Dynamics of Personality Disorders

Temperament, character, and properties of the nervous system

In psychiatry, it is extremely important to differentiate innate properties of the nervous system from acquired traits. For example, a quality such as generosity is viewed by clinicians exclusively as a manifestation of character, rather than a characteristic of temperament or an indicator of a person's abilities.

The typology of temperaments and nervous system properties includes the following important clinical phenomena:

• Melancholic temperament. Individuals with this type are distinguished by marked passivity and excessive sensitivity. Pessimism and low self-esteem predominate in their mental status. At the same time, they demonstrate a pronounced capacity for genuine sympathy and deep empathy toward others.
• Epileptoid temperament. A specific variant that in behavioral terms is distinguished by a paradoxical combination of courage and pronounced vindictiveness.
• Introversion. A state in which a person (introvert) is characterized by withdrawal, a pronounced tendency toward constant introspection, and external indifference to events occurring around them.
• Sthenicity. A term used to denote a patient's persistence and indefatigability, indicating a high level of physical and mental energy.

Furthermore, according to the teachings of I.P. Pavlov, the predominance of the first signaling system in an individual directly implies high emotionality and impressionability.

Constitutional types and somatopsychic connections

Physical body structure often correlates with certain psychological features and a predisposition to somatic pathologies. The following patterns are distinguished:

1. Pyknic body build. Characterized by rounded proportions. Patients with this constitutional type tend to have excess body weight.
2. Athletic body build. In clinical practice, this somatotype is most often combined with manifestations of epileptoid temperament.
3. Epileptoid constitution. Patients belonging to this type have a specific somatic vulnerability. They experience various injuries, spinal and joint lesions, and migraine attacks somewhat more frequently than the general population average.

Accentuation and personality types

Accentuation acts as a transitional stage between normality and pathology. Accentuated personalities are people who possess a number of prominent traits that significantly distinguish them from the majority of the human population. Despite these pronounced features, such individuals retain a quite sufficient capacity for successful social adaptation.

Among specific character types, the following are distinguished:

• Stuck-type (persistent). The behavior of such people is always dominated by distrust of others and pronounced stubbornness.
• Dysthymic (introverted) personalities. They are characterized by a specific symptom complex that includes constant suspicion, heightened anxiety, consistently low self-esteem, paradoxically combined with credulity and high perseverance in task performance.

Personality pathology and defective states

Under an unfavorable course or the influence of endogenous and exogenous factors, persistent disorders develop. Pathological personality development is the process of consolidation of pre-existing pathological stereotypes in a person's behavior.

The extreme variants of disorder dynamics include:

• Psychopathy. In modern clinical practice, it is viewed as a variant of pathological personality development, representing a persistent anomaly of the patient's character.
• Alcoholic personality degradation. These are specific, profound mental changes resulting from chronic alcoholism. Clinically, they manifest as absolute irresponsibility and shamelessness. In addition, such patients are typically extremely indiscriminate in establishing contacts and communicating with complete strangers.
• Schizophrenic personality defect. A severe consequence of an endogenous process. Clinically, it manifests as progressive social and physical passivity, as well as marked impoverishment of the emotional sphere, which together form apathy-abulia syndrome.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Clinical presentation of apathy-abulia syndrome in schizophrenia
• Differential diagnosis of accentuations and psychopathies
• I.P. Pavlov's doctrine of signaling systems in the context of psychiatry
• Specifics of the development of alcoholic personality degradation

Other topics in "Chapter 3. Healthy and Pathological Personality"

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