The word “perseveration” is literally translated from Latin as perseverance. Perseveration in psychology is an action that is repeated repeatedly and is beyond human control. Therefore, it is allocated to a pathological state.
Types of perseverations
Perseverations can manifest themselves through various disorders.
Motor perseverations
They are based on damage to parts of the brain.
They can represent multiple repetitions of individual parts of an entire movement - these are elementary motor perseverations. Their cause is damage to the premotor parts of the cerebral cortex and the subcortical structures underlying them.
With systemic motor perseverations, the prefrontal parts of the cerebral cortex are affected and repetitions of complete movements are observed.
Another form is speech motor perseveration. They are expressed in the repetition of syllables and words in oral and written speech. In right-handed people, this form of impairment depends on damage to the left hemisphere of the brain in the lower parts of the premotor cortex.
Sensory perseverations
They depend on the damage to the cortical parts of the analyzers. They are expressed in constantly repeating sounds, visual images, and sensations on the skin.
Intellectual perseverations or perseverations of thinking
With this type of perseveration, the left hemisphere most often suffers - the lesions are located in the cortex of the frontal lobes. Patients have impaired thinking. This manifests itself in the form of repetition of inadequate intellectual actions.
Types of speech stereotypies
Several types of speech stereotypies are known: persistent repetition of one conclusion or word (perseveration), repetition of the same expression, figure of speech (standing turns), repetition of words or syllables in a certain rhythm or in rhymed form (verbigeration).
Perseveration - we sing odes to the persistence of the stubborn
The term perseveration comes from the Latin word perseveratio, which means “perseverance”, “persistence”. In speech, perseveration manifests itself as repeated reproduction of the same syllables, words or sentences.
A word or thought seems to be “stuck” in the patient’s mind, and he repeats it repeatedly and monotonously when communicating with his interlocutor. In this case, the repeated word or phrase is not related to the topic of the conversation. The patient's speech is monotonous. Perseveration can be expressed both orally and in writing.
Perseveration is the result of associative activity, part of consciousness and does not occur by chance. It should not be confused with obsessive phenomena, since the latter have an element of obsession, and the patient is aware of the absurdity of his actions.
Verbigeration is a common fate of schizophrenics
A mental disorder in which the patient repeats and shouts in a monotonous voice the same interjections, words, and phrases. These repetitions are automatic and meaningless and can last several hours or even days.
The patient rhythmically, often in rhyme, repeats words and combinations of sounds that do not make sense. Verbigeration should be distinguished from perseveration, since with the latter, repetitions depend on neuropsychic states, and disappear with the elimination of these states.
Standing speed
Standing phrases are fragments of phrases, expressions, words, and similar ideas that the patient repeatedly reproduces during a conversation.
At first, the patient pronounces them with the same intonation, and subsequently simplifies, reduces, and the process comes down to a stereotypical repetition of words.
Often the pronounced standing phrases are greatly distorted and it becomes impossible to understand their original meaning and sound.
Palilalia
Palilalia means the patient repeating a phrase, or part of it, a single word or syllable, from a fragment of speech he himself uttered, two or more times in a row.
Repetition occurs at normal voice volume; the volume may gradually decrease and the rate of speech become faster. For example, having given an answer to a question, the patient repeatedly and continuously repeats the answer.
Manifestations of palilalia relate not only to intellectual forms of speech, but also to emotional ones (exclamations, shouts). However, it usually does not refer to mechanically pronounced turns of automated speech. The number of repetitions can reach two dozen or more.
Echolalia
With echolalia, the patient repeats phrases and words that were said by people around him. Echolalia is often characteristic of young children, and in them it is not a pathology.
This is considered a pathology when echolalia causes mental retardation, or its development is observed in an adult.
Causes
Perseverations can arise as a consequence of neuropathologies, mental changes and psychopathologies.
In the first case, the organic component suffers due to:
- traumatic brain injuries;
- brain tumors;
- epilepsy associated with metabolic disorders;
- encephalitis.
Mental causes are due to personality disorders and developmental features:
- autism;
- obsessive-compulsive disorder (obsession with ideas, manifested through the need for action);
- giftedness (expressed as pathological persistence in achieving a goal related to the interest of development);
- hyperactivity (due to lack of attention, actions are performed that encourage it to be compensated).
The concept of “inert thinking” can be used to define a group of syndromes of thinking disorders, the main symptom of which is insufficient mobility of mental processes. It includes viscous thinking, perseverative thinking and thinking with stereotypies. Elements of inertia of mental activity are also observed in depressive states, however, in these cases, the inertia of thought processes is a secondary factor, since the leading role is played by slowing down of thinking and persistent depressive affect, characterized by the attenuation of incentives for an action that has already begun.
B.V. Zeigarnik (1976) calls the mental activity of patients with epilepsy inert thinking. We consider this term to be broader - the inertia of the course of mental processes can explain such psychopathological phenomena as rigidity, perseverations and stereotypies, which in relation to behavioral acts are united by the concept of “fixed forms of behavior”. G.V. Zalevsky (1976) understands fixed forms of behavior as acts of behavior that are persistently and involuntarily repeated or continued in situations that objectively require their cessation or change. In relation to the pathology of thinking, it seems more appropriate to us to talk about fixed forms of mental activity. Manifestations of inert thinking are observed in diseases of various origins, mainly in schizophrenia, as part of gross organic pathology of the brain. Therefore, we cannot talk about their causal etiological relationship; we are talking about similar pathogenetic mechanisms that can be caused by both functional and organic-destructive changes.
Viscous thinking
observed in epileptic dementia. It is characterized by thoroughness, a tendency to detail, the inability to separate the main from the secondary, stiffness, “treading water”, the inability to leave the circle of certain ideas and switch to something else. The viscous thinking of patients with epilepsy can be characterized primarily as rigid, insufficiently labile.
Getting stuck on little things and details, the epileptic patient, however, never loses sight of the purpose of his story. The facts reported to the patient are associated with random circumstances, but within the given topic. The patient carefully describes the details, lists them in such a way that it is difficult to interrupt him. It is difficult for him to connect details with the general content. This tendency to get stuck, “sticking” to the same circle of ideas, excessive detail, and inability to highlight the main thing characterize thinking in epilepsy. Although the patient deviates in his reasoning from the direct path leading to the goal, he does not lose attention to this goal itself. When talking about something, he either marks time, or gets carried away by details, teachings, reasoning, explanations, but remains within the circle of those ideas that are indicated by the initial intention of the narration. The theme of the story does not change. The pace and character of speech of a patient with epilepsy is extremely difficult to correct.
Ya. V. Bernstein (1936) pointed out that stiffness and inertia of thinking in epilepsy, being primary, is always included in the complex symptom complex of characteristic features of the main lesion, is reflected in every feature of this lesion and all its features are reflected in it. Indeed, stiffness is characteristic of the entire mental life of a patient with epilepsy; it manifests itself in his behavior, affectivity, and in the peculiarities of his thinking. At the same time, rigidity, which can be observed in other diseases, is specifically colored in the epilepsy clinic due to its inextricable connection with other symptoms inherent in epileptic dementia.
The speech of a patient with viscous thinking is characterized by oligophasia, repetitions, pauses, diminutives and endearments. Patients fill pauses in speech with words such as “you understand”, “so to speak”, “means”, etc. Already in ordinary conversation, patients with viscous thinking show a tendency towards excessive thoroughness and detail. This is revealed even more when they describe a drawing or retell a text. Often, having described the drawing in great detail, listing even the most insignificant details depicted on it, the patient still cannot comprehend it or grasp its content. This weakness of judgment corresponds to the severity of the epileptic dementia.
Here is a typical example of viscous thinking: the patient turns to his interlocutor.
“Not just anything, but really - can I ask you for a cigarette? Yesterday my mother came - she comes to see me every other day - and brought me cigarettes. He says: “Take it, Minechka, I brought you some cigarettes.” Good cigarettes - I love them. I was so happy that mommy brought cigarettes, and they were just my favorite ones. And the nanny says: “Now, Minechka, you have something to smoke, mummy brought some cigarettes.” But at night, not just anything, but really, when I was sleeping, this sick man smoked my cigarettes. Would you give me something? but really, a cigarette, and tomorrow mommy will bring many more cigarettes, and I’ll give them to you.”
Viscous thinking in epilepsy is also characterized by pronounced egocentric tendencies. This is clearly visible in the example above. With severe epileptic dementia, the patient’s responses are monotonous and have the character of cliches - the patient can respond to all stimulus words in an associative experiment with 2-3 words (“good” or “bad”, “I know” or “I don’t know”). Often verbal reactions reflect only the patient’s attitude towards objects designated by stimulus words. When asked to compose a story based on 3 given words “house, lamp, fire,” the patient wrote:
“We got a new apartment and moved to a five-story building. My wife didn’t like the room because there was no light bulb, and I had to run to the store in the evening to buy a light bulb. A bright light illuminated our new room. I went to the kitchen to put some tea. When a bright light sparkled on the gas stove, I put the kettle on and returned to my room.”
This kind of inclusion of oneself in a situation is considered as a sign of the predominance of specific ideas in the thinking of patients with epilepsy, insufficiency in understanding the conditional nature of the task, as a manifestation of egocentric tendencies (I. Ya. Zavilyansky, R. E. Tarashchanskaya, 1959). External distractions have little effect on the course of thought processes - while expressing his thoughts, the patient does not pay attention to the questions with which his interlocutor interrupts his speech, even if this should make the task facing him easier.
A similar inclusion of oneself in the situation is observed in the pictograms of patients with epilepsy, which are always of a purely situational nature and reflect the personal experience and assessment system inherent in the subject.
The inertia of the mode of activity of patients with epilepsy is especially clearly revealed when performing tasks using switching methods (addition and subtraction with one of the addends or the subtrahend alternating, proofreading request with switching).
Perseverative thinking.
Perseveration in thinking is understood as the tendency for any thoughts, ideas, images, words or phrases to get stuck in the patient’s mind, regardless of changes in the situation and violation of the goal of the activity. G.V. Zalevsky (1976) writes about the weakening during perseveration of the representation of the goal of activity. Perseveration manifests itself in the patient’s speech.
Perseverations are most often observed as part of gross organic pathology of the brain - with cerebral atherosclerosis (mainly when it is significant or in the presence of local symptoms), senile dementia, Alzheimer's disease, Pick's disease. They are especially clearly detected when the lesion is localized in the frontal lobe. In these cases, perseverations are a frequent structural component of motor aphasia. Thus, a patient suffering from motor aphasia, at the doctor’s request, repeats the word “yes” after him, after which the doctor unsuccessfully asks him to repeat the word “no” after him, but the patient stubbornly says “yes”. Only after a long break was the patient able to repeat “no” after the doctor. In such cases, perseverations in speech are often accompanied by motor perseverations. The patient does not always correctly assess the presence of such manifestations.
Perseverations are also found in amnestic aphasia. The patient names the object shown to him, and then names all other objects with the same words. For example, seeing a kettle, the patient says: “This is to drink... they boil it, and then drink it.” Then they show him a thimble and he says: “Well, a teapot... they need to sew. My daughter has something like this.”
Patients do not notice perseveration with simultaneous damage to the speech-perceiving analyzer, for example, with sensory-motor aphasia.
Within the framework of the aphasic syndrome, perseveration is, as it were, a structural component of aphasia and persists for a long time even after the disappearance of the main aphasic manifestations. They are also observed in non-focal organic lesions of the brain - in severe but non-stroke cerebral atherosclerosis, in mental retardation.
There are numerous observations of perseverations in thinking and speech in schizophrenia. According to N. Flegel (1965), they cover a wide range of speech phenomena - from individual sounds to words, fragments of phrases and entire speech patterns. E. Kraepelin (1927) associated the appearance of perseverations in schizophrenia with the impoverishment of ideas and the tendency to fill these gaps in thinking at the expense of previous ideas. N. Flegel (1965), being in the same positions, in the genesis of perseverations attaches great importance to the increasing automation of mental and speech activity.
Perseverations are also observed during severe fatigue, and
also under the influence of alcohol. In such cases, however, they are episodic and short-term in nature.
Stereotypes in thinking. Stereotypes are understood as a tendency to repeat the same acts of mental activity. Sometimes individual words are repeated stereotypically, in other cases we are talking about thinking in stereotypes. The degree of automation in the process of stereotypy also varies. Thus, verbigeration (the manifestation of stereotypy in the speech of patients with schizophrenia) is characterized by a completely meaningless, automatic, involuntary repetition of the same words or phrases. Motor and hallucinatory stereotypies seem just as automated. The latter are often carried out with insufficiently clear consciousness, for example, during acute intoxication. Stereotypies of thoughts are somewhat more arbitrary, however, in these cases, the phenomena of mental automatism obviously play a large role.
Stereotypes should be distinguished from perseverations. Perseverations, according to M. S. Lebedinsky and V. N. Myasishchev (1966), are characterized by the fact that an already completed action, entirely or in some of its elements, penetrates into the subsequent one, aimed at solving a new task, although for its implementation the perseveratory components of the activity , which began as part of the previous task, are alien and unsuitable. With stereotypies, the patient’s activity (mental, speech, motor) loses all meaning and is not at all connected with solving any problem. We cannot grasp the connection between stereotypical phrases in thinking or speech with any previous activity; they are also alien to previous mental tasks.
Stereotypes appear over a long period of time and do not change under the influence of a specially created switch in the mode of activity of the psychiatrist in communication with the patient. Perseverations depend on the degree of difficulty of solving a new problem; they are more easily identified in activities similar to past actions. These signs are not found in stereotypies. Unlike perseverations, the patient does not try to counteract stereotypies.
E. Kraepelin (1918), who saw in stereotypies a tendency to repeat the same ideas for a long time, emphasized that with them, unlike perseverations, the content of these ideas does not depend on the previous ones.
We give an example of stereotypy in the thinking of a patient with schizophrenia.
“I was attacked 8 years ago by foreign intelligence officers, who cut my stomach and sewed radio equipment in my stomach. And wherever I go, I hear voices on the radio in my head from the radio machines that are hardwired in my stomach, I hear how on the radio various feelings are instilled into my soul. The seam after the abdominal incision, when radio equipment was sewn into it, was smoothed out and the radio equipment was felt so much that the seam was no longer visible.” Next, several pages detail the patient’s painful experiences and describe his pseudohallucinatory experiences. The patient very clearly outlines the phenomena of Capgras syndrome observed in him (the same foreign intelligence officers replaced his closest relatives—12 people—in his village with people similar to them). Eight pages later in the same letter, the patient writes: “Foreign intelligence officers cut open my uncle’s stomach and then sewed radio devices into it, and with these radio devices they angered him so much that he hit his wife, and his wife died. The prosecutor did not know that the uncle had radio equipment sewn into his stomach and that they deliberately angered him, and the uncle was tried in the city of Makeyevka. This is what foreign intelligence officers wanted, so that my uncle would be convicted and put in prison.”
This motif (foreign intelligence officers sewing radio equipment into various people’s stomachs) is stereotypically repeated in the future, throughout the patient’s written and oral speech in relation to a variety of people. We see here the tendency noted by E. Kraepelin (1910) in patients with schizophrenia to constantly return to the same thoughts and ideas, which the author defined as stereotypies in thinking.
Stereotypes are observed not only in schizophrenia. They are often found in the clinic of organic psychoses. An example of stereotypy of organic genesis is the gramophone record symptom (chimes symptom) described by W. Mayer-Gross (1931). It refers to the standing turns characteristic of Pick's disease and consists of a stereotypical and non-stop repetition with unchanged intonations at certain intervals of time of the same story or several phrases. According to the course of the disease, standing turns in Pick's disease undergo changes due to the increase in dementia and the breakdown of speech - they are increasingly simplified, reduced and ultimately reduced to a stereotypically repeated phrase or several words.
Over time, standing phrases become more and more meaningless, sometimes the words in them are so paraphatically distorted that they lose even the remotest resemblance to the prototype word.
Perseverations in childhood
As a child grows up, he forms certain habits. With developmental pathologies or disorders, they can turn into perseverations.
The following symptoms may be observed:
- repetition of phrases regardless of the topic of conversation;
- lack of variety in games;
- increased interest in certain parts of the body or places on the skin (manifested in scratching, touching);
- graphic recording of some objects through drawings and writing;
- frequently repeated requests that do not correspond to the situation.
Diagnosis of perseverations includes tests with writing sentences, examples of multiplication and completing mazes.
Causes of perseveration
This disorder often arises as a result of physical effects on the brain. In addition, the individual has difficulty switching attention.
The main reasons for the neurological nature of the described syndrome are:
– suffered localized brain lesions, reminiscent of aphasia (an illness in which the individual cannot pronounce verbal structures correctly);
– obsessive reproduction of actions and phrases appears as a result of already existing aphasia;
– traumatic brain injury with lesions of the lateral segments of the cortex or the anterior zone, where the prefrontal convexity is located.
In addition to neurological causes associated with brain damage, there are psychological factors that contribute to the development of perseveration.
The persistence of reproducing phrases and manipulations arises as a result of stressors that affect subjects for a long time. This phenomenon is often accompanied by phobias, when a defense mechanism is activated by reproducing operations of the same type, which give the individual a feeling of non-danger and calm.
If autism is suspected, excessively scrupulous selectivity in certain actions or interests is also noted.
The described phenomenon is often detected with hyperactivity, if the child believes that he is not receiving enough attention, in his opinion. In this case, perseveration also acts as a component of defense, which in the child’s subconscious compensates for the lack of outside attention. With such behavior, the baby seeks to attract attention to his own actions or attention.
The phenomenon in question often appears among scientists. An individual is constantly learning something new, striving to learn something important, which is why he becomes fixated on a certain little thing, statement or action. Often the behavior described characterizes such an individual as a stubborn and persistent person, but sometimes such actions are interpreted as a deviation.
Intrusive repetition can often be a symptom of obsessive-compulsive disorder, which is expressed in following a certain idea that forces the individual to constantly perform specific actions (compulsions), or in the persistence of some thought (obsession). Such persistent repetition can be seen when the subject washes his hands, often unnecessarily.
Perseveration must be distinguished from other illnesses or stereotypes. Phrases or actions of a repetitive nature are often a manifestation of an established habit, sclerosis, subjective annoying phenomena in which patients understand the strangeness, absurdity and meaninglessness of their own behavioral patterns. In turn, with perseveration, individuals do not realize the abnormality of their own actions.
If an individual develops signs of perseveration, but there is no history of stress or trauma to the skull, this often indicates the occurrence of both psychological and mental variations of the disorder.
Therapy for perseveration
The treatment algorithm depends on the causes of perseveration. Psychotherapy is always the basis. For neuropathology, along with therapy, nootropic and sedative drugs and vitamin complexes are used.
Treatment of perseveration consists of a combination of therapeutic techniques.
- Waiting for symptoms to change or disappear during therapy.
- Exclusion from the patient’s life of activities that are a constant object of speech. This strategy is suitable for treating combinations of intellectual and motor perseverations.
- Sudden switching between conversation topics or activities during relapses.
- Introducing restrictions into the patient’s perseverative activity. This allows you to dose perseverative stimuli.
- Complete exclusion of a stimulus by denying it or recognizing the harm it causes.
- Consciously ignoring a stimulus as useless.
- Achieving an understanding of the primary thoughts that arise at the moment of perseveration.
When diagnosing, it is important to remember that there is no clear boundary between perseverations and lifestyle habits. If a surgeon tends to wash frequently, it is likely that this is just a skill transferred from the professional sphere to everyday life.
What is perseveration
Perseveration is considered a very unpleasant manifestation of obsessive behavior. A characteristic feature is the reproduction of a certain physical action, phoneme, representation, phrase.
A typical example is a song that gets stuck in your head for a long time. Many subjects noticed that they wanted to repeat certain word forms or melody out loud for a certain period. Such a phenomenon, naturally, is a weak analogy of the deviation in question, but this is precisely the meaning of perseverative manifestations.
Individuals suffering from this disorder have absolutely no control over their own person at such moments. Intrusive repetition appears absolutely spontaneously and also suddenly stops.
The deviation in question is found in the persistent reproduction of an idea, manipulation, experience, phrase or concept. Such repetition often develops into an obsessive, uncontrollable form; the individual himself may not even detect what is happening to him. Thus, the concept of perseveration is a phenomenon caused by a psychological disorder, mental deviation or neuropathological disorder of an individual's behavioral patterns and speech.
Such behavior is also possible in cases of severe fatigue or distraction, not only in cases of mental illness or neurological disorders. It is believed that the basis of perseveration is the processes of repeated excitation of neural elements caused by the delay of the signal about the end of the action.
The violation in question is often mistaken for stereotypy, however, despite the general desire for obsessive repetition, perseveration is distinguished by the fact that it is the result of associative activity and a structural component of consciousness. Subjects suffering from perseveration undergo therapy with doctors who first help identify the root cause, after which they carry out a set of measures aimed at eliminating the reproducible thought, phrase, or repeated action from the daily life of the subject.
In order to prevent the formation of the described syndrome in adults, parents should carefully monitor the baby’s behavioral response for signs of perseveration. We can distinguish the following “attributes” of the violation in question: regular repetition of one tiny phrase that does not correspond to the topic of the conversation, characteristic actions (a baby, for example, can constantly touch a certain area on the body in the absence of physiological prerequisites), constant drawing of identical objects.
In childhood, there are specific manifestations of perseveration due to the peculiarities of the psychology of children, their physiology, and the active change of life guidelines and values of the little ones at different stages of growing up. This gives rise to certain difficulties in differentiating the symptoms of perseveration from the conscious actions of the baby. In addition, manifestations of perseveration can camouflage more serious mental disorders.
For the sake of earlier identification of possible mental disorders in children, one should carefully monitor the manifestations of perseverative symptoms, namely:
– systematic reproduction of one statement, regardless of the circumstances and the question asked;
– the presence of certain operations that are repeated invariably: touching a certain area of the body, scratching, narrowly focused activity;
– repeated drawing of one object, writing a word;
– invariably repeated requests, the need for fulfillment of which is highly doubtful within the boundaries of specific situational conditions.
