Borderline personality disorder in an adolescent. Dissocial personality disorder

Personality disorders, as a rule, arise in adolescents and actively develop until full mental maturity, often integrating into a person’s established psychotype. Professionals say that the above diagnosis can only be made from the age of fifteen to sixteen: before that, mental characteristics often associated with active physiological changes in the body.

Previously, personality disorder was not identified as a special type of mental disorder and was classified as classical psychopathy, which arose as a result of underdevelopment of the nervous system due to a number of factors (trauma, heredity, harmful environment, etc.).

This condition can be caused by birth trauma and genetic predispositions to violence in various forms and certain life situations.

Quite often, personality disorder is confused with impaired perception, psychosis and the influence of various diseases, however, these conditions differ in complex clinical symptoms, features of the qualitative and quantitative specificity of a psychiatric disorder,

Symptoms of disorders by type

Each type of disorder has its own symptoms:

Passive-aggressive

Patients are irritable, envious, rather angry, threaten to commit suicide, but, as a rule, do not do this. The condition is aggravated by constant depression due to alcoholism, as well as various somatic disorders.

Narcissistic

There is a significant exaggeration of one's own talents and merits, multiple fantasies on various topics. They love admiration for themselves and envy others successful people and require unyielding submission to their own demands.

Dependent

People with this syndrome often have very low self-esteem, they show self-doubt and try to avoid responsibility. A special problem in this case is the fundamental difficulties of making important decisions; people with such a personality disorder easily endure insults and humiliation, and are afraid of loneliness.

Alarming

Manifests itself in fear of various environmental factors. They are afraid to speak publicly, have a number of social phobias, are very sensitive to criticism, and require constant support and approval from society.

Anancast

There is excessive shyness, impressionability, and lack of confidence in oneself and one’s strengths. Such patients are often overcome by doubts, they are afraid of responsible work, and sometimes they are overcome by obsessive thoughts.

Histrionic

They crave constant attention and are very impulsive to the point of hysteria. Extremely changeable moods will often change. People try to stand out in the most extravagant way, often lying and making up various stories about themselves in order to gain more significance from society. They often behave openly and friendly in public, but in families they are tyrants.

Emotionally unstable

They are very excitable and respond to any events very violently, openly expressing anger, dissatisfaction, and irritation. The outbursts of such people often lead to open violence if they meet resistance/criticism from other people. Their mood is very changeable, unpredictable, and they have a great tendency to act impulsively.

Dissocial

Tendency to ill-considered and impulsive actions, disregard for moral standards, indifference and aversion to responsibilities. Such people do not regret their actions, they often lie, manipulate others, and they do not have anxiety or depression.

Schizoid personality disorder

Such people strive for isolated life activities; they do not want close relationships and ordinary contacts with others. Patients are indifferent to praise or criticism, show very little interest in sexual relations, but they often become attached to animals. The predetermining factor is the maximum possible isolation from the surrounding society.

Paranoid

They almost always experience unfounded suspicions about deception, exploitation, or other actions on the part of society. Patients are unable to forgive other people; they believe that they are always right and understand only the authority of power and authority. In extreme forms they can be dangerous, especially if they intend to pursue or take revenge on their imaginary enemies and offenders.

Diagnostics

All the main criteria by which personality disorders can be correctly diagnosed are contained in the latest edition of the International Classification of Diseases (ICD-10).

In particular, conditions that cannot be explained by brain diseases or extensive brain damage, as well as known mental disorders, become decisive.

1. The chronic nature of altered behavior, which arose over a long period of time and is not associated with the etymology of episodes of mental illness.
2. The style of altered behavior systematically disrupts adaptation to life or social situations.
3. Disharmony with behavior and one’s own positions is revealed, manifested in deviations from the norm in perception, thinking, and communication with other people. Lack of impulse control, affectivity, and frequent excitability/inhibition are also diagnosed.
4. As a rule, the disorder described above is accompanied by a partial or complete loss of productivity in society or work.
5. The above-described manifestations occur in childhood and also in adolescents.
6. The condition leads to large-scale distress, which manifests itself in the later stages of the development of the problem.

If at least three of the above-mentioned signs are found in a patient who has been given a potential diagnosis of Personality Disorder, then the likelihood of its correct diagnosis after receiving additional tests, if necessary, is considered proven.

Treatment for Personality Disorder

It should be understood that personality disorders are a rather severe mental disorder, therefore any treatment is mainly aimed not at changing the personality structure, but at neutralizing the negative manifestations of the syndrome and partial compensation of normal mental functions. In modern medicine, two main approaches are used.

Psychological-social therapy

In particular, this includes individual, group, and family therapy conducted by experienced neuropsychotherapists, psychological education, as well as environmental treatment and exercises in special self-help groups.

Drug therapy

Recent research shows that popular classic method combating personality disorder is ineffective, so even in the FDA recommendations you will not find instructions on drug treatment. Some experts recommend using antipsychotics and antidepressants in this case, usually in small doses. Antipsychotics and benzodiazepines are widely used, mainly to suppress violent episodes, but their continued use can cause deterioration. depressive states, drug dependence and even the reverse effect of excitement.

In any case, it is simply impossible to independently treat or alleviate the symptoms of a personality disorder. We recommend that you contact several independent specialists on this issue at once, carefully weigh their suggestions and recommendations, and only then make a decision, especially when it comes to taking certain groups of drugs for permanent basis or revolutionary techniques of dubious unverified origin.

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Personality disorder, also called personality disorder, is a distinct form of severe pathological abnormalities in the human mental sphere. 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 congenital defects of the nervous system, inferiority that arose against the background of unfavorable heredity, and negative factors that provoke developmental defects in the fetus. However, the pathogenetic mechanisms of personality disorder 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. Several spheres of personality are simultaneously involved in a pathological mental process, which almost always leads to personal degradation, makes integration impossible, complicates the full functioning of a person in society.

The onset of a personality disorder occurs in late childhood or adolescence, with symptoms of the disease appearing much more intensely later in a person’s life. Since the juvenile period is marked by peculiar psychological changes in a 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 a complete lack of rationalism.

According to the International Classification of Diseases, 10th revision, ten diagnoses are distinguished into individual forms of personality disorder. 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 norm. The fundamental difference between pathology is that when personality is accentuated, the three main signs of mental pathology are never simultaneously determined:

• impact on all life activities;
• static over time;
• significant interference for social adaptation.

In accentuated individuals, a set of excessive psychological characteristics never simultaneously affects all spheres of life. They have the opportunity to both achieve positive social achievements and also have a negative charge that is transformed over time into 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 interferes with full functioning in society. The group of “personality disorders” does not include abnormal mental manifestations that arose as a result of direct brain damage, neurological diseases 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 tangible contradiction in the life positions and behavior of the 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 manner is global and significantly complicates or makes it impossible for a person to adapt normally 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

basis paranoid disorder there is a pathological persistence of affect, 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 renewed vigor at the slightest mental memory. 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

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The modern taxonomy of mature personality disorders is based on the classification of P. B. Gannushkin (1933), G. E. Sukhareva (1959) and types of accentuated personalities in adults, according to K. Leonhard (1964, 1968). According to ICD-10, the following types of personality disorders are distinguished.

Paranoid (paranoid) personality disorder

The main personality trait of this type is the tendency to form highly valuable ideas that influence the person’s behavior. The assessment of the current situation is subject to affective logic, its analysis is subjective, judgments are often erroneous, and they cannot be corrected. The content of paranoid syndromes at the height of their development is determined by the ideas of reformism, jealousy, litigiousness, persecution, hypochondriacal and love.

Diagnostic criteria for paranoid personality disorder:

Excessive sensitivity to failures and rejections;

Tendency to constantly be dissatisfied with someone, refusal to forgive insults, causing damage and being looked down upon;

Suspiciousness and a general tendency to misrepresent facts by misinterpreting neutral or friendly actions of others as hostile or suspicious;

A militantly scrupulous attitude towards issues related to individual rights, which does not correspond to the actual situation;

Renewed unjustified suspicions regarding the sexual fidelity of a spouse or sexual partner;

The tendency to experience one’s increased significance, which is manifested by constantly attributing what is happening to one’s own account;

Being caught up in unimportant “conspiracy” interpretations of events occurring with or around a given person.

Long before the formation of a paranoid personality structure, affective disorders, increased excitability, short temper, irritability, and a tendency to fixate on negatively colored experiences are noted. They are characterized by a heightened sense of justice, accuracy and conscientiousness, excessive straightforwardness in judgment, sternness, determination, a desire for independence, and an overestimation of their merits.

Paranoid manifestations develop under the influence of external objective factors, the most frequent and significant of which are psychogenics and somatic diseases.

The formation of paranoid psychopathy always occurs gradually, with an increase and deepening of abnormal personality qualities and aggravation of sepathocharacterological features, the development of persistent and systematized, as a rule, monothematic paranoid ideas of various contents.

Schizoid personality disorder characterized by isolation, secrecy, external isolation and coldness, separation of judgments from the real situation. There is no internal unity and consistency of mental activity as a whole, paradoxicality and whimsicality are observed emotional life. Emotional disharmony is manifested by a combination hypersensitivity towards some aspects of life while at the same time being emotionally cold towards others. Outwardly, these faces look eccentric, strange, eccentric. Their affective reactions are often outwardly unexpected and inadequate. They have no empathy for the troubles and troubles of others. Along with this, they often turn out to be highly gifted and intelligent individuals, prone to non-standard conclusions and statements.

In accordance with ICD-10 for schizoid disorder personality is characterized by the following characteristics:

Little or nothing is enjoyable;

Emotional coldness, alienated or flattened emotionality;

Inability to show warm and affectionate feelings towards other people, as well as anger;

Weak response to both praise and criticism;

Little interest in sexual contact with others;

Increased preoccupation with fantasy and interpretation;

Almost invariable preference for solitary activities;

Noticeable insensitivity to prevailing social norms and conditions;

Lack of close friends or trusted connections and desire to have such connections.

Emotionally unstable personality disorder(excitable type) was previously described under various names “emotionally labile” (Schneider, 1923), “reactive-labile” (P. B. Gannushkin, 1933) or “emotionally labile” (K. Leongard, 1964, 1968) and etc. In childhood, labile adolescents, as a rule, do not particularly stand out among their peers. Only some people show a tendency to neurotic reactions. However, almost everyone's childhood is filled infectious diseases caused by opportunistic flora. Frequent sore throats, continuous colds, chronic pneumonia, rheumatism, pyelocystitis, cholecystitis and other diseases, although they do not occur in severe forms, tend to take a protracted and recurrent course. Perhaps the factor of “somatic infantilization” plays an important role in many cases of the formation of a labile type. The main personality trait of the emotionally unstable type is extreme mood variability. We can talk about the emerging formation of a labile type in cases where the mood changes too often and too abruptly, and the reasons for these fundamental changes are insignificant. An unflattering word spoken by someone, an unfriendly look from a random interlocutor, an inopportune rainfall, or a button torn from a suit can plunge you into a dull and gloomy mood in the absence of any serious troubles or failures. At the same time, some pleasant conversation, interesting news, a passing compliment, a well-dressed suit for the occasion, heard from someone, although unrealistic, but tempting prospects can lift the mood, even distract from real troubles, until they remind you again anything about yourself. During a psychiatric examination, during frank and exciting conversations, when you have to touch on various aspects of life, over the course of half an hour you can see more than once tears ready to well up and soon a joyful smile. Mood is characterized not only by frequent and sudden changes, but also by their significant depth. Well-being, appetite, sleep, ability to work, and the desire to be alone or only with a loved one, or to rush into a noisy society, in company, with people, depend on the mood of a given moment. According to the mood, the future is either painted with rainbow colors, or appears gray and dull, and the past appears either as a chain of pleasant memories, or seems entirely consisting of failures, mistakes and injustices. The same people, the same environment seem either sweet, interesting and attractive, or boring, boring and ugly, endowed with all sorts of shortcomings. Unmotivated changes in mood sometimes create the impression of superficiality and frivolity. But this judgment is not true. Persons of the emotionally unstable type are capable of deep feelings, for great and sincere affection. This is primarily reflected in their attitude towards family and friends, but only towards those from whom they themselves feel love, care and participation. Affection for them remains, despite the ease and frequency of fleeting quarrels. Devoted friendship is no less characteristic of labile teenagers. They spontaneously look for a psychotherapist in a friend. They prefer to be friends with someone who, in moments of sadness and dissatisfaction, is able to distract, console, tell something interesting, encourage, convince that “everything is not so scary,” but at the same time, in moments of emotional uplift, they will easily respond to joy and fun, satisfy the need for empathy. Emotionally labile teenagers are very sensitive to all kinds of signs of attention, gratitude, praise and encouragement - all this gives them sincere joy, but does not at all encourage arrogance or conceit. Blame, condemnation, reprimands, and lectures are deeply felt and can lead to hopeless despondency. Labile teenagers endure real troubles, losses, and misfortunes extremely hard, showing a tendency to reactive depression and severe neurotic breakdowns. The emancipation reaction in labile adolescents is expressed very moderately. They feel good in the family if they feel love, warmth and comfort there. Emancipatory activity manifests itself in the form of short outbursts, caused by the vagaries of mood and usually interpreted by adults as simple stubbornness. Self-esteem is distinguished by sincerity. Emotionally labile teenagers are well aware of the characteristics of their character, they know that they are “people of mood” and that everything depends on their mood. Being aware of the weaknesses of their nature, they do not try to hide or obscure anything, but, as it were, invite others to accept them as they are. In the way those around them treat them, they reveal surprisingly good intuition, immediately, with nervous contact, feeling who is disposed towards them, who is indifferent, and who harbors at least a drop of ill will or hostility. The response arises immediately and without attempts to hide it.

Histrionic personality disorder is manifested by egocentrism, the desire to appear better and more significant in one’s own eyes and the eyes of others than one actually is. The desire to attract attention is manifested in theatricality, demonstrative emotional reactions, and posing. Such persons strive to be constantly in the center of attention of others, therefore they are always emotionally animated, prone to imitating the behavior and facial expressions of persons significant to them, to fantasizing and pseudology. In a subjectively unfavorable or uncomfortable situation, they easily have affective reactions with sobs, expressive gestures, acting out scenes, often with hysterical fits, breaking dishes, and threatening suicide. But true suicide attempts by this type of linden are very rare. Manifestations of hysterical psychopathy in some cases are more complex and are characterized by more vivid polymorphic fantasies, an altered understanding of the real situation and one’s place in it, and the appearance of brightly colored visions that reflect the psychogenic situation. In other cases, hysterical disorders are more elementary and are expressed in hysterical paralysis, paresis, an unexpectedly manifested feeling of suffocation (“lump in the throat”), blindness, deafness, gait disorders (astasia-abasia), and hysterical seizures. All these disturbances are transient, arise in traumatic situations and disappear against the backdrop of normalization of the real situation. But hysterical forms of reaction tend to become consolidated over time and subsequently appear in the form of a cliché that determines the characteristics of behavior.

According to ICD-10, to diagnose hysterical personality disorder, it is necessary to identify the following grounds:

Self-dramatization, theatricality, exaggerated expression of emotions;

Suggestibility, slight influence surroundings or circumstances;

Superficiality and lability of emotionality;

Constant desire for excitement, recognition from others and activities in which the person is the center of attention;

Inappropriate seductiveness in appearance and behavior;

Excessive preoccupation with physical attractiveness.

Anancastic personality disorder from childhood it manifests itself slightly and is limited to timidity, timidity, motor clumsiness, a tendency to reason and early “intellectual interests”. Sometimes, already in childhood, obsessive phenomena are discovered, especially phobias - fear of strangers and new objects, darkness, fear of being behind a locked door, etc. Less commonly, one can observe the appearance of obsessive actions, neurotic tics, etc. The critical period when the anancastic character is revealed as fully as possible is the first grades of school. During these years, serene childhood is replaced by the first demands for a sense of responsibility. Such demands represent one of the most sensitive blows to the psychasthenic character. Education in conditions of “increased responsibility”, when parents entrust non-children with supervision and care of younger children or helpless old people, the position of the eldest among children in difficult material and living conditions contributes to the development of psychasthenia.

The main features of personality disorder of the anancast type in adolescence are indecision and a tendency to reasoning, anxious suspiciousness, love of introspection and, finally, the ease of developing obsessions - obsessive fears, fears, actions, rituals, thoughts, ideas. The anxious suspiciousness of an anancaste teenager differs from similar features of the astheno-neurotic and sensitive types. If the astheno-neurotic type is characterized by fear for one’s health (the hypochondriacal orientation of suspiciousness and anxiety), and the sensitive type is characterized by concern about attitudes, possible ridicule, gossip, unfavorable opinions of others about oneself (relative orientation of suspiciousness and anxiety), then the fears of a person with Anancastic personality structure is entirely addressed to the possible, even the unlikely, in the future (futuristic orientation). As if something terrible and irreparable did not happen, as if some unforeseen misfortune happened to them, and even more terrible - to those loved ones to whom they show pathological attachment. Real dangers and hardships that have already happened are much less frightening. Among teenagers, it is especially common to worry about their mother - lest she get sick and die, although her health does not inspire any fear in anyone, lest she get into a catastrophe or die under a vehicle. If the mother is late from work or stays somewhere without warning, the psychasthenic teenager does not find a place for himself. Specially invented signs and rituals become protection against constant anxiety about the future. Another defense is specially developed pedantry and formalism. Indecisiveness and reasoning go hand in hand in an anancaste teenager. Such teenagers are strong in words, but not in actions. Any independent choice, no matter how insignificant it may be, for example, which film to go see on Sunday, can become the subject of long and painful hesitation. However, already decision must be executed immediately. Persons with an anancastic personality structure do not know how to wait, showing surprising impatience. They often have a reaction of overcompensation in relation to their indecision and tendency to doubt. This reaction is manifested by self-confident and categorical judgments, exaggerated decisiveness and hasty actions at moments when leisurely prudence and caution are required. The resulting failures further intensify indecision and doubt.

According to ICD-10, anancastic personality disorder is diagnosed when the following signs are identified:

Excessive tendency to doubt and caution;

Preoccupation with details, rules, lists, order, organization, or schedules;

Perfectionism (striving for perfection), which prevents the completion of set goals and objectives;

Excessive conscientiousness, scrupulousness, and inappropriate concern for productivity at the expense of pleasure and interpersonal connections;

Increased pedantry and adherence to social conventions;

Rigidity and stubbornness;

Unreasonably insistent demands that others do everything exactly as they do, or an unreasonable reluctance to allow others to do anything;

The emergence of unstable and unwanted thoughts and urges.

Anxious (avoidant) personality disorder Since childhood, it has been manifested by timidity and timidity. Such children are often afraid of the dark, avoid animals, and are afraid of being left alone. They are alienated from overly lively and noisy peers, do not like overly active and mischievous games, risky pranks, avoid large groups of children, feel timid and shy among strangers, in a new environment, and are generally not inclined to easily communicate with strangers. All this sometimes gives the impression of isolation, isolation from the environment and makes one suspect autistic tendencies characteristic of schizoids. However, with those to whom these children are accustomed, they are quite sociable. They often prefer playing with children to their peers, feeling more confident and calm among them. The early interest in abstract knowledge and “childish encyclopedicism” characteristic of schizoids also does not appear. Many people willingly prefer quiet games, drawing, and modeling to reading. They sometimes show extreme affection for their relatives, even when treated coldly or harshly by them. They are distinguished by their obedience and are often known as “home children.” School frightens them with crowds of peers, noise, fuss, bustle and fights during recess, but, having become accustomed to one class and even suffering from some of their fellow students, they are reluctant to move to another group. They usually study diligently. They are afraid of all kinds of tests, checks, and exams. They are often embarrassed to answer in front of the class, afraid of being confused, causing laughter, or, conversely, they answer much less than what they know, so as not to be considered an upstart or an overly diligent student among their classmates. The onset of puberty usually occurs without any particular complications. Difficulties in adaptation often occur at 16-19 years of age. It is at this age that both main qualities of the sensitive type, noted by P. B. Gannushkin, appear - “extreme impressionability” and “sharply expressed feeling own insufficiency."

The emancipation reaction in anxious teenagers is quite weak. Childhood attachment to relatives remains. They not only tolerate the care of elders, but even willingly submit to it. Reproaches, lectures and punishments from loved ones are more likely to cause tears, remorse and even despair than the protest usually typical of teenagers. A sense of duty, responsibility, high moral and ethical requirements both for others and for oneself is formed early. Peers are terrifying with their rudeness, cruelty, and cynicism. I see many shortcomings in myself, especially in the area of ​​moral, ethical and volitional qualities. The source of remorse in male adolescents is often masturbation, which is so common at this age. Self-accusations of “vileness” and “licentiousness” arise, cruel reproaches for the inability to resist a harmful habit. Onanism is also attributed to its own weakness of will in all areas, timidity and shyness, failures in studies due to allegedly weakening memory, or thinness, disproportion of physique, sometimes characteristic of the period of growth, etc. The feeling of inferiority in anxious adolescents makes the overcompensation reaction especially pronounced. They seek self-affirmation outside of weak points their nature, not in areas where their abilities can be revealed, but precisely where they especially feel their inferiority. Girls are eager to show their cheerfulness. Timid and shy boys put on a mask of swagger and even deliberate arrogance, trying to show their energy and will. But as soon as the situation, unexpectedly for them, requires bold determination, they immediately give up. If it is possible to establish trusting contact with them and they feel sympathy and support from the interlocutor, then behind the fallen mask of “nothing at all” there appears a life full of reproaches and self-flagellation, subtle sensitivity and exorbitantly high demands on oneself. Unexpected participation and sympathy can replace arrogance and bravado with stormy tears. Due to the same reaction of overcompensation, adolescents with this type of personal constitution find themselves in public positions (prefects, etc.). They are nominated by educators, attracted by obedience and diligence. However, they are only sufficient to carry out with great personal responsibility the formal side of the function entrusted to them, but informal leadership in such teams goes to others. The intention to get rid of timidity and weakness of will pushes boys to engage in strength sports: wrestling, dumbbell gymnastics, etc.

According to ICD-10, diagnosis of this type of personality disorder is possible when the following manifestations are identified:

Constant general feeling of tension and heavy forebodings;

Ideas about one’s social inability, personal unattractiveness and inferiority in relation to others;

Increased concern about criticism or rejection in social situations;

Reluctance to enter into relationships without guarantees of being liked;

Limited lifestyle due to the need for physical safety;

Avoidance of social or professional activity associated with significant interpersonal contacts due to fear of criticism, disapproval or rejection.

Hyperthymic type of personality disorder described in detail by K. Schneider (1923) and P. B. Gannushkin (1933) in adults and G. E. Sukhareva (1959) in children and adolescents. P.B. Gannushkin gave this type the name “constitutionally excited” and included it in the group of cycloids. Information from relatives indicates that from childhood, hyperthymic adolescents are distinguished by great mobility, sociability, talkativeness, excessive independence, a tendency to mischief, and a lack of a sense of distance in relation to adults. From the first years of life, they make a lot of noise everywhere, love the company of their peers and strive to command them. Teachers of children's institutions complain about their restlessness. The first difficulties may appear when entering school. With good abilities, a lively mind, the ability to grasp everything on the fly, restlessness, distractibility, and lack of discipline are revealed. Therefore, they study very unevenly - sometimes they show off A's, sometimes they get D's. The main feature of hyperthymic teenagers is almost always a very good, even elated mood. Only occasionally and for a short time is this sunshine darkened by outbursts of irritation, anger, and aggression.

The good mood of hyperthymic teenagers harmoniously combines with feeling good, high vitality, often blooming appearance. They always have a good appetite and healthy sleep. The reaction of emancipation can be especially clear, because of this, conflicts easily arise with parents, teachers, educators, which are led to by petty control, everyday care, instructions and moralizing, “working through” in the family and at public meetings. All this usually only causes an intensification of the “struggle for independence,” disobedience, and deliberate violation of rules and regulations. Trying to escape from the care of the family, hyperthymic teenagers willingly go to camps, go on tourist trips, etc., but even there they soon come into conflict with the established regime and discipline. As a rule, there is a tendency to unauthorized absences, sometimes for long periods. True escapes from home among hyperthyms are rare. The reaction of grouping is not only under the sign of constant attraction to peer companies, but also the desire for leadership in these companies. An uncontrollable interest in everything around makes hyperthymic teenagers indiscriminate in their choice of acquaintances. Contact with random people they meet is not a problem for them. Rushing to where “life is in full swing,” they may end up in an unfavorable environment and end up in an asocial group. Everywhere they quickly get used to it, adopt manners, customs, behavior, clothes, fashionable hobbies. Alcoholization poses a serious danger for hyperthymic individuals from adolescence. They drink in company with friends, prefer shallow euphoric stages of intoxication, but easily take the path of frequent and regular drinking. The reaction of hobby in hyperthymic adolescents is distinguished by the richness and variety of manifestations, but most importantly, by the extreme inconsistency of the hobby. Collections give way to gambling, one sporting hobby to another, one club to another, boys often give a fleeting tribute to technical hobbies, girls to amateur artistic activities. Accuracy is by no means their distinguishing feature either in their activities, or in fulfilling promises, or, what is especially striking, in monetary matters. They don’t know how to calculate and don’t want to; they willingly take on debt, pushing aside unpleasant thought about subsequent retribution. Always in a good mood and high vitality create favorable conditions to reassess your abilities and capabilities. Excessive self-confidence encourages you to “show yourself off,” to appear before others in a favorable light, and to boast. But they are characterized by sincerity of enthusiasm, real confidence in their own abilities, and not a strained desire to “show themselves more than they really are,” like real hysterics. Deceit is not their characteristic feature; it may be due to the need to dodge in difficult situation. The self-esteem of hyperthymic adolescents is quite sincere.

Hyperthymic-unstable variant psychopathization is the most common. Here, the thirst for entertainment, fun, and risky adventures comes more and more to the fore and pushes people to neglect classes and work, to alcoholism and drug use, to sexual excesses and delinquency, which ultimately can lead to an antisocial lifestyle. The decisive role in the fact that hyperthymic-unstable psychopathy grows from hyperthymic accentuation is usually played by the family. Both excessive guardianship - hyperprotection, petty control and cruel dictatorship, and even combined with dysfunctional family relationships, and hypoguardianship and neglect can serve as incentives for the development of hyperthymic-unstable psychopathy.

Hyperthymic-asteroid variant occurs much less frequently. Against the background of hyperthymia, hysteroidal features gradually emerge. When colliding with life's difficulties, in the event of failures, in desperate situations and with the threat of serious punishment, a desire arises to pity others (even to the point of demonstrative suicidal actions), and to impress with one’s originality, and to boast, to “show off.” Perhaps in the development of this type also vital role Wednesday plays. Upbringing according to the “family idol” type (Gindikin, 1961), indulgence in childhood whims, excess of praise about imaginary and real abilities and talents, the habit of always being in sight, created by parents, and sometimes by the wrong actions of educators, cause adolescence difficulties that may prove insurmountable.

Hyperthymic-affective variant psychopathy is characterized by increased features of affective explosiveness, which will create similarities with explosive psychopathy. Outbursts of irritation and anger, often characteristic of hypertimics, when they encounter opposition or fail, here become especially violent and arise at the slightest provocation. At the height of passion, control over oneself is often lost: abuse and threats come out without any consideration of the situation, in aggression one’s own strengths are not commensurate with the forces of the object of attack, and resistance can reach “violent madness.” All this usually allows us to talk about the formation of excitable type psychopathy. This concept, it seems to us, implies a very collective group. The similarity between hyperthymic affectivity and the explosiveness of epileptoids remains purely external: there is great easygoingness, a tendency to easily forgive insults and even be friends with someone with whom you just had a quarrel. Other epilentoid features are also absent. Perhaps, in the formation of this variant of psychopathization, traumatic brain injuries, which are not so rare in boys of the hyperthymic type, may play a significant role.

Dependent personality disorders appear in childhood restless sleep and poor appetite, moodiness, fearfulness, tearfulness, sometimes night terrors, nocturnal enuresis, stuttering, etc. The main features of a dependent personality are increased fatigue, irritability and a tendency towards hypochondriasis. Fatigue is especially evident in mental activities. Moderate physical exercise are better tolerated, but physical stress, for example, the environment of sports competitions, turns out to be unbearable. The irritability of dependent individuals differs significantly from the anger of epileptoids and the hot temper of hyperthymics and is most similar to affective outbursts in adolescents of the emotionally labile type. Irritation, often for an insignificant reason, easily pours out on others, who sometimes accidentally fall under the hot hand, and is just as easily replaced by remorse and even tears. Unlike epileptoids, affect is not distinguished by either a gradual build-up, or strength, or duration. Unlike the hot temper of hyperthymics, the reason for outbursts is not necessarily the opposition encountered; affect also does not reach violent frenzy. A tendency toward hypochondriasis is a particularly typical feature. Such adolescents listen carefully to their bodily sensations, are extremely susceptible to iatrogenic behavior, willingly undergo treatment, go to bed, and undergo examinations. The most common source of hypochondriacal experiences, especially in boys, is the heart. Delinquency, running away from home, alcoholism and other behavioral disorders are not typical for dependent teenagers. But this does not mean that they do not have specifically adolescent behavioral reactions. The desire for emancipation or the craving for grouping with peers, not receiving direct expression due to asthenicity, fatigue, etc., can gradually fuel unmotivated outbursts of irritation towards parents, educators, elders in general, prompt blaming parents for the fact that their health is given little attention, or generate deep hostility towards peers in whom specifically adolescent behavioral reactions are expressed directly and openly. Sexual activity is usually limited to short and quickly exhausted bursts. They are drawn to their peers, miss their company, but quickly get tired of them and look for rest, loneliness or company with a close friend. The self-esteem of dependent adolescents usually reflects their hypochondriacal attitudes. They celebrate addiction bad mood from feeling unwell, bad dream at night and drowsiness during the day, tiredness in the morning. When thinking about the future, concerns about one's own health occupy a central place. They are also aware that fatigue and irritability dampen their interest in new things and make criticism and objections that constrain their rules intolerable. However, not all features of relationships are noticed well enough.

According to ICD-10, to diagnose a dependent personality type, it is necessary to identify the following signs:

The desire to shift most of the important decisions in one’s life to others;

Subordination of one's own needs to the needs of others on whom they depend, and inadequate compliance with their desires;

Reluctance to make even reasonable demands on people on whom the person is dependent;

Feeling uncomfortable or helpless alone due to excessive fear of not being able to live independently;

Fear of being abandoned by a person with whom there is a close connection and being left to oneself;

Limited ability to make day-to-day decisions without extensive advice and encouragement from others.

Types of Personality Disorders in Children

The pathocharacterological properties that unite this group of personality disorders are impulsivity with a pronounced tendency to act without taking into account the consequences and lack of self-control, combined with mood instability and violent affective outbursts that arise at the slightest provocation. There are two types of this variant of personality disorder - impulsive and borderline.

Impulsive type corresponds excitable psychopathy. Psychopathy of this type, as E. Kraepelin points out, is characterized by unusually strong emotional excitability. Its initial manifestations are detected in preschool age. Children often scream and become angry. Any restrictions, prohibitions and punishments cause violent protest reactions in them with viciousness and aggression. IN junior classes These are “difficult” children with excessive mobility, unbridled pranks, capriciousness and touchiness. Along with hot temper and irritability, they are characterized by cruelty and gloominess. They are vindictive and quarrelsome. An early-detected tendency to a gloomy mood is combined with periodic short-term (2-3 days) dysphoria. In communicating with peers, they claim leadership, try to command, establish their own rules, which often leads to conflicts. They are most often not interested in studying. They do not always stay in school or vocational school, and once they start working, they soon quit.

Formed psychopathy of the excitable type is accompanied by attacks of anger, rage, affective discharges, sometimes with an affectively narrowed consciousness and sharp motor agitation. In temperament (especially easily arising during periods of alcoholic excesses), excitable individuals are capable of committing rash, sometimes dangerous actions. In life, these are active, but incapable of long-term purposeful activity, unyielding, tough people, with vindictiveness, with the viscosity of affective reactions. Among them, there are often people with disinhibited drives, prone to perversions and sexual excesses.

The subsequent dynamics of excitable psychopathy, as shown by the work of V. A. Guryeva and V. Ya. Gindikin (1980), is heterogeneous. With a favorable course, psychopathic manifestations are stabilized and even relatively fully compensated, which is greatly facilitated by the positive influences of the environment and the necessary educational measures. Behavioral disorders in such cases are significantly smoothed out by the age of 30-40, and emotional excitability gradually decreases. However, a different dynamic is possible with a gradual increase in psychopathic characteristics. Chaotic life, inability to restrain impulses, increasing alcoholism, intolerance to any restrictions, and finally, a tendency to violent affective reactions serve in such cases as the causes of long-term disruption of social adaptation. In the most severe cases, acts of aggression and violence committed during affective outbursts lead to a collision with the law.

The borderline type has no direct analogues in the domestic taxonomy of psychopathy, although according to some personality parameters it is comparable to the unstable type of psychopathy. Borderline personality disorder overlaps with other personality disorders - primarily hysterical, narcissistic, dissocial, and needs to be differentiated from schizotypal disorder, schizophrenia, anxiety-phobic and affective disorders(See description of the dynamics of borderline personality disorder).

A borderline personality is characterized by increased impressionability, affective lability, vividness of imagination, mobility of cognitive processes, constant “involvement” in events related to the sphere of current interests or hobbies, extreme sensitivity to obstacles on the path to self-realization and functioning at maximum capabilities. Difficulties in the sphere of interpersonal relationships, especially the situation of frustration, are also perceived more acutely. The reactions of such subjects even to trivial events can acquire an exaggerated, demonstrative character. As M. Smiedeberg (1959) emphasizes, they too often experience those feelings that are usually detected only in a situation of stress.

Initial pathocharacterological manifestations (emotional lability, suggestibility, tendency to fantasies, rapid change of hobbies, instability of relationships with peers) are detected already in adolescence. These children ignore school rules and parental restrictions. Despite their good intellectual capabilities, they perform poorly because they do not prepare for classes, are distracted in class, and reject any attempts to regulate their daily routine.

The distinctive properties of borderline personalities include lability of self-esteem, variability of ideas about both the surrounding reality and one’s own personality - a violation of self-identification, inconstancy of life attitudes, goals and plans, and the inability to resist the opinions of others. Accordingly, they are suggestible, susceptible to outside influences, easily adopt forms of behavior that are not approved by society, indulge in drunkenness, take stimulants, drugs, and can even acquire criminal experience and commit an offense (most often we are talking about petty fraud).

Borderline psychopaths easily become dependent on others, sometimes strangers. As they come closer, they quickly form complex structure relationships with excessive subordination, hatred or adoration, the formation of overvalued attachments; the latter serve as a source of conflicts and suffering associated with the fear of rupture and future loneliness, and can be accompanied by suicidal blackmail.

The life path of borderline individuals seems very uneven, replete with unexpected turns in social route, marital status. Periods of relative calm alternate with various kinds collisions; transitions from one extreme to another are easy - this is sudden love, overcoming all obstacles, ending in an equally sudden break; and passion for a new business with objectively high professional success, and sudden abrupt change places of work after a minor industrial conflict; this is also a passion for travel, leading to a change of residence and progression. However, despite all the shocks of life, these people do not lose their sanity; when they get into trouble, they are not as helpless as they might seem, and can find an acceptable way out of the situation at the right time. The zigzags of behavior inherent in most of them do not prevent fairly good adaptation. Easily adapting to new circumstances, they maintain their ability to work, find work, and rebuild their lives.

Within the dynamics of borderline personality disorder, phases that are erased and not accompanied by manifest affective symptoms are observed, unfolding mainly in the autopsychic sphere. Long periods of recovery from increased activity, a feeling of optimal intellectual functioning, a heightened perception of the surrounding life can be replaced (most often in connection with psychogenic or somatic - pregnancy, childbirth, intercurrent illness - provocation) by dysthymic phases. Complaints of decreased mental capabilities, a feeling of incompleteness of feelings and cognitive functions, and in more severe cases, the phenomena of mental anesthesia, come to the fore in the clinical picture in these cases.

Among other pathological reactions, judging by the descriptions of J. G. Gunderson, M. Singer (1965), Ch. Perry, G. Kjerman (1975), J. Modestine (1983), with borderline disorders, psychogenically provoked transient outbursts with a varied clinical picture are most often encountered, including, along with affective, dissociative hysterical, unsystematized delusional disorders. Although these psychopathological manifestations (“mini-psychoses”), as a rule, are quickly reduced, their nosological qualification is fraught with difficulties. First of all, it is necessary to exclude schizophrenia, affective and schizoaffective psychoses.

The criteria that reduce the validity of the diagnosis of an endogenous disease are such features of “mini-psychoses” as psychogenic provocation, transient nature, complete reversibility in the absence of a tendency to systematization and chronification.

Depending on the etymology of the disease, three types of personality disorders are distinguished.

• Hereditary psychopathy. They can be passed on to children at the genetic level.
• Acquired psychopathy. Such personality disorders can develop against the background of improper upbringing or prolonged exposure to negative examples.
• Organic personality disorders are acquired due to injury and infection of the brain and disorders of the central nervous system both in the womb and during childhood. Such disorders can develop against the background of autoimmune diseases.

Personality disorders can also be caused by overdevelopment childish character. For example, childhood fears in adolescence can result in phobias, manias and avoidance behavior.

Symptoms

Personality disorders can be identified by changes in children's behavior. Depending on the type of psychopathy, sick children may behave differently:

• Paranoid personality disorder is characterized by the appearance of an overvalued idea (the idea of ​​illness, jealousy, persecution, etc.). The patient may be overly suspicious and sensitive to rejection. His thinking is characterized by subjectivity and affectivity.
• Schizoid personality disorder is an imbalance in a child's emotions, thoughts and actions. The patient prefers to spend time alone, likes to fantasize, but does not know how to empathize with other people, is emotionally cold, and finds it difficult to establish trusting relationships.
• Dissocial personality disorder may also be called weak-willed psychopathy. The main features of a patient with this diagnosis are a lack of principles, non-compliance with accepted moral standards, and inability to maintain strong ties (family, friendship, business).
• Emotionally unstable mental disorder is characterized by capricious and constantly changing behavior. There may be outbursts of aggression and cruelty, and adolescents periodically threaten suicide or self-injury.
• The hysterical type of personality disorder is characterized by demonstrative behavior. All emotions and actions are exaggerated and aimed at attracting the patient’s attention.
• Psychasthenic disorder is characterized by a constant feeling of anxiety, worry about every detail, and the patient’s desire to do everything in the best possible way.
• Anxious or sensitive personality disorder is observed in children who are in constant anxiety about any reason, which is why they impose restrictions on their activities and communication.
• Dependent disorder is a child's fear of remaining helpless, the inability to be independent. With this form of psychopathy, children cannot make decisions on their own and always shift responsibility to others.

Diagnosis of personality disorder in a child

To confirm the diagnosis, the doctor observes the child for six months and, if the signs persist or the clinical picture intensifies, can make a diagnosis. To identify the disease, Schulte tables can be used, and the Wechsler method is practiced.

Electroencephalogram and magnetic resonance imaging are used to detect changes in the brain and central nervous system.

Complications

The most important complication of any type of psychopathy is difficulties with adaptation and socialization. Depending on the form and stage of the disease, this can lead to a lot of difficulties for the child or his loved ones.

Treatment

What can you do

If one or more signs are detected, you should contact a specialist for a full diagnosis of the child’s psyche. When making a diagnosis, it is necessary to identify the cause and get rid of it.

Many acquired personality disorders can be treated. Of course, this will require treatment and psychotherapy.

In the case of genetic and organic psychopathy, talking about treatment is not entirely correct. You can only maintain a stable condition of the child and prevent exacerbations.

Regardless of the causes and form of the child’s mental illness, it is important to strictly follow the recommendations of a specialist and not be led by children’s whims and their own fears.

What does a doctor do

To make a diagnosis, a specialist must monitor the patient’s behavior for at least 6 months. In case of brain injury or infection, the diagnosis can be made much earlier.

Depending on the form of psychopathy, causes childhood disorder individual, the doctor develops a treatment regimen. Treatment involves addressing the underlying cause of the disorder and restoring the child's behavior. This is achieved by prescribing medications and consulting with a psychologist.

Prevention

First of all, the parents themselves must create an adequate psychological climate in the family in which their child will grow up. During pregnancy or even during the planning period it is worth visiting family psychologist, which will help you prepare for the arrival of a new family member and will tell you how to behave with him and with each other in the presence of the baby. After birth, you can also visit a psychologist to solve any difficulties in parenting.

Mental problems can appear even in the prenatal period. For normal development psyche future mom should monitor her condition during pregnancy; any deviations in women’s health can negatively affect the child’s psyche.

If the family had relatives on the husband’s or wife’s side with mental disorders, then the couple needs to be prepared for the possibility of such a pathology in their baby.

If your child has injured his head or doctors have discovered autoimmune diseases, brain tumors or other pathologies, they must be treated immediately so that they do not become the cause of a child’s personality disorder.

Personality disorders include accentuation and psychopathy. Accentuations are milder and transient (i.e. temporary) disorders, while psychopathy is a persistent character anomaly. Typically, accentuations develop during the development of character and smooth out as they grow older. Character traits with accentuations may not appear all the time, but only in some cases, in a certain environment, and are almost undetectable under normal conditions. Social maladjustment with accentuations is either completely absent or temporary.

Psychopathy is an anomaly of character that includes the totality and relative stability of pathological traits, and their severity to a degree leading to social maladjustment.

The totality of pathological character traits in adolescence manifests itself quite clearly. A teenager endowed with psychopathy discovers his type of character in any environment, in the family and at school, with peers and with adults, in work and in entertainment, in everyday conditions and in emergency circumstances.

Relative stability is a sign meaning weak variability pathological nature over time.

Social maladjustment in the case of psychopathy usually lasts throughout adolescence. It is only due to the characteristics of his character, and not because of a lack of abilities, low intelligence or other reasons, that a teenager does not stay in any educational institution, and quickly quits the job where he has just entered. Relationships with family are also usually full of conflicts. It is very important to emphasize that adaptation among peers is disrupted.

Epidemiology: the frequency of personality disorders among adolescents is per 10,000 population: 3 for males and 1 for females. Most common types psychopathy in male adolescents is epileptoid and schizoid, in female adolescents – hysteroid.

Classification

A.E. Lichko considered two main types of psychopathy - constitutional (i.e., caused by hereditary factors and characteristics of the environment in which the child grew up) and organic (caused by brain injury, infection, toxic effects and other brain lesions). Both disorders are divided into the following types.

Labile type. The main feature in adolescence is extreme instability of mood, which changes too often and too sharply for insignificant or even unnoticeable reasons to others. An unflattering word spoken by someone or an unfriendly glance from a random interlocutor can suddenly plunge you into a gloomy mood without any serious troubles or failures. And, on the contrary, an interesting conversation, a fleeting compliment, tempting but unrealistic prospects heard from someone can instill gaiety and cheerfulness and even distract from real troubles until they remind you of themselves in some way. During frank and exciting conversations, you can see either tears ready to well up in your eyes or a joyful smile.

Everything depends on your mood at the moment: well-being, appetite, performance, and sociability. According to the mood, the future is either painted with rainbow colors, or appears dull and hopeless, and the past appears either as a chain of pleasant memories, or entirely consisting of failures and injustices. And the everyday environment seems sometimes cute and interesting, sometimes boring and ugly.

Sensitive type. Since childhood, they have been shy and fearful. They are often afraid of the dark, avoid animals, especially dogs, and are afraid of being left alone or being locked at home. They are alienated from lively and noisy peers. They do not like active games and mischief. Timid and shy among strangers and in unusual surroundings. They are not inclined to communicate easily with strangers. All this can leave a false impression of isolation and isolation from the environment. In fact, such children are quite sociable with those they are accustomed to. They often like to play with children, feeling more confident and calm with them. They are attached to family and friends even if they are treated coldly and harshly. They are distinguished by their obedience and are known as “home children.” School scares them with noise, fuss and fights during breaks. They usually study diligently. They are afraid of all kinds of tests, checks, and exams. They are often embarrassed to answer at the board. They are afraid of being branded an upstart. Having become accustomed to one class and even suffering from persecution from some classmates, they are extremely reluctant to move to another.

Psychasthenic type. The main features of the psychasthenic type are indecision, a tendency to endless reasoning, anxious suspiciousness in the form of fears for the future - one’s own and that of one’s loved ones, a love of introspection, soul-searching and the ease of developing obsessive fears, actions, rituals, ideas, thoughts. Fears are addressed to the possible, even unlikely, in the future: that something terrible and irreparable might happen to themselves or to those close to whom they show extremely strong affection. Adversities that have already happened frighten them much less. Boys are especially prone to worry about their mother: lest she get sick and die, get hit by a vehicle, etc. If the mother is late, or stays somewhere without warning, such a teenager does not find a place for himself.

Schizoid type. From the first years, such children love to play alone. They are little attracted to their peers, avoid fuss and noisy fun, prefer the company of adults, silently listening to their conversations among themselves for a long time. During adolescence, all the features of the schizoid type become extremely acute. First of all, isolation and isolation are striking. Sometimes spiritual loneliness is of little burden to a teenager who lives by his own, unusual for others, interests and hobbies. Characterized by the inability to empathize: to respond to the joy or sadness of another, to understand someone else’s offense, to respond to worry and anxiety. Weakness of intuition and empathy creates the impression of coldness and callousness. Some actions may seem cruel, but they are associated with an inability to feel the suffering of others, and not with a desire for sadistic pleasure. Unavailability inner world and restraint in the manifestation of feelings make many actions unexpected and incomprehensible to others, because the entire course of previous experiences and motives remains hidden. Eccentricities happen, they are unexpected, but they do not serve the egocentric purpose of attracting attention to themselves.

Unstable type. An individual with this psychopathy is subject to the influence of those around him, and since he is prone to entertainment, easy pleasures, does not like to work and study, he often finds similar friends with whom he can commit criminal offenses (theft, robbery, hooliganism and even murder), easily falls under their evil influence. Such people do not have long-term goals and plans, live for today, cannot save and earn money, but love to spend it. A person with this type of psychopathy may spend his entire salary on entertainment for himself and friends, despite the fact that he will not have money for the next month. more funds to support their children. This feature is further aggravated by the fact that such people practically do not experience affection and love for their family and relatives, they do not accept explanations and admonitions about their behavior, do not put themselves in the place of others and are not able to feel a sense of shame, and avoid responsibility in every possible way for yourself and those around you. They do not have definite plans and change their behavior under the influence of external circumstances; They say about such people that they “have no backbone.”

Epileptoid type. The main feature is a tendency to periods of angry and melancholy mood with simmering irritation and a search for an object on which to vent evil. Such states last for hours, sometimes days, gradually developing and slowly weakening. Affective explosiveness is closely related to them. Flashes of excitement seem sudden only at first glance. The affect builds up for a long time and gradually. The reason for the explosion may be insignificant, playing the role of the last straw. The affects are not only strong, but also long-lasting; adolescents cannot calm down for a long time. In passion, unbridled rage, cynical abuse, brutal beatings, indifference to the enemy’s helplessness and inability to take into account his superior strength are possible. Less often, rage turns into auto-aggression with self-harm, sometimes even severe. Instinctive life is characterized by great tension. A strong sexual desire and a tendency to sexual excesses can be combined with sadistic and masochistic tendencies. Love is almost always tinged with the dark colors of jealousy.

Hysterical type. The main feature is egocentrism, an insatiable thirst for the attention of others to one’s own person, the need to evoke surprise, admiration, reverence, and sympathy. At worst, even indignation and hatred towards oneself are preferred, but not the prospect of remaining unnoticed. All other qualities feed on this trait. Deceit and fantasy are entirely aimed at embellishing one’s personality in order to again attract attention to oneself.

In adolescence, for the same purpose, to attract attention, but primarily from peers, behavioral disorders can be used. Delinquency boils down to absenteeism, reluctance to study and work, since the “dull life” does not satisfy them, and to occupy a prestigious position in study and work that would please their pride, they lack both ability and, most importantly, perseverance. Nevertheless, idleness and idleness are combined with very high, in fact unsatisfied, claims regarding the future profession. Prone to defiant behavior in public places. More severe behavioral disorders usually do not occur.

In 2/3 of cases it is favorable (gradual smoothing of psychopathic traits is accompanied by preservation of social adaptation). In 1/3 of cases, which primarily include excitable and unstable types of P., there is a tendency (especially under unfavorable living conditions) to decompensation and disruption of social adaptation.

The vast majority of psychopathic individuals (with the exception of some paranoid individuals and in a state of deep decompensation) who have committed an offense are recognized as sane and subject to criminal liability.

Treatment for symptoms of decompensation in psychopathic individuals is carried out by a psychiatrist, often on an outpatient basis. Medicines in the treatment of psychopathy have very limited value. During periods of severe decompensation, during acute affective reactions, in order to relieve emotional stress, anxiety or depression, it is necessary to resort to injections of antipsychotics, tranquilizers and antidepressants.

Psychotherapy and medical-pedagogical correction. There is an opinion that psychotherapy for psychopathy is ineffective. Some forms of psychotherapy, for example, collective, are even considered contraindicated. Only educational measures are supposedly useful. On the other hand, it is well known that it can be extremely difficult to achieve tangible results with these measures specifically in psychopathy. Therefore, psychotherapy (most often individual) and medical and pedagogical measures must be constantly combined.

An important corrective method is family psychotherapy. Even in harmonious families, parents often incorrectly assess the character traits of a teenager suffering from psychopathy and, as a consequence, make inadequate demands. If, with the help of family psychotherapy, it is possible to correct incorrect intrafamily relationships, then this eliminates one of the most significant causes of frequent decompensations. In some cases, when family relationships are severely and persistently disturbed, it is more rational to remove the teenager from the family and place him in a special educational institution. In cases of severe psychopathy, prolonged hospitalization is sometimes justified if the maximum level of adaptation is achieved in hospital conditions.

Prevention

Prevention of psychopathy is extremely difficult due to ignorance of the endogenous patterns of their development. One can only strive to prevent decompensation through rational corrective measures. Psychopathic developments can certainly be the object of active prevention, aimed at ensuring that adolescents with character accentuations do not grow up in a system of precisely the type of incorrect upbringing that is a blow to weaknesses their character. Prevention of organic psychopathy, in addition to the prevention and treatment of brain pathology in early period ontogenesis, includes the treatment of neuropathic and correction of behavioral disorders throughout childhood. Success in this direction creates hope that puberty may become not a pathogenic, but a sanitizing factor.

References:
1. D.N. Isaev, “Psychopathology of childhood.” Textbook for universities. S-P., 2003
2. A.E. Lichko "Teenage Psychopathy". Guide for doctors, 2nd edition, expanded and revised. Leningrad, 2007

Executor:
Head of the Psychiatric Department,
psychiatrist
Alexey Alexandrovich Ermakov.

Personality disorders in adolescents

At puberty, the formation of disharmonious personalities, also called psychopathic, is completed and differ from normal ones in that it is difficult for them to adapt to the environment painlessly for themselves and others. These permanent properties, although they may intensify or develop throughout life, they do not change dramatically. They determine the entire mental appearance of the individual. The diagnosis of psychopathy is made based on the following signs:

1) the totality of pathological character traits, manifested in ordinary and
stressful situations;

2) stability of pathological character traits that persist throughout life;

3) social maladjustment as a consequence of pathological character traits.

Along with hereditary psychopathy in adolescents, under the influence of improper upbringing or prolonged bad influence, they complete their formation various shapes pathocharacterological development (acquired psychopathy). Organic psychopathy - a consequence of prenatal, perinatal and early postnatal brain damage - acquires the most pronounced expression. Forms of personality disorders are described here.

Paranoid personality disorder characterized by excessive sensitivity to failures and refusals; dissatisfaction with someone, that is, refusal to forgive insults or damage caused; suspicion and misinterpretation of neutral or friendly actions of people as hostile or suspicious; a militant attitude towards one’s rights, out of compliance with the facts; unjustified suspicions regarding a partner’s fidelity; attributing everything that happens to oneself; suspicions about the existence of conspiracies against his person. The most characteristic- the formation of highly valuable ideas that determine their entire behavior, which is associated with confidence in their own importance, one-sided perception of reality, lack of criticism, subjectivity and affective coloring of thinking. These include ideas about the presence of a non-existent disease, unfair treatment, an unusual invention, ideas of jealousy, influence.

Schizoid personality disorder, autistic psychopathy, is characterized by disharmony of development, lack of unity, contradictory emotions, aspirations and actions. Such a person is incapable of experiencing pleasure, is distinguished by restraint, emotional coldness, and inability to show warm feelings and empathize with others. She has a weakened response to praise and blame, and has little interest in sexual contacts. There is a tendency to fantasize and act alone, withdraw into oneself, and find it difficult to establish trusting relationships. The rules of relationships between people are not taken into account, and in connection with this, eccentric actions arise. There is no desire to have close friends, and because of this they are absent.

Dissocial personality disorder, unstable or weak-willed psychopathy, is characterized by inconsistency of behavior with social norms, callous indifference, irresponsibility and disregard for morality, inability to maintain strong business, friendly, family and sexual relationships in the absence of difficulties in their formation. These individuals do not tolerate failure well, are aggressive, and are unable to feel guilty and learn from mistakes and situations that led to punishment. They do not react to the accusations of others, but give plausible explanations for their misdeeds, avoid studying and work, strive for pleasure, and participate in asocial companies, where they find themselves in subordinate roles.

Emotionally unstable personality disorder, impulsive or explosive psychopathy, characterized by changing and capricious moods, unexpected actions without consideration possible consequences, conflict, often accompanied by fights, especially when others condemn their impulsive actions. Outbursts of uncontrollable rage and cruelty arise. There is no planning for anything in advance and the ability to foresee future events. The ability to work sustainably only comes with reward. The tendency to create tense (unstable) relationships with others can lead to emotional crises and be complicated by threats of suicide or self-harm.

Histrionic personality disorder, demonstrative psychopathy, is manifested by disharmony of personality development in the presence of pronounced signs of childishness. Hysteroids are distinguished by a thirst for attention, exaggerated emotions that create the impression of depth of experience, theatrical behavior, suggestibility, subordination, superficial, violent and changeable emotionality, and a thirst for recognition. They strive for activities that would not weaken interest in them, are overly concerned about their physical attractiveness, and are prone to demonstrative attempts at suicide.

Psychasthenic personality disorder, anxious-suspicious psychopathy, characterized by indecision, a tendency to doubt, preoccupation with details, order, the desire to do everything the best way, which often prevents tasks from being completed. A psychasthenic is overly responsible, inappropriately concerned with the productivity of his activities to the detriment of pleasure, unusually pedantic, committed to social conventions, stubborn, demanding of others that they do everything exactly as he does. He is constantly worried about his future. Obsessions often appear. Because of impatience, hasty actions are often taken when caution is required.

Anxious personality disorder, sensitive psychopathy, has features such as constant feeling tension and gloomy forebodings, ideas about one’s inability to live, lack of physical attractiveness and mental abilities. There is an excessive fear of being criticized or gossiped about, and a reluctance to enter into relationships without the certainty of not being rejected or ridiculed. Self-restraint in lifestyle to maintain a sense of security, avoidance of social or professional activities associated with many interpersonal contacts for fear of disapproval of oneself are also characteristic.

Dependent personality disorder, a conformist personality, is characterized by the need to have a guardian, shifting responsibility for certain changes in life onto others, limited ability to make everyday decisions, subordinating one’s own needs to the needs of people, the inability to make reasonable claims to those on whom one depends, the experience of helplessness in loneliness due to for inability to be independent, fears of being abandoned by someone with whom there is a close emotional connection.

Treatment of personality disorders . Medicines are used only in cases of decompensation to relieve dysphoria, anxiety, depression, increased excitability or impaired drives. For this purpose, aminazine (25-75 mg IM), tizercin (25-75 mg IM), seduxen (20-40 mg IM), neuleptil (30-90 mg), Sonapax (25-200 mg) are prescribed. mg), nozepam (30-60 mg). Medical and pedagogical measures must be combined with psychotherapy.

Clinical examination . Adolescents with moderately severe psychopathy belong to group D-3 and are examined at least 2 times a year. Severe psychopathy and decompensation states require treatment.

Expertise . Adolescents, depending on the severity of psychopathy and the presence or absence of decompensation, belong to the 5th or 4th health groups. Prevention should include corrective pedagogical measures and psychotherapy. With severe and decompensated psychopathy, a teenager cannot work in production. Teenagers with pronounced, non-compensable psychopathy are not fit for military service. Adolescents with moderately severe personality disorders and unstable compensation have limited suitability for military service.

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Pathopsychology of adolescence and youth. Psychological diagnosis of personality disorders and behavioral disorders (144h)

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Advanced training program curriculum
“Pathopsychology of adolescence and youth. Psychological diagnosis of personality disorders and behavioral disorders"

Name of modules and topics

Total labor intensity, h

By curriculum distance learning, hours

Independent work of students, h

Module I. Theoretical aspects of diagnosing personality disorders and behavioral disorders in adolescence and young adulthood

Modern classification of personality disorders and behavioral disorders in the ICD-10, DSM-IV and DSM-V systems

Situational and personal reactions, types of anomalies and deviations of behavior in adolescence and youth

Accentuations of character and psychopathy in adolescence and youth and their diagnosis. Basic diagnostic methods (PDO, Leonhard-Smishek questionnaire, MMPI, SMIL, method for determining personality type and the likelihood of personality disorders by J. Oldham and L. Morris)

Module II. Diagnosis of adolescent behavioral reactions and deviations

Diagnostics of protest and emancipation reactions (questionnaire “Severity of emancipation reaction in adolescents” (OVREP), questionnaire “Personal Protest Activity” (PAL)

Diagnosis of child-parent and interpersonal relationships of a teenager (ADOR “Teenagers about Parents” method, Interpersonal Relationships Questionnaire (IRE), methods for studying teenage loneliness)

Diagnostics for assessing risky behavior of adolescents in various areas (propensity for alcoholism and drug addiction, extreme sports, etc.)

Diagnosis of teenage extremism

Escape and vagrancy syndrome and its diagnosis. Abandonment and Vagrancy Scale

Module III. Diagnosis of anomalies and deviations of behavior in adolescence and youth

Aggression and aggressive behavior in adolescents. Diagnosis of teenage aggressiveness

Addictive behavior. Diagnosis of chemical and non-chemical addictions. Diagnosis of computer and Internet addiction. Diagnosis of codependent behavior

Auto-aggressive behavior in adolescence. Diagnosis of suicide risk

Eating disorder. Clinical questionnaires for anorexia and bulimia

As a result of studying under the program, you will receive a certificate

Additionally, you can receive a certificate of competence

License to exercise
educational activities

You can check your license on the website of the Federal Service for Supervision in Education and Science (Rosobrnadzor). To do this, in the “TIN” column, indicate the TIN - 3460061960 and click Search. There is no need to provide any other information.

Series, form number: 34Л01 0001081