DISORDERS OF

PERCEPTION

P R E S E N T E D BY : P R O T I M A E K KA
D E P T. O F C L I N I C A L P S Y C H O L O G Y
M.PHIL. TRAINEE 1ST YEAR
 CONTENT

Introduction
Disorders of Perceptions
 Sensory Distortions
 Sensory Deceptions
• PSYRATS
• Summary
• References
 INTRODUCTION

The physical process during which our sensory

receptors -involved in hearing, seeing, smelling,
tasting and touching- respond to external stimuli
is called Sensation.

When sensory information is detected by a

sensory receptor, sensation has occurred.
 Click icon to add picture
Perception is
the
organization,
identification
and
interpretation
of the
information you
receive
through your
senses.
We can say
that sensation
is physiological
and Perception
 DISORDERS OF PERCEPTION
Divided into:
1. SENSORY DISTORTION: There is a constant
real perceptual object, which is perceived
in a distorted way.

2. SENSORY DECEPTION: a new perception

occurs that may or may not be in response
to an external stimulus.
SENSORY DISTORTIONS

Are a result of :

1. Changes in 2.Changes in
intensity of quality of the
the stimulus stimulus

3. Changes in
4.Distortions
the spatial
of experience
form of the
of time
stimulus
1.Changes in intensity of the stimulus:

 HYPERAESTHESIA:  HYPOAESTHESIA
 Increased intensity of  Decreased intensity of
sensations sensations
 Lowering of the
 physiological threshold
physiological threshold.
for all sensation is raised.
E.g. Hyperacusis (increased
sensitivity to noise)- A E.g.: Hypoacusis occurs in
person may hear the sound delirium
of a door closing like a clap  or patients complaining
of thunder. everything looks black or
 Seen in: Anxiety and all food taste same
depressive disorders,  Seen in: Delirium &
hangover from alcohol,
depression
migraine.
 VISUAL
HYPERAESTHESIA
 2. Changes in the quality of a
stimulus:

 Distortion mainly in the visual perception

 Due to toxic substances or drugs
 Predominance of colour
 Yellow -xanothopsia
 Green -chloropsia
 Red - erythropsia

 Seen in : mania – objects look perfect & beautiful ;

In derealization everything appears unreal and strange
 3.Changes in Spatial form(Dysmegalopsia)

 It refers to change in the perceived shape and size of

the stimulus
 Micropsia: seeing objects smaller than they really are.
Megalopsia or mcropsia: seeing objects larger than they
really are.
 Porropsia: seeing objects farther away from the
observer then they really are.
 Metamorphosia: seeing objects in a distorted shape.
 Seen in: retinal disease
 Disorders of accommodation
 Temporal and parietal lobe lesions
 Poisoning with atropine or hyoscine
MICROPSIA
 DISTORTIONS OF EXPERIENCE OF TIME

It refers to the judgment of passage of time.

Two varieties of time: a) physical- determined
by physical events. b) personal – personal
judgment of the passage of time
For e.g.
 In Mania- time flies quickly
 In depression or patients with psychotic
depressive symptoms– time flies slowly
 Schizophrenia- time goes in fits and starts
 BODY IMAGE DISTORTIONS

Hyperschemazia, or the perceived magnification of

body parts. Part of the body is painful it may feel
larger than normal.
 Can occur with a variety of organic and psychiatric
conditions.
The perception of body parts as absent or diminished
is known as aschemazia or hyposchemazia.
Most likely to occur in parietal lobe lesions such as
in thrombosis of the right middle cerebral artery,
following transaction of the spinal cord or in health
volunteers when underwater
 Sims’ (2003 ) comprehensive description of body image
distortions cites Critchley (1950 ) as describing a patient with a
parietal lobe infarct who had complex hyper- and hyposchemazia:

‘It felt as if I was missing one side of my body (the left), but it also
felt as if the dummy side was lined with a piece of iron so heavy
that I could not move it … I even fancied my head to be narrow, but
the left side from the center felt heavy, as if filled with bricks.’

 Paraschemazia: a feeling that a part of the body is twisted or

separated
 Hemiasomatognosia: a feeling as if one side of the body is
missing
 SENSORY DECEPTION

Illusions Hallucinations
are misinterpretations of - are perceptions without
stimuli arising from an an adequate external
external object.
stimulus.
 ILLUSION

PERCIEVE
D OBJECT MENTAL FALSE
IMAGE PERCEPTI
(STIMULUS ON
)

For e.g.- the person walking along a dark

road may misinterpret a rope to be a
snake.
Gestalt psychology emphasized that we
perceive entire patterns or configurations and
not merely individual component parts.

An incomplete perception that is meaningless

in itself is filled in by a process of extrapolation
from previous experience and prior expectation
to produce significance.

It is necessary for us to make sense of our

environment, so when the sensory cues are
incomplete, we fill in the gaps and a whole
perceptual experience becomes meaningful.
 FANTASTIC ILLUSION

Illusions in which patients saw extraordinary

modifications to their environment.

For e.g.- One had a patient who looked in the

mirror and instead of seeing his own head saw
that of a pig.

However, fantastic illusions belong more in the

worlds of fiction than in the realm of psychiatry
 TYPES OF ILLUSION

A. Completion illusion: Illusion due to inattention such as

misreading words in newspapers or missing misprints
because we read the word as if it were complete.
For e.g. the word ‘– ook’ might be misread as ‘book’ even
though the faded letter maybe an ‘ l’ .

B. Affect illusion: arise in the context of a particular mood

state.
For e.g. a bereaved person may momentarily believe they ‘
see’ the deceased person or the delirious person in a
perplexed and bewildered state may perceive the innocent
gestures of others as threatening.
C. PAREIDOLIA:
vivid illusions occur without the patient making any
effort.
These illusions are the result of excessive fantasy
thinking and a vivid visual imagery.
Pareidolias occur when the subject sees vivid pictures
in fire or in clouds, without any conscious effort on his
part and sometimes even against his will.

Illusions have to distinguished from intellectual

misinterpretation. For e.g. – when someone says that
a piece of rock is a precious stone or that the doctor is
not really a doctor but a public persecutor, this is an
intellectual misinterpretation.
PAREIDOLIA
 HALLUCINATION
 “ A perception without an object”
 According to Jaspers, Hallucination is “a false
perception which is not a sensory distortion or a
misinterpretation, but which occurs at the same time as
real perception”.
 According to Slade (1976a), three criteria are essential
for an operational definition:
1.Percept-like experience in the absence of an external
stimulus;
2.Percept-like experience that has the full force and
impact of a real perception;
3.Percept-like experience that is unwilled, occurs
spontaneously and cannot be readily controlled by the
percipient.
What distinguishes hallucinations from true
perceptions is that they come from ‘within’ ,
although the subject reacts to them as if they
were true perceptions coming from ‘without’ .

For e.g.- hearing voices not hear by others or

seeing thing not seen by others.
 PSEUDO-HALLUCINATION

• Pseudo-hallucinations are a type of mental image that,

although clear and vivid, lack the substantiality of
perceptions;
• They are seen in full consciousness, known to be not
real perceptions,
• located not in objective space but in subjective space
(for example, inside the head).
• Pseudo-hallucinations can be identified in the auditory,
tactile or visual modalities.
• JASPER’S one example is: a patient with a chronic
psychotic illness who himself distinguished between
hallucinatory voices in objective space and voices which
he heard inwardly.
 CAUSES OF HALLUCINATION

 INTENSE EMOTIONS: depressed patients for e.g. patients having

delusion of guilt may hear voices reproaching them; schizophrenic
patients who are often of persecutory nature may hear commentary
voices on the persons actions.

 SUGGESTIONS: various studies and experiments show that normal

subjects can be persuaded to hallucinate either by hypnosis or task
motivating instruction.

 DISORDERS OF A PERIPHERAL SENSE ORGAN: hallucinations can

occur in patients with-
 Ear diseases ( hallucinatory voices)
 Eye diseases (visual hallucinations)
 Peripheral lesions of sense organs
 SENSORY DEPRIVATION: If all incoming stimuli are
reduced to a minimum in a normal subject, they will
begin to hallucinate after a few hours. Hallucinations
are usually changing VHs and repetitive words and
phrases.

 DISORDERS OF THE CENTRAL NERVOUS SYSTEM:

Lesions of the diencephalons and the cortex can
produce hallucinations.
HALLUCINATION OF DIFFERENT
SENSES
 AUDITORY HALLUCINATION:

 It simple, hearing voices not heard by others

 Voices may be single or multiple, male or female
or both, people known or unknown to the patient.
 Voices vary in quality, ranging from those that are
quite clear to those that are vague and without
clarity.
 They may also be abusive, neutral, sometimes
incomprehensible nonsense or neologisms.
 Hearing may be elementary or unformed. For e.g.
hearing simple noises, bells, whistling , rattles etc
 Partly organized like music.
 Completely organized like audible voices with clarity.

 SEEN IN :
1. Schizophrenia at any stage of illness
2. Organic states like delerium or dementia
3. Severe depression
4. Chronic Alcoholic patients
5. Mania

 Characteristics of hallucinatory voices :

 patients hearing one’s own thoughts spoken aloud(thought
echo)
 voices heard arguing with each other
 a 3rd person giving running commentary on the patients actions
etc.
 VISUAL HALLUCINATION

 Elementary visions in the form of flashes of light,

 Partly organized in the form of patterns ,
 Completely organized visions of people, objects or
animals.
 More common in Delirium
 Patients with temporal lobe epilepsy may have
combined Auditory and visual hallucinations
 Patients with late onset of Schizophrenia may see
or hear people being tortured, murdered and
mutilated.
 OLFACTORY HALLUCINATIONS

The hallucination of smell.

The smell may be pleasant or unpleasant, but it usually
has a special and personal significance.
E.g. patients with schizophrenia may belief that people
are pumping a poisonous gas into the house. Some
religious people may say that they can smell roses
around certain saints.
Occur in:
 Schizophrenia
 Epilepsy
 Other organic states like temporal lobe disturbances
 GUSTATORY HALLUCINATION

Hallucination of taste
Patients often describe loss of taste or state that
all foods taste the same like we see in Depression
Occur in:
 Schizophrenia
 Acute organic cases
 TACTILE HALLUCINATION

Hallucination of touch
Sims (2003) classifies tactile hallucinations‘ into 3
main aspects:
Superficial: Affecting skin sensation
1. Thermic: abnormal perception of hot or cold.
E.g. my feet is on fire)
2. Haptic: perception of touch or pain. E.g. a dead
hand touched me or knives stabbing my neck
3. Hygric: perception of fluid. E.g I can feel water
level in my chest.
4.Paraesthesia: sensations of tingling or pins and needles

 Kinesthetic: hallucinations which affect the muscles and

joints and patients feel their limbs are being twisted or
pulled. Mostly seen in patients with Schizophrenia.

 Visceral : hallucinations of twisting and tearing pains. Bizarre

complains of that the patients organs are being torn or ripped
of. Quite common in Schizophrenia

SEEN IN:
Schizophrenia
 Common in acute organic states
 Cocaine Psychosis
 THE SENSE OF PRESENCE

an abnormal sense of presence

Most normal people have from time to time the
sense that someone is present when they are
alone, on a dark street or climbing a dimly lit
staircase.
However, sometimes there is the feeling that
someone is present, whom they cannot see, and
whom they may or may not be able to name.
For e.g. A patient described a presence over
her right shoulder that followed her from
room to room and even though she knew
that there was nobody there, the feeling was
intense and distressing, so much so that at
times she hid under the bedclothes to
escape.
Seen in:
 organic states,
 schizophrenia
 borderline personality disorder.
 HALLUCINATORY SYNDROMES

It refers to those disorders in which there are persistent

hallucinations in any sensory modality in the absence of other
psychotic features.
also termed Hallucinosis
The main hallucinatory syndromes that are identified are as
follows:
 Alcoholic hallucinosis: These are usually auditory and occur
during periods of relative abstinence.
 They may be threatening or reproachful, although some
patients report benign voices.
 Sensorium is clear
 hallucinations rarely persist longer than one week and
 They are associated with long-standing alcohol misuse.
 Organic hallucinosis:
These are present in 20– 30 per cent of patients
with dementia,
especially of the Alzheimer type,
and most commonly in auditory or visual.
There is also disorientation and memory is
impaired.
SPECIAL KINDS OF HALLUCINATIONS
 FUNCTIONAL HALLUCINATIONS

A phenomenon in which an external stimulus is

necessary to provoke hallucination.
The perception of the stimulus and the hallucination
in the same modality are experienced simultaneously.
For e.g. a schizophrenic patient first heard the voice
of God as her clock ticked: later she heard voices
coming from the running tap and from the chirruping
of the birds.
Patients can distinguish both features from each
other.
Some patients put in plugs in the ears to reduce the
intensity of the stimulus.
 REFLEX HALLUCINATION

A stimulus in one sensory modality producing a

hallucination in another is called a reflex hallucination.
As a doctor was writing in his case notes during his
interview of a female patient, she said, ‘I can feel you
writing in my stomach’.
a hallucinatory form of synaesthesia, as the experience
of a stimulus image in one sense modality
simultaneously producing an image in another.
for example, the feeling of discomfort caused by seeing
and hearing somebody scratch a blackboard with their
fingernails.
 EXTRACAMPINE HALLUCINATION

The patient has a hallucination that is outside the

limits of the sensory field.
For example, a patient sees somebody standing
behind them when they are looking straight
ahead, or hears voices talking in London when
they are in Liverpool.
These hallucinations can occur in healthy people
as hypnagogic hallucinations, but also in
schizophrenia or organic conditions, including
epilepsy.
 AUTOSCOPY

Autoscopy is the experience of seeing an image of

oneself in external space and knowing that it is
oneself .
It is sometimes called the phantom mirror image.
There are two main types of Autoscopy:
(1) Negative autoscopy: it is when the patient looks
into the mirror and sees no image.
(2) Internal Autoscopy: It is when the patient sees
ones own internal organs.
 HYPNAGOGIC & HYPNOPOMPIC

Hypnagogic are perceptions that occur while going to

sleep
Hypnopompic perceptions that occur on waking up
The consciousness level fluctuates considerably in
different stages of sleep,
Perception probably occur in a phase of increasing
drowsiness: the structure of thought, feelings,
perceptions, fantasies and, ultimately, self-awareness
becomes blurred and merges into oblivion.
These experiences occur in many people in good
health.
 ORGANIC HALLUCINATION

Hallucinations that occur in any sensory modality &

they may occur in variety of neurological and
psychiatric disorders.
Organic Visual Hallucinations occur in eye disorders as
well as in disorders of CNS and lesions of optic tract.
Lesions of the parietal lobe –somatic hallucinations
with distortion or splitting off of body parts
Lesions of the temporal lobe – multi-sensory
hallucinations
 The phantom limb: Develops after a lesion of the
peripheral nerve or the medulla or the spinal cord.
PATIENT’S ATTITUDE TO HALLUCINATIONS

 In organic hallucinations the patient is usually terrified by the VHs

and may try desperately to get away from them.
For e.g. Most delirious patients feel threatened and are generally
suspicious. This may lead to resistance to all nursing care and to
impulsive attempts to escape from the threatening situation, such
that they may jump out of windows and jeopardize their lives.
 Patients with depression often hear disjointed voices abusing them
or telling them to kill themselves. They are not terrified by the
voices, since they may have thought of this for some time anyway.
 In acute schizophrenia is often very frightening and the patient at
times may attack the person he believes to be their source.
 Those with chronic schizophrenia on the other hand are often not
troubled by the voices and may treat them as old friends
PSYCHOTIC SYMPTOM RATING
SCALE
SUMMARY
 REFERENCES

Casey P, Brendan K, (2019) Fish’s Clinical

Psychopathology; Signs and symptoms in
Psychiatry 4th Edition. The Royal College of
Psychiatrists
Oyebode F,(2018) Sim’s Symptoms in the Mind;
Textbook of Descriptive Psychopathology 6th
Edition. E.I.H Limited Unit printing Process
THANK YOU!