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Depressive psychopathy. Tags: types of psychopathy, classification of psychopathy, schizoid psychopathy, hysterical psychopathy, asthenic psychopathy

Psychopathy(from the Greek psyche - soul and pathos - suffering) - a congenital or developed in the early years personality anomaly, an anomaly of higher nervous activity, causing mental inferiority.

Personal behavior is modified depending on the form of psychopathy, becoming abnormal for certain groups of stimuli. In the development and course of psychopathy, there are different stages of exacerbation of psychopathic traits and phases of decompensation.

Causes of psychopathy

Psychopathic personality type arises on the basis of the interaction of congenital or early acquired biological inferiority of the nervous system with acutely negative environmental conditions. A characteristic feature of a psychopathic personality is the disharmony of its emotional-volitional sphere with the relative preservation of intelligence. Psychopathic personality traits complicate social adaptation, and under traumatic circumstances lead to maladaptive behavioral acts.

Psychopaths do not have irreversible personality defects. Under favorable environmental conditions, their mental anomalies are smoothed out. However, in all mentally difficult conditions for them, a breakdown reaction and behavioral disadaptation are inevitable. Among persons who commit violent crimes, psychopaths occupy a leading place. Psychopaths are characterized by mental immaturity, manifested in increased suggestibility, a tendency to exaggeration, and unfounded suspiciousness.

The leading factor in the psychopathization of a personality in some cases is congenital constitutional characteristics (the so-called nuclear psychopathy), in others it is the psychogenic influence of the environment (“pathocharacteristic development of the individual”).

Long-term exposure to unfavorable social factors may be the main cause of psychopathic personality development, its distorted mental formation.

Personality, emerging in conditions constant gross suppression, humiliation, begins to show timidity, depression, uncertainty or, conversely, increased excitability, aggressiveness, confrontation. An environment of universal adoration and admiration, unquestioning fulfillment of all the child’s whims can lead to the formation of a hysterical personality type, the development of egocentrism, narcissism (narcissism). Along with this, traits of explosiveness (explosiveness, impulsiveness) develop. In continued conditions of excessive guardianship, asthenicity, lack of initiative, helplessness, and external behavioral orientation (blaming one’s failures on external circumstances) are formed. Since the pathocharacteristic development of personality is predominantly determined by the social factor, it is possible to stop this process under favorable social conditions.

Classification of psychopathy

The classification of psychopathy is still controversial.

Basic types of psychopathy:

  • psychasthenic;
  • excitable (explosive);
  • hysterical;
  • paranoid;
  • schizoid psychopathy.

Psychoasthenic psychopathy

Psychasthenic psychopaths They are characterized by an increased level of anxiety, fearfulness, lack of self-confidence, extremely increased sensitivity to traumatic circumstances, and maladjustment in mentally stressful situations. Their intellectual constructs and life plans are divorced from real living conditions; they are prone to morbid philosophizing (“intellectual chewing gum”), stagnant soul-searching (they like to “saw sawdust”), and obsessions. Psychasthenics are characterized by a functional predominance of the second signaling system and weakness of the subcortical systems, which is manifested in the general energetic weakening of their higher nervous activity, the weakness of the most fragile inhibitory process. Their motivational sphere is characterized by stagnant, obsessive impulses.

Excitable psychopathy

Excitable (explosive) psychopaths They are characterized by increased irritability, a constant state of mental tension, explosive emotional reactivity, reaching the point of inadequate attacks of rage. They are characterized by increased demands on others, extreme egoism and selfishness, distrust and suspicion. They often fall into a state dysphoria- evil melancholy. They are stubborn, quarrelsome, conflict-ridden, petty-picky and domineering. They are rude, and when angry they are extremely aggressive, capable of inflicting severe beatings, and do not even hesitate to kill. Their affective behavior occurs against the background of a narrowed consciousness. In some cases, malice and explosiveness (explosiveness) will be mixed in the direction of stagnant drives (drunkenness, vagrancy, gambling, sexual excesses and perversions).

Istic psychopathy

Hysterical psychopaths They differ mainly in their thirst for recognition. They strive for external manifestation of their significance, demonstration of their own superiority, and are prone to theatricality and panache, posing and external showiness. Their desire for exaggeration often borders on deceit, and delights and disappointments are manifested violently and expressively (theatrical gestures, wringing of hands, loud prolonged laughter and sobs, enthusiastic hugs and grievances “for life”). Their life strategy is to be the center of attention by any means necessary: ​​unbridled fantasizing, constant lies (pathological liars and mythomaniacs). In pursuit of recognition, they do not even stop at self-incrimination. The psyche of these people is immature and infantile. In neurophysiological terms, they are dominated by the first signaling system, the activity of the right hemisphere. Their immediate impressions are so vivid that they suppress criticism.

Paranoid psychopathy

Paranoid psychopaths (paranoids) are characterized by an increased propensity for “overvalued ideas.” This is due to the extreme narrowness of their thinking, single-mindedness of interests, increased self-esteem, egocentrism, and suspicion of other people. Low plasticity of the psyche makes their behavior conflicting; they are constantly in a fight with imaginary enemies. Their main focus is “invention” and “reformism”. Non-recognition of their merits leads to constant clashes with the environment, litigiousness, anonymous denunciations, etc.

Schizoid psychopathy

Schizoid psychopaths highly sensitive, vulnerable, but emotionally limited (“cold aristocrats”), despotic, prone to reasoning. Their psychomotor skills are defective - clumsy. They are pedantic and autistic—alienated. Their social identification is severely impaired - hostility to the social environment. Psychopaths of the schizoid type lack emotional resonance to the experiences of other people. Their social contacts are difficult. They are cold, cruel and unceremonious; their internal motivations are poorly understood and are often determined by orientations that are extremely valuable to them.

Psychopathic individuals are extremely sensitive to certain psycho-traumatic influences, touchy and suspicious. Their mood is subject to periodic disorders - dysphoria. Tides of angry melancholy, fear, and depression cause them to become increasingly picky about others.

Psychopathic personality traits

Psychopathic personality traits are formed due to extremes in educational methods - oppression, suppression, belittlement form a depressed, inhibitory personality type. Systematic rudeness and violence contribute to the formation of an aggressive personality type. The hysterical personality type is formed in an atmosphere of full adoration and admiration, fulfillment of all the whims and whims of a psychopathic individual.

Psychopaths of the excitable and hysterical type are especially prone to sexual perversions - homosexuality(sexual attraction to people of the same sex), gerontophilia(for elderly people), pedophilia(to children). Other behavioral perversions of an erotic nature are also possible - scopophilia(secretly spying on other people's intimate acts), erotic fetishism(transfer of erotic feelings to things), transvestism(the desire to experience sexual satisfaction when dressing in clothes of the opposite sex), exhibitionism(sexual satisfaction when exposing your body in the presence of people of the other sex), sadism(erotic tyranny), masochism(autosadism).

All sexual perversions are signs of mental disorders.

(constitutional psychopathy, personality disorders) - mental disorders in which there is a persistent disturbance of character and behavioral tendencies, affecting several areas of the personality. Arises from birth or early childhood and persists throughout life. Accompanied by social and personal maladaptation of varying degrees of severity. Psychopathy is a multifactorial disease, the significance of various factors can vary significantly. The diagnosis is made taking into account the history and clinical symptoms. Treatment – ​​assistance in adaptation, psychotherapy, drug therapy.

General information

mental disorders observed throughout the patient's life. They are characterized by persistent disturbances of character and behavior, leading to deterioration of social and personal adaptation. According to statistics obtained in 2008 as a result of large-scale international studies, more than 10% of the population suffers from psychopathy (including mild forms). At the same time, the prevalence of emotionally unstable, schizotypal, histrionic and dissocial personality disorder is approximately 2% for each disorder, and the frequency of anxiety and narcissistic disorder ranges from 0.5 to 1%.

A connection with gender is revealed. Asthenic, hysterical and emotionally unstable personality disorder are more often diagnosed in women, other psychopathy - in men. Some patients experience a combination of symptoms characteristic of several personality disorders. Due to its widespread prevalence, the diagnosis and treatment of psychopathy is becoming a problem of high medical and social significance. Treatment of this pathology is carried out by specialists in the field of psychiatry, psychotherapy and clinical psychology.

Causes of psychopathy

The significance of certain factors in the development of psychopathy has not yet been reliably clarified, which is due to the difficulty of studying the circumstances influencing the formation of this group of mental disorders. The undoubted importance of the genetic factor has been established - relatives of patients with psychopathy are more likely to have similar disorders than the population average. Often representatives of two or more generations of the same family, for example, father and son or mother and daughter, suffer from psychopathy. At the same time, one cannot ignore the influence of a vicious system of relationships in the family of a psychopath and a large number of pathological beliefs and patterns of behavior acquired by a child who, from the first days of life until reaching adulthood, communicates with a patient with psychopathy.

Many experts believe that complicated pregnancy, difficult childbirth, and early childhood illnesses may play a certain role in the development of psychopathy. There is a connection with physical, psychological and sexual abuse suffered in childhood. Researchers believe that unfavorable living conditions during childhood aggravate genetically determined character traits and personality traits and increase the risk of developing psychopathy.

Classification of psychopathy

The traditional classification of Gannushkin, used by Soviet and Russian psychiatrists, included seven types of psychopathy: asthenic, psychasthenic, schizoid, paranoid, excitable, hysterical, affective and unstable. Since 1997, after the transition to the ICD-10 classification of diseases, psychopathy began to be called personality disorders. The ICD-10 identifies the following types of personality disorders:

  • Schizoid disorder (corresponding to schizoid psychopathy)
  • Paranoid disorder (corresponding to paranoid psychopathy)
  • Schizotypal disorder
  • Antisocial disorder
  • Emotionally unstable disorder (corresponding to excitable psychopathy)
  • Histrionic disorder (corresponding to hysterical psychopathy)
  • Narcissistic disorder
  • Obsessive-compulsive disorder (corresponding to psychasthenic psychopathy)
  • Avoidance disorder
  • Dependent disorder (corresponds to asthenic psychopathy)
  • Passive-aggressive disorder.

It should be noted that, despite the adoption of ICD-10, there is still no absolute unity among psychiatrists on the issue of classification of psychopathy, which is due to the complexity and significant polymorphism of the clinical picture of this mental disorder.

Forms of psychopathy

Schizoid psychopathy (schizoid personality disorder)

The main signs of schizoid psychopathy are a lack of need for close relationships, a persistent desire to minimize social contacts, some disregard for social norms, emotional coldness and detachment from one’s own feelings, combined with theorizing and withdrawal into fantasy. Patients suffering from schizoid psychopathy are unable to express any strong feelings - both positive (joy, tenderness, delight) and negative (rage, anger).

Such patients have little interest in sexual contacts, friendships and creating a family. They prefer to lead a solitary lifestyle. People suffering from schizoid psychopathy find it difficult to work in a team, so they choose professions that require individual activity. They either enjoy a small number of activities or do not enjoy them at all. They are indifferent to both condemnation and approval, they care little about accepted social norms.

Psychoanalysts believe that the reason for the development of schizoid psychopathy is the duality of parental messages and the need for intimacy, combined with the fear of absorption, which forces one to maintain a distance in communicating with people. Intellectualization becomes the main mental defense. There is a pronounced tendency to sublimation. The diagnosis of schizoid psychopathy is made in the presence of four or more of the listed symptoms at the age of 18 years or older, their manifestation in different contexts and persistence throughout life. Treatment – ​​social adaptation, long-term psychoanalytic therapy.

Paranoid psychopathy (paranoid personality disorder)

The hallmarks of paranoid psychopathy are resentment, suspicion, overreactions to rejection or the inability to satisfy needs, as well as a distorted perception of the environment with a tendency to distort facts, take everything personally, interpret the actions of other people in a negative way and suspect them of bad intentions. Patients suffering from paranoid psychopathy are constantly dissatisfied with someone or something. It is difficult for them to forgive the mistakes of others; behind any accident they see malicious intent, build conspiracy theories, are sensitive to issues of individual rights, and consider neutral or positive words and actions of other people as an attack on their own reputation. A characteristic feature of this psychopathy is constant excessive jealousy.

The main defense mechanisms of the psyche are projection, denial and reactive formation. Patients suffering from paranoid psychopathy experience many pronounced negative emotions (anger, envy, resentment, desire for revenge, anger, fear, guilt, shame), but they deny their feelings and project them onto others. The diagnosis is made when three or more of the above signs of psychopathy are identified. A prerequisite is the constancy of these signs and their influence on several aspects of the patient’s life. Treatment includes social adaptation measures and long-term psychotherapy.

Excitable psychopathy (emotionally unstable personality disorder)

There are two types of excitable psychopathy: impulsive personality disorder and borderline personality disorder. Both pathologies are characterized by impulsiveness, a tendency to violent, bright, uncontrollable expression of emotions, often inconsistent with the significance of real circumstances. The distinctive features of psychopathy are instability of the self-image, serious problems in building social relationships, high tension in personal relationships, fluctuations from idealization to devaluation of the partner.

Patients suffering from excitable psychopathy experience a pronounced fear of loneliness, but due to beliefs that arose in childhood, they cannot build stable relationships. On the one hand, people with excitable psychopathy doubt their own worth and significance, consider their feelings and interests unimportant and try to hide them, on the other hand, they assume that others can use them and suspect others of selfish interests. High emotional stress “splashes out” in the form of uncontrollable outbursts of rage and anger, often incomprehensible to others. This psychopathy is characterized by periods of anxiety and irritability, self-aggressive behavior and sexual promiscuity.

Many patients attempt suicide and abuse substances. The impulsive version of excitable psychopathy differs from borderline disorder by more pronounced aggressiveness, cruelty and emotional instability and a lower level of control over one’s own behavior. The diagnosis of psychopathy is made in the presence of severe impulsivity, a significant decrease in the ability to plan and uncontrollable outbursts of anger. Treatment is long-term psychotherapy aimed at correcting pathological beliefs and stabilizing the image of one’s own “I”, in combination with measures for social adaptation.

Histrionic psychopathy (hysterical personality disorder)

Characterized by excessive emotionality combined with the need to remain in the center of attention of others in any way. Emotions are superficial, unstable, and often overly exaggerated (theatrical). To attract attention, patients suffering from hysterical psychopathy actively use their own sexuality and view their appearance as a tool for manipulating others.

There is egocentrism, superficiality of judgment, lack of need for a full analysis of situations, and high suggestibility. Patients with hysterical psychopathy easily fall under the influence of others. The diagnosis is made in the presence of three or more stable signs characteristic of this disorder. Treatment – ​​assistance in social adaptation, long-term psychotherapy. Psychoanalytic therapy is considered the most effective technique.

Other psychopathy

Psychasthenic psychopathy(obsessive-compulsive personality disorder) is characterized by indecisiveness, stubbornness, excessive attention to detail, perfectionism, neatness, and the need to control the environment. Patients with psychasthenic psychopathy constantly plan something aimlessly, trying to take into account the smallest details. It is difficult for them to relax; they constantly strive to find some “useful activity” for themselves, preferring unnecessary work to relaxation and communication with friends.

Asthenic psychopathy(dependent personality disorder) is manifested by vulnerability, high sensitivity and an excessive need for the care of others. Patients suffering from this psychopathy are afraid of imaginary separation, get lost in unusual surroundings, become overly attached to other people and are afraid of loneliness. They tend to take the position of a follower, avoid responsibility, and have difficulty making any decisions. Concomitant autonomic disorders and increased exhaustion are observed.

Schizotypal psychopathy(schizotypal personality disorder) is characterized by an inability to form close relationships, unusual behavior, and mystical thinking. Patients believe that they have some kind of extraordinary, usually extrasensory, abilities: they read the future, see and understand something hidden from the eyes of other people, have telepathy, etc. They are characterized by unusual behavior and speech rich in metaphors.

Antisocial psychopathy(dissocial personality disorder) is accompanied by a gross disregard for generally accepted social norms and disregard for the rules of behavior in society. Patients show indifference to the feelings of others, are prone to risk, aggression and impulsive behavior. If desired, patients suffering from antisocial psychopathy can easily get along with other people, but have an extremely limited ability to form attachments. They do not feel guilty, they tend to blame other people for everything and find plausible explanations for any of their own actions.

Narcissistic personality disorder– psychopathy, in which there is a belief in one’s own uniqueness, a need for admiration and a lack of empathy. Patients are convinced that they are different from the “gray mass”, that their talents and achievements are of particular significance. They believe that they should be loved, admired and obeyed. At the same time, the “empty” inner “I” of a person suffering from psychopathy requires constant external confirmation of its own significance and uniqueness. The patient experiences envy of others and believes that other people envy him.

Avoidant personality disorder(anxiety disorder) is a psychopathy in which patients constantly suffer from feelings of inferiority. They are extremely sensitive to criticism, fear the displeasure and disapproval of other people, restrain emotions when communicating with strangers, and avoid new activities. They believe in the superiority of others. They are so afraid of being rejected that they maintain a distance that prevents other people from getting close enough for approval or rejection.

Passive-aggressive personality disorder– psychopathy, in which there is constant passive resistance to any type of activity. Patients fluctuate from protest to repentance, easily enter into conflicts with other people, complain and criticize others, and envy other people's successes. They tend to take the position of an “eternal sufferer,” exaggerating their own troubles.

The basis of treatment for all of these psychopathies is long-term psychotherapy. The technique is chosen taking into account the characteristics of the disorder. In most cases, the most effective are classical psychoanalysis, Jung's depth psychoanalytic therapy, and various combinations and modifications of these methods. If necessary, tranquilizers and antidepressants are prescribed for psychopathy. Purposeful social adaptation in adolescence and youth plays an important role: support when joining a team, help in choosing a profession, etc.

Psychopathy (Greek psyche - soul and pathos - suffering) – a borderline disorder of personality development, characterized by disharmony in the emotional and volitional spheres. This is an incorrect, painful development of character, an anomaly of character, from which both the person himself and society suffer (“deformity of character”). Psychopathy is not a mental illness, but it is not a normal option, nor is it health.

Psychopathy is characterized by 3 main signs, established by the Russian psychiatrist P.B. Gannushkin:

1. The totality of pathological character traits that manifest themselves always and everywhere, under any conditions.

    Stability of pathological character traits - they first appear in childhood or adolescence, less often in adults, and persist throughout a person’s life; periodically they increase (decompensation) or weaken (compensation), but do not completely disappear.

    Violation of social adaptation is precisely due to pathological character traits, and not due to unfavorable external influences.

Psychopathy is formed when a combination of congenital or acquired in early childhood (in the first 2-3 years) inferiority of the nervous system with adverse environmental influences (but based on the biological inferiority of the child’s nervous system).

There are many reasons for the occurrence of psychopathy, the main ones are the following:

    hereditary factors - psychopathic parents most often give birth to children with a similar pathology (these are so-called constitutional, genetic psychopathy - the most unfavorable option, they cannot be corrected even with proper upbringing);

    alcoholism and drug addiction in parents;

    various factors that negatively affect the fetus in the intrauterine period of development (alcohol, nicotine, drug intoxication of the mother, taking medications, poisoning with anything, mental trauma and infectious diseases, especially viral ones, nutritional deficiencies, severe toxicosis of pregnancy, threat of miscarriage, placental abruption etc.);

    birth injuries, asphyxia during childbirth, prolonged difficult labor, application of forceps, etc.;

    traumatic brain injuries, brain infections (meningitis, encephalitis), severe poisoning in the first 3 years of a child’s life;

    long-term debilitating illnesses in the first 3 years of life;

    disadvantages of upbringing (atmosphere of scandals, drunkenness, single-parent family, permissiveness, etc.)

Psychopathy should be distinguished from character accentuation.

Accentuation of character(Latin accentus - emphasis and Greek charakter - trait, feature) - these are mildly expressed deviations of character, sharpening of certain personality traits. This is not a disease, but one of the normal variants.

The concept of accentuated personalities was developed by K. Leonhard.

With accentuation of character (as opposed to psychopathy):

    social adaptation is not impaired (or the impairment of adaptation is minor and temporary);

    features of accentuation do not appear everywhere and not always;

    a person is aware of his shortcomings and tries to avoid situations that affect him, and with psychopathy there is an uncritical attitude towards himself and his own behavior.

Both psychopathy and character accentuations with similar manifestations are called the same.

Manifestations of psychopathy are diverse. Despite the rarity of pure types and the predominance of mixed forms, it is customary to distinguish the following classic types of psychopathy:

    Explosive (excitable) psychopathy . From early childhood, the child is characterized by loudness, slight excitability, motor restlessness, light sleep with frequent awakenings, and twitching. Then the following main pathological features appear:

    1. irritability and short temper, lack of restraint,

      bouts of uncontrollable rage,

      mood disorders (sadness, anger, fear),

      aggressiveness, vindictiveness, despotism,

      tendency to quarrels and fights (aggressive reaction like a short circuit “stimulus - reaction”),

      the desire to assert oneself at the expense of the weak,

      self-centeredness, cruelty, etc.

Behavior at school is uncontrollable; such a child cannot be taught discipline. Does not show interest in classes, studies poorly, does not feel the distance between himself and the adult. Most people have been drinking alcohol since adolescence, and their pathological character traits become even more pronounced (this is the group with the highest risk of developing alcoholism). They can be energetic and active. Among them there are gamblers (as a rule, this takes on a painful nature). Conflicts with others run through their entire lives and cause disruption of social adaptation: they are intolerant at school, family, in the army, at work.

With excitable psychopathy, those around him suffer more than the psychopath himself (although in fights he also suffers).

    Hysterical psychopathy . The first personality deviations appear in children at 2-3 years of age or in preschool age. Children are capricious, touchy, active, inclined to talk, imitate adults, imitate them; easily remember poems, jokes, anecdotes overheard from adults; They are impressionable and emotional, often the idols of the family. They have high self-esteem.

Hysterical psychopathy is characterized by:

    the desire to appear larger than it actually is;

    desire to be the center of attention;

    an unquenchable thirst for recognition;

    selfishness (living at the expense of others), selfishness, indifference to others;

    posturing, actions designed for external effect;

    tendency to lie, fantasize;

    the importance of assessing others;

    ability to gain trust and rapport

Such children and adults usually have a good memory, uninhibited thinking, and quickly master a new profession, but they are not characterized by perseverance and hard work. They only like what comes easy. They prefer professions where they can be visible. They have big problems with honesty and integrity (they should never be trusted to manage money). Like all weak individuals, they are cowards, they will betray and sell everyone, because... They love themselves more than anything in the world. Prone to alcohol abuse.

    Unstable psychopathy , in which there is blatant irresponsibility and lack of permanent attachments; people with such a character easily get married, easily leave, often change their place of work, place of residence (“rolling stones”), these are people who live for one minute.

4. Asthenic psychopathy .Its main features are:

    timidity, shyness, timidity;

    lack of self-confidence;

    lethargy, decreased activity;

    vulnerability, mimosis;

    increased fatigue, by the end of the lesson their attention is scattered, unable to perceive new material.

An asthenic person at home must rest for a long time before doing homework. Usually such children do not have friends, they cannot call and ask for lessons, or they are embarrassed to do so. Parents should constantly help them with homework. They are very worried before any important event - an exam, a performance, etc. A slight complication in their life situation causes them to have neurotic reactions such as neurasthenia. They cannot carry out assignments or hold positions associated with great responsibility and the need to manage other people. Moreover, failures in such cases are very painful.

5.Psychasthenic psychopathy . S.A. Sukhanov called psychasthenics anxious and suspicious individuals. Their main features:

    indecision, suspiciousness;

    tendency to doubt, difficulties in making decisions;

    tendency to introspection, mental chewing gum;

    a feeling of inferiority, but at the same time pronounced pride and increased appreciation;

    touchiness;

    communication difficulties

Since childhood, such people are fearful, impressionable and anxious, and are characterized by low physical activity. At school age, anxiety intensifies, they painfully endure reprimands, repeatedly check the correctness of solutions to problems, and take the longest tests in class (they double-check!). at the same time, most of them are of the thinking type and have good intelligence. They have an inquisitive mind, a desire to meticulously get to the bottom of things, they are excellent performers, they ask a lot of questions (but only to their people), but the call to the board is painful. The “weakest” point is the need to make a quick decision or complete work in a short time .

Psychasthenic psychopathy is the option when the person himself suffers the most, and not society (they spend their whole life in a heroic struggle with themselves).

6.Paranoid psychopathy .Its distinctive features are

    suspicion, suspiciousness;

    a high degree of readiness to form highly valuable ideas (most often ideas of jealousy, litigiousness, and invention);

    selfishness, self-confidence, lack of doubt;

    belief in one's infallibility;

    intransigence, activity in defending one’s idea

    inflated self-esteem.

    Schizoid psychopathy has the following features:

    unsociability, isolation, isolation, secrecy;

    phlegmatic, but also capable of outbursts of emotions;

    emotional coldness, dryness;

    lack of empathy;

    greater proximity to nature and books than to peers (such people are always aloof, often lonely);

    in friendship - constancy, importunity, jealousy;

    one-sidedness and inflexibility of judgment (a person can be boring, corrosive)

    Cycloid psychopathy, the main symptom of which is a constant change in mood (either high or low) with cycles from several hours to several months.

    Pathological drives , which include kleptomania, pyromania, sexual psychopathy (in which sexual satisfaction is achieved only in a perverted way), including:

    homosexuality (attraction to people of the same sex);

    sadism (satisfaction of sexual feelings while causing pain to a partner);

    masochism (satisfaction of sexual feelings when pain is caused by a partner);

    pedophilia (sexual attraction to children);

    sodomy, bestiality (sexual attraction to animals);

    exhibitionism (satisfaction of sexual feelings by exposing the genitals in front of people of the opposite sex) and others.

Various psychopathic personalities quite often come into conflict with others. By creating conflict situations themselves, they make it even worse for themselves, because... during a conflict, an additional psychogenic effect occurs and a psychopathic reaction may develop with an exacerbation of abnormal character traits (the teacher must take this into account). A psychopathic reaction occurs suddenly, in response to insignificant (for a normal person) events (for example, someone accidentally touched someone while passing by), as a rule, it is inadequate, most often expressed in the form of protest, indignation, anger, malice, rage and even aggression.

3. Neuroses and neurotic conditions in children and adolescents

Neuroses are the most common group of neuropsychiatric diseases in children. The manifestations of their neuroses are very diverse.

The cause of neuroses is interpersonal conflicts (neurotic conflict). Neurosis is a form of mental adaptation (with the manifestation of signs of maladaptation). It is always conditioned constitutionally, associated with the characteristics of the psyche, and not with the nature of the traumatic situation. The form of neurosis in a person does not change throughout his life. The neurotic form of response is established in childhood as a manifestation of overcompensation of some quality when significant relationships with the microenvironment are disrupted and has a childish connotation. There are no organic changes in the brain during non-existence.

An important feature of neurosis is that a person is aware of his illness and strives to overcome it. The ability to adapt to the environment is retained.

There are three main forms of neurosis:

      Neurasthenia (asthenic neurosis) - the most common form of neurosis. In the development of neurosis in children and adolescents, the main role belongs to stress or chronic psychological trauma , most often associated with conflicts in the family (quarrels between parents, alcoholism, their divorce, a conflict situation due to the lack of work of spouses, a sense of social injustice - the inaccessibility of much that other peers have) or protracted school conflicts. Matters and the wrong approach to education (excessive demands, unnecessary restrictions), as well as poor health child due to frequent illnesses, contributes to the development of overloading the child with various activities , primarily intellectual (increased teaching load in specialized schools, additional classes in clubs, etc.). However, the factor itself of intellectual (as well as physical) overload in childhood and adolescence, although it can cause overwork and asthenia of the nervous system, in the absence of a traumatic situation, it usually does not lead to the development of asthenic neurosis.

Asthenic neurosis in its expanded form occurs only in school-age children and adolescents (initial and atypical asthenic reactions are observed in children of early, preschool and primary school age).

The main manifestation of neurasthenia is the condition irritable weakness, characterized by On the one side, increased lack of restraint, a tendency to affective discharges of dissatisfaction, irritability and even anger, often aggression (excessive reaction to a minor issue), and on the other hand- mental exhaustion, tearfulness, intolerance to any mental stress, rapid fatigue. Passive defense reactions are excessively expressed. At the same time, volitional activity is reduced, a feeling of futility arises against the background of over-responsibility, a depressed mood, dissatisfaction with oneself and everyone around is noted, depression is a strong melancholy, accompanied by a feeling of despair and anxiety, there may be attempts at suicide (suicide).

With neurasthenia, autonomic disturbances are always present: palpitations, a feeling of cardiac arrest or interruptions, pain in the heart area, a tendency to vascular fainting (with a rapid change in body position), decreased or increased blood pressure, shortness of breath, increased gag reflex, decreased appetite, shallow sleep, coldness hands, feet, sweating (hyperhidrosis), which contributes to the child’s colds, which in turn aggravate the course of asthenic neurosis.

      Hysteria (Greek hystera - uterus) - in frequency it ranks second after neurasthenia. Occurs in infantile, hysterical individuals with poor mental adaptation (often with a pyknotic somatic constitution), often in a traumatic situation associated with a contradiction between what is desired and what is actually achievable (low academic performance, inattention from peers, etc.), with damaged pride, with dissatisfaction with their position in the team. Its forms are varied and are often disguised as various diseases (“the big liar”, “the big monkey” - this is how this type of neurosis is figuratively called). Its forms reflect two well-known animal (and children’s) types of reaction in the face of danger - “imaginary death” (freezing ) and “motor storm” (frightening, avoidance, attack) – seizures (like epilepsy). A hysterical attack usually occurs in the presence of spectators and is aimed at attracting their attention. Partial fixation can manifest itself as functional paralysis and paresis, disorders of pain sensitivity, coordination of movements, speech disorders (stuttering, soundlessness up to complete muteness), attacks of suffocation reminiscent of asthmatic ones, etc. “Flight into illness” plays the role of a kind of pathological defense of the individual from difficult situations. situations, justify the child’s poor performance or eliminate the need to go to school.

      Obsessive-compulsive neurosis. It occurs more often in asthenics, people of a melancholic nature. It is believed that definite obsessive-compulsive neurosis cannot arise before the age of 10. This is due to the achievement of a certain degree of maturity of self-awareness of the child’s personality and the formation of an anxious and suspicious background of the psyche, on the basis of which obsessive phenomena arise. In younger children, it is advisable to talk not about neurosis, but about neurotic reactions in the form of obsessive states.

There are two types of neurosis:

    - obsessive anxiety neurosis(phobias). Their content depends on the age of the child. In younger children, obsessive fears of infection and contamination, sharp objects, and closed spaces predominate. In older children and adolescents, fears associated with the consciousness of their physical “I” dominate. For example, obsessive fears of illness and death, fear of blushing (ereitophobia), obsessive fear of speech in people who stutter (logophobia). A special type of phobic neurosis in adolescents is no expectation, which is characterized by anxious anticipation and fear of failure when performing any habitual action (for example, fear of giving oral answers in front of the class, despite being well prepared), as well as violation of it when trying to perform it.

    - neurosis of obsessive actions. However, obsessive states of a mixed nature often occur. In this case, the mood tends to decrease, and autonomic disorders occur.

    Children often have systemic neuroses :

    - neurotic stuttering - disturbance of the rhythm, tempo and fluency of speech associated with muscle spasms involved in the speech act. It occurs more often in boys than in girls.

    - Mutism ( lat.mutus - silence) is a disorder predominantly of school age (rare in adults), because The child’s developing speech is the youngest function of the psyche, and therefore is more often broken under the influence of a wide variety of harmful factors.

    Children with mutism need to be treated with care - not to punish, not to ridicule, not to insult, not to put them on the board until they speak.

    - neurotic tics– a variety of automated and unusual elementary movements (blinking, licking lips, twitching of the head, shoulders, various movements of the limbs, torso), as well as coughing, “grunting”, “grunting” sounds (so-called respiratory tics), which arise as a result of fixation of one or another protective action. Most often observed between the ages of 7 and 12 years. Tics can become obsessive in nature, in which case they are a manifestation of obsessive-compulsive neurosis ;

    - anorexia nervosa– refusal to eat;

    - neurotic sleep disorder – disturbance of falling asleep, depth of sleep with night awakenings, night terrors, as well as sleepwalking (somnambulism) and sleep talking.

    - neurotic enuresis – unconscious urinary incontinence, mainly during night sleep ;

    - neurotic encopresis – involuntary release of feces, which occurs in the absence of disorders and diseases of the lower intestine. As a rule, the child does not feel the urge to defecate, at first does not notice the presence of bowel movements, and only after some time does he feel an unpleasant odor. Most often occurs at the age of 7–9 years, more often in boys.

    Treatment methods for neuroses are based on a combination of pharmacological therapy with various types of psychotherapy.

    Buyanov M.I. Conversations about child psychiatry. – M.: Education, 1992

    Buyanov M.I. Fundamentals of psychotherapy for children and adolescents. - M.: Education, 1998

    Doroshkevich M.P. Neuroses and neurotic conditions in children and adolescents: Textbook for students of pedagogical specialties of higher educational institutions / -Mn.: Belarus, 2004

    Enikeeva D.D. Borderline states in children and adolescents: foundations of psychiatric knowledge. A manual for students. Higher Ped. Educational institutions.-M.: 1998

    Fundamentals of psychological knowledge - Textbook. Author-compiler G.V. Shchekin - Kyiv, 1999

    list the most common signs of disorders of cognitive activity, emotional and volitional activity.

    name borderline mental states in children.

    explain the need for knowledge about such conditions for the teacher.

    characterize different types of psychopathy

    Having analyzed the causes of psychopathy, give recommendations for their prevention.

    give the concept of neurosis.

    talk about the types of neuroses and their prevention.

Questions submitted for independent study:

1. Factors for the risk of mental illness in the era of scientific and technological revolution: urbanization, physical inactivity, information revantation, etc..

Weiner E.N. Valeology: a textbook for universities. – M.: Flinta: Nauka, 2002. – pp. 68-74; 197-201.

Additional block of information.

The living conditions of modern man differ significantly from those in which he became a biosocial being. In the early stages of the existence of Homo sapiens, he led a lifestyle close to natural. In particular, he was characterized by a high level of physical activity, which in itself corresponded to the neuropsychic stress necessary in the struggle for existence. People lived in small communities, living in an ecologically clean natural environment, which could be replaced (but not changed) by the entire community if it became unsuitable for life.

The development of civilization went in the direction of property stratification and professional specialization of people, necessary for mastering new tools, increasing the length of training and gradually lengthening the period of specialization of part of the population. From the perspective of the life of one generation, all these changes occurred rather slowly, against the background of relatively slow changes in the habitat, low population density and while maintaining a high level of physical activity. All this did not represent any special requirements for the human psyche that went beyond the requirements established in evolution .

The situation began to change with the beginnings of the development of capitalism and progressive urbanization, and most radically in the second half of the 20th century, when human lifestyle began to change rapidly.

Urbanization(Latin urbanus – urban) – socio-demographic process, which consists in the growth of the urban population, the number and size of cities, which is associated with the concentration and intensification of technogenic functions, the spread of a changed urban lifestyle

Urban population growth is sharp increased the density of person-to-person contacts.. Increased speeds of human movement lead to an increasing number of interpersonal contacts, and to a significant extent - with strangers. From a mental point of view, these contacts often turn out to be unpleasant for a person (the danger of developing distress). On the contrary, family relationships have a beneficial effect, if, of course, the relationships between family members are good. However, unfortunately, favorable family relationships occupy only 20-30 minutes a day in the family, according to statistics. There is often a disruption of traditional family ties.

Certain factors of a noticeably changed external environment have an undoubted influence on the psyche of modern man. So, The noise level has increased significantly within the city limits, where it significantly exceeds the permissible norms (busy highway). Poor sound insulation, TV, radio, etc. turned on in your own apartment or in your neighbors. make the influence of noise almost constant. Unlike natural ones (wind noise, etc.), they have a negative effect on the entire body and on the psyche in particular: breathing rate and blood pressure change, sleep and the nature of dreams are disturbed, insomnia and other unfavorable symptoms develop. Such factors have a particularly strong impact on the growing child’s body, and the level of fear in children increases more clearly.

A special place in radioactive contamination plays a role in disruption of a person’s mental state(the nervous system is very sensitive to its effects), electromagnetic pollution in the form of radiation from a tangle of wires and electrical appliances (makes a person more aggressive). On the emotional sphere of a person Some forms of rock music also have an extremely unfavorable effect, which are characterized by a monotonous rhythm, emphatically emotionally intense coloring of the soloists’ voices, increased volume above normal levels and a special spectrum of sound.

It should be taken into account that the person himself is a source of weak electromagnetic and other physical fields. Perhaps a large crowd of people (and this is typical for a city) generates electromagnetic waves of various characteristics, which at an unconscious level can have a negative effect on the brain.

Indirect influence on the state of the brain and mental health also has chemical pollution of the atmosphere(an increase in carbon monoxide in the inhaled air worsens gas exchange in brain tissue and reduces its functional characteristics, etc.).

Destruction of the natural human environment(which itself is a particle of nature), replacing it with an artificial environment made of stone and concrete, containing isolated spaces, etc., deforms the human psyche, especially the emotional component, disrupts perception, and reduces health potential.

The scientific and technological revolution led to a decrease in the share of physical labor, that is, to decreased level of physical activity(development of physical inactivity). This circumstance disrupted the natural biological mechanisms in which the latter was the final link in life activity, therefore the nature of life processes in the body changed and ultimately the stock of human adaptive capabilities and his functional reserves decreased.

According to Academician Berg, over the last century, energy expenditure on muscle activity in humans has decreased from 94% to 1%. And this indicates that the body’s reserves have decreased by 94 times. Physical inactivity is especially unfavorable in children during the period of maturation of the body, when energy deficiency limits not only physical development, but also psychological (including intellectual). There may be a need for doping, first psychological, then medicinal, and quite possibly narcotic.

Physical inactivity turns off the final link of the stress response – movement. This leads to tension in the central nervous system, which, given the already high information and social overload of modern man, naturally leads to the transition of stress into distress, reduces physical and mental performance, and disrupts normal brain function.

Modern life is associated with exceptionally large flow of varied information, which a person receives, processes and assimilates. According to some data, every 10-12 years the volume of newly acquired information in the world corresponds to that accumulated over the entire previous history of mankind. This means that modern children need to learn at least 4 times more information than their parents did at the same age, and 16 times more than their grandparents. But the modern human brain has remained almost the same as it was 100 and 10,000 years ago. This creates the preconditions for information overload. In addition, reducing the time for processing new information increases neuropsychic stress, which often causes negative reactions and conditions leading to disruptions of normal mental activity. At the same time, the brain tries to protect itself from excess and unfavorable information, which makes a person emotionally less sensitive, emotionally “dumb,” less responsive to the problems of loved ones, insensitive to cruelty, and then to kindness, and aggressive. In some cases, this is already observed in young children.

The considered risk factors, characteristic of most cities, are associated with the so-called diseases of civilization - diseases widespread among economically developed countries: hypertension, coronary heart disease, gastric ulcer, diabetes, metabolic diseases, bronchial asthma, neuroses, mental disorders, etc. .

List the main health risk factors associated with the scientific and technological revolution.

Explain the negative impact of urbanization on human mental health.

Describe the connection between physical inactivity and human mental health

Describe the effect of excess information on the human psyche.

Give the concept of diseases of civilization.

Psychopathy represents painful personality changes, with disturbances in the emotional sphere, volitional disorders, pathological experiences and attacks of inappropriate behavior. People suffering from these types of disorders may retain intellectual abilities, but often lose them. The development of psychopathy gradually leads to the fact that patients develop inappropriate behavior in society and lose the ability to normal social adaptation. Psychopathic manifestations are especially difficult if painful changes begin in childhood.

A representative of the German school of psychiatry, K. Schneider, argued that the personality of a psychopath exposes both himself and the people around him to suffering. Psychopathic manifestations can undergo dynamic changes with a person's age and development. Clinical symptoms especially increase in adolescence and in old people.

Table of contents:

Causes of psychopathy


Please note:Severe diseases of internal organs and severe stressful situations can be provoking factors for the development of pathological changes. According to official data, up to 5% of the population suffers from psychopathy.

Despite the prevalence of this pathology, its causative factors have not been sufficiently studied. Scientists disagree on some issues of classification and on the mechanisms of development of painful changes.

A separate large group of causes of psychopathy includes brain lesions that are caused by:

  • environmental pollution;
  • severe infectious diseases;
  • traumatic head injuries;
  • poisoning;
  • elevated.

The listed groups of harmful effects lead to painful changes in the brain and nervous system, and as a result, severe changes occur in the psyche.

Also, social factors are of great importance in the development of pathology: the atmosphere in the family, school, work groups, etc. These conditions especially play a role in childhood.

The hereditary nature of the transmission of psychopathy is of no small importance.

Basic classifications of psychopathy

The problem of psychopathy has interested many world-class scientists. This led to the creation of many classifications. We will look at the most common ones, those most often used in clinical medicine.

According to the main groups (O.V. Kebrikov) the following are distinguished:

  • nuclear psychopathy(depending on the constitutional type of a person, in which the main role is played by heredity);
  • marginal psychopathy(arising due to problems of a biological nature and social reasons);
  • organic psychopathy(caused by organic brain lesions, and manifesting themselves at the stage of personality development, at the age of 6-10 years).

An additional role in the development of psychopathic traits is played by:

  • separation of the child from his parents and family;
  • overprotection, developing painful self-esteem;
  • lack or complete lack of attention to your children;
  • “Cinderella” syndrome – relegation to the background of an adopted child, or the formation of a complex in children as a result of parental intense attention paid to one child at the expense of others;
  • the “idol” phenomenon is a painful perception of caring for other children by a child who is the “favorite” of family society.

Please note:existing psychopathic character traits can clearly manifest themselves due to defects in upbringing and give rise to painful emotional reactions and pathological behavior.

The main medical classification of psychopathy divides the disease according to the leading psychopathological syndrome.

In practical medicine, psychopathy is distinguished:

  • asthenic;
  • psychasthenic;
  • schizoid"
  • hysterical;
  • epileptoid;
  • paranoid;
  • excitable;
  • affective;
  • heboids;
  • with sexual disorders and perversions

Symptoms of the main clinical forms of psychopathy

The main manifestations of psychopathy depend on the developing type of disease

Symptoms of asthenic psychopathy

This form is characteristic of people of a weak psychophysical type, prone to increased vulnerability, hyper-sensitivity, and quickly exhausted under severe nervous and physical stress. They are characterized by excessive anxiety (fearfulness), cowardly actions, and frequent indecisiveness when necessary to take responsibility.

Deep and prolonged experiences lead to a constantly depressed mood. Over time, an excessive tendency to worry about one’s health appears and develops.

An asthenic psychopath is constantly tired, and good health is an extreme rarity for him. Character traits are dominated by excessive pedantry and bile, there is a certain life algorithm, the boundaries of which are very difficult for the patient to go beyond.

This form is also characteristic of a weak type of nervous system. The main feature of patients is the predominance of the second signaling system. Characteristic of people of the mental type. The behavior of these psychopaths is dominated by corrosiveness and excessive analysis of events and actions, especially their own. The patient is concerned about abstract, unimportant issues. For example, the color of the shirt you should wear when going out. Reasoning about whether it is worth going in these clothes right now can lead a person to a dead end, and he will not go to the place he needs at all. Among the main symptoms of psychasthenic psychopathy are painful doubts (“mental chewing gum”) that arise for any, even the most insignificant, reason. Psychasthenics are characterized by pettiness and pedantry, which to an extreme degree reach the level of obsessive states.

Psychasthenics constantly engage in self-reexamination. Obsessive thoughts distract patients from real life. The insufficiency of the first signaling system makes patients emotionally narrowed, “flat” and indifferent.

Patients with this form of the disease look withdrawn, avoid people and communication, and are prone to self-absorption (pronounced introverts) . The thoughts and ideas of patients are poorly understood by others and are very unique. His appearance and hobbies are unusual. There is a disconnection from the interests of the outside world.

They say about such people that they are “not of this world,” eccentric and indifferent to themselves and others. They often have developed intellectual abilities . According to the classification of I.V. Shakhmatova is distinguished: sthenic type of schizoid psychopathy (with symptoms of isolation, emotional dullness, rigidity and coldness) and asthenic type (closeness is noticeable, accompanied by daydreaming, anxiety and combined with strange hobbies - “weirdos”).

Typology of a person with a predominance of the first signaling system. Characteristic of the artistic type of nervous activity. Vivid emotions come first in life for this category of patients. , which are prone to rapid polar changes . This leads to mood swings and unstable behavior.

Patients suffering from this form are very proud, self-centered, with a characteristic feature of being constantly in the center of attention (demonstrative behavior). These patients are characterized by inventing stories, a tendency to fantasize and embellish facts, sometimes they get so “deluded” that they themselves begin to believe in their own writings. Symptoms often develop in this form of psychopathy .

People suffering from this type of mental disorder have viscous thinking, fixation on details, and extreme pedantry. Their thinking is slow and “swings” heavily. Among the main symptoms are pettiness, scrupulousness and excessive prudence. .

In behavior there are sharp changes in attitude towards people: from sugary obsequiousness to outbursts of anger and intransigence. One of the characteristics of the type is the inability and unwillingness to forgive. Epileptoid psychopaths can harbor anger and resentment all their lives, and at the slightest opportunity resort to revenge. Outbursts of anger are strong and prolonged. Patients with this form of the disease often exhibit sadistic tendencies.

Patients in this group are prone to one-sided and fixated thinking, and are susceptible to the formation of overvalued ideas that can completely take over their volitional and emotional sphere. The most common manifestation of this painful quality is suspicion.

A paranoid psychopath can find in each of his acquaintances the traits of an attacker watching him. Often, patients attribute envy towards themselves to the people around them. It seems to the patient that everyone wants to harm him, even doctors. The painful symptoms of paranoid psychopathy often manifest themselves in ideas of jealousy, fanatical thinking, and constant complaining. It is quite natural that this category of psychopaths has conflictual relationships with other people.

This group of patients is more prone than others to uncontrolled outbursts of anger, inappropriate actions, and attacks of unmotivated and pronounced aggression. Psychopaths are overly demanding of other people, too touchy and selfish. They have little interest in the opinions of outsiders.

At the same time, patients with excitable psychopathy may exhibit symptoms of depression and despair. The most often excitable type is characteristic of alcoholics, drug addicts, and socially pathological individuals (thieves, bandits). Among them, the largest percentage of offenders and persons subject to examination in forensic medical examinations.

This type of mental disorder occurs in the form of hyperthymia– a condition in which patients are characterized by a constantly elevated mood with a feeling of carelessness and activity. This type of patient tends to take on all sorts of things in a row, but is not able to complete any of them. There is frivolity, increased talkativeness, importunity and leadership tendencies. Affective psychopaths quickly find a common language with everyone and no less quickly get bored with their “stickiness.” They have a tendency to find themselves in difficult, conflict situations.

The second type of disorder is hypothymia, is the opposite of hyperthymia. Patients diagnosed with affective psychopathy are in a depressed state. They tend to see the negative sides in everything, express dissatisfaction with themselves and others, they often experience hypochondriacal symptoms, and extreme degrees of pessimism are observed. They are withdrawn and feel guilty before everyone; they consider themselves guilty of everything that happens. At the same time, hypothymic people are sensitive. Any word can deeply hurt the patient.

The type of this pathological process contains deviations in the sphere of the concepts of duty, honor, and conscience. Patients of a cruel disposition, merciless and selfish, with an atrophied concept of shame. Universal human norms do not exist for them. This type of psychopathy always occurs in severe form. Heboid psychopaths are characterized by sadism and indifference to the suffering of other people.

Symptoms of psychopathy with sexual perversions and disorders

The clinical picture of these disorders occurs in combination with other types of psychopathy. Sexual perversions include pedophilia, sadomasochism, bestiality, transvestism and transsexualism. The forms of these deviations are constantly reviewed by specialists to determine the line between the symptoms of the disease and the behavior within the mental norm.

Psychopathy occurs cyclically. Periods of improvement are followed by exacerbations of the disease process. Psychopathy must be distinguished from personality accentuations (extreme degrees of character manifestation).

Please note:accentuations are not a pathology, although their manifestations may resemble psychopathy. Only a qualified psychiatrist can distinguish psychopathy from accentuation.

Treatment of psychopathy

Therapy for psychopathy begins with eliminating the cause that served as the trigger for the development of clinical manifestations (infectious diseases, injuries, stress, diseases of internal organs, etc.)

Drug treatment includes:

  • restoratives: vitamins, antioxidants, immunomodulators;
  • sedatives (calming for mild forms of pathology);
  • tranquilizers (to stabilize the emotional background during constant overexcitation);
  • neuroleptics (for affective forms);
  • antidepressants (in cases of depression);
  • sleeping pills (for stabilization in excitable forms of the disease);
  • symptomatic (for problems with the heart, liver, kidneys).

Treatment of psychopathy must necessarily be accompanied by psychotherapy (hypnosis, waking suggestion, rational psychotherapy). Acupuncture, physiotherapeutic procedures, especially electrosleep are widely used.

Prevention of psychopathy

Prevention of this group of diseases is possible only with large-scale measures at the state level, including the solution of socio-economic issues, early detection of abnormal types of behavior in children and the creation of favorable conditions for their development, with gradual adaptation to society.

The task of medicine is to effectively treat somatic diseases.

Educational institutions must instill in children a healthy lifestyle and improve their cultural and educational level.

You will receive more detailed information about the course of psychopathy, methods of their diagnosis and treatment by watching this video review:

Lotin Alexander, medical columnist

Classifications of psychopathy are very diverse. There have been attempts to reduce all types of psychopathy to two - excitable and inhibited; there were descriptions including more than a dozen types. The following types are included in ICD-10.

Schizoid personality disorder(schizoid psychopathy) according to ICD-10 is characterized by the following character traits:

  • inability to experience pleasure (anhedonia);
  • emotional coldness and inability to express warm or hostile feelings towards others;
  • weak reaction to praise and blame; little interest in sexual intercourse with others;
  • a tendency to fantasize to oneself (autistic fantasy) and introspection (immersion in the inner world);
  • lack of close, trusting contacts with others;
  • difficulty in understanding and assimilating generally accepted norms of behavior, which is manifested by eccentric actions.

The most striking character trait is isolation and unsociability (from childhood they preferred to play alone). They often live by their unusual interests and hobbies, in which they can achieve success (unique information in a narrow field, deep interest in philosophical and religious issues, unusual collections, etc.). Hobbies and fantasies fill the inner world, almost always closed to others. Fantasies are intended for oneself and can be ambitious or erotic (with outward asexuality). Emotional restraint looks like coldness, although inner feelings can be strong and deep. It is difficult to establish informal emotional contacts. Lack of intuition is manifested by the inability to understand other people's desires, fears, and experiences. They are prone to nonconformism - they do not like to act “like everyone else.” Situations where it is necessary to quickly and indiscriminately establish informal contacts, as well as the violent invasion of strangers into one’s inner world, are difficult to bear.

Dissociative identity disorder(psychopathy of an unstable type, antisocial personality disorder) according to ICD-10 is recognized by the following characteristics:

  • disregard for the feelings of others and lack of empathy - the ability to penetrate into their experiences;
  • irresponsibility and disregard for social norms, rules and responsibilities;
  • inability to maintain stable relationships with others; low tolerance to frustration (inability to get what you want);
  • ease of aggressive outbursts, including violence; lack of guilt and inability to learn from the past, especially from punishment;
  • tendency to blame others for everything and complain about failures;
  • constant irritability.

The main feature is a constant thirst for light entertainment and pleasure, an idle lifestyle with evasion of all work, study, and fulfillment of any duties, both social and family. From adolescence they are drawn to antisocial companies, alcohol, and drugs. Sexual life serves only as a source of pleasure. They are unable to fall in love or become attached to loved ones and friends. They are indifferent to their future - they live in the present. They are weak-willed and cowardly, they try to run away from any difficulties and troubles. They do not tolerate loneliness well - they are unable to occupy themselves with anything. The situation of neglect, lack of guardianship and strict control is detrimental.

Emotionally unstable personality disorder(emotionally labile type of psychopathy, explosive, affective, impulsive, excitable, epileptoid psychopathy) according to ICD-10 represents a combined group with various disorders of the emotional sphere. In Russian psychiatry, it is customary to distinguish between two close, but not identical, types.

Explosive (affectively labile) psychopathy characterized by emotional outbursts at the slightest provocation, but anger is easily replaced by tears, swearing and throwing things - by moaning, aggression towards others - by self-harm, attempted suicide. The mood often changes, which leads to restlessness, lack of composure, and distractibility. They are completely uncontrollable, boil over at the slightest comments or opposition, and react extremely painfully to emotional rejection and any stress.

Epileptoid psychopathy differs in that, in addition to explosiveness (a tendency to uncontrollable affective reactions with aggression and auto-aggression), states of dysphoria periodically arise - a dark and angry mood, during which patients are looking for something to vent their accumulated evil on. Dysphoria lasts from several hours to several days. Violent affective reactions are usually preceded by a gradual boiling of initially suppressed irritation. In the heat of the moment, during fights, they become wild and are capable of inflicting heavy damage. Sometimes disturbances of impulses are revealed, most often sadistic-masochistic tendencies. They take pleasure in tormenting, sophisticatedly mocking or brutally beating the weak, defenseless, dependent on them, unable to fight back. Often, from childhood, they love to torture and kill animals. But they can receive sensual pleasure by causing pain to themselves with cuts and burns from burning cigarettes. Alcohol intoxication is more often of the dysphoric type. They like to get drunk to the point of insensibility. Suicidal attempts can be either demonstrative with the aim of blackmailing someone, or during dysphoria with the actual intention of committing suicide.

Histrionic personality disorder(hysterical psychopathy), according to ICD-10, can be diagnosed with:

  • the presence of a tendency to self-dramatization, theatrical behavior, exaggerated expression of emotions;
  • suggestibility, easy susceptibility to the influence of others;
  • superficial and labile effectiveness; self-centeredness with the desire to forgive oneself everything and not take into account the interests of others;
  • constant desire to be appreciated and slight vulnerability;
  • thirst for situations where you can be the center of attention;
  • manipulative behavior (any kind of manipulation) in order to achieve their goals.

Among the listed character traits, the most striking is the constant desire to be in the center of attention of others, demonstrativeness, and pretentiousness. For this purpose, they even resort to performances depicting suicide attempts. Suggestibility, often highly emphasized, is in fact very selective: one can only suggest that which does not contradict egocentric aspirations. But the level of aspirations is high: they claim much more than their abilities and capabilities allow. Under the influence of severe mental trauma, hysterical psychoses can occur - twilight states, pseudodementia, etc.

Anancastic (obsessive-compulsive) personality disorder(psychasthenic psychopathy) according to ICD-10 is characterized by:

  • indecision, constant doubts;
  • excessive precautions regarding a possibly dangerous or unpleasant course of events;
  • perfectionism (i.e. the desire to always achieve the highest results, to do everything in the best way, regardless of the unimportance of the matter);
  • the need to re-check what has been done;
  • extreme preoccupation with detail in trivial matters and loss of broad perspective;
  • extreme conscientiousness, scrupulousness, concern, preventing one from experiencing pleasure;
  • pedantry and adherence to conventions with limited ability to express warm feelings;
  • rigidity and stubbornness, insistence that others obey the order they have established;
  • the appearance of unwanted thoughts and impulses, which, however, do not reach the level of severe obsession;
  • the need to plan all activities in advance in the most insignificant details.

Obsessive thoughts, movements, rituals, fears, self-invented “signs” and “prohibitions” are observed almost constantly, sometimes intensifying and sometimes weakening (for example, for important occasions, always wear the same clothes, walk only one route, do not touch anything). why black, etc.). Pedantry, the desire to foresee everything in advance and plan it in the smallest detail, and minute adherence to rules serve as compensation for constant fear for the future - one’s own and that of one’s loved ones. Other compensatory mechanisms may turn out to be exaggerated: indecision when a decision has already been made turns into impatience, shyness into unexpected and unnecessary categoricalness. This type of psychopathy usually manifests itself from school years, but intensifies when they begin to live independently and need to be responsible for both themselves and others.

Anxious (“avoidant”) personality disorder(sensitive psychopathy) according to ICD-10 criteria can be recognized by:

  • constant feeling of internal tension and anxiety;
  • shyness and feelings of inferiority, self-doubt;
  • constantly trying to please and be accepted by others;
  • increased sensitivity to criticism from others;
  • by tendency to refuse to enter into relationships with others until they are sure that they will not be criticized;
  • a very limited circle of personal attachments;
  • tendencies to exaggerate the potential danger and risk of everyday situations, avoiding some of them, which, however, does not reach stable phobias (obsessive fears);
  • according to a limited lifestyle that allows you to feel safe.

Great impressionability and a sense of inferiority are two main traits. They see many shortcomings in themselves and are afraid of being ridiculed and condemned. Their isolation is purely external - a consequence of being fenced off from strangers and unfamiliar situations. They are quite sociable with those they are used to and trust. The situation in which they become the subject of unkind attention from others, when a shadow falls on their reputation or they are subjected to unfair accusations, becomes intolerable. They are prone to depressive reactions, during which they can gradually and secretly prepare for suicide or are capable of unexpected desperate acts leading to serious consequences (including causing serious harm or killing their offenders).

According to ICD-10 criteria, dependent personality disorder corresponds to one of the types of asthenic psychopathy. It is characterized by a tendency to shift responsibility for oneself to others and to completely submit to the interests of the one on whom one depends, neglecting one’s own desires. They evaluate themselves as helpless, incompetent and unbearable. They have a fear of abandonment and a constant need for reassurance in this regard. They cannot stand loneliness and feel empty and helpless when ties with those on whom they depend are severed. Responsibility for misfortunes is transferred to others.

Mixed types of personality disorder are diagnosed when it is difficult to identify a separate type due to the fact that the traits of different types are represented relatively evenly. However, completely “pure” types of psychopathy are relatively rare - the type should be determined by the predominant features. Just as with character accentuations, mixed types can be intermediate (mainly hereditarily determined, for example, schizoid-epileptoid psychopathy), or amalgam (the endogenous core of one type is overlaid with the traits of another due to the long-term adverse influence of the environment, for example, on the constitutional traits of emotional lability during education in childhood, as a “family idol”, histrionic, i.e. hysterical, traits are superimposed).

Organic psychopathy is most often mixed, representing various combinations of emotionally labile, histrionic and dissociative traits (i.e. explosive, hysterical and unstable psychopathy). Diagnosis of organic psychopathy is based on the following signs. There is a history of intrauterine, birth and early postnatal (first 2-3 years of life) traumatic brain injuries, brain infections and neurointoxication. Residual neurological “microsymptoms” are revealed: asymmetry of facial innervation, mild oculomotor disturbances, uneven tendon and skin reflexes, mild diencephalic disorders. An X-ray of the skull shows abnormalities of ossification and signs of increased intracranial pressure; the EEG usually shows pronounced diffuse changes. A pathopsychological examination reveals attention deficits and fatigue when repeating tasks.

Other classifications of psychopathy. Many classifications have been proposed. Some of them are descriptive - types are distinguished according to the most striking character traits, others are based on a certain principle. In Russian psychiatry, an example of the first is the taxonomy of P. B. Gannushkin (1933), and the second - his student O. V. Kerbikov (1968), as well as B. V. Shostakovich (1988) and A. E. Lichko (1977) .

P.B. Gannushkin described several groups of psychopathy.

The group of cycloids (constitutional-depressive, constitutionally-excited, cyclothymic, emotive-labile) are distinguished by the characteristics of the dominant mood - constantly depressed, elevated, periodically or frequently changing. The group of asthenics (neurasthenics, “overly impressionable”, psychasthenics) was united by a tendency to easy exhaustion and “irritable weakness”. In addition, groups of schizoids, paranoids, epileptoids, hysterical and unstable psychopaths, etc. were identified, most of which are included in ICD-10 under the same or different names. For classification, O.V. Kerbikov took the types of higher nervous activity of I.P. Pavlov and, first of all, divided psychopathy into excitable (explosive, epileptoids) and inhibited (asthenics, psychasthenics). But especially outside the chosen principle were “pathologically closed” (i.e. schizoid), hysterical, unstable, sexual and mosaic (i.e. mixed) psychopathy. B.V. Shostakovich used the psychological principle for taxonomy: the predominance of changes in the sphere of thinking (schizoids, psychasthenics, paranoid), in the sphere of affective disorders (epileptoids, excitables, cycloids, hysterical) or in the sphere of volitional disorders (unstable, sexual). A. E. Lichko combined the taxonomy of psychopathy and character accentuations, describing the same types, which are either variants of the norm (accentuation) or reaching a pathological level of deviation (psychopathy).