Where are you? What are you doing there? What date are we on? Who are you? A large majority of people will be able to answer these questions.

However, if these same questions are asked of someone with brain injuries or who is intoxicated with some drugs or medications, it is possible to find that they do not know how to answer them, that there are serious doubts or that the answers are completely wrong (for example, a person may say that it is 1970 or that he is in a shopping mall when he is actually in a hospital). These are people who show the existence of orientation disorders .

Orientation

Before defining the different orientation disorders, it is necessary to specify what this concept refers to. Orientation is considered to be the cognitive ability that allows us to be able to determine our position in space and time from the environmental references, as well as who we are and what we do in that spatial-temporal position.

Most people identify with the concept of orientation only with the ability to determine our relationship with the environment and to situate ourselves in a given space and time. This type of orientation is called allopsychic .

However, there is another type of orientation, the autopsy orientation. This refers to the orientation linked to one’s own being: we know that we are us, or that our hand or other parts of our body are part of us and do not belong to another person.

Orientation is very much linked to other processes such as consciousness, attention and memory , and can be influenced by failures in any of these skills or processes. For example, through memory we are able to establish and order our experiences in time or remember the meaning or concept of the place where it is.

The main orientation disorders

Once we understand what the term orientation means, we can identify different pathological orientation processes: orientation disorders. In this sense we can find the following pathologies or problems .

1. Disorientation

Disorientation means the loss of the ability to place oneself in space and/or time correctly. The subject does not identify his situation and does not know how to respond if asked where he is or the date. Such disorientation may be only temporal or spatial, or appear both together.

It is also possible that this disorientation is not complete : for example the patient may know that it is 2017, but not the month or the day.

Disorientation can also occur (either alone or together with the previous ones) at an autopsy level, not knowing who he is, what he does there or not recognizing himself.

2. Double orientation

The double orientation is given when the subject is able to orient himself in certain moments or makes a mixture between the real situation and unreal or abnormal elements . For example, he may say that he is in a hospital in a colony on Mars, being certain that he is in a hospital.

3. Conspiracy or false orientation

The subject is considered oriented and provides data regarding his spatial-temporal location or who he is, but the answers he provides are unrealistic and elaborated by the subject himself ignoring the real answers.

Some affected brain elements

The alterations in orientation can come from the affectation of different brains. For example, orientation management in space has been linked to the functioning of the hippocampus, which allows to establish a mental map of space . Time and its measurement are often linked to the striatum, the supraquiasmatic nucleus and the management of biorhythms.

A malfunction of the nerve connections from the thalamus to the cortex and vice versa can lead to alterations such as confabulation. Injuries to the parietal lobe may also explain the presence of disorientation.

In what contexts do they appear?

Orientation disorders can occur in a wide variety of situations. It is common for them to appear in any situation where there are alterations in consciousness. Also are linked to cortical and subcortical degeneration and to memory and attention problems.

One of the disorders in which they usually appear is schizophrenia together with other psychotic disorders, being possible to observe in many cases the confabulated orientation or the double orientation. In some manic episodes they can also be observed. It is also very common for some of the above-mentioned disorders to appear in neurodegenerative diseases such as Alzheimer’s or other dementias.

Organic intoxication from the use of toxic substances, drugs or some medications can also lead to orientation disorders. It is not uncommon to appear in Wernicke-Korsakoff syndrome, or in withdrawal syndromes.

Finally, disorientation can be mentally generated in disorders such as dissociative disorders (e.g. de-realization or depersonalization), agnosias or in some cases of mood or anxiety disorders.

Possible treatments

The treatment to be used in cases of orientation disorders will depend to a great extent on the causes of these disorders, limiting each treatment to the corresponding situations.

In general, it is tried that the subject orientates himself by indicating the data he does not know , encouraging him to observe contextual clues and/or trying to make the person link the data that fail to something known. It is also useful to explain the situation to the person concerned and to those close to him/her in order to reassure them.

Bibliographic references:

  • Belloch, Sandín and Ramos (2008). Manual of Psychopathology. Madrid. McGraw Hill. (vol 1). Revised edition.
  • Santos, J.L. (2012). Psychopathology. Manual CEDE de Preparación PIR, 01. CEDE: Madrid.