Orientation Disorders: Symptoms, Types And Treatment

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 to someone with brain injuries or who are 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 you are in a shopping center when you are actually in a hospital). These are people who manifest the existence of orientation disorders

The orientation

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

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

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

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The orientation is very 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 is understood as the loss of the ability to place oneself in space and/or time correctly. The subject does not identify her situation and does not know how to respond if they ask him where he is or the date. This disorientation may be only temporal or spatial, or both may appear 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 day.

Disorientation can also occur (either alone or together with the previous ones) at an autopsychic level, not knowing who one is, what one is doing in that place or not recognizing oneself.

2. Double orientation

Double orientation occurs when the subject is able to orient himself at certain moments or makes a mix between the real situation and unreal or abnormal elements For example, you can say that you are in a hospital in a colony on Mars, when it is true that you are in a hospital.

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3. Conspiratorial orientation or false orientation

The subject is considered oriented and provides data regarding his/her spatiotemporal location or who he/she is, but the answers you provide are unreal and prepared by the subject himself, ignoring the real responses.

Some brain elements affected

Alterations in orientation may come from the involvement of different brain areas. For example, the management of orientation in space has been linked to the functioning of the hippocampus, which allows establish a mental map of space Time and its measurement are often linked to the striatum, the suprachiasmatic nucleus, and the management of biorhythms.

A malfunction of the nervous connections that go from the thalamus to the cortex and vice versa can cause alterations such as confabulation. Lesions of the parietal lobe can also explain the presence of disorientation.

In what contexts do they appear?

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

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

Organic poisoning due to the consumption of toxic substances, drugs or some medications can also cause orientation disorders. It is not uncommon for it to appear in Wernicke-Korsakoff syndrome, or in withdrawal syndromes.

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Finally, disorientation can be mentally generated in disorders such as dissociative disorders (for example derealization or depersonalization), agnosias or in some cases mood or anxiety disorders.

Possible treatments

The treatment to be used in cases of orientation disorders will depend largely on the causes of said disorder, limiting each treatment to the corresponding situations.

In general, it is usually attempted that the subject orients himself by indicating the data that he does not know, encouraging them to observe contextual clues and/or trying to get the person to link the data that fails to something known. It is also useful to explain the situation to the affected person and those close to him in order to reassure them.