Distortion of the Experience of Time

Distortion of the experience of time is a change in a person's personal, felt sense of how quickly or slowly time is passing, separate from actual clock time. Mood has a well-known everyday effect on this — time seeming to fly when happy and to drag when sad — but in some mental states this ordinary effect becomes far more pronounced or takes on unusual qualities of its own.

This has traditionally been framed around a distinction between physical time, which is measured externally and objectively, and personal time, which is the individual's own subjective judgement of duration and is what becomes disturbed in these presentations.

Also known as

Age disorientation: A specific loss of accurate personal time-orientation seen in some chronic illnesses, in which the person misjudges their own age or how much time has passed in their life, distinct from ordinary confusion.

Recognition features

A felt sense that time is passing unusually slowly, unusually quickly, or in an irregular, disjointed way, out of proportion to actual elapsed time
Often tracks closely with mood: pronounced slowing in severe low mood, pronounced speeding in elevated mood
May include a sense that time is moving in fits and starts, sometimes with an elaborated belief about external interference, such as tampered clocks
In acute confusional states, may appear together with disorientation to time in the ordinary sense (not knowing the date or time of day)

Eliciting it at interview

Ask an open question first: "How has time felt to you lately — does it seem to be passing faster or slower than usual, or in an unusual way?"
Where the person describes an unusual pattern, such as time moving in bursts, ask gently whether they have any explanation for why this might be happening
Distinguish this from ordinary temporal disorientation by checking whether the person can still correctly state the date and time when asked directly

Distinguishing features

Differs from temporal disorientation in an acute confusional state, which is a failure to know the actual date or time, rather than a distorted subjective sense of its pace
Differs from a delusional elaboration about time (such as a fixed belief that clocks have been deliberately altered), which may accompany the distortion but is a separate belief-level phenomenon layered on top of it
The direction of distortion (speeding versus slowing) often tracks recognisably with the person's prevailing mood state

Common misconceptions

That any complaint about the passage of time is vague or clinically unimportant; the direction and character of the distortion can carry useful diagnostic information about mood and organic state
That time distortion always means the person is disoriented in the ordinary sense; the two can occur independently of one another

Practice this

During a period of severe low mood, a 47-year-old woman describes each afternoon feeling as though it lasts an entire day, remarking that she has repeatedly checked the clock certain that hours must have passed, only to find that mere minutes have gone by. When asked directly, she correctly states the date and time. What is this presentation? · A patient describes time feeling as though it is moving in bursts, sometimes seeming to leap forward suddenly. When asked, he can still correctly state the date, day of the week, and his location. Before revealing the answer: does his accurate orientation rule out a genuine disturbance in how he is experiencing time? · One patient in a severe depressive episode describes each hour feeling as though it drags on endlessly, yet when asked directly she correctly states the date, the day of the week, and her current location. A second patient, acutely unwell following a urinary infection, cannot say what day it is, believes he is still at home rather than in hospital, and is unsure how long he has been unwell. Are both of these best understood as a distortion of the experience of time? · You want to screen a patient with a significant mood disturbance for a distortion of the experience of time. Which single opening question is most appropriate? · Why might time seem to pass unusually slowly for a patient during a severe depressive episode, in a way that is clinically meaningful rather than simply a vague complaint?

Illustration

References

Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 3, 'Disorders of Perception'.