Various psychopathy. Reasons for the development of excitable psychopathy

Psychopathy is a characterological pathology that is not characteristic of healthy individuals. Psychopathy is a marginal pathology located on the border between healthy and pathological mental functioning. It is easy for these people to assert themselves in the aspect of their profession. But in interpersonal relationships they are despotic, it is not easy to live with them, because they are often unbearable. Many people have psychopathological tendencies that do not fully manifest themselves as full-blown psychopathy.

It is impossible for psychopathic individuals to take root in human society; they manifest their own negativity to the extent to which they are allowed, depending on the environment. These individuals often commit crimes, which often brings them into contact with forensic psychiatrists. Psychopaths skillfully pretend to be innocent, willingly using their illness.

What is psychopathy?

In scientific psychiatry, psychopathy is a relatively new phenomenon. However, she was always there, just before medicine made no attempt to define it. These were simply people with bad character. But medicine is developing and moving forward. Psychopaths were first discovered in a forensic examination in the 19th century, when a patient behaved in ways that made her unidentifiable. It was then that the term psychopathy appeared. The behavior of a psychopath is contrary to generally accepted normative laws. This is a borderline norm, while they are unsafe, capable of any profitable offer.

It has been proven that the human brain is programmed for empathy, because it contributes to survival. But psychopaths are non-empathetic individuals; for some congenital or acquired reasons they have lost the character traits that are responsible for this. At the same time, they still have cruelty. Characteristic traits should be expressed evenly, ideally, but with psychopathy some, mostly unpleasant, exaggerated ones, but good ones are only in embryo, if they exist.

Psychopaths, like accentuators, are people with an atypical psychiatric diagnosis. They are not in the ICD10, nor in the American psychiatric model. But at the same time, they are regulars in psychiatric hospitals, as they often commit suicide or some kind of crime bordering on the norm. The study of this problem is relevant in the context of crime, because psychopaths are quite common in a criminogenic society, and they are skilled liars, can decide to cause serious harm and are capable of talking to anyone.

A very common prototype of a psychopath is some kind of maniac who is very dangerous to society, and also cunning. But they often prove themselves to be quite successful, due to their cunning and lack of morality. These are good businessmen or actors, but higher feelings completely closed to them. If primary emotions, which did not evolve from animals, are inherent in them, then the higher ones, responsible for care and love, are completely absent. The fascinating fact is that if a psychopath is raised in the right environment, quite strictly and in the context of the right manners, then his psychopathy will not manifest itself. But only for a moment, until everything in his life is relatively safe. With psychopathy, behavioral and emotional maladaptation is expressed, so a person cannot change his behavior or act correctly. Thus, when he finds himself in a bad environment, his inclinations manifest themselves with impressive force.

At the same time, these people’s intelligence is very developed, and they also think very unconventionally. Their vision of the world is unusual. Unfortunately, their bad character is not always able to allow them to open up. Sometimes it's upsetting to think about why unconventional talent always has some flaws. But in general, humanity is still unable to form only one type of behavior, and this is good. After all, our evolution is possible only with our maximum diversity and distribution. Therefore, at this stage it is important to study different people, understand the reasons and what can be useful from this, and only then judge. Psychopathy is a special form of thinking that remains with a person forever.

Causes of psychopathy

Psychopathy has not been studied enough to say exactly which cause is the most determining. The formation of psychopathy is influenced by many factors, but one of them is always the trigger, influencing to a greater extent. If psychopathy accompanies a child from birth, then this is its constitutional form. This form is genetically determined, it is a nuclear form. At the same time, by correctly influencing the child, parents are able to prevent this trait from germinating. That is, genetic influence in this form is a key factor, but external attitudes can aggravate the situation or, conversely, increase successful person. In this case, biological reasons are decisive. There is even a constitutional division for this type of psychopathy. If parents are alcoholics and the nervous system is underdeveloped, this problem can also manifest itself.

Psychopathy due to organic causes is trauma that can come from childhood. These reasons include intrauterine diseases, birth injuries and early injuries before the age of three. A separate subgroup distinguished in organic pathology is brain damage by various environmental pollutants, severe infectious diseases that have the clinical manifestations of encephalitis and meningitis. Increased background radiation and serious poisoning also affect the brain. All these factors lead to brain changes that provoke mental changes. But if external factors are added to these reasons, then the pathology takes on a different course and this form is already called mosaic. With her, the more expressively they showed organic reasons, the weaker the external factors will manifest themselves.

Another type of psychopathy is regional. In this case, the role of organic pathology is absent, and all pathology develops due to the environment in which the child grows and is formed. In this case, the environment of its development most influences psychopathy.

Often serious illnesses may be the root cause or severe stress. Psychopathy in children often manifests itself in pathological relationships in the family and society, because children are very vulnerable. Psychopathy in adolescents occurs when abnormal development some characterological traits, volitional, or in the pathology of emotions.

Often, psychopathy can be hereditary, but this is a controversial issue. After all, a person suffering from psychopathy with the problem of manifestation of higher emotional characteristics, will have a hard time raising someone who is not a psychopath. Therefore, it is not worth talking unequivocally about genetic inheritance.

Personal psychopathy from the psychoanalytic side may be due to irrational family upbringing. With improper upbringing from childhood, psychopathological traits develop very quickly. There are four types of upbringing that contribute to the subsequent formation of psychopathy, these include overprotection, while parents constantly impose their position on the child, he cannot develop, and is not capable of independent actions. With hypoprotection, parents absolutely do not care about their child; they are not interested in his upbringing and achievements. When raised as an “idol in the family,” the child is overpraised, he does nothing, and cannot adapt to society. “Cinderellas,” according to their characters, feel unloved. They are constantly compared to other children and humiliated. Without knowing affection, a person subsequently shapes his behavior in this way.

Psychopathy: signs in men

Psychopathy is a personality-abnormal register-syndrome. Such men have a pathology of the higher nervous system. These individuals are unbalanced and exhibit emotional lability. Their behavior is demonstrative and inappropriate. Such men are absolutely unpleasant. Depending on the form of psychopathy, their behavior may differ, but all have emotional instability. A person has unstable volitional instincts, while intellectually - without pathology. Because of this, men develop behavioral disorders, even antisocial.

The causes of psychopathy in men are similar to the common ones ordinary reasons. Male psychopaths are terrible liars; when you try to find out something, you cannot get a word of truth out of him. They pretend all the time, and when necessary, this is a very masterful pretense. Moreover, they are hypocrites. Due to the fact that they do not feel higher emotions, but have a little psychological sense, they have learned to very skillfully manipulate others, in particular their relatives. They do this by pretending. They feign pity, love, tenderness, sympathy, while they are absolutely “parallel” to them, even to those closest to them. They show coldness emotionally and are quite immoral. If they have any serious relationships, it is only so as not to catch the eye and not significantly separate themselves from society.

The family of a psychopath suffers greatly; their companions may be subject to chronic family violence. Marriage to a psychopath creates deep, incurable personal traumas. And such relationships will only lead to pain, and even often involve them in lawlessness.

Psychopathy in children, particularly boys, manifests itself very early, and they have disharmonious behavior. Psychopathy in adolescents, particularly young men, is already germinating and taking root in antisocial behavior. They often end up in colonies and do not leave penitentiary institutions for a long time.

Very often they fail either educationally or professionally. But this is not a pattern; with the right parental control and influence, psychopaths can adapt perfectly. Such men are excellent businessmen, managers or organizers, the main thing is that sadistic tendencies do not manifest themselves, otherwise the staff will have a hard time.

For men, psychopathy is not a death sentence; these individuals can be very useful to society. It is important to choose the right levers of influence. A psychopath will not break the law or any rules if he knows that he will get what he deserves for doing so. Thus, it is very important to put them within strict bounding boxes. With such a strong influence, these individuals are very respectable members of society.

Psychopathy: signs in women

Many sexists are very fond of saying that every existing woman is a psychopathic person. And, who knows, maybe they met only psychopaths along the way. But in the general population count, there are fewer psychopathic women than men. Undoubtedly, there is a possibility that women are less examined from this perspective. Because male psychopaths are a common contingent in prisons or during psychological examinations at some jobs, when joining the police, law enforcement agencies. But women are more prone to slightly different manifestations of psychopathy. In principle, they are examined less for such problems.

Such women are disharmonious. They express themselves in egocentrism. They are very hot-tempered. At the same time, they can act immorally. They have poor emotional control. This can subsequently lead to various forms. Female psychopaths are generally very melancholic and often feel sad.

Psychopathic women are also residents of the penitentiary system, but less violent. It is easier to rehabilitate them, and the percentage of crimes they commit is lower.

For women, the reasons do not vary much, but in general they are more susceptible to the external environment. A family of alcoholics is dangerous for them, as well as organic pathology. Upbringing can also leave its unpleasant imprint.

Such women are great actresses and can therefore manipulate very well. In general, the psychopath is indifferent to her family and is quite callous. These women do not agree to put up with the rules of the public. Their irresponsibility reaches the extreme; they live only to please their own person. They often conflict with everyone and like to impose their own conditions.

Depending on the type of psychopathy, they are either great actresses who can act out any performance, or they are also selfish people who don’t care about anything. But there are also closed, apathetic psychopaths who cannot be understood at all. Severe inhibition or severe dependence is also considered a form of psychopathy. Such women impartially influence the upbringing of their children, which leads to the formation of psychopathic children.

Psychopathy in adolescents has a number of age-related crises, for example, puberty, while in girls it is very pronounced, and in older age it may undergo compensation. Psychopaths in puberty often wander and try to leave home. Antisocial behavior usually appears after the first ten years of life. Such women often attract psychopathic men and often become alcoholics, especially in comparison with the fair sex who are relatively free of mental disorders.

A characteristic feature is also the hypersexuality of psychopaths, while they have no remorse or shame, thus they are not repulsed by practically any perversions. But there is a note: everything again depends on upbringing, because within strict limits, they may not show this.

Symptoms of psychopathy

No matter what type of psychopathy a person suffers from, there are always common symptoms. Thus, there is a violation of personal harmony, which disrupts behavior. In turn, pathological behavior affects personality adaptation. Psychopathy is formed in kindergarten, but compensation can occur over time. This is a very positive outcome, in which the individual will prove to be absolutely healthy in the future. But, if decompensation of psychopathic personality traits occurs, then psychopathy will manifest itself, fully revealing itself.

A psychopath is not socially adapted as a professional; he also cannot occupy a suitable niche. To diagnose psychopathy, you need to talk with the person and his family. Personality psychopathy can be assumed if three of the above symptoms are identified.

To clarify the cause and diagnose regional, mosaic or organic psychopathy, it is necessary to exclude injuries and infections. Ask relatives of the alleged psychopath about his upbringing. But, if these are the parents themselves, you need to be as correct as possible. You should definitely clarify how the pregnancy progressed and whether any illnesses or difficulties arose.

From instrumental examinations you need to do an electroencephalography in order to discard the presence of organic matter. The brain during life is best examined on an MRI, because it is known that psychopaths have pockets of less involved cortex in their brains than healthy individuals.

Among laboratory research methods, it would not be superfluous to do blood tests and tests to detect viruses. After all, infection also leads to the development of psychopathy.

The first psychopathic signs appear in kindergarten. Since childhood, such a child does not show sympathy, even to his relatives. They are often cruel to other children and animals. If a child is naughty, then he does not repent, like most children, he has no conscience.

IN adolescence these individuals cannot enter society. They act antisocially, often stealing and drinking. Thus, psychopaths are registered with the police from a young age. Such children violate parental prohibitions, commit thefts, wander, never ask for forgiveness, and are not tormented by their conscience. They absolutely do not worry about school grades for any reason. Regardless of the consequences, they never draw conclusions or change their line of behavior. At the same time, they strive for dangerous actions without fear of punishment. These children are manipulators and strive to destroy their personality. Often asking parents, you can hear about a difficult character. It makes sense to ask in more detail, because... this is the possible origin of psychopathy.

To identify this pathology, consultation with a psychologist using tests to identify psychopathological characterological characteristics and accentuations will help.

Types, forms and types of psychopathy

Psychopathy, according to the classification, has 3 degrees of severity:

Severe psychopathy, third degree. Compensation is very weakened if it occurs, and often its partial only aggravates the situation. Compensatory intervals are always not fully expressed and are very short. Even minor reasons provoke complete decompensation, and sometimes there is no need for a reason. Sometimes the line between and psychopathy cannot be determined, a person is so angry and depressed. It may even manifest itself as twilight states. These individuals are completely unable to establish normal family relationships; they often turn into stalemate dependence. There is no self-criticism.

Severe psychopathy, second degree. Compensation mechanisms are unstable, which leads to short-term compensation. Decompensations form for the slightest reasons. They are not fully adapted either to society or to the family. They often change their attitude towards any employment. They have unfulfilled abilities and have strong conflicts with relatives.

Moderate psychopathy, first degree. The compensation is quite impressive. Breakdowns only occur in certain situations, and how they manifest and for how long depends on the hurt or trauma caused. When the traits of a psychopath become more acute and adaptation with others and family is impaired, one can think about decompensation. Bad behavior, however, often does not go to extremes. Social adaptation is unstable, but within a certain range of interests of a psychopath, productive work is absolutely possible. Family relationships are not harmonious, since the personality is completely different from each family member. With some types of psychopathy, criticism remains and the person is able to evaluate his character, although sometimes selectively.

The types of psychopathy are as follows:

Asthenic psychopathy is characterized by severe shyness, shyness, and indecisiveness. These individuals have been very impressionable since childhood. They adapt very poorly to a different atmosphere. Imagination and sensitivity manifests itself not only with mental stimuli, but also with the slightest force load. They are strongly focused on personal well-being. Quite painful, sensitive to the weather, weather sensitive.

Psychasthenic psychopathy is expressed in constant indecision and doubt. Such individuals are shy. They are very vulnerable, timid, but their level of pride is simply off the charts. They are quite strict with themselves, engage in introspection, and are self-critical. This is an area where close contact between psychopathy and neuroses is inevitable. The fears of a psychasthenic are always addressed to the future. They come up with rituals that will save them from upcoming troubles. They cannot tolerate any changes. Often, as another form of defense, pedantry and diligence arise.

Schizoid psychopathy, when manifested expressively, can lead a person to lack jurisdiction. Deprivation of intuition and inability to worry cause the coldness of schizoids. They do not have the ability to persuade with their own judgments. The inner world of schizoids is hidden from any external interference. Only a select few are privileged to learn a little about the schizoid. The inner consciousness of schizoid individuals is filled with hobbies and various fantasy images. At the same time, the wealth of the inner world depends on intellectual characteristics and talent. Schizoid psychopathy can lead a person to self-sacrifice.

Paranoid psychopathy is characterized by stubbornness, straightforwardness, and a narrow range of hobbies. Such individuals harbor extremely valuable ideas. Such individuals often write complaints and report. The craving in the battle for justice is transformed into a very unpleasant form with conflict. They believe that their opinion is the most important. They closely monitor their health.

Excitable psychopathy is manifested by extreme irritability. At the same time, such people are quick-witted, but do not draw conclusions. They are deceitful, vindictive, and at the same time flatterers and sycophants. There may often be disturbances of instincts, especially intimate ones, and drives; they wander. Murderers and perverts are identified among them.

Hysterical psychopathy occurs from an early age. These little ones do not tolerate praise from others. They willingly demonstrate their talents and love praise. These individuals have suicidal demonstrative tendencies. Their habits are demonstrative and theatrical. They embellish any incident in life, talk about themselves painfully, and are very self-centered. They love to participate in gossip and be the center of attention.

Affective psychopathy manifests itself in constant changes in mood, or a person has a pathological mood. Hypothymic psychopaths are always sad and dissatisfied with everything. Life does not make them happy, which often leads them to search for easy pleasures. And cyclothymic psychopathy is manifested by invariably elevated mood. These individuals are sociable, make friends easily, and can carry on a conversation. They are efficient, but irresponsible and not picky about sexual intercourse.

Unstable psychopathy is manifested by a high level of obedience of the individual. These individuals are easy to inspire, no matter what. They are susceptible to external factors. They agree with everything and please, but at the same time they do not fulfill their words. Such people do not have a strong-willed core, and everything in their life depends on their environment.

Personality psychopathy also has a mixed form. In this case, several types of psychopathy are combined in a varied manner.

Treatment of psychopathy

For correct selection medical advice from a psychiatrist is important. The surrounding background plays an important role in a psychopath. With the right upbringing and social influence, psychopathic traits are softened. It is important for a psychopath to find a job, because social significance always refrains from impartial actions. Psychotherapy has a very good effect on psychopaths. It will help a psychopath understand himself, decide on his life goals and discard many of the inadequacies in his character. Also, such individuals are affected by transactional analysis, which helps the individual determine his ego state.

If drug treatment is unavoidable, it is used depending on the type of psychopathic personality. Triftazin 2.5-5 mg/day, Aminazine 0.3-0.6 g/day for hysterical reactions, preferably in minimally effective dosages for hysterical manifestations. If the patient is angry, then Haloperidol 0.5-2 mg/day and Tizercin 0.025-0.1 g/day. In case of inappropriate behavior, Sonapax helps well - 25 mg/day.

Until recently (more precisely, until the tenth revision of the classifier of diseases), both neuroses and psychopathy were considered within the framework of borderline mental disorders.

In the latest International Classification of Diseases, the usual borderline categories have been replaced by the collective term “personality disorders.” Pathological personal characteristics of a particular individual that bring suffering to himself or the society in which he resides are classified as psychopathy. Note that we are talking about anomalies, not character traits.

Psychopathy is an unsanctioned name for the condition of a specific anomaly of human character. Psychopaths are often called people who are excitable, who react inappropriately sharply to events that are unpleasant for them, and who are not always able or willing to control their behavior. They cannot critically evaluate their not always adequate actions and look at them from the side of other people. However, such behavior can be the result of serious errors in upbringing and in a completely healthy person.

Is psychopathy a disease or a character?

For a long time, psychiatry ignored antisocial disorders; they were dealt with by criminologists and the judiciary. Psychopaths who did not break the law were considered people with difficult characters.

The term “psychopathy” itself means “a disease of the mind,” however, most experts do not consider it as a common mental disorder.

Psychopaths think rationally and are well oriented, their actions are sane, they know perfectly well what they are doing, however, such actions are incompatible from the point of view of an ordinary person with a sound mind.

French psychiatrist F. Pinel, two centuries ago, describing the behavior pattern of a psychopathic personality, called psychopathy “a mental illness without insanity.”

Psychopathy was perceived as a disease of the soul a long time ago, back in ancient times, but it was studied seriously in the second half of the last century, and with the advent of new diagnostic methods that allow scanning the brain, the development of genetics and neurobiology, it became possible to study the biological basis of antisocial behavior.

Does not progress in psychopathy mental retardation, psychotherapist sessions allow patients to hone their ability to manipulate people. Psychopaths can perfectly hide their main mental anomaly - lack of empathy and absolute egocentrism, and do not dwell on it. Psychopathy is more difficult to recognize than other mental disorders. Until now, the court has not been lenient towards these people, generally rightly considering that they are capable of being aware of their actions.

Currently, personality disorders are classified as mental illnesses, however, the line between illness and normality is very thin. It is believed that they are based on some distortion in the development of the central nervous system, often not obvious, which was influenced by unfavorable external stimuli.

Pedagogical errors alone are not enough to cause the formation of psychopathy. Explosive temperament and antisocial behavior are not grounds for classifying a person as a psychopath. For accentuated individuals, whose deviations from the norm are sufficiently compensated and do not reach a pathological level, the diagnosis of a psychotic disorder is also considered inappropriate.

So psychopathy is a disorder of higher nervous activity, which means it is still a disease, usually manifested in a lack of balance between the processes of excitation and inhibition, a pronounced predominance of one of them.

Psychopathy is a whole group of personality disorders; there are many variants of patient behavior, depending on which different types of disease are distinguished. The development of psychopathy usually occurs under the influence external factors in people with hereditary or impaired activity of the central nervous system at an early age.

Among psychopaths there are many people who have a good education, successful career growth, they are called socialized. A specific feature of psychopaths is considered to be intellectual integrity and a lack of ability to empathize with both negative and positive emotions of another person. This painful condition is not characterized by a progressive course with personality degradation and the development of dementia. However, the normal intellect of a psychopath, under the influence of unfavorable external factors, is dissonant with his emotional and volitional sphere, which leads to social maladjustment, and acute mental trauma is fraught with serious violations of social foundations.

Psychopaths make up a significant group of people with criminal tendencies, which is facilitated by their one-sided perception of reality from the point of view solely of their expectations and the absence of higher moral qualities. Categories such as empathy, repentance, affection, love are unknown to them. Although, under favorable conditions, psychotic disorders practically do not manifest themselves, which is confirmed by the story of the American neuroscientist J. Fallon. But any deviation from the expected, the appearance of any problems often leads the patient to an emotional breakdown.

Epidemiology

Statistical information on the frequency of occurrence of psychopathy has significant discrepancies due to the lack of a unified approach among different authors to the identification of this disease.

Using the assessment criteria of the International Classification of Diseases, Tenth Edition, on average, approximately 5% of the world's population suffers from various types of personality disorders. Another 10% have individual psychopathic traits, however, they do not reach the diagnosis of psychopathy.

Psychiatric scientists give slightly different figures. They estimate that approximately 1% of the world's population meets clinical criteria for psychopathy, with the higher figures of 3 to 5% reflecting its prevalence in the business world, where psychopathic personality traits are much more common.

Among patients receiving psychiatric care on an outpatient basis, the proportion of psychopaths ranges from 20 to 40%, in hospitals - half of the patients with personality disorders.

In prisons, psychopathy is detected in 78% of male prisoners and half of female prisoners; other sources cite figures of 20-30% and 15%, respectively.

It is believed that there are much more psychopaths among men than among women, which is also confirmed from a genetic point of view. The gene for increased aggressiveness (MAO-A), located on the X chromosome inherited from the mother by a man, manifests itself 100%. Among psychopaths, 4/5 are men.

Carriage of this gene is much more common among nations where aggressiveness and belligerence among males is encouraged. Among African residents, the rage gene is found in 59% of the population, with indigenous New Zealanders (56%) and Chinese residents (54%) not far behind them. In the modern civilized world, aggressiveness has lost its high status - just over a third of representatives of the Caucasian race (34%) are carriers of the MAO-A gene.

Causes of psychopathy

There are several assumptions about the etiology of the formation of a psychopathological personality. The unity achieved is that the main impact of the hypothetical causes relates to the early period of development.

Among the reasons considered: the conception of an embryo with a hereditary predisposition; genetic modifications during this period; the influence of negative factors on intrauterine development; injuries received during childbirth or the early postnatal period, infections or intoxications that provoked inferiority of the central nervous system.

Researchers of this problem associate the strongest impact of external factors with critical periods early development– the moment of conception, the third and fourth weeks of pregnancy, the moment of childbirth and the so-called “fourth trimester” - the first three months after birth. For example, the mother is an alcoholic, a drug addict, or she is under constant stress due to intra-family conflicts; a child left by the mother in the care of the state, and similar situations.

Then, according to experts, susceptibility to unfavorable external factors decreases somewhat, however, before the child reaches the age of three, he develops complex adaptive behavioral skills. Therefore, stress factors operating at this stage of development disrupt the formation of a normal standard of behavior.

The psychodynamic concept, common in the UK and USA, is based on the teachings of Sigmund Freud. The leading role in the development of psychopathy is given to the disruption of the relationship between parents (guardians) and the child at the earliest stages of its development (again, up to three years), which provokes the formation of pathological complexes in the child, which are predominantly sexual in nature. Psychopathy in this case is considered as a defensive reaction of the body. The disadvantages of this concept are the inability to experimentally confirm this version, as well as a one-sided view of the problem. It does not take into account the influence of the social environment, that is, relationships within the family are analyzed in isolation.

Back in the 19th century, when the concept of “psychopathy” began to be widely used, doctors began to notice that members of the same family often had similar traits of a psychopathic personality, expressed to varying degrees. Even then, scientists became interested in whether psychopathy is inherited. Research identical twins, even separated in early childhood and living with different parents, they said that a hereditary predisposition still exists.

However, only the development of genetics made it possible to identify a specific type of genes encoding monoamine oxidase A, a catalyst for the biotransformation of neurotransmitters (adrenaline, norepinephrine, serotonin, melatonin, histamine, dopamine), which regulate mood and behavior. They are also called the “rage gene” or “warrior gene”, as well as the psychopathy gene; its carriers are distinguished by natural cruelty, selfishness, aggressiveness, and lack of empathy.

A person with such a genetic set will not necessarily grow up to be a psychopath, however, the atmosphere of cruelty and violence surrounding him from early childhood will complete the process of formation of psychopathy. But children, even with an unfavorable hereditary predisposition, who grow up in a warm family environment, where all family members love and care for each other, and parents strictly control the child’s behavior, become full-fledged members of society.

Canadian professor R. Hare notes that the processing of the emotional component in the brain of a psychopath occurs, as physiological MRI shows, differently than in a healthy person. His perception deficit affects everything emotional sphere, positive and negative. The part of the brain responsible for emotions is simply not activated.

Currently, psychopathy is divided into three main groups based on its origin.

Congenital psychopathy (nuclear, constitutional) is caused by hereditary predisposition. In these cases, one of the blood relatives exhibits character anomalies characteristic of psychopaths. Hypothetically, such qualities are inherited by daughters from both parents and sons from mothers, although the exact mechanisms of transmission of genetic information have not been identified. The MAO-A gene is located on the X chromosome, so males receive it from their mother, and since this chromosome is unpaired, its influence is fully felt.

Women have a pair of X chromosomes. Having inherited the psychopathy gene from one of the parents paired with a “pure” one, a woman practically does not feel its effect. The presence of the aggression gene on both chromosomes has not yet been studied.

Acquired psychopathy is divided, in turn, into organic and regional. The first, as the name implies, are a consequence of cerebral organ deficiency caused by the damaging effects of infectious agents, intoxication or brain injury during the period intrauterine development, infancy or early childhood.

The second type is acquired as a result of prolonged exposure to a very unfavorable pedagogical atmosphere surrounding the child in childhood and adolescence. “Unloved”, emotionally rejected children acquire asthenic character traits, total control and hypertrophied care leads to the development of psychoasthenia, permissiveness and unconditional admiration for the “family idol” form hysterical traits in the child, lack of control and reasonable restrictions, combined with parental indifference, contributes to the development of increased excitability . Regional acquired psychopathy develops at a later age than constitutional and organic ones; they are considered less stable and deep.

In the overwhelming majority of cases, it is not possible to attribute this antisocial personality disorder to any specific form of psychopathy, since the formation of abnormal personal characteristics occurs under the influence of a combination of a number of different unfavorable reasons.

Risk factors

Studies of patients with psychopathological traits, and scientists usually focus on individuals with extreme psychopathy, being in prison after committing criminal acts suggests that the likelihood of developing psychopathy increases in people:

• with a certain genetic makeup;
• with reduced activity in the temporal and frontal sectors of the brain membranes responsible for the ability to empathize, comply with ethical standards and social values;
• with intrauterine injuries;
• injured during childbirth;
• those who suffered brain damage at an early age (from birth to three years);
• pedagogically neglected, neglected or brought up in an atmosphere of permissiveness;
• exposed to a negative social environment.

Risk factors for the birth of a psychopathic child are considered to be a family history of syphilis, drug addiction, and alcoholism.

Substance abuse, in addition to other factors, accelerates the onset and aggravates the course of a personality disorder. Psychopathy and alcoholism are closely related, even the gene responsible for aggressive behavior is activated in the body of its carrier under the influence of alcohol. The activation of this gene is facilitated by cruel treatment of the child himself or by bullying and violence that he witnessed.

During age-related crises (periods of formation and involution), hormonal changes (puberty, pregnancy, menstruation, postpartum period), the likelihood of increased psychopathic manifestations increases.

Psychopathy is classified as a multifactorial pathology, the mechanism of development of which is different in origin.

Pathogenesis

To date, there is no single and generally accepted concept of the formation of a psychopathic personality.

But all scientists recognize the importance of the early period of development, including the moment of conception, when the unborn child can inherit a set of genes with a tendency to psychopathy, an unfavorable course of pregnancy in his mother, difficult childbirth and external interference in the natural genetic adaptation program for the formation of behavior that is normal from a universal human point of view, disrupting its progress. The mechanism is implemented in the first three years of a child’s life, when unfavorable external influences stimulate the consolidation of certain forms of behavior, which are consistent and persist throughout the individual’s life.

For example, there is a noticeable lag in the development of children raised from birth to two years in children's boarding schools (orphanages), with whom from the moment of birth there was no key attachment figure - a mother or a person who replaced her. The mother's antisocial behavior, her indifference to the child or, on the contrary, excessive care also increases the likelihood of primary mental personality disorders. In children with a hereditary predisposition, psychopathy sometimes manifests itself very early - at two or three years.

An important pathogenetic link is the social factor. Its independent role in the formation of regional psychopathies is also recognized. Also, against the background of unfavorable conditions, psychopathy is decompensated, while a favorable background contributes to the normalization of the individual’s behavior.

Age and hormonal crises contribute to the increase in psychopathic symptoms. The use of psychoactive substances provokes activation of the MAO-A gene.

The neurophysiological side of the mechanism of development of psychopathy is revealed in I. P. Pavlov’s concept of the types of higher nervous activity; from these positions it was considered by both Russian and Canadian scientists. Various types of psychopathological personality disorders stem from pathological incoherence nervous processes, signaling systems, interaction of the subcortex and cerebral cortex. The basis for the formation of psychopathy of the excitable type is the absence of inhibition processes; the psychoasthenic form develops with the predominant influence of the second signaling system over the first and weakness of the subcortex of the brain, and the hysteroid form, on the contrary, when the first prevails over the second, and also the cerebral cortex over the subcortex. The pathophysiological basis of the asthenic form of the disease lies in the weakness of higher nervous activity, and the paranoid one - in the tendency to form foci of stagnation in the second signaling system.

A number of already known and not yet studied factors influence the pathogenesis of psychopathy, and the result will depend on the degree of pathogenicity of each of them.

Symptoms of psychopathy

The first signs of psychopathy with a hereditary predisposition appear in childhood, sometimes quite early at two or three years. When raising a child in a supportive environment, pathological character traits are smoothed out. Compensated psychopathy is a completely acceptable phenomenon in society, although an individual’s tendency to unusual, often shocking behavior, causeless mood swings, and some hard-heartedness and recklessness is noted. However, socialized psychopaths find their place in society, often have families, children, and friends who evaluate them quite positively.

Behavior in psychopathy varies depending on its form and accentuation. However, experts from different conceptual areas identify three main features that are characteristic of all types of psychopathy, expressed to varying degrees:

• fearlessness, audacity - psychopaths have a reduced sense of fear and danger, combined with high resistance to stress, they are confident in their own abilities, have great perseverance and try to dominate in society;
• disinhibition – impulsive, easily given in to impulse, have a need to satisfy their desires “here and now”, without thinking about the consequences and not limited by generally accepted behavioral norms;
• meanness and heartlessness - incapable of empathy, they use any means, including violence, to get what they want immediately, they are prone to exploitation, disobedience, and manipulation of other people.

This triarchic model of behavior (the triad of psychopathy) is characteristic of people with a psychopathic personality.

Other researchers highlight the narcissistic tendencies of psychopaths, noting that they are almost always very pleased with themselves. Communication with other people comes down to their exploitation, manipulative actions, ignoring other people's interests and feelings. Disobeying a psychopath can cause a very severe aggressive reaction.

Personality traits such as psychopathy, narcissism and complete lack of principles, called the dark triad, have many common characteristics. To these negative traits is often added a tendency towards sadism.

Psychopathy in the psychiatric hierarchy occupy an intermediate place, delimiting last resort norms called character accentuation, which implies some more pronounced character traits of a person, manifested in connection with traumatic situations for a short time in the form of psychosis or neurosis, and progressive mental pathologies.

Personality psychopathy does not fit into the general boundaries of describing mental illnesses, so for a long time it was classified as a borderline painful state, not recognized as a disease, but a psychopath cannot be called a healthy personality either. Character accentuation and personality psychopathy are separated from each other by a ghostly line that even experienced psychiatrists cannot always discern. The main difference is the constancy of psychopathy, it accompanies a person all his life, while accentuation looks like accents on certain character traits that stand out more than others, and therefore are dissonant against the general background. These accents do not appear constantly, but under the influence of certain traumatic situations. Emphasizing certain traits does not prevent a person from leading a normal life in society.

Average psychological picture a psychopath looks something like this: at first glance, he is an enterprising, energetic, charming person who does not suffer from an inferiority complex; later such traits as cunning and the ability to manipulate others, deceit, callousness and callousness appear. This person never repents of his actions, does not feel guilty and does not regret anything.

In institutions and organizations, psychopaths, as a rule, are charming and efficient in front of their superiors, however, they are rude, insulting and aggressive towards employees below them in the hierarchical ladder. Their business skills are usually highly valued. Courage, the ability to take risks and quickly make decisions, sometimes non-trivial, from the point of view of an ordinary person, generally bring good dividends to psychopaths; manipulative abilities allow them to achieve a lot from employees and lead them. Although their unscrupulousness and lack of morality are assessed rather negatively, the harm caused by a psychopath occupying a high leadership level is considered to be much greater than its benefit.

Psychopathy in the family

Working with a psychopath is not easy, but it is much worse when a family member is a psychopath. There are no recipes, the best way is not to create a family with psychopathic personalities. A psychopathic husband will sincerely consider his wife and children to be his property, and much in the development of further events will depend on the conditions in which he grew up. A socialized psychopath will carry out his duties, raise children, support his family, simply because it is easier, more comfortable and convenient for him, and not because he loves his wife and children or feels responsible for them. However, even in this case, no one can guarantee that he will not break down; this person cannot be relied upon. And his wife will have to put up with many of her husband’s oddities.

A psychopathic wife is also not a gift, and in this case there is a connection with her upbringing. She will not love her husband and children, because she cannot, and she will also not have responsibility towards them. But a socialized psychopath can easily pass for a caring mother - doing homework with the children, taking them to extracurricular activities, playing games, and also playing the role of a devoted wife, especially if her husband meets her expectations.

Psychopaths, wealthy and socialized, prefer to communicate with older children; small children, requiring hourly care and presence, simply irritate them. If possible, such parents will try to shift the care of small children to a nanny, grandmothers or other relatives. Fathers who are “burning” at work usually command respect; mothers, businesswomen, and career women are also not uncommon in the modern world.

Much worse are antisocial psychopaths who grew up in an unfavorable environment, had a bad start in life and an unstable financial situation. At best, they will be indifferent to the child and will not pay attention to him; at worst, which happens much more often, they can abuse him physically and mentally, and even drag him into illegal actions.

Psychopathy in men has been better studied, since there are many more of them among psychopathic individuals, and they are also found in prisons, where research is mainly carried out.

The symptoms of psychopathy do not depend on gender, and the difference in manifestations is determined by its type, as well as by differences in society’s assessment of the behavior of men and women.

For example, if many authors, when describing female psychopaths, call them sexually promiscuous, then when talking about men, they mention many relationships, marriages or broken hearts, which in fact characterizes psychopaths of any gender as sexually active and, in their own way, attractive , as well as irresponsible and soulless manipulators who know how to get what they want at any cost, without thinking about the future.

And, you see, a female tramp and/or alcoholic also causes a slightly different reaction in society than a man leading the same lifestyle.

Psychopathy in women is characterized by less aggressiveness and the use of physical violence, which is simply typical for the female gender in general. They are much less likely to commit criminal acts in a state of passion, among them there are often kleptomaniacs, but in terms of psychological sadism, a psychopathic woman will give any man a hundred points ahead. In general, some experts believe that in fact there are no fewer female psychopaths, they just need to be assessed differently.

Psychopaths of any gender are egocentric; they are all guided only by their immediate desires, ignoring the interests of those around them and even those closest to them. A psychopathic mother in most cases represents serious threat mental health of her children, much more than a psychopathic father, because children, especially small ones, spend the bulk of their time with their mother in most families.

It is almost always noted that a psychopathic husband is a huge mental trauma for his wife, and often - a high likelihood of physical abuse.

Psychopathic women are also uncontrollable in family life. Lack of self-control, long-term goals, callousness and a tendency to abuse substances, deceit and meanness can ruin the life of any normal man.

The first signs of inherited psychopathy appear as early as two or three years of age. Young children are emotionally unstable, they lack a sense of pity for animals, peers and relatives, it is difficult to get sympathy and repentance from them for cruel acts. Basically, the first thing parents pay attention to is cruelty towards other children and/or animals, the desire to dominate, to command other children, to use force against those who disagree.

Psychopathy of preschool age is diagnosed according to S. Scott (Institute of Psychiatry, London) according to the following criteria:

• frequent insults towards others (regardless of person or relationship);
• regular attempts to cause pain to any living beings (prick, sting, squeeze, pull), older children try to exert moral influence;
• total disobedience, attempts to escape in order to disobey the rules;
• the child never feels guilty;
• adequate perception can be achieved only with the help of reward;
• for any failure the child blames others, never himself;
• does not react to comments and is not afraid of punishment.

It’s worth thinking about if children of senior preschool and primary school age constantly fight, take other people’s things without asking, or try to set fire to or blow up something.

The real storm hits parents when their children reach adolescence. They are rude, run away from home, do not want to obey, and cannot be intimidated by any threats. Teenagers do not feel their guilt and responsibility, reacting violently to punishment. Psychopaths are not interested in the feelings of other people at any age.

It is teenagers who most often start having problems with the law; they may start drinking, taking narcotic drugs, to commit crimes.

Psychopathy in adolescents occurs in a severe form; this is a critical age of hormonal changes and personality formation. It is during this period that it is most difficult for parents to cope with a psychopathic child. Basically, of course, such children are characterized by increased excitability, stubbornness; there may be sharp transitions from fun to a depressed state, hysteria, tearfulness and even fainting.

The transition to adolescence can be marked by so-called metaphysical intoxication - attempts to solve some complex insoluble problems and thus make humanity happy.

After approximately 20 years of age, compensation for the condition usually occurs; in successful psychopaths, the mood stabilizes and adaptation in society occurs.

Stages

Despite the fact that psychopathy is not characterized by progression, like other mental illnesses and diseases in general, it has its own dynamics. It is not a static state, it is evolving and has certain stages of development.

The prepsychotic stage takes quite a long time. Constitutional (nuclear) psychopaths go through the formation of psychopathic character traits in childhood and adolescence; the pathology acquired in adulthood also goes through a prepsychotic (subclinical) stage, in which clinical symptoms are not yet sufficiently pronounced.

In psychopaths, two states are distinguished: compensated, when the individual is at peace with society (usually achieved through the comfortable conditions of his existence), and decompensated, when a pathological psychogenic reaction develops (decompensation most often occurs due to adverse influences from the outside). For each type of psychopathy, different factors have a decompensating effect. And reactions can also be unambiguous to the type of psychopathy; these do not last long - sometimes several hours, sometimes several days. After very significant mental trauma, decompensation may occur, manifesting itself in the form of a reaction that was not previously dominant in a given individual, for example, asthenia in an excitable psychopath or, conversely, a depressed person will exhibit an explosive temperament.

Ambiguous structural changes in the character of a psychopath are usually longer lasting, but still reversible when the causes that caused this condition are eliminated. The symptoms of such shifts are represented not by psychotic symptoms, but by characterological reactions - for some time the individual may be consumed by some passion, he may develop a condition unmotivated aggression, hopeless melancholy, the desire to commit suicide. If the traumatic situation is not resolved, the reaction can become protracted, become entrenched, and over time severe psychopathy develops.

Regardless of the type of psychopathy, they develop according to the same cyclical scenario. The personality anomalies of a psychopath lead to the creation of a conflict situation, as a result of which the patient develops a psychopathic reaction that lasts for a more or less long time. After its completion, a worsening of psychopathy is noted.

Complications and consequences

The danger for society and the psychopath himself is posed by decompensation of psychopathy, leading to an increase in personality anomalies that impede natural adaptation in society.
The clinical course of decompensation looks like an exacerbation of an individual’s abnormal personal qualities, specific to a particular type of psychopathy - hysterical fits, affective tantrums, depression, hypochondria, acute delusional syndromes, reformism, litigiousness.

Psychopathy develops throughout a person’s life; the influence of society plays a huge role in its dynamics. Favorable – helps smooth out psychopathic manifestations and compensate for them. On the contrary, under the influence of many constant unfavorable factors, an antisocial personality is formed, which can cause significant damage to society.

There are no complications with a personality disorder - a person will live with it all his life. However, over time it can both smooth out and worsen. Frequent decompensations aggravate the course of psychopathy, which can greatly worsen the quality of life of the individual himself and become a specific threat to his life or the people around him. Often there are various forms of attacks of aggression and antisocial behavioral reactions on the part of psychopaths, some are quite harmless, others can pose a real danger. It is not for nothing that in places of deprivation of liberty, psychopaths make up from a third to half of all prisoners.

Fluctuations in hormonal levels - adolescence, pregnancy, menstruation, menopause, as well as crisis age stages - contribute to decompensation of the disease and aggravation of its course.

Adolescence is considered especially dangerous, when, in addition to hormonal changes, maturation and personality formation occur. During this period, individuals with psychopathic traits become more stubborn, unwilling to obey, and impulsive. Adolescents are characterized by emotional instability - unmotivated transitions from bursts of fun to tearfulness, depression, sadness; outbursts of rage or aggression for no reason, hysterics, tearfulness, fainting. Teenagers often run away from home, begin to wander, and lead an antisocial lifestyle.

Stormy puberty is often replaced by philosophizing, reflection, and metaphysical quests. After 20-23 years, successful psychopathic individuals usually begin a period of compensation, the personality is socialized and the character becomes more balanced.

During the period of decline of sexual function, psychopathic personality characteristics become aggravated again, emotional balance is disturbed, the individual becomes more impulsive, angry, irritable and/or whiny. When involution coincides with a change in lifestyle, for example, retirement, decompensation of psychopathy can worsen: anxiety, depression, depression appear in combination with hypochondria and hysteria, and litigiousness and conflict increase.

Diagnosis of psychopathy

Methods for studying patients with personality disorders include a variety of studies. Firstly, socially maladjusted individuals usually come to the attention of specialists in the field of psychiatry. Socialized psychopaths who have no problems adapting to society are quite satisfied with themselves, and they themselves and their families never seek medical help. Long-term decompensated psychopathy is noteworthy, but in order to establish a diagnosis of a personality disorder, it is necessary to exclude general somatic causes of mental disorders.

To do this, laboratory tests are carried out to give an idea of ​​the patient’s general health, and some specific tests may be prescribed.

Neurophysiological research includes encephalography - magnetic, electrical, neuroradiographic - various types of tomography, the most informative and modern of which is functional magnetic resonance imaging, which allows assessing not only the structure of the brain, but also the course of metabolic processes and blood flow.

The diagnosis of psychopathy is made on the basis of conversations with the patient, during which psychiatrists and psychologists, using a set of specific techniques and methods, identify mental disorders of a person.

Psychiatrists conduct a clinical conversation and are guided by the criteria of the latest edition of the classifier of diseases to make a diagnosis.

A medical psychologist uses various tests and interviews in his work to identify a symptom complex - a stable combination of positive and negative features psyche existing as a single whole.

When diagnosing a personality disorder, the Minnesota Multidimensional Personality Test is used; its adapted version, the Standardized Multifactor Personality Study, is popular in the post-Soviet space. These questionnaires have clinical scales that allow you to establish the type of personality disorder - to identify the patient’s proximity to a certain personality type (paranoid, asthenic, schizoid), the degree of gender identification, anxiety and tendency to antisocial actions. Additional scales allow you to assess the patient’s sincerity, as well as correct his unreliable answers.

The Psychopathy (Sociopathy) scale, the fourth scale on the Minnesota Multifaceted Personality Test, assesses the test taker's similarity to antisocial personality disorder. High scores on questions on this scale indicate the individual’s inability to live in a society of his own kind. They characterize test takers as impulsive, angry, conflict-ridden, and not following the moral and ethical rules accepted in human society. Their mood is subject to fluctuations, they are very susceptible to insults, reacting aggressively to the offender and losing control over their behavior.

R. Hare's test for psychopathy is very popular; the questionnaire includes twenty main characterological traits of a psychopath. Each item is worth a maximum of three points; if the subject receives more than 30 points, he is predisposed to psychopathy. The questionnaire is accompanied by an interview in which the test taker outlines his biography: talks about education, places of work, describes his marital status and possible conflicts with the law. Since psychopaths are notorious liars, interview data must be documented. The R. Hare test was designed to detect psychopathy in people who have committed criminal offenses, although it can be used in other cases.

In psychiatric practice, various assessment methods are used to determine the patient’s self-esteem, the quality of his relationships with other people, cognitive functions, the level of perception, attention, and memory are studied.

The basis for recognizing a person as a psychopath are the following Gannushkin criteria for psychopathy:

• stability (stability) of abnormal character traits, that is, they accompany the patient throughout his life.
• the psychopathic feature is comprehensive, that is, it completely determines the characterological structure of the individual (totality);
• pathological anomalies of character are so noticeable that they make it difficult, if not completely impossible, for the individual to adapt to life in society.

The same P.B. Gannushkin notes that psychopathy is characterized by certain dynamics (strengthening or weakening of a personality disorder). And the environment has the greatest influence on dynamic processes.

In general, the diagnosis of psychopathy is quite complex, people are examined using different methods, because psychopathic symptoms can be observed after injuries and intoxications of the brain, with endocrine disorders, and also - manifestations of decompensated psychopathy resemble obsessive-compulsive disorders, schizophrenia, and psychosis. Only an experienced doctor can differentiate psychopathy from other pathologies.

For self-diagnosis, people who suspect psychopathy in themselves or their loved ones, but have not yet broken the law and have not consulted a doctor, can be tested, for example, using the M. Levenson Psychopathy Questionnaire. The questionnaire items represent different statements, and the test taker evaluates his attitude towards them on a four-point scale. Primary psychopathy is interpreted as a lack of empathy for other people (heartlessness), secondary - as an impulsive reaction to events.

Dante's test for psychopathy is also requested on the Internet. It does not specifically answer whether you have a mental disorder. And other self-diagnosis tests cannot replace a trip to the doctor.

Differential diagnosis

Pathological anomalies in psychopathy should be total and stable in nature, and individual, albeit noticeably expressed, character anomalies that do not reach the level of pathology are classified as accentuated character traits. The types of accentuations correspond to the types of psychopathy, however, accentuations usually appear temporarily, under the influence of a traumatic factor, during the period of growing up, are later smoothed out and do not lead to maladjustment in society. The differences between accentuation and psychopathy, according to many authors, are precisely quantitative in nature and lie in their dosage, which is not perceived as pathology.

Differentiation of personality disorder is carried out with psychopathic states after brain injury, infections and intoxications with damage to the central nervous system, endocrinopathies and other diseases. One of the criteria for distinction is the fact that before the appearance of a psychopathic-like state due to illness or injury, the personality developed quite normally.

They also differentiate constitutional or nuclear psychopathy with marginal, that is, psychogenic and pathocharacterological developments that can occur at any age under the influence of psychotrauma. They are distinguished from congenital ones by a clear onset; in the first case, a personality disorder is noticed from early childhood. The abnormal character traits of a psychopath are characterized by their constant presence.

Sociopathy is also highlighted as a result of the influence of unfavorable living conditions and differentiates from nuclear forms of psychopathy, leading to the development of antisocial attitudes in the individual.

Affective psychosis and some of its manifestations resemble decompensated affective psychopathy, however, upon completion of the affective phase, patients experience intermission of psychosis and all mental functions are normalized. Whereas psychopathic personality traits are not completely smoothed out even during the period of compensation. Affective phases - depressive, manic, manic-depressive - last no less than one or two weeks (sometimes several years), occur periodically and spontaneously, completely disrupt the patient’s lifestyle and necessitate seeking medical help.

Intellectual disability and psychopathy have many common features, in particular, in their pathogenesis there is underdevelopment of the frontal and temporal lobes, and in their manifestations - infantilism of thinking. Both of them belong to borderline states. However, in patients with personality disorders, cognitive functions are not impaired and, according to the Wechsler test, the intellectual level is often even above average. The most difficult thing is to differentiate psychopathy from intellectual disability caused by pedagogical neglect. In such individuals, intellectual deficiency may well be combined with psychopathic personality traits.

Paranoia in a mild form is considered by modern psychiatry as a paranoid personality disorder; the symptoms in this case are no different. With the progression of the disease and transition to delirium with disturbances of rational activity, the state accompanied by hallucinations is interpreted as an isolated delusional disorder. Main clinical criterion differentiation is based on the time of onset of the disease. Paranoid psychopathy is usually constitutional and the first signs of abnormalities appear at an early age; a progressive endogenous disease is characterized by late manifestation (often after 40 years).

Narcissism as a character trait is inherent in psychopaths in general; their egocentrism, narcissism, inflated self-esteem, and often sexual deviation are considered in the symptom complex of psychopathy. However, by itself it is not sufficient for diagnosis. Character accentuation can be narcissistic. Psychiatrists distinguish between normal and pathological or grandiose narcissism, the latter being considered the prerogative of psychopathic individuals.

Empathy is the ability to determine the mood of another person, sympathize with his experiences, and “tune in” to the same wavelength as him. It is believed that this property is unknown to psychopaths; this is one of the main characteristics of psychopathy. People can have different levels of empathy, but psychopathic individuals lack this ability, regardless of any type of psychopathy. Cyclothymics or affective psychopaths, who are able to sense the mood of others, in the new classifier already belong to patients with mild forms of manic-depressive psychosis. They are no longer classified as psychopaths.

Schizophrenia is characterized by the presence of mania, delusions, hallucinations, auditory and visual. Schizophrenics have incoherent speech, poor emotions, a sloppy appearance, and inappropriate reactions and actions. However, such symptoms are typical for severe schizophrenia. And the sluggish process is practically indistinguishable from schizoid psychopathy. The progressive course and, as a rule, later manifestation of schizophrenia will be its main difference from schizoid personality disorder.

Neurosis, like psychopathy, was previously considered as a borderline state between normality and mental illness. In modern American classifiers this term has already been abolished.

P.B. Gannushkin believed that neuroses and psychopathy are mutually related, their symptoms and causes overlap with each other. In decompensation, the leading role is given to psychogenic causes; there is no progression of dementia, delusions and hallucinations. Both disorders are reversible.

With neurosis, there is usually a close connection with the stress factor and the appearance of neurosis. Before this event, the patient was absolutely normal, while the psychopath always showed strangeness. Timely treatment of neurosis helps to normalize the patient’s condition, whose personality structure is normalized.

Psychasthenia or, in modern reading, obsessive-compulsive or anxiety disorder (ICD-10) defines a mentally weak personality type with an intellectual mindset.

Psychoasthenic psychopathy mainly manifests itself at an early age and accompanies a person throughout his life, and acquired disorders manifest themselves after psychological trauma, and after treatment the patient’s nervous system is usually restored.

Treatment of psychopathy

Psychopathy in the stage of decompensation is almost always accompanied by social and personal disadaptation. It is during such periods that it is necessary to help the patient find stable ground under his feet.

The preferred method is to provide psychotherapeutic assistance. Psychotherapy for psychopathy is carried out with the aim of correcting an individual’s personal attitudes and compensating for abnormal characterological deviations, developing in him an understanding of the need to comply with moral norms and rules in relationships with other people, as well as intensifying aspirations for productive activity.

Compensation for psychopathy

The doctor selects the method of working with the patient individually, based on the type of personality disorder and the degree of decompensation. The course begins with individual lessons with a predominance of activation of rational attitudes. Classes are conducted in the form of explanations and discussions.

Methods based on suggestion (hypnotic sessions, auto-training and others) are used with great success in the treatment of hysterical forms of psychopathy, although in this case the improvement is short-term.

From individual sessions they move on to group sessions - where patients learn to build relationships on the principles of universal morality, establish contacts with each other, and participate in role-playing games.

Family sessions are held to help normalize relationships between family members, find compromise solutions, and achieve mutual understanding.

Treatment with medications is not recommended, however, in some cases it cannot be avoided; in case of severe and profound personality disorders, it becomes necessary to take medications constantly in order to avoid decompensation.

Medicines are also selected individually, taking into account the type of disorder and their selective action.

Thus, antidepressants are used to compensate for inhibited psychopathy. In a state of subdepression, Amitriptyline, a tricyclic antidepressant that blocks cholinergic receptors of the central and peripheral nervous system, can be prescribed, due to which the patient’s mood improves, anxiety and anxiety disappear. The daily dose of the drug is approximately 75-100 mg.

Maprotiline, enough powerful drug with a tetracyclic structure. It is used in patients with an exaggerated sense of guilt. It has a noticeable thymonoanaleptic effect, eliminates melancholy, inhibition, and stops bursts of excitement. The drug is allowed to be used in pediatrics. As a rule, no more than 75 mg per day is prescribed.

These drugs are contraindicated in post-infection patients, with decompensated hypertension and heart muscle failure, men with a benign prostate tumor, pregnant and lactating women.

In the event of the development of hypomanic syndrome, the antipsychotic Clozapine (Leponex) is prescribed, which is characterized by a powerful and rapid sedative effect. Patients taking the drug reduce the number of suicide attempts. However, long-term use can significantly affect the composition of the blood.

An alternative to Clozapine can be Finlepsin (daily dose 0.4-0.6g) or Haloperidol drops (daily dose 10-15mg).

In hysterical forms of psychopathy, the same Finlepsin (0.2-0.6 mg), Neuleptil (10-20 mg) or Propazin (100-125 mg) is used to compensate for the patient’s condition - daily doses are indicated.

Patients are usually treated on an outpatient basis. During a course of psychotropic medicines It is necessary to completely stop drinking alcohol, since these drugs are incompatible with alcohol. This combination is fraught with the development of negative effects, including death. Also, during treatment, it is not recommended to drive a car or perform other work that requires concentration.

Indications for emergency hospitalization in a psychiatric clinic (without the patient’s consent) are severe stages of psychopathy, decompensation in the form of psychosis. For example, twilight consciousness in hysteroids, psychosis with delusions in paranoids, dysphoric disorders in epileptoids, in addition - cases aggressive behavior posing a danger to others or attempting suicide, causing harm to oneself.

It is impossible to cure psychopathy, especially congenital one, however, it is quite possible to achieve long-term compensation for the individual’s condition.

Treatment of psychopathy with folk remedies

Therapy with psychotropic drugs has many side effects, often reminiscent of the mental disorder itself, and also affects the functioning of the gastrointestinal tract and cardiovascular system, and changes the composition of the blood.

Traditional medicine has a less harmful effect on the body, although it can also lead to side effects, one of which is a variety of allergic reactions. But the severity of side effects from herbal preparations is not comparable to the undesirable consequences of taking medications. In addition, most drugs that act on the psyche are addictive, and psychopathic individuals are already prone to substance abuse.

Therefore, resorting to treatment with folk remedies, especially after consulting with a doctor or herbalist, may not be the worst idea.

Hyperactive personality traits can be somewhat corrected with the help of calming herbs: motherwort, peony evasive, valerian root, cudweed, dandelion, mint, lemon balm and other herbs. Each herb can be brewed separately, or you can make herbal mixtures. In this case, the effect will be stronger.

You can take baths with infusions of soothing herbs or use essential oils of the same plants.

For example, it is believed that some aromas promote calm concentration, greater concentration and perseverance. These are essential oils of sandalwood, eucalyptus and jasmine.

The aromas of juniper and ylang-ylang set you up for productive activity.

The aromas of cloves, nutmeg, thyme, and cinnamon are contraindicated for excitable individuals.

For inhibited psychopaths, in particular, individuals of the asthenic type, infusions of ginseng, echinacea, licorice, calamus, elecampane, and angelica are recommended.

Aromatherapy with oils of oregano, mimosa, lemon balm, mint, valerian, iris, anise, coriander, geranium will first strengthen the nervous system, then you can apply stimulating aromas: orange, basil, cloves and cinnamon.

Depressive reactions to stressful situations relieved with herbs such as chamomile, peppermint, lemon balm, soapwort, and valerian.

Aromatherapy helps to cope with attacks of anger or despondency, eliminate bad mood, excessive excitement, activate the intellect, clarify consciousness and even strengthen spirituality. Sandalwood, rose, juniper, Cedar oil, myrrh and frankincense.

Mix at least three oils and spray the aroma in the room; sometimes the composition of the oils needs to be changed.

Geranium, lavender, chamomile, tuberose oil will help calm excitable psychopaths; distract from depression and improve the mood of depressed people - jasmine, ylang-ylang, angelica herbs.

For hypertensive patients, it is recommended to use geranium, chamomile and rose oils to reduce their emotional background and normalize their mood, replacing them with a composition of clary sage, thyme and ylang-ylang.

Worry and anxiety, self-doubt are relieved by the aromas of sage, fern, rosemary, and oregano. Severe fatigue will go away from the aromatic composition of sage, clove and marjoram oils. Also for hypothymics and psychasthenics (asthenics) vitality and the mood is lifted by the aromas of fern, sage, oregano, and rosemary oils.

Juniper, marjoram, ginger, clove, and cinnamon oils restore lost strength and love of life.

All alternative means are good to combat psychopathy: yoga therapy (preferably under the guidance of an experienced yoga therapist, at least in the beginning), meditation, mineral therapy, color resonance therapy and others.

Prevention

It is important for any child to grow up in a supportive environment, and especially for children with constitutionally determined psychopathic personality traits.

Adults need to strive for the absence of negative external influences that provoke the emergence of antisocial character traits, especially at the age when behavioral norms and moral principles accepted in society are formed.

At the initial stages of personality development, the most important role in the prevention of psychopathy is given to pedagogical influence, then it is joined by social adaptation and vocational guidance, taking into account individual characteristics.

Forecast

There are known cases where, in a favorable environment, individuals genetically prone to psychopathy grew into completely socially adapted and respectable citizens.

The most unfavorable prognosis is given by specialists for hysterical psychopathy, although suitable living conditions lead to mature age to sustainable compensation. Hysteroids can socialize and acquire some skills for productive activities. From this group of psychopaths, pathological liars practically do not adapt.

Psychopaths are responsible for their illegal actions and are not considered disabled. Psychopathy and disability are incompatible concepts, at least in modern society. Perhaps in the future, when this phenomenon is better studied and explained, they will be included in the disabled population. In case of severe decompensation, a sick leave certificate may be issued, certifying a temporary lack of ability to work.

When, due to prolonged decompensation, persistent signs of mental illness appear, then the VTEK can recognize the psychopath as a group III disabled person with certain recommendations for organizing his work regime.

Cinematic psychopathic characters, according to R. Heyer, one of the leading experts on psychopathy, are far from real characters, although, of course, such developments are also possible. Films that portray psychopathy as a phenomenon do not pretend to have a scientific approach and are made for the sake of box office receipts. Their heroes are more likely members of a “club of the elite” than typical characters.

Psychopathy is an abnormal personality variant or pathological character, in which there is a deficiency of some and an exaggerated development of other character traits.

Such uneven development of individual characterological properties - disharmony of the psyche - is the main sign of psychopathy and manifests itself from an early age. It concerns primarily the emotional and volitional qualities of the individual with the relative preservation of intellectual abilities. Psychopathy arises on the basis of congenital inferiority of the nervous system, the cause of which may be heredity, harmful effects affecting and, etc. However, the formation and identification of psychopathy occurs to a large extent under the influence of the external environment, i.e., improper upbringing, negative environmental influences , psychogenic injuries, somatic diseases.

Psychopathy differs from (see) intellectual integrity; from mental illness- absence of a growing personality defect; from neuroses - by its irreversibility. It is necessary to distinguish psychopath-like states from true or constitutional psychopathy - persistent character anomalies that arise during life after various diseases (brain injuries, epidemics, infectious diseases, etc.).

Forms of psychopathy are distinguished mainly on the basis of the predominance of certain pathological character traits.

Asthenic psychopaths characterized by increased impressionability, timidity, indecisiveness, as well as mild mental and physical exhaustion. They are easily, although briefly, irritated, and are incapable of prolonged effort and diligent work. Frequent sleep disorders, disturbances of appetite and gastrointestinal tract activity force them to pay increased attention to their physical health. Low mood prevails.

Excitable psychopaths(some call them epileptoid psychopaths) are characterized by excessive irritability, reaching in some cases attacks of frenzied rage. Over a trifle, such persons can insult, beat, and even commit murder. Such conditions arise especially easily in them during periods of mood changes, usually manifested by melancholy and anger. These people are rude, vindictive, stubborn, inclined to consider only their own opinions, despotic and absurd. Among them there are often people who abuse alcohol or drugs, and gamblers.

Thymopathies- The main symptom of this group of patients is constant mood changes. Hyperthymic people are characterized by a constantly elevated mood, optimism, often a careless attitude towards what is prohibited, as well as an excess of energy, enterprise, great capacity for work, which, however, may be scattered, and therefore the work they begin is often not completed. These people are active, sociable, and often unceremonious in their behavior. They love to argue and get irritated easily, but quickly calm down. Hypothymics are people with a constantly low mood, seeing only negative things in their surroundings, sad or gloomy pessimists. They are always dissatisfied with everything, and first of all with themselves, and easily fall into despair. They are unsociable, untalkative, and do not like to attract attention or talk about themselves. Outwardly they often look slow, gloomy and preoccupied.

Reactive-labile psychopaths are distinguished by a very changeable mood, the changes of which usually depend on external, but often the most insignificant reasons. Therefore, throughout the day, many times their good mood can be replaced by a depressed one.

Psychasthenic psychopaths(psychasthenics) are characterized by anxiety, self-doubt, and a tendency to constant doubt and self-examination. Every upcoming action causes them to think, sometimes painfully. They often experience various obsessive states. Psychasthenics always imagine the future as full of difficulties and failures, and therefore it is more significant for them than what is happening at the moment. When communicating with people they are shy and fearful. Previously, a group of psychasthenic psychopaths was designated by the concept of “psychasthenia.”

Hysterical psychopaths- always strive to appear to others as more significant personalities than they actually are. At the same time, they themselves are convinced that they have various non-existent advantages and constantly strive to attract attention to themselves. They are characterized by posing, a tendency to fantasies and lies, capriciousness and mood swings. Their attachments and experiences are usually devoid of depth, and their judgments and actions depend entirely on random circumstances, and therefore can be diametrically opposed. Stubbornness and intractability are combined with increased suggestibility.

Schizoid psychopaths They are characterized by isolation, secrecy, and lack of need to communicate with people. At the same time, they can often find a rich inner life, manifested in fantasies, introspection, and analysis of what is happening around them, although outwardly they may seem indifferent to what surrounds them. They are characterized by increased sensitivity and vulnerability when it comes to themselves, but at the same time they often show emotional coldness towards the most ordinary human experiences.

Paranoid psychopaths They are distinguished by self-confidence, increased self-esteem, perseverance, and stubbornness. Doubts and hesitations are alien to them. These are people with an extremely narrow outlook, extremely one-sided in judgments and assessments, prone to fixating attention on a small number of ideas, which then begin to dominate in their minds, crowding out everything else. Such ideas can be invention, the fight against imaginary violations, jealousy, love claims, etc. To implement them, paranoid psychopaths show unusual persistence, and failures only increase it. They often develop litigious behavior.

Under the influence of external factors - psychogenic or somatic nature, and sometimes without any apparent external reason, psychopaths experience acute and protracted reactive states of various clinical manifestations (see), neurotic reactions (see Neuroses), and depression. These transient mental disorders are referred to as the so-called dynamics of psychopathy.

Proper education and professional guidance appropriate to the characteristics of a pathological personality are of great importance in the prevention of psychopathy. In the treatment of psychopathy great importance belongs to (see), as well as to treatment (see). Psychopaths during periods of deterioration require observation and treatment by a psychiatrist and neurologist. In some cases, treatment in a psychiatric hospital is indicated.

Psychopathy (from the Greek psyche - soul, mental properties and pathos - suffering, illness; synonym: pathological characters, constitutional psychopathy, abnormal personality variants) - characterological characteristics of the personality (the formation of which occurs from the moment of its formation), expressed in disharmony mainly emotionally -volitional properties with relative preservation of intelligence; these features are pathological character, since they prevent such subjects from adapting to the external environment painlessly for themselves and those around them.

Criteria for the concept of “psychopathy”. The pathological properties inherent in psychopaths determine the entire personality structure and are more or less constant. The existence in the psyche of a particular subject of any individual elementary irregularities and deviations does not yet give grounds to classify him as a psychopath (P. B. Gannushkin). The practical criterion of psychopathy is the following: psychopathic individuals are such abnormal individuals, from whose abnormality either they themselves or society suffer. Psychopathy differs from mental retardation by the absence of congenital mental deficiency (gifted people are also found among psychopaths). For mental illnesses with a progressive course (schizophrenia, epilepsy, organic diseases) psychopathy is distinguished by the absence of progression with the development of dementia, an irreversible personality defect.

In the past, psychopathy included so-called degenerative psychoses. Currently, this term is not used as obsolete. Formally, degenerative psychoses are similar to psychopathy due to the genetic-constitutional factor of etiology inherent in both. Currently, these psychoses are attributed primarily to familial (hereditary) schizophrenia, which proceeds sluggishly, with psychopathic changes that are irregularly interrupted by acute attacks (“delusional outbursts of degenerates” described by old authors).

It is also necessary to distinguish psychopathy from psychopath-like conditions after traumatic brain injury, infectious diseases, central nervous system intoxication, and endocrinopathies (see Endocrine mental syndromes). An example of psychopathic-like changes are character disturbances in adolescents who have suffered epidemic encephalitis. Essential for differential diagnosis is the establishment of the fact that before the appearance of psychopathic-like changes, personality development proceeded normally, changes arose after the illness. Psychopathy differs from neuroses in its general disharmonious personality.

Psychopathy is characterized by underdevelopment of some or exaggerated development of other properties that every healthy person has, but in a more harmonious combination (E. A. Popov). In other words, psychopathy is characterized by a partial delay in personality development (partial dysontogeny). It manifests itself primarily in the area of ​​emotions, will, and drives in the form of partial infantilism (juvenilism), asynchrony, unevenness, and delayed development and leads to the formation of pathological congenital characteristics of the nervous system with persistent disturbances in the ratio of basic properties and in the interaction of signaling systems, cortex and subcortex.

Etiology. Psychopathy is polyetiological. The causes of partial dysontogeny can be hereditary factors, intrauterine exposure to hazards on the embryo and fetus, birth injuries, pathology of the early postnatal period. Underdevelopment and childishness of the psyche is manifested in increased suggestibility, a tendency to exaggeration and overly developed imagination in hysterical subjects, in emotional instability in emotionally labile subjects, in weakness of will in unstable psychopaths, in immature thinking with childish features, subject to power affects, in paranoid psychopaths. Unfavorable environmental conditions are of great importance in the development of psychopathy; improper upbringing, negative influences, psychogenic traumas can lead to an exacerbation of psychopathic traits. According to O.V. Kerbikov, in some cases the leading factor in the development of psychopathy is a constitutional factor (“nuclear psychopathin”), in others it is the factor of psychogenic influence of the environment (“pathocharacterological development”).

Classification and symptoms. There is no generally accepted classification of psychopathy. In the light of the doctrine of the types of higher nervous activity, the following main types of psychopathy are distinguished (however, in addition to “pure” types of psychopathy, there are also transitional forms).

Hypotymic (constitutionally depressed) psychopaths are persons with a constantly low mood, innate pessimists, with a feeling of inferiority, dissatisfied with themselves, incapable of prolonged volitional tension, easily falling into despair, incapable of initiative, very sensitive to troubles, seeing everything in a gloomy light, slow, outwardly gloomy, gloomy and silent.

Hyperthymic (constitutionally excited) psychopaths are persons with constantly elevated mood, self-esteem, sociable, active, and mobile. They are distinguished by superficiality and instability of interests, distractibility. They rarely follow through with their exaggerated plans. Their sociability turns into excessive talkativeness and a constant need for entertainment. They do not distinguish the boundaries between what is permitted and what is forbidden. Many of them are prone to deceit and boasting, others are dominated by pronounced conceit and a certain irritability, which leads them to frequent disputes (“obnoxious arguers”), and when objecting, to outbursts of anger.

Emotionally labile (reactively labile) psychopaths are distinguished by extreme variability of mood, which fluctuates over the most insignificant reasons. A harsh remark, a memory of a sad event, or the thought of impending trouble causes depression. Such individuals often give the impression of being “capricious and touchy”; They are distinguished by a richness of emotional shades, mobility of feelings, and react heavily to mental trauma with pathological reactive states.

Asthenic (constitutionally nervous) psychopaths are characterized by a combination of mental excitability, irritability, sensitivity with increased exhaustion and fatigue. When exhaustion predominates, general lethargy, inability to make prolonged effort and assiduous work, indecision, absent-mindedness, and a tendency toward hypochondria appear; the mood is usually depressed. When excitability predominates - irritability, a pronounced sense of personal insufficiency combined with excessive egocentrism, increased pride, which can lead to clashes with others. What is common to asthenics is a rapid decline in productivity, as a result of which they work irregularly, in fits and starts, often start successfully, but quickly give up, which gives reason to accuse them of laziness. Many of them are timid, shy, extremely sensitive (“mimosa-like”).

Psychasthenic psychopaths - see Psychasthenia.

Excitable (explosive) psychopaths are characterized by extreme irritability, leading to attacks of rage, and the strength of the reaction does not correspond to the strength and quality of the stimulus. For a minor reason, such persons can insult, cause a scandal, become aggressive in anger, can inflict beatings and wounds, and do not even stop at killing; therefore, excitable psychopaths are often encountered in forensic psychiatric practice. They are characterized by attacks of mood disorder (dysphoria) in the form of angry melancholy, sometimes with an admixture of fear. They are prone to alcohol and drug abuse. These are people with one-sided, sthenic (exciting) affects, intolerant of the opinions of others, persistent, stubborn, domineering, picky, demanding obedience and submission. In some cases, malice and aggressiveness recede into the background and excessive strength of drives appears (people of drives). Among them there are gamblers and spendthrifts, drunkards, dipsomaniacs (binge drunks), persons exhibiting sexual perversion or suffering from periodic attacks of an uncontrollable desire for vagrancy (P. B. Gannushkin).

Hysterical (thirst for recognition) psychopaths are characterized by a desire to appear significant in their own opinion and in the eyes of others, which does not correspond to the real capabilities and merits of these subjects. Hysterical psychopaths are characterized by theatricality, posing, often deceit, a tendency to deliberate exaggeration, excessive fantasy, and demonstrative behavior. They combine increased suggestibility with stubbornness (hysterical negativism). The emotions of hysterical psychopaths are unstable and superficial; Their strong attachments are replaced by a thirst for recognition, actions designed for the viewer, for external effect. They do not disdain any means to attract attention to themselves, they try to seem original and amaze others unusual manifestations any illness (scenes of seizures, fainting), play the offended and insulted, talk about their imaginary misfortunes and successes, do not hesitate to make false accusations (for example, they accuse the doctor who treated them of attempted rape) and self-incrimination (attribute to themselves crimes that they did not commit ). Often, instead of a sober assessment of reality, fiction appears, the real situation is replaced by a fictional one. The psyche of hysterical psychopaths is characterized by childishness and immaturity. Those of them who combine a thirst for recognition with excessively rich fantasy and deceit are called pseudologists (pathological liars). Most often, inventions concern their own personality. Such deceit is not always disinterested: many derive tangible benefits from their lies through scams, deception, quackery, and luring money out of gullible people under various pretexts.

Paranoid psychopaths (paranoids) are characterized by a tendency to form overvalued ideas, which are characterized by the strongest affective coloring compared to all other thoughts and ideas, as a result of which these thoughts and ideas occupy a dominant position in the mental life and activity of the subject. The main overvalued idea of ​​a paranoid psychopath is the thought of the special significance of his own personality. They are characterized by extreme egoism, excessive conceit, narrow-mindedness, persistence in defending their beliefs, subordination of thinking to affects (only what the paranoid wants and likes is correct: “a strong desire is the father of thought”). Paranoid psychopaths strive to see their desires fulfilled and fight against those individuals who oppose this, developing great energy, making a large number of enemies, some real, most imaginary. Sometimes such a psychopath reveals a desire for invention and reform, and everyone who disagrees with him becomes his enemies, since increased distrust and suspicion are generally characteristic of paranoid psychopaths. Failure to recognize the merits of a psychopath by those around him leads him to clashes with others, and he does not give in to persuasion, threats, or requests. From failures he only draws strength for further struggle. His reaction can be expressed in the form of litigiousness (quelerantism): he starts a lawsuit, protests court decisions, appeals to the press, to the highest legislative authorities. In addition to subordination to affects, the thinking of a paranoid psychopath is characterized by reasoning, expressed in an inclination to various kinds of abstract constructions, and what still needs to be proven is accepted as proven.

Unstable (weak-willed) psychopaths- weak-willed people who easily fall under the influence of the environment, especially bad ones, easily follow
bad examples, suggestible, pliable, without deep attachments, incapable of consistent purposeful activity, lazy and sloppy. Under the influence of a bad environment, they easily become drunkards and abuse drugs. Education and organized work create the conditions for controlling the behavior of a weak-willed psychopath and allow him to become a fairly useful member of society.

Schizoid (pathologically withdrawn) psychopaths They are distinguished by isolation, secrecy, and a violation of contact with reality, which, due to their isolation, is perceived extremely subjectively and inaccurately. They do not have an affective resonance to other people's experiences, the understanding of which is difficult for them; It is difficult for them to find an adequate form of contact with others. Characterized by a combination of increased sensitivity and vulnerability with emotional coldness, paradoxical emotional reactions and behavior. In life they are usually called eccentrics, originals, strange, eccentric.

The ratios of individual forms of psychopathy can be judged by the following statistics (taking into account subjects who have committed socially dangerous acts): among psychopaths who underwent a forensic psychiatric examination at the Institute of Forensic Psychiatry named after. prof. Serbsky, excitable ones predominated - 20.4% and hysterical ones - 17.2%.

The above classification of psychopathy is traditional, but not the only one. One of the latest taxonomies of psychopathy [N. Petrilowitsch, 1966] lists the following groups of psychopaths: hyperthymic and expansive, depressive, asthenic, unstable and explosive, insecure, thirsty for recognition, weak-willed, fanatical and paranoid, anankasty ( obsessive), insensitive.

Dynamics of psychopathy is expressed in mood swings, pathological psychogenic reactions (in response to mental trauma), in pathological personality development (protracted reactive states), which leads to decompensation of psychopathy. Excitable psychopaths easily experience violent affective discharges, while hysterical psychopaths easily experience hysterical psychogenic psychoses. Paranoids (delusional syndromes) are more often observed in asthenic psychopaths, paranoids, hysterics, and schizoids. Depression occurs especially easily in depressed and emotionally labile psychopaths. Asthenic hypochondriacal developments - in asthenic, emotionally labile, hysterical people. Extremely valuable invention, reformism, querulanism - among the paranoid. When assessing psychopathy, it must be remembered that with age, the phenomena of partial developmental delay can be smoothed out. Thus, developmental hysteria observed during puberty often levels out later, and the personality becomes fairly balanced. As the personality develops, children's pseudology and partial disturbances of drives disappear. Volitional instability and psychopathic emotional coldness can be a transient condition of adolescence.

Pathocharacterological development of personality is highlighted, in which a close connection with environmental conditions (upbringing, family troubles, etc.) is revealed. Under the influence of environmental factors, the type of higher nervous activity is modified, its typical features are formed, which gradually become the same as with congenital constitutional psychopathy, which is the basis for the formation of a certain structure of a psychopathic personality. For example, the formation of asthenic psychopathy can be facilitated by an environment of constant humiliation and punishment (O. V. Kerbikov).

A practicing physician must have knowledge of the clinical picture and dynamics of psychopathy to such an extent as to be able to diagnose it and refer the patient for treatment and follow-up to psychoneurological dispensaries.

Treatment and prevention psychopathy include psychotherapy (see), educational measures, occupational therapy, physiotherapy, drug treatment. Of great importance are the correct work regime and the correct professional orientation, which contribute to the necessary training of the nervous processes of a psychopath. Drug treatment has an auxiliary value and must be strictly individualized; a single scheme cannot be given. For dysphoria, states of affective tension and anxiety, Librium (Elenium) and meprobamate are indicated. For those who are emotionally excitable, chlorpromazine and reserpine are prescribed; for depressive mood swings, tofranil (melipramine) with meprobamate is prescribed.

Forensic psychiatric examination. In most cases, psychopaths are recognized as sane. Only in some cases (for example, severe asthenic and paranoid psychopathy) is the degree of psychopathy so deep that the psychopath is declared insane.

For the first time in Russian medical literature, the concepts of “psychopathy” and “psychopaths” appeared in 1884. Then forensic psychiatrists I.M. Balinsky and O.M. Chechett conducted an examination of a certain Semenova, who was accused of murdering a girl, and came to the conclusion that she cannot be considered mentally ill in the generally accepted sense of the word, but it is also difficult to recognize her as mentally healthy. The case caused a great public outcry and newspapers began calling Semenova a “psychopath,” meaning her difficult character. Until now, in everyday life, “psychopaths” are people whose behavior brings a lot of concern to others, and sometimes contradicts the norms of public morality.

Today, psychopathy refers to stable congenital or acquired character traits that introduce disharmony into the human psyche and create significant difficulties in life. Everyday life. As a rule, with psychopathy, some character traits are very strongly expressed, while others are underdeveloped. For example, irritability and excitability are excessively expressed, and the function of behavior control is reduced. Or this: a high level of aspirations, egocentrism and lack of an adequate assessment of one’s capabilities. Healthy people may have such traits, but in them they are balanced and behavior does not go beyond social norms. Psychopathy differs quite significantly from mental illness. Individuals with psychopathic tendencies do not worsen over time, but they also do not improve – i.e. there is no dynamics. Also, such people do not have intellectual impairments, there are no delusions or hallucinations. Psychopaths are characterized by a one-sided perception of the environment, i.e. they see only what matches their expectations, and other information is ignored or denied. Therefore, people with psychopathy often have inadequate self-esteem (both high and low) and cannot learn from their mistakes.

Causes of psychoptia

The causes of psychopathy have not been thoroughly studied. Some scientists believe that the character traits that form psychopathy are genetically determined, just like eye color, for example. Others are inclined to think that a psychopath is shaped by an unfavorable environment. There is also an opinion that psychopathy is based on unrecognized organic brain damage.

Symptoms of psychopathy

The external manifestations of psychopathy are extremely diverse. Depending on the prevailing motives in behavior, the following types of psychopathy are distinguished:

1. Paranoid psychopathy Such people are prone to suspicion, they have a heightened sense of justice. They are vindictive and difficult to get along with in groups. They are too straightforward in communication. In a family, these are often jealous spouses. Often paranoid psychopaths are passionate about litigiousness - i.e. initiate legal proceedings for any reason, hypochondria is common - the belief in the presence of some disease and obsession with one’s health.
2. Schizoid psychopathy. These are closed dreamers, eccentrics with non-standard judgments. In everyday life they are stupid, but they are passionate about abstract sciences - philosophy, mathematics. Schizoids are lonely, but they are not burdened by this. They are often indifferent to loved ones.
3. Unstable psychopathy. Such people are characterized by a lack of willpower. They also do not have any interests or their own point of view. They are subject to external influence and suggestible. Such people have no remorse; they easily make promises and forget about them. They do not feel a sense of affection even to close relatives. At school they often had behavior problems, and in adolescence they ran away from home (if the parents tried to somehow discipline the child). As adults, these people are prone to dependency and search for easy money, without thinking about morality. Therefore, among patients with unstable psychopathy there are many criminals, alcoholics, and drug addicts.
4. Excitable psychopathy. Outwardly, such people may be no different from those around them until their interests are affected. In this case, an inadequate outburst of anger, irritation, and aggression is possible. Sometimes patients regret their incontinence, but do not fully admit their guilt. In childhood, excitable psychopaths constantly had conflicts with peers, in adulthood they often change jobs, and they tend to blame others for all their troubles in life.
5. Hysterical psychopathy. People of this type are characterized by theatrical behavior, a desire to be the center of attention, and inflated self-esteem. They dress brightly, are sociable, impressionable, and suggestible. Interested in art. They attach great importance to relationships with the opposite sex, are constantly in a state of love, but deep feelings uncharacteristic for them.
6. Psychasthenic psychopathy. These are anxious, suspicious and insecure people. They are punctual, hardworking, but do not achieve success in life due to fear of failure and inability to make decisions on their own. The social circle is small, they are strongly attached to loved ones. They don't like public attention. Sometimes, to relieve constant anxiety, they may abuse alcohol.
7. Asthenic psychopathy. Its main symptom is increased fatigue and decreased performance. Asthenics cannot concentrate on one thing for a long time. They are unsure of themselves, impressionable, and quickly get tired of society. Concerned about their health.
8.Affective psychopathy. These people are characterized by frequent mood swings, including for no apparent reason. Sometimes they are active and cheerful, but after some time they become depressed and gloomy. Such changes may be associated with the seasons.

These are the main variants of psychopathy. In practice, they are often mixed, i.e. in the character of the patients are expressed different traits. Understanding such a variety of options is not easy for a doctor either; as for attempts to independently diagnose psychopathy, they are doomed to failure, because It is almost impossible for a person without specialization in the field of psychiatry to draw a line between manifestations of psychopathy and the character traits of a healthy person. Without a psychiatrist’s verdict, it is impossible to confidently say whether a person has psychopathic traits or whether he has a mental illness, for example, schizophrenia or depression. Therefore, if there are any of the listed symptoms that negatively affect a person’s life in society, it is better to consult a specialist: a psychiatrist or psychologist.

Timely seeking qualified help will help improve social functioning and avoid many problems in the future (after all, if a serious mental illness is hidden under the guise of psychopathy, then quickly started treatment significantly improves the prognosis for the patient).

Examination for suspected psychopathy

When contacting a psychiatrist, most likely, to clarify the diagnosis, an electroencephalogram will be prescribed - a painless method for studying the functioning of the brain, and a consultation with a psychologist to identify the characteristics of thinking, the state of intelligence, and memory. The doctor may need to review the examination data of a neurologist or urine and blood tests. This is necessary to exclude some diseases in which symptoms similar to manifestations of psychopathy may be observed (for example, thyroid disease, consequences of stroke, traumatic brain injury, epilepsy).

Treatment of psychopathy

Treatment of psychopathy with medications is carried out if pathological character traits are so pronounced that they create a significant problem for the daily life of the patient and his environment. For low mood, antidepressants (fluoxetine, Prozac, amitriptyline and others) are prescribed. For anxiety, tranquilizers (phenazepam, rudotel, mezapam and others) are used. If there is a tendency towards aggression or antisocial behavior, the doctor will prescribe antipsychotics (haloperidol in small doses, sonapax, etaprazine, triftazine). Also, antipsychotics with sedative properties (chlorprotexen) are used for sleep disorders, because Psychopaths easily develop dependence on sleeping pills. For severe mood swings, anticonvulsants (carbamazepine) are effective.

It must be remembered that when treating with psychotropic drugs, the use of alcohol and, especially, drugs is unacceptable, because this combination can lead to irreversible consequences, even death. Also, during the treatment period, it is better to refrain from driving; at least, it is necessary to clarify this issue with the attending physician. It is advisable for the patient’s relatives to monitor the dosage of the drug, because With psychopathy, there is often a tendency to abuse medications. Without a doctor's prescription, you can buy mild sedatives at the pharmacy, such as valerian, novopassit, motherwort tincture (if we are talking about psychopathy of the excitable type or there is anxiety), but you can hardly expect visible results from them.

Psychotherapy sometimes gives good results in correcting manifestations of psychopathy. Methods such as psychodrama are used - this is a type of group psychotherapy in which scenes from everyday life are played out. Psychoanalysis is popular in Western countries - long-term individual program psychotherapy to identify subconscious complexes and negative attitudes.

It happens that people avoid contacting psychiatrists, even if there are indications for this. Fearing publicity or side effects of psychotropic drugs, such patients resort to traditional medicine. But herbalists have no effective treatments for psychopathy. All they can recommend is herbal teas, consisting of valerian, lemon balm, mint, hops and other plants with soothing properties. Perhaps aromatherapy will be offered using essential oils of geranium, lavender, marjoram, or hot baths with some infusions (usually the same lemon balm or pine extracts). Such methods most likely will not cause direct harm to health, but they are often a hobby traditional medicine prevents the patient from receiving modern medical care, which leads to a worsening of the condition. In consultation with your doctor, you can use medicinal plant therapy along with the main treatment.

Psychopathy greatly complicates the patient’s life in society and often makes his loved ones unhappy. Psychopaths often find themselves in criminal situations, and they often make suicide attempts - sometimes due to the inability to control their impulses, and sometimes for the purpose of blackmail or attracting attention to themselves. Asthenics and psychasthenics with good intellectual data cannot achieve recognition due to their character traits, and awareness of this fact can lead them to depression. Depression, in turn, often entails alcohol or drug abuse - patients consider this method of relaxation to be the simplest and most effective, but in reality the problems only get worse. Timely and correct treatment saves patients and their families from these troubles. Also, visiting a specialist will help you not to miss the onset of more severe mental illnesses, which from the outside may seem like a manifestation of psychopathy.

Psychiatrist Bochkareva O.S.

The content of the article

Psychopathy (personality disorders), part 1

Classification and clinic of psychopathy

The main clinical variants of psychopathic personalities are quite well described in the works of P. B. Gannushkin (1933), M. O. Gurevich (1949), V. A. Gilyarovsky (1954), I. F. Sluchevsky (1957), G. E. Sukhareva (1959), O. V. Kerbikova (1971), A. E. Lichko (1977), E. Kraepelin (1915), E. Kretschmer (1921). All classifications and descriptions of psychopathic personalities are actually based on the syndromic principle, but attempts are still being made to subdivide them according to etiology and pathogenesis. For example, O. V. Kerbikov (1971) identified nuclear and marginal psychopathy - true and occurring according to the type of pathocharacterological development, that is, arising as a result of unfavorable upbringing conditions, I. F. Sluchevsky (1957) grouped them depending on the type of higher nervous activity , G. E. Sukhareva (1959) - depending on the age of the patient at the time of their appearance and the presence of exogenous cerebral-organic damage (delayed, distorted and damaged development). In the ICD 9th revision, psychopathy is classified according to the leading psychopathological syndrome.
Here is a classification of psychopathy along with codes.
Classification of personality disorders, or psychopathy
1. Personality disorders of the paranoid (paranoid) type, or paranoid psychopathy (301.0).
2. Personality disorders of the affective type, or affective (hyper- and hypothymic) psychopathy (301.1).
3. Personality disorders of the schizoid type, or schizoid psychopathy (301.2).
4. Personality disorders of the excitable type, or excitable psychopathy (301.3).
5. Personality disorders of the anankastic type, or psychasthenic psychopathy (301.4).
6. Personality disorders of the hysterical type, or hysterical psychopathy (301.5).
7. Personality disorders of the asthenic type, or asthenic psychopathy (301.6).
8. Personality disorders of the emotionally stupid type, or heboid psychopathy (301.7).
9. Other personality disorders, or psychopathy of unstable, polymorphic (mosaic) types, partial disharmonious mental infantilism, etc. (301.8).
10. Psychopathy with sexual perversions and disorders (302) - homosexuality (302.0), bestiality (302.1), pedophilia (302.2), transvestism (302.3), exhibitionism (302.4), transsexualism (302.5), fetishism, masochism and sadism (302.8) .

Paranoid psychopathy

Paranoid psychopathy is characterized not by paranoidity as such, but by a constant inadequately overestimated or underestimated assessment of one’s own properties, the significance of positive and negative external (social) factors affecting the interests of the individual, and a pronounced tendency towards overvalued ideas with corresponding behavior. The criteria for diagnosing paranoid psychopathy are excessive sensitivity to situations that mainly infringe on personal interests, a tendency to a perverted interpretation of reality, the behavior and attitude of others, exaggerated self-esteem, militant and persistent assertion of one’s own rightness and importance, and insufficient self-criticism. Typical properties of persons with this form of psychopathy are egocentrism, distrust and suspicion, subjectivism, narrowness, limited and one-sided interests and assessments, rigidity of opinions and emotions, stenism in defending and implementing their ideas, unshakable confidence in the truth of beliefs, claims and rights, tendentiousness and far-fetched judgments, tension of dominant affects. The attitude of patients towards everyone who disagrees with them is usually openly hostile or hostile (N.I. Felinskaya, Yu.K. Chibisov, 1975).
Thus, with paranoid psychopathy, personality disharmony is manifested in immaturity and paradoxical thinking, selective fanaticism, reasoning, rigidity of thinking and emotions, opposition to everything that contradicts personal beliefs and interests, rigidity, egocentrism (P. B. Gainushkin, 1933). Noteworthy is the ability to record and use small facts, slips of the tongue and unfortunate expressions of others, to distort them, to convince others that one is right (in a short time), as well as persistence and cruelty in achieving selfish (extremely rarely, altruistic) goals, inability to learn from unsuccessful actions, ingenuity in shifting blame to others, persecuting and defaming those who disagree, in presenting oneself as deceived and persecuted. Often these are “hunted persecutors” with a store of lies and hypocrisy, only briefly experiencing a semblance of a critical assessment of their character.
Mental coldness, limited intellect and general outlook, cruel rationalism, vindictiveness, pettiness ultimately exclude their normal relationships in the microsocial environment and in society as a whole. (N.I. Felinskaya and Yu. K. Chibisov (1975) distinguish the following clinical variants of paranoid psychopathy:
1) with litigious-paranoid ideas;
2) with hypochondriacal ideas (increasedly anxious and suspicious individuals, fixating attention on their health, with a tendency to form overly valuable hypochondriacal thoughts, seeking help from medical specialists, constantly dissatisfied and dissatisfied);
3) with overvalued ideas of jealousy (“pathological jealous people” are individuals who are highly suspicious, distrustful, selfish, despotic and unsure of their sexual usefulness, looking for evidence of betrayal and seeking recognition);
4) with ideas of attitude (a combination of sensitivity, suspiciousness and suspicion with the desire for recognition; failures serve as a source of extremely valuable ideas of attitude and ill will). In addition, there are “domestic tyrants”, “despots”, “pathological misers”, etc. They are characterized by extreme intransigence, fanatical conviction that they are right, cruelty and despotism towards people dependent on them, pathological greed and passion for hoarding, and emotional rigidity. As a result of this, the life of family members or subordinate groups turns into a nightmare; they are subjected to sophisticated bullying, sometimes eke out a miserable existence, are doomed to undeserved humiliation, and are forced to be hypocrites.
Paranoid psychopaths do not always clearly demonstrate their pathocharacterological characteristics outwardly. They often ingratiate themselves into the trust of others, creating the impression of humiliated and offended, but persecuted for justice, conscientious, honest, selfless and decent people. For a certain time, they are “overgrown” with sympathizers, people close to them in spirit or dissatisfied with something, who willingly listen to discussions about “undeserved insults from scoundrels,” about injustice, outrages inflicted on them by family members, neighbors, officials, etc. Secretly they use unscrupulous hints, rumors, slander, slanderous information, and write anonymous letters that are false or distort the facts. They use all sorts of intrigues to “push heads” against people they dislike or who do not support the irrepressible claims of the litigator and querulist. Paranoid psychopaths do not spare “friends” and fellow travelers if they showed the slightest distrust or doubt about the veracity of what they heard or refused to support them.
The lifestyle of paranoid psychopaths is often harsh, ascetic, subordinate to the implementation of the leading idea. The resulting painful conditions, deprivations of loved ones and oneself are not taken into account.
According to our observations, two main variants of paranoid psychopathy can be distinguished - extroverted and introverted. Patients with extroverted psychopathy are energetic, self-confident, decisive, open and demonstrative, although they do not neglect disguised actions. When faced with opposition to their aspirations, the behavior of patients acquires an active and offensive character, but to a certain extent. Unlike people suffering from paranoid psychoses, they usually do not exceed the boundaries of the “instinct of self-preservation,” a degree of caution beyond which they face serious responsibility. Therefore, we consider the sometimes accepted conclusions about the insanity of patients with paranoid psychopathy to be not always sufficiently substantiated. Patients with introverted psychopathy are not so demonstrative, but no less persistent in achieving their goals. Their external defenselessness, weakness, naivety, and integrity are deceptive, which often misleads others. Hidden deceit, stubbornness, hypocrisy, hypocrisy, intrigue are no less dangerous than militant shamelessness in extroverted psychopathy. Currently, we can talk about the pathomorphosis of paranoid psychopathology in the direction of precisely the last variant of external manifestations.
Autochthonous dynamics are characterized by phases of increasing and decreasing affective tension and paranoid activity. Internal factors of exacerbation include deterioration in well-being, seasonal mood swings, the premenstrual period and a number of others, and external factors include failures in terms of paranoid claims, conflict situations in the family, with neighbors, and at work. Decompensation is often accompanied by episodes of agitation, anger, threats and aggression, and less often by hysterical reactions. With age, activity decreases, but the increase in involutionary rigidity and hostility leads to increased hypocrisy, didacticism, querulant “epistolary” activity, and reasoned criticism.
The diagnosis of psychopathy seems doubtful when the initial overvalued nature of the symptoms is at times replaced by paranoid delusions or gradually develops into it under the influence of somatic diseases or unfavorable life circumstances. In such cases, one should think about mental illnesses - somatogenic, psychogenic (in a psychopathic personality) or schizophrenia.

Affective type psychopathy

Individuals suffering from affective psychopathy are characterized by the presence of either an elevated mood with inexhaustible optimism, or a depressed mood with a pessimistic assessment of everything that happens, or periodic changes from one state to another. A number of psychiatrists (P.B. Gannushkin, 1933; E. Kretschmer, 1921, etc.) classified such patients as cycloid personalities. P.B. Gannushkin identified constitutionally excited, constitutionally depressive, cyclothymic and emotive-labile (reactive-labile) variants of affective psychopathy, N.I. Felinskaya and 10. K. Chibisov (1975) - hyperthymic, hypothymic and cyclothymic. The clinical description of these variants of psychopathy presented by P. B. Gannushkin still remains classic and quite complete.
Persons suffering from hyperthymic affective (constitutionally excited) psychopathy are characterized by almost constantly high spirits, increased optimism, enterprise, projectism, adventurism in plans and actions, activity, sociability, even importunity, verbosity, desire for leadership, fickleness of hobbies and frivolity. In childhood and adolescence, they are the initiators of far from innocent actions and jokes towards comrades and educators, adventurous and therefore often dangerous plans and actions; They are often considered difficult children. In adulthood, one notices their inexhaustible energy and optimism, their frivolous attitude towards generally accepted norms of relationships, which ultimately causes bewilderment, wariness, and antipathy among those around them.
The intellectual level of such individuals can vary from high to low. P. B. Gannushkin (1933), E. Kraepelin (1915) and other psychiatrists noted that some hyperthymic individuals are gifted in various areas, become witty inventors, successful in public areas activities, but dishonest businessmen and swindlers. However, excess energy, adventurism, boasting, inconstancy in everything, a lack of moral sense, disregard for the requirements of legality and morality, a tendency to sexual and alcoholic excesses ultimately create conflict situations from which such people do not always find a successful way out, despite their exceptional resourcefulness . In forensic psychiatric examinations, one has to deal with such psychopaths with criminal inclinations, who have been successfully engaged in fraud, large-scale fraud and deception for a long time, leading a “large lifestyle”, cleverly using the gullibility of others, especially women.
In addition to hyperthymic-active natures, P. B. Gannushkin identified “innocent talkers” with a tendency to boast and deceit, with an exaggerated imagination, as well as “pseudo-verulants.” The first are euphoric, verbose, lively, boastful, annoying, but frivolous, empty, and unproductive; They do not inspire confidence and are the subject of jokes and ridicule, which they ignore.
“Pseudo-verulants” are selfish, irritable, know-it-all, intolerant of objections (“obnoxious debaters”). The disagreement of others can cause them to flare up in anger, irritation and even aggression, and cause persecution, but, unlike paranoid psychopaths, they are not so persistent, more easy-going, and easily change “anger to mercy.” As P. B. Gannushkin notes, hyperthymic people, along with adventurism and gambling, have a tendency towards laziness and sybarism. These are often picnics, active and cheerful, prone to obesity. Failures are easily experienced, quickly forgotten and returned to the old ways.
Persons suffering from hypothymia are characterized by constant pessimism in assessing reality, their present and future. From childhood, they are characterized by isolation, capriciousness and tearfulness, but more often such traits clearly manifest themselves in adolescence. The darkened coloring of the perception of life is accompanied either by unjustified condemnation of what is happening, the actions of people, events, or by soul-searching, self-flagellation, and a search for one’s own guilt. Such people find any work uninteresting and tedious; in advance they see in it insurmountable difficulties, which makes them fall into despair. Being sensitive and touchy, patients withdraw, isolate themselves from others, feel more or less optimal only in a narrow circle of friends and relatives, taking into account the characteristics of their character. However, constant dissatisfaction with everything, grumbling for any reason, gloom and a tendency to condemn everything, increased suspiciousness and hypochondriasis cause a negative reaction in others, which further aggravates the general pessimistic mood of patients.
Under the influence of troubles, somatic diseases and as a result of autochthonous mood swings, hypothymic psychopaths may experience subdepressive and depressive states with overvalued formations, among which the idea of ​​the meaninglessness of existence with suicidal tendencies is dangerous.
Phases of a more pronounced depressive state resemble affective depressive psychoses that occur within the framework of manic-depressive psychosis. When making a diagnosis, it should be remembered that psychopathy is accompanied by overvalued ideas, and manic-depressive psychosis is accompanied by delusional depressive ideas. The main signs of psychopathy are a subdepressive background of mood as a characteristic personality trait throughout life, a close connection between deterioration and improvement of general condition with well-being or ill-being in the personal and work spheres, and great accessibility to dissuasion and criticism.
Cyclothymic affective psychopathy is characterized by a change from a slightly elevated mood (exaltation) to a lower one, which corresponds to hyper- and hypothymic behavior.
Thus, this type of psychopathy is characterized by constant fluctuations in mood and activity productivity, which have a significant duration and often coincide with the seasons of the year (spring and autumn). The hyperthymic state is accompanied by a feeling of a surge of energy and optimism, high productivity at work and at the same time - internal tension, intolerance to emerging obstacles, increased irritability and anger with corresponding reactions that cause protest from others. The hypothymic state manifests itself in a decrease in mood and performance, a pessimistic assessment of life and everything that happens around. In a hypothymic state, suicidal thoughts often appear - patients “get tired” of the “pendulum-like” state of health and lifestyle, of the expectation of a decline in mood. With age, the contrast of experiences may decrease, but the duration of ups and downs in mood increases. In older people, as a rule, hypothymic (subdepressive) states become predominant. They either get used to them, or turn into “hopeless pessimists” and grumblers.P. B. Gannushkin (1933) also classified emotive-labile states as affective, considering them as a variant of cyclothymia, but not with phase, but with constant, chaotic, unpredictable mood swings throughout even one day. According to our data, such personalities are found even more often than those with distinct phase states. As P.B. Gannushkin pointed out, they are characterized by capriciousness and variability of mood, its dependence on the slightest deterioration in well-being, failures, remarks, carelessly spoken words, etc. Their cheerfulness is easily replaced by a feeling of despair. Emotionally labile psychopaths have a particularly difficult time with the loss of loved ones and other shocks, and they may experience pathological reactions and reactive psychoses. Such individuals are fragile, tender, childishly naive, suggestible and capricious natures, completely dependent on their mood in life and work.

Schizoid psychopathy

Persons suffering from schizoid psychopathy are characterized by weakness of attachments, social contacts, secrecy of experiences, inadequate sensitivity, combined with emotional coldness, unusual hobbies, behavior, appearance, etc. According to P. B. Gannushkin, the most typical signs in such persons are isolation from the outside world, lack of unity and consistency mental processes, bizarre paradox and inadequacy of emotional life and behavior.
Such people are strange, eccentric, “not of this world,” autistic, with angular manners, pretentious appearance and clothing, divorced from reality, with unusual hobbies, ideas and judgments, and self-centered actions. A peculiar combination of mental hyperesthesia and sensory coldness is manifested by painful reactions to external circumstances affecting personal interests, with self-absorption and alienation, with cold indifference to the point of callousness and cruelty to the interests and feelings of others, including close people. Despite intellectual abilities and even giftedness in some direction, schizoid psychopaths remain deaf to criticism and attempts to correct their incorrect behavior, do not react to them or reject them with contempt.
Schizoid psychopaths perceive their surroundings selectively and distortedly, while from factual data they make unexpected, paradoxical conclusions and conclusions with a tendency towards symbolism and reasoning. They have a tendency to theorize and are passive towards pressing needs, although they can be active and persistent in relation to the tasks that interest them.N. I. Felinskaya and Yu. K. Chibisov (1975) distinguish sensitive variants of schizoid psychopathy, with a predominance of isolation, with a predominance of emotional coldness and with overvalued formations; I. V. Shakhmatova (1972) -thenic and asthenic, which are very close to the concepts of “extroverted” and “introverted”.
The sensitive variant is characterized by increased vulnerability and sensitivity, suspiciousness, suspicion, timidity, isolation and isolation, daydreaming, a tendency to escape reality into the world of fantasy and abstract constructions. With schizoid psychopathy with a predominance of isolation, isolation, unsociability, stiffness and dryness, and a lack of affective resonance come to the fore. Schizoid psychopathy with a predominance of emotional coldness is characterized by a lack of a sense of duty, sympathy and respect for others, coldness, unceremoniousness, cruelty, inability to take others into account, lack of reproaches and modesty. Schizoids with a penchant for overvalued formations are characterized by a tendency towards autistic, abstract overvalued ideas with a desire to act in the plane of their content, contrary to the interests of others and society.
Stabilization and compensation of the symptoms of schizoid psychopathy usually coincide with personal and situational well-being, especially in adulthood. Autochthonous deteriorations are possible, but they usually arise as a result of conflicts or somatic diseases. Decompensation can be manifested by overvalued formations of an extra- or introverted type with corresponding behavior. We consider the diagnosis of psychotic paranoid and paranoid states within the framework of decompensation of schizoid psychopathy, as well as paranoid one, to be unfounded. Since these are qualitatively new psychopathological phenomena of a psychogenic and other nature, they should be considered as corresponding diseases in psychopathic individuals.

Excitable type psychopathy

The main sign of psychopathy of the excitable (explosive) type is a constantly inherent tendency to inappropriate, unrestrained, uncontrolled outbreaks anger, hatred and aggression for minor reasons, to dysthymic and dysphoric reactions. Characterized by affective excitability, touchiness, pickiness, suspicion, selfishness, inadequate demands, and inability to take into account the opinions of others.
The following variants of excitable type psychopathy with explosiveness, viscosity and individual hysterical signs are distinguished (N. I. Felinskaya, Yu. K. Chibisov, 1975). The first option is characterized by sharp excitability with a tendency to destructive actions and self-harm against the background of an affectively narrowed consciousness; the second - dysphoric type excitability with stuck affect against the background of such characterological features as pettiness, pedantry, viscosity, emotional rigidity and cruelty (epileptoid psychopathy); the third - excitability with traits of demonstrativeness, theatricality and exaggeration during the affect (on the border with psychopathy of the hysterical type).
Persons suffering from excitable type psychopathy have a high tendency to alcohol and other excesses, and they often enter into conflicts that lead to hooliganism. The period of decompensation is characterized by unrestrained behavior, hostility and aggressiveness, excitability at the slightest provocation, a tendency to overvalued negative interpretation of the attitude of others, and uncriticality of one’s actions. The calm demeanor and decisive action of others usually have a calming effect on psychopaths.

Psychasthenic psychopathy (personality disorders of the anaicastic type)

Persons suffering from psychasthenic psychopathy are characterized by a lack of self-confidence, timidity, shyness, suspiciousness, indecisiveness, anxiety, scrupulosity exacerbated to the point of absurdity, caution, rigidity, a feeling of incompleteness of actions, a tendency to doubt, pedantry, self-examination, introspection, obsessive thoughts, fruitless obsessive philosophizing.
N.I. Felinskaya and Yu.K. Chibisov (1975) identify several variants of psychasthenic psychopathy. Distinctive Features of the first option (inhibited), in addition to those listed, the authors consider reduced activity, doubts with a long struggle of motives and the inability to make decisions, fearfulness, timidity, anxiety, which is why they practically do not experience a sense of optimism and joy. In another variant, fruitless philosophizing predominates, needs, drives, a sense of reality and the vividness of experiences are insufficiently developed. At the same time, rational activity abstracted from life with groundless doubts, self-doubt and “mental chewing gum” dominates. When anxious suspiciousness prevails, constant doubts about the correctness of past, present and future actions, regarding the state of one’s health and position, anxiety, fear of supposed adverse consequences, increased vulnerability and sensitivity to obvious and imaginary reproaches come to the fore. In psychopathy with a predominance of obsessions, there is a tendency to obsessive thoughts and ideas, phobias and motor actions (rituals, movements and tics).
Psychasthenic psychopathy can also be divided into extra- and introverted variants. In the first case, psychasthenic characteristics are, as it were, compensated by an active seeking of advice, reaching the level of importunity, but usually not bringing relief and benefit; in the second case, by passive submission to circumstances with isolation, a feeling of helplessness, or immersion in fruitless and groundless hypochondriacal experiences.

Hysterical psychopathy (personality disorders of the hysterical type)

Hysterical psychopathy is manifested by mental and physical infantilism, selfishness, deceit, thirst for recognition and attracting attention to oneself, theatricality, demonstrativeness, flamboyant expressiveness of behavior, increased excitability, brightness and superficiality of emotional reactions, suggestibility and self-hypnosis, a tendency to hyperbolism, fantasizing with pseudology and affective thinking, to hysterical reactions. To adapt and achieve the desired goal, such people use pretentious behavior and clothing, lies, flattery, blackmail and “flight into illness,” designed for external effect.
P. G. Gannushkin (1933) considered the main signs of hysterical psychopathy to be the desire at all costs to attract the attention of others and the lack of objective truth both in relation to others and to oneself (distortion of real relationships). This manifests itself in the capricious instability of emotional reactions, behavior and relationships with other people, in increased affective dependence on the situation, selfishness, deceit, boasting, interpretation of what is happening in a favorable light for oneself, in general mental immaturity, indiscriminateness in the means of achieving one’s goal, even scandals, slander, false accusations, etc. This also includes the so-called pathological liars, swindlers and scammers.
N. I. Felinskaya and Yu. K. Chibisov (1975) identify the following variants of hysterical psychopathy:
1) with a tendency to elementary hysterical manifestations (the occurrence of various primitive somatoneurological reactions in the form of hysterical “monosymptoms” - convulsive and fainting seizures, paralysis and paresis, stuttering, gait disorder, astasia-abasia, anesthesia and hyperesthesia, shortness of breath, palpitations, uncontrollable vomiting etc.); At the same time, according to our observations, in recent years, cases of complex hysterical attacks with “passionate poses” and astasia-abasia have again become more frequent in women;
2) with a predominance of emotional disharmony (exaggerated, hyperbolic external manifestations of experiences in the form of excitement with sobs, threats and blackmailing auto-aggression, or feigned indifference, disappointment and emptiness, or depressive detachment). The interests and activities of such persons are superficial and unstable, designed to attract attention;
3) with a predominance of volitional disorders in the form of hyperbully (increased, but not long-term persistence in achieving a certain goal), hypobulia (helplessness in overcoming even the slightest obstacle, lack of will, suggestibility and subordination) or chaotic alternation of these states;
4) with a predominance of fantasy (propensity for fiction, playing at being an extraordinary person);
5) with features of pseudology (with affective, “crooked” logic, with a distorted perception and interpretation of reality, expressed subjectivity in the selection and denial of facts, deceit, resourcefulness, unfounded inconsistency in relation to generally accepted opinions);
6) with a predominance of mental infantilism (a combination of “thirst for recognition” with intellectual immaturity, superficiality of emotional reactions and volitional impulses, which is manifested by naivety, childishness of judgment, the predominance of imaginative thinking over abstract-logical thinking, vividness of imagination, increased suggestibility, childish stubbornness).
In general, hysterical psychopathy is characterized by extroverted manifestations, but introverted variants are also possible, which is confirmed by the data of our research. Thus, there are cases when what is in the foreground is not demonstrative extravagance, assertiveness and activity, but demonstrative humiliation and helplessness, no less self-centered and effective in achieving life goals, sometimes more exhausting to others. Representatives of the first group are more often subjected to forensic psychiatric and military medical examinations in connection with insubordination, malicious violation of public order, insults, threats, blackmailing behavior, and physical violence. Representatives of the second group (“weak”, “defenseless”) act as extortionists and despots in the family and in the work team, exploiting the compliance and kindness of others. Hysterical psychopaths in crisis situations, especially when there is a threat of responsibility, often resort to suicidal actions - threats and demonstrative attempts, which can end fatally when pushed to this by other participants in the conflict situation.

Asthenic psychopathy (personality disorders of the asthenic type)

The most characteristic signs of asthenic psychopathy are the patient’s intolerance of everyday physical and mental stress, their increased exhaustion and vulnerability, helplessness in the face of difficulties, lack of self-confidence, anxiety, timidity, shyness, resentment, low self-esteem, weakness of motives, a tendency to obsessions and overvalued formations of hypochondriacal content. Psychopathological symptoms are accompanied by the phenomena of vegetative-vascular dystonia, complaints of fatigue, and persistent poor health. As the compensation for asthenic psychopaths is often exaggerated pedantry, conservatism, and the desire to preserve the usual way of life.

Emotionally Stupid Personality Disorders (Heboid Psychopathy, Emotionally Stupid Personality)

Psychopathy of this type is characterized by the inferiority of patients with higher emotions (sense of duty, conscientiousness, modesty, honor, sympathy), their selfishness, cruelty, coldness, indifference, indifference to generally accepted moral standards, a tendency towards perverted sensuality, despite the resulting suffering of others, including close people. Forms of satisfying drives and needs are often striking in their senseless cruelty and sadism. This is one of the most unfavorable forms of psychopathy. Even in a state of compensation, patients are examples of calculating, soulless despotism, careerism, tyranny, and unceremoniousness in the ways and means of achieving the goal.

Psychopathy of unstable type

Patients with unstable type psychopathy are also described as “unrestrained” (E. Kraepelin, 1915) and “weak-willed” (K. Schneider, 1959; N. Petrilovitsch, 1960). They are characterized by inconstancy in motives and aspirations, combined with an inability to achieve purposeful goals. activities. From childhood, they ignore prohibitions, order and the requirements of discipline, they are distinguished by frivolity and unreliability in studying and carrying out assignments, suggestibility, susceptibility to bad influence and distractibility. As adults, they often lead a frivolous lifestyle, engage in promiscuous sex, easily become involved in drunkenness, and use drugs. These are weak-willed, unreliable and irresponsible subjects.
Polymorphic (mosaic) psychopathy, types of partial disharmonious mental infantilism and others are mixed variants of personality disorder that cannot be clearly classified. In diagnostic practice, such psychopathy is often observed with a formalized typicality of manifestations, with a predominance of excitability or inhibition. The presence of a large number of cases of polymorphic psychopathy can, apparently, be explained to some extent by the development of biogenic and predominantly sociogenic pathomorphism of the clinical picture of typical variants of psychopathy.
Previously, much attention was paid to such behavioral anomalies as suicidemania, dromomania (vagrancy), pyromania (impulsive urge to set fires) and kleptomania (impulsive theft), considering them independent psychopathological phenomena. However, in reality they hardly exist in this understanding. According to our observations, leaving home, vagrancy, arson, theft, suicidal and other abnormal acts have very real motivation, specific situational or psychopathological conditioning and are part of the individual structure of psychological or psychopathological characteristics of a person of different origins. They are observed in mentally healthy and mentally ill persons, in those suffering from oligophrenia, psychopathy, as well as in acquired organic and moral defects, alcohol intoxication, etc., that is, they are committed as a result of different motives and mechanisms. Therefore, the psychiatric diagnosis of these “manias” and “perversions” as independent psychopathological manifestations seems unfounded and unjustified. In the vast majority of cases, they are presented as private behavioral characteristics within the framework of nosological diagnosis. Accordingly, punishability and liability in such cases should be determined by a nosological diagnosis.
It should be noted that in this regard, sexual perversions are no exception. As psychopathological phenomena, they are usually observed in psychoses and psychopathological conditions, but often have a secondary, situational origin. True, primary sexual perversions, when normal sexual desire is absent, are apparently very rare. In most cases, they should be considered as a symptomatic manifestation - as one of the signs of moral instability and immaturity, personality disharmony or disorder in the sexual sphere.
In the ICD 9th revision, sexual perversions and disorders include such forms of sexual behavior that do not correspond to accepted biological and social goals, are aimed at people of the same sex or are carried out in an unnatural way in conditions that do not interfere with the normal satisfaction of sexual needs. It is recommended to classify them according to the main mental illness, but it is also possible to separate them out as separate diagnostic forms for differentiated accounting. In most of these cases, sexual perversion is observed against the background of a psychopathic structure or mental retardation. Complete subordination of behavior to a perverted sexual instinct is noted only in cases of absence or perversion of differentiation of sexual feelings and attractions in combination with intellectual underdevelopment and lack of criticism.
In accordance with official classifications and descriptions, sexual disorders and perversions include masturbation, homosexuality (lesbianism and pederasty), bestiality (sodomy), pedophilia, exhibitionism, transvestism, transsexualism, fetishism, masochism, sadism, etc. Description of the mentioned most common forms perversions indicates that for the most part they are acquired - situational, secondary, that is, essentially reflect a distortion of the socio-psychological characteristics of the individual (mainly in sexual behavioral terms), and only a small number of them (transsexualism, transvestism and some cases of homosexuality) is caused by congenital biological factors - delayed somatopsychic sexual differentiation. In relation to the latter group, it is permissible to use the previously used term “sexual psychopathy” or “perverse psychopathy”. The spread of other sexual perversions is largely determined by the level of social tolerance and punishment, especially when it concerns healthy individuals and psychopathic subjects.
The clinic of psychopathy is usually considered from the standpoint of its statics and dynamics. P. G. Gannushkin (1933, 1964) drew attention to the possibility of change (weighting) clinical symptoms psychopathy during age-related crises (adolescence and menopause), under the influence of other constitutional factors (spontaneous, autochthonous phases and episodes), somatic diseases (somatogenic reactions) and mental influences (psychogenic reactions - shock, actual reactions and development). The author considered constitutional, somatogenic and psychogenic factors, as well as phases and reactions, in their unity.
It has now been proven that a psychopathic personality can have states of compensation and decompensation in the form of psychopathic reactions of varying duration (autochthonous, somatogenic and psychogenic exacerbations of psychopathic symptoms), situational and neurotic reactions, reactive and other psychoses. Thus, the symptoms of true psychopathic reactions reflect the main psychopathic traits characteristic of a given type, then - traits characteristic of all or most psychopathic personalities, which depends on the degree of decompensation. Thus, in the clinical picture of psychopathic reactions, specific and nonspecific ones (inherent in all types of psychopathy) can be observed ) symptoms in various combinations. In addition, it usually reflects a decompensating factor (mental trauma, somatic illness, etc.) in the form of psychogenic layers, situational opposition, symptoms of somatogenic asthenia, etc.
Psychogenic non-psychotic decompensation of psychopathy is usually designated as a situational or neurotic reaction (depending on the characteristics of the symptoms). These reactions in psychopathic individuals are manifested by a combination of exacerbation of psychopathic traits with situationally determined behavior or neurotic symptoms. In such cases, the diagnosis, for example, psychopathy of the hysterical type with a situational or neurotic reaction or a situational or neurotic reaction in a psychopathic personality, usually depends on the predominance of certain symptoms. However, it should be taken into account that in a long-term psychotraumatic situation such reactions can acquire a stable character, becoming an integral part of the entire clinical picture of psychopathy, giving it new signs or the external form of a different type of psychopathology (usually excitable or paranoid).
The expediency of isolating the psychotic variant of decompensation of psychopathy is questionable (P. B. Gannushkin, 1933; N. I. Felinskaya, Yu. K. Chibisov, 1975; A. B. Smulevich, 1983). In this case, the authors mean psychogenic, somatogenic, exogenous and endogenous decompensation. However, if we are talking about psychoses that arise as a result of the influence of the mentioned factors, then they should be interpreted in the appropriate nosological key (as psychogenic, somatogenic and other psychoses).
Isolating psychotic decompensation of psychopathy is inappropriate not only for theoretical, but also for practical reasons, especially when it concerns forensic psychiatric examination, since in this case it is as if many mental illnesses are absorbed by psychopathy and the preconditions are created for the erosion of the criteria of sanity for psychopathy. The vagueness of the definition of such psychopathic states as “pathological psychopathic reaction”, “deep personal pathology of a psychopathic personality”, “severe violation of social adaptation”, with the assertion of insanity, actually leads to a decrease in social demands on the behavior of psychopathic individuals, to the formation of irresponsibility in them. Reactions and states such as neurotic and psychotic, developing as a result of various internal and external influences, should hardly be attributed to the dynamics of psychopathy, since they have their own self-diagnosis within the boundaries of certain nosological groups ( acute reactions to stress, adaptation reactions, neuroses, reactive and somatogenic psychoses, schizophrenia, etc.), especially since the most important condition for their occurrence is the presence of an innate or acquired predisposition, including psychopathic personality development. In fact, even reactions to a situation, for example in the conditions of everyday life, are observed only in weakened individuals predisposed to this, that is, those with a functional or organic inferiority of the central nervous system, psychopathic personality traits, etc. It is no coincidence that some foreign researchers question the existence of “ pure” neuroses, namely: neuroses without a previous psychopathic or other basis - and do not see a clear boundary between neuroses and psychopathy. Accordingly, the diagnosis of psychopathy or any painful condition in a psychopathic personality is often a diagnosis of choice, and we do not see a contradiction in this, since this is a reflection of the close interaction of endogenous and exogenous factors in these types of mental pathology. Psychopathy, as an indicator of inferior development of the brain and personality, often acts as a risk factor that facilitates the emergence of various types of psychopathological conditions, including psychotic ones,

Etiology, pathogenesis and differential diagnosis of psychopathy

In theories of the etiology and pathogenesis of psychopathy, the main role is assigned to two factors - biological and social, according to which constitutional (“nuclear”), organic, “marginal” (pathocharacterological development) psychopathy and psychopathic states are distinguished. As already mentioned, for a long time the formation of a psychopathic personality was explained from the standpoint of theories of degeneration, hereditary burden, constitutional and typological insufficiency of neuropsychic functions acquired in the prenatal period or in early childhood, inferiority of the central nervous system, that is, the obligatory presence of congenital or early acquired organic or functional brain failure. Along with this, unfavorable conditions of upbringing and education from early childhood occupy a significant place.
P.B. Gannushkin adhered mainly to the constitutional theory of the origin of true (“nuclear”) psychopathy. Subsequently, an attempt was made to explain their development from the standpoint of the teachings of I. P. Pavlov on the types of higher nervous activity. For example, I. F. Sluchevsky (1957) considered psychopathy as pathological variants of types of higher nervous activity and divided them depending on this into two groups:
1) psychopathy arising on the basis of a pathological variant of a strong unbalanced type (paranoid, hyperthymic-circular, hyperthymic-explosive and perverse forms), 2) psychopathy arising on the basis of a pathological variant of a weak type (psychasthenic, parabulic, hysterical and hypochondriacal forms). Some scientists also considered psychophysical infantilism to be the biological basis of psychopathy.
P. B. Gannushkin (1933, 1964) emphasized that psychopathic pictures are not fatally inevitable, ready from childhood, but develop and change throughout life depending on social and biological conditions, and that in favorable conditions the brightness of their manifestations decreases. M. O. Gurevich (1949) considered it necessary for a psychopathic personality to have a congenital or early acquired anomaly in the development of the nervous system, and a partial anomaly affecting only the physiological systems that regulate behavior, and not cognitive activity. G. E. Sukhareva (1959) wrote that an anomaly in the development of the nervous system is only a biological basis, a tendency towards a certain type of response, that for the emergence of psychopathy a social factor is necessary: ​​environmental unfavorability, improper upbringing in the family and the team, lack of corrective educational influences and etc.
The biological predisposition to psychopathic symptom formation is currently considered ambiguously, since it may have different genesis: occurs as a result of hereditary and constitutional instability (constitutional psychopathy), brain damage during the prenatal period or in early childhood under the influence of infections, intoxications, injuries, metabolic disorders (organic psychopathy), etc.
G. E. Sukhareva took psychopathic personality development as a basis three types of central nervous system abnormalities:
1) delayed development according to the type of mental infantilism (the participation of hereditary burden cannot be ruled out, but a more significant role is played by external harmful factors that act for a long time during the prenatal period or in early stages child development: persistent infections, chronic intoxication, disorders digestive tract, starvation, improper feeding, poor hygienic conditions, etc.);
2) disproportionate development of the nervous system and the body as a whole (pathological heredity plays a predominant role, but the influence of external hazards cannot be excluded);
3) damaged, “broken” development due to damage to the nervous system in the early stages of ontogenesis.
There is no reason to deny the existence of hereditarily determined or constitutional psychopathy. Clinicians are aware of the possibility of hereditary transmission of temperamental characteristics, some primary emotional reactions, etc., the possibility of influencing the fetus and mental development the child's painful experiences of the mother during pregnancy, her somatic diseases and intoxications.
The emergence of constitutional psychopathy is a long-term process, occurring at the psychophysiological, individual and socio-psychological levels (V.V. Stalin, 1983) according to the type of functional disharmony in personality formation. In organic psychopathy, organic brain damage comes to the fore, preventing the normal development of mental functions, and in marginal psychopathy, the assimilation of asocial and antisocial patterns of emotional reactions and behavior of close significant persons comes to the fore. In this case, very complex interactions can arise between constitutional and exogenous factors, the influence of which is inevitable in any case. There are often cases of unexpectedly sharp changes in the behavior of a child or adolescent after a head injury or any disease, the consequences of which cannot be explained alone. The child ignores everything positive and internalizes only negative examples. Most likely, this occurs through the mechanism of disinhibition of internal abnormal tendencies as a result of the disease removing fragile skills of acceptable behavior. The possibility of the formation of psychopathy under the influence of exogenous brain damage is all the more likely the earlier it occurred. At the same time, with age, a normally developing personality is less susceptible to exogenous psychopathic development.
In 20% of the psychopaths we observed, heredity was reliably burdened with characteropathies, alcoholism, psychoses, 12% had a delay in general development in childhood without a proven external cause, 55% had a history of complications of the prenatal period, birth injuries, head injuries and severe somatic diseases in the first years of life. Neurological symptoms were observed in 10% of patients, signs of delayed intellectual development and nervousness in the first years of life - in 20%.
It has been established that acquired inferiority of brain functions - “minimal brain failure” - is a risk factor for abnormal personality development, however, as a rule, when combined with unfavorable social conditions of upbringing and education in childhood (G. E. Sukhareva, 1959; V. V. Kovalev, 1980).
The more early period During ontogenesis, exogenous brain damage occurs and the more distant its psychopathic consequences are observed, the less organic they differ in nature and vice versa. For example, psychopathy that occurs after birth trauma is closer in clinical manifestations to constitutional psychopathy than psychopathy that develops after trauma in preschool and early school age. In the latter case, psychopathy is accompanied by organic signs in the form, mainly, of increased vulnerability and explosiveness of the explosive, hysterical or asthenic type. In such cases, therapeutic measures aimed at the pathogenetic mechanisms of the organic process turn out to be very effective. However, facilitated under these conditions, the gradual fixation and stereotyping of inadequate forms of emotional reactions and behavior as a consequence of conflicting relationships with the social environment lead to psychopathy or psychopathization - a psychopathic state.
We believe that in such cases one should not sharply distinguish and contrast psychopathic and psychopath-like development observed in childhood and adolescence. The consequences of such damage before adolescence inclusive, manifested mainly by behavioral anomalies, can be further interpreted as psychopathy (secondary, organic) and as psychopathic-like development (at organic basis) with encryption for psychopathy. If psychopathic-like states arise as a result of brain lesions in adolescence and adulthood, then they must be diagnosed as consequences of the corresponding diseases (psychopathic-like states of exogenous etiology).
It has been proven that constant intra-family conflicts, an environment of hatred, envy, stinginess, hypocrisy, cruelty, neglect, spoiling, moral laxity, etc., affecting a child, can themselves be the cause of the abnormal development of his character. This fact is reflected in the descriptions of so-called sociopathy (A.K. Lenz, 1927), characteropathies, pathocharacterological development, regional psychopathy (V. Ya. Gindikin, 1967; O.V. Kerbikov, 1971), antisocial personalities (J. Rappeport , 1974). Many children from dysfunctional families with age exhibit pathocharacterological traits, a tendency to abuse alcohol, other bad habits, antisocial and criminogenic behavior (O. V. Kerbikov, 1971; A. E. Lichko, 1977; G. K. Ushakov, 1978 ; K. Seidel, N. Szewczyk, 1978; R. Werner, 1980). However, being categorical in this matter is unacceptable, since in similar families children often grow up with normal characterological properties and social attitudes. According to our observations, in persons with socially conditioned (“marginal”) psychopathy, the pathocharacterological signs are often the same as those of one of the parents, having a pronounced egoistic orientation. They are not so massive, although outwardly demonstrative, they compensate more quickly when their claims are satisfied and are amenable to re-education. The most frequently observed are explosive, hysterical and asthenic variants of such psychopathies.
On the other hand, late-onset regional psychopathy (pathocharacterological development) is considered by us as a result of predominantly unfavorable upbringing conditions and is presented as a distorted formation of self-awareness, self-attitude, attitude towards other people, social norms and values. It manifests itself mainly in immaturity of social orientation and increased selfishness. The biological basis as such is not seriously affected here. Therefore, such psychopathic development is almost impossible to distinguish from defects in upbringing. Therefore, serious doubts arise about the validity of many cases of diagnosing so-called marginal psychopathy, or sociopathy (acquired, acquired psychopathic conditions), since it turns out that after a change in the external situation, patients subsequently study, work and live normally, without showing any social inability. They are “psychopathic” only when it suits their own interests and does not threaten negative consequences.
In the emergence of psychopathy, foreign authors attach decisive importance to delayed psychosexual development, an unconscious conflict between the biological and the social. They deny the influence of social conditions that shape the basic personality traits and the possibility of social correction of character and behavior. Accordingly, a psychopathic personality is defined as asocial. When making a diagnosis, difficulties may arise in distinguishing psychopathy from neurotic personality development, since it is often based on a previously hidden psychopathic structure, which is actualized in a long-term psychotraumatic situation and gradually “overgrows” with neurotic symptoms. Sometimes there is a need to differentiate psychopathy and psychopath-like manifestations and consequences of certain mental illnesses (schizophrenia, etc.). In such cases, a diagnostic decision as close as possible to the truth can be made as a result of an analysis of anamnestic information, the structure of psychopathological symptoms and its dynamics. Tracing psychopathic traits throughout life and the absence of fundamentally new productive or negative symptoms during decompensation make it possible to make a diagnosis of psychopathy.

Prevention of psychopathy, treatment and social and labor rehabilitation of patients

The basis for the prevention of psychopathy should be measures aimed at creating normal conditions development in the early stages of ontogenesis (in prenatal and early postnatal periods), prevention, early detection and treatment of various diseases, to ensure favorable living conditions, development and upbringing of the child. The tasks in this area are diverse and affect the entire lifestyle of an individual family and society as a whole.
A number of consequences of scientific and technological progress (deterioration environmental situation, increasing sources of penetrating radiation, chemicalization, denaturalization of food, etc.) need more careful study and control, as they can have bad influence on the development of the child’s body and central nervous system. In recent decades there has been an increase in the number of cases allergic reactions to various foods, household chemicals and medications, changes in the body's reactivity, a tendency to a sluggish, chronic course of infectious and other diseases, which can also serve as the basis for psychopathic development. Accordingly, the implementation in our country of therapeutic and preventive measures to improve the health and improvement of women, mothers and the child population is undoubtedly of great importance for reducing the frequency of psychopathy.
Along with this, there are a number of serious socio-psychological problems in ensuring normal, especially family, conditions for personality formation. Thus, there is a tendency for parents to withdraw themselves from raising a child, shifting responsibility to preschool institutions and schools, insufficient care for the child due to the constant high production and social employment of parents, disharmony of the family or educational attitudes in it, instilling in the child dependent attitudes and a dismissive attitude to social norms, an increase in the number of divorces, as a result of which about 700 thousand children are left without a father every year and are raised by one mother, as well as an increase in household drunkenness, especially among women with an unsettled personal life, etc.
No less important is the problem of treating patients with psychopathy. Any type of psychopathy in everyday manifestation or during decompensation can acquire an expansive or sensitive (extra- or introvertive) form, although many psychiatrists believe that this is more typical for schizoid, affective and paranoid types (A. B. Smulevich, 1983; E. Kretschmer , 1930; N. Binder, 1967, etc.). As a result, the number of clinical variants of the dynamics of psychopathy, requiring a differentiated, complex therapeutic approach, is significantly increasing. Patients with psychopathy are prescribed drugs aimed at improving the somatic sphere (if indicated - anti-inflammatory, antipyretic, restorative drugs) and improving the neuropsychic state (neuroleptics, tranquilizers , antidepressants and psychostimulants), and also use psychotherapy. In expansive forms of decompensation, sedatives are used as the main ones, and in sensitive forms, drugs that have a sedative and often antidepressant and psychostimulant effect are used.
In persons with psychopathic or psychopath-like disorders of various structures, fairly uniform and universal reactions are usually observed: acute excitement, hysterical, depressive, hypochondriacal, protest, jealousy, asthenic and others, which in most cases are accompanied by dominant and overvalued ideas with psychomotor disinhibition, aggressive and auto-aggressive behavior or inhibition, often with unpredictable actions. In such cases, emergency care is necessary, the use of antipsychotic drugs and tranquilizers, including in combination with antidepressants. The general principle of therapy is basically the same as for neuroses and reactive states. To relieve conditions with abnormal behavior, psychotropic drugs are prescribed in higher doses and for a longer period of time. A course of sulfosine therapy (3-5 injections or more) is often effective. For asthenic and asthenodepressive reactions, tranquilizers, antidepressants (azaphen and amitriptyline) and psychostimulants are used. In some cases, hypoglycemic doses of insulin are prescribed, for somatogenic asthenodepressive reactions - general restoratives, and in the presence of residual effects of organic damage to the central nervous system - dehydration drugs.
Particular emphasis should be placed on the need for differentiated use of psychotherapy and psychogogy (medical pedagogy) after the acute phenomena of decompensation have been relieved. According to indications, various psychotherapeutic methods are used, including hypnosis.
Social and labor rehabilitation measures are associated with the therapy and prevention of tesio decompensation. It is noted that in favorable social, living and working conditions, psychopathic traits, as a rule, manifest themselves slightly and can be compensated for many years, especially in adulthood and with sufficiently developed intelligence. An individual approach to communication with patients, to the choice of profession and favorable working conditions can dramatically reduce the risk of psychopathic reactions. Using in the right direction some of the characterological characteristics of psychopaths can be useful for the team and society as a whole. On the contrary, a disdainful attitude towards psychopaths, ignoring their interests and needs, reduces compensatory capabilities and increases their antisocial and criminogenic danger. At the same time, individualization of attitude towards psychopathic individuals does not relieve them of social responsibility (to society and the law).
When conducting an examination, it is taken into account that psychopathy is a personality pathology (an anomaly of its development), a condition that usually remains within the framework of a non-psychotic mental pathology that does not completely deprive a person of working capacity and the ability to self-control. Persons suffering from psychopathy, as a rule, are recognized as able to work (disability of group III can be established as an exception, temporarily, in case of severe decompensation), sane and capable.