The main variants of psychopathy and their brief clinical characteristics. About the causes of psychopathy

Classifications of psychopathy are very diverse. There were attempts to reduce all varieties of psychopathy to two - excitable and inhibited; there were descriptions including more than a dozen types. The following types are included in ICD-10.

Schizoid personality disorder(schizoid psychopathy) according to ICD-10 is characterized by the following character traits: inability to experience pleasure (anhedonia); emotional coldness and inability to express warm or hostile feelings towards others; weak response to praise and censure; little interest in sexual intercourse with others; propensity to fantasize about oneself (autistic fantasizing) and to introspection (immersion in inner world); lack of close trusting contacts with others; difficulty in understanding and assimilation of generally accepted norms of behavior, which is manifested by eccentric actions.

The most striking character trait is isolation and lack of sociability (since childhood, they preferred to play alone). Often they live by their unusual interests and hobbies, in the field of which they can achieve success (unique information in a narrow industry, a deep interest in philosophical and religious issues, unusual collections, etc.). Hobbies and fantasies fill the inner world, almost always closed to others. Fantasies are intended for themselves and are ambitious or erotic (with outward asexuality). Emotional restraint looks like coldness, although inner experiences can be strong and deep. It is difficult to establish informal emotional contacts. The lack of intuition is manifested by the inability to understand other people's desires, fears, experiences. Prone to non-conformism - do not like to act "like everyone else." Situations where it is necessary to quickly and indiscriminately establish informal contacts, as well as the forcible intrusion of outsiders into one's inner world, are hard to endure.

dissociative personality disorder(psychopathy of an unstable type, antisocial personality disorder) according to ICD-10 is recognized by the following features: neglect of the feelings of others and lack of empathy - the ability to penetrate into their experiences; irresponsibility and neglect social norms, rules and responsibilities; inability to maintain stable relationships with others; low tolerance for frustration (the inability to get what you want); ease of aggressive outbursts, including brutality; lack of guilt and inability to learn from the past, especially from punishments; a tendency to blame others for everything and complain about failures; constant irritability.

The main feature is the constant thirst for easy entertainment and pleasures, an idle lifestyle with the avoidance of any work, study, fulfillment of any duties, both social and family. With adolescence are drawn to asocial companies, alcohol, drugs. Sexual life is only a source of pleasure. They are unable to fall in love, nor to become attached to relatives and friends. They are indifferent to their future - they live in the present. Weak-willed and cowardly, they try to run away from any difficulties and troubles. They endure loneliness badly - they are unable to occupy themselves with something. The situation of neglect, lack of guardianship and strict control turns out to be detrimental.

Emotionally unstable personality disorder(emotionally labile type of psychopathy, explosive, affective, impulsive, excitable, epileptoid psychopathy) according to ICD-10 represents a combined group with various disorders of the emotional sphere. In Russian psychiatry, it is customary to distinguish between two close, but not identical types.

Explosive (affectively labile) psychopathy characterized by emotional outbursts at the slightest provocation, but anger is easily replaced by tears, swearing and throwing things - moaning, aggression towards others - self-harm, attempted suicide. The mood often changes, which leads to restlessness, lack of concentration, distractibility. They are completely unrestrained, boil up at the slightest remark or opposition, react extremely painfully to emotional rejection and any stress.

Epileptoid psychopathy differs in that, in addition to explosiveness (a tendency to unbridled affective reactions with aggression and auto-aggression), periodically there are states of dysphoria - a gloomy-malicious mood, during which patients are looking for something to disrupt the accumulated evil. Dysphoria lasts from several hours to several days. Violent affective reactions are usually preceded by a gradual boiling over of initially suppressed irritation. In passion, during fights, they go berserk - they are able to inflict heavy damage. Sometimes disturbances of inclinations come to light, most often sadistic and masochistic inclinations. They take pleasure in torturing, subtly mocking or brutally beating the weak, defenseless, dependent on them, unable to fight back. Often since childhood they love to torture and kill animals. But they can get sensual pleasure by hurting themselves with cuts, burns from burning cigarettes. Alcohol intoxication is more often of a dysphoric type. They love to get drunk to the point of insensibility. Suicidal attempts can be both demonstrative in order to blackmail someone with them, and during dysphoria with the actual intention to commit suicide.

Histrionic personality disorder(hysterical psychopathy), according to ICD-10, can be diagnosed in the presence of a tendency to self-dramatization, theatricality of behavior, exaggerated expression of emotions; suggestibility, easy compliance with the influence of others; superficial and labile efficiency; self-centeredness with the desire to forgive oneself everything and not to take into account the interests of others; constant desire to be appreciated and easy vulnerability; thirst for situations where you can be the center of attention of the environment; manipulative behavior (any manipulation) to achieve their goals.

Among these character traits, the most striking is constant desire to be in the center of attention of the environment, demonstrativeness, pretentiousness. To this end, they even resort to performances depicting suicidal attempts. Suggestibility, often highly emphasized, is in fact very selective: one can suggest only that which does not contradict egocentric aspirations. But the level of claims is high: they claim much more than their abilities and opportunities allow. Under the influence of severe mental trauma, hysterical psychoses can occur - twilight states, pseudo-dementia, etc.

Anancaste (obsessive-compulsive) personality disorder(psychasthenic psychopathy) according to ICD-10 is characterized by indecision, constant doubts; excessive forethought in relation to a possibly dangerous or unpleasant course of events; perfectionism (i.e., the desire to always achieve the highest results, to do everything in the best way, regardless of the unimportance of the matter); the need to re-check what has been done; extreme preoccupation with details in trifling things and loss of broad perspective; extreme conscientiousness, scrupulousness, preoccupation that interferes with enjoyment; pedantry and conventionality with limited ability to express warm feelings; rigidity and stubbornness, insisting that others obey the order they have established; the appearance of unwanted thoughts and impulses, which, however, do not reach the degree of severe obsession; the need to plan every activity in advance in the most insignificant details.

obsessive thoughts, movements, rituals, fears, self-invented “signs” and “prohibitions” are observed almost constantly, either intensifying or weakening (for example, for important occasions, always wear the same clothes, walk only along one route, do not touch anything black, etc.). Pedantry, the desire to foresee and plan everything in advance in the smallest detail, petty observance of the rules serve as compensation for the constant fear for the future - one's own and one's loved ones. Other compensatory mechanisms may be exaggerated: indecision when already decision turns into impatience, shyness - unexpected and unnecessary peremptoryness. This type of psychopathy usually manifests itself with school years, but it intensifies when they begin to live independently and you have to be responsible for yourself and for others.

Anxiety (“avoidant”) personality disorder(sensitive psychopathy) according to ICD-10 criteria can be recognized by constant feeling internal tension and anxiety; shyness and feelings of inferiority, self-doubt; constant attempts to please and be accepted by others; increased sensitivity to criticism from the outside; by a tendency to refuse to enter into relationships with others until they are sure that they will not be criticized; a very limited circle of personal attachments; tendencies to exaggerate the potential danger and risk of everyday situations, avoiding some of them, which, however, does not reach stable phobias (obsessive fears); in a limited way of life that allows you to feel safe.

Great impressionability and a sense of inferiority are two main features. They see many shortcomings in themselves and are afraid of being ridiculed and condemned. Their isolation is purely external - a consequence of being fenced off from strangers and unfamiliar situations. With those to whom they are accustomed and who are trusted, they are quite sociable. Unbearable is the situation in which they become the subject of malevolent attention of others, when a shadow falls on their reputation or they are subjected to unfair accusations. They are prone to depressive reactions, during which they can gradually and secretly prepare suicide or are capable of unexpected desperate acts leading to serious consequences (up to inflicting serious injuries or killing offenders).

According to the ICD-10 criteria, dependent personality disorder corresponds to one of the types of asthenic psychopathy. It is characterized by a tendency to shift responsibility for oneself to others and to completely obey the interests of the one on whom they depend, neglecting their own desires. They evaluate themselves as helpless, incompetent and unbearable. They have a fear of being abandoned and a constant need for reassurance in this regard. They cannot stand loneliness, they feel empty and helpless when ties with the one they depended on are cut off. Responsibility for misfortunes is transferred to others.

Mixed personality disorders are diagnosed when it is difficult to identify a distinct type due to the fact that the traits different types presented relatively evenly. However, completely “pure” types of psychopathy are relatively rare - the type should be determined by the predominant features. As with accentuations of character, mixed types can be intermediate (mainly hereditary, for example, schizoid-epileptoid psychopathy), or amalgamous (features of another are superimposed on the endogenous core of one type due to prolonged adverse environmental influences, for example, on the constitutional features of emotional lability during education in childhood, histrionic, i.e., hysteroid, features are superimposed as the “idol of the family”).

Organic psychopathy is most often mixed, presenting various combinations of emotionally labile, histrionic, and dissociative traits (i.e., explosive, hysterical, and unstable psychopathy). Diagnosis of organic psychopathy is based on the following signs. She has a history of intrauterine, birth and early postnatal (first 2-3 years of life) craniocerebral trauma, brain infections and neurointoxication. Residual neurological “microsymptoms” are revealed: asymmetry of facial innervation, blurred oculomotor disturbances, uneven tendon and skin reflexes, mild diencephalic disorders. On the x-ray of the skull, abnormalities of ossification and signs of increased intracranial pressure are visible, on the EEG, pronounced diffuse changes. Pathopsychological examination reveals impaired attention, exhaustion when repeating tasks.

Other classifications of psychopathy. Many classifications have been proposed. Some of them are descriptive - types are distinguished by the most striking character traits, others proceed from a certain principle. In Russian psychiatry, the taxonomy of P. B. Gannushkin (1933) can serve as an example of the first, and the second - of his student O. V. Kerbikov (1968), as well as B. V. Shostakovich (1988) and A. E. Lichko (1977) .

P. B. Gannushkin described several groups of psychopathy.

The group of cycloids (constitutionally depressive, constitutionally excited, cyclothymic, emotively labile) are distinguished by the peculiarities of the dominant mood - constantly depressed, elevated, periodically or frequently changing. The group of asthenics (neurasthenics, “overly impressionable”, psychasthenics) was united by a tendency to be easily exhausted and “irritable weakness”. In addition, there were groups of schizoids, paranoids, epileptoids, hysterical and unstable psychopaths, etc., most of which are included in the ICD-10 under the same or other names. O. V. Kerbikov took the types of higher nervous activity of I. P. Pavlov for classification and, first of all, divided psychopathy into excitable (explosive, epileptoid) and inhibited (asthenics, psychasthenics). But “pathologically closed” (i.e., schizoids), hysterical, unstable, sexual and mosaic (i.e., mixed) psychopathy were especially placed outside the chosen principle. B. V. Shostakovich used the psychological principle for systematics: the predominance of changes in the sphere of thinking (schizoids, psychasthenics, paranoid), in the sphere of affective disorders (epileptoids, excitable, cycloids, hysterical) or in the sphere of volitional disorders (unstable, sexual). A. E. Lichko combined the systematics of psychopathy and character accentuations, describing the same types, which are either variants of the norm (accentuations), or reaching a pathological level of deviation (psychopathy).

If a person behaves inappropriately, we immediately label him as a “psychopath”. What does the term psychopathy really mean? What are the hallmarks of a personality disorder? What are psychopathy, and why do they develop?

Psychopathy is a borderline state between mental health and mental illness. But if many mental disorders can be cured or at least achieve a significant improvement in the patient's condition, then a personality disorder will accompany a person throughout his life.

What it is?

This is an anomaly of character, a persistent congenital or acquired disorder that prevents a person from building interpersonal relationships and adapting to a social environment.

The main difference between a personality disorder and a mental disorder is that psychopathy is characterized by stability, lack of flow.

Of course, over time, personality traits can undergo certain changes, but there are no such significant changes as with mental illness, changes in various areas of the personality with psychopathy.

Causes

Each of us is born with a certain set individual qualities. Eye color, hair color, body constitution, height - all this is genetically programmed. In the same way, certain traits or anomalies (as in psychopathy) of character are laid down at birth.

Of course, every person undergoes some changes during his life, develops, coexisting with other people, being in society. But in general, most of our qualities are already laid at conception.

If we talk about the causes of psychopathy, then basically the causes of this mental disorder lie in the genes: the baby is already born with certain features, not only appearance, but also characteristic. But there are situations when the development of an anomaly of character is primarily associated with an unfavorable situation. The combination of character traits originally characteristic of a given person with an unfavorable situation contributes to the consolidation of abnormal behavior, exacerbates maladaptation.

An example of non-standard social situations that worsen the course of a personality disorder can be a stay in an orphanage, in prison.

So, in most cases, in all problems in life, in relations with other people, mother nature is to blame, which created a person as he is.

Common features

Another extreme is the lack of persistent interests, increased suggestibility, underdevelopment of volitional qualities and the absence of one's own point of view. These symptoms are characteristic of antisocial personality disorder. Thus, the symptoms of psychopathy can be varied. What common features unite these different, at first glance, pathologies?

Criteria

There are the following diagnostic criteria psychopathies (common symptoms for all personality disorders):

The first criterion is the relative stability and low reversibility of pathological character traits.

Unlike mental illness, signs of personality disorders change little over time. Of course, during adolescence, the behavior of a psychopath may undergo some changes, but in general, the leading signs by which a person can be diagnosed with a certain psychopathy persist throughout life. For someone, an irresistible desire to attract attention is characteristic, while the other is fenced off from others by an invisible veil all his life.

The second criterion is the totality of psychopathic personality traits .

A psychopath is a psychopath everywhere: at work, in the family, on the street, and in public transport. He simply cannot behave differently with people, is not capable of different behavior. The existing pathology affects the core of the personality, so abnormal behavior extends to all areas of life.

The third criterion is a violation of social, family and professional adaptation.

For people with this disorder, it is incredibly difficult, almost impossible to adjust to existing norms. It is said about psychopaths that they "do not live themselves and do not allow others to live." Although there are some exceptions in terms of professional adaptation. If you choose the right profession, then a person can become successful in work. For example, hysterical psychopathy is characterized by the desire to draw attention to his person. If such man will go in the theatrical field, where it is full of spectators, it can realize its inner potential.

Psychopathy and character accentuation

Accentuation of character is a variant of the norm, in which certain character traits are excessively strengthened, as a result of which selective vulnerability can be found in relation to certain psychological influences, while normal resistance to other influences remains.

Accentuation appears only under certain conditions, for example, under the influence of mental trauma. But in general, it does not lead to social maladjustment of such a person.

Once again I want to emphasize that character accentuation is a variant of the norm, in contrast to psychopathy - border state between health and mental illness.

Psychopathies are painful personality changes, with disturbances in the emotional sphere, volitional disorders, pathological experiences and bouts of inappropriate behavior. People suffering from these types of disorders may retain intellectual abilities, but often lose them. The development of psychopathy gradually leads to the fact that patients develop inappropriate behavior in society, the ability to normal social adaptation is lost. Psychopathic manifestations are especially difficult if painful changes begin in childhood.

The representative of the German school of psychiatry, K. Schneider, argued that the personality of a psychopath exposes both himself and the people around him to suffering. Psychopathic manifestations can undergo dynamic changes with the age and development of a person. Especially clinical symptoms increase in adolescence and in the elderly.

Causes of psychopathy

Note:provoking factors in the development of pathological changes can be severe diseases of internal organs, severe stressful situations. According to official data, up to 5% of the population suffers from psychopathy.

Despite the prevalence of this pathology, its causal factors have not been studied enough. Scientists differ both in some questions of classification, and in the mechanisms of development of painful changes.

In a separate large group causes of psychopathy identified brain lesions that are caused by:

• environmental pollution;
• severe infectious diseases;
• traumatic head injuries;
• poisoning;
• elevated .

These groups of harmful effects lead to painful changes in the brain, nervous system, and as a result, there are severe changes in the psyche.

Also, social factors are of great importance in the development of pathology: the atmosphere in the family, school, work teams, etc. Especially these conditions play a role in childhood.

The hereditary nature of the transmission of psychopathy is of no small importance.

The main classifications of psychopathy

The problem of psychopathy was of interest to many world-class scientists. This has led to the creation of many classifications. We will consider the most common, most commonly used in clinical medicine.

According to the main groups (O.V. Kebrikov), the following are distinguished:

• nuclear psychopathy(depending on the constitutional type of a person, in which the main role is assigned to heredity);
• marginal psychopathy(arising from problems of a biological nature and social causes);
• organic psychopathy(caused by organic lesions of the brain, and manifested at the stage of personality development, at the age of 6-10 years).

An additional role in the development of psychopathic traits is played by:

• separation of the child from parents, family;
• overprotectiveness, developing a painful self-importance;
• lack or complete lack of attention to their children;
• "Cinderella" syndrome - relegation to the background of the adopted child, or the formation of a complex in children due to increased parental attention paid to one child at the expense of others;
• the “idol” phenomenon is a painful perception of caring for other children by a child – the “favorite” of the family society.

Note:the existing psychopathic character traits can clearly manifest themselves with defects in upbringing and give painful emotional reactions and pathological behavior.

The main medical classification of psychopathy divides the disease according to the leading psychopathological syndrome.

In practical medicine, psychopathy is distinguished:

• asthenic;
• psychasthenic;
• schizoid"
• hysterical;
• epileptoid;
• paranoid;
• excitable;
• affective;
• heboid;
• with sexual disorders and perversions

Symptoms of the main clinical forms of psychopathy

The main manifestations of psychopathy depend on developing species diseases

Symptoms of asthenic psychopathy

This form is characteristic of people of a weak psychophysical type, prone to increased vulnerability, hypersensitivity, quickly depleted with strong nervous and physical activity. They are characterized by excessive anxiety (fearfulness), cowardly actions, frequent indecision, if necessary, to take responsibility for themselves.

Deep and prolonged experiences lead to a permanently depressed mood. Over time, an excessive tendency to take care of one's health appears, develop.

Asthenic psychopath is constantly tired, good health for him - an extreme rarity. Excessive pedantry, acrimony prevail in character traits, there is a certain life algorithm, it is very difficult for the patient to go beyond the boundaries of which.

This form is also characteristic of a weak type of nervous system. The main feature of patients is the predominance of the second signaling system. It is characteristic of people of the mental type. The behavior of these psychopaths is dominated by corrosiveness and excessive analysis of events and actions, especially their own. The patient is concerned about abstract, unimportant questions. For example, the color of the shirt in which you need to go out. Reasoning about whether it is right now to go in these clothes can lead a person to a dead end, and he will not go to the place he needs at all. Among the main symptoms of psychasthenic psychopathy are painful doubts (“mental chewing gum”) that arise for any, the most insignificant reason. Psychasthenics are characterized by pettiness and pedantry, which reach the level of obsessive states to an extreme degree.

Psychasthenics are constantly engaged in self-reexamination. Intrusive thoughts distract patients from real life. The insufficiency of the first signaling system makes patients emotionally narrowed, "flat" and indifferent.

Patients with this form of the disease look closed, avoid people and communication, are prone to self-immersion (pronounced introverts) . Thoughts and ideas of patients are obscure to others, very peculiar. Appearance, hobbies are unusual. There is a detachment from the interests of the outside world.

They say about such people that they are “not of this world”, eccentric and indifferent to themselves and others. Often they have developed intellectual abilities. . According to I.V. Chess allocate: sthenic a type of schizoid psychopathy (with symptoms of withdrawal, emotional dullness, rigidity and coldness) and asthenic type (closedness is noticeable, accompanied by daydreaming, anxiety and combined with strange hobbies - “freaks”).

Typology of a person with a predominance of the first signal system. Characteristic of the artistic type of nervous activity. Vivid emotions come to the fore in the life of this category of patients. , that are prone to rapid polar changes . This leads to mood swings, unstable behavior.

Patients suffering from this form are very proud, self-centered, with characteristic feature- to be constantly in the center of attention (demonstrative behavior). These patients are characterized by inventing stories, a tendency to fantasize and embellish facts, sometimes they “lie” so much that they themselves begin to believe in their writings. This form of psychopathy often develops symptoms .

People suffering from this type of mental disorder have viscous thinking, obsession with details, and extreme pedantry. Their thinking is stiff, hard "swaying". Among the main symptoms are pettiness, scrupulousness and excessive prudence. .

In behavior, there are sharp changes in attitude towards people: from sugary obsequiousness to outbursts of anger and intransigence. One of the features of the type is the inability and unwillingness to forgive. Epileptoid psychopaths can harbor anger and resentment all their lives, and at the slightest opportunity resort to revenge. Outbursts of anger are strong and prolonged. Patients of this form of the disease often exhibit sadistic tendencies.

Patients of this group are prone to one-sided and obsessive thinking, are prone to the formation of overvalued ideas that can completely take over their volitional and emotional sphere. The most common manifestation of this morbid quality is suspicion.

A paranoid psychopath can find in each of his acquaintances the features of an intruder who is watching him. Often, patients attribute envy towards themselves to people around them. It seems to the patient that everyone wants to harm him, even doctors. Painful symptoms of paranoid psychopathy often manifest themselves in ideas of jealousy, fanatical thoughts, constant complaints. It is quite natural that the relationship of this category of psychopaths with other people is conflicting.

This group of patients is more prone to uncontrolled outbursts of anger, inappropriate actions, attacks of unmotivated and pronounced aggression. Psychopaths are overly demanding of other people, too touchy and selfish. They have little interest in the opinions of outsiders.

At the same time, patients with excitable psychopathy may show symptoms depressive states, despair. The most often excitable type is inherent in alcoholics, drug addicts, socially pathological personalities (thieves, bandits). Among them is the largest percentage of offenders and persons who are examined by forensic medical examinations.

This type of mental disorder occurs in the form hyperthymia- a condition in which patients are characterized by a constantly elevated mood with a feeling of carelessness and activity. This type of patient is inclined to take on all the cases in a row, but not one of them is able to complete. There is frivolity, increased talkativeness, importunity and leadership tendencies. Affective psychopaths quickly find a common language with everyone and no less quickly get bored with their “stickiness”. They have a tendency to get into difficult, conflict situations.

The second type of disorder hypothymia, is the opposite of hyperthymia. Patients diagnosed with "affective psychopathy" are in a depressed state. They tend to see negative aspects in everything, express dissatisfaction with themselves and others, they often have hypochondriacal symptoms, and extreme degrees of pessimism are observed. They are closed and feel a sense of their own guilt in front of everyone, consider themselves guilty of everything that happens. At the same time, hypothymics expressed resentment. Any word can deeply hurt the patient.

The type of this pathological process contains deviations in the sphere of the concepts of duty, honor, conscience. Sick of a cruel disposition, merciless and selfish, with an atrophied concept of shame. General human norms do not exist for them. This type of psychopathy always proceeds in a severe form. Geboid psychopaths are characterized by sadism and indifference to the suffering of other people.

Symptoms of psychopathy with sexual perversions and disorders

The clinic of these disorders proceeds in combination with other types of psychopathy. Sexual perversions include pedophilia, sado-masochism, bestiality, transvestism and transsexualism. The forms of these deviations are constantly reviewed by specialists in order to determine the line between the symptoms of the disease and the variant of behavior within the framework of the mental norm.

Psychopathies run in cycles. Periods of improvement are replaced by exacerbations of the disease process. Psychopathies must be distinguished from personality accentuations (extreme degrees of manifestation of character).

Note:accentuations are not a pathology, although their manifestations may resemble psychopathy. Only a qualified psychiatrist can distinguish psychopathy from accentuation.

Treatment of psychopathy

Therapy of psychopathy begins with the elimination of the cause that triggered the development of clinical manifestations ( infectious diseases, injuries, stress, diseases of internal organs, etc.)

Medical treatment includes:

• fortifying agents: vitamins, antioxidants, immunomodulators;
• sedatives (soothing in mild forms of pathology);
• tranquilizers (to stabilize the emotional background with constant overexcitation);
• neuroleptics (with affective forms);
• antidepressants (in cases of depression);
• sleeping pills (for stabilization in excitable forms of the disease);
• symptomatic (with problems with the heart, liver, kidneys).

Treatment of psychopathy must be accompanied by psychotherapy (hypnosis, waking suggestion, rational psychotherapy). Acupuncture, physiotherapy, especially electrosleep are widely used.

Prevention of psychopathy

Prevention of this group of diseases is possible only with large-scale measures on state level, including the solution of socio-economic issues, early detection of abnormal types of behavior in children and the creation of favorable conditions for their development, with gradual adaptation in society.

The task of medicine is to effectively treat somatic diseases.

Educational institutions should instill in children healthy lifestyle life, to raise the cultural and educational level.

You will receive more detailed information about the course of psychopathy, methods of their diagnosis and treatment by watching this video review:

Lotin Alexander, medical columnist

Psychopathy is a psychological term denoting abnormal deviations in the activity of the nervous system, which manifest themselves in personality disharmony and lead to mental inferiority.

The behavior of the subject subject to this disorder is characterized by increased eccentricity, pronounced excessive impulsivity, aggression towards others and immoral acts. The disease is characterized by the inability of the individual to control their emotional experiences. Such a pathology in the character in the future can cause melancholy and depressive states.

Statistical data

The study of the characteristics of psychopathy in women and girls and data on the statistics of offenses committed by them do not reveal the percentage of men and women among those subject to mental disorders.

But using the PCL R technique, which diagnoses signs of psychopathy in the population for research purposes, in 1997 it was found that 15.5% of criminals serving time in prisons and penal colonies- female faces. The figure for men is much higher and varies from 25% to 30%.

Another study, a year later, showed the following results: 12.9% of the females of the 78 population in prison, with whom work was carried out according to the PCL-R method, could qualify as psychopaths. And according to statistics compiled by Smith, Brinkley and Newman (in press), out of 528 female prisoners, one in nine is at risk for a mental disorder and has characteristic symptoms.

It is generally accepted that psychopathy is a disorder that affects males to a greater extent. This is the reason for such a small amount of work and research in relation to female psychopathy. But those that exist have established the fact of differences in the behavior of male and female psychopaths: the female part of the population with mental disabilities is less aggressive and cruel than men, and they have a significantly lower repetition of their criminal acts.

Causes

This pathology develops due to prolonged exposure to adverse social factors that form the personality of the individual. According to experts, this mental disorder is not a disease, but only reflects pathological deviations in character, which can be caused by the following reasons:

• congenital defect of the nervous system;
• injuries received during childbirth or during the period of embryonic development;
• physical injuries to the head that affect the activity of the brain;
• genetic predisposition;
• alcoholism of family members;
• the consequences of past diseases;
• systematic susceptibility of the individual to psychological pressure from society.

Psychopathy arises due to a distorted, as a result of pathological upbringing, worldview of the individual and the wrong values ​​​​introduced into the consciousness, promoted in the family. There are 4 options for education that adversely affect the development of the individual:

1. Hyper-custody, expressed by excessive concern for the child and reaching a manic addiction. The child is deprived of the opportunity to make decisions and overcome life's difficulties, because he has no idea how to do it right.
2. Neglect or free upbringing. In this case, the child does not receive the necessary attention and is forced to independently adapt to the world around him from an early age.
3. Permissiveness. Parents satisfy all the needs of their child and do not refuse him anything. In the future, such children turn out to be capricious and spoiled individuals, suffering from an exaggerated sense of significance and inflated self-esteem.
4. Despotic or authoritarian form of education. This option refers to families in which children do not receive the care, love and support they need. Any wrong action of such a child results in immediate punishment. The personality of such children, formed by the fear of doing something wrong, will later be characterized as weak and insecure.

Manifestations of psychopathy

Psychology identifies several manifesting types of psychopathy.

paranoid woman

Women of this type have a pronounced egoism, high demands on others and a high degree of emotionality. They know what they want from life and clearly follow their goals, even if other people may suffer in the process. The considered disorder in the paranoid type of people is expressed in social maladjustment and inability to build relationships in the family. Therefore, they are most often lonely and unsettled in their personal lives, which they deny in every possible way.

Subject to mental disorders, they impose their only true opinion on others and, if it is not accepted, they are ready to defend their truth to the last. Extremely vengeful and vindictive. In relation to a man who has assumed the responsibility to go along with such a woman through life, they are jealous and suspicious. Manic moods haunt them throughout their lives.

Hysterical psychopathy

Hysterics of this type are endowed by nature with acting skills and talent, which they do not hesitate to use in any situation. Like paranoid women, unable to control their emotions, they first perform actions, and only then the thought process turns on in their minds. They need constant attention and admiration, they should always be at the center of any events. Infantile and capricious. They skillfully manipulate others, for this they can resort to false suicidal attempts. They love drama, intrigue and outbursts of passion that should rage around their personas.

The life partner of such a woman should be ready for everyday theatrical performances, with her beloved in leading role. He certainly does not threaten to die of boredom.

Manifestations of schizoid psychopathy

Representatives of this form of disorder differ from other types by isolation and immersion in their own world. They are indifferent to what is happening, apathetic and prefer not to share their experiences, but to keep them in themselves.
The peculiarity of melancholic women is that they do not have features that are characteristic of the female sex in general. And this distinguishes them from other types of women in psychopathy.

Psychasthenic woman

Indecisive, insecure psychasthenics are notorious and extremely painfully perceive criticism addressed to them. They are not able to defend their position and do not have their own point of view. They are highly valued by management at work, as they are not able to say “no” and refuse additional loads.

Asthenic psychopathy

The hallmarks of this type of psychopathy are commitment to family and close people, sensitivity to other people's experiences, altruism and complete dedication, without demanding anything in return. The reverse negative side is suggestibility, painful attachment to the object of one's love, dependence on someone else's opinion. This type of women is characterized by low working capacity and unwillingness to bother themselves with everyday trips to work.

Timid and shy, such women make ideal wives in the future, ready to unquestioningly obey their man and follow him even into exile.

Manifestations of excitable psychopathy

The excitable form of pathology is accompanied by irascibility, increased aggression, unstable emotional background. Symptoms of the disorder are expressed in abnormal behavior and the need to conflict with others. This makes it difficult to create family relationships, work and social adaptation. But among women of this type there are those who get along well with the team, arrange personal life and raise children.

Unstable psychopathy

The emotional lability of this type of mental deviation is harmoniously combined with weak will and inability to control one's behavior. Women with an unstable form of psychopathy have antisocial and immoral behavior, sexual emancipation, criminal tendencies and substance abuse. Men are ready to be carried away by such a lady and make a couple of adventures, but they prefer to commit themselves and give their hand and heart to mentally balanced representatives of the beautiful half of humanity.

Diagnostics

This disease can be diagnosed if the patient has three or more of the following:

• indifference and apathy towards others, inability to experience and sympathy, callousness;
• rejection of social attitudes and norms and unwillingness to bear responsibility for their actions;
• signs of social maladaptation, expressed in the inability to build relationships with people;
• life for the sake of his desires, for the implementation of which the patient is ready to show aggression, cruelty and violence;
• lack of guilt or shame for the actions committed;
• an increased degree of conflict and the need to blame others for everything;

Symptoms of a psychopathic disorder can manifest themselves in the actions and actions of an individual:

• frequent offenses that can result in arrests or jail time;
• lying for personal gain, hypocritical behavior, lack of morality;
• outbursts of aggression, impulsiveness, insults and bullying of people that can lead to fights;
• lack of self-preservation instinct, desire to feel adrenaline and put your life and the lives of others at risk;
• irresponsibility, financial debts, neglect of work, misappropriation of other people's property.

Treatment

Prevention of symptoms, first of all, is aimed at changing the social components of the individual: taking measures to educate in the family, in educational institutions, assistance in establishing strong ties with people, employment corresponding to the intellectual and mental level patient.

Pathology diagnosed by a specialist, in addition to social impact, includes psychotherapeutic methods of treatment: hypnosis, family therapy, group therapy, autotraining. Medical forms of treatment are also actively used, in which patients are prescribed psychotropic drugs and antidepressants.

The prescribing specialist takes into account the individual characteristics of each patient, the degree and type of mental disorder.

Psychopathy is not a disease in the usual sense, but this does not mean at all that this form of mental disorder does not require medical supervision and intervention. Therefore, it is worth abandoning self-treatment and entrusting your mental health to a psychiatrist certified in his field.

Psychopathies are abnormal personality variants or pathological characters, in which there is a lack of some and an exaggerated development of other character traits.

Such an uneven development of individual characterological properties - disharmony of the psyche - is the main symptom of psychopathy and manifests itself from an early age. It concerns, first of all, the emotional-volitional qualities of a person with the relative preservation of intellectual abilities. Psychopathies arise on the basis of a congenital inferiority of the nervous system, the cause of which may be heredity, harmful effects on and, etc. However, the formation and identification of psychopathy largely occurs under the influence external environment, i.e., improper upbringing, negative environmental influences, psychogenic injuries, somatic diseases.

From (see) psychopathy differs in intellectual safety; from mental illness - the absence of a growing personality defect; from neuroses - by its irreversibility. From true or constitutional psychopathy, it is necessary to distinguish psychopathic states - persistent character anomalies that occur during life after various diseases (brain injuries, epidemic, infectious diseases, etc.).

Forms of psychopathy are distinguished mainly on the basis of the predominance of certain pathological character traits.

Asthenic psychopaths characterized by increased susceptibility, timidity, indecision, as well as mild mental and physical exhaustion. They are easily, though briefly irritated, incapable of prolonged effort and assiduous work. Frequent disorders sleep, appetite and activity disturbances gastrointestinal tract make them show increased attention to your physical health. Low mood prevails.

excitable psychopaths(some call them epileptoid psychopaths) are characterized by excessive irritability, reaching in some cases attacks of frenzied rage. For a trifle, such persons can inflict insults, beatings, even commit murder. Such states arise in them especially easily during periods of change of mood, usually manifested by melancholy and anger. These people are rude, vindictive, stubborn, inclined to reckon only with their own opinion, despotic and absurd. Among them there are often people who abuse alcohol or drugs, gamblers.

Timopathy- The main symptom of this group of patients are permanent mood changes. Hypertimics - are distinguished by a constantly elevated mood, optimism, often a careless attitude to what is unlawful, as well as an excess of energy, enterprise, great efficiency, which, however, can be scattered, and therefore the work they have begun is often not brought to an end. These people are mobile, sociable, often unceremonious in handling. They like to argue, easily get irritated, but quickly calm down. Hypotimics - persons with a constantly lowered background of mood, seeing only negative in the environment, dull or gloomy pessimists. They are always dissatisfied with everything and, first of all, by themselves, they easily fall into despair. Uncommunicative, uncommunicative, do not like to draw attention to themselves and talk about themselves. Outwardly, they often look slow, gloomy and preoccupied.

Reactive-labile psychopaths are distinguished by a very changeable mood, the changes of which usually depend on external, but often the most insignificant reasons. Therefore, during the day they have many times a good mood can be replaced by a depressed one.

Psychasthenic psychopaths(psychasthenics) are distinguished by anxiety, self-doubt, a tendency to constant doubts and self-examination. Every upcoming action causes them reflections, sometimes painful. Often they have a variety of obsessive states. The future is always drawn to psychasthenics full of difficulties and failures, and therefore it is more significant for them than what is happening in this moment. In dealing with people, they are shy and fearful. Formerly a group psychasthenic psychopaths were designated by the concept of "psychasthenia".

Hysterical psychopaths- strive to always appear to others as more significant personalities than they really are. At the same time, they themselves are convinced that they have various non-existent virtues and constantly strive to attract attention to themselves. They are characterized by posturing, a penchant for fantasies and lies, capriciousness and variability of mood. Their affections and experiences are usually devoid of depth, and their judgments and actions depend entirely on random circumstances, and therefore can be diametrically opposed. Stubbornness and intractability are combined in them with increased suggestibility.

Schizoid psychopaths are distinguished by isolation, secrecy, lack of need to communicate with people. At the same time, you can often find a rich inner life in them, manifested in fantasies, introspection, analysis of what is happening around them, although outwardly they may seem indifferent to what surrounds them. They are characterized by increased resentment and vulnerability when it comes to themselves, but at the same time they often show emotional coldness to the most ordinary human experiences.

Paranoid psychopaths characterized by self-confidence, increased self-esteem, perseverance, stubbornness. They are alien to doubt and hesitation. These are people of extremely narrow outlook, extremely one-sided in judgments and evaluations, prone to fixing attention on a small number of ideas, which then begin to dominate in their minds, crowding out everything else. Such ideas can be invention, the fight against imaginary violations, jealousy, love claims, etc. To implement them, paranoid psychopaths show unusual persistence, and failure only increases it. They often develop litigious behavior.

Under the influence of external factors - psychogenic or somatic, and sometimes without visible external cause psychopaths have different clinical manifestations acute and protracted reactive states (see), neurotic reactions(see neurosis), depression. These transient mental disorders are referred to as the so-called dynamics of psychopathy.

Of great importance in the prevention of psychopathy are proper upbringing and professional orientation corresponding to the characteristics of a pathological personality. In the treatment of psychopathy is of great importance (see), as well as treatment (see). Psychopaths during periods of deterioration need observation and treatment by a psychiatrist and a neurologist. In some cases, treatment in a psychiatric hospital is indicated.

Psychopathies (from the Greek psyche - soul, mental properties and pathos - suffering, illness; synonym: pathological characters, constitutional psychopathy, abnormal personality variants) - characterological features of the personality (the formation of which occurs from the moment of its formation), expressed in disharmony mainly emotionally - strong-willed properties with relative safety of intellect; these features are pathological character, since they prevent such subjects from adapting to the external environment painlessly for themselves and others.

Criteria for the concept of "psychopathy". The pathological properties inherent in psychopaths determine the entire structure of the personality and are more or less permanent. The existence in the psyche of a particular subject in general of any individual elementary irregularities and deviations does not yet give grounds for classifying him as a psychopath (P. B. Gannushkin). The practical criterion of psychopathy is the following: psychopathic personalities are such abnormal personalities, from whose abnormality either they themselves or society suffer. Psychopathies differ from oligophrenia by the absence of congenital mental deficiency (among psychopaths there are also gifted people). From mental illness with a progressive course (schizophrenia, epilepsy, organic diseases) psychopathy is distinguished by the lack of progression with the development of dementia, an irreversible personality defect.

In the past, so-called degenerative psychoses were classified as psychopathy. This term is not currently used as obsolete. Formally, degenerative psychoses are brought together with psychopathy by the genetic-constitutional factor of etiology inherent in both. Currently, these psychoses are predominantly classified as familial (hereditary aggravated) schizophrenia, proceeding sluggishly, with psychopathic changes that are irregularly interrupted by acute attacks (“delusional outbursts of degenerates”, described by old authors).

Psychopathies should also be distinguished from psychopathic states after traumatic brain injury, infectious diseases, CNS intoxications, and endocrinopathies (see Endocrine Mental Syndromes). An example of psychopathic changes are character disorders in adolescents who have had epidemic encephalitis. Significant for differential diagnosis has the establishment of the fact that before the appearance of psychopathic changes, the development of the personality proceeded normally, the changes arose after the illness. Psychopathies differ from neuroses in the general disharmonious disposition of the personality.

Psychopathy is characterized by underdevelopment of some or exaggerated development of other properties that every healthy person has, but in a more harmonious combination (E. A. Popov). In other words, psychopathy is characterized by a partial delay in the development of the personality (partial dysontogeny). It manifests itself mainly in the field of emotions, will, drives in the form of partial infantilism (juvenilism), asynchrony, unevenness, developmental delay and leads to the formation of pathological congenital features of the nervous system with persistent disturbances in the ratio of basic properties and in the interaction of signaling systems, cortex and subcortex.

Etiology. Psychopathies are polyetiological. Causes of partial dysontogeny can be hereditary factors, intrauterine exposure to hazards on the embryo and fetus, birth trauma, pathology of the early postnatal period. Underdevelopment, childishness of the psyche is manifested in increased suggestibility, a tendency to exaggeration and overdeveloped fantasy in hysterical subjects, in emotional instability in emotively labile subjects, in weakness of will in unstable psychopaths, in immature thinking with childlike features, subject to the power of affects, in paranoid psychopaths. Great importance in the development of psychopathy unfavorable environmental conditions; wrong upbringing, negative influences, psychogenic trauma can exacerbate psychopathic traits. According to O. V. Kerbikov, in some cases, the leading factor in the development of psychopathy is the constitutional factor (“nuclear psychopatin”), in others, the factor of the psychogenic impact of the environment (“pathocharacterological development”).

Classification and symptoms. There is no generally accepted classification of psychopathy. In the light of the doctrine of the types of higher nervous activity, the following main types of psychopathy are distinguished (however, in addition to the "pure" types of psychopathy, there are also transitional forms).

Hypothymic (constitutionally depressive) psychopaths - persons with a constantly low mood, born pessimists, with a sense of inferiority, dissatisfied with themselves, incapable of prolonged volitional tension, easily falling into despair, incapable of initiative, very sensitive to troubles, seeing everything in a gloomy light, slow, outwardly gloomy, gloomy and not talkative.

Hyperthymic (constitutionally excited) psychopaths are persons with a constantly elevated mood, conceit, sociable, active, mobile. They are distinguished by superficiality and instability of interests, distractibility. Their exaggerated plans are rarely carried through to the end. Their sociability turns into excessive talkativeness and a constant need for entertainment. They do not distinguish between the permitted and the forbidden. Many of them are prone to deceit and boasting, while others are dominated by pronounced self-conceit and a certain irritability, which leads them to frequent disputes ("unbearable debaters"), and in case of objections - to outbursts of anger.

Emotively labile (reactively labile) psychopaths are characterized by extreme mood volatility, which fluctuates over the most insignificant occasion. A sharp remark, a memory of a sad event, a thought of impending trouble cause depression. Such personalities often give the impression of "capricious touchy"; they are distinguished by a richness of emotional nuances, mobility of feelings, they react heavily to mental trauma with pathological reactive states.

Asthenic (constitutionally nervous) psychopaths are characterized by a combination of mental excitability, irritability, sensitivity with increased exhaustion and fatigue. With the predominance of exhaustion, general lethargy, inability for prolonged effort and diligent work, indecision, absent-mindedness, and a tendency to hypochondria appear; the mood is usually depressed. With the predominance of excitability - irritability, a pronounced sense of one's own insufficiency, combined with excessive egocentrism, increased self-esteem, which can lead to clashes with others. Common to asthenics is a rapid drop in productivity, as a result of which they work irregularly, in impulses, often start well, but quickly give up, which gives reason to accuse them of laziness. Many of them are timid, shy, extremely sensitive (“mimosa-like”).

Psychasthenic psychopaths - see Psychasthenia.

Excitable (explosive) psychopaths are characterized by extreme irritability, reaching fits of rage, and the strength of the reaction does not correspond to the strength and quality of the stimulus. On an insignificant occasion, such persons can insult, make a scandal, become aggressive in anger, can beat and injure, do not stop even before killing; therefore, excitable psychopaths are often found in forensic psychiatric practice. They are characterized by bouts of mood disorder (dysphoria) in the form of malicious longing, sometimes with an admixture of fear. They are prone to alcohol and drug abuse. These are people of one-sided, sthenic (exciting) affects, intolerant of the opinions of others, persistent, stubborn, domineering, picky, demanding obedience and submission. In some cases, malice and aggressiveness recede into the background for them, and an excessive force of inclinations appears (people of inclinations). Among them there are gamblers and spendthrifts, drunkards, dipsomaniacs (drunken drunkards), persons showing sexual perversion or suffering periodic attacks irresistible desire for vagrancy (P. B. Gannushkin).

Hysterical (hungry for recognition) psychopaths are characterized by the desire to appear in their own opinion and in the eyes of others as significant personalities, which does not correspond to real opportunities and the virtues of these subjects. Hysterical psychopaths are characterized by theatricality, posturing, often deceit, a tendency to deliberate exaggeration, excessive fantasy, demonstrative behavior. They combine increased suggestibility with stubbornness (hysterical negativism). The emotions of hysterical psychopaths are unstable and superficial; strong attachments are replaced by a thirst for recognition, actions designed for the viewer, for an external effect. They do not disdain any means to attract attention to themselves, they try to appear original, to amaze others with unusual manifestations of some kind of illness (scenes of seizures, fainting), play offended and offended, talk about their imaginary misfortunes and successes, do not stop at false accusations (for example, , accuse the doctor who treated them of attempting to rape) and self-incrimination (attributing to themselves crimes that they did not commit). Often, instead of a sober assessment of reality, fictions come forward, the real situation is replaced by a fictional one. The psyche of hysterical psychopaths is characterized by childishness, immaturity. Those of them who combine the thirst for recognition with excessively rich fantasies and deceit are called pseudologs (pathological liars). Most often, fictions concern them self. Such deceit is by no means always disinterested: many derive tangible benefits from their lies through scams, deceit, charlatanism, defrauding money from gullible people under various pretexts.

Paranoid psychopaths (paranoids) are characterized by a tendency to form overvalued ideas, which are characterized by the strongest affective coloring in comparison with all other thoughts and ideas, as a result of which these thoughts and ideas occupy a dominant position in the mental life and activity of the subject. The main overvalued idea of ​​the paranoid psychopath is the idea of ​​the special significance of his own personality. They are characterized by extreme egoism, excessive conceit, narrowness of outlook, persistence in defending their convictions, subordination of thinking to affects (only what the paranoid wants and likes is correct: “ desire is the father of thought). Paranoid psychopaths strive to see their desires come true and fight against those who oppose this, developing great energy, making money. a large number of enemies, part of the real ones, for the most part imaginary. Sometimes such a psychopath reveals a desire for invention, reformism, and everyone who does not agree with him becomes his enemy, since increased distrust and suspicion are generally characteristic of paranoid psychopaths. Non-recognition by others of the virtues of a psychopath leads him to clash with others, and he does not give in to persuasion, threats, or requests. From failures, he only draws strength for further struggle. His reaction can be expressed in the form of litigation (querulism): he starts a lawsuit, protests court decisions, appeals to the press, to the highest legislative instances. In addition to subordination to affects, the thinking of a paranoid psychopath is characterized by reasoning, expressed in an inclination to various kinds of abstract constructions, and what still needs to be proved is taken as proven.

Unstable (weak-willed) psychopaths- weak-willed people who easily fall under the influence of the environment, especially a bad one, easily follow
bad examples, suggestible, malleable, without deep attachments, incapable of consistent purposeful activity, lazy and sloppy. Under the influence of a bad environment, they easily become an inveterate drunkard, abuse drugs. Education and organized work create conditions for controlling the behavior of a weak-willed psychopath and allow him to become a fairly useful member of society.

Schizoid (pathologically withdrawn) psychopaths are distinguished by isolation, secrecy, a violation of contact with reality, which, due to their isolation, is perceived extremely subjectively and inaccurately. They have no affective resonance to other people's experiences, the understanding of which is difficult for them; it is difficult for them to find an adequate form of contact with others. A combination of increased sensitivity and vulnerability with emotional coldness, paradoxical emotional reactions and behavior are characteristic. In life, they are usually called eccentrics, originals, strange, eccentric.

About ratios individual forms psychopathy can be judged by the following statistics (taking into account subjects who have committed socially dangerous acts): among psychopaths who have undergone a forensic psychiatric examination at the Institute of Forensic Psychiatry. prof. Serbsky, excitable prevailed - 20.4% and hysterical - 17.2%.

The above classification of psychopathy is traditional, but not the only one. In one of the latest systematics of psychopathy [Petrilovich (N. Petrilowitsch, 1966)] the following groups of psychopaths are given: hyperthymic and expansive, depressive, asthenic, unstable mood and explosive, insecure, thirsty for recognition, weak-willed, fanatical and paranoid, anancastes ( obsessive), insensitive.

The Dynamics of Psychopathies expressed in mood swings, pathological psychogenic reactions (in response to mental trauma), in the pathological development of the personality (protracted reactive states), which leads to decompensation of psychopathy. In excitable psychopaths, violent affective discharges easily occur, in hysterical psychopaths - hysterical psychogenic psychoses. Paranoids (delusional syndromes) are more often observed in asthenic psychopaths, paranoids, hysterics, schizoids. Depressions appear especially easily in depressive and emotively labile psychopaths. Asthenic hypochondriacal development - in asthenic, emotively labile, hysterical. Overvalued invention, reformism, querulianism - among the paranoid. When evaluating psychopathy, it must be remembered that with age, the phenomena of partial developmental delay can be smoothed out. So, the developmental hysteria observed at puberty often levels out later, and the personality becomes quite balanced. As the personality develops, children's pseudology and partial disturbances of drives disappear. Volitional instability and psychopathic emotional coldness can be a transient state of adolescence.

The pathocharacterological development of the personality is distinguished, in which a close connection with environmental conditions (upbringing, family troubles, etc.) is found. Under the influence of environmental factors, the type of higher nervous activity is modified, its typical features are formed, which gradually become the same as in congenital constitutional psychopathy, which is the basis for the formation of a certain structure of a psychopathic personality. For example, the formation of asthenic psychopathy can be facilitated by an environment of constant humiliation and punishment (O. V. Kerbikov).

A practical doctor must have knowledge of the clinic and the dynamics of psychopathy to such an extent that he can diagnose it and refer the patient for treatment and dynamic observation to neuropsychiatric dispensaries.

Treatment and prevention psychopathy include psychotherapy (see), educational activities, occupational therapy, physiotherapy, drug treatment. Of great importance are the correct working regime and the correct professional orientation, which contribute to necessary training nervous processes psychopath. Drug treatment is of secondary importance and must be strictly individualized; a single scheme cannot be given. With dysphoria, states of affective tension and anxiety, librium (elenium), meprobamate are indicated. Affectively excitable prescribe chlorpromazine, reserpine, with depressive mood swings - tofranil (melipramine) with meprobamate.

Forensic psychiatric examination. In most cases, psychopaths are recognized as sane. Only in some cases (for example, severe asthenic psychopathy and paranoid) is the degree of psychopathy so deep that the psychopath is recognized as insane.