Perseveration

This article is about the psychological and psychiatric meaning of the term.

In psychology and psychiatry, perseveration is the repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.^[1] Symptoms include "lacking ability to transition or switch ideas appropriately with the social context, as evidenced by the repetition of words or gestures after they have ceased to be socially relevant or appropriate,"^[2] or the "act or task of doing so,"^[3] and are not better described as stereotypy (a highly repetitive idiosyncratic behaviour).

In a broader sense, it is used for a wide range of functionless behaviours that arise from a failure of the brain to either inhibit prepotent responses or to allow its usual progress to a different behavior, and includes impairment in set shifting and task switching in social and other contexts.^[4]

The primary definition of perseveration in biology and clinical psychiatry involves some form of response repetition or the inability to undertake set shifting (changing of goals, tasks or activities) as required, and is usually evidenced by behaviours such as words and gestures continuing to be repeated despite absence or cessation of a stimulus.^[1][2][3][4]

More broadly in clinical psychology, it describes mental or physical behaviours which are not excessive in terms of quantity but are apparently both functionless and involve a narrow range of behaviours, and are not better described as stereotypy (a highly repetitive idiosyncratic behaviour).
In general English, perseveration (vb: "to perseverate") refers to insistent or redundant repetition, not necessarily in a clinical context.^[5]

Associated conditions and manifestations

Perseveration of thought indicates an inability to switch ideas or responses.^[6] An example of perseveration is, during a conversation, if an issue has been fully explored and discussed to a point of resolution, it is not uncommon for something to trigger the reinvestigation of the matter. This can happen at any time during a conversation.

Physical brain injury, trauma or damage

• Perseveration is particularly common with those who have had traumatic brain injury.
• Perseveration is sometimes a feature of frontal lobe lesions,^[6] and of other conditions involving dysfunction or dysregulation within the frontal lobe. This is especially true when the lateral orbitofrontal cortex or inferior prefrontal convexity (Brodmann areas 47/12) are affected.^[7]
• Perseveration is also sometimes seen as a symptom of aphasia.

Other neurological conditions

• Perseveration may also refer to the obsessive and highly selective interests of individuals on the autism spectrum. This term is most connected to Asperger syndrome.
• In attention deficit hyperactivity disorder (ADHD), perseveration or "hyperfocus" commonly occurs ^[8] as an impairment of set shifting and task switching.^[9][10][11] The resistance to transition may be a coping mechanism or the brain's method to compensate for the lack of ability to regulate the application of attention.
• In people who are both intellectually gifted and suffer a learning disability, the state of hyperfocus and flow can be confounded with perseverance.^[8]
• Apart from their direct symptoms, people with obsessive–compulsive disorder can have specific problems with set shifting and inhibition of prepotent responses.^[12]

Confounds (conditions with similar appearing symptoms)

• Perseveration may be confused with habitual behaviours in a number of other conditions and disorders, such as obsessive–compulsive disorder, including post-traumatic stress disorder (PTSD), body dysmorphic disorder, trichotillomania, and habit problems.^[13]

Unproven:

• Several researchers have tried to connect perseveration with a lack of memory inhibition (the person repeats the answer because they have not been able to forget a past question and move on to the current subject); however, this connection could not be found, or was small.^[14][15]

References

1. Helm-Estabrooks N. The problem of perseveration. Semin Speech Lang. 2004;25(4):289–90. doi:10.1055/s-2004-837241. PMID 15599818.
2. "Perseveration". Psych Central.com.
3. "Perseveration - Define Perseveration at Dictionary.com". Dictionary.com.
4. Dictionary of Biological Psychology - p.595
5. "Perseverate | Define Perseverate at Dictionary.com". Dictionary.reference.com. Retrieved 2014-03-03.
6. "Psychiatric Glossary of Terms in Psychiatry". priory.com.
7. Iversen, Susan D.; Mishkin, Mortimer (1970). "Perseverative interference in monkeys following selective lesions of the inferior prefrontal convexity". Experimental Brain Research. 11 (4): 376–86. doi:10.1007/BF00237911. PMID 4993199.
8. Misdiagnosis And Dual Diagnoses Of Gifted Children And Adults: Adhd, Bipolar... - Webb, p.50-51]: Notes prior research into "hyperfocus" in ADHD, identifies it with "flow" in gifted children, observes that what is called hyperfocus in such cases "seems to be a less medical-sounding description of perseveration. Thus the apparent ability to concentrate in certain limited situations does not exclude the diagnosis of ADD/ADHD."
9. Taking Charge of Adult ADHD, Barkley R. - p.61-62 "One track Mind"
10. Meaux, Julie B. (2000). "Stop, look, and listen: the challenge for children with ADHD". Issues in Comprehensive Pediatric Nursing. 23 (1): 1–13. doi:10.1080/01460860050121394. PMID 11011659.
11. Miranda, Monica Carolina; Barbosa, Thais; Muszkat, Mauro; Rodrigues, Camila Cruz; Sinnes, Elaine Girão; Coelho, Luzia Flavia S; Rizzuti, Sueli; Palma, Sonia Maria Mota; Bueno, Orlando Francisco Amodeo (2012). "Performance patterns in Conners' CPT among children with attention deficit hyperactivity disorder and dyslexia". Arquivos de Neuro-Psiquiatria. 70 (2): 91–6. doi:10.1590/S0004-282X2012000200004. PMID 22311211.
12. Gyula, Demeter; Mihály, Racsmány; Katalin, Csigó; András, Harsányi; Attila, Németh; László, Döme (2013). "Ép rövid távú memória és károsodott végrehajtó funkciók kényszerbetegségben" [Intact short-term memory and impaired executive functions in obsessive compulsive disorder]. Ideggyógyászati Szemle (in Hungarian). 66 (1-2): 35–41. PMID 23607228.
13. Pediatric Obsessive-Compulsive Disorder~differential at eMedicine
14. Zelazo PD, Müller U, Frye D, et al. (2003). "The development of executive function in early childhood". Monogr Soc Res Child Dev. 68 (3): vii–137. doi:10.1111/j.1540-5834.2003.06803010.x. PMID 14723273.
15. Sharon, Tanya; DeLoache, Judy S. (2003). "The role of perseveration in children's symbolic understanding and skill". Developmental Science. 6 (3): 289–96. doi:10.1111/1467-7687.00285.

External links

• The dictionary definition of perseverate at Wiktionary
• Media related to Perseveration at Wikimedia Commons