Psychopathies are personality abnormalities, pathological conditions characterized by instability, imbalance of mental processes, and insufficient social adaptation. They are not a disease in the strict sense of the word, since in relation to them it is impossible to talk about the beginning, course and outcome. This does not mean that psychopathies are devoid of dynamics, but it is peculiar in nature. P.B. Gannushkin, who showed that psychopathy has a state of compensation and decompensation.
Decompensation of psychopathy can be caused by biological factors (for example, it is often observed at the age of puberty) and socio-environmental. In a state of compensation, psychopathic personalities are fully adapted to life in society and to work, they are socially adapted; The state of decompensation is primarily characterized by social maladaptation.
The main criteria for psychopathy were developed by Soviet psychiatrists P. B. Gannushkin (1933) and O.V. Kerbikov (1961). These include the following:
1) the severity of the pathological properties of the personality to the extent of violation of social adaptation; 2) the relative stability of the pathological properties of the personality, their low reversibility; 3) the integrity, totality of pathological personality traits that determine the entire mental appearance.
Violations of social adaptation are manifested in the form of inadequate in form and severity of reactions to the environment. Psychopathic personalities that reveal traits of a pathological nature coexist poorly in society and become a source of conflict.
Psychopathic individuals make up about 5% of the total number of patients registered in neuropsychiatric dispensaries and admitted to psychiatric hospitals.
heredity psychopathy care treatment
The role of heredity and somatogenic factors
Constitutional-hereditary, exogenous-organic, endogenous and socio-environmental factors take part in the formation of psychopathy. The importance of these factors in the development of various forms of psychopathy is not the same, which gave the basis to O.V. Kerbikov to offer their genetic systematics, according to which there are two main groups of psychopathies: nuclear (constitutional, true) and acquired. The latter are divided into post-procedural (for example, personality psychopathization that occurred in connection with the schizophrenic process after it is stopped), organic (psychopathic changes due to transferred meningitis, meningoencephalitis, traumatic brain injury, etc.) and marginal, in which psychopathy is formed in connection with an unfavorable prolonged course of neurosis, reactive psychosis, in the presence of a long-existing, traumatic psyche situation. The formation of regional psychopathies goes through the pathological development of personality.
A significant role in the formation of psychopathy is played by improper upbringing. Soviet psychiatrists V.Ya. Gindikin I.V. Guriev gave a description of the main types of improper education, which lead to the formation of a pathological nature in a child. These are: the “idol of the family” the child in the family adore, praise, demonstrate his exclusivity, fulfill any of his whims, do not accustom to working life; hyper-custody – they pay excessive attention to the child, try to make him a “child prodigy”, deprive them of their independence, and restrict communication with other children; hypo-care – insufficient attention to the child, he is left to his own devices, no one is engaged in his upbringing; “Cinderella” – the child is completely devoid of affection, he is systematically humiliated, insulted, kept in fear, deprived of pleasures; “Hedgehogs” – systematic threats and beatings of the child, adult imposing their will on the child, lack of warmth, affection, encouragement.
According to clinical features, the following options (types) of psychopathy are distinguished.
Excitable (epileptoid) psychopaths are characterized by increased excitability, hot temper, increased irritability, frequent mood swings (dysphoria), a tendency to conflict with others, in the family and in the work collective. Excitable psychopaths easily have bouts of anger, while they are rude, not delicate enough, and poorly control their actions. Antisocial, aggressive acts in them are especially often observed in connection with the intake of alcohol. Usually in a calm state, they are pedantic, thorough, somewhat tightly mobile in their mental manifestations, mating.
Asthenic psychopaths are characterized by the ease of occurrence of states of fatigue, lethargy, timidity. They are overly sensitive to grievances and grievances, overly sensitive. Even minor troubles and more or less complicated situations discourage them. Asthenics are prone to low mood, introspection, are not confident in themselves, do not cope well with the physical and mental stresses that cause them general weakness, fatigue, and headache.
Psychasthenic psychopaths are distinguished by anxious-suspicious character traits, increased timidity. They, like asthenics, are overly sensitive, easily vulnerable, and over-exhausted. A characteristic feature is a highly developed sense of duty, honesty, scrupulousness. Psychasthenics pay a lot of attention to the analysis of their actions, the justification of their correctness, justice. Pangs of conscience and reproaches against them easily arise. Having done some work, they repeatedly check and double-check its quality. Usually in the evening this tendency of psychastenics to “dig” in themselves is most pronounced: a careful analysis of everything done and said during the day prevents them from falling asleep. In psychastenics, it is especially easy to have all kinds of obsessions. Psychasthenics tend to believe in good and bad omens; they often observe protective rituals. In a state of compensation, psychastenics are good workers, exceptionally conscientious and pedantic. With the onset of decompensation, their ability to work decreases mainly due to a decrease in quantitative indicators – self-doubt builds up, which makes the psychasthenic again and again check the quality of his work.
Hysterical psychopaths are overly emotional. In behavior, they are demonstrative, theatrical, always striving to be in the spotlight. This is often associated with their inherent deceit, a tendency to fiction, fantasies. This desire for pathological fantasies is called fantastic pseudology. Wanting to attract attention, tantrums sometimes go to self-harm. So, a certain patient was repeatedly treated in the therapeutic and surgical departments for various internal bleeding. It was not possible to establish their cause in any way, and only after she was supervised by the advice of a psychiatrist did it become clear that she was hiding a needle in the mattress from a syringe, which under her blanket inflicts damage on her skin, and draws blood into her mouth and swallows it, either simulates bleeding from the mouth. Tantrums are characterized by increased suggestibility, are prone to self-hypnosis. Therefore, auto-suggestive paralysis, paresis, and other manifestations that resemble the symptoms of a number of somatic diseases easily arise in them. There are even descriptions of hysterical, autosuggested pregnancy.
Schizoid psychopaths differ in isolation, they are as if fenced off from the surrounding reality, autistic. They are characterized by increased sensitivity to various adverse psychogenic factors and at the same time emotional coldness. Schizoids are immersed in the world of their own experiences and have almost no interest in the surrounding reality. Often they give the impression of eccentric people “not of this world”, incapable of solving important everyday problems.
Unstable psychopaths include individuals whose behavior is determined by their environment. In a prosperous environment, they may not violate generally accepted norms of behavior, work in good faith. However, such individuals are easily influenced by antisocial elements, become involved in the company of criminals and at the same time they are attracted to alcohol and drugs. They are characterized by weakness of higher emotional-volitional impulses, increased suggestibility, inconstancy. Some psychiatrists call unstable psychopaths “limp.”
Paranoid psychopaths include overly suspicious, fanatical, or prone to litigation people. Paranoid psychopaths are suspicious, everywhere they see an unfriendly attitude, intrigues directed against them, an attempt to belittle authority, to take the patient’s place at work. They are extremely distrustful, prone to the easy emergence of delusional ideas of jealousy. An excessive desire for justice is inherent in possessive psychopaths. Starting with some grounded grudge, they fill up higher authorities with an avalanche of complaints against offenders and demand their punishment in court. They do not stop their activities even in those cases when the reason for it has lost its relevance. For example, a litigious psychopath (querulent) has already received a new apartment, but continues to write numerous complaints about his former neighbors, filed them with a friendly and people’s court, etc.
For paranoid psychopaths, the ease of the formation of delusional (paranoid) syndromes is characteristic of the type of development. In such cases, they talk about paranoid personality development. This is most often a delirium of jealousy, invention, reformism or Querulent (litigious) development. Such a personality development is considered as a psychotic state, and upon forensic psychiatric examination such persons are recognized as insane, although in most cases psychopathic individuals who committed offenses are recognized as responsible.
In the prevention of psychopathy, it is very important to notice deviations in the character and behavior of the child as early as possible and take appropriate medical and pedagogical measures – rationally organize his life, study and work, place him in a healthy, stable team. Hard-educated psychopathic children are placed in special educational institutions. In cases of severe social decompensation, psychopaths are hospitalized in a psychiatric hospital.