Personality disorders of the model of psychotherapeutic care. Psychotherapy - a method of treating mental disorders
The method of applying dynamic psychotherapy for personality disorders is not much different from that used for neuroses. Such treatment can be carried out individually or in a group (see Chapter 18).
There are some differences in emphasis in the individual treatment of personality disorders compared to the treatment of neuroses. Less attention is paid to the reconstruction of past events and more to the analysis of behavior in the present. In the so-called character analysis, one studies in detail how the patient relates to other people, how he copes with external difficulties and how he controls his own feelings. This approach is more directive than classical methods of analyzing neurotic symptoms, although transference analysis remains an essential element. In order to emphasize the discrepancy between the patient's usual attitude towards other people and the real life situation, the doctor must reveal himself to a greater extent than is usually accepted in classical analysis. At the same time, the analysis of the doctor's emotional attitude towards the patient can serve as an important indicator of the likely reaction of other people to the patient.
Histrionic Personality Disorder
Murphy and Guze (1960) made an interesting report on the difficulties involved in treating patients with histrionic personality disorder. They describe the direct and indirect demands that such patients may make to the doctor. Direct demands include unreasonable requests for medical treatment, frequent requests for reassurances of continued readiness to help, telephone calls at the most inopportune times, and attempts to impose unrealistic treatment conditions. Indirect demands come in various forms, such as seductive behavior, threats of dangerous acts such as taking an overdose of a drug, repeated unfavorable comparison of current treatment with past treatment. The physician must be alert to the first signs of such demands and establish a framework for the relationship, making it clear to what extent he intends to tolerate the patient's behavior. This must be done before the requirements of the latter increase excessively.
obsessive personality disorder
Patients with personality often express a great willingness to please the doctor. However, in this type of personality disorder, psychotherapy is usually not beneficial, and inappropriate use of it can lead to excessive painful introspection, with the result that the condition worsens rather than improves.
Schizoid personality disorder
The inherent desire to avoid close personal contacts in schizoids makes it difficult to use any kind of psychotherapy. Often, after several sessions, the patient stops attending them; if he continues treatment, he tends to intellectualize his problems and there are doubts about the scientific validity of the methods used in the clinic.
The doctor must try to gradually penetrate these "intellectual barriers" and help the patient become aware of his emotional problems. Only then can the doctor start looking for ways to solve them. It is a slow process at best and often ends in failure.
borderline personality disorder
Patients with borderline personality disorder do not respond well to exploratory psychotherapy, and attempts at such treatment may worsen their emotional control and increase their anxiety. It is usually better to use supportive care, focusing all efforts on turning towards practical goals related to solving everyday problems.
Persistence and depth of personality changes, rejection of any help make personality disorders one of the most difficult medical problems.
Medical therapy may be useful for some patients at certain times. Drugs are unlikely to cure personality disorder, but there is growing evidence that drug treatment can reduce the severity and duration of some manifestations of personality disorders.
Impulsivity and aggressiveness, often found in borderline and antisocial disorder. Since changes in the level of GABA, serotonin, and dopamine in the brain were found in patients with aggressiveness and impulsivity, drugs that affect the level and ratio of mediators are used in the treatment. Lithium salts (lithium carbonate), serotonergic drugs (fluoxetine, sertraline), antipsychotics (haloperidol in small doses, neuleptil, rispolept, etc.)
Emotional lability is especially characteristic of people with borderline, histrionic, narcissistic disorder. There is evidence that low doses of neuroleptics reduce emotional vulnerability, and antidepressants are also used in small doses, both tricyclic and MAO inhibitors. Dysphoria is treated with carbamazepine.
Anxiety is a very non-specific symptom and can be seen in many personality disorders, but most commonly in dependent, avoidance, and obsessive-compulsive disorders. The drugs of choice are tranquilizers (clonazepam, alprazolam, etc.).
With short-term perceptual disorders and delusions that may occur during decompensation of schizotypal, schizoid, paranoid disorders, antipsychotics (stelazin, triftazin, haloperidol) are prescribed.
Drug treatment is usually chosen by those patients who expect immediate action from therapy, consider drugs as a tangible means of controlling themselves, suppressing unwanted actions. When prescribing drug therapy, it is necessary to take into account the possibility of drug abuse, especially psychostimulants and tranquilizers. Drug treatment must be combined with other methods - psychotherapy (individual and group).
At psychotherapy planning it is often important to analyze the origin and development of a personality disorder, and not just the type. For the most successful therapy, a good psychotherapeutic alliance is necessary. It is necessary to discuss with patients those symptoms, those forms of behavior that are undesirable for them. It is said that it is impossible for a man to change his nature, all he can do is change circumstances. Treatment consists in helping the person choose a way of life that would be less in conflict with his character. For example, it is important to find out the situations under which aggressive behavior most often occurs.
Psychotherapy should be structured, consistent and regular. Psychotherapy allows the patient to discuss both present difficulties and past experiences.
Group psychotherapy is an effective addition to individual therapy, allowing the patient to express their feelings without fear of consequences. This type of psychotherapy also provides social support and the opportunity to establish meaningful connections with people both inside and outside the psychotherapy group.
Short term hospitalization sometimes needed during acute psychotic episodes or when disruptive behavior is at risk. Hospitalization can also provide temporary removal from an external traumatic factor.
Therapy for personality disorders in dual diagnosis
The term "dual diagnosis" refers in particular to individuals suffering from personality disorders and an addictive problem. These types of people need therapeutic approaches that take into account two types of disorders, which greatly complicates the effectiveness of the intervention. A number of studies have shown that individuals with psychiatric disorders, including personality disorders, have an increased risk of developing addictive disorders.
There is evidence to suggest that elimination or reduction of addictive substance abuse leads to improvement or elimination of mood and anxiety disorders, but to a much lesser extent to a change in the main symptoms of the personality disorder itself. By itself, this fact indicates that personality disorders are an independent nosological category and require additional therapeutic interventions.
A number of authors provide evidence that the coexistence of mental state-altering substance abuse and personality disorders is associated with an increase in psychiatric symptoms, and with a more destructive nature of the addictive realizations themselves.
P. Links (P. Links) and M. Target (M. Target) describe in such cases an increased risk of suicide, frequent hospitalizations, legal and labor behavior problems.
Patients with a dual diagnosis are more prone to develop an irresistible craving for various forms of addictive realizations, including the use of substances with addictive properties. They are more likely to experience emotional and somatic disorders. They are characterized by frequent interpersonal conflicts. In individuals with personality disorders, insufficiently intensive anti-addictive therapy rarely leads to the prevention of relapse.
B. Thomas, T. Melchert, and J. Banken point to the following data in this context: with standard hospital treatment, after one year, 94% of patients with personality disorders relapsed. while in addicts without personality disorders, relapse was diagnosed in 56% of cases.
At the same time, I. Naes and C. Davis note that the prognosis for addicts with borderline personality disorder (BPD) looked better (compared to antisocial disorder). The results of intensive intrahospital therapy for alcoholism were no worse than those of addicts without signs of PCR.
Despite the prevailing view of the "incurability" of antisocial personality disorder (ALP), K. Evans (K. Evans) and J. Sullivan (J. Sullivan) consider it appropriate to develop strategies and tactics that can be effective in some cases. This position is based on observations indicating that ALR is not uniform in severity, but is a sequence (continuum) in which ALRs of different depths are presented: from very intense at one pole to conduct disorder and oppositional disorder at the other. For example, carriers of relatively mild forms of APR are more prone to fear reactions and have a better chance of correcting them.
One of the important predictors of therapy success is age. Therapeutic interventions in childhood and early adolescence are more effective, which is explained by less fixation on antisocial behavior and greater control of children and adolescents by authority figures. Persons with ALR in the middle period of life are motivated to therapy by the development of long-term affective disorders. I. Pinik et al. (E. Penick et al.) observed a positive effect of antidepressant treatment in people with ALR and alcoholism in a state of depression and anxiety disorder. The authors concluded that ALR does not necessarily block the treatment of a comorbid disorder.
K. Evans and J. Sullivan emphasize that the goal of therapy for APR is not to turn the patient into a highly sensitive, empathic person, since this is unattainable. The goal is for the individual with APD to adapt, to make him/her convinced that following the social rules of conduct will enable them to achieve greater success, "look better" socially, and reduce the amount of trouble in life.
Therapy of persons suffering from APR and having a dual diagnosis (plus alcohol addiction) has a number of specific features. K. Evans and J. Sullivan call them “three Cs”: corral (fencing), confront (confrontation) and consequences (consequences). Fencing implies the need for patients/patients to be in a closed system without the right to move freely. Otherwise, they will not systematically (or not at all) attend sessions. Confrontation involves the removal of the psychological defenses used in APR. It is important, first of all, to break through the barrier of denial, using cognitive approaches.
Individuals with ALR must understand that their false statements and explanations are recognized by the specialist. At the same time, the latter should not act in a critical authoritarian role, but resort to the tactics of conversation in the form of "adult - adult" in the model of transactional analysis. What matters is the ability of the specialist to understand the motivations hidden by people with APD, aspirations for certain places of spending time, contacts with specific people, alcoholics, drug addicts and other antisocial persons. The specialist should also discuss the question of what dividends the patient / patient is trying to derive for himself from consultation and therapy. This may be, for example, the mitigation of punishment for convicted persons; the desire to preserve family life, especially in cases where it has created a "most favored nation status" for the use of alcohol or other substances that change the mental state. Thus, some points of mutual understanding can be found on the basis of demonstrating to the patient errors in their thinking, which objectively lead not to pleasure, but to a deterioration in their social position and a decrease in the possibilities of hedonistic realizations. Mistakes in thinking include frequently occurring minimization of negative aspects, rationalization, and common lies. K. Evans and J. Sullivan find that in the process of group therapy, a discussion on the topic of specific errors in thinking has a strong effect on people with APD.
The authors focus on the abuse of alcohol by persons with ALR syndrome of the "royal child", which consists in inflated ego without really high self-esteem. "I am unique / unique and I am above other people" - such a motto is associated with the opposite: "I am nothing / I am nothing." This design provokes an attraction to alcohol. The consequences of behavior in the assessment of persons with ALR are limited to an antisocial attitude to receive pleasure, high, excitement, immediate satisfaction of desires. Long-term negative consequences are not taken into account, are not taken into account. There is no fear of negative consequences. Persons with ALR do not analyze the connection of the punishment that has befallen them with their antisocial behavior, although it would seem that it is obvious. Although always difficult to teach people with APD to understand the high probability or inevitability of negative consequences of antisocial behavior, it is an important element of therapy.
Alcohol addicts with APR have the peculiarity that they do not drink alcohol as systematically as ordinary alcohol addicts. However, in a state of alcohol intoxication, they cause, in general, more harm. Characteristic for them is a sharp increase in antisocial activities when intoxicated.
Codependency correction is included in the structure of therapy as an extremely significant block. It aims to destroy the situation of "enabling" - the creation of the most favored nation status for an addict with ALR, which is sometimes metaphorically called "hothouse environment". The family members of an addict with APR are usually codependents who use inappropriate strategies to keep patients from substance abuse. They include control, patronage and competition, and objectively lead only to negative consequences, stimulating an increased sense of impunity, irresponsibility, projective identifications, and denial of the problem.
Teaching family members in this context can be helpful, although the situation is more complicated if they themselves have ALR traits. Codependent family members usually show signs of anxiety and depression, which are exacerbated by the inability to correct the addictive behavior of their loved ones. Family members of antisocial addicts literally use themselves, their emotions, activity, motivations, finances and health in futile attempts to correct the situation.
Addicts with ALR show a clear tendency to blame their addictive problems on co-dependent individuals, for which different formulations are used, depending on the situation, such as: “I do this in protest against your petty control”; “You bring me up with constant surveillance”; “Your defense humiliates me in front of relatives / neighbors, so I get drunk”; "I can't bear these constant reproaches," etc.
K. Evans and J. Sullivan believe that in the correction of antisocial addicts it is possible to use a twelve-step model, taking into account their personal characteristics. The importance of the "first step" as a core element in therapy is emphasized: "I admit my powerlessness over alcohol" (or other addictive agent). The recognition of impotence is due to the fact that addicts must understand that they are unable to control both the use and its consequences. It is important to identify the loss of control over behavior during drinking, one's impotence, as well as the recognition of erroneous inferences used to justify the use of addictive agents and other forms of antisocial behavior (manipulation, deceit, irresponsibility, blaming others, etc.). It is necessary to focus the attention of antisocial addicts on their recognition of the negative consequences of antisocial behavior.
Persons with borderline personality disorder (BPD) show a tendency to intermittent substance abuse that affects their professional development.
Maintaining sobriety, therefore, is a major concern for persons with PD who suffer from alcohol addiction or occasional alcohol abuse, as does the use of other addictive substances. K. Evans and J. Sullivan equate sobriety in these patients/patients with safety. They believe that the 12-step model has a lot to offer borderline addicts, in particular, to help get rid of the negative "I"-image. The writing of an autobiography and its analysis, the use of a free story about one's life (narrative), despite the presence of dramatic and psycho-traumatic events in the analysis, can have a positive value.
Addictive tendencies in persons with PHR are manifested, in particular, in cases of their upbringing in addictive families, where there was an alcohol scenario in everyday life. Intensive alcohol consumption in persons with PHR may be part of the structure of impulsive behavior, limited to the latter, but may also act as a way to eliminate unpleasant experiences, change the general background of dissatisfaction with oneself and the world around. In the latter variant, there is often a change in compulsions with a fixation on food (overeating), gambling, sex, etc.
P. Links et al. have shown that the use of mental state-altering substances by persons with PDH leads to an increase in the symptoms of the disorder, including self-injurious behavior. The risk of physical trauma, sexual violence, accidents increases.
K. Evans and J. Sullivan offer some specifics in the application of the 12-step program for borderline addicts. They highlight the presence of a "terrible combination" in which PLR is mixed with chemical addiction. Among other things, in such cases, the acquisition of new skills is delayed. As a "first step", from the point of view of the authors, it is important to focus on uncontrollability in relation to alcohol and other addictive substances. It is necessary to ensure that the patient/patient identifies situations where alcohol use was out of control and caused problems. The term "powerlessness" horrifies borderline addicts because they don't see it as a metaphor, but as something very specific to their ego.
The "Second Step" is essentially a declaration of faith. "We have come to believe that a Power greater than ours can bring us back to health." The problem is that for people with LHP, faith and connection with a higher power can be difficult to reflect on. These individuals live in the moment, they have little ability to plan their future. Therefore, faith and hope for improvement in the future are difficult for them to achieve. Given this feature, the "second step" is divided into small fragments. To do this, patients/patients are asked to discuss how their drinking/substance abuse was abnormal; give some examples of positive experiences that occurred during the non-recourse to addictive means; describe even minor positive events in their lives since abstinence.
The concept of a "Higher Power" requires special attention. It is necessary to find out the features of the individual manifestation of religious feeling, its projections in terms of faith in God, in Nature, in Something indefinable, but Present, in Purpose, in the Meaning of life.
In working through the “third step” (“we have made the decision to entrust our will and our lives to the care of God as we understand Him”), patients / patients are trained to get rid of obsessive thoughts, stop senseless attempts to overcontrol other people, events. Symbolic actions are used, such as writing on paper a list of problems that are most difficult to get rid of, burning notes and burying ashes; tying such pieces of paper to a balloon and releasing it into the air. This takes into account the fact that many borderline patients believe in the power of symbolic rituals.
Persons with a dual diagnosis (PLD + addiction) need consultations and treatment by highly qualified specialists who have experience in quickly responding to the possibility of destructive impulsive actions. It requires knowledge of the family situation, significant intimate relationships, risk areas that predispose to self-harm, suicide and aggression.
The risk zones for borderline addicts (as well as for people with BPD in general) are the experiences of abandonment, primarily related to intimate relationships, including the fear of leaving itself, conflicts with a significant partner in a "tandem" relationship, and real abandonment. Emotional support in such states is extremely important, it can prevent destructive reactions, including addictive realizations.
S. Ball (S. Ball) in 2004 proposed in cases of personality disorders aggravated by addiction, a therapy model called the "Dual Focus Therapy Scheme" (STDF). It is based on the hypothesis that the core of the pathology in personality disorders is the interaction of two broad cognitive-behavioral constructs: 1) early maladaptive schemas and 2) maladaptive behaviors that reflect these maladaptive schemas. The primary goal of therapy is intervention aimed at reducing the intensity of the influence of maladaptive schemas and the development of more adaptive behaviors. The ideal goal of STDF is to achieve control over behavior and enable patients to meet significant human needs. Various methods are used to reduce impairment both on the first axis (addiction, short-term mental disorders) and on the second axis (symptoms of personality disorders).
According to the definition of A. Beck et al. and J. Young, early maladaptive schemas are persistent negative beliefs about oneself, other people and the environment. All major experiences and behaviors are organized around these dysfunctional beliefs. Schemas form early in life, develop gradually, become more complex, and begin to affect ever wider areas of life. In persons with personality disorders, the dysfunction of these circuits is pronounced, they are extremely rigid and resistant to attempts to change them. J. Young, he et al. gives the following characteristics of early maladaptive schemes. They are:
1) develop in the interaction of temperament and repeated negative experiences in contacts with the closest people (parents, siblings, peers);
2) generate high levels of affect, have self-damaging effects, or harm others;
3) interfere with basic needs for autonomy, self-expression and interpersonal contacts;
4) deeply penetrate into the psyche, become central in the "I";
5) “triggered” (activated) by everyday events or mood states.
J. Young, S. Ball (S. Ball), R. Schottenfeld (P. Schottenfeld) do not associate specific schemes with specific forms of personality disorder, but give 18 main schemes. Each personality disorder has one or more of these.
Cluster "A":
1) abandonment/instability;
2) mistrust/violence;
3) emotional deprivation;
4) defectiveness/shame;
5) social isolation/alienation.
All these schemes are combined into the "Breaking of connections and repulsion" cluster.
Cluster "B":
6) dependence/incompetence;
7) hypersensitivity to danger;
8) mixing / underdeveloped "I";
9) the impossibility of achieving.
These schemas are grouped into the "Violation of autonomy and fulfillment" cluster.
Cluster "B":
10) privilege/dominance;
11) insufficient self-control/self-discipline.
The schemes are grouped into the Boundaries Violation cluster.
Cluster "G":
12) submission;
15) self-sacrifice;
16) seeking approval.
The cluster is called “Other Orientation”.
Cluster "D":
17) hypersensitivity to mistakes, negativity;
18) overcontrol/emotional suppression.
Signs are combined into a cluster "Hyper vigilance and suppression".
On the basis of maladaptive schemes, maladaptive behavioral styles are formed, including long-term, unconsciously emerging cognitive and behavioral reactions. These reactions are self-damaging. J. Young et al. the behavior styles are divided into: a) obeying the early maladaptive scheme; b) avoiding the schema; and c) compensating for the schema.
STDF identifies addiction as the primary disorder, but also considers dysfunctional schema activation and maladaptive avoidance (avoidance of schema-activating people, situations, and moods) as factors that increase the risk of relapse in individuals with personality disorders. Within the framework of the model, addictive realization may arise as a direct consequence of the activation of various maladaptive schemes and personality traits.
STDF is carried out for 24 weeks, it is strictly individual in nature, concentrating on the establishment of the main early maladjustment schemes with subsequent therapeutic effects on them. Prevention of recurrences of returning to dysfunctional forms of behavior due to automatic switching to previous algorithms (dysfunctional schemes) is being carried out.
STDF is an integrated corrective intervention with a dual focus - on addictive realizations and on personality disorder. Patients activate introspection, the search for independent problem solving and skills to prevent the realization of addictive desires and exacerbations of symptoms of a personality disorder.
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Course work
"Personality disorders in modern psychotherapy"
Introduction
Conclusion
Introduction
Personality disorders are a rather interesting psychological phenomenon. Sometimes it is very important to know why it is difficult to get along with this or that person, why he himself cannot adapt to the world around him. It happens that we now and then meet people who at first glance seem absolutely normal, the same as everyone else, but upon closer examination it turns out that they are more suspicious, more touchy, more narcissistic than others. Usually, it is difficult to say about such people that they are sick, but it is sometimes very difficult to call them healthy. Therefore, the concept of "personality disorder" was introduced, so it is very important to understand what it is and how to deal with it.
According to foreign authors in 1999, approximately 5-10% of the world's population is characterized by personality disorders. And in fact, this is not so small: approximately 300-600 million people. Each of them experiences certain difficulties in adapting and can cause certain inconveniences to their environment, and thus the problem of spreading the negative consequences of a personality disorder can be enormous. In this regard, I believe that it is very important to have an idea of what personality disorders are, and to know what grounds exist for their diagnosis and methods of correction.
Thus, the tasks that I want to solve in this work are the following:
to consider general ideas about personality disorder: the origin of the concept, the causes of occurrence and interpretation;
consider a variety of personality disorders;
to get acquainted with the methods of diagnosing personality disorders and methods of their correction.
Chapter 1. Understanding Personality Disorders
1.1 The concept of personality. Norm and pathology
To understand what personality disorders are, to understand their symptoms and to characterize the pathology in general, you first need to familiarize yourself with the very concept of norm and personality.
What can be called a person as such? It is difficult to answer this question unambiguously, since there are many approaches to its understanding. In addition to psychology, philosophy and sociology were also interested in personality. Within the framework of these areas of scientific knowledge, it had its own specific meaning. Let's say that in philosophy a person is the totality of all social relations, and in sociology it is "a stable system of socially significant features that characterize an individual, a product of social development and the inclusion of an individual in a system of social relations through activity and communication." As a psychologist, I am interested in understanding the personality precisely in psychology, in which it also has many variations.
Within psychology itself, there are also a huge number of approaches to personality or so-called theories. Each of them interprets the personality in its own way, which is associated with a different understanding of its components and its relationships. For this work, it would be inappropriate to consider each of them in detail, and therefore, I want to give only one definition of personality, which, in my opinion, reflects the most important aspects for my work: "personality is those characteristics of a person that are responsible for agreed manifestations of his feelings, thinking and behavior.
The problem of norm and pathology in psychology has always been posed acutely. If in relation to other sciences, these concepts are more or less delimited, then in psychology there is no clear division. In our case, the concept of the norm "seems to hang in the air." It does not have its own, permanent position: the norm is either health, or conformity to the majority, or good adaptive ability, etc. The synthesis of these positions, unfortunately, also does not help to solve the problem. Often, the criterion of the norm is the optimal conditions for mental development, which also cannot be called indisputable, or a combination of other human norms (for example, biological or legal). In this regard, often, the norm of psychology is confused with the norms inherent in other sciences, other areas of human life.
Of course, in the problem of understanding the normal personality, the fact that different researchers bring different meanings to it also played a role. Some identify personality with an individual, others with character, others with social status, fourth with a generic essence, and fifth with a combination of different levels of human development. In addition, there are disagreements about when the personality appears: in the process of development or from birth. All this leads psychology to the fact that the final subject of study is not the personality as a holistic phenomenon, but its individual manifestations, individual signs, which already in themselves have their own position on the axis of norm and pathology.
It turns out that a person has his own relationships, his own characteristics. So, A.N. Leontiev wrote that "personality<…>is a special quality that acquiredindividual in society, in the totality of relations, social in nature, in which the individual gets involved.
In other words, personality is systemicand therefore " supersensible"quality, although the bearer of this quality is a completely sensual, bodily individual with all his innate and acquired properties.
From this point of view, the problem of personality forms a new psychological dimension: otherthan the dimension in which studies of certain mental processes, individual properties and states of a person are carried out; it is a study of his place, positionsin a system that is a system of public relations, communication,which are revealed to him; it is a study of what for whatand howa person uses what is innate to him and acquired by him (even temperamental traits and, of course, acquired knowledge, skills, skills. thinking) ".
It can be said that the norm and pathology of a personality depend on how this very personality, in the totality of its relationships, helps a person to join himself, to realize himself. And one speaks of the "abnormality" of a personality when a person's familiarity with himself, with his essence, is violated, confused or becomes rather complicated. But in addition to the relationship of the individual, the person to himself, the relationship of the person to others and with others is also central. It can even be said that it is these relationships that underlie the personality, and especially the basis for determining its norm and pathology.
It is necessary to remember about accentuations. For the first time this concept was introduced by K. Leonhard as an assessment of the relationship of a person with the world. Usually, accentuation is understood as pronounced, pointed personality traits. If we consider the position of accentuations on the "norm-pathology" continuum, then they will occupy a position on the border between opposites and characterize the extreme version of the norm. In its manifestation, personality disorders are very close to accentuations.
As noted above, in personality disorders, disorders are usually observed in different areas - conscious, intellectual, etc. With accentuations, a sharpening or weakening of the severity of one of the spheres can also be observed. Then it becomes unclear what distinguishes them. To eliminate questions about the separation of personality disorders from accentuations, Gannushkin and Kebriyanov introduce the following main characteristics of pathology: relative stability in time (accentuations can replace each other over time), totality of manifestation and social maladaptation. Only if these characteristics are observed can we speak of a personality disorder.
1.2 The concept of personality disorder. Ideas about personality disorders
As already mentioned, there are many views on the problem of personality. It follows that there is no single approach to the question of its pathology either. However, when speaking about personality, it is impossible to single out one or two clearly dominant concepts, then it is easier to do this with respect to personality disorders.
It is worth saying that the term "personality disorder" ("personality disorder ) is used only in a psychological way, although initially this pathology as such was introduced and described by psychiatrists as "psychopathy".
"Psychopathy is a persistent personality anomaly with disharmony of the emotional-volitional sphere and peculiar, predominantly affective, thinking." Psychopathies are characterized by the fact that they appear in childhood or adolescence and persist for life without undergoing significant changes; they "determine the entire mental appearance of the individual, imposing their imperious imprint on his entire mental structure." Psychopaths always stand out very sharply against the background of their environment, wherever they are: in the society of "normal", healthy people, in the society of the mentally ill. And all because psychopaths are on the border between sick and healthy individuals, and behave according to their position.
At first glance, in their manifestation, they are very close to accentuations (which is also evidenced by some classifications of psychopathy, dividing them into cycloid, schizoid, etc.), in connection with which psychiatrist P.B. Gannushkin singled out three main distinguishing features of psychopathy: the totality of manifestation, the relative persistence of characterological disorders and impaired adaptation. At the same time, the last sign should be emphasized, since in the event of a personality disorder, it is precisely the possibility of a healthy, adequate interaction with the environment and the ability to adapt to it that are violated in the first place.
However, not every psychopathy can now be called a personality disorder. Somewhere on the border of the 19th-20th centuries, the characterological violation was divided into two types: "psychopathy" as such and "psychopathic constitution". And it was the "psychopathic constitution" that was used to refer to people characterized by similar forms of personality disorder. And in 1997, this term was written out of the ICD-10 and replaced by "personality disorders". However, there was still an important difference between the understanding of these terms: while psychopathy was considered a congenital disorder, nothing was known about the origin of personality disorders.
So what is a personality disorder? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a personality disorder is a persistent pattern of an individual's inner experiences and behavior that deviates markedly from the expectations of the culture in which the individual lives, is rigid, widespread, and unchanging. over time, begin in adolescence or adolescence and lead to distress or impairment.
Basically, personality disorders are studied by cognitive psychology, but you can notice certain threads to its understanding in other directions. For example, humanistic psychologists saw the basis of personality in its interpersonal relationships. For them, a person acted as an active object, as "someone" defined, that is, as "the bearer of some standards, some rights and obligations." So the person always plays a role. And it is through its playing that the development of the human psyche occurs. On the basis of such reasoning, the "role theory" was built. Its representatives also believed that the role is not always real. It can also exist in the verbal plane, in the plane of imagination. That is, a person can imagine himself in a certain position in relation to the world, represent in himself qualities that are not inherent in the present. And already in this there is a certain connection with mental disorders. It often happens that a person, not being able to cope with a particular task and, as a result, with his role, imagines that in an imaginary plan he copes with this task, and all his further real actions will already depend on his imaginary role. which will gradually become real for him. True, in this case, a dissonance arises between reality and the role of a person, his sense of himself and his relationship with the world. It was in this that I saw a peculiar picture of personality disorders in humanistic psychologists - in the impossibility and / or unwillingness of a person to fulfill his true role, in replacing the true role with an imaginary one.
Psychoanalysis laid the foundation for the study of personality disorders by cognitivists. These were mainly the cases of Anna O. and the rat-man described by Freud. Initially, Freud, of course, did not diagnose these cases as personality disorders, but now, based on the diagnostic criteria described in the DSM, such disorders can be called such. It was in the DSM-I of 1952 that the basic description of personality disorders was given, which was later rewritten and supplemented in new versions of the Manual.
Initially, cognitive psychologists in their work focused on the ego psychology of Adler, Horney, Sullivan and Frankl. Their work was mainly aimed at introspective observation and changing the personality of the patient. Later, on the basis of this work, Beck and Ellis began to incorporate cognitive-behavioral techniques into their work with patients, constantly pointing out the effects of these techniques on both symptom structure and behavioral "patterns". That is, in this way, they pointed out that cognitive psychotherapy not only eliminates the external signs of personality disorders, but also affects the underlying causes of their occurrence.
It is the change in the underlying problems of the personality that is the main goal in the treatment of personality disorders, according to cognitivists. In their opinion, these problems are a relatively conscious phenomenon and, under certain conditions, can become even more accessible to a person. And if the theorists of a purely behavioral approach believed that the cause of personality disorders heals in a violation of motivation, then the cognitivists looked deeper: “The main premise of the cognitive model of psychotherapy is that the main source of dysfunctional emotions and behavior in adults is attribution errors, and not deviations in motivation. or reactions," wrote Beck and Freeman. Thus, Beck developed the concept of the "scheme" of personality disorders, in which the psychotherapist's activity is aimed at working precisely with schemas: at their isolation from behavior, evaluation and change.
At the moment, the cognitive-behavioral approach to personality disorders is dominant, but there are still few studies with a registered result.
1.3 Causes and mechanisms of personality disorders
Speaking about the causes and prerequisites for the development of mental disorders, it is important to remember that throughout the history of psychology, many hypotheses have been put forward. Some of them supported the idea that all mental disorders are exclusively biologically inherent characteristics, while others saw their cause in the development and upbringing of the individual. At the moment, most representatives of the scientific world adhere to the fact that both biological and social factors are of great importance in the development of mental disorders, including personality disorders.
Beck and Freeman in their book "Cognitive Psychotherapy of Personality Disorders" write that the probable causes of the development of personality disorders are peculiar hypertrophied and inappropriate forms of genetically embedded behavioral strategies for the life of a modern person. Such adaptive forms that are natural for humans, such as, for example, avoidance of danger, defensive behavior, are present in each of us. Under certain life circumstances, they are activated, but we can control their implementation. However, in personality disorders, such control is not possible.
When implementing a behavioral strategy, people with personality disorders experience certain disorders in the emotional and cognitive spheres. We all know perfectly well that each person is unique: that is, he has an initial set, a combination of psychological characteristics, traits. Depending on which of these characteristics dominates, it will depend on which accentuation or which type of personality disorder a person is most prone to. However, if everything was explained only by the initial predisposition, then each of us would have his own diagnosis. However, childhood plays an important role in our development. It is in the early period that the foundation is laid for the consolidation of maladaptive forms of behavior.
When a child is faced with a problematic situation, he automatically turns on the corresponding genetically embedded strategy of behavior. "A pattern can have an adaptive advantage only as long as its frequency of occurrence is below a certain critical threshold; hence it is called a frequency-dependent adaptive strategy." It follows from this that if a given situation tends to repeat, then there is a kind of exercise in using this strategy of behavior, and if this strategy is reinforced (for example, leads to the desired result), then over time it becomes natural and habitual for this individual, but while being maladaptive.
However, the human cognitive sphere plays an equally important role in the development of personality disorders. Every mental disorder carries with it certain dysfunctional beliefs (attitudes). They are not always unique, but they also form the basis for the development of personality disorders. Beck and Freeman identified a number of dysfunctional beliefs, each of which corresponds to a specific personality disorder and leads to the activation of a specific behavioral strategy. Below is a table containing these characteristics.
Table 1 - Core beliefs and strategies associated with traditional personality disorders
Personality DisorderBasic Beliefs/AttitudesStrategy (Observed Behavior)DependentI am helplessAttachmentAvoidI may be offendedAvoidancePassive-aggressiveMy interests may be offendedResistanceParanoidPeople are potential enemiesCautionNarcissisticI am specialDesire for greatnessHistrianI must impresshystericalObsessive-compulsiveMistakes are bad. I must not be mistakenPerfectionismAntisocialPeople need to be masteredAttackSchizoidI need lots of space
Among the disorders listed in the table, schizotypal and borderline disorders are absent. The reason for their absence is that in schizotypal disorder, the content of thoughts is not so much important as the features of their manifestation. And Beck and Freeman refer to cognitive impairment in relation to borderline disorder more as an "ego deficit" than as a specific belief content.
Such dysfunctional beliefs also arise from repeated repetition of relevant situations. With each repetition (or "exercise") there is an increase in belief: let's say "In this situation, I can not do anything, because I do not yet have sufficient skills" develops into "I am useless", or "I often do the right thing, so I am praised" develops into "I always do everything right. I'm special." Thus, over time, beliefs become pervasive and inflexible. They do not give a person a way to retreat - to rethink himself, to compare with reality. And this is an important note: people with a personality disorder, because of their dysfunctional beliefs, cannot test them with reality. For them, their thoughts and their behavior are applicable everywhere and always, in any situation.
As mentioned in the previous parts, personality disorder affects all areas of the human psyche. So the affective sphere - the sphere of emotions and feelings does not remain unchanged. With personality disorders, a so-called affective loop is formed: a person simply gets hung up on interpreting a situation in a certain way, which is expressed in his facial expressions and behavior. A relevant stimulus leads to the activation of a certain affective circuit, along with which all other circuits (cognitive, motivational, instrumental) are activated in a chain reaction. It is after this that the control system can be turned on. However, as I said, in people with a personality disorder, it is broken - so the final reaction will always correspond to a certain strategy.
Another level of violation of a person's personality is his self-esteem. Inadequately reinforced in childhood or intentionally and unnecessarily infringed, it can lead to the formation of certain beliefs in a person: from feeling and identifying oneself as the best and irreplaceable to identifying oneself as the most insignificant. Repeated suggestion to the child of his existing or non-existent qualities will lead to the formation of certain beliefs in him, which in the future may be embodied in personality disorders. The rules of behavior instilled in us since childhood work in a similar way: for example, increased control (giving hypertrophied meaning to the words “no”, “should”) can lead to the formation of obsessive-compulsive disorder.
Yes, indeed, childhood is very important for the development of personality disorders. So, for example, Kraepelin calls the cause of such a violation a kind of mental retardation, and the manifestation of certain characteristics, features of these disorders - "partial partial infantilisms (mainly of will and feelings)" . However, in addition to this, psychiatrists no longer distinguish any conditions for the formation of personality disorders and are themselves confused in the problem of their isolation.
Thus, personality disorders go sequentially, affecting all its components, all its structures, while childhood is of great importance for the development of the disease.
If we talk about the causes as such, then the American Psychological Association (American Psychological Associated) identifies the following causes of the onset and development of personality disorders:
.genetic factor. Some American researchers are investigating the genetic predisposition of an individual to develop personality disorders. So, let's say one team has isolated a gene that may be a factor in obsessive-compulsive disorder; and other researchers are studying the relationship between aggression, anxiety, and fear, traits that may be related to the onset of personality disorders.
2.Childhood trauma. Longitudinal studies of personality disorders were conducted, based on one of which, a relationship was revealed between the type of childhood trauma, its frequency and the development of personality disorders. So, for example, people with borderline personality disorder had a fairly high level of sexual trauma in childhood.
.Verbal abuse. Studies were conducted on 793 mothers and their children, on the basis of which it was found that even verbal abuse, threats matter. Mothers were asked to tell them when they yelled at their children that they didn't love them or that they would get rid of them. Further research revealed that these children were closer to developing future personality disorders such as obsessive-compulsive disorder, borderline, narcissistic, or paranoid disorder.
.High reactivity. Sensitivity to light, noise, texture, and other stimuli may also play a role. Overly sensitive children who are highly reactive are more likely to develop personality traits such as shyness, timidity, or anxiety. However, these studies do not give an unequivocal answer to the question of the occurrence of personality disorders.
.Relationships with others.
Thus, it can be said that personality disorders are formed under the influence of many factors and have a very complex mechanism of relationships between the cognitive, affective, conscious and other spheres of the human personality.
1.4 Classifications of personality disorders. Symptoms
There are several classifications of personality disorders. This is explained by the position that the author takes in relation to them, and by the scientific direction he is used to working with.
The most common are the classifications given in international collections of diseases and disorders: in the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, in addition to them, there are other classifications. So, psychiatrist B.V. Shostakovich analyzed different approaches to personality disorders (psychopathies) by different researchers. For clarity, he presented the disorders in the form of tables, also dividing them into groups in accordance with the clusters (sections) DSM-IV. In accordance with his observations, it can be said that Krepeleny in 1904 identified such disorders as: eccentrics, grumpy, querulants (corresponding to cluster A), excitable, science fiction, liars and swindlers (corresponding to cluster B), and unstable (corresponding to cluster C ). Kretschmer, on the other hand, distinguished three types: schizoids (corresponding to cluster A), epileptoids and cycloids (corresponding to cluster B). Gunnushkin in 1933 identified the following types: schizoids (dreamers), fanatics, paranoids (corresponding to cluster A), epileptoids, cycloids, constitutionally depressive, emotively labile, hysterical and pathological liars (corresponding to cluster B) and just like at Krepelen, - unstable (corresponds to cluster C). Also, the unstable type belongs to the latter group in Popov and Kerbikov.
If we recall the course of psychology, it becomes clear that the main reason for the allocation of psychopathy in domestic psychiatry was organic genesis. Perhaps this will be the main difference between domestic classifications and foreign ones. So, in American psychotherapists, as mentioned earlier, the main cause of personality disorders is a person’s childhood: the conditions of his upbringing and violations of relations with his family and environment. Consequently, this appears in the DSM as the main reason for the division. Thus, for DSM, the social factor, the factor of adaptation, becomes the key to creating a classification.
The Personality Disorders section of the DSM-IV-TR includes three large clusters. They are distinguished on the basis of the similarity of the main characterological features of personality disorders and the ways in which the individual responds to external influences. Each cluster includes a specific set of personality disorders. In the International Classification of Diseases 1999 (ICD-10), personality disorders have a slightly different organization, in my opinion, more confusing and unclear. Here, personality disorders themselves are classified in the large group F6 "Disorders of personality and behavior in adulthood." The differences between these two classifications are very large - even the names, absence or presence of the disease differ.
I will be looking at personality disorders in terms of the DSM-IV-TR organization. As already mentioned, this section includes three clusters: "A", "B", "C". Cluster "A" includes paranoid, schizoid and schizotypal disorders. Already here one of the cardinal differences between DSM-IV-TR and ICD-10 is found: if in the ICD schizotypal disorder is still closely intertwined with schizophrenia and is included in the same group with it (“Schizotypal, schizotypal and delusional disorders”), then in DSM, it has already been separated from it and moved to the section of personality disorders.
Cluster "B" includes antisocial, borderline, hystreonic, and narcissistic personality disorders. There are also a number of differences here. So, for example, the distinguished antisocial disorder in the ICD-10 has its counterpart, presented as "dissocial personalities" (F60.2), and borderline personality disorder is described as a subgroup of emotionally unstable personality disorders (F60.3).
Cluster "C" includes avoidant, dependent and obsessive-compulsive personality disorder, as well as non-specific personality disorders. In the ICD-10 you can find a description similar to them. Thus, obsessive-compulsive disorder is presented in ICD-10 as an anancaste disorder (F60.5), and avoidant is presented as "anxious (avoidant) personalities" (F60.6), and only dependent personality disorder has the same name. The remaining "non-specific personality disorders" in the American classification include passive-aggressive personality disorder, depressive and sadistic disorders. The description of passive-aggressive personality disorder is extremely similar to adolescent reactions of opposition, however, in adults, these manifestations may already mean a disorder that is diagnosed in ICD-10 as mixed personality disorder (F61.0).
Thus, since there are many criteria for defining personality disorders, there are many classifications of them. However, I consider the DSM-IV-TR classification to be the most complete and accurate, therefore, in the future, when describing disorders, I will use it.
1.4.1 Paranoid personality disorder
An essential feature of paranoid personality disorder is extreme suspicion and distrust of others. These signs appear in early adulthood and appear in almost all situations.
People with this personality disorder believe that others are going to exploit them, harm them, threaten them, etc., even if there is no reason for such suspicions. They always expect to be shunned, think that others are conspiring or against them. They often think that they have been deeply and irreversibly hurt by another or others, for no reason at all. They tend to constantly test their friends and comrades for loyalty and reliability. At the same time, any deviation from the characteristics of fidelity they expect reinforces distrust of others.
Such people avoid making close contacts or trusting anyone, as they believe that the information they provide will be used against them. They may refuse to answer personal questions, stating "it's nobody's business". In various events, they see a humiliating hidden meaning. So, for example, they may regard someone's accidental mistake as a deliberate humiliation, and a harmless joke as a deliberate serious insult. They do not know how to correctly interpret compliments (for example, they perceive a compliment in honor of a new acquisition as criticism addressed to them). They never accept offers of help as they see it as a criticism of their work.
People with this disorder never forgive hurts or insults they think they have received. Any small grievances cause them a feeling of hostility, which often lasts a very long time. They carefully monitor the malevolent intentions of other people, and very often feel that they have been "attacked" by them after all. They react quickly to perceived insults, and sometimes even react with anger in advance. Such people are often overly jealous, suspect their spouse or partner of infidelity, collect direct and indirect evidence of infidelity. They prefer to completely control their intimate relationships, they prefer to constantly know where their partner is with whom and why.
As a rule, people with paranoid personality disorder have trouble establishing close relationships. Their excessive suspicion now and then can be expressed in open complaints, constant arguments, or quiet but visible aloofness. Since they are too vigilant, their strategies of behavior can be quite diverse: from cunning and attack, to feigned coldness. While they can sometimes be sensible, reserved, and unemotional, more often than not, they show a wide range of negative emotions: hostility, stubbornness, and sarcasm. And of course, such behavior can alienate others from them or even turn others against them.
Since people with paranoid personality disorder lack trust in others, they have a high need for self-sufficiency and autonomy, and they also need a high degree of control over others. In this connection, they are often tough, overly critical of others and unable to cooperate, while they themselves can not stand to hear criticism addressed to them. They tend to blame others for their own shortcomings and mistakes. Due to their "explosive nature", they often argue with people and get involved in legal fights. They try to prove the maliciousness of the actions of others by attributing to them motives corresponding to their fears. They may exhibit often hidden, unrealistic grandiose fantasies associated with power and authority, and tend to develop stereotypes about people who are different from them or people from other places of residence. Such people do not like simplified schemes of the world, constantly looking for details. They tend to become fanatics and join cults, groups of people who share their interests.
People with paranoid personality disorder may have brief flare-ups of mental reactions to stress (minutes to hours). In some cases, this disorder may remind the psychotherapist of the stage preceding schizophrenia. Often these people tend to develop depression, agoraphobia and obsessive-compulsive disorder. Also, such people are most prone to taking psychoactive drugs and alcohol.
Studies have shown that a large number of people with paranoid personality disorder had parents with schizophrenia or had close family relationships with people with persecutory delusional disorder as children.
Summing up, what are the main features of paranoid personality disorder can be identified?
A. Beginning in early adulthood and manifesting in most situations, a deep and unreasonable tendency to interpret people's actions as intentionally humiliating or threatening, as indicated by four (or more) of the following:
) displaying unreasonable expectations that others will exploit or harm him;
) unjustified doubts about the loyalty or reliability of friends or partners;
) the patient does not trust others, because he believes that the information he says will be used to his detriment;
) detection of hidden derogatory or threatening meaning in neutral remarks or ordinary, everyday events;
) long experiences a feeling of resentment and does not forgive insults or disrespect;
) is sensitive to disrespect and reacts quickly with anger or counterattack;
) unnecessarily calls into question the loyalty of a spouse or external partner.
B. The presence of these symptoms not only in the course of schizophrenia, other mood disorders, and not only as a manifestation of the physiological characteristics of the general state of health.
1.4.2 Schizoid personality disorder
An essential feature of schizoid personality disorder is an overarching pattern of detachment and a limited range of expressed and experienced emotions. This pattern appears in early adulthood and appears in many contexts.
Individuals with a personality disorder appear to have no desire for intimacy, seem indifferent to having closer relationships, and do not seem to enjoy relationships with family or social groups much. They prefer to spend time on their own rather than with others. Often such people are socially maladapted, "loners", and choose a type of activity that does not require interaction with others. They prefer to work with mechanisms or solve abstract problems, such as: a computer or mathematics; very little interest in sexual relations with other people, but may enjoy a few sexual experiences, if any. Typically, these people are desensitized to sensory, bodily sensitivity, and interpersonal relationships, such as walking on the beach at sunset or having sex. Such people, as a rule, have no close friends, except perhaps the closest relatives themselves.
People with schizoid personality disorder often seem indifferent to the criticism of others, it seems that they absolutely do not care who and what might think about them. They may be oblivious to the finer points of normal social interaction and often react inappropriately to any contact, so that they often appear socially inept or aloof and self-absorbed. Their reaction is usually "mild", without excessive emotional gestures and facial expressions. They claim that they rarely experience any strong emotions such as anger or joy. They often show reduced emotionality and appear cold and indifferent. If they find themselves in an environment that is unusual for them, in which, although being in comfortable conditions, they need to interact with people, they say that they experience painful sensations.
People with schizoid personality disorder have difficulty expressing anger even in response to direct provocations, which are caused by their lack of emotion. Their life often seems to them aimless. Such people react passively to important circumstances and events in their lives. Due to their lack of social skills, they often have few friends, rarely meet anyone and marry. The professional activities of such people can be disrupted, especially if interpersonal interaction is required, but in conditions of social isolation they can do their job very well.
Despite the fact that schizoid personality disorder is extremely rare, its prevalence may increase due to an increase in potential families of people with schizophrenia and schizotypal personality disorder.
The main features of schizoid personality disorder:
A. A pervasive pattern of indifference to social relationships and a limited range of expressed and experienced emotions, beginning in early adulthood and existing in different contexts, as indicated by four (or more) of the following:
- the patient does not want to enter into close relationships (including relationships within the family) and does not enjoy them;
) almost always prefers to act alone;
) has little (or no) desire to have sexual contact with other people;
) rarely enjoys certain activities (if any);
) has no close friends or comrades (or only one), apart from immediate family;
) is indifferent to the praise and criticism of others;
) is affectively limited, such as keeping aloof, cold, rarely responding with gestures or facial expressions, such as a smile or nod.
B. The presence of these symptoms not only in the acute period of schizophrenia or delusional disorder, or other disorder of the psycho-emotional sphere, but also is not associated with widespread developmental disorders and manifestations of the general state of human health.
1.4.3 Schizotypal personality disorder
An essential feature of the manifestation of schizotypal personality disorder is a total pattern of lack of interpersonal relationships, characterized by discomfort, a decrease in the ability to establish close relationships, and also manifested in distorted cognitive processes and behavior. This pattern appears at an early age and is present in almost all contexts.
People with schizotypal personality disorder have pervasive ideas (that is, they misinterpret an incident or situation as being special and tailor-made for the sufferer). These beliefs must be distinguished from the beliefs that are seen in delusional disorders. Such individuals can often be fascinated by the paranormal or things that are outside of their subculture. Often they think they have special powers, can read other people's minds or predict events. They may believe that they have direct magical control over the behavior of others that can be exercised directly (for example, they may say that the spouse went to walk the dog because he was ordered to); or they are subject to indirect magic, so they perform various rituals (for example, they pass by some object three times to avoid bad consequences). They may have perceptual changes (for example, feel the presence of another person, hear his voice). Their speech can be quite unusual - meet strange words or be strangely constructed. It is often lost, evasive, or blurry, but without much actual distortion or inconsistency. Their responses can be either too abstract or too specific, and words can often be used in unusual ways.
People with this disorder are often suspicious and paranoid. They are often described as eccentric because of their unkempt way of dressing, speaking and behaving.
People with schizotypal personality disorder have difficulty establishing interpersonal kinship and find it difficult to form bonds with other people. Although they may express dissatisfaction with their lack of relationships, they nevertheless feel little desire to participate in establishing intimate contacts, and as a result, they usually do not have any close people other than close relatives. Such people tend to social situations, especially where there are new people. If required, they will interact with other people, but will always feel that they do not fit the environment. As a rule, when interacting with others, their social anxiety does not decrease, but on the contrary, it can increase, they may become even more suspicious of the motives of other people.
Individuals with schizotypal personality disorder are more likely to seek help only with symptoms of anxiety and depression. This disorder is most common in schizophrenia and in parents with schizotypal personality disorder.
Main criteria:
A. A pervasive pattern of lack of interpersonal connections and bizarre thoughts, appearance, and behavior from early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
) ideas of relation (excluding delusions of relation);
) strange beliefs or thoughts about the supernatural that affect behavior and are inconsistent with the norms of this culture;
) unusual perceptual experiences, such as illusions;
) strange speech (without weakening associations or incoherence), for example, poor, off-topic, unclear or too abstract;
a) suspicion or paranoid ideas;
) inadequacy or limitation of emotions;
) strange or eccentric behavior or appearance, such as untidiness, unusual mannerisms, talking to oneself;
) no close friends or comrades (or only one), not counting the next of kin;
) excessive social anxiety, such as extreme discomfort in social situations involving strangers.
B. The presence of these symptoms not only in the acute period of schizophrenia, another mental disorder, or in the case of a gross developmental disorder.
1.4.4 Antisocial personality disorder
An essential feature of antisocial personality disorder is a pervasive pattern of neglect or violation of the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern is also defined as psychopathy, sociopathy, or antisocial personality disorder. The central features of this disorder will be manipulation and deceit.
In order to be diagnosed with antisocial personality disorder, the patient must have reached the age of eighteen, and the characteristic signs must have been manifested since at least 15 years. This conduct disorder involves persistent, repetitive behaviors that violate the rights of others. Features of such behavior can be classified into one of four groups: aggression towards people or animals, destruction of property, deceit or theft, or other serious violations of the law.
A similar pattern of behavior is observed in adulthood. People with antisocial personality disorder do not conform to social norms for legitimate behavior. They tend to repeatedly commit acts sufficient to warrant arrest, such as destroying property, harassing others, stealing, or continuing illegal activities. They ignore the desires and feelings of others. They often lie and manipulate others for personal gain (such as money, sex, or power). They can constantly lie, use other people's names or other people, feign illness. Their impulsiveness can manifest itself in the inability to plan for the future. Such people make decisions spontaneously, under the influence of the moment, without taking into account the consequences for themselves and others, which can lead to a quick and sudden change of place of residence and relationships. Individuals with antisocial personality disorder tend to be irritable and aggressive, and may repeatedly get into fights or commit acts of physical violence (beating a spouse or child). In this case, these actions should be distinguished from self-defense. In addition, such people show a complete disregard for their own safety and the safety of others. This may be evidenced by their driving (periodic speeding, driving under the influence of alcohol, several accidents). They may engage in sexual assault, drunken brawls; they can also leave the child alone or send one on a trip.
People with antisocial behavior tend to be persistently and extremely irresponsible. They may refuse to work and at the same time not build real plans for the future. They may not show up at work without explaining it with their own or family problems. Often they find themselves in debt and lose parental or guardian rights. Such persons do not show much remorse for their actions. They may be indifferent to other people's problems and tend to rationalize their illegal actions. They can accuse their victims of being too gullible, defenseless, helpless, say that they deserve such a fate, or show complete indifference to them. As a rule, such people are not able to compensate or correct the consequences of their actions, and they will do everything possible to avoid punishment.
The main distinguishing features of antisocial personality disorder:
A. A pervasive pattern of neglect or violation of the rights of others beginning at age 15 and meeting three (or more) of the following criteria:
) non-compliance with the norms of the law, as evidenced by constant arrests;
) deceiving others, lying, using pseudonyms or other people for the purpose of obtaining benefits or pleasure;
a) impulsiveness and inability to plan for the future;
) irritability and aggressiveness, manifested in constant fights and attacks;
) complete disregard for one's own and other people's safety;
) manifestation of complete irresponsibility (failure to fulfill official and financial obligations);
) lack of remorse, a tendency to rationalize their actions.
B. Manifest until at least 18 years of age.
B. To be distinguished from conduct disorders, which also begin at age 15.
D. Manifestation of symptoms not only during the period of schizophrenia or affect.
1.4.5 Borderline personality disorder
The hallmark of borderline disorder is a pervasive pattern of instability in interpersonal relationships, emotions, and self-image that manifests itself in early adulthood and is present in a variety of contexts.
Individuals with borderline personality disorder make great efforts to avoid real or imagined rejection. They are very sensitive to environmental conditions. They experience a strong fear of rejection and get angry inappropriately, even when their expectations are dragged out in time. If they are denied, then they believe that they are "bad". Such a fear of rejection causes an unwillingness to be alone, and the patient begins to believe that he must be with other people. To avoid rejection, they may exhibit impulsive actions such as self-harm or suicidal behavior.
People with borderline personality disorder tend to have unstable and violent relationships. For example, they may idealize parents or partners on the first and second dates, spend a lot of time with a partner, put a lot of effort into establishing intimate relationships. However, they can quickly switch from idealizing other people to devaluing them when they begin to feel that the other person doesn't care enough for them, doesn't love them enough, and isn't "enough" at all. Such people are ready to worry and protect another person, cherish him, but only if in return this person will always be there and ready to fulfill their slightest demand. Such people are prone to a quick and sudden change in views on other people. Often this is due to the sudden disappearance from their lives of someone whose departure was not expected.
This personality disorder can also be characterized by extremely unstable self-esteem or sense of self. Self-esteem can change dramatically under the influence of a change in goals, motives or professional aspirations. There may also be sudden changes in views about one's career, one's gender identity, one's friends or relatives. Some of these people may even begin to feel that they do not exist at all. Such experiences usually arise when a person ceases to feel support and care, when he feels the loss of any significant relationship for him.
Individuals with this disorder show impulsivity in at least two areas that are destructive to them. They are prone to gambling, wasting time irresponsibly, using alcohol or drugs, as well as unsafe sex and reckless driving. Such people tend to constantly express intentions to harm themselves, commit suicide, but only 8-10% of those who intend to commit suicide commit suicide. Typically, these actions occur at the peak of impulsivity, when these people are very angry or experienced the loss of someone important.
People with borderline personality disorder may show emotional instability due to high mood reactivity (eg, intense episodic emotional outbursts that can last up to hours or sometimes days). If dysphoria occurs, it is mainly characterized by increased levels of anger, panic of despair, and is rarely accompanied by periods of well-being and contentment.
People with borderline personality disorder can often feel empty. They are often bored and may be constantly looking for something to do. Oftentimes, such people often have trouble controlling their anger and display it in inappropriate situations. They may show outbursts of anger and anger, especially when their loved one does not show them the attention and care they deserve. Such emotional outbursts often make them feel guilty, which makes them more convinced that they are "evil". In moments of extreme tension, such people may experience transient paranoid ideas and dissociative symptoms (such as depersonalization), but they are usually not too long or too severe. Such reactions usually appear in response to some real or imagined event, and often last up to several minutes.
Main diagnostic criteria:
A. An overall pattern of instability in interpersonal relationships, emotions, and self-esteem, which manifests itself in early adulthood and is present in various contexts, and which is characterized by five (or more) of the following criteria:
) desperate attempts to avoid real or perceived rejection or rejection (excluding suicidal or self-harmful behavior described in paragraph 5);
) a pattern of unstable and intense interpersonal relationships, characterized by the alternation of extreme forms of excessive idealization and devaluation;
) violations of self-identification: loss of self-image and self-awareness;
a) impulsiveness in at least two areas that are potentially self-destructive, eg spending money, sex, substance use (excluding suicide or self-harm mentioned in paragraph 5);
a) repeated suicide threats, suicide attempts or suicidal behavior or self-harm;
) emotional instability: pronounced mood swings from normal to depression, irritability or anxiety, usually lasting several hours and only occasionally more than a few days;
a) chronic feelings of emptiness and boredom;
- inadequate, intense anger or lack of control over anger, for example, frequent manifestations of irascibility, constant anger, repeated fights;
) the presence of transitional stages of tension, characterized by paranoid ideas or dissociative symptoms.
1.4.6 Histrionic personality disorder
An essential feature of histrionic personality disorder is an overall pattern of excessive emotionality and the desire to attract attention to oneself. It develops at the beginning of maturity and is present in all contexts.
People with histrionic personality disorder feel awkward or uncomfortable when they are not the center of attention. As a rule, in order to attract attention, they behave lively and dramatic, their enthusiasm, seeming openness and coquetry can initially charm new acquaintances. However, by such behavior they are just trying to attract attention to themselves. They assign themselves the role of "party stars". if they are not paid attention, then they tend to do something dramatic (make up stories about themselves, create scenes). They need frequent visits to the doctor and embellish their symptoms.
The appearance and behavior of people with histrionic personality disorder is often rated as sexually provocative and seductive. At the same time, such behavior is directed not only at people with whom this individual has sexual or romantic relationships, but also manifests itself in various other situations (for example, in the professional sphere). Emotional expression in such people may be weak and rapidly changing. People with this disorder constantly use their appearance to get attention. They are too concerned about the impression they make on others, and they spend too much time and money on clothes and personal care. They may constantly "beg for compliments" and are easily offended if someone tells them that they do not look good in reality or in a photograph.
The speech of such people is overly impressionistic and vague. They express their opinions dramatically and vividly, but the main reasons for this opinion remain rather vague and unsupported by facts. For example, a person with histrionic personality disorder may say that a certain person is a wonderful person, but be unable to provide any specific examples of good qualities to support this opinion. people with this disorder are characterized by excessive theatricality, drama and exaggerated expression of emotions. They may embarrass friends and acquaintances by over-exhibiting their emotions and attitudes in public. However, their emotions come and go very quickly and are not remembered for long.
People with histrionic personality disorder have a high degree of suggestibility. Their thoughts and feelings easily change under the influence of external factors and the influence of other people. They can be trusting and especially trust those people who once solved some of their problems. They make their decisions quickly, based on hunches and beliefs. They tend to evaluate relationships with other people as closer than they really are, based only on some views and concurring opinions.
The main distinguishing features of histion personality disorder:
A. A pervasive pattern of over-emotionality and attention-seeking that occurs in early adulthood and exists in a variety of contexts, as indicated by four (or more) of the following:
) feels uncomfortable when not the center of attention;
) in relation to others inadequately demonstrates sexual behavior;
) detects rapid change and superficiality of emotions;
) constantly uses appearance to draw attention to himself;
) speech is excessively impressionistic and not rich in details;
) expresses emotions inappropriately exaggerated and theatrical;
) is easily suggestible, i.e. easily changes under the influence of circumstances or other people;
) perceives the relationship as closer than it really is.
1.4.7 Narcissistic personality disorder
The hallmark of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that develops in early adulthood and manifests itself in a variety of contexts.
Individuals with this disorder have a grandiose sense of self-importance. They often overestimate their abilities and inflate their achievements to unimaginable proportions, often boasting. They may often blithely believe they deserve a lot without putting in the effort, and are often surprised if they don't get what they "deserved". Often, in solving their problems, they do not take into account the contribution of other people. They often fantasize about permanent success, power, beauty, wealth, or ideal love. They may reflect on "long overdue" privileges for them and compare themselves to famous or popular people.
Individuals with narcissistic personality disorder believe that they are superior to others, more professional and expect others to admit it too. They feel that they can only be understood by those who are of high status, respected and famous enough, who "are just like them". People with this disorder believe that their abilities are specific and beyond the understanding of ordinary people. Their own self-esteem rises (or rather, "mirrored") depending on who they appear to those with whom they communicate.
People with this personality disorder demand excessive admiration. Their self-esteem is very fragile. They may be concerned about how well they do a given task and how they are being evaluated. This can often take the form of a need for constant attention and admiration. They can expect to be pompously received on arrival, and are very surprised when people do not sacrifice their interests for them. They can constantly ask for compliments, often with a special charm. They think they have special rights, unreasonably expect to be treated well. They expect to be served and don't understand or get angry when they don't. They may feel they shouldn't stand in line and feel that other people's business is not as important as their own, so they don't understand when others can't put their business aside for them. This sense of privilege, combined with a lack of sensitivity to the wants and needs of others, can lead to their knowing or unwitting exploitation. They may think that they will still get what they want or need, no matter what the consequences may be for others. Romantic relationships or friendships seem to occur only when the other person can help them achieve their goals or help them raise their self-esteem.
People with narcissistic personality disorder typically lack empathy and have difficulty acknowledging the feelings, experiences, and needs of others. They may feel that others are completely concerned about their welfare. They tend to put a lot of emphasis on their problems, failing to acknowledge that others have them too. They are often contemptuous and impatient with those who talk about their problems and concerns. They may not pay attention to the fact that their words can hurt someone. And they consider other people's complaints as a sign of weakness. People with narcissistic personality disorder often show emotional coldness and a lack of shared interests with others.
These people are often jealous of others and believe that others are jealous of them. They may feel they are more deserving of the privileges of others. Such people can be characterized by arrogant, arrogant behavior. Such people often show snobbery and contempt.
The main criteria that characterize narcissistic personality disorder:
A. An overall pattern of grandiosity, need for admiration, and lack of empathy that develops in early adulthood and manifests itself in a variety of contexts and is reflected in five (or more) characteristics:
) has an inflated sense of self-importance (for example, exaggerates achievements and talents, expects "special" treatment without corresponding achievements);
) is preoccupied with fantasies of unlimited success, power, splendor, beauty, or ideal love;
) believes that he and his problems are unique and can only be understood by certain people;
) requires constant attention and admiration for him;
) feels he has special rights;
) inclined to use others to achieve their own goals;
) lack of empathy: inability to understand and experience the feelings of others;
) is often envious of others and believes that others envy him;
) in behavior and relationships demonstrates arrogance and arrogance .
1.4.8 Avoidant personality disorder
Avoidant personality disorder is characterized by a pervasive pattern of social discomfort, feelings of inferiority, and heightened sensitivity to negative evaluation that manifests itself in early adulthood and in virtually all contexts.
Individuals with this disorder avoid work, school, and other interpersonal activities because they fear criticism, disapproval, or rejection. They may refuse additional work or a promotion because they are afraid of criticism from colleagues. Such people avoid making new friends if they are not sure that they will be loved and not subject to criticism. It is very difficult for them to establish close relationships, and then only when they are sure of their uncritical acceptance. They may be reserved, have difficulty talking about themselves, and hide their feelings for fear of being ridiculed or embarrassed.
Because these people are concerned about being criticized or rejected, they may have a low threshold for defensiveness. They may feel intense pain, even if someone treats them only slightly disapprovingly or critically. They tend to be shy, quiet, depressed, inconspicuous out of fear that any attention to them might humiliate them. They believe that no matter what they say, others may judge it as wrong, so they sometimes prefer to remain silent. They subtly feel and react to ambiguous signals that can make fun of them. Despite the fact that they want to participate in public life, they are still afraid. People with avoidant personality disorder feel inadequate and often have low self-esteem. In contacts with strangers, their uncertainty and tightness are manifested to a greater extent. Such people often see themselves as socially inept, personally unattractive, and inferior to others. They usually do not want to engage in risky or new activities, as they may show others their awkwardness. They tend to exaggerate the potential dangers of ordinary situations, and lead boring, reclusive lives in order to be sure of their own safety. Such people may even cancel the interview for fear of being embarrassed at the wrong time.
The main diagnostic criteria for avoidant personality disorder are:
A. A pervasive pattern of social discomfort, feelings of inferiority, and hypersensitivity to negative evaluation that manifests itself in early adulthood and in virtually all contexts, and is characterized by four (or more) criteria:
a) avoids social or professional activities that involve significant interpersonal contact due to concerns of criticism, judgment or rejection;
) does not want to get along with people if he is not sure that he is loved;
) is reserved in close relationships for fear of being ridiculed;
) is concerned that he may be subject to criticism or rejection in socially significant situations;
) restrains himself in new interpersonal situations due to feelings of inferiority;
) evaluates himself as socially inept, personally unattractive and generally worse than others;
) exaggerates potential difficulties, physical dangers or risks in some ordinary, but unusual business for him.
1.4.9 Dependent personality disorder
A characteristic feature of addictive disorder is a pervasive pattern of need for care, which leads to submissiveness and fear of separation. This pattern begins to emerge in early adulthood and in almost all contexts. Dependence and submissiveness stem from a person's self-esteem, so that he ceases to be able to exist without others.
Because people with dependent personality disorder fear losing the favor of those they care about, they often have difficulty expressing their dissatisfaction. They are more likely to agree and accept things that they think are wrong than to enter into a situation that can lead to the loss of guardianship by others over them. They cannot properly be angry with those whose support and care is important to them, for fear of being repulsed. However, one must distinguish between such fears and fears based on real observations.
People with dependent personality disorder find it difficult to start acting on their own. They are insecure and believe that they need help to start and finish something. They will wait for others to start because they believe that others tend to do better than they do. Such people are convinced that they do not know how to act on their own, and therefore they constantly need help. However, they can continue to perform well if they know that someone controls and manages them. They rely on others to get things done and often don't learn independent living skills to stay addicted.
Such people can make efforts to organize guardianship over them, looking for volunteers who will manage and take care of them. For this, they are even ready to provide what is needed, even if this is not true. Because of their need to stay connected, they may commit acts such as self-sacrifice, or they may voluntarily be subjected to verbal, physical, or sexual abuse. Such people feel uncomfortable and helpless when they are alone, because they have a great enough fear that they cannot take care of themselves. They will follow on the heels of any significant people, just for the sake of not being alone, even if they are not interested in relationships with these people.
If habitual close relationships end (for example, the death of a parent), then people with dependent personality disorder urgently begin to look for a person who will take care of them. Their belief that they cannot exist without close relationships encourages them to quickly and indiscriminately find a new face for themselves to depend on. People with this disorder often fear that they will have to take care of themselves. They consider themselves so dependent on another important person that they are very afraid of being left by him, even if there is no reason for it.
So, the main diagnostic criteria for dependent personality disorder:
A. A pervasive pattern of need for care, leading to resignation and separation anxiety, occurring in early adulthood and manifesting itself in a variety of contexts, as indicated by five (or more) of the following:
) is unable to make day-to-day decisions without much advice or support from others;
) allows others to take responsibility for most important decisions in life;
) because of fear of rejection, agrees with people, even when he believes that they are wrong;
) experiences difficulties with the beginning of the implementation of their intentions or independent actions;
) willingly does unpleasant or humiliating things to please other people;
) feels uncomfortable or helpless when alone, or goes to great lengths to avoid being alone;
) feels empty or helpless when close relationships end;
) is often preoccupied with the fear that he will be abandoned and he will have to take care of himself.
1.4.10 Obsessive Compulsive Personality Disorder
An essential feature of obsessive-compulsive personality disorder is a total pattern of preoccupation with orderliness, perfectionism, the desire for interpersonal control at the expense of openness and emotionality. This pattern appears in early adulthood and is present in a variety of contexts.
People with obsessive-compulsive personality disorder tend to maintain a sense of control, even in the face of pain, paying great attention to rules, small details, procedures, lists, tables, and forms of activity. They are hyper-cautious and prone to constant repetition of actions, checking already committed for errors and inaccuracies. They do not pay attention to the fact that other people may get annoyed with their behavior. For example, such people, if they lose the list of what they have to do, will not waste time restoring their affairs from memory, but will search for the lost list for a long time and painstakingly. They do not manage their time well, leaving the most important tasks to the last moment. Since they pay so much attention to detail, testing each one for "perfection", they may not be able to finish the job as a whole. For example, they can continually rewrite the report, bringing it to "perfection", but at the same time absolutely not keeping up with the deadlines.
People with obsessive-compulsive personality disorder place excessive emphasis on work and productivity at the expense of leisure and friendships. But their behavior is not due to production necessity. They often feel like they just don't have time to just go for a walk or relax. They may put off activities that they enjoy, such as recreation, for so long that they may not come to fruition at all. When they are given a lot of time for leisure or recreation, they may feel very uncomfortable if they do not engage in work so as not to "waste time". They also pay great attention to household chores (for example, they wipe the floor "to the holes"). If they are spending time with friends, then they are likely to choose one of the organized activities (such as sports). They approach their hobby or any entertainment event with special care, high organization and work hard. In all tasks they put emphasis on "perfection".
People with obsessive-compulsive personality disorder may be overly conscientious, scrupulous, and inflexible in matters of morality and ethics. They may force others to follow rigid moral or performance principles. They can also be ruthlessly self-critical. People with this disorder respect authority and the law, so they believe that the rules must be followed unambiguously, regardless of the circumstances.
People with this disorder may not be able to give up shabby and unnecessary things, even if they have no emotional significance. Such people tend to collect. They feel that throwing away items is wasteful and "you never know what you might need" so they get very upset if someone throws away their stuff.
People with obsessive-compulsive disorder do not like to delegate their work to others. They stubbornly insist that they will do everything themselves and in their own way, and no one will be able to do their job the way it should. They always give very detailed instructions on how to do something, and are extremely annoyed when they are offered an alternative. It happens that they may even turn down offers of help when they are behind schedule, so they still believe that no one can do their job better.
People with this disorder may be unnecessarily stingy, believing that expenses should be well controlled to ensure a normal life in case of disasters. Such people are characterized by cruelty and stubbornness. They worry so much that all their activities can be built according to one pattern that they do not accept other people's ideas and do not consult anyone. Absorbed by their opinion, they do not notice the criticism of others, and even in case of failure, they still act in a “programmed” way, explaining this as a “matter of principle”.
Thus, the following criteria for obsessive-compulsive personality disorder can be distinguished:
A. A pervasive pattern of preoccupation with orderliness, perfectionism, emerging in early adulthood and manifesting itself in a variety of contexts, as indicated by four (or more) of the following:
a) preoccupation with details, rules, lists, order, organization or schedules to the point where the main point of the activity is lost;
) perfectionism that prevents completion of a task, such as the inability to complete a project because it has not met one's own overly strict standards;
) excessive attention to work and productivity to the detriment of leisure and friendship (not related to material gain);
) excessive conscientiousness, scrupulousness and inflexibility in matters of morality and ethics;
) the inability to throw away worn or unnecessary things, even when no feelings are associated with them.
) does not want to discuss work or work with other people if they are not ready to follow his procedure;
) stingy with respect to himself and others, saves money for future possible disasters;
) demonstrates cruelty and stubbornness.
1.4.11 Nonspecific personality disorders
This category contains personality disorders that do not have their own set of diagnostic criteria. An example would be the presence of features of more than one specific disorder that do not meet a certain set of criteria for diagnosing a single disorder (so-called "mixed disorders"), but they cause significant deterioration or impairment in any of the areas of a person's life ( e.g. social or professional).
1.4.11.1 Depressive personality disorder
A feature of this disorder is a pervasive pattern of depressive cognition and behavior that begins in early adulthood and manifests itself in a variety of contexts. This pattern does not appear exclusively during major depressive episodes, and does not form part of dysthymic disorders. Depressive cognitions and behaviors include a persistent and total feeling of sadness, gloominess, joylessness, and unhappiness. These people are too serious, they do not know how to enjoy the rest, and they also lack a sense of humor. They think they don't deserve to have fun or be happy. They also tend to ruminate and worry about their negative thoughts and unhappiness. They believe that things will be worse in the future than they are in the present, and generally doubt that improvements can ever come. They can be overly harsh towards themselves and their shortcomings. Their self-esteem is very low and they often focus on their feelings of inferiority. As a rule, they judge other people as cruelly as they judge themselves. They often focus on the shortcomings, stubbornly ignoring the positive qualities and traits.
The main criteria for diagnosing depressive personality disorder are:
A. An overall pattern of depressive cognitions and behaviors that begins in early adulthood and manifests itself in a variety of contexts and meets five (or more) of the following criteria:
) in everyday mood despondency, gloominess, joylessness prevail;
) self-esteem is inadequately underestimated, there is a feeling of worthlessness;
) are overly critical and cruel towards themselves;
) thoughtful and tend to worry;
) are critical and negative towards others;
) are pessimistic;
) are prone to feelings of guilt and remorse.
B. Manifested not only during major depressive episodes and dysthymic disorders.
1.4.11.2 Passive-aggressive personality disorder (Negative Personality Disorder)
The essential difference of this disorder is the total pattern of negative attitudes and passive resistance to demands in the social and professional spheres, which occurs in early adulthood and manifests itself in various contexts. This pattern does not appear exclusively in major depressive episodes and in dysthymic disorders. Such people are usually easily offended, resist and refuse to function at the level that others require of them. Most often, this quality manifests itself in work situations, but it can also manifest itself in everyday, social situations. Their resistance is most often expressed in procrastination, forgetfulness, stubbornness, deliberate inefficiency, especially if the task for them is set by an authoritative person. Unable to do their job, such people often interfere with others. They constantly feel deceived, misunderstood, and continually complain about others. When difficulties arise, they shift the responsibility for their failures to others. They can be sullen, irritable, cynical, controversial, argumentative. Authoritative persons for them often become the subject of discontent. They are also envious and resent the success of peers who have achieved the respect of authority figures. These people often complain. They are negative about the future and may comment in phrases such as "you have to pay to be good" and so on. Such people may oscillate between expressing hostility towards the people who give them the task, and showing sympathy for them, reassuring them and promising that next time everything will be different.
The main diagnostic criteria for passive-aggressive personality disorder are:
A. A pervasive pattern of negative attitudes and passive resistance to demands in social and professional areas, emerging in early adulthood and manifesting itself in a variety of contexts, as indicated by four (or more) of the following:
) passively resists performing routine social and professional tasks;
) complains about being misunderstood and devalued;
) is sullen and prone to disputes;
) unreasonably criticizes and despises the authorities;
) envious and offended by those who are more fortunate than him;
) alternates between hostility and remorse.
B. Does not appear only in major depressive episodes and dysthymic disorders.
Chapter 2. Diagnostic and psychotherapeutic work with personality disorders
2.1 Diagnosis of personality disorders
Personality disorders are very close in their manifestations to the norm, so it is often difficult to distinguish them from the "normal" behavior of people. Only when the manifested personality traits turn out to be total, inflexible and maladaptive and lead to significant violations or damage to various areas of life, one can speak of the presence of a personality disorder.
Diagnosis of personality disorders requires that the patterns assessed in an individual have been manifest for a number of years, and their features should be obvious by the beginning of adulthood. These patterns must be distinguished from characteristics that appear during stress and states of altered consciousness (eg, affect, anxiety, drunkenness). The psychotherapist must assess the stability of personality traits characteristic of personality disorders in various situations. Sometimes, only one contact with a person is enough, but sometimes more meetings are required to make a diagnosis. A diagnosis can also be made if the qualities shown by him are not only a problem for the individual, but also for other people.
When diagnosing a personality disorder, one must always take into account the culture of the individual, his ethnic group and social environment. The psychotherapist should not confuse disorders with the adaptation of a person to a new territory, with the expression of his mores, traditions, customs, religious or political beliefs, which the person originally adhered to in his culture. This is especially important when the therapist is evaluating someone from a different society: in this case, you need to learn as much as possible about the other culture.
The diagnosis of a personality disorder can be made in children and adolescents, but only if the signs being tested have been observed for a long time, are total and cannot be called temporary age characteristics or symptoms of other diseases. When diagnosing a personality disorder in people under 18 years of age, follow-up for at least one year is required (the only exception is antisocial personality disorder, which cannot be diagnosed until 18 years of age).
Certain personality disorders are more commonly diagnosed in men (eg, antisocial personality disorder). Others (eg, borderline, histrionic, and dependent disorders) are more commonly diagnosed in women. Most likely, this is due to the existing psychological differences between men and women.
The DSM-IV-TR provides general criteria for diagnosing personality disorders, which include the following:
A. The presence of a persistent pattern of internal experiences and behavior that deviates markedly from the expectations of the individual's culture and manifests itself in two (or more) of the following areas:
)cognitive (for example, ways of perceiving and interpreting oneself, other people and events);
2)affective (eg, range, intensity, instability, and inappropriateness of emotional responses);
)interpersonal interactions;
) sphere of control.
B. The pattern is total, stable and inflexible.
C. The pattern results in clinically significant impairment or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and extended over time, its onset can be traced back to at least adolescence or early adulthood.
E. It is better not to consider the pattern as a manifestation or consequence of other mental illnesses.
E. The pattern is not associated with a direct effect on the psyche of substances (for example, drugs or medicines) or with the general condition of the individual (for example, a head injury).
Criteria for diagnosing each disorder separately have been discussed in chapter 1, section 1.4.
2.2 Psychological correction
In the treatment of personality disorders, two main areas are used: psychotherapeutic and medication. The latter is more likely to be aimed at relieving individual symptoms (depression, anxiety, etc.) and is used by psychiatrists, so it is not advisable for me, as a psychologist, to consider this area of treatment.
So what are the main types of psychotherapeutic assistance that a psychologist can provide. There are a number of areas in which such assistance is provided:
)Consulting;
2)Dynamic psychotherapy (explores how a person's past experiences can influence his behavior);
)Cognitive psychotherapy (emphasis is placed on changing the pattern of disorders);
)Cognitive analytic therapy (recognition and change of patterns of disorder in behavior);
)Dialectical behavioral therapy (combines some of the techniques from behavioral and cognitive psychotherapy, as well as some techniques from Zen Buddhism; includes individual and group psychotherapy);
)Treatment in the therapeutic community (a rather lengthy method that includes almost constant contact with the therapist and other persons with disorders, and also sometimes includes "hospitalization" for especially vivid episodes).
Cognitive psychotherapy, largely based on psychoanalysis, has received the greatest development in relation to the study and correction of personality disorders, so I will focus on it.
For the most part, people with personality disorders consider themselves normal and healthy, they rarely seek help themselves, and if they do, it is usually only to eliminate some unwanted symptom or resolve a situation. They may complain of depression or anxiety, which may actually be a personality disorder. Therefore, one of the primary tasks of the psychotherapist is to find out the reasons for the client's contact with him, the designation of the goals of therapy, the client's expectations and the construction of a work plan. The therapist needs to collect certain material on which he must implement his activities.
As already mentioned, people with personality disorders very rarely turn to a psychotherapist themselves. Basically, they are either directed by friends, family, or a court order. Such people believe that all the problems they face are not their fault, so they often do not see their violations. Working with such clients is extremely difficult and requires a lot of time, if only to establish a trusting relationship between the therapist and the client.
Often, people with personality disorders do not want to admit that they have this disorder, so they prefer that the therapist cope with the symptoms, rather than go deep. Here, by the way, one important feature of the psychotherapist's actions is noted: when a personality disorder is detected, it is not necessary to announce the diagnosis to the client as a label, a seal on his whole life, designating it with a mean scientific term; it is better to use descriptive techniques, naming only some individual signs of the disorder, without causing a sharp negative on the part of the client. However, even if the client refuses to admit that he has a personality disorder, it must be remembered that its correction is the main goal of the psychotherapist, not psychotherapy. "It is important to remember that in treatment the focus is on the goals of the patient and not on other people (including the therapist)."
As already mentioned, it is important to establish a relationship of trust. It is under such conditions that it is possible to combine the personal goals of the client and the psychotherapist, which ensures the effectiveness of psychotherapy. The main thing is not to set the client against yourself, not to "press" too much, not to impose your point of view. It is very important not to rush the client, but also not to drag out the therapy process too much.
There are times when the client does not want to make contact, because he does not feel the desire to change. His disorder can "play into his hands", not only not causing discomfort, but also bringing some pleasant moments to life, so you need to act carefully, gradually helping a person to take a different look at life.
A condition of any cognitive psychotherapy is informing the client about its process. And here it is not only about the methods of work that can be applied, but also about the consequences that it can have on the client. People with personality disorders tend to feel anxious and uncomfortable when they begin to adjust their personality, so it is very important to warn them about the possible occurrence of such a feeling, "so that it does not come as a surprise and does not cause shock" .
It is important to remember and understand that people with a personality disorder are poorly aware of their dysfunctional beliefs and, as discussed in the previous chapter, cannot check them against reality. Therefore, it must be taken into account that the patterns of behavior and perception habitual for such people are extremely difficult and difficult to change, therefore it is necessary to pay great attention to each component of their pattern: behavioral, cognitive and emotional. Each one needs to be worked on separately, using their own techniques for each.
In working with a client, a psychotherapist can allow him to be equal to himself, to become a "role model" for him. Often this can be very useful at all: as the patient begins to verify himself with others and adequately assess his condition. Many people with a personality disorder who have gone through therapy have said that they have taken the best qualities from their therapists. However, it is important here not to allow the client to completely adopt the image of a psychologist.
A number of problems may arise during psychotherapy. For example, it may happen that the thoughts of the therapist and the client will coincide on certain issues, and they may also find similar dysfunctional beliefs. In this case, the therapist needs to deal with his beliefs so that the "common problem" does not slow down the process itself.
In addition, there may be issues that slow down the course of therapy. Basically, they are associated with certain situations or the inability of one of the parties to perform certain tasks. So, on the part of the client, such problems can be detected: as a lack of cooperation skills; negative thoughts about the likely failure of psychotherapy; the client's expectations that his recovery may lead to adverse consequences, and other fears and concerns regarding changes in personality; lack of social skills; having a benefit from one's present condition; lack of motivation; client rigidity; insufficient self-control, etc. On the part of the psychotherapist, similar problems can also be observed, as well as others, such as: lack of skills in working with a certain group of clients; insufficient formulation, unrealistic or vague goals of psychotherapy, etc. Also, factors that hinder the process of therapy may be an unsuccessfully chosen time and place, certain situational conditions, etc. In this regard, the psychotherapist must be able to help his clients cope with such problems and have sufficient knowledge and skills to avoid mistakes.
As already mentioned, in order to correct and eliminate personality disorders, it is necessary to work with each element of the structural organization of the personality. In this connection, a large number of techniques and methods are used, some of which work with imagination, others, for example, with recreating and playing situations of the past. Also, it should be said that each personality disorder has its own approach to correction and treatment. All these methods, approximate plans and ways of working with personality disorders are very well and thoroughly discussed in the book by A. Beck and A. Freeman "Cognitive Psychotherapy for Personality Disorders".
personality disorder psychotherapy correction
Conclusion
In this paper, various personality disorders have been considered and their main manifestations have been described. According to these descriptions, I think it becomes clear and understandable what this violation is and how to deal with it: to change cognitive, affective and behavioral "schemes". In order to prevent this disorder, it would be quite logical to provide favorable conditions for upbringing, childhood, since it plays a very important role in the development of personality disorders. This is especially significant for those people who are at risk - have close relatives with schizophrenia or a similar disorder.
Another conclusion that I came to in the course of this work is that foreign researchers are mainly involved in personality disorders. In our country, this topic was considered only by a few authors, and their observations are mainly based on the work of German and American psychotherapists. They, in turn, paid great attention to the study of this issue and the construction of therapeutic models, which are used to correct personality disorders.
Thus, in this work, various approaches to the understanding and problems of personality disorders were analyzed, different types of the disease were described, and methods of diagnosis and psychotherapy were considered. I am passionate about this topic, and in the future it would be interesting for me to conduct research on identifying personality disorders in adolescents and young people.
List of used literature
1.Antropov Yu.A. Fundamentals of the diagnosis of mental disorders: hands. for doctors / Yu.A. Antropov, A.Yu. Antropov, N.G. Neznanov. - M.: GEOTAR - Media, 2010. - 384 p.
2.Averin V.A. Psychology of Personality DOC. Tutorial. - St. Petersburg: Publishing House of Mikhailov V.A., 2009.
.Beck A., Freeman A. Cognitive psychotherapy for personality disorders. - St. Petersburg: Peter, 2012.
.Bratus B.S. personality anomalies. - M.: Thought, 2012. - 301 p.
.Vasilyuk F.E. Lifeworld and Crisis: A Typological Analysis of Critical Situations // Psychological Journal. 2007. V.16. No. 3. P.90-101.
.Vasilyuk F.E. Methods of psychotherapeutic pain relief. - Moskov. psychother. journal, 2007, N4, p.123?146.
.Wiggins O., Schwartz M., Norko M. Prototypes, ideal types and personality disorders: a return to classical psychiatry.
.Gannushkin B.P. Clinic of psychopathy: their statics, dynamics, systematics. - Nizhny Novgorod: Publishing house of NGMD, 2008. - 128 p.
.Garanyan N.G., Kholmogorova A.B. The allure of narcissism. // Counseling psychology and psychotherapy. 2012. №2. - C.102-112.
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work (7.7), freedom (7.95), which, in turn, demonstrates the personal orientation of the respondents.
The hierarchy of respondents with a low level of envy looks different. The following values were in the first positions: health (2), having good and true friends (5.5), social recognition (6.5), freedom (6.5), love (7.5), development (7.5). ), self-confidence (7.5), i.e. socialization values due to orientation towards other people, integration in society, achievement of a certain social status, i.e. aimed at social space and self-determination in it.
Thus, it can be noted that the level of envy determines the direction of life. The hierarchy of values of respondents with a high and medium level is aimed at the individual-personal space, while the hierarchy of values of respondents with a low level is directed at the personal and social space.
Literature
1. Adler A. Understand the nature of man / trans. with him. E.A. Tsypin. St. Petersburg: Academic project, 1997. 256 p.
2. Beskova T.V. Social psychology of envy. Saratov: ITs Nauka, 2010. 192 p.
3. Solovieva S.A. Value-semantic sphere of personality as the most important component of the formation of subjectivity in the professional training of teachers // Subjectivity in the personal and professional development of a person: materials of the II All-Russia. scientific-practical. conf. / under the general editorship. G.V. Mukhametzyanova. Kazan: KSUI, 2005. S. 191-192.
4. Freud 3. Basic principles of psychoanalysis: Per. with German, English Moscow: Refl-book; Kyiv: Vakler, 1998. 288 p.
5. Horney K. Collected works: in 3 volumes. T. 1. Psychology of a woman. Neurotic personality of our time: transl. from English. Moscow: Smysl, 1997. 496 p.
6. Jung K.G. Psychology of the unconscious. Moscow: Kanon+, 1996. 399 p.
7. Rokeach M. The nature of human values. N.Y. : The Free Press, 1973. 438 p.
GORSHENINA NADEZHDA VIKTOROVNA - Applicant for the degree of Candidate of Psychological Sciences, Department of Personality Psychology, Kazan (Volga Region) Federal University, Russia, Kazan ( [email protected]).
GORSHENINA NADEZHDA VICTOROVNA - a competitor of scientific degree of Psychological Sciences candidate, Personality Psychology Chair, Kazan (Volga) Federal University, Russia, Kazan.
UDC 159.9.072.422 BBK 88.37
R.D. MINAZOV
INDIVIDUAL PSYCHOTHERAPY FOR PERSONALITY DISORDERS
Key words: personality disorders, individual psychotherapy.
The model of individual psychotherapy of patients with personality disorders is described. The model is illustrated by a clinical case, which presents the patient's self-report after the stage of psychotherapeutic cooperation.
INDIVIDUAL PSYCHOTHERAPY OF PERSONALITY DISORDERS
Key words: personality disorders, individual psychotherapy.
This paper describes a model of individual psychotherapy of patients with personality disorders. The model is illustrated by a clinical case where the patient's self-report is presented after the stages of psychotherapy cooperation.
Many patients with borderline disorders go through the so-called "medical maze" before they get to see a psychotherapist. With the development of paid medicine, it becomes unprofitable for medical institutions and private practitioners to lose a patient from dynamic observation.
Denia. As a result, numerous appointments with doctors of various specialties, overdiagnosis, unjustified laboratory tests, and sometimes observation by specialists in occult practices. All this aggravates the already difficult clinical condition of the patient. Sometimes decades can pass from the first visit of an internist to the first visit of a psychotherapist by a patient.
The patient, as a rule, is concerned about such psychopathological manifestations as obsessive-compulsive disorders, panic, psychosomatic manifestations, eating disorders and much more. Personality disorder, being central to the clinical picture, remains in the shadow for the patient himself. Therefore, a mental health professional can get carried away with the treatment of painful symptoms, losing sight of the pathological core of the personality.
For the first time, the clinic of personality disorders (psychopathies) was described in detail by P.B. Gannushkin. Since then, there have been numerous changes in the classification and systematics of these diseases, but the approach to diagnosis is still relevant today. According to the author, psychopathy is stationary, i.e. non-progressive states. E. Kraepelin pointed out that pure psychopathy of the same type is quite rare, so mixed forms are often observed. As in the early 20th century, psychotherapy remains the main treatment for personality disorders. However, earlier it was aimed at correcting "abnormal reactions to living conditions and living conditions." The modern concept of the formation of mental disorders defines bio-psycho-socio-spiritual targets for long-term psychotherapy. K. Jaspers reported that “we have not at all touched upon the question of what types of psychopathy and to what extent are revealed in one or another period of time, in one or another era” . P.B. Gannushkin systematized psychopathy and also noted the influence of the era on the types of these disorders. It is not surprising that in REM-1U-TR, unlike ICD-10, a narcissistic personality disorder is described, which reflects the spirit of the postmodern era, the internal and external conflicts of a modern person.
In 2013, the American REM-U classification of mental disorders was published, which, to a greater extent than all its predecessors, is based on scientific evidence. Where fashion, expert authority, personal points of view, and ardently defended but scientifically unproven theories previously played an important role in the development of classification, now the emphasis has shifted to scientific evidence. According to some researchers, the systematics of SEM is constantly expanding, and the labels of the disease are hung on the "usual" variations in behavior. SEM-U supporters oppose, explaining that the modern classification is not diagnostic, but serves to describe human behavior.
Today, in patients with personality disorders, we observe the manifestation of a personality defect exclusively during the crisis period, as opposed to the totality described by P.B. Gannushkin. In contrast to the traditional teaching about psychopathy, these patients are sometimes socially adapted and can even be considered successful people in their chosen profession.
Not every patient can afford to undergo a course of recommended open-ended psychotherapy. The short term of individual therapy is achieved by setting a "psychotherapeutic diagnosis" and a clear identification of "targets of psychotherapy". The target of psychotherapy is a phenomenon manifested by the patient or proposed by the psychotherapist, change
which in the process of psychotherapy is a conscious goal of interaction. Using the example of patients with neuroses, the authors describe the following groups of "targets": Group 1 - clinical psychotherapeutic targets (psychotherapeutic targets of nosological specifics); 2nd group - targets specific to the individual psychological and personal characteristics of the patient; 3rd group - targets specific to the psychotherapeutic process; group 4 - psychotherapeutic targets specific to the clinical situation; 5th group - targets specific to the psychotherapeutic method.
Primitive defenses, as well as diffuse identity, characteristic of individuals with a borderline personal organization, make it difficult to work in a psychodynamic way. And the methods of problem-oriented psychotherapy at the initial stage focus the patient on current life difficulties (the system of relationships with the external and internal world) and structure therapeutic sessions. This, on the one hand, allows you to create a spirit of cooperation in the doctor-patient relationship, on the other hand, it minimizes the emphasis on the diagnosis, which allows you to maintain his self-esteem. At further stages of psychotherapy, the concepts of "psychological defenses", "resistance", "transfer" are introduced. The patient needs to focus on these phenomena, fill in a diary of introspection. Working with these phenomena creates a dynamic from the "periphery to the center" and forms new requests for psychotherapeutic cooperation. Here the affective sphere, internal and external conflicts, and the connection with the patient's object relations can be studied in detail. The next step is to work with "character defects". This term is taken from the 12-step model of addiction rehabilitation, but is metaphorically understandable by patients with personality disorders, especially when presented with a drawing of such a tree. The activation of resources contributes to the strengthening of the ego, after which a discussion of the diagnosis of a personality disorder is possible. And before it is impossible to agree on the concept of the disease? Is this not clear anymore? Thus, the main diagnosis falls into the field of view of the patient himself, henceforth being conscious. Let us cite as an illustration the self-report of Z., 30 years old.
“When I first went to see a psychiatrist, I was put on medication that kept me sleeping, so I looked for other ways to deal with my problems. At that time, I was worried about obsessive thoughts “did I run over someone when I was driving, did I get a needle or other sharp object in my eye?” All this distracted from normal life, and at the same time there was something comforting in it ... I worked hard and began to drink at night to distract myself from obsessive thoughts and fall asleep. I didn't notice how I started drinking more beer. So I became an alcoholic. There are women there, different every day, clubs, the social circle has changed. Several years passed, my wife left me, because every day I humiliated her. Only later did I find out that I, it turns out, is not just a neurotic, an alcoholic, a sex addict, but I am a border guard. The trip to the psychotherapist was not easy for me, I doubted for a long time, I thought about how chatting with him would help me. He demanded effective pills or healing hypnosis from him. For some reason, the doctor decided to take a break from my sores for a while, and I only wanted to talk about them, but somehow smoothly we got down to the topics of my relationship with my subordinates, wife, sister, mother. But the most difficult thing for me was talking about my father. I liked working with postcards, I saw the reflection of my experiences and thoughts in them. I became aware of the connection between my symptoms and my current problems. It was more difficult to sort out the connection of my symptoms with my past. Then I realized that I was punishing myself for past sins. It was not without reason that earlier my symptoms manifested themselves in the fact that I simply could not get out of the shower, so carefully I washed off the “past dirt” from myself. This stain was also left by my father. Picture
family once again hammered a nail into my mind - the awareness of what is really going on in our relationship. After some time, I decided to tell about my father, it did not happen as soon as, I think, he wanted. Immediately I remembered that I had always been bad for my father, not as perfect as he wanted me to be. He had big plans for me, I think that I had to do what he failed in his life. But fate played a cruel joke with him, making me like that. This feeling that I am bad still lives with me. And, apparently, that's why I always did everything to play this game, and started playing .... It was difficult to determine my main negative feeling. Then I drew a weight, I did not think that it hangs around my neck and is called guilt. Working with guilt and my relationship with my father interrupted my work with a psychotherapist, perhaps I was not ready for such a serious restructuring at that time. Then I found out what comrade Resistance is and how it manifests itself, the doctor promised to assign me a specialty, at least a psychologist, if I cope with the task of finding this "well-wisher" and following his insidious plan. I understood that the Resistance is myself, and I understood that inside I am not alone, there are many of us. I was impulsive and therefore interrupted our sessions many times, then returned. My emotions took over everything, they ruled me all the time, as far as I can remember. Of course, I will not leave myself, and I have to continue my work.. I will have patience. Now I have been sober for 7 months, I sleep peacefully and can work.”
To intensify and structure the treatment process, methods are used to focus on the basic conflicts of the individual. The nuclear conflict theme of relationships is an original version of a short-term focal psychodynamically oriented psychotherapy, which was developed by the American psychologist Luborsky (_. _urogeku) in the early 1990s. . The focus of psychotherapeutic intervention is the emotionally significant relationship of the patient in his reference environment. The themes of nuclear conflict relationships are derived from the patient's narrative. In the described clinical case, a protracted conflict with the father was identified in the patient. Avoidance of this topic hindered the healing process. At the same time, the introduction of the concepts of "transfer" and "resistance" at this stage made it possible to keep the patient in an outpatient setting and expand his self-image.
For a long time, patients with personality disorders were classified as incurable. In the last decade, the situation has changed, and we are seeing patients in therapeutic remission. Working with these patients makes serious demands on the psychotherapist himself. Personal example, faith in the patient, professional competence, empathy, tolerance - this is not a complete list of the conditions for successful therapy of patients with personality disorders.
Literature
1. Blaser A., Heim E, Ringer H., Tommen M. Problem-oriented psychotherapy. Integrative approach / transl. with him. L.S. Kaganov. M.: Klass, 1998. 272 p.
2. Gannushkin P.B. Clinic of psychopathy, their statics, dynamics, systematics. M.: Medical book, 2007. 124 p.
3. Korolenko Ts.P., Dmitrieva N.V. Personality disorders. St. Petersburg: Piter, 2010. 400 p.
4. Kulakov S.A. Psychotherapeutic diagnosis in the rehabilitation of patients dependent on psychoactive substances // Narcology. 2013. No. 9. S. 85-91.
5. Lichko A.E. Psychopathies and character accentuations in adolescents. St. Petersburg: Rech, 2009. 256 p.
6. Luborsky L. Principles of psychoanalytic psychotherapy: A guide to supportive expressive treatment: Per. from English. Moscow: Kogito-Centre, 2003.
7. Nikolaev E.L., Chuprova O.V. Psychological features of the temporal perspective of personality in the system "dependent-codependent" // Bulletin of the Chuvash University. 2013. No. 2. S. 102-105.
8. Typology of psychotherapeutic targets and its use to improve the quality of individual psychotherapeutic programs in the treatment of patients with neurotic disorders: method. recommendations / R.K. Nazyrov, S.V. Logacheva, M.B. Craft and others. St. Petersburg: Publishing House of NIPNI im. V.M. Bekhtereva, 2011. 18 p.
9. Jaspers K. Collected works on psychopathology: in 2 vols. M.: Academy; St. Petersburg: White Rabbit, 1996. 256 p.
10. De Man J. De DSM-5 in 1 oogopslag // De Psychiater. 2013. No. 5. P. 8-10.
11. DSM-5: wetenschappelijker onderbouwd dan ooit // De Psychiater. 2012. No. 3. P. 30-31.
MINAZOV RENAT DANISOVICH - Candidate of Medical Sciences, psychotherapist, clinic "Insight", Russia, Kazan, ( [email protected]).
MINAZOV RENAT DANISOVICH - candidate of medical sciences, psychotherapist, «Insight» Clinic, Russia, Kazan.
UDC 159.972+616.1 BBK 88.4
E.L. Nikolaev, E.Yu. LAZAREVA
FEATURES OF MENTAL DISADAPTATION IN CARDIOVASCULAR DISEASES
Key words: cardiovascular disease, mental maladaptation, anxiety, depression, hypochondria.
Data are presented on the features of the structure of mental maladaptation in cardiovascular pathology, according to which mental disorders of the affective spectrum are more common, manifested by symptoms of anxiety and depression, which can be combined with hypochondriacal disorders. In the genesis of mental maladaptation, there is a connection with stressful influences, personal and psychosocial factors.
E.L. NIKOLAEV, E.Yu. LAZAREVA SPECIFIC FEATURES OF MENTAL MALADJUSTMENT IN CARDIOVASCULAR DISEASES Key words: cardiovascular diseases, mental maladjustment, anxiety, depression, hypochondria.
The review presents data on the structural features of mental maladjustment in cardiovascular diseases. Affective spectrum disorders manifesting with symptoms of anxiety and depression that can be combined with hypochondrical presentations are more often. Genesis of mental maladjustment is traced to life stressful influences, personal and psychosocial factors.
As noted in our previous publications, the adaptive capabilities of a person, including those in a state of illness, are associated not only with the functional state of the body and its ability to adequately respond to adverse factors, but also with a certain set of individual psychological characteristics of the individual, as well as with ways of processing intrapersonal conflicts. The importance of the factor of mental adaptation in cardiovascular diseases (CVD), as well as the high frequency of its violation - mental maladjustment, justifies the emergence of a separate interdisciplinary direction - psychocardiology - located at the junction of cardiology, psychology and psychiatry.
This work is devoted to a brief review of scientific reports on the features of the structure of mental maladjustment in patients with CVD based on the most frequently detected psychopathological symptoms in common forms of cardiac pathology.
Thus, according to epidemiological studies, reliable relationships have been established between cardiac pathology and depression. There is a growing body of information about the relationship between anxiety and CVD in the general population.
A multicenter three-year study conducted in Russia to study the frequency of anxiety and depressive symptoms in patients