Borderline personality disorder and adolescents. Mixed personality disorder: symptoms, types and treatment

Hysterical personality disorder is one that is prone to a protracted course. A person with hysterical accentuation manifests himself very brightly, demonstratively, drawing the entire focus of attention onto himself. Show business for hystericals is the best opportunity to realize themselves and receive admiration and praise, because they crave with every fiber of their soul.

Histrionic personality disorder - symptoms

Psychiatrists of past centuries called hysterical personality disorder hysteria or hysterical psychopathy; the main symptom of this disorder is considered to be an increased insatiable need for attention. It was believed that hysteria was more characteristic of the female sex and came from “wandering the uterus around the body” - this is what doctors believed 2-3 centuries ago. Hysterical disorders - the symptoms of this type of neurosis are basically the same for both men and women, with minor differences occurring due to gender characteristics.

Hysterical psychopathy in women

The actresses are still the same, and this is what happens more often. Women of the hysterical type of accentuation choose show business professions, theater stages, and the stage - this is their element, where they can receive applause and praise in abundance. Hysterical psychopathy in women - signs and symptoms:

• unable to control emotions;
• crave admiration and absolute attention;
• always in the thick of things;
• infantilism;
• terry egocentrism;
• they do not know the feeling of shame;
• faint;
• create intrigues, passions, and tragedies around themselves.

Hysterical psychopathy in men

In men, oddly enough, hysterical psychopathy is more pronounced than in the fair sex. Violent manifestations of feelings, hysterics, and in relationships with the opposite sex - intense jealousy. The hysterical father of the family is a sad picture; he always “pulls the blanket over himself” and, in fact, is another child for a woman, requiring exclusive attention to himself. A hysterical man often threatens to commit suicide if relationships with the opposite sex fail. In general, the symptoms are similar to hysteria in women.

Hysterical psychopathy in children

“We all come from childhood” - this expression also applies to hysterical accentuation and psychopathy. The reasons may be both heredity and inadequate parenting of the child. More often hysterical disorder Personality problems in children arise in families where one child is raised. All his whims are fulfilled even to the detriment of his parents, and the child grows up to be a demonstrative and manipulative person. How does hysterical psychopathy manifest in childhood?

• spoiled;
• unacceptability of criticism and refusal;
• constantly attracting attention to oneself in order to receive praise (dancing, singing, reciting poetry);
• academic success depends on the amount of praise from teachers and parents;
• in girls it manifests itself violently in adolescence with demonstrative suicide attempts and dromomania (running away from home, vagrancy).

Hysterical conversion disorders

Conversion symptoms accompany hysterical disorder and are always a protective psychological mechanism. At one time, the famous psychiatrist and neurophysiologist Charcot spoke of hysteria as a “great malingerer,” all this due to the variety of conversion symptoms that manifest themselves as signs of others serious illnesses. Hysterical conversion disorders accompanied by such psychogenic, somatic reactions as:

• paresis;
• paralysis;
• seizures;
• astasia;
• abasia;
• mutism;
• blindness;
• deafness.

Hysterical neurotic disorder

Hysterical personality psychopathy belongs to a group of neuroses that significantly worsen the life of a person and the people around him. To others, such a man or woman looks like a spoiled, capricious, self-centered person, which is not far from the truth, but the basis of such behavior is a deep neurosis, accompanied by various disorders physiological and psychogenic nature:

• sensation disorder;
• motor activity disorders;
• perception disorder.

Hysterical sensation disorders

The hysterical type of psychopathy affects a person’s perception of reality; people with hysterical accentuation or psychopathy complain of pain throughout the body, crawling, and goosebumps. There are several types of sensation disorder:

• hysterical anesthesia– occurs under the influence of stress, psychological trauma, patients complain of loss (partial or complete) of skin sensitivity, hearing and even vision, the difference from a true disorder will be the presence unconditioned reflexes, for example, following the therapist’s fingers with his gaze when checking vision;
• hypoesthesia- in demonstrative individuals it manifests itself during depression, characterized by a decrease in interest in life and a pessimistic attitude.

Dissociative histrionic disorder

Hysterical psychopathy has a variety of symptoms. Just a couple of centuries ago, all dissociative disorders were classified as hysterical. In addition to the above hysterical disorders, which also belong to dissociative disorders, the following are considered very common manifestations:

1. Dissociative fugue- hysterical personality disorder, in which a person loses memory of his previous personality and becomes different, comes up with a new name for himself, goes into a different profession, leaves home, can go to the other side of the world. Memory returns over time and the person suffering from dissociative disorder sees himself in an unfamiliar place, with strangers, memories of existing in this place are lost during the fugue.
2. Trance, obsession- an altered state of consciousness in which a person is not aware of himself as his own personality. Often occurs during prolonged monotonous movements and activities.

Hysterical disorder and suicide

Among completed suicides, about 40% occur among individuals with hysterical accentuation of character. This is not always a true intention to commit suicide. Hysterical personality psychopathy is characterized by the following features in committing suicide attempts:

• the intention to commit suicide is formed gradually;
• the topic of death constantly appears in conversation;
• notifies everyone around about the upcoming attempt (they publish their suicide intentions on social networks);
• the nature of the suicide attempts being made is demonstrative and blackmailing in order to attract attention to oneself (for example, one of the partners threatens the other to commit suicide if he does not stop cheating);
• they leave notes, they can demonstratively prepare objects with which they want to commit suicide (for example, they leave pills in a visible place);
• places to commit suicide are chosen large cluster people (in their hearts they hope that people will dissuade them).

Histrionic personality disorder - treatment

If a person has hysterical psychopathy, drug treatment is ineffective, and antidepressants are indicated only for concomitant prolonged depression, and antipsychotics for hysterical psychosis, in other cases hysterical neurotic disorder personality is treated with psychotherapy. Psychoanalysis sessions stabilize the patient’s psyche well, allowing one to work out the underlying causes of hysteria. Cognitive behavioral therapy is also effective and allows you to build a new line of behavior in relationships with loved ones and society.

Under histrionic personality disorder understand personality disorder with superficial and labile effectiveness, dependence on other persons, thirst for recognition and attention to oneself, suggestibility and theatrical behavior. A synonym is the term “infantile personality.” In ICD-10 and DSM-III-R, the corresponding symptoms and syndromes are combined under the name “histrionic personality disorder.”

This personal option is mentioned here due to the fact that it relates to the sphere of manifestation of those hysterical disorders in which hysterical symptoms manifest themselves not in the form of individual physical or mental symptoms, but in the corresponding behavior of the individual as a whole.

Diagnosis based on a thorough medical history, the absence of neurological pathology (confirmed additional research) and on detailed psychiatric and psychological research. In this case, it is necessary to determine the level of cognitive functioning, emotional characteristics, the patient’s personality structure and, above all, the possible relationship between symptoms and typical provoking situations or conflicts (Remschmidt).

Differential diagnosis between psychophysiological (psychosomatic) reactions and conversion (hysterical) reactions

In respect of differential diagnosis of hysterical and conversion syndromes must be distinguished from a number of other diseases. The following restrictions must be made:
1. Separation from psychosomatic diseases. Most important principles Alexander developed in this area back in 1943. They are shown in the table.
2. Discrimination of paralysis and psychogenic seizures from other psychogenic movement disorders. In the differential diagnosis between conversion syndromes and psychogenic seizures, for example, video-EEG technology may be useful. But various conversion syndromes should also be distinguished from tics, hyperventilation tetany and hypoglycemic states with impaired consciousness.
3. Distinction from schizophrenic psychoses. It is during adolescence that schizophrenic diseases often develop, which initially manifest themselves in the form of “hysterical symptoms.” However, it often becomes possible to distinguish from another only after long-term observation.

Borderline personality disorder, as I said, can arise for various reasons. These are not necessarily villainous parents; it may also be something like “genes”.

Of course, you can suspect some problems from childhood. Often difficult children “outgrow” their problems and everything becomes normal.

However, adolescence, with persistent and expanding problems, should serve as a second wake-up call.

Adolescence is quite a difficult time for any child. Everyone is individual and goes through it differently. Even if everything is normal outwardly, it does not mean that the child does not experience any difficulties.

There are children who have real storms and battles with society and family during adolescence. And again, it is not a fact that a rebel will become a poorly adapted person later. As I also said, every teenager needs different strengths push away from the family to become an independent person.

This does not mean at all that the child should leave and no longer communicate with his family. This is the time when it is no longer the family, but the child who decides in which waters to swim.

So here is a list of signs by which one can again suspect that something is wrong with the child. Let me emphasize again - not to make a diagnosis, but again to pay attention.

1. Intense overemotional reaction.

The child clearly reacts more than even teenagers should. The tram doors closed in front of my nose or the ice cream ran out. Those. It’s not like the beloved tram left with all his friends and it’s not the ice cream that the child had been waiting for for 2 months, but a banal tram and banal ice cream. Those. It’s unpleasant, but you can get there by other transport and buy exactly the same ice cream around the corner.

The child is not just upset, he is vomiting and tossing, crying, wringing his hands, cursing fate, cannot even calm down at night, and all his moaning tends to be “Am I the most unfortunate person in the world or are everyone around me bastards.” In other words, the reaction to an unpleasant, but not critical moment, is too dramatic and can last even up to several days.

2. A quickly occurring defensive reaction.

Whatever one may say, it is impossible to always be accepted everywhere in life just because you want it. Somewhere you still have to move a little in order to like it, to show yourself. People sometimes express their dissatisfaction.

Teenager at risk borderline disorder reacts to every situation where he was not accepted, again excessively and immediately takes the position of a victim or begins to attack. Even if the claims are justified, this does not stop him.

For example, a child wrote a bad essay. Well, here's the really bad thing. Because yesterday he sat all day and played on the computer, and at 10 o’clock in the evening it suddenly dawned on him that there was still homework. And I wrote my opus literally on my knee in the toilet, while brushing my teeth in the evening. The teacher naturally gave me the wrong grade that I would have liked. In response, the child begins to either behave aggressively towards the teacher, or indulges in self-deprecation and excuses, demanding to give a grade that suits him.

3. Paranoid reactions.

If something goes wrong, even by accident, the child thinks up the malice of those around him. Has the tram left? The driver specifically waited for him to approach the doors and closed them. And then he laughed evilly and rubbed his hands for the rest of the day, imagining how the poor child missed the transport. The teacher gave the essay a low grade on purpose because he hated it, etc.

4. The desire for self-harm and the implementation of these ideas (cuts hands, burns oneself with cigarettes, etc.)

5. Intense unstable relationships.

Teenagers fall in love. It seems to them that this is the strongest love for life. For a teenager at risk of borderline disorder, such “loves” are quite frequent, between them there are deep gaps like “he never loved me, but just wanted to laugh, and now I’ll kill myself.”

Indeed, it cuts your hands into dark stripes, poisons you, etc. Then new love to the grave, and disappointment to the grave. And this happened several times during adolescence.

6. The desire for violence.

Teenagers sometimes get angry with their parents and even say that they hate them. It even happens that something is broken in our hearts. A child at risk of borderline disorder begins to do this systematically, including causing damage to property, threatening to kill former lovers, teachers, neighbors and anyone who has not pleased them.

7. Eating disorders accompany BPD quite often and it begins precisely in adolescence.

There can be a whole spectrum here, but most often bulimia, anorexia and binge eating.

8. Impulsivity and sensation seeking.

Again, teenagers love thrills, but on average, their experiments do not cross the lines of the law or this happens sporadically.

Problematic children regularly move on. They more regularly steal from stores, speed, drink alcohol and soft drugs while driving, harass passers-by, and do not hesitate to use emotional and even physical violence towards others, especially those who are clearly weaker.

They are more likely to become involved in gambling addiction and have a higher risk of chemical and behavioral addictions. Often they try drugs one after another and it is in this group that it happens more people with polydrug addiction.

They often run away from home at the slightest conflict, cursing their parents. In addition, they more often engage in casual sex without using protection.

In these cases, it is better not to wait for the child to go crazy, but to send him to a specialist. This is necessary primarily for developing better self-control, the ability to regulate stress and interaction with society. The teenage psyche is more plastic than the adult psyche, and children at this time perceive information about how to behave more effectively more easily.

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

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

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

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

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

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

Classification

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevention

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

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

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

Personality disorders in adolescents

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

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

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

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

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

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

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

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

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

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

Psychasthenic personality disorder, anxious-suspicious psychopathy, is characterized by indecision, a tendency to doubt, preoccupation with details, order, and the desire to do everything in the best possible way, which often interferes with the completion of tasks. A psychasthenic is overly responsible, inappropriately concerned with the productivity of his activities to the detriment of pleasure, unusually pedantic, committed to social conventions, stubborn, demanding of others that they do everything exactly as he does. Worried constant anxiety for your future. Obsessions often appear. Because of impatience, hasty actions are often taken when caution is required.

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

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

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

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

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

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

© 2014-2018, ANO DPO "VGAPPSSS"
Use, reproduction and distribution of this intellectual property (curriculum and program description) without the consent of the copyright holder is punishable by law

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

Name of modules and topics

Total labor intensity, h

According to the curriculum, distance learning, h

Independent work of students, h

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

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

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

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

Module II. Diagnosis of adolescent behavioral reactions and deviations

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

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

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

Diagnosis of teenage extremism

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

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

Aggression and aggressive behavior in teenagers. Diagnosis of teenage aggressiveness

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

Auto-aggressive behavior in adolescence. Diagnosis of suicide risk

Eating disorder. Clinical questionnaires for anorexia and bulimia

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

Additionally, you can receive a certificate of competence

License to exercise
educational activities

You can check the license on the website Federal service for supervision in the field of education and science (Rosobrnadzor). To do this, in the “TIN” column, indicate the TIN - 3460061960 and click Search. There is no need to provide any other information.

Series, form number: 34Л01 0001081

A person's personality traits become apparent after late adolescence and either remain unchanged throughout life or change slightly or fade with age. The diagnosis of personality disorder (ICD-10 code) is of several types mental pathologies. This disease affects all areas of a person’s life, the symptoms of which lead to severe distress and disruption of the normal functioning of all systems and organs.

What is a personality disorder

Pathology is characterized by a person’s behavioral tendency, which differs significantly from the accepted cultural norms in society. In a patient suffering from this mental illness, there is social disintegration and severe discomfort when communicating with other people. As practice shows, specific signs Personality disorders arise in adolescence, so put accurate diagnosis possible only at 15-16 years old. Prior to this, mental disorders were associated with physiological changes in the human body.

Causes

Mental personality disorders arise for various reasons - from genetic predispositions and birth injuries to violence suffered in different life situations. Often the disease occurs against the background of parental neglect of the child, intimate abuse, or the child living in a family of alcoholics. Scientific research shows that men are more susceptible to pathology than women. Risk factors that provoke the disease:

• suicidal tendencies;
• alcohol or drug addiction;
• depressive states;
• obsessive-compulsive disorder;
• schizophrenia.

Symptoms

People who have a personality disorder are characterized by an antisocial or inappropriate attitude towards all problems. This provokes difficulties in relationships with other people. Patients do not notice their inadequacy in behavioral patterns and thoughts, so they very rarely seek help from professionals on their own. Most individuals with personality pathologies are dissatisfied with their lives and suffer from constant increased anxiety, bad mood, and eating disorders. The main symptoms of the disease include:

• periods of loss of reality
• difficulty in relationships with marriage partners, children and/or parents;
• feeling of devastation;
• avoidance social contacts
• inability to cope with negative emotions;
• the presence of feelings such as uselessness, anxiety, resentment, anger.

Classification

To make a diagnosis of a personal disorder according to one of the ICD-10, the pathology must satisfy three or more of the following criteria:

• the disorder is accompanied by deterioration in professional productivity;
• mental states lead to personal distress;
• abnormal behavior is pervasive;
• chronic nature stress is not limited to episodes;
• noticeable disharmony in behavior and personal positions.

The disease is also classified according to DSM-IV and DSM-5, which group the entire disorder into 3 clusters:

1. Cluster A (eccentric or unusual disorders). They are divided into schizotypal (301.22), schizoid (301.20), paranoid (301.0).
2. Cluster B (fluctuating, emotional or theatrical disorders). They are divided into antisocial (301.7), narcissistic (301.81), hysterical (201.50), borderline (301.83), unspecified (60.9), disinhibited (60.5).
3. Cluster C (panic and anxiety disorders). They are dependent (301.6), obsessive-compulsive (301.4), avoidant (301.82).

In Russia, before the adoption of the ICD classification, there was its own orientation of personality psychopathies according to P. B. Gannushkin. The system of a famous Russian psychiatrist, developed by a doctor at the beginning of the 20th century, was used. The classification includes several types of pathologies:

• unstable (weak-willed);
• affective;
• hysterical;
• excitable;
• paranoid;
• schizoid;
• psychasthenic;
• asthenic.

Types of Personality Disorders

The prevalence of the disease reaches up to 23% of all mental disorders human population. Personality pathology has several types, which differ in the causes and symptoms of the disease, the method of intensity and classification. Different shapes disorders require treatment individual approach, therefore, the diagnosis should be made with special care to avoid dangerous consequences.

Transitional

This personality disorder is a partial disorder that occurs after severe stress or moral shocks. The pathology does not lead to a chronic manifestation of the disease and is not a severe mental illness. Transistor disorder can last from 1 month to 1 day. Prolonged stress is provoked by the following life situations:

• regular overstrain due to conflicts at work, nervous conditions in the family;
• tedious journey;
• going through divorce proceedings;
• forced separation from loved ones;
• being in prison;
• domestic violence.

Associative

Characterized by fast current associative processes. The patient's thoughts change so quickly to his friend that he does not have time to pronounce them. Associative disorder manifests itself in the fact that the patient’s thinking becomes superficial. The patient is prone to switching attention every second, so it is very difficult to grasp the meaning of his speech. The pathological picture of the disease also manifests itself in a slowdown in thinking, when it is very difficult for the patient to switch to another topic and it is impossible to highlight the main idea.

Cognitive

This is a violation in the cognitive sphere of life. Psychiatry points to such an important symptom of cognitive personality disorder as a decrease in the quality of brain performance. With help central department nervous system a person comprehends, interconnects and interacts with the world around him. The causes of cognitive impairment can be many pathologies, differing in the condition and mechanism of occurrence. Among them are a decrease in brain mass or organ atrophy, circulatory failure and others. Main symptoms of the disease:

• memory impairment;
• difficulty expressing thoughts;
• deterioration in concentration;
• difficulty in counting.

Destructive

Translated from Latin, the word “destructiveness” means destruction of structure. The psychological term destructive disorder indicates an individual's negative attitude towards external and internal objects. The personality blocks the release of fruitful energy due to failures in self-realization, remaining unhappy even after achieving the goal. Examples of destructive behavior of a metapsychopath:

• destruction of the natural environment (ecocide, environmental terrorism);
• damage to works of art, monuments, valuable items (vandalism);
• undermining public relations, society (terrorist attacks, military actions);
• purposeful decomposition of another person’s personality;
• destruction (murder) of another person.

Mixed

This type of personality disorder is the least studied by scientists. The patient exhibits one or the other type psychological disorders, not of a persistent nature. For this reason mixed disorder personality is also called mosaic psychopathy. The patient's instability of character appears due to the development of certain types of addiction: gaming, drug addiction, alcoholism. Psychopathic personalities often combine paranoid and schizoid symptoms. Patients suffer from increased suspicion and are prone to threats, scandals, and complaints.

Infantile

Unlike other types of psychopathy, infantile disorder is characterized by social immaturity. A person cannot resist stress and does not know how to relieve tension. In difficult situations, the individual does not control emotions and behaves like a child. Infantile disorders first appear in adolescence, progressing as they grow older. Even with age, the patient does not learn to control fear, aggression, and anxiety, so they are denied group work and are not accepted into military service or the police.

Histrionic

Dissocial behavior in histrionic disorder manifests itself in the search for attention and increased excessive emotionality. Patients constantly demand from those around them confirmation of the correctness of their qualities, actions, and approval. This manifests itself in louder conversation, louder laughter, and inadequate reaction in order to concentrate the attention of others on oneself at any cost. Men and women with histrionic personality disorder display inappropriately sexual clothing and eccentric passive-aggressive behavior, which is a challenge to society.

Psychoneurotic

The difference between psychoneurosis is that the patient does not lose contact with reality, being fully aware of his problem. Psychiatrists distinguish three types of psychoneurotic disorders: phobia, obsessive-compulsive disorder and conversion hysteria. Psychoneurosis can be provoked by great mental or physical exercise. First-graders often face such stress. In adults, psychoneurological shocks cause such life situations:

• marriage or divorce;
• job change or dismissal;
• death of a loved one;
• career failures;
• lack of money and others.

Diagnosis of personality disorder

The main criteria for the differential diagnosis of a personality disorder are poor subjective well-being, loss of social adaptation and performance, and disturbances in other areas of life. For correct setting When making a diagnosis, it is important for the doctor to determine the stability of the pathology, take into account the cultural characteristics of the patient, and compare it with other types of mental disorders. Basic diagnostic tools:

• checklists;
• self-esteem questionnaires;
• structured and standardized patient interviews.

Treatment for Personality Disorder

Depending on the attribution, comorbidity and severity of the disease, treatment is prescribed. Drug therapy includes taking serotonin antidepressants (Paroxetine), atypical antipsychotics (Olanzapine) and lithium salts. Psychotherapy is carried out in attempts to change behavior, make up for educational gaps, and search for motivation.

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