Personality disorders among adolescents are common. What is a personality disorder? What is it
Patients with personality disorders often see a psychiatrist; they are among those patients who are especially difficult to treat. According to DSM-III-R, such patients have deeply ingrained, inflexible, maladaptive patterns in both their attitudes and perceptions of their environment and themselves.
Personality disorders become evident by adolescence or earlier and continue throughout life. Those who suffer from personality disorders inevitably face difficulties in life and love. If a clinician is able to penetrate the protective armor of a personality disorder, he will very often discover anxiety and depression. Patients with these disorders persistently do not see themselves as others see them, and they lack empathy for others. As a result, their behavior is very annoying to others. Thus, personality disorders tend to create a vicious circle in which already weak interpersonal connections become even worse due to the form of adaptation characteristic of these individuals. In general, people with personality disorders are not easy to understand. On the contrary, neurotics themselves are aware of their impairments. According to special terminology, neurotic symptoms are autoplastic (i.e., the adaptation process occurs due to changes in one’s “I”) and the disorders observed in them are manifestations of ego-dystonia (i.e., they are unacceptable for the individual himself). However, people with personality disorders are significantly more likely to refuse psychiatric care and to deny the violations observed in them. Their disorders are alloplastic (relating to adaptation due to changes in the external environment) and ego syntonic (acceptable to the ego); they do not feel anxious about their maladaptive behavior.
Because individuals with personality disorders typically do not experience pain from society's perception of them as seriously impaired, they are often thought to be unmotivated to seek treatment and cannot be cured. Such characteristics may not encourage mental health professionals to take care of these patients, and many doctors refuse to work with them.
CLASSIFICATION
The DSM-III-R divides personality disorders into three classes (clusters). The first class (A) includes paranoid, schizoid and schizotypal personality disorders. Subjects with these disorders often appear strange and eccentric. The second cluster (B) includes histrionic, narcissistic, antisocial and borderline personality disorders. Subjects with these disorders often come across as theatrical, emotional, and erratic. The second cluster, with the possible exception of borderline disorders, can be characterized by Carl Jung's concept of extraversion. The third cluster (B) includes personality disorders such as avoidance, dependence, as well as obsessive-compulsive and passive-aggressive. Individuals with these disorders are often anxious and fearful. The third cluster can be characterized by a feature that Jung called introversion.
According to DSM-III-R, many individuals exhibit traits that cannot be classified into just one specific disorder, and if a patient has disorders that meet the criteria for more than one disorder, each should be labeled.
ETIOLOGY
GENETIC FACTORS
The most convincing evidence that the genesis of personality disorders contributes genetic factors, are research mental state in 15,000 pairs of American twins. Among monozygotic twins, concordance for personality disorders was several times higher than among dizygotic twins.
Cluster A diseases (paranoid, schizoid and schizotypal) are most often found in biological relatives of patients with schizophrenia. Significantly larger number relatives with schizotypal personality disorders were found in the family history of persons with schizophrenia than among control groups. Fewer correlations are found between paranoid and schizoid personality disorders and schizophrenia.
Cluster B diseases (hysterical, narcissistic, antisocial and borderline) show a genetic predisposition
to antisocial personality disorders, which are also associated with alcoholism. Depression is more common in families of patients with borderline disorders. There is also a strong association between histrionic personality disorder and somatization disorder (Briquet's syndrome), with patients with each
disorders there is an overlap of symptoms.
Borderlines have more relatives than controls who have mood disorders, and borderline and mood disorders often coexist.
Cluster B disorders (obsessive-compulsive, passive-aggressive, dependency, and avoidance) may also have a genetic basis. Obsessive-compulsive features are more common in monozygotic than in dizygotic twins; obsessive-compulsive individuals also exhibit a greater number of symptoms associated with depressive disorders(eg, shortened FBS latency, abnormal dexamethasone suppression test). Individuals with avoidant behavior often exhibit high levels of anxiety.
FEATURES OF TEMPERAMENT (CHARACTER)
Features of temperament emerge in childhood; later they can be correlated with personality disorders that develop in adolescence. For example, children who are naturally fearful may then exhibit avoidance behavior.
Central dysfunction nervous system in children, associated with minor organic disorders, most often observed in antisocial and borderline personalities. Children with minimal brain disorders constitute a risk group for the development of personality disorders, especially the antisocial type.
BIOCHEMICAL RESEARCH
Hormones. Streets with impulsive traits are often found to have increased levels of testosterone, 17-estradiol and estrone. In primates, androgens increase the potential for aggressive and sexual behavior; however, the role of testosterone aggressive behavior in humans is unclear. The dexamethasone suppression test (DST) in some borderline patients with depressive disorders showed pathological abnormalities.
Platelet monoamine oxidase. Low platelet count
monoamine oxidase (MAO) correlates with activity and sociability in monkeys. It is noted that students with low level MAOs spend more time doing social activities than students with a high level of MAO.
Smoothness of pursuit eye movements (SSEM). Smoothed tracking eye movements are observed in streets with traits of introversion, low self-esteem, isolation and schizotypal personality traits. These movements are saccadic, i.e. jerks. These results do not have clinical application, but point to the role of heredity.
Neurotransmitters. Endorphins have effects similar to endogenous morphines, including analgesia and suppression of the activation response. High level endogenous endorphins are often found in phlegmatic, passive subjects. A comparison of personality characteristics and dopaminergic and serotonergic systems showed that these systems have an activating effect on activity. Levels of 5-hydroxyindolic acid, a metabolite of serotonin, are low in those who attempt suicide, as well as in aggressive and impulsive individuals.
PSYCHOANALYTIC THEORIES
Freud believed that personal characteristics are the result of fixation at one of the psychosocial stages of development and interaction of impulses and people in the surrounding area (known as the choice of objects). He used the term "character" to describe the organization of personality and identified certain characteristic types: 1) oral character; individuals with this type of character are passive and dependent; they eat and consume too much various substances: 2) anal character; individuals belonging to this type are punctual, precise, economical (in English, this is punctual, parsimonous, precise, the “P” triad of anal character) and stubborn; 3) characters with obsessions that are rigid and dominated by a rigid superego; 4) narcissistic characters, aggressive and thinking only about themselves.
Wilhelm Reich used the term "character armor" to describe the mechanisms that protect people from internal impulses and which must be explored before successful psychotherapy can be applied. Carl Jung used the term "introvert" to describe the detached, introspective personality type, and "extrovert" to describe the outward-looking, sensation-seeking type. Erik Erikson believed that a lack of trust in others predisposes people to develop paranoid disorders and an inability to become independent.
In order to avoid conjectural conclusions and remain objective in its rationale, DSM-III-R does not take psychodynamic theories into account when classifying personality disorders. To make a correct diagnosis, the doctor must be based on the facts that he observes; however, if the patient believes that he is healthy, successful treatment can only be based on the conclusions that the doctor makes. For success in treatment, the doctor must not lose sight of the outwardly revealed dependence in a patient with paranoid character traits, who hides behind this dependence the stubborn independence characteristic of this character; The doctor should also not ignore the unexpressed fear that manifests itself through the flattering mood of a subject with a schizoid character.
Defense mechanisms. To help a patient with personality disorders. the doctor must evaluate his defense mechanisms. Defense is an unconscious mental process that the ego uses to resolve conflicts along with others belonging to the four guiding stars of the inner life - instinct (desire or need), reality, important people and consciousness. If defense mechanisms work successfully, especially with personality disorders. they can cut short anxiety and depression. So the main
The reason why patients with personality disorders do not want to change their behavior, i.e., suppress their defense mechanisms, is the reluctance to expose themselves to anxiety and depression.
In addition, the protection is dynamic and reversible. Although protection is characterized as pathology, like pus and fever, protection is a manifestation of health, just like pus and fever.
Although patients with personality disorders can be considered as having dominant and rigid mechanisms, each patient uses his own defense mechanism. Thus, the question of what to do with the patient’s defense mechanisms will be discussed here as general question, rather than in sections devoted to individual disorders. Many of the interpretations given here in the language of psychoanalytic psychiatry can, in principle, be translated into the language of cognitive and behavioral approaches.
Advocacy for patients with personality disorders is part of the threads and threads of their life history and their personality. However, no matter how maladaptive their behavior may be, it represents a homeostatic solution internal problems. Neurotics remain critical and sometimes view their defense mechanisms as helpful. On the contrary, patients with personality disorders meet the interpretation of their defense mechanisms with anger. The breakdown of their defense mechanisms causes excessive anxiety and depression, and careless handling of such patients disrupts the contact between doctor and patient. Thus, when trying to break down defense mechanisms, one must either rely on strong social support, like AA, or replace these mechanisms with alternative ones, such as the help of the Angel Society in forming the desired reaction or in becoming a traffic policeman.
Fantasy. Many individuals, especially eccentric, lonely, fearful individuals, who are often characterized as schizoid, make extensive use of fantasy defense mechanisms. They seek comfort and satisfaction within themselves by creating imaginary lives, especially imaginary friends in their heads. Often such people seem extremely lonely. It is necessary to understand such people, to understand that their detachment is associated with fear of intimacy, and not to criticize them or fight back, being rejected by them. The doctor should show a calm, reassuring and significant interest in them, without insisting on reciprocity. It is helpful to recognize their fear of intimacy and discover the reason for their eccentricity.
Dissociation. The second defense mechanism, dissociation or neurotic denial, consists of replacing an unpleasant affect with a pleasant one. Those who frequently use dissociation appear theatrical and emotionally flattened; they can be called hysterical personalities. Their behavior resembles the arrested development of an anxious teenager who, in order to avoid anxiety, carelessly exposes himself to danger. To view such patients as irresistible and seductive is to overlook their anxiety, but to make them aware of their pretense and defect means to further strengthen their defense mechanisms. Since they are seeking recognition for their attractiveness and masculinity, the doctor should not be too reserved. At the same time, while remaining calm and firm, the doctor must constantly remember that these patients often unwittingly lie all the time. Patients who use dissociation benefit from the opportunity to relieve their anxiety; in the process they “remember” what they had “forgotten.” Often dissociation and denial can be influenced if the therapist uses displacement. To do this, you should talk to the patient about the same affectively significant problems, but in the context of less dire circumstances. By emphasizing the denied affect in such patients, without directly opposing what they say, real facts, you can force the patient to tell the truth himself.
Insulation. The third type of protection, significantly different from the others, is insulation. It is common among older people who have good self-control, who are often considered compulsive, and who, unlike hysterical personalities they remember the truth in all details, but there is no affect. During periods of crisis, there may be an increase in isolation, overly formal behavior and this is difficult to cure. The fact that the patient stubbornly tries to maintain his own course of action in the current situation often irritates and bores the doctor. Improvement can often be achieved in such patients through precise, systematic, and rational explanation. They value efficiency, clarity, and punctuality as much as they value affective displays on the part of the physician. Whenever possible, the physician should allow the patient to control his own treatment, and not enter into a fight with his desires.
Projection. The fourth type of defense found in patients with personality disorders is projection, in which they transfer their own unacknowledged feelings to other people. Increased blaming of others, sensitivity to criticism sometimes seem like prejudice, a furious and unfair search for guilt on the part of others, but this should not be responded to with defense and argument. You must be well aware that even small mistakes on the part of the experimenter will be taken into account and may lead to further difficulties in communicating with the patient. Unwavering honesty and concern for the rights of the patient, as well as maintaining the same formal, distanced, although friendly behavior as with patients suffering from fantasies, can also be beneficial in this case. If you take the path of confrontation, the doctor risks becoming the patient's enemy, and the conversation will be interrupted. However, the doctor should not agree with the seven unfair accusations that the patient makes; he must ask whether there might be some discrepancy with the truth.
The counterprojection method has a particularly good effect. With this method, the doctor recognizes and expresses complete trust to the paranoid patient regarding his feelings and perceptions. Further, the doctor does not discuss the patient’s complaints and does not support them, but says that the world that the patient describes is imaginary. You can then move on to real motives and feelings, even if they mistakenly relate to someone else, and begin to strengthen the alliance with the patient.
Hypochondria. A fifth mechanism typical of patients with personality disorders, especially borderline, dependent, or passive-aggressive variants, is hypochondriasis. Unlike usual cases, the patient does not express hypochondriacal complaints for the sake of secondary gain. The instantaneous reactions of a hypochondriac allow us to judge that his hypochondriacal complaints are not the factor that mainly determines his condition. Having discovered that the doctor has figured it out, the patient first feels guilty, then angry, and his attitude towards the doctor worsens. In other words, a hypochondriac does not tolerate reproaches. Often, behind the hypochondriac's complaints that others are not helping him, bereavement, loneliness, or unacceptable aggressive impulses are hidden. Following the first step, which is self-reproach, complaints of pain begin, somatic disease and neurasthenia, which cannot be trusted, or the restatement of insoluble life problems. The mechanism that hypochondriacs use involves punishing others with the pain that the patient himself feels and his discomfort. Hiding the real unfulfilled desire to be dependent, the hypochondriac, thanks to his complaints, gets the opportunity to feel that he is right by reproaching others.
Split. The seventh mechanism that occurs in patients with personality disorders, especially borderline ones, is splitting. In splitting, instead of synthesizing and assimilating opinions about persons who have not cared for the patient very well in the past, and instead of responding correctly to persons playing important role surrounded by the patient, the patient begins to divide all people, both from the past and from the present, into good and bad. For example, in a hospital, some staff are idealized, while others are indiscriminately condemned. There are devastating consequences as a result of this defensive behavior; it immediately turns the staff against the patient. It is best to deal with splitting if staff are familiar with this defense mechanism and anticipate it; this should be discussed at a staff meeting and gently made clear to the patient that no one person is too good or too bad.
Passive aggression. The seventh mechanism often observed in patients with borderline and passive-aggressive personality disorders is the following: that the patient turns anger against himself. In military psychiatry and the DSM-III-R, this behavior is called passive-aggressive; in terms of psychoanalytic theory this is called masochism. This includes failure, prolonged stupid or defiant behavior, self-deprecating cheating, as well as more naked types of self-injurious behavior. The hostility present in such behavior can never be completely hidden; indeed, when a patient cuts his wrist, it causes such anger in those around him that they perceive him as a sadist, not a masochist.
Passive aggression is best dealt with by trying to cool the patient's anger. It is hardly reasonable to react to provocative suicide attempts of patients in such a way as if they were mistaken for manifestations of depression or to isolate them in secluded places or in a hospital. The pleasure and anxiety relief that some patients experience from repeated cutting should be considered the same disorder as masturbatory behavior. It is better not to treat such behavior as perverse, but to delicately ask: “Maybe there is another way to make you feel better. Can you express your feelings in words?
Sometimes those suffering for a long time, sacrificing themselves, patients find themselves in a state of medical institution free yourself from the willingness to add to yourself a heavy burden that already exists, and resist habitual pleasures. It is useful to set before the patient the task of getting well, thus, as if giving him a new task. In any contact with patients, it is necessary to protect oneself by avoiding derogatory remarks about the stupidity and incomprehensibility of their behavior. If stubborn passive-aggressive patients resist getting help, it can sometimes be helpful to take a break. By leaving the room or postponing the next meeting, you can break the fighting pattern and emphasize that the patient's passive-aggressive tactics will reduce attention to him, not increase him. After a short break, the doctor will be able to continue the conversation in a calmer manner, which will no longer resemble a sadistic one.
Expression by action. The eighth defense mechanism typical of personality disorders is expression through action (reaction). This mechanism is direct expression through the action of an unconscious desire or conflict in order to avoid its transition to a conscious level, either in the form of an idea or the affect accompanying it. Typical examples include temper tantrums, unprovoked attacks, child abuse and promiscuity. Due to the fact that behavior is manifested without awareness, it seems to the observer that there is no element of value in the behavior expressing action (reaction). When responding to such behavior, the doctor must proceed from the principle “nothing human is alien to me.” As with conversion hysteria, anxiety and pain can be hidden behind indifference, but unlike conversion hysteria, the reaction must be stopped as quickly as possible. Prolonged expression of action can cause terrible harm to both the patient and the staff. If response is impossible, a conflict arises that is not covered by defense mechanisms. When faced with a response during a conversation, aggressive or sexual, the doctor must remember that: 1) the patient has lost control of himself; 2) whatever the doctor says will apparently not be heard; 3) to capture the patient’s attention is the most important task. Depending on the circumstances, the doctor's response may be: "How can I help you if you are screaming?" Or, if the doctor sees that the patient’s loss of control over himself is increasing: “If you continue to scream, I will leave.” Or, if the doctor is really afraid of the patient, you can simply leave and ask for help, including the police. Inevitably, fear arises when confronted with reactive behavior, and no one should have to endure that fear alone.
Other types of stereotypic behavior. Narcissism, addiction and relationships where there is no way to win. They are other types of behavior that the patient repeatedly develops, which frighten others and make it difficult to help the patient. In contrast to the above eight defense mechanisms, these three types have little homeostatic value.
Narcissism. Being in a state of fear, many patients with personality disorders view themselves as strong and significant subjects. To the observer, this behavior may look like vanity, grandeur and high status, which the patient tries to attribute to himself, or narcissism. This leads to the fact that the patient is usually critical of the doctor. Some patients suggest that the doctor pays for the right to care for them. The doctor may respond by being defensive, arrogant, or rejecting the patient. Nobody likes to be humiliated like that. The simple fact of telling patients that they are sick and potentially helpless can cause them to react with such arrogance. The doctor will succeed if he alleviates these reactions, instead of belittling the importance of the patient, which he values too highly; we can say that the patient has all the rights; You can even arrange for expert consultation if necessary, thereby reassuring the patient and reducing his rivalry with the staff caring for him.
Addiction. The second type of stereotypical behavior in personality disorders is dependence, which, however, is ardently refuted by the free. Dependence often manifests itself first of all by attributing to oneself any special rights, and then by indignation when these rights are “violated.” Pessimism, doubt, immaturity are typical features that lead to dependence and increased demands on others; the patient often feels that the staff is laughing behind his back. The indignation and demands of a patient with addiction are similar to the demands for justice on the part of a person in debt. The problem, however, is that there is a huge debt and thus paying it off is impossible. When the patient feels resentment that goes beyond his old relationship with an unpaid debt, his demandingness and attribution to himself
special rights seem especially absurd. Since personality disorders initially cause frustration, the doctor first responds to the patient's unreasonable desires by moving away from the patient, and a vicious circle begins.
The contagiousness of an internally dependent patient can awaken the need for dependence in the doctor, who must be aware of this. It is clear that meeting every unreasonable desire of the patient and taking excessive care of him will not bring him any benefit; It will also not help if the doctor feels that “there is enough snow” and moves away from the patient in fear. In general, when communicating with addicted patients, three rules should be followed. First, for the purpose of self-protection, the doctor must determine realistic boundaries. For example, you can say: “Today I can only spend 15 minutes with you, but tomorrow we will communicate for 30 minutes, from 11 o’clock.” Secondly, the doctor should never show that the patient has reached the limit, either through impatience or punishment. Patients should never feel that interest in them has disappeared; You cannot deprive a patient of anything without giving him something in return. Third, at the same time that limits are defined, those who care for the patient must be prepared to carry out that care as fully as is appropriate. Instead of explaining to an addicted patient that barbiturates cannot be used because they are addictive, it is better to tell the patient that he can take 50 mg of diphenhydramine, which is “better” than barbiturates because it is not addictive. The best way out is not to remind dependent patients what they cannot have, but to try to give them what they need.
Behavior in which no one wins. The third type of stereotypical behavior that causes difficulties in treatment can be called the paradigm in which no one has a chance to win. A no-one-wins situation refers to one of those situations in which two people are in a position that neither of them can change. Without compromise or change in behavior, both parties must lose when they might otherwise win if they agreed. If two self-confident people try to trap each other by expressing mutual indignation and ascribing to themselves all the rights, both of them will be deceived. A subject with personality disorders quickly manages to find a way to get something without giving anything. By choosing people with whom the patient would like to communicate, one may run the risk of reviving past deceptions or destructive relationships on the part of the patient. Consequently, those who suffer from personality disorders are forever entangled in problematic relationships from which there is no way out or good solution.
SOCIO-CULTURAL FACTORS
Some personality disorders may arise from poor parenting, that is, from a mismatch between temperament and experience in caring for children: For example, anxious child, also raised by an anxious mother, is more susceptible to personality disorders than the same child if raised by a calm mother. Stella Chess and Alexander Thomas called this "value matching". A culture that encourages aggression unwittingly contributes to the development of paranoid and antisocial personality disorders. The environment can play a role. For example, active child may become hyperactive if kept in a small apartment, whereas the same child may grow up normal if raised in big house, in which the middle classes live, with windows overlooking the courtyard.
Personality disorder, also called personality disorder, is a distinct form of severe pathological abnormalities V mental sphere person. According to statistics, the incidence of personality disorder reaches a very high level - over 12% of the human population. Pathology is more common in males.
Personality disorder - description and causes
The term "personality disorder" used in modern psychiatry in accordance with the recommendations of ICD-10 instead of the outdated name "constitutional psychopathy". The previous name of personality disorder did not quite correctly reflect the essence of the disease, since it was accepted that the foundation of psychopathy is birth defects nervous system, inferiority arising from unfavorable heredity, negative factors provoking developmental defects in the fetus. However pathogenetic mechanisms Personality disorders are more diverse and variable depending on the subtype of the disease and the purely individual typological characteristics of a person. The cause of a personality disorder can be a genetic predisposition, an unfavorable course of pregnancy in the patient’s mother, birth trauma, physical or psychological abuse in early childhood, and severe stressful situations.
Personality disorder implies the presence of a person’s characterological constitution, personality structure, and behavior patterns that cause significant discomfort and severe distress in the individual’s existence and contradict the norms existing in society. In pathological mental process several spheres of personality are involved simultaneously, which almost always leads to personal degradation, makes integration impossible, complicates the full functioning of a person in society.
The onset of personality disorder occurs late childhood or adolescence, with the symptoms of the disease appearing much more intensely in later life person. Since the juvenile period is characterized by peculiar psychological changes teenager, it is quite problematic to make a differentiated diagnosis at the age of sixteen. However, it is quite possible to identify the present accentuation of personality and predict the further direction of development of a person’s characteristics.
Characterological structure- a set of stable psychological characteristics of an individual, regardless of time and situations, in the areas of thinking, perception, in ways of reacting and relationships with oneself and the world around us. A typical set of individual traits completes its formation before early adulthood and, despite further dynamic extinction or development of individual elements, the structure of the psyche remains a relatively unchanged construct in the future. The development of a personality disorder can be assumed when individual components individuals become extremely inflexible, destructive, maladaptive, immature and deprive them of the opportunity to function fruitfully and adequately.
Individuals suffering from a personality disorder are often frustrated and unable to control their behavior, which causes them significant problems in all aspects of life. Such pathological conditions often coexist with depressive and anxiety disorders, hypochondriacal manifestations. Such individuals are characterized by abuse of psychostimulants and severe violations of eating habits. Often they are distinguished from healthy members of society by a clear contradiction in behavior, fragmentation and illogicality of individual actions, emotionally charged manifestations, cruel and aggressive actions, irresponsibility and complete absence rationalism.
According to the International Classification of Diseases, 10th revision, separate forms There are ten diagnoses for personality disorders. Pathological conditions are also grouped into three separate clusters.
The forms of specific personality disorders are similar conditions observed in accentuated individuals, but the main difference in the phenomena is the significant severity of manifestations, a clear contrast between the variation of individuality in the universal human norm. The fundamental difference between pathology is that when the personality is accentuated, the three main signs of mental pathology are never simultaneously determined:
- impact on all life activities;
- static over time;
- significant obstacles to social adaptation.
In accentuated individuals, a set of excessive psychological characteristics never simultaneously affects everything. life spheres. They have the opportunity to achieve positive social achievements, and there is a negative charge that is transformed over time in pathology.
Signs of a Personality Disorder
Despite the lack of precise terminology, the concept of “personality disorder” refers to the manifestation in a person of a number of clinical symptoms and signs of a destructive pattern of behavior that causes mental suffering to the individual and prevents full functioning in society. The group of “personality disorders” does not include abnormal manifestations of the psyche that arose as a result of direct damage to the brain, diseases neurological profile and cannot be explained by the presence of another mental pathology.
To be diagnosed with a personality disorder, the patient's symptoms must meet the following criteria:
- There is a noticeable contradiction in life positions and behavior of a person, affecting several mental spheres.
- A destructive, unnatural model of behavior has been formed in a person for a long time, wears chronic nature, not limited to periodic episodes of mental pathology.
- An abnormal behavioral pattern is global and makes it significantly difficult or impossible to normal adaptation person to diverse life situations.
- Symptoms of the disorder are always first observed in childhood or adolescence and continue to be demonstrated into adulthood.
- The pathological condition is a strong and pervasive distress, but this fact can only be recorded as the personality disorder worsens.
- Abnormal mental status may lead, but not always, to a significant deterioration in the quality and volume of work performed and cause a decline in social efficiency.
Forms of personality disorder and symptoms according to ICD-10
In traditional psychiatric practice, there are ten subtypes of personality disorder. Let us describe their brief characteristics.
Type 1. Paranoid
The basis of paranoid disorder is pathological persistence of affect and a tendency to suspicion. In a patient of a paranoid type, the feelings that caused a strong emotional reaction do not subside over time, but persist for a long time and manifest themselves with new strength at the slightest mental recollection. Such persons are overly sensitive to mistakes and failures, painfully touchy, and easily vulnerable. They exhibit ambition, arrogance, and self-confidence. With paranoid personality disorder, people do not know how to forgive insults, are distinguished by secrecy and excessive suspicion, and a general disposition towards all-encompassing mistrust. Individuals of the paranoid type have a tendency to distort reality and attribute all the actions of others, including not only neutral, but also friendly ones, to hostile and harmful motives. Such people are characterized by groundless pathological jealousy. They stubbornly defend their rightness, showing intractability and embarking on protracted legal battles.
Type 2. Schizoid
Deviations that negatively affect children's adaptability to their environment are now commonly called personality disorders. Such mental disorders in children are detected quite rarely, since throughout the entire period of growing up the psyche constantly undergoes changes. Sometimes children develop conditions that have characteristics of a personality disorder.
Once a child reaches adolescence, we can talk about the end of personality formation. If signs of a personality disorder persist during this period, then we can already talk about a condition that needs correction.
Causes of disharmony
Personality disorders in children can take different forms. Based on the causes of the disease, there are three main types:
- a hereditary disorder is caused by the presence of a genetic predisposition and is passed on from generation to generation:
- acquired disorder progresses with wrong approach to raising a child, as well as under the long-term influence of a negative environment and examples;
- organic psychopathy develops as a result of injury or infectious disease of some parts of the brain or the entire central nervous system.
Prerequisites for the development of disharmony may appear during pregnancy. To prevent this from happening, a woman must monitor her health and avoid deviations that could negatively affect the condition of the baby.
The psychological climate in the family has a great influence on the process of forming a child’s personality. If a child has suffered a head injury or contracted an infectious disease, it is necessary to take active actions for his speedy recovery. Otherwise, there is a high risk of developing complications, including personality disorders.
Symptoms and diagnosis
Diagnosing personality disorders in children is quite difficult. Specialists need to observe for about 6 months little patient to be able to make an accurate diagnosis.
Personality disorder manifests itself in different ways, depending on the type of disease:
1. A paranoid type disorder is accompanied by the appearance in a child of one idea, which turns out to be extremely valuable for him. This could be the idea of illness, persecution or jealousy, etc. In this state, children become extremely suspicious; they react very sharply to refusals to satisfy their desires.
2. The disorder may have a schizoid overtone. Typical behavior a child with a similar personality imbalance is a refusal to communicate. In this state, it is very difficult to establish a trusting relationship with someone; the child is restrained in emotions and is not capable of empathy. But at the same time, the patient loves to fantasize.
3. Weak-willed psychopathy or dissocial type of personality disorder is manifested in complete non-compliance with generally accepted moral standards. The child does not have his own principles, and is also unable to maintain family and friendly ties.
4. Emotional instability can also be observed in children with personality imbalance. Most often this type psychopathy occurs in adolescents. Aggression and cruelty are common symptoms of this condition and occur in outbreaks. From time to time, you can hear threats from a teenager to commit suicide.
5. Distinctive feature hysterical psychopathy is demonstrativeness. The patient’s behavior, all his actions and emotions are aimed at attracting attention to himself.
6. A psychasthenic disorder is diagnosed in a child if he is constantly in an anxious state associated with worries about every little thing or detail. The patient strives to complete any task in the best possible way, in the end it becomes obsessions leading to personality imbalance.
7. Excessive fears and anxiety, leading to self-restraint in activities or communication, are characteristic of sensitive personality disorder in children.
Children may also develop a personality disorder, which experts call dependent. In this state, the child is afraid of his helplessness. Such children do not know how to make decisions on their own.
Manifestations of some types of personality disorder are very often mistaken for pedagogical neglect. Distinguish pathological changes only an experienced psychoanalyst or psychiatrist can treat the psyche from elementary bad manners. When the first symptoms appear, parents should seek qualified help. If proper treatment and correction are not carried out, the child will have difficulties adapting to society in the future.
Treatment
The doctor chooses the most appropriate treatment regimen based on the reasons that caused the pathological changes in the child’s psyche. If we're talking about O hereditary form illness or organic disorders in the work of the central nervous system, the emphasis is on drug treatment and supportive care. Specialists working at the Psychoendocrinology Center use the most modern developments and techniques aimed at identifying the cause of the disease. The small patient is monitored for a long time, after which a decision is made on the choice of treatment regimen.
Acquired forms of personality disorders in children can be corrected in most cases. Drug treatment rarely brings significant results; psychotherapy plays a large role in healing. If the need to take medications nevertheless arises, the doctor at the Psychoendocrinology Center prescribes only one drug, which is taken in a course.
Regardless of what causes personality disorder in children, it is necessary to begin treatment after detecting the first signs of the disease. Timely contact with specialists and strict adherence to recommendations will ensure positive success from treatment.
Borderline personality disorder, as I already said, can arise from various reasons. These are not necessarily villainous parents; it may also be something like “genes”.
Of course, you can suspect some problems from childhood. Often difficult children “outgrow” their problems and everything becomes normal.
However, adolescence, with persistent and expanding problems, should serve as a second wake-up call.
Adolescence is quite a difficult time for any child. Everyone is individual and goes through it differently. Even if everything is normal outwardly, it does not mean that the child does not experience any difficulties.
There are children who have real storms and battles with society and family during adolescence. And again, it is not a fact that a rebel will become a poorly adapted person later. As I have already said, every teenager needs to push away from the family with varying degrees of force in order to become an independent person.
This does not mean at all that the child should leave and no longer communicate with his family. This is the time when it is no longer the family, but the child who decides in which waters to swim.
So here is a list of signs by which one can again suspect that something is wrong with the child. Let me emphasize again - not to make a diagnosis, but again to pay attention.
1. Intense overemotional reaction.
The child clearly reacts more than even teenagers should. The tram doors closed in front of my nose or the ice cream ran out. Those. It’s not like the beloved tram with all his friends left and not the ice cream that the child had been waiting for for 2 months, but a banal tram and banal ice cream. Those. It’s unpleasant, but you can get there by other transport and buy exactly the same ice cream around the corner.
The child is not just upset, he is vomiting and tossing, crying, wringing his hands, cursing fate, cannot even calm down at night, and all his moaning tends to be “Am I the most unfortunate person in the world or are everyone around me bastards.” In other words, the reaction to an unpleasant, but not critical moment is too dramatic and can last even up to several days.
2. A quickly occurring defensive reaction.
Whatever one may say, it is impossible to always be accepted everywhere in life just because you want it. Somewhere you still have to move a little in order to like it, to show yourself. People sometimes express their dissatisfaction.
A teenager at risk of borderline disorder reacts to every situation where he was rejected again excessively and immediately takes a victim position or begins to attack. Even if the claims are justified, this does not stop him.
For example, a child wrote a bad essay. Well, here's the really bad thing. Because yesterday he sat all day and played on the computer, and at 10 o’clock in the evening it suddenly dawned on him that there was still homework. And I wrote my opus literally on my knee in the toilet, while brushing my teeth in the evening. The teacher naturally gave me the wrong grade that I would have liked. In response, the child begins to either behave aggressively towards the teacher, or indulges in self-deprecation and excuses, demanding to give a grade that suits him.
3. Paranoid reactions.
If something goes wrong, even by accident, the child thinks up the malice of those around him. Has the tram left? The driver specifically waited for him to approach the doors and closed them. And then he laughed evilly and rubbed his hands for the rest of the day, imagining how the poor child missed the transport. The teacher specially set the essay low rating because he hates him, etc.
4. The desire for self-harm and the implementation of these ideas (cuts hands, burns oneself with cigarettes, etc.)
5. Intense unstable relationships.
Teenagers fall in love. It seems to them that this is the strongest love for life. For a teenager at risk of borderline disorder, such “loves” are quite frequent, between them there are deep gaps like “he never loved me, but just wanted to laugh, and now I’ll kill myself.”
Indeed, it cuts your hands into dark stripes, poisons you, etc. After new love to the grave, and disappointment to the grave. And so several times over time adolescence.
6. The desire for violence.
Teenagers sometimes get angry with their parents and even say that they hate them. It even happens that something is broken in our hearts. A child at risk of borderline disorder begins to do this systematically, including damaging property, threatening to kill ex-lover, teachers, neighbors and everyone who did not please.
7. Disorder eating behavior accompany BPD quite often and it begins precisely in adolescence.
There can be a whole spectrum here, but most often bulimia, anorexia and binge eating.
8. Impulsivity and sensation seeking.
Again teenagers love thrill, but on average, their experiments do not cross the lines of the law or this happens sporadically.
Problematic children regularly move on. They more regularly steal from stores, speed, drink alcohol and soft drugs while driving, harass passers-by, and do not hesitate to use emotional and even physical violence towards others, especially those who are clearly weaker.
They are more likely to become involved in gambling addiction and have a higher risk of chemical and behavioral addictions. Often they try drugs one after another and it is in this group that it happens more people with polydrug addiction.
They often run away from home at the slightest conflict, cursing their parents. In addition, they more often engage in casual sex without using protection.
In these cases, it is better not to wait for the child to go crazy, but to send him to a specialist. This is necessary primarily for developing better self-control, the ability to regulate stress and interaction with society. The teenage psyche is more plastic than the psyche of an adult, and children at this time perceive information about how to behave more effectively more easily.
