Emotionally unstable personality disorder

Unstable psychopathy

Also known as dissocial personality disorder or antisocial personality. The main clinical feature of such patients is total weakness of will, lack of patience, and perseverance.

• Motivational sphere: Patients are driven by a thirst for immediate gratification of desires. If refused, they achieve their goal through deceit. They are completely incapable of planning, avoid any work, and seek exclusively easy pleasures.
• Attitude toward misdeeds: Characterized by absolute irresponsibility and a lack of shame. When caught, they lie primitively, deny guilt, beg for mercy, or betray accomplices. They make empty promises that they break immediately.
• Social adaptation: They find it extremely difficult to obtain an education. Out of boredom, they fall into antisocial companies, start abusing alcohol and drugs. Under external influence, they commit absurd crimes (meaningless thefts, assaults).
• Interpersonal relationships: Despite the ease of making contact, they do not form lasting attachments. Their attitude toward family is purely exploitative: they steal things, extort money, and often run away from home.

Explosive psychopathy

Synonyms: excitable, epileptoid psychopathy, or the impulsive type of emotionally unstable disorder. The basis of the clinical picture is extreme irritability and intolerance.

• Conflict dynamics: Outside of situations where their interests are compromised, patients can be welcoming, honest, and open. But at the slightest contradiction, they become aggressive, unleash abuse on their opponent, or start a fight. After a violent reaction, they quickly calm down, feel satisfied, and sometimes apologize.
• Lack of a sense of proportion: In a state of affect, patients do not calculate their strength and can inflict severe injuries on an offender, which often leads them to court. At the same time, they possess reckless courage and easily endure heavy physical labor.
• Dysphoria and self-directed aggression: Attacks of irritation are epileptiform in nature. In moments of rage, episodes of self-harm are possible (for example, multiple cuts on the forearms).
• Organic background: Early organic brain diseases and trauma are often discovered in the anamnesis. EEG records paroxysmal phenomena and CNS dysfunction.

Psychological profile and defense mechanisms

Patients with these disorders rarely come to the attention of psychiatrists of their own free will. Most often this occurs during forensic psychiatric examinations or during the treatment of comorbid substance use and alcoholism.

1. Defense mechanisms: Unstable psychopathy is dominated by primitive defenses—displacement, avoidance, and identification. In the explosive form during stress, coping-confrontation, acting out, and displacement are activated.
2. Reaction to psychoactive substances: Alcohol consumption leads to loss of control and outbursts of malice, provoking senseless and crude antisocial acts (for example, hooliganism in public places).
3. Inner world: Patients with explosive psychopathy constantly provoke conflicts with others. However, they quickly release negative emotions and are not prone to intrapersonal conflicts. Due to this feature, such patients do not suffer from neuroses.

Typical clinical pattern

The development of the explosive type can be traced from childhood. In childhood, the child is extremely disobedient, restless, and prone to dangerous amusements (for example, games with explosives leading to injuries).

In adolescence, against the background of emotional shocks (for example, a quarrel with a partner), self-directed aggression is vividly manifested—inflicting cuts with attempts to hide them from loved ones. In adulthood, social maladaptation is exacerbated by alcohol: absurd acts while intoxicated are typical, leading to expulsion from educational institutions or dismissal.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Psychological defense mechanisms (identification, displacement, acting out)
• Epileptiform disorders and dysphoria in psychiatry
• Forensic psychiatric examination in personality disorders
• Diagnosis of paroxysmal phenomena on EEG

Other topics in the section "Chapter 25. Disorders of Adult Personality and Behaviour"

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