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Haltlose type personality disorder


Personality disorder classification - wikidoc

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]

Overview

There are two approaches used to classify personality disorders; categorical and dimensional. Categorical classification is based on distinct operational criteria depending on behavioral characteristics. DSM-5 and ICD-10 both uses this approach. As compared to this, dimensional classification is based on the personality traits and using a quantitative distinction. It places normality at one end and disorder at other. DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics: CLUSTER A is defined as odd and eccentric and include Paranoid, Schizoid, and Schizotypal. CLUSTER B is defined by erratic and emotional behavior and includes Antisocial, Borderline, Histrionic and Narcissist. CLUSTER C PDs patients are anxious and fearful and incorporate Avoidant, Dependent and Obsessive-Compulsive. ICD-10 classifies into 3 clusters as well, which are A, Odd/eccentric and includesParanoid and Schizoid, B, Dramatic and includes Dissocial, Emotionally unstable borderline type, Emotionally unstable impulsive type and Histrionic, and C, Anxious/fearful that include Anxious, Dependent and Anankastic.

Classification

List of Personality Disorders Defined in the DSM

  • DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics:
    • CLUSTER A: odd and eccentric
      • Paranoid-distrust and suspiciousness
      • Schizoid-detachment from social relationships
      • Schizotypal-distortion in interpersonal relationships and cognition, and behavioural eccentrism
    • CLUSTER B: erratic and emotional
      • Antisocial-disregard and violation of rights of others
      • Borderline-instability in interpersonal relationships, and impulsivity
      • Histrionic-eccessive emotionality and attention-seeking behaviour
      • Narcissist-grandiosity and lack of empathy
    • CLUSTER C: anxious and fearful
      • Avoidant-social inhibition and fear of criticism
      • Dependent-submissive and excessive need for reassurance
      • Obsessive-Compulsive-preoccupation with perfectionism and orderliness
  • ICD-10 classifies into 3 clusters as well, which are as follows:
    • A: Odd/eccentric
      • Paranoid
      • Schizoid
    • B: Dramatic
      • Dissocial
      • Emotionally unstable borderline type
      • Emotionally unstable impulsive type
      • Histrionic
    • C: Anxious/fearful
      • Anxious
      • Dependent
      • Anankastic

The DSM-IV lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled Personality Disorder NOS (Not Otherwise Specified).

Cluster A (odd or eccentric disorders)

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic disorders)

  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

Cluster C (anxious or fearful disorders)

  • Avoidant personality disorder
  • Dependent personality disorder (not the same as Dysthymia)
  • Obsessive-compulsive personality disorder (not the same as Obsessive-compulsive disorder)
Revisions and Exclusions from Past DSM Editions

The revision of the previous edition of the DSM, DSM-III-R, also contained the Passive-aggressive Personality Disorder, the Self-defeating Personality Disorder, and the Sadistic Personality Disorder. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.

World Health Organization

The ICD-10 section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others. [1]

The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[2]

There is also an 'Other' category involving conditions characterized as eccentric, haltlose (derived from "haltlos" (German) = drifting, aimless and irresponsible),[3]immature, narcissistic, passive-aggressive or psychoneurotic. An additional category is for unspecified personality disorder, including character neurosis and pathological personality.

There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.

Other

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "proposed diagnostic categories needing further study" without specific criteria, namely sadistic personality disorder (a pervasive pattern of cruel, demeaning and aggressive behavior) and Self-defeating personality disorder (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).[4] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[5]

Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual[6]
DSM-I DSM-II DSM-III DSM-III-R DSM-IV(-TR) DSM-V Proposals
Personality
Pattern disturbance:
Inadequate Inadequate
Schizoid Schizoid Schizoid Schizoid Schizoid
Cyclothymic Cyclothymic
Paranoid Paranoid Paranoid Paranoid Paranoid
Schizotypal Schizotypal Schizotypal Schizotypal*
Personality
Trait disturbance:
Emotionally unstable Hysterical Histrionic Histrionic Histrionic
Borderline Borderline Borderline Borderline
Compulsive Obsessive-compulsive Compulsive Obsessive-compulsive Obsessive-compulsive Obsessive-compulsive
Passive-aggressive:
Passive-depressive subtype Dependent Dependent Dependent
Passive-aggressive subtype Passive-aggressive Passive-aggressive Passive-aggressive
Aggressive subtype
Explosive
Asthenic
Avoidant Avoidant Avoidant Avoidant
Narcissistic Narcissistic Narcissistic Narcissistic**
Sociopathic personality
Disturbance:
Antisocial reaction Antisocial Antisocial Antisocial Antisocial Antisocial-psychopathic
Dyssocial reaction
Sexual deviation
Addiction
Appendix: Appendix: Appendix:
Self-defeating Negativistic Dependent
Sadistic Depressive Histrionic
Paranoid
Schizoid
Negativistic
Depressive

* – Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.
** – Originally proposed for deletion; status remains unclear for DSM-5.

Millon's Description of Personality Disorders

Psychologist Theodore Millon, who has written numerous popular works on personality, proposed the following description of personality disorders:

Millon's brief description of personality disorders[7]
Type of personality disorder Description
Paranoid Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.
Schizoid Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor need human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.
Schizotypal Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs.
Antisocial Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.
Borderline Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods.
Histrionic Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention.
Narcissistic Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.
Avoidant Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.
Dependent Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.
Obsessive–compulsive Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive.
Depressive Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.
Passive–aggressive (Negativistic) Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.
Sadistic Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and closeminded.
Self-defeating (Masochistic) Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.

Additional Classification Factors

Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and attribution.[8]

References

  1. ↑ WHO (2010) ICD-10: Specific Personality Disorders
  2. ↑ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)". Apps.who.int. Retrieved on 2013-04-16.
  3. ↑ Langmaack, C. (2000). "'Haltlose' type personality disorder (ICD-10 F60.8)". The Psychiatrist. 24 (6): 235–236. doi:10.1192/pb.24.6.235-b.
  4. ↑ Fuller, AK, Blashfield, RK, Miller, M, Hester, T (1992). "Sadistic and self-defeating personality disorder criteria in a rural clinic sample". Journal of Clinical Psychology. 48 (6): 827–31. doi:10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2–1 Check |doi= value (help). PMID 1452772.CS1 maint: Multiple names: authors list (link)
  5. ↑ Millon, Theodore (2004) Personality Disorders in Modern Life, John Wiley & Sons, ISBN 0471668508.
  6. ↑ Widiger, Thomas (2012). The Oxford Handbook of Personality Disorders. Oxford University Press. ISBN 978-0199735013.
  7. ↑ Millon, Theodore (2004). Personality Disorders in Modern Life, p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.
  8. ↑ Murray, Robin M. et al (2008). Psychiatry. Fourth Edition. Cambridge University Press. ISBN 978-0-521-60408-6.

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What Was a Constitutional Psychopath?

Source: Gwendolyn Murray, used with permission

A student recently shared that in 1911, her relative was institutionally discharged with a diagnosis of Constitutional Psychopath. She wondered if it meant her ancestor was a socially corrupt, morally depraved individual, like what we call psychopaths today.

Not likely.

The usual definitions

To the uninitiated, "psychopath" is likely not reserved for someone with a debased relationship to society, as those in the psychology field know it.

Many readers have likely encountered "psychopath" or "psycho" being used as a catch-all for people acting in some psychologically-puzzling manner. This could range from the vexing behaviors of someone with severe OCD to Cluster B personality disorders. It's as if the prefix "psycho" is simply pop-culture shorthand indicating the observance of something psychologically askew.

In my classes and trainings, students often wonder how psychopath differs from sociopathy, the latter tending to be associated with antisocial personality disorder (APD). A raised hand often leads to, "Aren't they all the same?" Ostensibly, yes, but let's look at the nuance as it's accepted in the field.

APD, sociopath, and psychopath are a matter of synonym and degree. Antisocial personality disorder is just a modern term for sociopath (e.g., Millon, 2011; Shannon, 2019) in that it was thought to be more descriptive of the interactive style. In short, "antisocial" has nothing to do with social inhibitions like in social anxiety disorder; it means they do things in a fashion grossly against societal norms, usually in a marked morally bereft fashion, in order to meet their needs.

Psychopaths, on the other hand, don't just disregard and violate the rules of society and the rights of others. What they do is egregious and beyond disregard, it is entirely without conscience. "Without conscience" so aptly describes the condition that Robert Hare, Ph.D. (1999), used this as the title of his comprehensive book on the subject.

Johnson (2019) nicely discusses the psychopathic nuances by painting a picture of psychopaths as more predatory, emotionally desensitized, calculating, and conniving; there is a marked effrontery to the "normal" antisocial activity. He explained that those on the psychopathic end of the spectrum are thought to be born with abnormal brain development, influencing the severity of their personality problems.

It may help to illustrate that your garden variety thug or murderer would more likely be in the APD realm; Saddam Hussein, Jeffrey Dahmer, Eileen Wournos, and BTK would easily meet APD criteria, but in a much more malicious manner, earning them the category of psychopath.

Before psychopathy as we know it

APD/psychopaths as we now understand them have existed since time immemorial. From the biblical Cain to Vlad the Impaler, the latter impaling people and then putting them on display outside his castle to watch them suffer (Markarian, 2020), society has dealt with severely morally-defunct characters.

In their respective eras, such people were probably most frequently referred to as some derivative of "evil," though an ancient Greek, Theophrastus, categorized them as "the unscrupulous" in recognition of the pathological lack of empathy (Kiehl & Hoffman, 2011). Closer to our times, Pinel, in 1801, wrote that some patients had "insanity without delirium" (Millon, et al., 1998). By this, he meant they were impulsive and self-damaging with intact reasoning abilities; in short, this illustrates the calculated, negative behaviors without regard for consequence that psychopaths exhibit. Millon furthered that this conceptualization went on to be termed "moral insanity" given the value-laden bent of psychiatry at the time.

"Psychopath" wasn't always synonymous with social scourge

According to Kiehl & Hoffman (2011), the word psychopath didn't enter the scene until 1888 when the German psychiatrist J.L.A. Koch used the term psychopastiche, literally meaning "suffering of the soul." Surely, this was the root of "psychopathology" as in the examination of psychological sufferings/diagnoses, like the course some readers took in graduate school.

Soon, as pointed out by Millon (2011), a shorter version, "psychopath," became popular. It was a generalized term of the era for any "persistent styles of abnormal functioning ... of an ostensive organic nature." Essentially, it was a catch-all term for psychological pathology/behaviors so omnipresent they were assumed to have genetic/congenital roots. "Psychopath" had yet to be considered synonymous with unconscionable activity.

This was, however, the dawn of the study of psychopathology as we know it. Koch soon began to recognize nuances amongst the psychopastiche, and it could be argued that this led to opening the gates of personality disorder study.

Taking a step closer to our modern understanding of the term, in 1891 Koch, beginning to expand from the general "psychopath," suggested that "moral insanity" be replaced with "psychopathic inferiority." Koch preferred "inferior" as it indicated the personalities deviated unfavorably from the norm (Millon, 2011).

Source: Stux/Pixabay

Have we come full circle in understanding the causes of psychopathy?

Given the proximity of Koch's use of the terms "constitutional" and "inferiority," one could also hypothesize that though he didn't write it, "inferior" to Koch indicated some arrested component of brain development that encouraged those afflicted to never expand from the pure id state they were born with. Thus, they weren't able to assimilate to acceptable social mores and behaviors and, though he couldn't prove it at the time, Koch was perhaps precocious in his belief that there were significant neurodevelopmental components contributing to this morally depraved state, much as Johnson discussed evidence for in 2019.

Researchers (e.g., DeBrito et al., 2021; Tully et al., 2021) continue to inform us of the increasing evidence of significant neurodevelopmental underpinnings of psychopathy. DeBrito (2021) documented that structural and functional brain abnormalities in, for example, the prefrontal cortex and amygdala contribute heavily to "disruption in emotional responsiveness, reinforcement-based decision-making and attention," which are characteristic of psychopathy.

Modern conceptualization of "psychopathy" and importance of subtypes

Though our modern idea of APD/psychopathy was included in the term psychopathic inferior, Millon (2011) was quick to note that, upon closer look, this was only a small portion of what Koch had in mind. He included numerous subtypes, some marked less by significant moral depravity than by high sensitivity, eccentricities, and impulsive fury.

It's interesting to consider that these composite states Koch noticed were primitive recognitions of what we now call mixed personality disorders, as written about in "Can a Person Have More than One Personality Disorder?" It is not unheard of, for example, that the eccentric paranoid or schizotypal personalities have an antisocial streak, as illustrated, for example, in Yudofsky (2005).

Eventually, the "inferiority" term did not sit well due to its belittling intonation (Millon, 2011), and, in America, "constitutional psychopathic state" and "psychopathic personality" became the preferred term for what we would now pointedly refer to as a psychopath. Provided the fascination with understanding this "insane/non-insane" disposition (Hulbert, 1939), differentiating and dissecting psychopathic (as we know it) presentations persisted.

In the 21st century, Millon (2011) listed seven distinct subtypes, including not only the more traditional malevolent sort but an adventurous type he called the "disaffected aggrandizing subtype. " This would align with what early on was called a Haltlose personality, a morally-devious modus operandi superimposed on a hypomanic personality. In short, a personality in regular need of new stimulation, impulsivity, and drifting in their antisocial pursuits to please themselves.

Source: Geralt/Pixabay

More recently, much like Koch, researchers continue to express interest in the utility of psychopathy subtypes. For example, Hicks and Drislane (2018) noted, "subtypes can help to inform the understanding of psychopathy and antisocial deviance more generally." This obviously can help with matters such as profiling, public safety, and further research on developing interventions, and, perhaps, eventually, even prevention, of psychopathic behavior.

All things considered

Ironically, it seems that the more it was attempted to neatly compartmentalize personality pathology into super-distinct disorders, the more evidence mounted for understanding them as more multifaceted and nebulous, leading to alternative conceptualization proposals (e. g., APA, 2013; Hopwood et al., 2018).

At the heart of these alternative proposals is understanding personality pathology in a more dimensional or trait-domain manner. Rather than taking note of defining symptoms of, say, Histrionic personality disorder, and leaving it at that, a dimensional or trait lens could encourage observation for clinically-relevant things that might be missed if a clinician is trying to neatly categorize the patient's diagnosis. A prime example is someone with marked histrionic characteristics who, upon closer examination, has strong dependency needs, as written about in "Why Some Adults May Still Have an Infantile Personality." Clearly, there can be treatment implications to nuance.

Disclaimer: The material provided in this post is for informational purposes only and not intended to diagnose, treat, or prevent any illness in readers. The information should not replace personalized care from an individual's provider or formal supervision if you’re a practitioner or student.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

De Brito S.A., Forth A.E., Baskin-Sommers A.R., Brazil I.A., Kimonis E.R., Pardini D., Frick P.J., Blair R.J.R., & Viding E. (2021). Psychopathy. Nature Reviews Disease Primers, 7 (1), 49. doi: 10.1038/s41572-021-00282-1.

Hare, R. (1999). Without conscience: The disturbing world of the psychopaths among us. Guilford.

Hicks, B. M., & Drislane, L. E. (2018). Variants (“subtypes”) of psychopathy. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 297–332). The Guilford Press. Abstract retrieved from APA PsycNet.

Hopwood, C. J., Kotov, R., Krueger, R. F., Watson, D., Widiger, T. A., Althoff, R. R., Ansell, E. B., Bach, B., Michael Bagby, R., Blais, M. A., Bornovalova, M. A., Chmielewski, M., Cicero, D. C., Conway, C., De Clercq, B., De Fruyt, F., Docherty, A. R., Eaton, N. R., Edens, J. F. , Forbes, M. K., … Zimmermann, J. (2018). The time has come for dimensional personality disorder diagnosis. Personality and mental health, 12(1), 82–86. https://doi.org/10.1002/pmh.1408

Hulbert, H. (1938). Constitutional psychopathic inferiority in relation to delinquency. Journal of Law and Criminology, 2 (1), 3-21.

Johnson, S. (2019). Understanding the violent personality: Antisocial personality disorder, psychopathy, & sociopathy explored. Forensic Research & Criminology International Journal, 7(2), 76-88.

Kiehl, K. A., & Hoffman, M. B. (2011). The criminal psychopath: History, neuroscience, treatment and economics. Jurimetrics, 51, 355–397.

Markarian, T. (2020, March 28). 15 of the most famous psychopaths in history. Reader's Digest. https://www.rd.com/list/most-famous-psychopaths-in-history/.

Millon T., Simonsen, E., & Burket-Smith, M. (1998). History and viewpoints. In Millon T., Simonsen, E. , Burket-Smith, M, & Davis, R. (Eds.). Pychopathy: Antisocial, criminal and violent behavior. Guilford.

Shannon, Joseph W. (2019, October 25). Character flaws: How to understand and navigate relationships with high conflict clients. Brattleboro Retreat, Brattleboro, Vermont.

Tully, J., Frey, A., Fotiadou, M., Kolla, N., & Eisenbarth, H. (2021). Psychopathy in women: Insights from neuroscience and ways forward for research. CNS Spectrums, 1-13. doi:10.1017/S1092852921001085

Yudofsky, S. (2005). Fatal flaws: Navigating destructive relationships with people with disorders of personality and character. American Psychiatric Publishing.

Personality disorder - causes, types, types, symptoms, signs, diagnosis (test), treatment

Features

Causes

Symptoms

Diagnosis

Treatment

Personality disorder, the causes of which are not always obvious, used to be called constitutional psychopathy. This is a mental disorder that accompanies a person throughout life. The main changes affect the character, thinking and behavior, which causes difficulties in social adaptation. The psychopath breaks the norms and rules accepted in the social environment. The severity of the changes is different - from everyday inconsistency to criminal acts with subsequent restriction of freedom.

Features of personality disorder

World statistics of diseases states that about 10% of the world's population suffers from psychopathy. Each type of personality disorder accounts for an average of about 2% of cases. A distinctive feature is that the first manifestations are noticeable already in early childhood, practically unchanged throughout life.

Psychopathy is not quite a disease in the usual sense of the word. The disease has a beginning, progression and consequences in the form of organic (irreversible) disorders of the function and structure of organs. Psychopathy is a special, painful personality structure that does not undergo any changes in the changing conditions of life. This prevents the psychopath from adapting to the environment. Relatively speaking, a person with a personality disorder will behave in the same way with a first grader and a scientist, in a tram and a living room, not realizing that different people and situations require different behavior.

The problem of psychopathic personalities, anomalies of character was thoroughly studied by the Soviet and Russian psychiatrist Pyotr Borisovich Gannushkin, whose definitions of personality disorders have not lost their relevance to this day.

Causes of personality disorders

Experts consider several main reasons:

  • genetic factor - practice shows that pathological character traits are found in representatives of different generations of the same family;
  • an established vicious system of interpersonal relationships - the child does not have before his eyes an example of a normal, sympathetic and empathetic family;
  • a psychopathic pattern (template, model) of behavior that the child unconsciously copies due to the lack of other examples;
  • pathological pregnancy, difficult childbirth and diseases of early childhood;
  • childhood abuse, physical or psychological;
  • difficult childhood, unfavorable developmental conditions.

Researchers believe that genetic factors are of paramount, determining importance. This theory is confirmed by the twin method: identical brothers and sisters, separated in early childhood and raised in different families, behave exactly the same in adulthood. Twins who have never interacted with each other show the same types of personality disorder.

Personality disorder symptoms

Gannushkin identified 7 types of psychopathy. Since the 90s, when the 10th revision of the International Classification of Diseases, Injuries and Causes of Death came out, the condition has been called a personality disorder, but the essence has not changed. Each type of psychopathy has its own distinctive features.

Schizotypal personality disorder is distinguished by the minimization of social contacts, lack of need for communication, coldness, lack of empathy (the ability to empathize). Schizoids are attracted to fantasies, various distant theories, they are unable to perceive life directly, sensually. Teamwork is not for them, they can be more or less successful in individual activities. Their main feature is indifference, both to themselves and to others. Such people sincerely do not understand what pleasure and joy are, because they have never experienced them.

Bipolar personality disorder according to Gannushkin includes 3 types: depressive, agitated and cyclothymic. Depressives are lifelong pessimists who are able to see only sad, gloomy sides in all the diversity of life. Excited - easy-going, carried away, often unable to foresee the consequences of their actions. The vast majority of gamblers and swindlers are of this type. Cyclothymics combine both of the above features, they are characterized by undulating mood swings, lack of stable attachments, blurring and diversity of interests.

Dissociative identity disorder in Western culture is called a split identity. It is believed that several personalities coexist in one person, which are periodically activated. We have been using this diagnosis since 2000, but it does not take root well. Domestic psychiatrists consider this disorder a kind of psychological defense of a person who has experienced extreme, unbearably painful emotions. At the same time, a person perceives the events of his life as something that happened to others.

Narcissistic personality disorder refers to the Greek myth of Narcissus, a young man who preferred the love of a real girl to looking at his reflection in the water of a stream. Like the hero of a myth, a narcissist is convinced of his exclusivity and originality, and this applies to everything from appearance to achievements. The narcissist believes that real achievements are hindered by the envy of others who put up all sorts of obstacles. Own uniqueness requires constant confirmation, so the narcissist maintains relationships only with those who admire him.

Organic personality disorder - a consequence of damage to the brain tissue by various hazards: trauma, intoxication, infection. Such a disorder occurs in the clinic in patients who have had a stroke, encephalitis, in alcoholics and drug addicts. In the latter, the condition is aggravated by the consequences of closed craniocerebral injuries, which they receive when falling from a height of their own height in a state of intoxication.

In a mild form of the disorder, the patient is disturbed by frequent headaches, weakness, fatigue, tearfulness, intolerance to stuffiness, meteorological dependence. Over time, thinking is disturbed, thoroughness, viscosity, concentration on minor details joins. Such a patient cannot separate the main from the secondary, speech becomes impoverished, emotions coarsen, periods of an evil-dreary mood (dysphoria) occur. An intellectual decline occurs, the patient cannot cope with the previous work, criminal episodes with fights and bodily injuries to the “offender” are not uncommon.

Borderline personality disorder is manifested by unstable mood, fluctuating from overestimation of oneself to humiliation. Patients are impulsive, commit rash acts, anxious, suicidal. Any little thing causes a feeling of emptiness, fears of being unnecessary, "thrown out of life." This disorder is the basis for the formation of drug addiction and eating disorders.

Personality disorder diagnostics

It is desirable to carry out such a diagnosis as early as possible, because the disorder accompanies a person all his life. Problem children should be under the supervision of a child psychiatrist in order to overcome teenage difficulties with minimal losses. Even a single consultation with a specialist will allow parents to correct the behavior of the baby, as they will understand the motives of his actions.

A variety of tests for personality disorder are used in adolescents and adults. Popular tests based on the work of Eysenck, Beck, Freeman. The test is a questionnaire with several standardized answers, a lie scale is provided so that the subject cannot be misled. The tests are fairly objective and are widely used in the clinic.

Personality disorder treatment

The basis of treatment is the choice of a life path, profession and occupation suitable for the type of personality. This is where a clinical psychologist can help. An occupation corresponding to a personality type can make a person so successful that no one will notice the disorder.

In severe cases, when the time for professional orientation is missed, medications (antidepressants, tranquilizers, nootropics), psychotherapeutic methods, including psychoanalysis, are used. Treatment options for advanced personality disorders are limited, especially in patients with addiction or irreversible brain damage.

The best solution for suspected psychopathy is timely consultation with an experienced psychiatrist.

Article author:

Novikov Vladimir Sergeevich

psychotherapist, clinical psychologist, kmn, member of the Professional Psychotherapeutic League

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