The concept of psychopathy. What is psychopathy

If a person behaves inappropriately, we immediately label him a “psychopath.” What does the term psychopathy actually mean? What are the hallmarks of a personality disorder? What types of psychopathy are there and why do they develop?

Psychopathy is a borderline state between mental health and mental illness. But if many mental disorders can be cured or at least a significant improvement in the patient’s condition can be achieved, then a personality disorder will accompany a person throughout his life.

What is it?

This is a character anomaly, a persistent congenital or acquired disorder that prevents a person from building interpersonal relationships and adapting to a social environment.

The main difference between a personality disorder and a mental disorder is that psychopathy is characterized by stability and lack of flow.

Of course, over time, personality traits may undergo certain changes, but such significant shifts as in mental illness, changes in various areas of personality in psychopathy do not occur.

Causes

Each of us is born with a certain set of individual qualities. Eye color, hair color, body constitution, height - all this is genetically programmed. Likewise, certain character traits or anomalies (as in psychopathy) are inherent at birth.

Of course, every person undergoes some changes during his life, develops, coexists with other people, while in society. But in general, most of our qualities are already laid down at conception.

If we talk about the causes of psychopathy, then basically the reasons for the occurrence of this mental disorder lie in the genes: the baby is already born with certain features, not only in appearance, but also in character. But there are situations when the development of a character anomaly is primarily associated with an unfavorable situation. The combination of character traits initially characteristic of a given person with an unfavorable situation contributes to the consolidation of abnormal behavior and aggravates maladjustment.

An example of non-standard social situations that worsen the course of a personality disorder may be staying in an orphanage or in prison.

So, in most cases, all problems in life, in relationships with other people, are to blame for Mother Nature, who created a person the way he is.

General features

Another extreme is the lack of strong interests, increased suggestibility, underdevelopment of volitional qualities and the absence of one’s own point of view. These symptoms are consistent with dissocial personality disorder. Thus, the symptoms of psychopathy can be very diverse. What common features do these seemingly different pathologies have in common?

Criteria

The following diagnostic criteria for psychopathy are identified (common symptoms for all personality disorders):

The first criterion is the relative stability and low reversibility of pathological character traits.

Unlike mental illness, the signs of personality disorders change little over time. Of course, during adolescence, the behavior of a psychopath may undergo some changes, but in general, the leading signs by which a person can be diagnosed with a certain psychopathy persist throughout life. Some people have an irresistible desire to attract attention to themselves, while others spend their entire lives shielding themselves from others with an invisible veil.

The second criterion is the totality of psychopathic personality traits .

A psychopath is a psychopath everywhere: at work, in the family, on the street, and on public transport. He simply cannot behave differently with people, he is not capable of different behavior. The existing pathology affects the core of the personality, so abnormal behavior extends to all areas of life.

The third criterion is a violation of social, family and professional adaptation.

It is incredibly difficult, almost impossible, for people with this disorder to adapt to existing norms. They say about psychopaths that they “do not live themselves and do not let others live.” Although there are some exceptions in terms of professional adaptation. If you choose the right profession, a person can become successful at work. For example, hysterical psychopathy is characterized by a desire to attract attention to one’s person. If such a person goes to the theater field, where there are a lot of spectators, he can realize his inner potential.

Psychopathy and character accentuation

Character accentuation is a variant of the norm in which certain character traits are overly enhanced, as a result of which selective vulnerability to certain psychological influences can be detected, while normal resistance to other influences is maintained.

Accentuation appears only under certain conditions, for example, under the influence of mental trauma. But in general, it does not lead to social maladaptation of such a person.

Once again I want to emphasize that accentuation of character is a variant of the norm, in contrast to psychopathy - a borderline state between health and mental disorder.

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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 perspective 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 “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.

With psychopathy, mental retardation does not progress; sessions with a psychotherapist 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 of 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 maladaptation, 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 Africans, the rage gene is found in 59% of the population, with native 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.

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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 of 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. Studies of identical twins, even those separated in early childhood and living with different parents, suggested that hereditary predisposition still occurs.

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 the “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 from that of a healthy person. The deficit of his perception concerns the entire 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 a deficiency of cerebral organs caused by the damaging effects of infectious agents, intoxications or brain injuries during fetal 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 vast majority of cases, it is not possible to attribute this antisocial personality disorder to any specific form of psychopathy, since the formation of abnormal personality 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 study individuals with extreme degrees of psychopathy who are in prison after committing criminal acts, suggest 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 cerebral 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 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.

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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 realized 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 of age.

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 a pathological mismatch of nervous processes, signaling systems, and the 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.

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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 the extreme version of the norm, called character accentuation, which implies some more pronounced character traits of a person, manifested in connection with situations traumatic for the psyche 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 condition, 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 throughout 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.

The average psychological portrait of 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 her 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 poses a serious threat to the mental health of her children, much greater than a psychopathic father, because children, especially small ones, spend most of their time in most families with their mother.

It is almost always noted that a psychopathic husband is a huge mental trauma for his wife, and often a high probability 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 can start drinking, taking drugs, and committing 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 an individual may be consumed by some kind of passion, he may experience a state of unmotivated aggression, hopeless melancholy, or a 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.

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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 attacks, affective outbursts, 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, the decompensation of psychopathy can worsen: anxiety, depression, depression appear in combination with hypochondria and hysteria, and litigiousness and conflict increase.

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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 mental characteristics that exist 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.

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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 identified as a result of the influence of unfavorable life conditions and is differentiated 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. The main clinical criterion for differentiation is 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 characteristic of 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 a 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 psychotrauma, 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 is a fairly 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 medications, it is necessary to completely abstain from 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 hysterics, psychosis with delusions in paranoids, dysphoric disorders in epileptoids, in addition - cases of aggressive behavior that pose a danger to others or suicide attempts, self-harm.

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 are relieved by 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. These properties are attributed to 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.

Restlessness 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 mood are lifted by the aromas of fern, sage, oregano, and rosemary oils.

Juniper, marjoram, ginger, clove, and cinnamon oils restore lost strength and vitality.

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

Forecast

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

Experts give the most unfavorable prognosis for hysterical psychopathy, although suitable living conditions lead to stable compensation in adulthood. 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.

Important to know!

This state of the human psyche is characterized by an acute onset and changeable symptoms - symptoms of different types of known mental states of varying intensity quickly replace each other, making it impossible to diagnose any of them.

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. The majority 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, 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 to complete 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 (satisfying 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 maladjustment). 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, there is dissatisfaction with oneself and everyone around, depression - severe 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 (“big liar”, “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 a 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 part 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 it was the latter that 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 its 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 even 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 which was 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, 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.

(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 Gannushkin classification, 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)
• Avoidant 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 method.

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 special 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.

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 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 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 a team. 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 and are constantly in a state of love, but deep feelings are 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 the 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. The patients' personalities exhibit 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 such a combination can lead to irreversible consequences, including death. Also, during the treatment period, it is better to refrain from driving; at least, you need to clarify this issue with your doctor. 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 the 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. In Western countries, psychoanalysis is popular - a long-term individual psychotherapy program 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 mixtures consisting of valerian, lemon balm, mint, hops and other plants with calming 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 often the passion for 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.