A violation of the body diagram is a violation of orientation in one’s own body, which is apparently associated with a violation of the higher synthesis of sensory perceptions in the parietal region. The patient may feel that his head is excessively large, his lips are swollen, his nose is pulled forward, his arm is sharply reduced or enlarged and lies somewhere nearby, separate from the body. It is difficult for him to understand “left” and “right”. The disturbance of the body diagram is especially pronounced in a patient with left-sided hemiplegia with simultaneous hemianesthesia and hemianopsia. He cannot find his arm, shows that it starts from the middle of his chest, notes the presence of a third arm, does not recognize his paralysis and is convinced of the ability to get up and walk, but “does not do it” because he “doesn’t want to.” If you show a patient his paralyzed hand, he will not recognize it as his own. These phenomena of anosognosia (lack of awareness of one’s illness) and autotopagnosia (failure to recognize parts own body, see) in the presence of diffuse atherosclerotic lesions of the vessels of the cerebral cortex are sometimes combined with their delusional interpretation, the patient, for example, claims that the sore arm is not his, but was thrown into his bed, that he put his leg in the corner, etc. Various kinds paresthesias painfully transform into colorful, lush delirium. With right-sided hemiplegia, such disorders of the body diagram are observed less frequently, since the body diagram is more provided by the parietal region of the right hemisphere.
One type of central nervous system disorder nervous system is a violation of the perception of one’s own body or, as this disorder is also called, a violation of the body diagram. This disorder was first described by three doctors Peak, Head and Schilder. They presented their concept of the disease at the beginning of the 20th century. Since then, psychiatrists have used it to describe the condition of patients who are “entangled” in their own body.
In diseases of the brain, there is an incorrect interpretation of signals coming from receptors with different parts bodies. Normally they fall into special zones brain, where he parses them into components and “decides” what he feels, how strongly he “feels” it and where the signal actually came from. If these zones are damaged, then a condition arises in which a person cannot say exactly where, for example, he was pricked with a needle - in his right hand or left, or what size his head is.
What is a body schema disorder?
To understand this term, let's turn to reference books. They write that a violation of the body diagram is a disorder of orientation in one’s own body or surrounding objects, in which the patient cannot say exactly what size, how far, on which side, etc. his limb or specific object is located. Most often, this disorder occurs with damage to the parietal lobe in the interparietal sulcus, especially when the lesion is localized in the right hemisphere.
The disturbance in the perception of one's own body is especially pronounced in cases where there is unilateral paralysis of the body in combination with loss of sensitivity in the same half of the body and bilateral blindness with loss of visual fields on one side. People in this condition cannot find their limb or indicate where it begins. At the same time, they may point to the leg or believe that an arm is beginning to grow from the elbow or from the middle of the chest.
Some patients may be sure that they have three legs or arms, 6 fingers or 2 noses - they are not only sure of this, but also feel it. It is characteristic that all patients do not consider themselves as such; they deny the presence of paresis or paralysis and also insist on the accuracy of their feelings. Denial of one's illness is called anosognosia, and failure to recognize one's own body parts is called pseudomelia.
If this pathology is combined with cerebral atherosclerosis, delusions, hallucinations, and delirium may also be present, which significantly complicates the diagnosis. In this state, the patient claims that the limb does not belong to him, it was planted by neighbors, and his own hand is in the closet, etc. Variations in in this case weight.
If the patient has symptoms of paresthesia - changes in sensitivity, which are often accompanied by a feeling of crawling, numbness, tingling, then the patient includes all this in the complex of his sensations and transforms them into delusional hypotheses in which he is tortured, or he is eaten from the inside by worms. Delirium has a strong emotional coloring, therefore it has great amount options depending on the characteristics of the patient’s psyche and his preferences.
Also, a disorder of the body diagram can be accompanied by metamorphopsia - incorrect perception of surrounding objects, changes in the assessment of size and staticity. For example, a patient may look at a chair with a back, and it will seem to him that it is a stool with spiral legs, which also rotates in space and is rapidly approaching him. In some cases, surrounding objects may acquire small or, conversely, enormous sizes; they may seem larger in number than they actually are; they may fall on the patient, try to crush him, or pull him inside. 
Some patients may perceive themselves both within themselves and as separate from their body. At the same time, they experience the feeling that they are in their own body, but they can observe themselves from the outside, as if detached.
Quite often, a violation of the body diagram is accompanied by changes in the perception of one’s own size. Thus, patients may perceive themselves as giants who find themselves in a small room where everyone is very miniature in size. As a result, they are afraid to move, lest they crush or break something. Some patients claim that they are so large that they need a bed for the whole room, otherwise they will not be able to fit on it, or that their head is much larger than the pillow, but their body has disappeared or become very small. That is why this disorder has another name - Alice in Wonderland syndrome.
A very important difference between psychosensory disorders and hallucinations is the distorted perception of real rather than fictitious objects. In addition, the patient recognizes objects, but perceives their shape, size, and distance to them incorrectly. This is the main difference between illusory and hallucinatory perceptions and psychosensory disorders.
What is allocheiria?
The number of psychosensory disorders described in patients suffering from body schema disorder is actually much larger, but the space of the article does not allow us to describe them all.
Finally, let us dwell on another type of disorder of psychosensory perception of one’s own body - allocheiria.
This term refers to the perception of stimulation on the other side of the body. It refers specifically to hands - “allos” is translated from Greek as another, and “cheir” is hand. Therefore, if irritation occurs on right hand the patient says that it occurs on the left hand, and vice versa. In other words, all sensations are symmetrically transferred from one hand to the other, i.e. all senses are transferred 180° - from right to left and from left to right.
In this case, there may be an incorrect indication of the location of irritation. For example, a patient has a finger pricked on his right hand, but he will feel that he has been pricked in left hand at the level of the forearm. Also, this disorder can be combined with hyperalgesia, a disturbance in temperature perception. In this case, touching the right hand with a cold object may be perceived by the patient as touching the other hand with a hot object.
When does allocheiria occur?
Allocheiria, as one of the types of disorders of perception of one's own body, can occur with damage to the brain, in particular the parietal lobe on the right.
Also, this disorder occurs when cerebral atherosclerosis, in the post-stroke period, when the hemorrhage affected the parietal part of the brain, with brain tumors, multiple sclerosis, some types of epilepsy and migraine, hysteria.
Body image, or body schema, is a subjective idea according to which a person makes a judgment about the integrity of his body, evaluates the position of its parts and their movement.
For neurologists of yesteryear, the body diagram was a postural model (see Head 1920). Schilder (1935) in his book “Image and appearance human body" argued that the postural model is just lowest level body schema organization and that there are also higher psychological levels based on emotion, personality and social interaction. It is known that in clinical practice There are body image anomalies that affect much more important points rather than the quality of posture or movement. These anomalies occur in both neurological and mental disorders; in many cases organic and psychological factors act in combination. Unfortunately, neither the mental nor neurological disorders that are the causes of body image disorders have yet been fully identified. In the following description we will general outline We follow the outline proposed by Lishman (1987) and recommend the relevant sections (pp. 59-66) of his book and the review by Lukianowicz (1967) to the reader who requires more detailed information about these disorders. The term "phantom limb" It is customary to refer to the lingering sensation of a missing body part. As such, this is perhaps the most compelling evidence in favor of the body schema concept. This phenomenon usually occurs after amputation of a limb, but similar cases have been described after removal of the mammary gland, genitals, or eyes (Lishman 1987, p. 91). The sensation of a phantom limb usually occurs immediately after amputation and can be painful, but normal conditions, as a rule, gradually disappears, although in a small proportion of patients it persists for years (see manuals on neurology or review by Frederiks (1969)).
Unilateral lack of self-awareness body And “inattention” to the affected side- the most common neurologically caused disorder of body perception. It usually affects the left extremities and most often occurs due to damage to the supramarginal and angular gyri of the right parietal lobe of the brain, particularly after a stroke. When the disorder is severe, the patient sometimes forgets to wash the affected side of the body, does not notice that he has shaved only one side of his face or that he is wearing only one shoe. With the most mild form of this disorder, it can only be identified by special testing using double irritation (for example, it can be concluded that there is a disorder if the examiner touches the patient’s wrists with a cotton swab, and the latter registers the touch only on one side, although when he does it himself, the sensation is present on both sides). Additional information can be found in Critchley (1953), whose book contains detailed description syndromes resulting from damage parietal lobes brain. Hemisomatognosis disorder (also known as hemi), which is much less common than the disorder described above. The patient reports the sensation of losing one limb, usually the left. The disorder can occur on its own or together with hemiparesis. It is often accompanied by one-sided spatial. The degree of awareness of this phenomenon varies: some patients are aware that the limb is actually there, although they feel its absence, while others are completely or partially convinced that the limb is really not there.
Anosognosia is a lack of awareness of illness, which also usually manifests itself on the left side of the body. Most often this disorder occurs on a short time in the first days after acute hemiplegia, but sometimes persists for a long period. The patient does not complain of loss of function on the paralyzed side of the body and denies this fact when anyone points it out. Dysphasia and blindness may also be denied (Anton's syndrome), Or amnesia (most pronounced with Korsakoff's syndrome).
Pain asymbolia- a disorder in which the patient perceives a painful (for normal perception) stimulus, but does not evaluate it as painful. Although such disorders are clearly associated with cerebral lesions, the presence of a psychogenic element is assumed, through which awareness of unpleasant phenomena is suppressed (see, for example, Weinstein and Kahn 1955). Of course, organic damage could hardly act in the absence psychological reactions, however, it is unlikely that the latter are the only reason pathological condition, as it occurs much more often on the left side of the body.
Autotopagnosia is the inability to recognize, name, or indicate according to command parts of one's body. This disorder can also manifest itself in relation to another person, but not in relation to inanimate objects. This rare condition occurs due to diffuse lesions, usually affecting both hemispheres of the brain. Almost all cases can be explained by concomitant dysphasia or spatial perception disorder (see Lishman 1987, p. 63). Distorted awareness of size and shape is expressed in the fact that a person feels as if his limb is enlarged, decreased, or otherwise deformed. Unlike the disorders already described, these sensations are not directly related to damage to specific parts of the brain. They can also occur in healthy people, especially when falling asleep or waking up, as well as during severe fatigue. Similar phenomena have sometimes been noted during migraine, in acute brain syndromes, after taking LSD, or as a component of epileptic aura. Changes in the shape and size of body parts (in Russian-language literature the term disturbance of the body diagram is used) are also described by some patients with schizophrenia. Almost always, with the exception of some cases, the unreality of this sensation is realized.
Doubling phenomenon- this is a feeling that any part of the body or the whole body is doubling. Thus, the patient may feel as if he has two left hands, or two heads, or as if his whole body has doubled. Such phenomena rarely occur during migraine, with, and also with schizophrenia. In an extremely pronounced form, a person has the experience of being aware of the presence of a copy of the entire body, a phenomenon already described as autoscopic
BODY SCHEME. The sensations coming from one’s own body are the basis for the formation of a synthetic spatial perception of one’s body in the form of its diagram. Normally, this perception seems dim* one might even say vague, but any disorder of the scheme is painfully perceived by the consciousness as a violation of the vital basis of the organism. The body diagram is, however, very sustainable education, which is proven, among other things, by the phenomenon of a phantom in amputees, when, despite the absence of a limb, the subject continues to perceive the diagram of the entire body, including the removed limb. The following manifestations of the violation of S. t. are observed: changes in the shape, size and severity of individual parts of the body, their disappearance, their separation (the head and arms are felt, but separately from the rest of the body), displacement of parts (the head, shoulders have sunk, the back is in front, etc.) . p.), increase, decrease, change in shape and weight of the whole body, splitting of the body (sensation of a double), disappearance of the whole body. That. we have transitions from partial sodas: atopically delimited to more general, total disturbances approaching depersonalization. The disorder of recognition of parts of one's body as a consequence of a violation of its pattern is called autopagio-zia (Pick), and finger agnosia (Gerstmann) should be considered a partial manifestation of the cut. With autotopagnosia, the patient loses landmarks in his own body (distinguishing between right and left, arms and legs, etc.). In addition to the already mentioned phantoms in amputees, Babinski’s anosognosia is closely related to the concept of S. t., when, for example. the patient does not perceive his hemiplegia, Schilder’s pain asymbolia (pain is felt, but is not associated with S. t.). S.'s violations of t. are usually associated with various other sensory disorders. Most often, dedo is about peculiar visual deceptions of the senses in the form of metamorphoses, i.e. geometrically optical disorders, when the subject sees objects distorted, turned upside down, reduced or increased in volume, etc., polyopia (multiplying objects in number), porropsia (impaired vision in depth - objects seem too distant or vice versa). In other cases of violation of Art. accompanied by disorders of the general senses and vestibular symptoms. It is important to note that in S.’s disorders of t. and in the indicated optical and vestibular symptoms the main one is a violation of spatial schizoid perceptions relating to both one’s own body and outside world. The connection between these and other disorders is quite constant. This last circumstance was the reason for the attempt to isolate a separate syndrome, the so-called. interparietal. This name is based on observations that have shown that violation of S. t. and corresponding optical symptoms occur when the cortex located in the depths of the posterior part of the interparietal groove is damaged. It should be noted, however, that the interparietal cortex is apparently only the leading link of an “extensive system that has other links in other places of the cortex, as well as in the visual thalamus, vestibular apparatus etc., as a result of which the appearance of elements of the “internarietal” syndrome is possible with lesions in various parts of the brain (especially in the visual thalamus); one can only assume on the basis of the data available in the literature (Potzl and his school) that the presence of a complete interparietal syndrome with a violation of St., motamorphopsia, etc. is available to a more specific localization in the specified area of the cortex. This is confirmed by the fact that S.'s violation of t. is often accompanied by other inferior parietal symptoms (apraxia, optical agnosia, alexia, acalculia, astreognosia, etc.). Violations of the body diagram are usually accompanied by affective disorders(anxiety, fear, horror). Violations of S. t. are observed in various focal lesions: skull injuries (in the parietal region), tumors, arteriosclerosis, cerebral syphilis, etc. More often these are left-sided lesions, but sometimes right-sided ones; in general, the question of the meaning of left and right for this syndrome hemispheres is not entirely clear. Violations of S. t. are possible with epilepsy, with circulatory disorders (for example, with apgioneurosis) and, finally, with mental illness. diseases of a diffuse nature (for example, schizophrenia). In such cases, this syndrome is often the starting point for the development of complex psychotic pictures, especially in the form of phenomena of depersonalization, etc. - The course of the disorder of S. t. depends on the form of the underlying disease: with a tumor, the symptom is constant; with epilepsy, apgioneurosis, it is characteristic episodic appearance (with epilepsy, sometimes in the form of a peculiar aura). With syphilis of the brain, the symptom disappears after specific treatment. The possibility of the appearance of a violation of S. t. in healthy people with special conditions: Parker and Schilder described this symptom when riding in an elevator (for example, a feeling of lengthening of the legs when the descending elevator suddenly stops). Violation of S. t. was also obtained experimentally by freezing or heating a skull defect in the parietal region (Noah, Potzl): patients during the experiment felt that their leg or arm had disappeared, etc. Similar phenomena were also obtained in experiments with mescaline poisoning. The symptom of disturbance of S. t., associated with new “human” areas of the cortex, undoubtedly has significance in the structure of many neuropsychiatric diseases, and it is not without practical interest for the neurosurgeon in the sense of establishing the localization of the lesion, of course, when compared with other phenomena. Lit.: G u r e v p h M., About interparietal syndrome in mental illness, Sov. neuropathologist, psychiatrist, and psychohygiene, vol. I, no. 5-6, 19 32; o n w e. Violation of the heat pattern in connection with psychosespastical disorders in psychoses, ibid., vol. II. issue ?, 1933; Chlenov L., Body diagram, Sat. works of the Institute of Higher Education. nervous activities, M., 1934; Gurew it sen ¥., ttber das in-terpariel.ale Syndrnm bei Geisteskrankhciti l, Ztschr. i. d..ges. Neurol. u. Psychiatr., B. CXL, 1932; HerrmannG. u.PotzlO., Die optisclie Allaesthesie, Studien znr l-sy-= chopathologie der Raumbildun*, V., 1928; HolIH. n.. Potzl O., Expevimentellfi Nachbildung yon Anosognosie,. Ztschr. f. d. ges. Neurol. u.Psychiatr., B. CXXXVII, 1931; Schilder, Das Korperschema, V., 1923. M. 1"urevich.
