Character psychopathy, personality psychopathy in children and adolescents, how to treat psychopathy

In the system of modern international classification of diseases, there is no such concept as “psychopathy” - it was replaced by the term “personality disorder”. Experts believe that this definition is more suitable to describe this disease, which is characterized by persistent personality deformation, distortions of internal perception and thinking. Psychopathy is less common in men than in women. However, in representatives of the stronger sex, the pathology manifests itself at an earlier age, is more severe and is quite difficult to treat. The complex therapy offered by the doctors of the Leto mental health center makes it possible to achieve stable, long-term remission and socialization of the patient.

Excitable type of psychopathy (explosive psychopathy)

The excitable or explosive type of psychopathy occurs predominantly in boys and first appears most often during the first biological crisis between the ages of 2 and 5 years. Children experience the following symptoms: excessive excitability, increased motor activity, aggressiveness, malice, capriciousness. Motor and affective discharges are accompanied by pronounced vegetative manifestations. The mood background is unstable: elevated mood is often replaced by a dysthymic mood with tears and whims. In preschool age, such children have difficulty adapting to kindergartens, beat children, and react with protest to comments. At school, gymnasium, lyceum and family, they constantly violate the regime, conflict with others, leave classes and leave home. Dysphoria, drive disorders, and asthenic symptoms are also noted. In the development of the excitable type of psychopathy, perinatal encephalopathy, residual organic pathology, and constitutional and hereditary factors are important.

Clinical picture

Personality disorders are not accompanied by pronounced neurological symptoms, with the exception of cases when the cause of the pathology is organic brain damage. Therefore, the diagnosis is made based on the characteristics of a person’s behavior, socialization skills, and interpersonal relationships.

Depending on the clinical manifestations, there are several forms of psychopathy in men:

• asthenic;
• anancaste;
• schizoid;
• paranoid;
• dissocial;
• emotionally unstable;
• hysterical.

Epileptoid type of psychopathy (epileptoid psychopathy)

The onset of epileptoid psychopathy usually occurs in prepubertal age. However, sometimes even preschoolers already exhibit pedantry, excessive accuracy, thoroughness, and viscosity. Any discomfort or infringement of rights causes violent affective and motor reactions. An angry mood, unlike excitable psychopathies, lasts a long time. Children are usually vindictive. At school age, children develop more pronounced egocentrism, a desire to fight for order, and an unfriendly, hostile attitude towards people around them.

Unstable type of psychopathy (unstable psychopathy)

The unstable type of psychopathy most often manifests itself in prepubertal age. Such children exhibit weakness of will, volitional delays, increased suggestibility, instability of interests, superficial judgments, frivolity, increased desire for pleasure, and a thirst for new experiences. Children do poorly at school, quickly fall under the influence of specific asocial companies, leave home and school, wander, smoke, drink alcohol, and use drugs. In companies they always play a subordinate role. Unstable psychopathy is often based on psychophysiological infantilism.

The main symptom of this syndrome is an increase in isolation, combined, on the one hand, with a noticeable decrease in academic performance and inability to work systematically, and on the other hand, with the appearance of pathological hobbies (“pathological hobbies”).

Closedness is manifested by silence, formal contact with others, some cooling towards loved ones, and also by the fact that they lose old friends and do not make new ones. Only sometimes do you have chance acquaintances with people who are inappropriate in age and social circle. The essence of these contacts is not disclosed to loved ones; sometimes they are associated with the mentioned pathological hobbies.

Studies are gradually abandoned. At first, sometimes they can spend seemingly many hours on homework, but it turns out to be either unfulfilled or done at an extremely low level. They passively attend lessons, and then may quit attending classes altogether.

However, a pronounced “drop in energy potential” does not occur. Study or work is replaced by intense activity in the field of unusual hobbies or behavior consisting of a chain of energetic, but striking in its illogical actions. For example, a 16-year-old teenager forced his 12-year-old sister to write a note to her mother (“Mom! I’m leaving forever!”), took her from her home outside the city to the forest and left her to spend the night in an abandoned dugout. In the evening, together with his mother, he went to look for her in the courtyards, report to the police, the next day he secretly took her food to the forest, and when she returned on her own, he explained his action by saying that “he wanted to check the effectiveness of the police.”

Pathological hobbies are distinguished by three features: 1) pretentiousness and unusualness for a given age and generation; 2) tension, extreme anger when they “prevent” you from doing what you love; filling a teenager’s entire life with it to the detriment of not only studies, but also rest, sleep, and health; 3) unproductivity - no real result, much less success, is achieved in the favorite field; sometimes even an astonishing lack of awareness is revealed in it, despite daily hours of study (a person who is keen on chemical experiments does not know the elementary school fundamentals of this discipline, etc.).

Among pathological hobbies, drawing out various plans, drawing up useless schedules, stereotypical drawings of airplanes, cars, etc. are especially common. Collecting can also be ridiculous - for example, collecting samples of feces of different types of animals, but it can be dangerous for others (home depot unexploded cartridges, grenades, mines found in places of former battles). Daily wanderings for many hours in the city for the purpose of, for example, studying transport routes, or in the zoo supposedly to study the life of animals, in forests and swamps in order to “get to know nature” can also become a pathological hobby; they cannot say anything coherent about their impressions. Pathological hobbies can also be physical-manual [Lichko A. E., 1973]: hours of exercise with dumbbells to build muscles, etc.

Pathological hobbies usually begin with the manifestation of the disease. However, previous hobbies (chess, music, drawing), which arose and became stronger even before the illness, can persist and remain quite productive.

Quite characteristic of this syndrome is a growing dislike for parents, especially for the mother or for the family member who was previously closest. Sometimes sloppiness, carelessness in clothing, reluctance to comb one's hair, wash one's hair, or change one's underwear are revealed.

Alcohol consumption is not typical for this syndrome. Only occasionally do they drink small amounts of alcohol alone, using it as a kind of doping that relieves internal tension. But they often smoke a lot. Sometimes there is also a tendency to experiment on oneself, including secretly trying out the effects of various toxic or intoxicating substances, but a persistent attraction to any one of them is not formed. Offenses are quite rare, and if they are committed, they are committed alone and are associated with pathological hobbies or due to abstruse arguments (for example, stealing a tape recorder in a “rich apartment” in order to give it to those teenagers who have nothing to buy it with). Suicide attempts are also rare, but unexpected and sometimes completely ridiculous. A passion for vagrancy may flare up, but more often one encounters a pathological attachment to the places where one spent one’s childhood. Then everything connected with childhood is remembered with tenderness - one of the teenagers called this experience “longing for a bygone childhood.”

Sexual activity is usually limited to intense masturbation. When masturbating, they are not too concerned about remaining unnoticed, but when reproached or questioned, they deny it with bitterness.

About half of patients show schizoid traits in premorbid childhood [Alexandrov A. A., 1981]. The rest did not display any striking character traits; They did not differ in any significant way from their peers.

Differential diagnosis mainly has to be made with the formation of schizoid psychopathy in adolescence, as well as with the pathocharacterological reaction against the background of accentuation of this type (Table 3). On the other hand, it is necessary to differentiate with the psychopathic debut of progressive schizophrenia. Diagnostic criteria will be outlined in the section devoted to these debuts. The probability of transition of the syndrome of increasing schizoidization into paranoid or apatoabulic syndrome is about 40% [Lichko A. E. et al., 1986].

Table 3. Differential diagnostic criteria between the syndrome of increasing schizoidization and schizoid psychopathy and character accentuation

As an example of the use of the mentioned differential diagnostic table, the following clinical illustrations are given.

Robert F.,

15 years. There is no information about hereditary burden of mental illness. He lives alone with his mother; his father died several years ago. back. Since childhood, he has been withdrawn, serious, and avoided noisy games. Until the age of 14, he studied well, was disciplined, was interested in chemistry and radio engineering, and went in for sports (swimming, rowing). He didn’t have close friends, but his relationships with his peers were smooth.

The last six months have gradually changed. He began to spend more and more time on some kind of chemical experiments, which he performed in his room. He went to bed late and “confused day and night.” I quit going to school. He couldn’t wake up on time in the morning and rudely pushed his mother away when she woke him up. In the evening, he kicked his mother out of his room so that she “wouldn’t interfere.” At home he did nothing to help her. He treated her illnesses with indifference. Stopped letting classmates in. Then he stopped washing his face, refused to take a bath, and did not want to change his underwear. He did not explain his behavior to his mother and was rude when questioned. I almost never went outside. Became tense and angry. He demanded that his mother buy him a microscope.

Upon admission to the psychiatric hospital, he was tense, refused to talk with the doctor, and demanded immediate discharge. After the injection of aminazine, he softened, sparingly said that he dreamed of creating a new type of plastic, and has long been interested in chemistry. I didn’t want to “waste my time,” so I quit going to school and didn’t let my friends visit me. I didn’t change my underwear because I “felt bad” in clean ones. After intravenous infusion of barbamyl there was no euphoria; said that he wanted to chemically obtain a new type of laser beam. He admitted that he was dissatisfied with his appearance. No other painful experiences were identified.

Triftazine treatment was carried out (up to 20 mg per day). His condition improved significantly, he greeted his mother warmly, but kept aloof from his peers. K. began to view his previous studies in chemical experiments with criticism. After being discharged, he resumed school while on maintenance therapy, did well in the exact sciences, but remained unsociable.

Physical development with moderate acceleration. Neurological examination revealed no abnormalities.

A pathopsychological examination revealed no signs of distortion of the generalization process; There was a certain tendency towards reasoning.

During a pathocharacterological examination, a mixed epileptoid-hysteroid type was diagnosed (does not correspond to the anamnesis and behavioral observations); ambivalence in relation to alcoholism was revealed (he had not previously consumed alcoholic beverages). No character discordance has been established.

Differential diagnostic criteria corresponding to the syndrome of increasing schizoidization in psychopathic-like schizophrenia (see Table 3): emotional attitude towards loved ones (hostility towards the mother), neatness (refusal to wash and change underwear), pathological hobby (unproductiveness of doing chemical experiments).

Criteria corresponding to schizoid psychopathy: study and work (abandoned due to loss of interest), emancipation reaction (rejection only of interference in hobbies), sexual activity (external asexuality).

Diagnosis.

Sluggish psychopathic schizophrenia. Syndrome of increasing schizoidization.

Catamnesis

3 years later. A year after discharge, he stopped taking triftazine. Soon he stopped leaving the house because “people were paying attention to him” and quit school. Was hospitalized again. After treatment. began studying at evening school, then working as a radio equipment technician. He remained withdrawn, uncommunicative, spent his free time at home alone, doing something, but hid his activities from everyone.

Dmitry Ch.,

13 years old. He was adopted as a baby. There is no information about heredity. Since childhood, he loved to play alone and did not get along with children. He studies well at English school, although the language is poor; He is interested in geography, loves to look at maps, and draws diagrams himself. He is not friends with anyone, avoids active games, but willingly rides a bicycle out of town alone. Last summer he was sent to a pioneer camp, but a few days later he escaped from there, without explaining the reasons. Shortly before admission to the children's psychiatric hospital, he escaped for the second time, which is why he was hospitalized. One left Leningrad for Vyborg, stealing money from home. A day later he was found spending the night under the boat. Returned home, he became withdrawn, did not speak or eat.

Upon admission, he remained silent, did not explain the reasons for his escape and his behavior at home, and persistently asked to let him go. In the department he kept aloof from the guys, obeyed the regime, ate without coercion, neatness was maintained. A few days later he came into contact with the doctor, talking about geography, then suddenly burst into tears, said that he had run away from home after a conflict at school, where he was unfairly accused of stealing an album with stamps from a friend, and demanded to “beg forgiveness to the whole class, and mom believed them.” I decided to run away to Vyborg because I recently read an interesting book about this city. During his escape, he saw the sights of this city; when it started to rain, he hid under an overturned boat and fell asleep. He categorically refused to go to the previous school, but agreed to another (“just not to the English school, I love geography and mathematics”).

During pathopsychological examination, no signs of generalization distortion were found. No pathological examination was performed.

Physically developed for his age. According to the dermatologist, he suffers from ichthyosis.

There are no differential diagnostic criteria (see Table 3) corresponding to the syndrome of increasing schizoidization in psychopathic schizophrenia. Criteria corresponding to schizoid psychopathy: characteristics of contacts (possible with an adult who can share interests), emotional attitude towards loved ones (outwardly cold, but touchy and withdraws in case of failures), study and work (does well in certain subjects), neatness (preserved), hobbies (productive studies of geography, knows it well beyond the program), running away from home (caused by an intolerable situation), psychological defense mechanisms (closes in difficult situations).

Diagnosis.

Acute impulsive affective reaction against the background of schizoid character accentuation.

Catamnesis

in 6 years. He graduated from school, courses for projectionists, works in his specialty and studies at an evening film technical school. From the age of 16. lives alone - his mother got married, moved to another city and broke all ties with him. He earns good money and has completely organized his own life. He is interested in photography. Has no close friends.

Hysterical type of psychopathy (hysterical psychopathy)

Hysterical psychopathy clearly manifests itself at puberty. The hysterical type is often characterized by the desire to achieve recognition by any means, to be visible and in the center of attention. The hysterical type is more common in girls. Some hysterical traits can appear even in preschool age. Girls strive to stand out with their clothes, command other children, perform at matinees and school events, and listen to praise. At school age, the desire to be first intensifies, pronounced selfishness appears, ignoring the interests of other children, and jealousy of the successes of classmates. Emotional reactions can be very vivid, and behavior can be demonstratively theatrical. To gain recognition, children can use intrigue, slander, fantasies, fiction and some of their unusual adventures or secrets. In adolescence, demonstrative suicide attempts and participation in extravagant groups (emo, rockers, bikers, metalheads, etc.) may be observed. In the origin of hysterical psychopathy, upbringing according to the type of family idol, hereditary and constitutional factors play a role.

Diagnostics

The examination stage requires some time from the doctors of our clinic.

To make an accurate diagnosis, they use:

• A conversation in the form of a dialogue, during which all the nuances of the person being examined are gradually clarified.
• Conversation with relatives.
• Dynamic monitoring of the patient.

A psychologist is involved in the diagnostic process, supplementing medical data with test methods and a special PSL-R questionnaire. He also makes additional recommendations for treatment.

When diagnosing, it is important not only to establish the psychopathic type, but also the stage of the process:

• Compensated.
• Subcompensated.
• Decompensated.

These data must be taken into account when prescribing treatment.

Types of psychopathy

Modern views on the problem have led to the formation of multiple classifications. Let's consider the most applicable one in domestic practice. It is based on the theoretical views and practical developments of Russian scientists, followers of P.B Gannushkin.

In the clinic of psychopathy, the following forms are distinguished:

• Asthenic – with characteristic fearfulness, psychophysical weakness, vegetative disorders. Mimosa type.
• Psychasthenic – manifested by excessive indecision, introspection, anxiety and fear of responsibility.
• Schizoid. The bearer of this psychopathic portrait is closed, self-absorbed, prone to intellectual activities, striving to direct all his talents to self-satisfaction. Knowing his worth, absolutely indifferent to others, capable of self-destruction and unemotional harm to other people.
• Paranoid. The patient is a stuck, stubborn and touchy bearer of overvalued ideas, often of a destructive nature, who pursues their implementation to the end.
• Epileptoid. Has excitability, rage and anger of extreme strength. Doesn't forgive anyone's mistakes and is vengeful. The idea of ​​vengeance can be carried around for decades unnoticed by others.
• Hysterical. Actor type. Obsessed with himself and demands the attention of others. He often lies to please himself and to get what he wants. Prone to taking psychoactive substances.
• Cycloid. A client with a sharply changing emotional background. From depression with depression he falls into the status of hyperthymic. In both cases there is a tendency towards socially pathological behavior.

Psychasthenic psychopathy (anxious-suspicious psychopathy)

Children with the psychasthenic type of psychopathy are characterized by anxiety, uncertainty, and suspiciousness. Such children often develop fears and obsessive states. They do not tolerate large psycho-emotional and stressful loads, separation from parents, relatives and relatives, and do not adapt well to a new team. At school, they usually study below their capabilities, because due to uncertainty they are not active and do not have time to complete independent work or tests on time.

Dissocial disorder

There are no prohibitions or restrictions for men with dissocial psychopathy. They live without caring about family, relatives, or their future, never finish what they start, prefer easy income (they often note an addiction to gambling), and strive to satisfy their financial needs at the expense of others.

Sometimes, by obeying the demands of family members, a man can find a well-paid job and do all the necessary things, but as soon as control is weakened, everything returns to normal. Patients easily become involved in antisocial companies, often use alcohol and drugs, and commit minor offenses.

Schizoid psychopathy (austic psychopathy)

Children with schizoid psychopathy already at an early age exhibit developmental dissociation, which consists of advanced speech, mental and intellectual functions against the background of delayed development of psychomotor skills. Children usually begin to read and count early, and are interested in non-childish and abstract problems. Subsequently, their hobbies may be of an extremely valuable and highly specialized nature. At the same time, their motor skills are inhibited, children master self-care skills late, and do poorly in labor and physical education classes. Children with schizoid psychopathy do not participate in noisy games and do not feel the need to communicate with peers. Emotional coldness in such children is combined with sensitivity. Unlike schizophrenia, they do not have progression and mental disorders.

Schizoid psychopathic disorder

In terms of external signs, some experts compare this variant of pathology with autism, since men suffering from this disease are withdrawn, very sensitive to their personal space, and prefer loneliness. They note emotional coldness and aloofness, and very often these traits are combined with a passion for reading, nature, and culture.

At the same time, the patient can experience troubles in the family, at work, and in his personal life very painfully. He is unable to free himself from memories of failures, insults addressed to him, or any shameful situations. Patients are very vulnerable, vulnerable, but they skillfully hide self-doubt and resentment behind external coldness and indifference. But at the same time, they do not take into account the opinions of others, they like to interfere in other people’s affairs, and give inappropriate advice.

Treatment of psychopathy

Comprehensive treatment of psychopathy makes it possible to normalize the development of a child’s personality. Treatment depends on the type of psychopathy and the age of the patient.

There are contraindications. Specialist consultation is required. Photo: Poznyakov | Dreamstime.com \ Dreamstock.ru The people depicted in the photo are models, do not suffer from the diseases described and/or all similarities are excluded.

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Asthenic personality disorder

The main symptoms of this form of the disease include:

• rapid exhaustion;
• weakness;
• irritability;
• shyness and timidity;
• apathy;
• general depressed state.

Men suffering from this type of psychopathy are characterized by impressionability and a tendency to introspection. Characteristic is a feeling of one’s own inferiority, insolvency; the future is always seen in a pessimistic light. They do not believe in their strength, are afraid of any difficulties and make every effort to avoid them.

As a rule, they take a passive position, are entirely dependent on the opinions of others, endure all insults without complaint, and unquestioningly carry out instructions. A tendency toward hypochondria is noted; the patient listens to all internal sensations. And even a slight deviation from the norm is perceived as a severe pathology.