What does disorder mean? What is a personality disorder

Very often, inappropriate or strange behavior of a person is not the result of a bad character or bad mood, but of a personality disorder. What it is?

What is a personality disorder?

A personality disorder is a type of mental disorder characterized by behaviors, thoughts, and ideas that deviate from generally accepted cultural norms. The pathology usually affects several key areas of life and provokes social disintegration. Translated from ancient Greek, the term sounds like “suffering of the soul” or “mental illness.”

According to various sources, about 12% of the world's population suffers from personality disorders. The diagnosis of personality disorder is usually made after a person reaches eighteen years of age, since earlier attempts to identify the pathology may give a distorted result. Although in adolescents, the strengthening of certain character traits is already quite clearly visible, which can sometimes be used to predict the progression of mental disorders in the future.

An increased risk of the disorder is observed in a dysfunctional family environment. Bad heredity also has a negative impact (if there are cases of mental problems in the family).

Personality disorder: symptoms of pathology

According to ICD-10, personality disorders can only include conditions that are not due to brain diseases and are not provoked by other mental pathologies. At least three of the following symptoms must appear:

1. A noticeable imbalance in behavior and personal positions, affecting several areas of an individual’s active existence, namely the processes of thinking and perception, attitude towards others, the ability to control one’s impulses, etc.
2. The stability of the signs, their chronic nature, i.e. the symptoms of the disorder arose a long time ago, persist over time and are not limited to episodes of mental illness.
3. The patient's inability to adapt to the vast majority of life situations.
4. The onset of the disorder during late childhood or adolescence and subsequent persistence of symptoms.
5. A clear decrease in productivity both in the field of social interactions and in the professional sphere.
6. Severe personality distress that often becomes noticeable long after the onset of the personality disorder.

Another classifier (DSM-IV) defines a personality disorder as a condition in which a person’s individual characteristics do not allow him to adjust and adapt to standard situations, which leads to a serious deterioration in the quality of life. Guided by this approach, the following symptoms of the disorder are identified:

• inconsistency of behavior and internal experience with the cultural requirements of society, which affects at least two of these areas - cognitive, affective, responsible for internal control or the ability to restrain impulsiveness;
• inflexibility of behavior patterns and their spread to a wide range of situations;
• pronounced distress and obvious problems in important areas of life (social, personal, professional, etc.);
• patterns of behavior are well-established and stable over time;
• the symptoms are not associated with any other mental disorder;
• pathological patterns are not associated with exposure to certain substances in the human body and are not provoked by head injuries.

Different types of personality disorders may be accompanied by different symptoms. But in all cases, the following are observed: a chronic course, an impact on life activity in general, and serious obstacles to adaptation in society.

Personality disorder: types of pathology

It is believed that several personality disorders can “fit” into one patient at once. The one that is most pronounced is usually diagnosed. Main types of personality disorder:

In some cases, the disorder belongs to the unspecified group.

Personality disorder: treatment

Since a mental personality disorder is not so much a distortion as a special personality structure, treatment is aimed exclusively at adapting a person to society, reducing the level of his fears and anxiety, “nurturing” the correct reactions to what is happening, etc. Mainly the complex of therapy includes:

1. Psychotherapy. Both individual and group sessions can be conducted. Family therapy is often indicated. The patient is told about his psychological characteristics and how to adapt them to the environment. The use of cognitive behavioral therapy and psychoanalysis methods is widespread. They definitely try to work out the most probable causes of the pathology.
2. Drug therapy. Medications are not very effective for personality disorders, but sometimes patients are prescribed antipsychotics.

The main difficulty in therapy is that the specialist is not always able to establish a trusting relationship with the patient, which is necessary for quality treatment. Sometimes you have to change the doctor if the patient refuses to cooperate.

A personality disorder greatly complicates life, but does not put an end to it. Almost always, the help of a good psychotherapist allows the patient to integrate into society. And although such disorders cannot be completely eliminated, they can be stopped to a sufficient extent so that a person feels comfortable in his own personality.

Last updated: 22/11/2014

What is meant by personality disorder? How exactly is this type of disorder diagnosed and classified?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), under personality disorder is understood as “internal sensations and a stable tendency in behavior, noticeably deviating from the norms accepted in the individual’s native culture, penetrating into several areas of the personality at once, first appearing in adolescence or early adulthood, stable over a long time, capable of leading to suffering or significant deterioration of the condition." Because these disorders are chronic and affect many different areas of the personality, they can lead to serious deterioration in the quality of both daily life and activities.

What causes personality disorders?

The causes of personality disorders have long been the subject of serious debate and disagreement. Some experts believe that personality disorders are triggered by early experiences that interfere with the development of normal thinking and behavior patterns. Other researchers believe that the true cause of personality disorders is biological or genetic in nature.
Although psychologists have not been able to definitively establish the cause, it is likely that a combination of genetic predisposition and environmental factors contribute to the development of personality disorders.

How are personality disorders diagnosed?

For a person to be diagnosed with a personality disorder, they must exhibit symptoms that meet the criteria set out in the Guidelines.

• These behaviors must be chronic, affecting various aspects of a person's life - including social interaction, work, school and close relationships.
• The person must exhibit symptoms that affect thoughts, emotions, interpersonal relationships, or impulse control.
• Behavioral patterns must be stable over a long period of time; the process of their formation can be traced back to adolescence or early adulthood.
• This behavior cannot be explained by any other mental disorder, addiction, or medical condition.

What are the types of personality disorders?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists a total of ten different personality disorders. These disorders are divided into three separate groups:
Cluster A. Unusual or eccentric

Cluster B. Theatrical, emotional or hesitant

Cluster C. Anxious or panicky

Differential diagnosis

Before a doctor diagnoses a personality disorder, he or she must rule out other disorders or illnesses that may also be causing the symptoms. After all, the symptoms characteristic of personality disorders are often similar to the symptoms of other disorders. It must be said that personality disorders can also be accompanied by other diseases.
Must be excluded before diagnosis.

However, they are all believed to be caused by a combination of genetic and environmental factors. Most disorders become less severe in older age.

Diagnosis is based on the clinical picture. Treatment is psychosocial therapy, sometimes medication.

A personal characteristic is a complex of fairly stable stereotypes of thinking, perception, reaction and interpersonal relationships. We can speak of a personality disorder when these characteristics become so pronounced, rigid and maladaptive that they disrupt the person’s lifestyle, interfere with work and/or affect interpersonal relationships. Decreased social adaptability causes significant distress to individuals with personality disorders and the people around them.

The clinical picture depends on the duration of manifestation. Many cases of personality disorder resolve on their own over time.

Personality disorders are divided into:

• auto-identification,
• interpersonal relationships.

Violations of self-identification can manifest themselves in impaired self-esteem (for example, a person cannot decide for himself whether he is kind or cruel) or life values, goals in life and his appearance (for example, a person behaves like a true believer within the walls of the church, but outside of it expresses blasphemous thoughts). Interpersonal problems usually manifest as an inability to create and/or maintain close relationships or a feeling of indifference to others (for example, a person is unable to empathize with others).

People with personality disorders often seem strange and unpleasant to others (including doctors). These people may have difficulty setting boundaries with others. Their self-esteem may be excessively high or unreasonably low. They are characterized by contradiction, individualism, hyper-emotionality, offensive or irresponsible behavior, which leads to physical and mental problems in the family. Personality disorders are often combined with mood disorders, anxiety, alcohol abuse, somatization and eating disorders. When a personality disorder is combined with other disorders, the prognosis is less favorable. Such conditions are less treatable.

Personality disorder occurs in 13% of individuals in the general population. So far, no relationship has been established with gender, social status and race. With borderline psychopathy, it’s the other way around: for every 3 women there is 1 man (but only for the clinical population, not the general population). For most personality disorders, the inheritance rate is about 50%, which is slightly higher than for other major mental disorders.

Classification of personality disorder

Schizotypal personality disorder, like related conditions - paranoid and schizoid personality types - is manifested by social detachment and emotional frigidity. In addition, schizotypal personality disorder is characterized by the following features: strange thinking, perception and mode of communication, such as archaic thinking, insight, relational ideas and paranoid ideation. Patients tend to be suspicious of any changes and are often hostile. These oddities support the diagnosis of schizophrenia, but are usually mild and erased in nature, which is not enough to make a diagnosis. People with a schizotypal personality type are believed to have genes for schizophrenia.

Borderline psychopathy. Doctors in both clinical and psychiatric hospitals often encounter borderline psychopathy. Borderline psychopathy is characterized by unstable self-esteem, mood, behavior and the patient’s relationship with other people.

Histrionic personality disorder can be classified as borderline psychopathy. In this condition, patients are characterized by extreme emotional lability and instability of social relationships.

People with borderline psychopathy are characterized by hypersensitivity. They tend to believe that their parents spent too little time on them during childhood and, therefore, feel empty, angry and feel entitled to attention from others. As a result, they constantly seek help and react extremely painfully to its absence. Their relationships with other people are fast and dramatic. When they feel cared for, they act like lonely street kids who need help for their depression, substance abuse, eating disorder, somatic complaints, and past abuse. When they lose someone who cared for them, they often show inappropriate, intense anger. Such mood swings are usually accompanied by radical changes in their views on the world around them, on themselves and other people. For example, a person moves very quickly from bad to good, from hatred to love, etc. When they are upset or feel self-hatred, they often engage in self-harm. When they feel abandoned, they exhibit dissociative symptoms, brief episodes of psychotic thinking. Or impulsive behavior begins to predominate, and sometimes suicidal actions.

Patients with borderline personality typically receive intensive care initially. But after repeated crises, vague, unfounded complaints and ineffective treatment in these patients can cause a hostile, negative reaction.

Borderline psychopathy often goes into remission. Once remission is achieved, relapse is extremely unlikely. However, the observed improvement in symptoms was not associated with improvements in social functioning. After 10 years, only 20% of patients have good personal relationships and permanent work.

Sociopathy. Sociopathy (and related psychopathic personality disorders) is characterized by a callous indifference to the rights and feelings of other people. Such people exploit others for their own material gain or simply for personal satisfaction. They are easily disappointed and do not tolerate disappointment well. Typically, such people conflict impulsively and irresponsibly, sometimes with hostility and violence. As a rule, they are not aware of the consequences of their behavior and do not feel remorse or guilt. Many of them have a well-developed ability to rationally explain their behavior while blaming others. Dishonesty and deceit form the basis of their relationship. Punishment rarely helps them change their behavior or way of thinking.

A sociopath often suffers from alcoholism, drug addiction, failure to keep his promises, frequent changes of residence and difficulties with the law. Average life expectancy is declining. However, with age, the manifestations of the disorder gradually subside.

Narcissism. The main feature of narcissism is pomposity, pomposity, and ideas of grandeur. Such people are distinguished by an exaggerated sense of their superiority and expect appropriate respect from others. They tend to put other people down because they believe their superiority justifies it. Their relationships with loved ones are characterized by the need for constant admiration. They often believe that other people are jealous of them and are very sensitive to criticism, lack of attention or failures in life. When faced with challenges that lower their high opinion of themselves, they may become enraged and suicidal.

Avoidant personality disorder characterized by avoidance of people or unpleasant life situations. Such people are afraid to start any personal relationship or any new business due to fear of failure or disappointment. Because such people constantly feel a strong conscious desire for love and care, they are constantly depressed by their isolation and inability to establish normal relationships with other people.

Anancastic personality disorder characterized by conscientiousness, an excessive tendency towards order and perfectionism. However, the psyche of such people is also not flexible. They adapt poorly to changes in life. Such people are very responsible. But because they don't want to make mistakes or miss details, they often get bogged down in details and forget about the final goal. Therefore, it is difficult for such people to make decisions and carry out orders. An exaggerated sense of responsibility becomes a source of anxiety. Such people rarely receive satisfaction from their achievements. However, most obsessive-compulsive traits are highly adaptable. As long as these traits are not exaggerated, such people can achieve a lot, especially in the field of natural sciences and other scientific fields that require high self-organization, exactingness and perseverance. However, conflicting feelings and interpersonal conflicts create certain inconveniences for them.

Diagnosis of personality disorder

• Interpersonal relationships.

Patients with personality disorders often fail to evaluate their condition objectively and complain of anxiety, depression, substance abuse urges, or other symptoms that are not always related to personality. A patient's feeling of discomfort (eg, irritation, anger, defensiveness) often indicates the presence of a personality disorder. However, such reactions are quite subjective, and doctors should strive to confirm their assumptions with other diagnostic methods. In addition, one must understand that the patient's problems are the result of his mental activity (many doctors wonder why they don't just stop doing this) or these problems appear to have developed due to bad habits such as social isolation, perfectionism, impulsiveness or due to excessive hostility.

Treatment for Personality Disorder

• Psychosocial treatment.
• A complex approach, often requiring long-term treatment.

Personality traits and the degree of their expression, as a rule, do not depend on drug treatment. Long-term therapy is often required.

General principles of treatment. Treatment is mainly aimed at the following:

• reduce stress,
• make the person understand that their problems are purely internal,
• correct maladaptive and antisocial behavior,
• change problematic personal characteristics of a person.

The main goal of treatment is to reduce the severity of stress-related manifestations. These symptoms can be reduced under the influence of psychosocial assistance, which, among other things, removes the patient from stressful situations or relationships. Drug treatment may also be effective. Relieving stress facilitates treatment of the underlying personality disorder.

Already in the first stages, it is necessary to show the patient that their problems with work or relationships come from within, that is, caused by their problematic worldview (for example, attitude towards assigned tasks, towards authority, or intimate partners). Achieving this level of understanding requires a significant amount of time, patience and diligence on the part of the clinician. The doctor must also understand the degree of emotional sensitivity of the patient and know effective ways to correct it. Family members and friends can help identify problems that have escaped the attention of the patient and his doctor.

Maladaptive and unwanted behavior must be corrected as quickly as possible in order to maximize the effectiveness of treatment. Behavior correction is the most important factor in treating patients. As a rule, behavior is successfully corrected within several months of group behavioral therapy. It is necessary to develop methods for limiting behavior and constantly apply them in practice. Sometimes patients undergo treatment on an outpatient basis or in social institutions. Self-help groups or family therapy can also effectively correct socially undesirable behavior of the patient. Great importance should be given to working with family members and friends,! because they have a certain influence on the patient’s behavior or train of thought.

Correcting problematic personality traits takes a long time, usually more than a year. The foundation of personality changes is individual psychotherapy. During treatment, the doctor must identify interpersonal problems and trace the dynamics of their development throughout the patient’s life. After this, it is necessary to help him understand how these problems are related to the characteristics of his personality, and teach the patient effective methods of correction. As a general rule, the clinician should always point out the unwanted behavior and its consequences to help the patient correct their maladaptive behavior and get rid of erroneous beliefs. Although the physician must proceed with caution, it must be understood that kindness and sound advice alone will not correct a personality disorder.

Treatment of specific disorders

Schizotypal personality disorder - antipsychotic medications and individual therapy focusing on reality testing, situational management and support. The effectiveness of such treatment is negligible.
Borderline psychopathy can be treated effectively by an experienced physician. Insufficient medical experience not only does not help the patient, but can also aggravate the condition. Borderline psychopathy is considered a primary treatment target when it is comorbid with major depression, panic disorder, bipolar disorder, or an eating disorder. Borderline psychopathy fades into the background if it is caused by the use of illegal substances. Many methods, including individual, group, family, and medication therapy, are effective in reducing suicidality, hospitalization, and depression. Dialectical behavior therapy is the most widely used. The therapist acts as a behavioral coach and is available 24 hours a day. Another equally effective treatment is general mental health care, which uses individual therapy once a week and sometimes medication. Mood stabilizers, in particular topiramate and lamotrigine, can quite effectively correct anger and emotional lability.

Sociopathy - to date, there are no effective treatment methods. Patients may be willful or hot-tempered. The doctor must know these nuances and promptly prevent patients from using treatment as an excuse to avoid social responsibility.

Narcissism is well treated with individual psychotherapy. But at the same time, the doctor must emphasize his compassion and never challenge the patient’s perfectionism, not infringe on his rights and not belittle his grandiosity.

People with avoidant personality disorder often respond well to individual treatment (especially cognitive behavioral therapy) and group therapy. However, patients can resist the changes quite stubbornly.

Anancastic personality disorder often responds to individual psychotherapy aimed at increasing the adaptability of patients and facilitating the perception of the outside world.

In most cases, it is difficult to communicate with such people; they often like to argue over trifles and are very stubborn. A person with a personality disorder perceives reality in a distorted form, and these symptoms manifest themselves in any situation.

This diagnosis is not made before the age of 18. However, to make a diagnosis, symptoms must have been continuously present for the previous five years. There are several main types of personality disorders: antisocial, narcissistic, borderline, histrionic, obsessive-compulsive, paranoid, schizoid, schizotypal, dependent and avoidant. There are several other varieties, but they are beyond the scope of our discussion.

Here are 10 signs that suggest a person has a personality disorder:

1. He constantly has mutual misunderstandings with others. He often hears in the words of others what they did not actually say. The narcissist feels that he is being idealized, although he is far from ideal, and those suffering from avoidant personality disorder hear contempt and anger in the words of others, which in fact are not there. In fact, such a person hears in the words of others the content of his own internal dialogue (insecurity or feelings of superiority).

2. He perceives reality incorrectly. By incorrectly interpreting the words of others, such people often have false ideas about what kind of relationship they have with others and what status they occupy in society. For example, hysterical individuals quickly begin to consider themselves the best friends of a person they have just met, not realizing that their new acquaintance does not think so.

3. They often spoil others' fun. For example, they tell how the film will end, come up with unlikely reasons why someone’s plans might fail, spoil others’ mood by causing scenes over trifles. They do all this to be the center of attention, to prove to others that they are smart and right - a typical manifestation of obsessive-compulsive and narcissistic traits.

4. They don't understand that "no" means no. The tendency to violate the personal boundaries of others is a typical symptom. Sufferers of these disorders do not recognize the right of others to set boundaries and easily violate any boundaries they do not like. People with antisocial and borderline personality disorders violate other people's boundaries for other reasons - the former get pleasure from it, and the latter often do not even realize that they are violating something.

5. They try to make themselves look like victims. To avoid responsibility, people with personality disorders tend to portray themselves as victims, for example by talking about their difficult childhoods and long-standing psychological traumas. But it's one thing for someone with post-traumatic stress disorder (PTSD) to suffer from painful flashbacks, but it's another thing entirely for a person to manipulate others or avoid responsibility by portraying themselves as victims and talking about a difficult past. Paranoid, dependent or antisocial individuals are especially prone to this.

6. They have an imbalance in their personal relationships. Some disorders (borderline, hysterical and dependent) are characterized by too close and emotional relationships, while other people (with narcissistic, avoidant, schizoid, schizotypal, obsessive-compulsive or antisocial disorder), on the contrary, have almost no access to emotional intimacy. In any case, relationships are built unbalanced - either too close, or cold and distant.

7. It is very difficult for them to change themselves. Growth and development are almost impossible for such people. They are capable of changing, but extremely slowly. Disorders usually cannot be completely cured, with the exception of borderline disorder, which research shows responds well to certain types of psychotherapy.

8. They shift the blame to others. If a person comes to a psychotherapist with a partner, he often tries to show himself as perfection, and his partner as almost crazy. People with obsessive-compulsive disorder often bring a paper to the therapist listing all their partner's shortcomings. When their mistakes and shortcomings are pointed out to them, they try to blame them on someone else.

9. They are prone to outright lies. It's one thing to tell a white lie to avoid hurting someone's feelings (something people with personality disorders usually don't care about), but it's another thing to outright lie to protect oneself. Such individuals cannot admit that they are the problem and resort to deception. And if they do admit it, they usually do it as dramatically as possible, trying to win over their interlocutor. The most dangerous thing is the lie of a person with antisocial personality disorder; it often threatens others with real mental trauma.

10. They have a distorted view of reality. Schizoid and schizotypal individuals have a distorted idea of ​​life and their place in it. They seem to look at the world through glasses through which everything is seen a little differently than it really is. Their view of the world is in many ways based more on fantasy than reality.

These 10 signs may be a reason to suspect a person has a personality disorder, but remember that only a specialist can make a final diagnosis, so you should not make hasty conclusions.

about the author

Psychologist-consultant with 15 years of experience. Her website.

Personality disorders represent a complex of deeply rooted rigid and maladaptive personality traits that determine specific perceptions and attitudes towards oneself and others, decreased social adjustment and, as a rule, emotional discomfort and subjective distress.

Personality disorders are very close to the concept of “accentuations”. These are similar phenomena, differing primarily in the degree of severity. The fundamental difference between them is that accentuations never simultaneously possess all three basic properties of personality disorders (impact on all areas of life, stability over time, social maladjustment).

They most often occur in adolescence or even childhood, and each type of disorder has its own characteristic age of formation. From the beginning of their emergence, these maladaptive personality traits are no longer defined in time and permeate the entire period of adult life. Their manifestations are not limited to any aspect of functioning, but affect all areas of the personality - emotional-volitional, thinking, style of interpersonal behavior.

For a long time in clinical psychology, pathocharacterological disorders were called “psychopathies.” Currently, instead of the term “psychopathy” it is preferable to use the term “personality disorder”. The change in terminology is due to the fact that the concept of “psychopathy” has the character of a humiliating “label” associated with a “moral” personality defect. Most often, the word “psychopath” is used in everyday speech to emphasize the asociality of the subject. And also it does not entirely accurately reflect the essence of the existing disorders, which lies not in a disorder of one or another mental function, but in a change in the nature of social interaction of the individual.

The main diagnostic criteria for personality disorder are:

1. The totality of pathological character traits that manifest themselves in any environment (at home, at work);

2. Stability of pathological traits that are identified in childhood and persist until adulthood;

3. Social maladjustment, which is a consequence of pathological character traits and is not caused by unfavorable environmental conditions.

Origin of personality disorders. Personality disorders occur in 6-9% of the population. Their origin is in most cases ambiguous. In their development, pathological heredity plays a role (primarily alcoholism, mental illness, personality disorders in parents), various kinds of exogenous-organic influences (traumatic brain injuries and other minor brain damage under the age of 3-4 years, as well as pre- and perinatal disorders), social factors (unfavorable conditions of upbringing in childhood, as a result of the loss of parents or upbringing in an incomplete family, with parents who do not pay attention to children, alcoholics, antisocial individuals who have incorrect pedagogical attitudes).

Classification of personality disorders (psychopathy). There are many classifications of personality disorders.

Classification according to P. B. Gannushkin :

Asthenic type. Psychopathic individuals in this circle are characterized from childhood by increased timidity, shyness, indecisiveness, and impressionability. They are especially lost in unfamiliar surroundings and new conditions, while experiencing a feeling of their own inferiority. Increased sensitivity, “mimosis” manifests itself both in relation to mental stimuli and physical activity. Quite often they cannot stand the sight of blood, sudden changes in temperature, and react painfully to rudeness and tactlessness, but their reaction of dissatisfaction can be expressed in silent resentment or grumbling. They often have various autonomic disorders: headaches, discomfort in the heart, gastrointestinal disorders, sweating, poor sleep. They are quickly exhausted and tend to become fixated on their own well-being.

Psychasthenic type. Personalities of this type are characterized by pronounced shyness, indecision, self-doubt and a tendency to constant doubts. Psychasthenics are easily vulnerable, shy, timid and at the same time painfully proud. They are characterized by a desire for constant introspection and self-control, a tendency to abstract logical constructs divorced from real life, obsessive doubts, and fears. For psychasthenics, any changes in life, disruption of the usual way of life (change of job, place of residence, etc.) are difficult; this causes them increased uncertainty and anxious fears. At the same time, they are efficient, disciplined, and often pedantic and annoying. They can be good deputies, but can never work in leadership positions. The need to make independent decisions and take initiative is destructive for them. A high level of aspirations and a lack of a sense of reality contribute to the decompensation of such individuals.

Schizoid type. Personalities of this type are distinguished by isolation, secrecy, isolation from reality, a tendency to internally process their experiences, dryness and coldness in relationships with loved ones. Schizoid psychopaths are characterized by emotional disharmony: a combination of increased sensitivity, vulnerability, impressionability - if the problem is personally significant, and emotional coldness, impenetrability in terms of other people's problems (“wood and glass”). Such a person is detached from reality, his life is aimed at maximum self-satisfaction without the desire for fame and material well-being. His hobbies are unusual, original, “non-standard”. Among them there are many people involved in art, music, and theoretical sciences. In life they are usually called eccentrics, originals. Their judgments about people are categorical, unexpected and even unpredictable. At work, they are often uncontrollable, as they work based on their own ideas about values ​​in life. However, in certain areas where artistic extravagance and talent, unconventional thinking, and symbolism are required, they can achieve a lot. They do not have permanent attachments, family life usually does not work out due to the lack of common interests. However, they are ready to sacrifice themselves for the sake of some abstract concepts, imaginary ideas. Such a person may be absolutely indifferent to his sick mother, but at the same time will call for assistance to the starving on the other side of the world. Passivity and inactivity in solving everyday problems are combined in schizoid individuals with ingenuity, enterprise and perseverance in achieving goals that are especially significant to them (for example, scientific work, collecting).

It should be noted that such a clinical picture is not always observed. Thus, material well-being and power, as a means of self-satisfaction, can become the main goal of a schizoid. In some cases, a schizoid is able to use his (although sometimes unnoticed by others) unique abilities to influence the world outside him. With regard to the activities of a schizoid in the workplace, it should be noted that the most successful combination is observed when the effectiveness of work brings him satisfaction, and it does not matter what type of activity he is engaged in (naturally, only if it is related to creation or, according to at least with the restoration of something).

Paranoid type. The main feature of psychopathic personalities in this circle is the tendency to form extremely valuable ideas, which are formed by the age of 20-25. However, already from childhood they are characterized by such character traits as stubbornness, straightforwardness, one-sided interests and hobbies. They are touchy, vindictive, self-confident and very sensitive to others ignoring their opinions. The constant desire for self-affirmation, categorical judgments and actions, selfishness and extreme self-confidence create the ground for conflicts with others. Personality traits usually increase with age. Getting stuck on certain thoughts and grievances, rigidity, conservatism, “the fight for justice” are the basis for the formation of dominant (overvalued) ideas regarding emotionally significant experiences. Highly valuable ideas, unlike delusional ones, are based on real facts and events and are specific in content, but judgments are based on subjective logic, a superficial and one-sided assessment of reality, corresponding to confirmation of one’s own point of view. The content of highly valuable ideas can be invention and reform. Failure to recognize the merits and merits of a paranoid person leads to clashes with others, conflicts, which, in turn, can become a real basis for litigious behavior. The “struggle for justice” in such cases consists of endless complaints, letters to various authorities, and legal proceedings. The patient’s activity and perseverance in this struggle cannot be broken by requests, convictions, or even threats. Ideas of jealousy and hypochondriacal ideas (fixation on one’s own health with constant visits to medical institutions with demands for additional consultations, examinations, the latest treatment methods, which have no real justification) can also be of great value for such individuals.

Excitable type. The leading features of excitable individuals are extreme irritability and excitability, explosiveness, leading to attacks of anger, rage, and the reaction does not correspond to the strength of the stimulus. After an outburst of anger or aggressive behavior, patients quickly “move away”, regret what happened, but in appropriate situations they do the same. Such people are usually dissatisfied with many things, look for reasons to find fault, enter into arguments on any occasion, showing excessive vehemence and trying to outshout their interlocutors. Lack of flexibility, stubbornness, conviction that they are right and the constant struggle for justice, which ultimately boils down to the struggle for their rights and personal selfish interests, lead to their lack of harmony in the team and frequent conflicts in the family and at work. One of the variants of excitable psychopathy is the epileptoid type. For people with this type of personality, along with viscosity, stuck-upness, and rancor, they are characterized by such qualities as sweetness, flattery, hypocrisy, and a tendency to use diminutive words in conversation. In addition, excessive pedantry, neatness, authority, selfishness and the predominance of a gloomy mood make them unbearable at home and at work. They are uncompromising - they either love or hate, and those around them, especially close people, usually suffer from both their love and hatred, accompanied by vindictiveness. In some cases, disturbances of impulses come to the fore in the form of alcohol abuse, drug abuse (to relieve tension), and the desire to wander. Among the psychopaths in this circle are gamblers and binge drinkers, sexual perverts and murderers.

Hysterical type. The most characteristic feature of hysterical individuals is the thirst for recognition, that is, the desire to attract the attention of others at any cost. This is manifested in their demonstrativeness, theatricality, exaggeration and embellishment of their experiences. Their actions are designed for an external effect, just to amaze others, for example, with an unusually bright appearance, a storm of emotions (delight, sobs, wringing of hands), stories about extraordinary adventures, inhuman suffering. Sometimes patients, in order to attract attention to themselves, do not stop at lies and self-incrimination, for example, attributing to themselves crimes that they did not commit. These are called pathological liars. Hysterical individuals are characterized by mental infantilism (immaturity), which manifests itself in emotional reactions, judgments, and actions. Their feelings are superficial and unstable. External manifestations of emotional reactions are demonstrative, theatrical, and do not correspond to the reason that caused them. They are characterized by frequent mood swings and rapid changes in likes and dislikes. Hysterical types are characterized by increased suggestibility and self-hypnosis, therefore they constantly play some role and imitate the personality that has struck them. If such a patient is admitted to the hospital, he can copy the symptoms of diseases of other patients who are in the ward with him. Hysterical individuals are characterized by an artistic type of thinking. Their judgments are extremely contradictory and often have no basis in reality. Instead of logical comprehension and sober assessment of facts, their thinking is based on direct impressions and their own inventions and fantasies. Psychopaths of the hysterical circle often achieve success in creative activities or scientific work, as they are helped by an unbridled desire to be in the center of attention, egocentrism.

Affective type. This type includes individuals with different, constitutionally determined, levels of mood. Persons with a constantly low mood constitute a group of hypothymic (depressive) psychopaths. These are always gloomy, dull, dissatisfied and uncommunicative people. In their work, they are overly conscientious, careful, and efficient, since they are ready to see complications and failures in everything. They are characterized by a pessimistic assessment of the present and a corresponding view of the future, combined with low self-esteem. They are sensitive to troubles and capable of empathy, but they try to hide their feelings from others. In conversation they are reserved and taciturn, afraid to express their opinion. It seems to them that they are always wrong, looking for their guilt and inadequacy in everything. Hyperthymic individuals, unlike hypothymic individuals, are characterized by constantly elevated mood, activity and optimism. These are sociable, lively, talkative people. In their work, they are enterprising, proactive, full of ideas, but their tendency towards adventurism and inconsistency are harmful in achieving their goals. Temporary setbacks do not upset them; they get back to work with tireless energy. Excessive self-confidence, overestimation of their own capabilities, and activities on the edge of the law often complicate their lives. Such individuals are prone to lying and not being obligated to fulfill promises. Due to increased sexual desire, they are promiscuous in making acquaintances and enter into reckless intimate relationships. Persons with emotional instability, that is, with constant mood swings, belong to the cycloid type. Their mood changes from low, sad, to high, joyful. Periods of bad or good mood of varying duration, from several hours to several days, even weeks. Their condition and activity change in accordance with changes in mood.

Unstable (weak-willed) type. People of this type are characterized by increased subordination to external influences. These are weak-willed, easily suggestible, “spineless” individuals, easily influenced by other people. Their whole life is determined not by goals, but by external, random circumstances. They often fall into bad company, drink too much, become drug addicts, and scammers. At work, such people are unnecessary and undisciplined. On the one hand, they make promises to everyone and try to please, but the slightest external circumstances unsettle them. They constantly need control and authoritative leadership. Under favorable conditions, they can work well and lead a healthy lifestyle.

One of the main ones is the cognitive classification of personality disorders, which distinguishes 9 cognitive profiles and corresponding disorders.

Let's look at the most typical ones.

Paranoid personality disorder

A person suffering from this disorder tends to attribute evil intentions to others; a tendency to form highly valuable ideas, the most important of which is the thought of the special significance of one’s own personality. The patient himself rarely seeks help, and if he is referred by relatives, then when talking with a doctor he denies the manifestation of personality disorders.

Such people are overly sensitive to criticism and are constantly dissatisfied with someone. Suspicion and a general tendency to distort facts by misinterpreting neutral or friendly actions of others as hostile, often lead to unfounded thoughts of conspiracies that subjectively explain events in the social environment.

Schizoid personality disorder

It is characterized by isolation, unsociability, inability to have warm emotional relationships with others, decreased interest in sexual communication, a tendency to autistic fantasies, introverted attitudes, difficulty in understanding and assimilating generally accepted norms of behavior, which manifests itself in eccentric actions. People suffering from schizoid personality disorder usually live by their own unusual interests and hobbies, in which they can achieve great success.

They are often characterized by a passion for various philosophies, ideas for improving life, schemes for building a healthy lifestyle through unusual diets or sports activities, especially if this does not require direct dealing with other people. Schizoids may have a fairly high risk of becoming addicted to drugs or alcohol in order to gain pleasure or improve contacts with other people.

Dissocial personality disorder

Characterized by a noticeable gross discrepancy between behavior and prevailing social norms. Patients can have a specific superficial charm and make an impression (usually on doctors of the opposite sex).

The main feature is the desire to continuously have fun, avoiding work as much as possible. Starting from childhood, their life is a rich history of antisocial behavior: deceit, truancy, running away from home, involvement in criminal groups, fights, alcoholism, drug addiction, theft, manipulating others in their own interests.. The peak of antisocial behavior occurs in late adolescence ( 16-18 years old).

Histrionic personality disorder

Characterized by excessive emotionality and a desire to attract attention, which manifest themselves in various life situations. The prevalence of histrionic personality disorder in the population is 2-3%, with a predominance in women. It is often combined with somatization disorder and alcoholism. Let us list the main features characteristic of this disorder: seeking the attention of others, inconstancy in affection, capriciousness, an irresistible desire to always be the center of attention, to arouse sympathy or surprise (no matter for what reason). The latter can be achieved not only by extravagant appearance, boasting, deceit, fantasy, but also by the presence of “mysterious diseases”, which can be accompanied by pronounced vegetative paroxysms (spasms, a feeling of suffocation during excitement, nausea, aphonia, numbness of the limbs and other sensitivity disorders) . The most intolerable thing for patients is indifference on the part of others; in this case, even the role of a “negative hero” is preferred.

Obsessive-compulsive personality disorder

Such people are characterized by a preoccupation with order, a desire for perfection, control over mental activity and interpersonal relationships to the detriment of their own flexibility and productivity. All this significantly narrows their adaptive capabilities to the surrounding world. Patients are deprived of one of the most important mechanisms for adapting to the world around them - a sense of humor. Always serious, they are intolerant of anything that threatens order and perfection.

Constant doubts in making decisions, caused by the fear of making a mistake, poison their joy from work, but the same fear prevents them from changing their place of activity. In adulthood, when it becomes obvious that the professional success they have achieved does not correspond to their initial expectations and efforts, the risk of developing depressive episodes and somatoform disorders is increased.

Anxious (avoidant) personality disorder

They are characterized by limited social contacts, a feeling of inferiority and increased sensitivity to negative evaluations. Already in early childhood, these patients are characterized as excessively timid and shy; they perceive attitudes towards themselves distortedly, exaggerating its negativity, as well as the risk and danger of everyday life. They find it difficult to speak in public or simply address someone. Loss of social support can lead to anxiety-depressive and dysphoric symptoms.

Narcissistic personality disorder

The most clearly manifested ideas from adolescence are ideas about one’s own greatness, the need for admiration from others and the impossibility of experiencing. A person does not admit that he can become the object of criticism - he either indifferently denies it or becomes furious. It is worth emphasizing the features that occupy a special place in the mental life of a person with narcissistic personality disorder: an unfounded idea of ​​one’s right to a privileged position, automatic satisfaction of desires; the tendency to exploit, to use others to achieve one’s own goals; envy of others or the belief in an envious attitude towards oneself.

Below are just a few classifications of personality disorders that have gained the greatest popularity and retain clinical significance to this day.

Classification by E. Kraepelin (1915) consists of 7 groups:

1. excitable;

2. unrestrained (unstable);

3. impulsive (people of desire);

4. eccentrics;

5. liars and deceivers (pseudologists);

6. enemies of society (antisocial);

7. pathological arguers.

In this classification, some groups are combined according to a clinical-descriptive principle, while others are combined according to socio-psychological or purely social criteria.

In the taxonomy of K. Schneider (1928), 10 types of psychopathic personalities are distinguished. This classification is based on a descriptive psychological principle.

1. Hyperthymic people - balanced, active people with a cheerful disposition, good-natured optimists or excitable, argumentative people who actively interfere in other people's affairs.

2. Depressed people - pessimists, skeptics, doubting the value and meaning of life, sometimes prone to self-torture and refined aestheticism, embellishing inner joylessness.

3. Insecure - internally constrained, prone to remorse, shy people, sometimes hiding this trait with an overly bold or even daring manner of behavior.

4. Fanatical - expansive, active individuals fighting for their legal or imaginary rights, or eccentric, prone to fantasy, sluggish fanatics detached from reality.

5. Those seeking recognition are vain, striving to appear more significant than they really are, eccentric in clothing and actions, prone to fiction.

6. Emotionally labile - persons prone to unexpected mood swings.

7. Explosive - hot-tempered, irritable, easily excitable.

8. Soulless - deprived of feelings of compassion, shame, honor, repentance, conscience.

9. Weak-willed - unstable, easily susceptible to both positive and negative influences.

10. >Asthenic - persons who feel their mental and mental insufficiency, complaining of low performance, difficulty concentrating, poor memory, as well as increased fatigue, insomnia, headaches, cardiac and vascular disorders.

Prognosis and treatment.

The course and prognosis of personality disorders varies and depends on the specific case. With schizoid personality disorders, complications are possible in the form of the development of schizophrenia, delusional disorder and other psychoses. With dissocial and emotionally unstable disorders, it is possible for the patient's condition to improve in adulthood, but there are also complications in the form of violent death, substance and alcohol abuse, suicide, criminal and financial problems. Hysterical psychopaths may experience somatization, conversion, dissociative, sexual, and depressive disorders.

Patients with personality disorders usually come to the attention of psychiatrists during periods of severe decompensation of the condition; the rest of the time they are not inclined to treatment. Various complexes are used in treatment: psychoanalysis, analytical psychotherapy, supportive psychotherapy, group therapy, family therapy, environmental therapy, hospitalization (short-term and long-term), pharmacotherapy (antidepressants, antipsychotics, tranquilizers).

Literature:

Gannushkin P. B. - “Clinic of psychopathy, their statics, dynamics, systematics” (1933)

A.B. Smulevich. "Borderline mental disorders."

Repina N.V. et al., Fundamentals of Clinical Psychology

A.E. Lichko Psychopathy and character accentuations in adolescents