CLINICAL neurologists have observed patients who do not react to painful stimuli and yet have no anesthesia. Some of these patients, instead of withdrawing, will sometimes actually proffer their limbs for the pinprick. In such a case an inexperienced examiner when carrying out a routine sensory examination might note that pain sensation was normal, inasmuch as the patient could distinguish between sharp and dull equally throughout the body. Or, on the contrary, he might report that there was generalized hypesthesia when the patient stated that the pinprick did not hurt.Asymbolia for pain denotes the inability to recognize the unpleasant or disagreeable component of a painful or threatening stimulus, with the result that little or no defense reaction is produced, although the noxious stimulus itself is perceived. Although related to apraxia, it is characterized by the fact that it is a type of apraxia only in this distinctive sphere of reaction to pain and danger. Schilder noted that the apraxia usually became evident only in actions directed against the patient's own body. He then added : "It is not alone the expres¬ sion of a deficiency. There is also a particular attitude toward pain which lacks the integration into a higher propositional act." Pain asymbolia must be distinguished from other conditions which bear a superficial resemblance to it, such as generalized analgesia due to lesions in the nervous system, hysterical anesthesia and congenital insensitivity.1 Another type of decreased or absent reaction to pain which may be psychologically related but which is clinically distinct from pain asymbolia is that found in psychotic persons, particularly those with catatonic schizophrenia. These patients often hurt or mutilate themselves without showing the slightest apparent sign of From the
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