Attention span is one of the skills that most frequently becomes altered in the presence of psychopathology. Below we will see the different deviations that attention can suffer depending on some of the most common psychological disorders.

Attention and its typologies

Although many authors have proposed different definitions of the concept of attention, one of the recent contributions (Rios, 2007) states that attention is a neurocognitive state of preparation, which precedes perceptive capacity and action, and which is formed from a network of cortical connections that are responsible for orientation, alert and executive control functions .

More specifically, attention is composed of the following elements: arousal, focal attention, sustained attention, selective attention, alternating attention (change of attentional focus according to the information that needs to be processed at each moment) and divided attention (capacity to attend to two types of stimulation simultaneously).

Attention disorders and psychopathologies

In an attempt to describe the relationship between altered attention span and its presence in certain psychopathologies , Higueras et al. (1996) have differentiated in their classification between aprosexies, hypoprosexies, pseudoprosexies, paraprosexies and hyperprosexies.

This taxonomy arranges the categories understanding attention as a one-dimensional variable in which the extremes (aprosexia and hyperprosexia) correspond to a total absence and an increased capacity to focus attention and concentration, respectively. Thus, more specifically, each of them is defined as follows:

1. Aprosexia

The total absence of attention is usually found associated with symptoms of intense agitation or stupor , a serious alteration of the level of consciousness in which the ability to be alert is very compromised. This state may be caused by organic factors (diffuse brain dysfunctions, for example) or psychiatric factors (melancholic, catatonic and hysterical states).

2. Hypoprosexia

These are states of diminished attentional capacity of lesser intensity than apposexia, and are divided into subgroups:

a) Distractibility : present in ADHD or the twilight state, a disorder of the narrowing of the field of consciousness.

b) Emotional attentiveness linked to anxiety-related symptoms.

(c) Attention deficit attributed to depressive and schizophrenic states.

d) Negligence , an inability to orient oneself after a focal-type brain injury.

e) Fatigability of attention , a state characterized by exhaustion of attention (typical of dementias and presence of tumours) and apathy associated with certain personality disorders.

3. Pseudoprosexies

They can be confused with apposexia in a superficial way because apparently the attentional capacity seems to be absent due to the patient’s pretence , although it is actually preserved. It is common in states of hysteria or in Gangser syndrome (a type of dissociative disorder) with the aim of drawing attention to the individual’s family and friends.

4. Paraprosexia

It is defined as an altered direction of attentional focus , related to hypochondriacal behaviour.

5. Hyperprosexia

They consist of an increased and transitory attentional state present in moments of altered consciousness such as hyperlucidity or extreme vigilance.

Attention as a cognitive process

Derived from scientific research at the end of the last century, Reed (1988) has related some psychopathologies with the aspect of attention that is most altered in each case. Thus, the following attention skills are distinguished.

1. Attention as concentration or sustained attention

It is defined as the maintenance of care over a long period of time. This capacity is related to the task of attention fixation and its most frequent alteration occurs in cases of extreme fatigue, sleep disturbance or states of malnutrition .

This category can include phenomena such as mental absence (exclusion of external information that is usually accessible, where attention is diminished for distracting stimuli or stimuli not closely related to the thought itself and in addition there is an increase in the threshold necessary to enable attentional focusing) or time gap (an absence of recording of events while performing an automatic cognitive processing task, such as during driving a vehicle on a regular route).

2. Attention as selection

Consists of the ability to discriminate relevant information by inhibiting other non-primary stimulating elements. That is, the ability to separate the stimuli that are determinant for the task in question from those that are secondary or irrelevant.

Given the limited nature of attentional capacity, a common phenomenon in this type of skill is “tuning in,” which consists of following one source of information when different sources compete for attention.

The alteration of this function is also known as “distractibility” and can appear in a wide range of psychopathological disorders such as anxiety disorders, manic episodes or twilight conditions (with symptoms similar to epilepsy).

3. Attention as activation or arousal

It is the general state of activation of the organism that allows it to be on alert and is related to attentional focus in terms of degree or intensity. This capacity is compromised in a state of high stress or anxiety , where there is a greater orientation of attention to threatening stimuli. These deviations are known as the “tunnel vision” phenomenon.

4. Care as Surveillance

It is defined as the state of hypersensitivity or high receptivity to the environment, as well as a type of attentional dedication in long-term tasks in which the subject must detect a low-frequency stimulus. In this type of capacity errors of commission (detection of a stimulus when it is not present) and omission (inadequate processing of non-detection of information present) are particularly relevant.

This ability is mainly altered in schizophrenic subjects, in individuals with high scores in the trait anxiety as in GAD, or Generalized Anxiety Disorder. Among its most frequent manifestations we can differentiate general hypervigilance (attending to any stimulus irrelevant to the task), specific hypervigilance (attending selectively to stimuli related to threatening information), widening of attention (prior to the detection of stressful stimulation or narrowing of attention (in the processing of a threatening stimulus, as occurs in paranoid subjects).

5. Attention as expectation

The ability to anticipate is a characteristic based on previous experience that allows the subject to be more effective when performing a specific task. This ability is altered, for example, in the reaction time of schizophrenic individuals.

According to Shakow’s research (1962), the latter have a “segmental set” that prevents them from benefiting from preparatory time intervals in tasks that measure reaction time. On the other hand, subjects without psychopathology are characterized by having a “general set”, which makes it possible to perceive the situation stimulating in a global way and allows the individual to respond without taking into account the irrelevant elements of the activity.

By way of conclusion

As can be seen, the alteration of the attentional capacity is present in a high comorbidity with anxious or schizophrenic psychopathology . A cognitive enhancement of this ability can become an important component in the intervention in this type of clinical disorders.

Bibliographic references:

  • García, J. (1997). Psychology of care. Madrid: Síntesis.
  • Ríos, M., Muñoz, J. and Paúl, N. (2007). Alterations in care after traumatic brain injury: assessment and rehabilitation. Journal of Neurology, 44, 291-297.