Disorders of the orientation: symptoms, types and treatment

March 31, 2024

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

However, if these same issues are made to someone with brain injuries or who are intoxicated with some drugs or drugs 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 can say that we are in 1970 or that you are in a mall when you are actually in a hospital). It's about people who manifest the existence of orientation disorders .

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The orientation

Before defining the different disorders of orientation, it is necessary to specify what this concept refers to. It is considered guidance to 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 said space-time position.

Most people identify with the guidance concept 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 the alopsychic .

However, there is another type of orientation, the autopsychic orientation. This refers to the orientation linked to the self: 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.

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

Related article: "Types of memory: how memory stores the human brain?"

The main orientation disorders

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

1. Disorientation

Disorientation refers to 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 they ask him where he is or the date. Said disorientation may be only temporary or spatial, or appear together both.

It is also possible that such disorientation is not complete : for example the patient can know that we are in 2017, but not the month or the day.

The disorientation can also occur (either alone or together with the previous ones) at the autopsychic level, not knowing who it is, what it does in that place or not recognizing itself.

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2. Double orientation

The double orientation occurs when the subject is able to orient at certain times or makes a mixture 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, it is true that you are in a hospital.

3. Counter-orientation or false orientation

The subject is considered oriented and provides data regarding its location, temporary space or who it is, but the answers it provides are unreal and elaborated by the subject himself ignoring the real answers.

Some brain elements affected

The alterations in the orientation can come from the involvement of different brain. 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 the biorhythms.

A malfunction of the nerve connections that go from the thalamus to the cortex and vice versa can generate alterations such as confabulation. Lesions of the parietal lobe may 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 where there are alterations of conscience. As well are linked to cortical and subcortical degeneration and to memory and attention problems.

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

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

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

Possible treatments

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

In general, it is usually tried that the subject is oriented indicating the data that is unknown , encouraging you to observe contextual clues and / or trying to make the person link the data that fails to something known. It is also useful to explain the situation to the affected person and their relatives in order to reassure them.