Fundamentals of the doctrine of psychopathies and etiology
The problem of personality disorders has been deeply studied in Russian psychiatry, where P.B. Ganushkin made the greatest contribution. He formulated the classical triad of criteria for psychopathy, which includes the totality of pathological character traits, their relative stability throughout life, and pronounced social maladaptation.
The origin of psychopathies is conventionally explained from the standpoint of a comprehensive biopsychosocial model. The formation of a pathological character is caused by a combination of all key factors:
- Pathological heredity;
- Organic lesions of the central nervous system in early childhood;
- Improper upbringing and negative environmental influences.
Depending on the prevailing etiological factor, O.V. Kerbikov proposed a specific classification. Psychopathies whose development is caused predominantly by environmental influences and improper upbringing in childhood are called marginal. They are contrasted with nuclear (or constitutional) forms, where the biological basis plays a leading role.
When making a diagnosis, the clinician must remember that the patient's subjective complaints may be inaccurate. The most objective view of personality structure can only be obtained through a thorough analysis of the actions the person has committed earlier in life.
Clinical features of various types
Pathological character traits have strict specificity depending on the type of personality disorder. In clinical practice, the following main variants are distinguished:
- Paranoid type. Patients are characterized by pronounced persistence and sthenic features, suspicion towards others, and egocentrism. A characteristic feature is intolerance to any infringement of personal rights and a persistent tendency to form overvalued ideas.
- Psychasthenic (anankastic) type. The basic traits are pronounced pedantry and a tendency to obsessive philosophizing (futile analysis of one's actions and constant doubts). Like dysthymic psychopaths, psychasthenics are distinguished by introversion (social withdrawal).
- Hysterical type. This disorder is based on psychic infantilism, manifesting as emotional immaturity. From the perspective of I.P. Pavlov's doctrine of higher nervous activity, these patients are characterized by a sharp predominance of the first signaling system, which forms the so-called "artistic type". Hysterical personalities (along with unstable ones) are extremely prone to deceit, fantasizing, and mendacity.
- Unstable type. The key characteristic of such patients is a complete lack of volitional core and patience.
Complications, impulse control disorders, and therapy
Personality disorders are often accompanied by periods of decompensation and spontaneous state changes. Seasonal activity fluctuations in psychopathies are conventionally called phases in clinical practice. During periods of decompensation, patients are prone to developing addictions. For example, alcoholism often becomes a form of decompensation in psychasthenia (as an attempt to relieve internal tension) and in unstable psychopathy (due to hedonistic attitudes).
In addition to personality accentuations, psychiatry distinguishes impulse and sexual sphere disorders. It is important to differentiate gender identity disorders (which include transvestism and transsexualism) from paraphilias. Among habits and impulse disorders, kleptomania deserves special mention: according to US research statistics, women predominate among patients with this diagnosis.
Treatment and management Treatment of personality disorders requires an integrated approach. In psychopharmacotherapy, the drugs of choice for patients with low self-esteem, anxiety, depression, and a tendency to groundless fears and panic attacks are antidepressants.
Psychotherapy is of paramount importance for the long-term correction of pathological character traits and social adaptation. Depending on the clinical picture, various approaches can be used:
- Cognitive therapy;
- Behavioral therapy;
- Rational therapy;
- Group psychotherapy;
- Suggestive methods.
Briefly: answers to topical questions
What clinical features are characteristic of the schizoid personality disorder type?
Schizoid personality disorder is characterized by social avoidance, emotional coldness, and a lack of empathy. In clinical practice, the following poles of schizoid characters are distinguished:
- Sensitive schizoids — hide from others, avoid society, do not tolerate interference in their personal lives, and do not need support.
- Expansive schizoids — do not hide from people, but are protected by a "shell of indifference" and emotional coldness; they are resolute and impassive.
- Mixed type — differs by a paradoxical combination of emotional coldness and increased vulnerability (the "glass and wood" type of character).
Typical defense mechanisms include autism, arrogance, and intellectualization.
Which groups of psychotropic drugs are used to relieve severe aggression and agitation in psychopathies?
Antipsychotics are used for behavioral correction in patients with psychopathies. Lithium salts are used when there is a tendency to mood swings, outbursts of aggression, and self-aggression.
- Antipsychotics (neuroleptics) — used for behavioral correction in psychopathies, neuroses, and behavioral disorders due to organic diseases. These include thioridazine, periciazine, alimemazine, perphenazine, sulpiride, and risperidone.
- Lithium salts — used for a tendency to mood swings, outbursts of aggression, and self-aggression.
What impulse control and habit disorders are distinguished in psychiatry besides kleptomania?
In addition to kleptomania, habit and impulse control disorders include the following conditions:
- Gambling disorder — pathological passion for gambling.
- Pyromania — the urge to commit arson.
- Trichotillomania — the impulse to pull out one's own hair.
- Gaming disorder — addiction to computer and video games.
- Compulsive buying (oniomania) — a form of habit disorder mentioned alongside other specific forms.
- Dipsomania — classified among impulse disorders.
- Dromomania — also distinguished within the group of impulse disorders.
Ganushkin's triad is easily remembered by the "S-T-D" rule: Stability (persists over time), Totality (manifests in all situations), Desadaptation (interferes with living in society).
Class and exam questions
What is meant by borderline psychopathies in O.V. Kerbikov's classification?
These are personality disorders that arose predominantly as a result of negative environmental influences and improper upbringing in childhood.
How to objectively assess a patient's personality when psychopathia is suspected?
The most accurate understanding of personality in clinical practice is formed on the basis of an objective behavioral history—a detailed analysis of actions previously committed by the person.
What is the physiological basis of the hysterical type according to I.P. Pavlov's theory?
Patients with the hysterical type are characterized by a sharp predominance of the first signaling system over the second, which forms an emotionally figurative, "artistic" type of perception of reality.
Which types of personality disorders are most characterized by a tendency toward fantasizing and deception?
Mendacity, a tendency to deceit and fantasizing, are the most characteristic common traits for hysterical and unstable psychopaths.
What else to study on this topic
- The biopsychosocial model of personality disorder formation.
- Differential diagnosis of phases in psychopathies versus affective disorders.
- Mechanisms of addiction formation as a method of decompensation (using psychasthenia as an example).
- Comparison of gender identity disorders and sexual preference disorders (paraphilias).
- Selection of the optimal direction of psychotherapy (cognitive, behavioral, etc.) for a specific type of personality disorder.
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Other topics in the section "Chapter 25. Disorders of Adult Personality and Behaviour"
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