patient who sticks out his tongue on demand, with each new task - raising his hand, closing his eyes, touching his ear, continues to stick out his tongue, but does not complete the new task.

The syndrome of constructive apraxia, which develops in patients with right hemisphere lesions, is associated with impaired visual-spatial perception. Although clearly aware of the purpose of the task, the patient cannot properly organize the sequence and interconnection of acts in time and space and understand the design of the task being performed. The characteristic combination of agnosia and apraxia made it possible to combine these disorders, which occur with damage to the right hemisphere, under a single term - apractognostic syndrome.

Body diagram- a complex, generalized image of one’s own body, the location of its parts in three-dimensional space and in relation to each other. This image appears in the human brain based on the perception of kinesthetic, painful, tactile, vestibular, visual, auditory and other afferent stimuli in comparison with traces of past sensory experience.

The body diagram is a necessary link in the implementation of any movement , changes poses , gait , tk. in all these cases sensations are necessary initial position body and its parts and taking into account the flow of reverse afferentation when they change. S. t. is of particular importance for the regulation of posture and movements under conditions of weightlessness.

In pathology, S.'s disorders are manifested by a distorted perception of one's own body and its parts. Violations of S. t. include various types misrecognition of body parts, their condition and position. The most common is anosognosia - the patient’s unawareness of a defect or painful condition any organ. For example, a patient with hemiplegia claims that he can freely make any movement with his affected arm or leg. There is also autotopagnosia - unawareness of the location of body parts, when the patient cannot show where his paralyzed arm is located. Disorders of S. t. also include loss of orientation in the right and left sides of the body, the feeling of the presence of additional (false) limbs - pseudopolymelia etc.

Peculiar sensitivity disorders are also often observed: failure to recognize painful stimuli or agnosia of pain, allochiria, when the patient perceives irritation on one side of the body in a symmetrical place on the other side, a symptom of sensory inattention - the patient, with a simultaneous injection at symmetrical points of the body on both sides, perceives an injection on only one side, but does not notice it on the other, etc.

Symptoms of S.'s violation of t. are observed with vascular, traumatic, tumor and other organic focal lesions that involve the thalamoparietal system, most often of the right hemisphere. The manifestation of these disorders is facilitated by hemiplegia and the severe general condition of the patient. Violations of S. t. usually disappear with further deterioration of the patient’s condition or, conversely,

as he recovers from his serious condition.

S.'s disorders of t. often develop simultaneously with the phenomena of derealization and depersonalization in epilepsy, schizophrenia, in the structure of phases (attacks) of a circular disease. Pathological sensations of changes in the size and shape of the body (autometamorphopsia) arise: in some cases there is a feeling of a total increase or decrease in the volume or weight of the body (total autometamorphopsia), in others there is a feeling of enlargement of individual parts of the body, for example, the upper or lower extremities, head (partial autometamorphopsia ). The sensation of increasing or decreasing the size of the body or its parts disappears with visual control. The appearance of S. t. disorders is often accompanied by the development of feelings of fear and anxiety.

Diagnostic value of violations C.

t. is that they are combined with others focal symptoms indicate participation in pathological process thalamoparietal system and parietal cortex, usually the right hemisphere of the brain.

Bibliography: Babenkova S.V. Clinical syndromes lesions of the right hemisphere of the brain in acute stroke, M., 1971; Badalyan L.O. Child neurology, p. 81, M., 1984; Collins R.D. Diagnosis of nervous diseases, trans. from English, M., 1976; Martynov Yu.S. Nervous diseases, M., 1988; Mehrabyan A.A. General psychopathology, M., 1972; Guide to Psychiatry, ed. A.V. Snezhnevsky, vol. 1, M., 1983; Handbook of Psychiatry, ed. A.V. Snezhnevsky, p. 51, M., 1985.

One type of central nervous system disorder nervous system is a violation of the perception of one’s own body or, as this disorder is also called, a violation of the body diagram. This disorder was first described by three doctors Peak, Head and Schilder. They presented their concept of the disease at the beginning of the 20th century. Since then, psychiatrists have used it to describe the condition of patients who are “entangled” in their own body.

In diseases of the brain, there is an incorrect interpretation of signals coming from receptors with different parts bodies. Normally, they end up in special areas of the brain, where he parses them into components and “decides” what he feels, how strongly he “feels” it, and where the signal actually came from. If these zones are damaged, a condition arises in which a person cannot say exactly where, for example, he was pricked with a needle - in his right hand or left, or what size his head is.

What is a body schema disorder?

To understand this term, let's turn to reference books. They write that a violation of the body diagram is a disorder of orientation in one’s own body or surrounding objects, in which the patient cannot say exactly what size, how far, on which side, etc. his limb or specific object is located. Most often, this disorder occurs with damage to the parietal lobe in the interparietal sulcus, especially when the lesion is localized in the right hemisphere.

The disturbance in the perception of one's own body is especially pronounced in cases where there is unilateral paralysis of the body in combination with loss of sensitivity in the same half of the body and bilateral blindness with loss of visual fields on one side. People in this condition cannot find their limb or indicate where it begins. At the same time, they may point to the leg or believe that an arm is beginning to grow from the elbow or from the middle of the chest.

Some patients may be sure that they have three legs or arms, 6 fingers or 2 noses - they are not only sure of this, but also feel it. It is characteristic that all patients do not consider themselves as such; they deny the presence of paresis or paralysis and also insist on the accuracy of their feelings. Denial of one's illness is called anosognosia, and failure to recognize one's own body parts is called; incorrect quantitative assessments of one's own body parts in medicine are called pseudomelia.

If this pathology is combined with cerebral atherosclerosis, delirium, hallucinations, and delirium may also be present, which significantly complicates the diagnosis. In this state, the patient claims that the limb does not belong to him, it was planted by neighbors, and his own hand is in the closet, etc. There are a lot of variations in this case.

If the patient at the same time has symptoms of paresthesia - changes in sensitivity, which are often accompanied by a feeling of crawling, numbness, tingling, then the patient includes all this in the complex of his sensations and transforms them into delusional hypotheses in which he is tortured, or he is eaten from the inside by worms. Brad has a bright emotional coloring, therefore, it has a huge number of options depending on the characteristics of the patient’s psyche and his preferences.

Also, a disorder of the body diagram can be accompanied by metamorphopsia - incorrect perception of surrounding objects, changes in the assessment of size and staticity. For example, a patient may look at a chair with a back, and it will seem to him that it is a stool with spiral legs, which also rotates in space and is rapidly approaching him. In some cases, surrounding objects may acquire small or, conversely, enormous sizes; they may seem larger in number than they actually are; they may fall on the patient, try to crush him, or pull him inside.

Some patients may perceive themselves both within themselves and as separate from their body. At the same time, they experience the feeling that they are in their own body, but they can observe themselves from the outside, as if detached.

Quite often, a violation of the body diagram is accompanied by changes in the perception of one’s own size. Thus, patients may perceive themselves as giants who find themselves in a small room where everyone is very miniature in size. As a result, they are afraid to move in case they crush or break something. Some patients claim that they are so large that they need a bed for the whole room, otherwise they will not be able to fit on it, or that their head is much larger than the pillow, but their body has disappeared or become very small. That is why this disorder has another name - Alice in Wonderland syndrome.

Very important difference psychosensory disorders from hallucinations is a distorted perception of real rather than fictitious objects. In addition, the patient recognizes objects, but perceives their shape, size, and distance to them incorrectly. This is the main difference between illusory and hallucinatory perceptions and psychosensory disorders.

What is allocheiria?

The number of psychosensory disorders described in patients suffering from body schema disorder is actually much larger, but the space of the article does not allow us to describe them all.

Finally, let us dwell on another type of disorder of psychosensory perception of one’s own body - allocheiria.

This term refers to the perception of stimulation on the other side of the body. It refers specifically to hands - “allos” is translated from Greek as another, and “cheir” is hand. Therefore, if irritation occurs on right hand the patient says that it occurs on the left hand, and vice versa. In other words, all sensations are symmetrically transferred from one hand to the other, i.e. all senses are transferred 180° - from right to left and from left to right.

In this case, there may be an incorrect indication of the location of irritation. For example, a patient has a finger pricked on his right hand, but he will feel that he has been pricked in left hand at the level of the forearm. Also, this disorder can be combined with hyperalgesia, a disturbance in temperature perception. In this case, touching the right hand with a cold object may be perceived by the patient as touching the other hand with a hot object.

When does allocheiria occur?

Allocheiria, as one of the types of disorders of perception of one's own body, can occur with damage to the brain, in particular the parietal lobe on the right.

Also, this disorder occurs in cerebral atherosclerosis, in the post-stroke period, when hemorrhage affected the parietal part of the brain, in brain tumors, multiple sclerosis, some types of epilepsy and migraine, hysteria.

BODY SCHEME. The sensations coming from one’s own body are the basis for the formation of a synthetic spatial perception of one’s body in the form of its diagram. Normally, this perception seems dim* one might even say vague, but any disorder of the scheme is painfully perceived by the consciousness as a violation of the vital basis of the organism. The body diagram is instead a very persistent formation, which is proven, among other things, by the phenomenon of phantom in amputees, when, despite the absence of a limb, the subject continues to perceive the diagram of the entire body, including the removed limb. Observed the following manifestations violations of S. t.: changes in the shape, size and weight of individual parts of the body, their disappearance, their separation (the head and arms are felt, but separately from the rest of the body), displacement of parts (the head, shoulders have sunk, the back is in front, etc. ), increase, decrease, change in shape and weight of the whole body, splitting of the body (sensation of a double), disappearance of the whole body. That. we have transitions from partial sodas: atopically delimited to more general, total disturbances approaching depersonalization. A disorder of recognition of parts of one's body as a consequence of a violation of its pattern is called autopagiosia (Pick), and finger agnosia (Gerstmann) should be considered a partial manifestation of the cut. With autotopagnosia, the patient loses landmarks in his own body (distinguishing between right and left, arms and legs, etc.). In addition to the already mentioned phantoms in amputees, Babinski’s anosognosia is closely related to the concept of S. t., when, for example. the patient does not perceive his hemiplegia, Schilder’s pain asymbolia (pain is felt, but is not associated with S. t.). Violations of S. t. are usually associated with various other sensory disorders. Most often, dedo is about peculiar visual deceptions of the senses in the form of metamorphoses, i.e. geometrically optical disorders, when the subject sees objects perverted, turned upside down, reduced or increased in volume, etc., polyopia (multiplying objects in number), porropsia (impaired vision in depth - objects seem too distant or vice versa). In other cases of violation of Art. accompanied by disorders of the general senses and vestibular symptoms. It is important to note that in S.’s disorders of t. and in the indicated optical and vestibular symptoms, the main thing is a violation of spatial schizoid perceptions relating to both one’s own body and the outside world. The connection between these and other disorders is quite constant. This last circumstance and was the reason for the attempt to isolate a separate syndrome, the so-called. interparietal. This name is based on observations that have shown that violation of S. t. and corresponding optical symptoms occur when the cortex located in the depths of the posterior part of the interparietal groove is damaged. It should be noted, however, that the interparietal cortex is apparently only the leading link of an “extensive system that has other links in other places of the cortex, as well as in thalamus, vestibular apparatus, etc., as a result of which the appearance of elements of the “internarietal” syndrome is possible with lesions in various parts of the brain (especially in the visual thalamus); one can only assume on the basis of the data available in the literature (Potzl and his school) that the presence of a complete interparietal syndrome with a violation of St., motamorphopsia, etc. is available to a more specific localization in the specified area of ​​​​the cortex. This is confirmed by the fact that S.'s violation of t. is often accompanied by other lower parietal symptoms (apraxia, optical agnosia, alexia, acalculia, astreognosia, etc.). Violations of the body diagram are usually accompanied by affective disorders(anxiety, fear, horror). Violations of S. t. are observed in various focal lesions: skull injuries (in the parietal region), tumors, arteriosclerosis, cerebral syphilis, etc. More often these are left-sided lesions, but sometimes right-sided ones; in general, the question of the meaning of left and right for this syndrome hemispheres is not entirely clear. Violations of S. t. are possible with epilepsy, with circulatory disorders (for example, with apgioneurosis) and, finally, with mental illness. diseases of a diffuse nature (for example, schizophrenia). In such cases, this syndrome is often the starting point for the development of complex psychotic pictures, especially in the form of phenomena of depersonalization, etc. - The course of the disorder of S. t. depends on the form of the underlying disease: with a tumor, the symptom is constant; with epilepsy, apgioneurosis, it is characteristic episodic appearance (with epilepsy, sometimes in the form of a peculiar aura). With syphilis of the brain, the symptom disappears after specific treatment. The possibility of a violation of S. t. is interesting healthy people at special conditions: Parker and Schilder described this symptom when riding in an elevator (for example, a feeling of lengthening of the legs when the descending elevator suddenly stops). Violation of S. t. was also obtained experimentally by freezing or heating a skull defect in the parietal region (Noah, Potzl): patients during the experiment felt that their leg or arm had disappeared, etc. Similar phenomena were also obtained in experiments with mescaline poisoning. The symptom of disturbance of S. t., associated with new “human” areas of the cortex, undoubtedly has significance in the structure of many neuropsychiatric diseases, and it is not without practical interest for the neurosurgeon in the sense of establishing the localization of the lesion, of course, when compared with other phenomena. Lit.: G u r e v p h M., About interparietal syndrome in mental illness, Sov. neuropathologist, psychiatrist, and psychohygiene, vol. I, no. 5-6, 19 32; o n w e. Violation of the heat pattern in connection with psychosescaping disorders in psychoses, ibid., vol. II. issue ?, 1933; Chlenov L., Body diagram, Sat. works of the Institute of Higher Education. nervous activities, M., 1934; Gurew it sen ¥., ttber das in-terpariel.ale Syndrnm bei Geisteskrankhciti l, Ztschr. i. d..ges. Neurol. u. Psychiatr., B. CXL, 1932; HerrmannG. u.PotzlO., Die optisclie Allaesthesie, Studien znr l-sy-= chopathologie der Raumbildun*, V., 1928; HolIH. n.. Potzl O., Expevimentellfi Nachbildung yon Anosognosie,. Ztschr. f. d. ges. Neurol. u.Psychiatr., B. CXXXVII, 1931; Schilder, Das Korperschema, V., 1923. M. 1"urevich.