Emotional personality disorder

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Emotionally unstable (labile) personality disorder is characterized by increased excitability, impulsivity, low ability to self-control and emotional imbalance. Like other personality disorders, it is a character pathology (“severe character”) rather than a disease. An experienced psychotherapist can help with the disorder.

Important

A “difficult character”, the inability to cope with one’s emotions is a reason to seek help from a psychotherapist.

Another name for aggressive, epileptoid, excitable, explosive personality disorder. Doctors sometimes treat it as two separate disorders—impulsive disorder and borderline personality disorder.

A common characteristic of people with both types of emotionally unstable personality disorder is that they have difficulty controlling themselves and obeying norms and rules due to poor self-control and impulsivity. Personality traits make it difficult to establish and maintain contacts with others. Treatment with a psychotherapist for such people is an opportunity to accept the characteristics of their psyche and learn to live in harmony with others.

Symptoms of epileptoid personality disorder

If we talk about the classification of emotionally unstable personality disorder, ICD-10 divides it into two subtypes:

Impulsive.
Borderline.

Emotionally unstable personality disorder of the impulsive type is characterized by severe emotional lability (frequent change of mood for no reason), a tendency to impulsive actions and aggressive outbursts with an inability to restrain itself. People with this disorder have a hard time withstanding criticism and reproach.

Epileptoids are characterized by jealousy, suspicion, a tendency to manipulate, irritability and outbursts of anger.

Emotionally unstable borderline personality disorder is less characterized by aggressive behavior towards others, but such people are prone to self-harm, even suicidal behavior. Read more about borderline disorder.

According to ICD-10, the disorder is characterized by general features of a personality disorder and specific features. The general criteria are as follows:

begins to manifest itself in childhood and adolescence, persists into adulthood;
it is difficult to identify clear phases of recovery/exacerbation;
character traits prevent you from communicating with loved ones and strangers, and prevent you from developing professionally;
a person is often self-centered, incapable of empathy (sympathy for other people), and constantly strives for pleasure.

Specific symptoms of the impulsive (explosive) type of emotionally unstable personality disorder:

Impulsivity in thoughts and actions.
Low ability to self-control.
Outbursts of anger.
Tendency to cruel and antisocial behavior.
Intolerance of blame and criticism.

To diagnose the impulsive type of emotionally unstable personality disorder, the psychotherapist talks in detail with the client.

Differential diagnosis is carried out with other personality disorders (borderline, hysterical), as well as with epilepsy. For this purpose, a pathopsychological study is used (performed by a clinical psychologist), EEG, and Neurotest.

An integrated approach to diagnosis is necessary so that the doctor can prescribe the most effective treatment for a given person.

Disharmonious disorders of mature personality

Disharmonious disorder of mature personality and behavior in adults (psychopathy) is an anomaly of personality development with a predominant deficiency in the emotional-volitional sphere, persistent disturbances in adaptation in behavior, starting in childhood and adolescence and persisting throughout subsequent life. This anomaly of character, leading in the structure of the personality, is characterized by a triad: the totality of violations, their persistence and severity to the level of social maladjustment . At the same time, the person with a disharmonious personality type and the people around him suffer. Subjects with personality disorders usually tend to refuse psychiatric help and deny the disorders observed in them.

In case of personality disorders, subjects are not exempt from criminal liability (in a forensic psychiatric examination), are recognized as unfit for military service, and there are restrictions on their choice of profession.

According to available data, the prevalence of these disorders is 2-5% among the adult population, 4-5% among those hospitalized in psychiatric hospitals, and the predominance of men among psychopathic personalities compared to women (2:1-3:1).

Causes

Genetic, biochemical and social factors predispose to the occurrence of disorders of mature personality and behavior in adults.

Genetic factors. Peculiarities of temperament (character), manifested from childhood, are more clearly visible in adolescence: children who are fearful in nature may subsequently exhibit avoidance behavior. Minor organic disorders of the central nervous system in children are subsequently most common in antisocial and borderline individuals.

Biochemical factors. Individuals with impulsive traits often experience increased levels of the hormones 17-estradiol and estrone. Low levels of platelet monoamine oxidase enzyme correlate to a certain extent with social activity. Dopaminergic and serotonergic systems have an activating effect on psychophysical activity. High levels of endorphins, helping to suppress the activation reaction, are found in passive, phlegmatic subjects.

Social factors. In particular, the discrepancy between the temperament (character) of a mother with anxiety traits and the educational approach leads to the development of increased anxiety in the child and a greater susceptibility to personality disorders than if he was raised by a calm mother.

Symptoms

Disharmony of personality and behavior manifests itself in several areas: in cognitive (providing human cognitive activity) - the nature of perception of the environment and oneself changes; in the emotional – the range, intensity and adequacy of emotional reactions (their social acceptability) changes; in the field of control of impulses and satisfaction of needs; in the sphere of interpersonal relationships - when resolving conflict situations, the type of behavior significantly deviates from the cultural norm, manifests itself in a lack of flexibility, insufficient adaptability in various situations. If in childhood there are pathocharacterological radicals (excessive excitability, aggressiveness, a tendency to run away and wander, etc.), then in adolescence their transformation into pathocharacterological personality formation can be observed, then in adulthood - into psychopathy. Here, a personality disorder diagnosis can be made from the age of 17.

Character accentuations are extreme variants of the norm, in which individual character traits are excessively enhanced. At the same time, there is selective vulnerability to certain mental influences with good and even increased resistance to others. At least 50% of the population of developed countries have accentuated character traits. The degree of severity of personality disorders (severe, pronounced, moderate) is determined by the degree of severity of compensatory mechanisms. Among the types of disorders of mature personality and behavior in adults, the following are distinguished.

Schizoid personality disorder, in addition to the general diagnostic criteria for psychopathy, is characterized by anhedonia, when little is enjoyable, emotional coldness, inability to show warm feelings or anger towards other people, poor response to praise and criticism, little interest in sexual contact with another person, increased preoccupation with fantasies, constant preference for solitary activities, ignoring social norms and conventions dominant in society, lack of close friends and trusted relationships.

Emotionally unstable personality disorder is characterized by a strong tendency to act impulsively, without regard for consequences, along with mood instability. There are two types of this personality disorder :

impulsive type with outbursts of cruelty and threatening behavior, especially in response to condemnation by others;

borderline type , which is characterized by a chronic feeling of emptiness, disorder and uncertainty of self-image, intentions and internal preferences, including sexual ones (a risk factor for the formation of sexual perversions), a tendency to be involved in intense and unstable relationships, excessive efforts to avoid solitude. If such individuals are left alone, there may be suicidal threats or acts of self-harm due to the low subjective value of life.

Hysterical personality disorder is characterized by theatricality of behavior, exaggerated expression of emotions, increased suggestibility, superficiality and lability of emotions, a tendency to mood swings, a constant desire for activities in which the individual is the center of attention, inadequate seductiveness in appearance and behavior, increased concern about one’s own physical attractiveness.

Anancastic (obsessive-compulsive) personality disorder is characterized by an excessive tendency to doubt and caution, preoccupation with details, rules, lists, order, organization or schedules; a desire for perfection that prevents completion of tasks; excessive conscientiousness; scrupulousness and inappropriate concern for productivity at the expense of pleasure and interpersonal connections; increased pedantry and adherence to social norms (conservatism); rigidity and stubbornness; insufficiently substantiated, the appearance of persistent and unwanted thoughts and desires.

Anxious (avoidant) personality disorder is characterized by a constant general feeling of tension and severe forebodings and ideas about one’s own social inadequacy, personal unattractiveness, and humiliation in relation to others; increased concern about criticism addressed to oneself, its reluctance to enter into relationships without guarantees of being liked; limited lifestyle due to the need for physical security; avoidance of social or professional activities for fear of being criticized or rejected.

Dependent personality disorder is characterized by actively or passively placing most of the decisions in one's life on others; subordination of one's own needs to the needs of other people on whom the patient depends and inadequate compliance with their desires; reluctance to make even reasonable demands on people on whom the patient is dependent; feeling uncomfortable or helpless alone due to excessive fear of not being able to live independently; fear of being abandoned by a person with whom there is a close connection and being left to oneself; limited ability to make day-to-day decisions without extensive advice and encouragement from others.

Dissocial personality disorder (antisocial psychopathy - “innate criminal type”) manifests itself as a callous indifference to the feelings of others; a rude and persistent position of irresponsibility and disregard for social rules and responsibilities; inability to maintain relationships in the absence of difficulties in their formation; extremely low tolerance to frustration, as well as a low threshold for the discharge of aggression, including violence; inability to feel guilt and benefit from life experiences, especially punishment; a pronounced tendency to blame others or put forward plausible explanations for one’s behavior, leading the subject to conflict with society.

Paranoid personality disorder is characterized by: excessive sensitivity to failures and rejections; the tendency to constantly be dissatisfied with someone; suspicion; a militantly scrupulous attitude towards issues related to individual rights, which does not correspond to the actual situation; renewed unjustified suspicions regarding the sexual fidelity of a spouse or sexual partner; a tendency to experience one’s increased significance, which is manifested by constantly attributing what is happening to one’s own account, and being caught up in unimportant “conspiracy” interpretations of events happening to a given person.

Diagnostics

It is placed on the basis of dynamic observation of the subject’s behavior and the results of psychological testing.

Treatment

Various methods of psychotherapy, in a state of decompensation, biological methods of therapy (neuroleptics, antidepressants, tranquilizers

Emotionally unstable personality disorder - treatment

People with emotionally unstable personality disorder especially urgently need the help of a psychotherapist. A specialist can teach them to control their emotions and prevent the negative impact of emotional outbursts on others (with impulsive disorder) and on the person himself (with borderline personality disorder).

Labile personality disorder has been described as one of the most difficult diagnoses to treat. Establishing contact with a person who suffers from an emotionally unstable personality disorder is not an easy task for a psychotherapist. Inexperienced specialists avoid a strong alliance with such patients so as not to lose their own peace of mind.

But it is important to remember that a personality disorder is not a disease; the patient does not have damage to the nervous system. Consequently, with proper treatment, it achieves serious positive results. People with borderline and aggressive personality disorders should be treated by an experienced psychotherapist.

Important

Psychotherapy is the main non-drug treatment method for mental disorders. Unlike medications that eliminate symptoms, it works with the cause - allowing you to achieve long-term, lasting results.

The main treatment method for emotional personality disorder is psychotherapy. Drug treatment is not used in all cases. Medication support is sometimes necessary if the personality disorder is combined with other illnesses, such as depression.

The most effective techniques for working with people who suffer from emotionally labile personality disorder are cognitive behavioral therapy and dialectical behavior therapy. They help patients become aware of the thoughts and feelings that influence their actions and teach them how to control themselves.

If all the doctor’s recommendations are followed and, most importantly, the patient’s desire to interact with the psychotherapist, therapy has a lasting positive effect. At the same time, the specialist does not seek to change the patient’s personality, but helps to accept himself and learn to live in harmony with himself and others.

Author: Specialist of the Alliance Mental Health Center

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The International Classification of Diseases, 10th Revision, lists BPD as “Emotionally unstable personality disorder (F60.3).”[2] It is this name that is common in Russia. This disorder is also called borderline disorder.

The causes of BPD are not completely clear, but it is becoming increasingly clear that the appearance of this disorder is due to genetic, brain, and social factors. Borderline disorder occurs 5 times more often in people with disrupted family relationships (neglected by parents, active criticism and rejection from loved ones). BPD is 3 times more common in women than in men.[3]

Unfavorable life factors (for example, physical or emotional abuse) also play an important role in the appearance of this deviation. A number of neurophysiological studies have shown that the manifestations of the disorder are associated with frontal-limbic groups of neurons.[4][5][6]

Prevalence

According to a 2008 study, the prevalence of the disorder in the population is 5.9%. About 20% of psychiatric hospitalizations are for patients with BPD.[7]

Emotional lability refers to sudden mood swings: panic or sadness may be replaced by attacks of aggression, then a burning feeling of guilt may arise, etc.

Separation anxiety is the anxiety that a person experiences due to separation from home and loved ones.

Treatment of schizoid disorder

Medications are not used to treat schizoid disorder - they do not work, they do not help. As a rule, by the time the need for treatment arises, patients have already independently isolated themselves from society. The patient does not allow strangers to approach him, and it can also be difficult for the doctor to “get through.” Due to self-isolation and alienation, treatment of schizoid disorder either does not occur at all, or occurs insufficiently. Typically, only small changes can be achieved.

Cognitive scientists can teach people to experience positive emotions from time to time. Behaviorists sometimes achieve results in developing some social skills. But the methods associated with working in groups are not suitable for schizoids - yet it is not easy for them to interact with people, they close themselves off and treatment of schizoid disorder becomes almost impossible.

Pathogenesis of borderline personality disorder

As with other mental disorders, the pathogenesis of BPD is multifactorial and not fully understood. According to some studies, borderline disorder shares similarities and causes with post-traumatic stress disorder (PTSD). In addition, their pathogenetic relationship is possible.

Most researchers agree that a history of childhood chronic emotional trauma contributes to the development of BPD. However, it is worth noting that insufficient attention is paid to studying the role of other pathogenetic factors: congenital brain dysfunctions, genetics, neurobiological factors and social environmental factors.

Social factors refer to the interaction of people in the process of growing and maturing in their families, surrounded by friends and other individuals.

Psychological factors include personality and temperament, adaptation to the environment, and developed skills to cope with stress.

Genetics

The heritability of BPD is approximately 40%. In reality, it is quite difficult to achieve an objective assessment of genetic factors. For example, the twin method can give overestimated indicators due to the presence of traumatic factors in the common family of siblings.[9] However, one study found that BPD is the third most heritable personality disorder out of ten. A study in the Netherlands (Trull & colleagues) found that genetic material on chromosome nine is associated with symptoms of BPD. Based on this, scientists concluded that genetic factors play a key role in the individual characteristics of the disorder in each individual patient. The same researchers previously found that 42% of BPD symptoms are determined by genetics and 58% by environmental influences.[10]

Features of the brain

A number of studies in the field of neuroimaging in BPD have shown the presence of reduction (decrease) of brain matter in specific areas. These departments are normally involved in regulating the response to stress and regulating the emotional sphere. We are talking about the hippocampus, the orbital-frontal areas of the cerebral cortex (prefrontal cortex), and the amygdala.[11]

The amygdala is smaller in absolute volume and more active in people with BPD. Reduced amygdala volume has also been found in patients with obsessive-compulsive disorder. One study found abnormally high activity in the left amygdala of people with BPD when they looked at cards depicting people in negative emotions. Because the amygdala generates all emotions, including negative ones, this unusually high activity may explain the intense and prolonged emotional expressions of fear, grief, anger and shame experienced by people with BPD. The same fact is interpreted by their ability to subtly recognize the emotions of other people.[12]
The prefrontal cortex tends to be less active in individuals with BPD, especially when memories of their “emotional abandonment” are recalled. This relative decrease in activity is most pronounced in the right anterior gyrus . Given the role of the prefrontal cortex in regulating emotional arousal, the relative inactivity of these areas may explain the difficulty people with BPD have in regulating their emotions and responding to stress.[13]

The hypothalamic-pituitary-adrenal (HPA) axis regulates the production of cortisol , which is released in response to stress. Levels of this adrenal hormone are actually higher in people with BPD than in the general population. This is a sign of HPA axis hyperreactivity. Hyper-reactivity may explain a higher biological response to stress and greater vulnerability to disturbing factors. Also, high cortisol levels are associated with a high risk of suicidal behavior.[12]

Neurobiological factors (estrogens)

A controlled study in 2003 found that BPD symptoms in women were predictably associated with estrogen (female sex hormone) levels during the menstrual cycle.[14]

Personal development factors (childhood trauma)

There is a strong relationship between child abuse, especially child sexual abuse, and the development of BPD.

Children who experience chronic self-maltreatment and difficulty forming attachments early in life are hypothesized to be on the path to developing BPD.[15]

Psychopathy of unstable type

The first symptoms of unstable type psychopathy are usually detected at an early age. Babies are unusually loud and restless, very active. At the same time, a slight developmental delay is observed: children for a long time retain the habit of grabbing everything they see with their hands, later they begin to walk and talk, later they learn to use cutlery, dress independently, etc.

By the beginning of school age, problems become more obvious. In elementary grades, children suffering from unstable type psychopathy do not observe discipline, do not respond to the word “no,” are easily distracted, do not complete assignments, and are extremely careless when handling textbooks, notebooks, and their own clothes. With this disorder, restless sleep and enuresis are often observed in childhood. After adolescence, restlessness and restlessness are replaced by external lethargy and lazy relaxation. However, the behavior is not normalized.

Patients with unstable type psychopathy are still not interested in studying and violate discipline, but they learn to do this less obviously, causing less dissatisfaction with teachers. Children skip school, are drawn to everything that can give momentary pleasure - light entertainment, asocial company, hobbies that do not burden them, that do not imply the investment of effort and purposeful activity (communication on the Internet, computer games). There are no realistic plans for the future. Teenagers suffering from unstable type of psychopathy do not tolerate loneliness well, because they do not know how to structure their time and find interesting activities on their own. Running away from home is possible (usually at the instigation of more authoritative peers).

In adolescence, some differences are found between constitutional and organic psychopathy of an unstable type. With an organic disorder, patients can be attached to loved ones, although this attachment is quite superficial and is combined with absolute disobedience. With constitutional psychopathy, more pronounced cynicism is observed. Patients perceive family as a source of convenience and material benefits, and are indifferent to the troubles and problems of loved ones.

In companies of peers, patients suffering from unstable psychopathy can sometimes demonstrate claims to leadership, but due to weakness of character they find themselves at the lower levels of the hierarchy and “pulling chestnuts out of the fire” for more authoritative members of the group. Patients often show cowardice (sometimes to the point of panic), but occasionally they become capable of reckless courage. They start using psychoactive substances early. At the same time, in patients with organic psychopathy of an unstable type, alcohol causes lightheadedness, headache and deterioration in well-being, while in patients with constitutional psychopathy such reactions are usually not observed.

There is also a difference in tobacco use. Patients with organic psychopathy have a hard time tolerating smoking, vomiting, lightheadedness and headache are possible, so they usually do not become addicted to nicotine. Patients with constitutional psychopathy, on the contrary, easily tolerate nicotine use and often start smoking before reaching adolescence.

Emotions are labile, mild euphoria predominates. People with unstable type psychopathy react violently to any restrictions, quickly change interests, overestimate their own capabilities and do not think about the future. This feature persists throughout life. A patient with an unstable type of psychopathy can spend his entire salary on some kind of entertainment or drinking for the whole company, knowing that the children need to buy clothes for the season, pay for clubs and sections, etc. He is often late for work, skips work, or neglects his duties . The only way to prevent such behavior is strict control from relatives and bosses.

Classification and stages of development of borderline personality disorder

American psychologist Theodore Millon identified 4 subtypes of BPD:[16]

1. Sad Borderline Disorder (includes avoidant or dependent personality traits).

Characteristic features: compliance, humility, loyalty, modesty; feeling of vulnerability and constant danger; the individual experiences feelings of hopelessness, depression, helplessness and impotence.

2. Touchy borderline disorder (includes passive-aggressive personality traits).

Characteristic features: negativism (opposition to everything), impatience, anxiety, as well as stubbornness, defiant behavior, gloominess, pessimism; a person is easily offended and quickly disappointed.

3. Impulsive borderline disorder (includes histrionic and antisocial personality traits).

Characteristics: capriciousness, superficiality, frivolity, feverish and seductive behavior; fearing loss, a person easily falls into agitation (excitement); gloominess and irritability; potentially suicidal intent.

4. Self-injurious borderline disorder (includes depressive and masochistic, as well as self-destructive personality traits).

Characteristic features: isolation, self-punishment, anger, conformity, deference, ingratiation, progressively rigid and gloomy state; there is a risk of suicide.

Severity of personality disorder[17]

Degrees of severity of personality disorders

Light

Average

Heavy

Interpretation Neuropsychic instability (the opposite concept is neuropsychic stability) is a tendency to breakdowns of the nervous system under significant physical and mental stress.
This concept includes various pre-morbid conditions (extreme variants of the mental norm) with a hidden, not expressed, or moderately expressed, but compensated form of the course, caused by deficits in the functioning of the nervous system and reducing the adaptive capabilities of the body. In the origin of neuropsychic instability, the determining role is played by the biological inferiority of the nervous system (congenital or acquired) in combination with unfavorable psychological and social factors. Neuropsychic instability gives rise to: suicidal attempts, self-harm, desertion, assault, evasion of official tasks, irritability, conflict, withdrawal, isolation, posturing, inability to perform due to forgetfulness, tearfulness, non-resistance to humiliation. Sources of neuropsychic instability: mental illness, illness (meningitis, encephalitis), traumatic brain injury, alcoholism, drug addiction, substance abuse, family troubles, mental retardation. Methods for identifying persons with neuropsychic instability: observation, analysis of documents, conversation, analysis of independent characteristics, testing, analysis of performance results, experiment, correspondence with parents, medical examination. Psychological and pedagogical dictionary of a naval unit teacher educator. - Novorossiysk: Publisher: Novorossiysk. G.A. Bronevitsky, G.G. Bronevitsky, A.N. Tomilin. 2005.

See what “Nervous-mental instability” is in other dictionaries:

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InterpretationTranslationEmotional instability is the tendency to exhibit excessively strong, short-lived, unpredictable and maladaptive emotional reactions.
* * * – emotional lability, a tendency to express sharply and unpredictably strong emotions, easy variability of feelings and moods, especially as a result of inadequate reactions to weak stimuli. Wed. the image of Nozdryov in “Dead Souls” by N. Gogol, Sheila Castleside in “Blackout at Gretley” by J. Priestley.

Wed. instability of behavior.

Encyclopedic dictionary of psychology and pedagogy. 2013.

See what “Emotional instability” is in other dictionaries:

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Emotional lability - Instability of emotional states, rapid change of one emotional reaction to another. E. l. is one of the signs of incoordination, disorders of higher nervous activity and the human psyche as a whole... Adaptive physical culture. Concise encyclopedic dictionary
Lability of affect is instability of mood, its constant fluctuations, frequent changes for minor reasons or for no apparent reason. In clinically significant cases, it is considered a manifestation of emotionally labile psychopathy. Synonyms: Emotional... ... Encyclopedic Dictionary of Psychology and Pedagogy
Neuroses are a group of functional neuropsychic disorders, the main causes of which are intrapsychic conflict (in psychoanalysis) and/or a traumatic situation (in domestic psychiatry), see Neurosis. Different types are known... ... Encyclopedic Dictionary of Psychology and Pedagogy
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Organic personality disorder
The frontal lobe of the brain (in red), when damaged, this syndrome occurs.
ICD-10	F
ICD-9

Organic personality disorder (personality disorder of organic etiology)

- a personality disorder caused by disease, damage or dysfunction of the brain.

Psychopathy (personality disorders)

A very relevant, extremely complex and remaining poorly studied category of disorders, which appears to occur everywhere, at all times and in almost all age groups of the population. The term “personality disorders” is too general because it can be extended to cover different types of personality anomalies, including those associated with diseases. The term “psychopathy” is more unambiguous, since it defines only those personality disorders that are not causally related to psychiatric and other diseases.

On its basis, other terms were created and firmly entered the lexicon, such as “psychopathic reaction”, “psychopathic development”, “psychopathic-like state”, etc. Replacing the latter with some derivatives of the term “personality disorder” is hardly possible. Let us add that the announced discrediting of the term “psychopathy” with evaluative connotations characterizes scrupulousness rather than a desire for terminological purity. The terms “schizophrenia”, “dementia” or “cerebral syphilis” are not at all pleasant to the ear, but no one even thinks of abandoning them. The substitution of words only creates the appearance of progress in knowledge about psychopathy, which in fact has not been there for many years.

Is the psychopathy of a loved one preventing you from living life to the fullest? Contact our psychiatric clinic. We will help!

Psychopathy (deformity of character, disharmony of character) is a persistent deviation in the development of character. The behavior patterns that form in this case are extremely rigid and result in significant adaptation disorders in various spheres of an individual’s life. Psychopathic, according to K. Schneider, is a character from which the patient himself or the people around him suffer. The author does not specify what kind of suffering he means, as if forgetting that without suffering neither the individual nor society develops. Such definitions do not clarify the essence of the matter; on the contrary, they only mislead. Have an extremely important role

The criteria for psychopathy were most definitely formulated during the period when the development of psychopathy was strictly associated with degeneration and the influence of hereditary and constitutional factors. According to P.B. Gannushkin, this is the constancy, innateness of abnormal character traits and the totality of the disorder.

Constancy - the stability of a psychopathic character from the birth of an individual and throughout his life. A psychopath is always a psychopath. The first criterion sounds like a life sentence. It means that a psychopath, by definition, is unable to form adaptive patterns of behavior. Meanwhile, it is generally accepted that diagnosing psychopathy in childhood and adolescence is premature: not all “difficult children” subsequently become psychopaths. The works of T.P. Simson (1958) and G.E. Sukhareva (1959) show that situationally determined pathological personality developments under favorable conditions can be smoothed out or disappear and that such unsocialized children do not actually become psychopaths. At the same time, permanent psychotraumatic conditions can contribute to the development and fixation of psychopathic traits in children.

Pathocharacterological development of personality (Gurieva, Gindikin, 1980), as well as psychogenic pathological development of personality (Kovalev, 1980) under unfavorable conditions (everyday, chronic psychotrauma) can result in the formation of psychopathy, but this may not happen if the living conditions of children and adolescents change to normal. The potential for personal growth has not been exhausted even among psychopaths of mature age. In a significant proportion of them, at the age of 25–50 years, psychopathic response patterns may be leveled out or completely disappear. Whether they remained psychopaths and whether they were psychopaths at all is a question not without intrigue.

Congenitality is the conditioning of the development of psychopathy mainly or exclusively by hereditary and constitutional factors. A psychopath is initially a psychopath. Groulet (1940) clearly states that psychopathy cannot be acquired; something that arose during life, under the influence of external circumstances, should not be diagnosed as psychopathy. Meanwhile, O.V. Kerbikov (1971) considered it necessary, along with congenital ones, to distinguish “marginal” or acquired psychopathy. Many modern psychologists express the belief that if the early patterns of parent-child relationships are unhealthy (particularly emphasizing the lack of attachment), this can lead to a personality disorder in the future. The fact that psychopathy is innate is not denied in ICD-10. By saying that psychopathic manifestations “always appear in childhood or adolescence,” he is essentially skirting the issue. The thesis about the innateness of psychopathy still remains unshakable, although it does not have solid and reliable evidence. He seems to repeat Lombroso’s theory of innate criminality, removing responsibility from an unhealthy society that disfigures the personality.

Totality is the deficiency of all spheres of personality in psychopathy. A psychopath is a psychopath in every way. O.V. Kerbikov emphasizes, however, the predominance of emotional-volitional deviations and the relative preservation of intelligence in psychopathy. The DSM-IV specifies that a psychopathic pattern must be present in at least two of the following personality domains: cognition, affectivity, interpersonal functioning, and impulse control. A similar position is reflected in ICD-10. Even in the best descriptions of psychopathic characters, the actual personal characteristics of patients, such as needs, goals, motives of behavior, interests, values and ideals, state of morality and legal consciousness, etc., are not particularly highlighted and analyzed in detail. In other words, there is no main thing that would give the right to use the term “personality disorders,” but the criterion of totality remains declarative.

As a clarification, let us add to the mentioned criteria violations of adaptation to normal life conditions. This “persistent” psychopathic pattern “must be rigid and pervasive (persistent, irreversible? - author) for a wide range of personal and social situations.” In other words, a psychopath is a psychopath everywhere. However, this is not always the case, especially considering the inappropriateness of using the term “adaptation” to a person. A normal person does not adapt to reality, he strives to change it, to create new forms of existence, more and more perfect and harmonious. The tendency to adapt is a quality of a neurotic or psychopathic personality. By adapting, people either create nothing or destroy something in their environment. In a dehumanized society, psychopaths adapt much more successfully than normal people.

The given criteria for psychopathy, due to their uncertainty, make it very difficult to diagnose psychopathy. A significant, if not the predominant part of cases of psychopathy are identified based on materials from forensic psychiatric examinations. On their own initiative, psychopaths rarely seek help; most of them do not identify themselves with psychiatric patients and do not consider their character abnormal. Therefore, information about the prevalence and incidence of psychopathy in general and its individual clinical forms is quite contradictory.

According to O.V. Kerbikov, during the Soviet period, psychopathy accounted for 5% of the total mass of psychiatric patients. G.I. Kaplan et al. (1994) indicate that schizoid personality disorder can affect up to 7.5% of the total population, antisocial personality disorder occurs in 75% of prison inmates, and borderline personality disorder occurs in approximately 1–2% of the population. The prevalence of other forms of personality disorders, the authors point out, is unknown. A large-scale epidemiological study (1984) found that antisocial personality disorder occurs in 2-3% of residents of the United States and Canada (it is unknown whether prisoners in prisons were taken into account).

R. Carson et al. (2004) suggest that approximately 10–13% of people in the population meet criteria for a personality disorder “at some point” in their lives. R. Scheider (1998) provides data according to which the prevalence of psychopathy in the population is 5–10%. The overall frequency of psychopathy in the population, according to Clinical Psychiatry (1998), is 6–9%. At the same time, counting the frequency of individual forms of psychopathy gives a different indicator: 17–22%, and this number does not include some “common” types of psychopathy due to the lack of appropriate indicators.

In his book “The Myth of the Psychopathic Personality,” B. Karpman (1948) writes with obvious irritation that most work on the problem of psychopathy “provides surprisingly little.” In most cases, the author believes, these are “hackneyed repetitions and repetitions of the same material,” “loading an already overflowing trash can.” The author, by the way, points out that if there are indications of the psychogenesis of personality deviations, we can talk about neurosis, but not about psychopathy. By analogy with the “feeling of schizophrenia,” the author puts forward the idea that a psychopath in a doctor always causes only a negative reaction by a complete absence of higher emotions.

As for the etiology of psychopathy, at present the theory of polyetiology of psychopathy is becoming more and more clear, recognizing the role in its development of not only hereditary-constitutional and organic determinants, but also sociocultural factors. Among the latter, child abuse, which is clearly becoming epidemic, is of outstanding importance. In this sense, it can be argued that psychopathy is primarily a social disease rather than a pathology in a narrow medical sense.

Typology of psychopathy. The beginning of the typology of anomalous personality was apparently laid by the Chinese philosopher Han Fei (288–233 BC). He described five "dangerous" types of people. These are “scholars who praise former rulers”; “talkers who care about their personal affairs”; “those who glorify their name and display themselves”; “bribe takers” and, finally, “speculators and manufacturers of crude counterfeits.” The author based the typology on the main life role played by “dangerous” people.

The first scientific classification by E. Kraepelin (1904), built on the model of Han Fei, included the following types of psychopathy: congenital criminals, unstable, pathological liars and cheats, as well as pseudo-queerulants. S.A. Sukhanov (1905) distinguished four types of psychopaths: psychasthenics (anxious and suspicious), resonant (paranoid), hysterical and epileptic types of personality disorder, believing that they occupy a place intermediate between normal characters and corresponding mental illnesses.

E. Bleuler (1920), using diverse criteria, describes the following types of psychopathy: easily excitable, unstable (easily succumbing to all kinds of temptations), impulsive people (spendthrifts, wanderers and drunkards, as well as gamblers and collectors), originals or eccentrics, liars and rogues, enemies of society, debaters. In the clinical-psychological classification of K. Schneider (1940), there are 10 types of psychopathy: hyperthymic, depressive, insecure, fanatical, seeking increased appreciation, emotionally labile, explosive, insensitive, weak-willed and asthenic. K. Schneider's taxonomy largely repeats the classification of psychopathy by P. B. Gannushkin (1933). The latter includes cycloids, emotionally labile, asthenics, schizoids, paranoids, epileptoids, hysterical, unstable, antisocial and constitutionally stupid psychopaths.

P.B. Gannushkin’s system, however, is represented primarily by clinical categories. ICD-10 (1994) distinguishes between paranoid, schizoid, dissocial, emotionally unstable, hysterical, anancastic, anxious and dependent personality disorders. Mention is also made of “other specific personality disorders” (eccentric, unrestrained, infantile, passive-aggressive and psychoneurotic personality disorders), “unspecified personality disorder” (pathological personality NOS and character neurosis NOS), mixed personality disorder and troublesome personality disorder . Affective psychopathies were excluded; they were placed under the headings “cyclothymia” and “dysthymia”. “Schizotypal personality disorder” (corresponds to low-progressive schizophrenia) is reflected in the heading “Schizophrenia, schizotypal and delusional disorders.” The criteria for psychopathy in ICD-10 are quite vague: along with clinical ones, they include psychodynamic and purely descriptive ones.

The DSM-III-R covers personality disorders of the paranoid and schizoid types, schizotypal personality disorder (schizotypal, according to ICD-10), histrionic personality disorder, narcissistic personality disorder, antisocial personality disorder, borderline personality disorder (“outpatient schizophrenia” ), avoidant and dependent personality disorder, obsessive-compulsive personality disorder, passive-aggressive personality disorder, and personality disorders not elsewhere classified (NDD) such as sadomasochistic personality disorder, self-harm personality disorder, and sadistic personality disorder .

V.M. Bleicher (1995) provides the following summary of the types of psychopathy accepted in a number of schools of domestic psychiatry: aggressive-paranoid (paranoid), anankastic, asthenic, affective (cycloid, hyperthymic, hypothymic, i.e. dysthymic, poikilotymic or reactive labile), insensitive, mosaic, unstable, organic, paranoid (with a tendency to form overvalued ideas of an expansive and sensitive nature), psychasthenic, sexual, schizoid and epileptoid.

Questions of the typology of psychopathy, thus, have not been finally resolved due to uncertainty regarding the boundaries, principles of taxonomy, criteria for psychopathy, as well as signs characterizing specific forms of personality disorder. Early on, researchers also encountered the problem of the impossibility of selecting “pure”, i.e., homogeneous groups of psychopathy for study, since a psychopathic personality is very often, if not always, determined by several pathocharacterological patterns, and in their different combinations.

It is also considered established that over time, one psychopathic pattern may change to another. This or that type of psychopathy is not, therefore, some kind of monolithic pathocharacterological structure, as, for example, ICD-10 tries to present it. The personality of a psychopath is fragmented, split and actually represents a series of pathological subpersonalities that are poorly connected to one another, each of which functions largely autonomously due to the immaturity of higher integrative authorities.

As is known, E. Kraepelin already wrote about the underdevelopment of the latter or the immaturity of the psychopathic personality. The patients' self-identification, meanwhile, does not suffer to such an extent that persistent and distinct disturbances in self-perception can be identified. Thus, the typology of psychopathy, understood as integral pathocharacterological formations that do not change over time, is a problem that, in principle, has no solution. The diagnosis of psychopathy can represent, perhaps, only currently relevant pathocharacterological patterns and, possibly, some psychopathological syndromes.

Regarding the last circumstance, E. Bleuler is very clear about, as if emphasizing that the border between psychopathy and mental illness remains open. The mentioned classifications of psychopathy in recent years have not brought clarity to this issue.

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Clinical picture

Organic personality disorder is characterized by significant changes in the pattern of behavior habitual before the illness. Drives, needs and expression of emotions are impaired. Cognitive performance is usually reduced in the areas of anticipation and planning, similar to the impairments in frontal lobe syndrome.

This disorder can manifest itself as a personality syndrome in limbic epilepsy, as a consequence of a lobotomy, after a leucotomy, damage to the frontal lobes of the brain (or damage to other surrounding areas of the brain).

The development of a characteropathic variant of psychoorganic syndrome with organic brain damage is classified as pseudopsychopathy[1].

With the frontal lobe syndrome of the frontal variant, dissocial personality disorder develops. ADHD and other behavioral disorders may occur in childhood.

Diagnostics

The diagnostic criteria of the International Classification of Diseases, 10th Revision (ICD-10) require the presence of 2 or more of the following features:[2]

significantly reduced ability to cope with goal-directed activities, especially those that require a long time and do not quickly lead to success;
altered emotional behavior, characterized by emotional lability, superficial unjustified fun (euphoria, inappropriate playfulness), which is easily replaced by irritability, short-term bouts of anger and aggression. In some cases, the most striking feature may be apathy;
expressions of needs and drives may arise without regard to consequences or social conventions (the patient may commit antisocial acts, such as theft, make inappropriate sexual demands, exhibit gluttony, or fail to observe personal hygiene);
cognitive impairment in the form of suspicious or paranoid thoughts or excessive preoccupation with a single, usually abstract topic (such as religion, “right and wrong”);
pronounced changes in the pace and flow of speech production, with features of random associations, over-inclusion (expanded inclusion of side associations in the topic), viscosity and hypergraphia;
altered sexual behavior (hyposexuality or change in sexual preference).

Etiology

ICD-10 provides an indication of the cause of personality disorder:

due to traumatic brain injury (F07.00)
in connection with vascular disease of the brain (F07.01)
in connection with epilepsy (F07.02)
due to brain tumor (F07.03)
in connection with HIV infection (F07.04)
in connection with neurosyphilis (F07.05)
in connection with other viral and bacterial neuroinfections (F07.06)
in connection with other diseases (F07.07)
due to mixed diseases (F07.08)
due to an unspecified disease (F07.09).
due to complicated diabetes mellitus

Borderline disorder in films and games

The main character of the thriller "Insidious Design" was discussed by psychiatrists and film experts, and was also used to illustrate the condition of borderline personality disorder.
The behavior of the Star Wars film's protagonist Anakin Skywalker meets criteria for borderline personality disorder, which partly explains the film's popularity among teenagers and can be used to inform the public and train medical students about the disorder.
The main character of the film Girl, Interrupted was diagnosed with borderline personality disorder and was treated in a psychiatric hospital.
The main character of the film "Extirpation", Pauline, diagnosed herself with "borderline personality disorder" due to serious psychological deviations.
Several characters from Korean manhwa and the TV series “Dr. Frost" suffered from borderline personality disorder.
Brenda Chenowith from Six Feet Under is believed to have borderline disorder, which she alludes to in Episode 3 of Season 2.

Literature

Alexei Franulic, Elizabeth Horta R.
Organic personality disorder after traumatic brain injury: cognitive, anatomic and psychosocial factors. A 6 month follow-up (English) // Brain Injury : journal. - 2009. - Vol. 14. - doi:10.1080/026990500120538.

>ICD-10 Personality DisordersSpecific This page was last edited on March 21, 2021 at 08:49 pm. Sources used:

https://cmzmedical.ru/zabolevaniya/emotsionalno-neustoychivoe-rasstroystvo-lichnosti/
https://probolezny.ru/pogranichnoe-rasstroystvo-lichnosti/
https://millitary_psychology.academic.ru/709/neuro-psychological_instability
https://psychology_pedagogy.academic.ru/21209/emotional_instability
https://wiki2.org/ru/organic_personality_disorder