Psychopathy in women, men and children

Until recently (more precisely, until the tenth revision of the disease classifier), both neuroses and psychopathies were considered within the framework of borderline mental disorders.

In the latest International Classification of Diseases, the usual borderline categories were replaced by the collective term "personality disorders". Pathological personality traits of a specific individual that cause suffering to him or the society in which he lives are classified as psychopathies. Note that we are talking about anomalies, not character traits.

Psychopathy is not a sanctioned name for a condition of a certain anomaly of human character. Psychopaths are often called excitable people, who react inappropriately and sharply to unpleasant events, who are not always able or willing to control their behavior. They cannot critically evaluate their not always adequate actions and look at them from the point of view of other people. However, such behavior can be a consequence of serious errors in upbringing and in a completely healthy person.

Is psychopathy a disease or a character trait?

For a long time, psychiatry ignored antisocial disorders; they were dealt with by criminologists and the judiciary. Psychopaths who did not cross the line of the law were considered people with a difficult character.

The term "psychopathy" itself means "disease of the mind", however, most experts do not consider it a common mental disorder.

Psychopaths think rationally and are well-oriented, their actions are sane, they know perfectly well what they are doing, at the same time, such actions are incompatible from the point of view of an ordinary person with a healthy mind.

The French psychiatrist F. Pinel, two centuries ago, describing the behavioral model of a psychopathic personality, called psychopathy “mental illness without insanity.”

People began to perceive psychopathy as a disease of the soul long ago, back in ancient times, but began to study it seriously in the second half of the last century, and with the advent of new diagnostic methods that allow scanning the brain, the development of genetics and neurobiology, it became possible to study the biological background of antisocial behavior.

With psychopathy, mental retardation does not progress, psychotherapy sessions allow patients to hone their ability to manipulate people. Psychopaths can hide their main mental anomaly - lack of empathy and absolute egocentrism, and do not dwell on it. Psychopathy is more difficult to recognize than other mental disorders. The court still does not condescend to these people, generally rightly believing that they are capable of being aware of their actions.

Personality disorders are currently classified as mental illnesses, but the line between illness and normality is very thin. It is believed that they are based on some kind of distortion in the development of the central nervous system, often not obvious, which is influenced by adverse external stimuli.

Pedagogical errors alone are not enough to form psychopathy. Explosive temperament and antisocial behavior are not grounds for classifying a person as a psychopath. For accentuated personalities whose deviations from the norm are sufficiently compensated and do not reach a pathological level, the diagnosis of psychotic disorder is also considered unjustified.

So psychopathy is a disorder of higher nervous activity, and therefore a disease, usually manifested in the absence of balance between the processes of excitation and inhibition, with a pronounced predominance of one of them.

Psychopathy is a whole group of personality disorders, there are many variants of patient behavior, depending on which different types of the disease are distinguished. The development of psychopathy usually occurs under the influence of external factors in people with hereditary or early age disordered activity of the central nervous system.

Among psychopaths, there are many people who have a good education, successful career growth, they are called socialized. A specific feature of psychopaths is considered to be intellectual preservation and the lack of ability to empathize with both negative and positive emotions of another person. This disease is not characterized by a progressive course with personality degradation and the development of dementia. Nevertheless, the normal intellect of a psychopath under the influence of unfavorable external factors dissonates with his emotional and volitional sphere, which leads to social maladjustment, and acute mental trauma is fraught with serious violations of social foundations.

Psychopaths make up a significant group of people with criminal tendencies, which is facilitated by their one-sided perception of reality from the point of view of their own expectations and the absence of higher moral qualities. Such categories as empathy, remorse, affection, love are unknown to them. Although under favorable conditions, psychotic disorders practically do not manifest themselves, which is confirmed by the story of the American neurobiologist J. Fallon. But any deviation from the expected, the emergence of any problems often leads the patient to an emotional breakdown.

Epidemiology

Statistical information on the frequency of occurrence of psychopathies has significant discrepancies due to the lack of a unified approach among different authors to identifying this disease.

Using the International Classification of Diseases, Tenth Edition assessment criteria, on average, about 5% of the world's population suffers from various types of personality disorders. Another 10% have individual psychopathic traits, but do not reach the diagnosis of psychopathy.

Psychiatrists give slightly different figures. They believe that approximately 1% of the planet's population meets the clinical criteria for psychopathy, and the higher figures of 3 to 5% reflect their prevalence in the business world, where psychopathic personality traits are much more common.

Among patients receiving psychiatric care on an outpatient basis, psychopaths account for 20 to 40%; in hospitals, half of the patients have personality disorders.

In places of imprisonment, psychopathy is found in 78% of male prisoners and half of female prisoners; other sources cite figures of 20-30% and 15%, respectively.

It is believed that there are many more psychopaths among men than among women, which is confirmed from the point of view of genetics. The gene of increased aggression (MAO-A), located in the X chromosome, inherited from the mother by a man, manifests itself 100%. Among psychopaths, 4/5 are men.

The gene is much more common among peoples who encourage aggressiveness and belligerence among males. Among Africans, the rage gene is found in 59% of the population, with the indigenous people of New Zealand (56%) and the people of China (54%) almost as close. In the modern civilized world, aggressiveness has lost its high status – just over a third of the Caucasian race (34%) are carriers of the MAO-A gene.

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Causes psychopathies

There are several assumptions about the etiology of the formation of a psychopathological personality. The consensus is that the main impact of the hypothetical causes relates to the early period of development.

The reasons considered include: conception of an embryo with a hereditary predisposition; genetic modifications during this period; the influence of negative factors on intrauterine development; injuries sustained during childbirth or the early postnatal period, infections or intoxications that provoked the inferiority of the central nervous system.

Researchers of this problem associate the strongest impact of external factors with critical periods of early development – the moment of conception, the third and fourth weeks of pregnancy, the moment of birth and the so-called “fourth trimester” – the first three months after birth. For example, the mother is an alcoholic, a drug addict, or she is under constant stress due to intra-family conflicts; a child left by the mother in the care of the state, and similar situations.

Then, as experts say, susceptibility to unfavorable external factors decreases somewhat, however, before the child reaches three years of age, complex adaptive behavioral skills are formed. Therefore, stress factors acting at this stage of development disrupt the formation of a normal behavior standard.

The psychodynamic concept, widespread in Great Britain and the USA, is based on the teachings of Sigmund Freud. The leading role in the development of psychopathy is given to the disruption of the relationship between parents (guardians) and the child at the earliest stages of its development (again, up to three years), which provokes the formation of pathological complexes in the child, which are predominantly sexual in nature. Psychopathy in this case is considered a protective reaction of the body. The disadvantages of this concept include the impossibility of experimentally confirming this version, as well as a one-sided view of the problem. It does not take into account the influence of the social environment, that is, relationships within the family are analyzed in isolation.

Back in the 19th century, when the term "psychopathy" began to be widely used, doctors began to notice that members of the same family often had similar traits of a psychopathic personality, expressed to varying degrees. Even then, scientists were interested in whether psychopathy was inherited. Studies of identical twins, even those separated in early childhood and living with different parents, indicated that hereditary predisposition did exist.

However, only the development of genetics made it possible to identify a specific type of genes encoding monoamine oxidase A, a catalyst for the biotransformation of neurotransmitters (adrenaline, noradrenaline, serotonin, melatonin, histamine, dopamine), which regulate mood and behavior. They are also called the "rage gene" or "warrior gene", as well as the psychopathy gene, its carriers are distinguished by natural cruelty, selfishness, aggressiveness, lack of empathy.

A person with such a genetic makeup will not necessarily grow up to be a psychopath, however, the atmosphere of cruelty and violence surrounding him from early childhood will complete the process of psychopathy formation. But children, even with an unfavorable hereditary predisposition, who grew up in a warm family environment, where all family members love and care for each other, and parents strictly control the child's behavior, become full-fledged members of society.

Canadian professor R. Hare notes that the processing of the emotional component in the brain of a psychopath, as physiological MRI shows, occurs differently than in a healthy person. The deficit of his perception concerns the entire emotional sphere, positive and negative. The area of the brain responsible for emotions is simply not activated.

Currently, psychopathies are divided into three main groups by origin.

Congenital psychopathy (nuclear, constitutional) is caused by hereditary predisposition. In these cases, one of the blood relatives has character anomalies characteristic of psychopaths. Hypothetically, such qualities are inherited by daughters from both parents and by sons from mothers, although the exact mechanisms of transmission of genetic information have not been identified. The MAO-A gene is located on the X chromosome, so males receive it from their mother, and since this chromosome is unpaired, its influence is felt completely.

Women have a pair of X chromosomes. Having inherited the psychopathy gene from one of the parents in a pair with a "clean" one, a woman practically does not feel its effect. The presence of the aggression gene in both chromosomes has not yet been studied.

Acquired psychopathies are subdivided, in turn, into organic and marginal. The former, as the name suggests, are a consequence of a deficiency of cerebral organs caused by the damaging effects of infectious agents, intoxications, or brain injuries during intrauterine development, infancy, or early childhood.

The second type is acquired as a result of prolonged exposure to a very unfavorable pedagogical atmosphere surrounding the child in childhood and adolescence. "Unloved", emotionally rejected children acquire asthenic character traits, total control and hypertrophied care leads to the development of psychoasthenia, permissiveness and unconditional admiration of the "family idol" form hysterical traits in the child, the lack of control and reasonable restrictions in combination with parental indifference contributes to the development of increased excitability. Marginal acquired psychopathies develop at a later age than constitutional and organic ones, they are considered less stable and deep.

In the vast majority of cases, it is not possible to attribute this antisocial personality disorder to any specific form of psychopathy, since the formation of abnormal personality characteristics occurs under the influence of a combination of a number of different unfavorable causes.

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Risk factors

Studies of patients with psychopathological traits, and scientists usually focus on individuals with extreme psychopathy who are in prison after committing criminal acts, suggest that the likelihood of developing psychopathy increases in people:

• with a certain genetic makeup;
• with reduced activity in the temporal and frontal sectors of the membranes of the brain, responsible for the ability to empathize, adhere to ethical standards and social values;
• with intrauterine injuries;
• those who received injuries during childbirth;
• those who suffered brain damage at an early age (from birth to three years);
• pedagogically neglected, neglected or raised in an atmosphere of permissiveness;
• exposed to the influence of a negative social environment.

Risk factors for the birth of a psychopathic child include a family history of syphilis, drug addiction, and alcoholism.

Substance abuse, in addition to other factors, brings the manifestation closer and aggravates the course of personality disorder. Psychopathy and alcoholism are closely related, even the gene responsible for aggressive behavior is activated in the body of its carrier under the influence of alcohol. The activation of this gene is facilitated by cruel treatment of the child himself or bullying and violence that he witnessed.

During age crises (periods of formation and involution), hormonal changes (puberty, pregnancy, menstruation, postpartum period), the likelihood of increased psychopathic manifestations increases.

Psychopathy is classified as a multifactorial pathology, the development mechanism of which varies in its origin.

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Pathogenesis

To date, there is no single and generally accepted concept of the formation of a psychopathic personality.

But all scientists recognize the importance of the early period of development, including the moment of conception, when the future child can inherit a set of genes with a tendency to psychopathy, an unfavorable course of pregnancy in his mother, difficult childbirth and external interventions in the natural gene adaptation program for the formation of behavior that is normal from a general human point of view, disrupting its course. The mechanism is realized in the first three years of a child's life, when unfavorable external influences stimulate the consolidation of certain forms of behavior that are distinguished by constancy and persist throughout the life of the individual.

For example, there is a noticeable developmental delay in children raised from birth to two years in children's boarding schools (orphans), who have not had a key attachment figure - a mother or a person who replaced her - since birth. The mother's antisocial behavior, her indifference to the child or, on the contrary, excessive care also increases the likelihood of primary mental personality disorders. In children with a hereditary predisposition, psychopathy sometimes manifests itself very early - at two or three years.

An important pathogenetic link is the social factor. Its independent role in the formation of marginal psychopathies is also recognized. Also, against the background of unfavorable conditions, psychopathy is decompensated, while a favorable background contributes to the normalization of the individual's behavior.

Age-related and hormonal crises contribute to the growth of psychopathic symptoms. The use of psychoactive substances provokes the activation of the MAO-A gene.

The neurophysiological side of the mechanism of psychopathy development is revealed in the concept of I. P. Pavlov on the types of higher nervous activity, from this position it was considered by both Russian and Canadian scientists. Various types of psychopathological personality disorders result from pathological inconsistency of nervous processes, signal systems, interaction of the subcortex and the cerebral cortex. The basis for the formation of excitable psychopathy is the absence of inhibition processes, the psychoasthenic form develops with the predominant influence of the second signal system over the first and weakness of the cerebral subcortex, and the hysteroid form - on the contrary, when the first prevails over the second, and also - the cerebral cortex over the subcortex. The pathophysiological basis of the asthenic form of the disease lies in the weakness of higher nervous activity, paranoid - in the tendency to form foci of stagnation in the second signal system.

A number of already known and not yet studied factors influence the pathogenesis of psychopathy, and the result will depend on the degree of pathogenicity of each of them.

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Symptoms psychopathies

The first signs of psychopathy with a hereditary predisposition appear in childhood, sometimes quite early at two or three years. When a child is raised in a benevolent environment, pathological character traits are smoothed out. Compensated psychopathy is a completely acceptable phenomenon in society, although there is a tendency for the individual to unusual, often shocking behavior, unreasonable mood swings, some cruelty and recklessness. However, socialized psychopaths find their place in society, often have families, children, friends who evaluate them quite positively.

Behavior in psychopathy varies depending on its form and accentuation. However, specialists from different conceptual schools identify three main features characteristic of all types of psychopathies, expressed to varying degrees:

• fearlessness, audacity - psychopaths have a reduced sense of fear and danger, combined with high stress resistance, they are confident in their own abilities, have great persistence and try to dominate in society;
• disinhibition - impulsive, easily succumb to impulses, have a need to satisfy their desires “here and now”, without thinking about the consequences and not limiting themselves to generally accepted behavioral norms;
• meanness and heartlessness - incapable of empathy, use any means, including violence, to get what they want immediately, prone to exploitation, disobedience, manipulation of other people.

This triarchic model of behavior (psychopathy triad) is characteristic of people with a psychopathic personality type.

Other researchers highlight the tendency of psychopaths to narcissism, noting that they are almost always very pleased with themselves. Communication with other people comes down to their exploitation, manipulative actions, ignoring other people's interests and feelings. Disobedience to a psychopath can cause a very harsh aggressive reaction.

Personality traits such as psychopathy, narcissism, and a complete lack of principles, called the dark triad, have many characteristics in common. These negative traits are often accompanied by a tendency toward sadism.

Psychopathy occupies an intermediate place in the psychiatric hierarchy, delimiting the extreme variant of the norm, called character accentuation, which implies some more pronounced character traits of a person, manifested in connection with traumatic situations of the psyche for a short time in the form of psychosis or neurosis, and progressive mental pathologies.

Personality psychopathy does not fit into the general boundaries of describing mental illnesses, so for a long time it was classified as a borderline morbid condition, not recognizing it as a disease, but you can’t call a psychopath a healthy personality either. Accentuation of character and personality psychopathy are separated from each other by a ghostly feature that even experienced psychiatrists cannot always discern. The main difference is the constancy of psychopathy, it accompanies a person throughout his life, while accentuation looks like an emphasis on some character traits that stand out more than others, and therefore dissonant against the general background. These accents do not appear constantly, but under the influence of certain psychotraumatic situations. Accentuation of some traits does not prevent a person from leading a normal life in society.

The average psychological portrait of a psychopath looks something like this: at first glance, he is an energetic, charming, proactive person who does not suffer from an inferiority complex; later, such traits as cunning and the ability to manipulate others, deceit, callousness and callousness appear. This person never repents of his actions, does not feel guilty and does not regret anything.

He is often bored, he can use psychoactive substances and lead a parasitic lifestyle, or he can be a successful businessman or politician. A psychopath usually does not set real goals and objectives for himself, does not plan for the future, he is impulsive and irresponsible. For the sake of a momentary whim, he can betray, this person does not respect anyone and does not try to change himself. Many note the empty look of psychopaths, the expressionless eyes of a "rotten fish". Many may have criminal records in the past, several marriages and many broken hearts, contempt for social norms is noticeable.

In institutions and organizations, psychopaths are usually charming and obedient to their superiors, but rude, offensive and aggressive towards employees below them on the hierarchical ladder. Their business qualities are usually highly valued. Courage, the ability to take risks and make quick decisions, sometimes non-trivial from the point of view of an ordinary person, mainly bring good dividends to psychopaths, manipulative abilities allow them to achieve a lot from employees and lead them. Although their lack of principles and morality are assessed rather negatively, it is believed that the harm caused by a psychopath occupying a high management level is much greater than his benefit.

Psychopathy in the family

Working with a psychopath is not easy, but it is much worse when a psychopath is a family member. There are no recipes, the best remedy is not to create a family with psychopathic personalities. A psychopathic husband will sincerely consider his wife and children his property, and much in the development of further events will depend on the conditions in which he grew up. A socialized psychopath will fulfill his duties, raise children, support the family, simply because it is easier, more comfortable and convenient for him, and not because he loves his wife and children or feels responsible for them. However, even in this case, no one can guarantee that he will not break down, this person cannot be relied upon. And his wife will have to put up with many of her husband's oddities.

A psychopathic wife is no gift either, and in this case the connection with her upbringing can be traced. She will not love her husband and children, because she cannot, and she will not have any responsibility towards them either. But a socialized psychopath can easily pass for a caring mother - doing homework with the children, taking them to extra classes, playing games, and also playing the role of a devoted wife, especially if the husband meets her expectations.

Psychopaths, wealthy and socialized, prefer communication with grown-up children, small children, requiring hourly care and presence, simply irritate them. If possible, such parents will try to shift the care of small children to a nanny, grandmothers or other relatives. Fathers, "burning" at work, usually command respect, mothers, business ladies, careerists, are also not uncommon in the modern world.

Much worse are antisocial psychopaths who grew up in an unfavorable environment, had an unsuccessful start in life and an unstable financial situation. At best, they will be indifferent to the child, will not pay attention to him, at worst, which happens much more often, they can abuse physically and morally, even involve him in illegal actions.

Psychopathy in men has been studied better, since there are many more of them among psychopathic personalities, and also because they are found in places of imprisonment, where, mainly, research is conducted.

The symptoms of psychopathy do not depend on gender, and the difference in manifestations is determined by its type, as well as differences in how society evaluates the behavior of men and women.

For example, if many authors, describing female psychopaths, call them sexually promiscuous, then, speaking about men, they mention many relationships, marriages or broken hearts, which in fact characterizes psychopaths of any gender as sexually active and, in their own way, attractive, as well as irresponsible and heartless manipulators who know how to get what they want at any cost, without thinking about the future.

And, you must agree, a female tramp and/or alcoholic also evokes a somewhat different reaction in society than a man leading the same lifestyle.

Psychopathy in women is characterized by less aggressiveness and use of physical violence, which is simply typical for the female sex in general. They commit criminal acts in a state of affect much less often, kleptomaniacs are often found among them, but in terms of psychological sadism, a female psychopath will give any man a hundred points ahead. In general, some experts believe that in fact there are no fewer female psychopaths, they just need to be assessed differently.

Psychopaths of any gender are egocentrics, they are all guided only by their momentary desires, ignoring the interests of others and even the people closest to them. A psychopathic mother in most cases poses a serious threat to the mental health of her children, much more than a psychopathic father, because in most families children, especially small ones, spend most of their time with their mother.

It is almost always noted that a psychopathic husband is a huge psychological trauma for his wife, and often there is a high probability of physical abuse.

Psychopathic women are also unmanageable in family life. Lack of self-control, long-term goals, callousness and a tendency to abuse psychoactive substances, deceit and meanness can ruin the life of any normal man.

The parasitism of psychopaths is assessed by society in different ways; men are often accused of this quality, simply because a woman who is supported by her husband and whose parents help her does not cause public condemnation.

Psychopathy in children

The first signs of inherited psychopathy appear as early as two or three years. Small children are emotionally unstable, they lack a sense of pity for animals, peers and relatives, it is difficult to get sympathy from them, remorse for cruel actions. Basically, the first thing parents pay attention to is cruelty towards other children and/or animals, the desire to dominate, command other children, use force against those who disagree.

Preschool psychopathy is diagnosed according to S. Scott (Institute of Psychiatry, London) by the following signs:

• frequent insults towards others (regardless of their faces and kinship);
• regular attempts to cause pain to any living beings (prick, hiss, squeeze, pull), older children try to exert moral influence;
• total disobedience, attempts to escape in order to avoid obeying the rules;
• the child never feels guilty;
• adequate perception can only be achieved through reward;
• in any failure the child blames others, but never himself;
• does not react to comments and is not afraid of punishment.

It is worth thinking about if older preschool and younger school-age children constantly fight, take other people's things without asking, try to set something on fire or blow something up.

A real storm falls on parents when children reach adolescence. They are rude, run away from home, do not want to obey, they cannot be intimidated by any threats. Teenagers do not feel their guilt and responsibility, reacting violently to punishment. Psychopaths are not interested in the feelings of other people at any age.

It is teenagers who most often start having problems with the law; they may start drinking, taking drugs, and committing crimes.

Psychopathy in adolescents occurs in a severe form, this is a critical age of hormonal changes and personality formation. It is during this period that parents find it most difficult to cope with a psychopathic child. Basically, of course, such children are characterized by increased excitability, stubbornness, there may be abrupt transitions from joy to depression, hysteria, tearfulness and even fainting.

The transition to adolescence can be marked by so-called metaphysical intoxication – attempts to solve some complex, unsolvable problems and thus make humanity happy.

At about the age of 20, compensation of the condition usually occurs, successful psychopaths' mood stabilizes and adaptation to society occurs.

Stages

Although psychopathy is not characterized by progression, as are other mental illnesses and illnesses in general, it has its own dynamics. It is not a static condition, it develops, and it has certain stages of development.

The prepsychotic stage takes quite a long time. Constitutional (nuclear) psychopaths go through the formation of psychopathic character traits in childhood and adolescence, the pathology acquired in adulthood also goes through a prepsychotic (subclinical) stage, in which clinical symptoms are not yet sufficiently expressed.

Psychopaths have two states: compensated, when the individual is at peace with society (usually achieved through comfortable conditions of his existence), and decompensated, when a pathological psychogenic reaction develops (decompensation most often occurs under adverse external influences). For each type of psychopathies, decompensating effects are exerted by different factors. And reactions can also be unambiguous for the type of psychopathy, such do not last long - sometimes a few hours, sometimes a few days. After very significant mental trauma, decompensation can occur, manifested in the form of a reaction that was not previously dominant in this individual, for example, asthenia in an excitable psychopath or, conversely, a depressive will show an explosive temperament.

Ambiguous structural changes in the character of a psychopath are usually longer lasting, but still reversible if the causes that caused this condition are eliminated. The symptoms of such changes are not represented by psychotic symptoms, but by characterological reactions - for some time, an individual may be consumed by some passion, he may experience a state of unmotivated aggression, hopeless melancholy, a desire to commit suicide. If the traumatic situation is not resolved, the reaction may become protracted, become entrenched, and over time severe psychopathy will develop.

Regardless of the type of psychopathy, they develop according to one cyclical scenario. The personality anomalies of a psychopath lead to the creation of a conflict situation, as a result of which the patient develops a psychopathic reaction that lasts for a more or less long time. After its end, an aggravation of psychopathy is noted.

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Complications and consequences

Decompensation of psychopathy, which leads to an increase in personality anomalies that prevent natural adaptation in society, poses a danger to society and the psychopath himself.
The clinical course of decompensation looks like an exacerbation of abnormal personality traits of an individual, specific to a particular type of psychopathy - hysterical attacks, affective outbursts, depression, hypochondria, acute delusional syndromes, reformism, litigiousness.

Psychopathy develops throughout a person's life, and the impact of society plays a huge role in its dynamics. Favorable - helps to smooth out psychopathic manifestations, to compensate for them. On the contrary, under the influence of many constant unfavorable factors, an antisocial personality is formed, which can cause significant damage to society.

There are no complications with personality disorder – a person will live with it all his life. However, over time it can either smooth out or worsen. Frequent decompensations aggravate the course of psychopathy, which can greatly worsen the quality of life of the individual himself, become a specific threat to his life or the people around him. Often there are different forms of attacks of aggression and antisocial behavioral reactions on the part of psychopaths, some are quite harmless, others can pose a real danger. It is not for nothing that psychopaths make up from a third to a half of all prisoners in places of imprisonment.

Fluctuations in hormonal levels – adolescence, pregnancy, menstruation, menopause, as well as age-related crisis stages – contribute to decompensation of the disease and aggravation of its course.

Adolescence is considered to be especially dangerous, when, in addition to hormonal changes, growing up and personality development occur. During this period, individuals with psychopathic traits become more stubborn, unwilling to obey, and impulsive. Emotional instability is typical for teenagers - unmotivated transitions from bursts of joy to tearfulness, depression, sadness; outbursts of rage or aggression without any reason, hysteria, tearfulness, fainting. Teenagers often run away from home, begin to wander, and lead an antisocial lifestyle.

Stormy puberty is often replaced by philosophizing, reflection, metaphysical searches. After 20-23 years, successful psychopathic personalities usually experience a period of compensation, the personality is socialized and the character becomes more balanced.

During the period of sexual function decline, psychopathic personality traits become more acute, emotional balance is disturbed, the individual becomes more impulsive, angry, irritable and/or tearful. When involution coincides with a change in lifestyle, such as retirement, decompensation of psychopathy may worsen: anxiety, depression, oppression combined with hypochondria and hysteria appear, litigiousness and conflicts increase.

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Diagnostics psychopathies

Methods of studying patients with personality disorders include various studies. Firstly, socially maladapted personalities usually come into the field of view of psychiatrists. Socialized psychopaths who have no problems with adaptation in society are quite satisfied with themselves, and they themselves and their relatives never seek medical help. Long-term decompensated psychopathy attracts attention, but in order to establish a diagnosis of personality disorder, it is necessary to exclude general somatic causes of mental disorders.

For this purpose, laboratory tests are carried out to provide an idea of the patient’s general health condition; some specific tests may be prescribed.

Neurophysiological examination includes encephalography - magnetic, electrical, neuroradiographic - different types of tomography, the most informative and modern of which is functional magnetic resonance imaging, which allows us to evaluate not only the structure of the brain, but also the course of metabolic processes and blood flow.

The diagnosis of psychopathy is made on the basis of conversations with the patient, during which psychiatrists and psychologists, using a set of specific techniques and methods, identify mental disorders in a person.

Psychiatrists conduct a clinical interview and are guided by the criteria of the latest edition of the disease classification system to make a diagnosis.

A medical psychologist uses various tests and interviews in his work, which allow him to identify a symptom complex - a stable combination of positive and negative mental characteristics that exist as a single whole.

When diagnosing personality disorders, the Minnesota Multifaceted Personality Test is used; its adapted version, the Standardized Multifactorial Personality Inventory, is popular in the post-Soviet space. These questionnaires have clinical scales that allow you to determine the type of personality disorder - to identify the patient's proximity to a certain personality type (paranoid, asthenic, schizoid), the degree of sexual identification, anxiety and tendency to antisocial actions. Additional scales allow you to assess the patient's sincerity, as well as correct his unreliable answers.

The Psychopathy (Sociopathy) Scale is the fourth item on the Minnesota Multifaceted Personality Test and evaluates the test subject and their similarity to antisocial personality disorder. High scores on this scale indicate the individual's inability to live in a society of their own kind. They characterize test subjects as impulsive, angry, conflictual, and not following the moral and ethical rules accepted in human society. Their mood fluctuates, they are very susceptible to insults, reacting aggressively to the offender and losing control of their behavior.

The R. Hare psychopathy test is very popular; the questionnaire includes twenty basic characterological traits of a psychopath. Each item is assessed at a maximum of three points; if the subject receives more than 30 points, he is predisposed to psychopathy. The questionnaire is accompanied by an interview in which the subject outlines his biography: talks about education, places of work, describes his family status and possible friction with the law. Since psychopaths are notorious liars, the data from the interview must be confirmed by documentation. The R. Hare test was designed to identify psychopathy in individuals who have committed criminal offenses, although it can be used in other cases.

In psychiatric practice, various assessment methods are used to determine the patient’s self-esteem, the quality of his relationships with other people, and to study cognitive functions, the level of perception, attention, and memory.

The basis for recognizing a person as a psychopath are the following criteria of Gannushkin's psychopathies:

• stability of abnormal character traits, that is, they accompany the patient throughout his life.
• psychopathic traits are all-encompassing, that is, they completely determine the individual’s character structure (totality);
• pathological character anomalies are so noticeable that they make it difficult, or even impossible, for an individual to adapt to life in society.

The same P.B. Gannushkin notes that psychopathy is characterized by a certain dynamic (strengthening or weakening of personality disorder). And the greatest influence on dynamic processes is exerted by the environment.

In general, the diagnosis of psychopathy is quite complicated, people are examined using different methods, because psychopathic symptoms can be observed after injuries and intoxications of the brain, with endocrine disorders, and also - the manifestations of decompensated psychopathy resemble obsessive-compulsive disorders, schizophrenia, psychoses. Only an experienced doctor can differentiate psychopathy from other pathologies.

For self-diagnosis of people who suspect psychopathy in themselves or their loved ones, but have not yet broken the law and have not consulted a doctor, you can take a test, for example, using the psychopathy questionnaire by M. Levenson. The questionnaire items are different statements, and the person being tested evaluates their attitude to them on a four-point scale. Primary psychopathy is interpreted as a lack of empathy for other people (heartlessness), secondary - as an impulsive reaction to events.

The Dante test for psychopathy is also requested on the Internet. It does not give a specific answer as to whether you have a mental disorder. And other self-diagnosis tests cannot replace a visit to a doctor.

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Differential diagnosis

Pathological anomalies in psychopathies should be of a total and stable nature, and individual, although noticeably expressed, character anomalies that do not reach the level of pathology are classified as accentuated character traits. The types of accentuations correspond to the types of psychopathies, however, accentuations usually manifest themselves temporarily, under the influence of a psychotraumatic factor, during adolescence, later smooth out and do not lead to maladaptation in society. The differences between accentuation and psychopathy, according to many authors, are precisely quantitative in nature and consist in their dosage, which is not perceived as a pathology.

Differentiation of personality disorder is carried out with psychopathic-like conditions after brain injury, infections and intoxications with damage to the central nervous system, endocrinopathies and other diseases. One of the criteria for distinction is the fact that before the appearance of a psychopathic-like condition in diseases or injuries, the personality developed quite normally.

Constitutional or nuclear psychopathies are also differentiated from marginal, i.e. psychogenic and pathocharacterological developments, which can occur at any age under the influence of psychological trauma. They are distinguished from congenital ones by a clear beginning, in the first case the personality disorder is noticed from early childhood. The abnormal character traits of a psychopath are distinguished by their constant presence.

Sociopathy is also distinguished as a result of the influence of unfavorable living conditions and is differentiated from nuclear forms of psychopathy, which lead to the development of antisocial attitudes in an individual.

Affective psychosis and some of its manifestations resemble decompensated affective psychopathy, however, after the end of the affective phase, patients experience an intermission of psychosis and all mental functions are normalized. While psychopathic personality traits are not completely smoothed out even during the compensation period. Affective phases - depressive, manic, manic-depressive - last no less than one or two weeks (sometimes several years), occur periodically and spontaneously, completely disrupt the patient's way of life and cause the need to seek medical help.

Intellectual disability and psychopathies have many common features, in particular, their pathogenesis is characterized by underdevelopment of the frontal and temporal lobes, and in their manifestations - infantile thinking. Both are borderline conditions. However, in patients with personality disorders, cognitive functions are not impaired and, according to the Wechsler test, the intellectual level is often even higher than average. The most difficult thing is to differentiate psychopathy from intellectual disability caused by pedagogical neglect. In such individuals, intellectual disability may well be combined with features of a psychopathic personality.

Mild paranoia is considered by modern psychiatry as a paranoid personality disorder, the symptoms in this case are no different. With the progression of the disease and the transition to delirium with disturbances of rational activity accompanied by hallucinations, the condition is interpreted as an isolated delusional disorder. The main clinical criterion for differentiation is the time of onset of the disease. Paranoid psychopathy is usually constitutional and the first signs of anomalies appear at an early age, for a progressive endogenous disease, late manifestation is characteristic (often after 40 years).

Narcissism as a character trait is inherent in psychopaths in general, their egocentrism, self-admiration, inflated self-esteem, and often sexual deviation are considered in the symptom complex of psychopathies. However, it is not enough for diagnosis. Narcissistic can be an accentuation of character. Psychiatrists distinguish normal and pathological or grandiose narcissism, the latter is considered the prerogative of psychopathic personalities.

Empathy is the ability to determine the mood of another person, sympathize with their experiences, "tune in" to the same wave with them. It is believed that psychopaths do not know this property, this is one of the main characteristics of psychopathies. People can have different levels of empathy, and psychopathic personalities do not have this ability, with any type of psychopathies. Cyclothymics or affective psychopaths, who are able to feel the mood of others, in the new classifier already belong to patients with mild forms of manic-depressive psychosis. They are no longer classified as psychopaths.

Schizophrenia is characterized by the presence of manias, delusions, hallucinations, auditory and visual. Schizophrenics have incoherent speech, scanty emotions, slovenly appearance, inadequate reactions and actions. However, such symptoms are characteristic of severe schizophrenia. And the sluggish process is practically indistinguishable from schizoid psychopathy. The progressive course and, as a rule, later manifestation of schizophrenia will be its main difference from schizoid personality disorder.

Neurosis, like psychopathy, was previously considered a borderline state between the norm and mental illness. In modern American classifiers, this term has already been abolished.

P.B. Gannushkin believed that neuroses and psychopathies are interrelated, their symptoms and causes overlap. In decompensation, the leading role is given to psychogenic causes, there is no progression of dementia, delirium and hallucinations. Both disorders are reversible.

In neurosis, there is usually a close connection between a stress factor and the appearance of neurosis. Before this event, the patient was absolutely normal, whereas in a psychopath, oddities always manifested themselves. Timely treatment of neurosis helps to normalize the patient's condition, whose personality structure is normalized.

Psychasthenia, or in modern terms, obsessive-compulsive or anxiety disorder (ICD-10), defines a mentally weak personality type with an intellectual mindset.

Psychoasthenic psychopathy mainly manifests itself at an early age and accompanies a person throughout life, and acquired disorders manifest after psychological trauma, and after treatment the patient’s nervous system usually recovers.

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Treatment psychopathies

Psychopathy in the decompensation stage is almost always accompanied by social and personal maladaptation. It is during such periods that it is necessary to help the patient find stable ground under his feet.

The preferred method is to provide psychotherapeutic assistance. Psychotherapy of psychopathies is carried out with the aim of correcting the individual's personal attitudes and compensating for abnormal characterological deviations, developing an understanding of the need to comply with moral norms and rules in relationships with other people, as well as activating aspirations for productive activity.

Compensation for psychopathy

The doctor selects the method of working with the patient individually, based on the type of personality disorder and the degree of decompensation. The course begins with individual sessions with a predominance of activating rational attitudes. The sessions are conducted in the form of explanations and discussions.

Methods based on suggestion (hypnotic sessions, auto-training and others) are used with great success in the treatment of the hysterical form of psychopathy, although in this case the improvement is short-lived.

From individual sessions they move on to group sessions, where patients learn to build relationships based on the principles of universal morality, establish contacts with each other, and participate in role-playing games.

Family sessions are held to help normalize relationships between family members, find compromise solutions, and achieve mutual understanding.

Medication treatment is not encouraged, however, in some cases it is unavoidable; in severe and profound personality disorders, it becomes necessary to take medications constantly to avoid decompensation.

Medicines are also selected individually, taking into account the type of disorder and their selective action.

Thus, antidepressants are used to compensate for inhibited psychopathies. In a state of subdepression, Amitriptyline, a tricyclic antidepressant that blocks cholinergic receptors of the central and peripheral nervous system, can be prescribed, due to which the patient's mood improves, and anxiety and worry disappear. The daily dose of the drug is approximately 75-100 mg.

Maprotiline is a fairly powerful drug with a tetracyclic structure. It is used in patients with an exaggerated sense of guilt. It has a noticeable thymonoanaleptic effect, eliminates melancholy, inhibition, and stops bursts of excitement. The drug is allowed to be used in pediatrics. As a rule, no more than 75 mg per day is prescribed.

These drugs are contraindicated in post-infarction patients, with decompensated hypertension and heart failure, men with benign prostate tumors, pregnant and lactating women.

In case of hypomanic syndrome development, the antipsychotic Clozapine (Leponex) is prescribed, which is characterized by a powerful and rapid calming effect. Patients taking the drug have a reduced number of suicide attempts. However, long-term use can significantly affect the blood composition.

An alternative to Clozapine can be Finlepsin (at a daily dose of 0.4-0.6 g) or Haloperidol drops (at a daily dose of 10-15 mg).

In hysterical forms of psychopathy, the same Finlepsin (0.2-0.6 mg), Neuleptil (10-20 mg) or Propazin (100-125 mg) are used to compensate for the patient’s condition – daily doses are indicated.

Patients are usually treated on an outpatient basis. During the course of psychotropic drugs, it is necessary to completely abstain from alcohol consumption, since these drugs are incompatible with alcohol. Such a combination is fraught with the development of negative effects, including death. Also, during treatment, it is not recommended to drive a car or perform other work that requires concentration.

Indications for emergency hospitalization in a psychiatric hospital (without the patient's consent) are severe stages of psychopathy, decompensation in the form of psychosis. For example, twilight consciousness in hysteroids, psychosis with delirium in paranoids, dysphoric disorders in epileptoids, as well as cases of aggressive behavior that pose a danger to others or suicide attempts, self-harm.

It is impossible to cure psychopathy, especially congenital psychopathy, however, it is quite possible to achieve long-term compensation for the individual’s condition.

Treatment of psychopathy with folk remedies

Therapy with psychotropic drugs has many side effects, often reminiscent of the mental disorder itself, and also affects the functioning of the gastrointestinal tract and cardiovascular system, and changes the composition of the blood.

Traditional medicine has a less harmful effect on the body, although it can also cause side effects, one of which is various allergic reactions. But the severity of side effects from herbal preparations is not comparable to the undesirable consequences of taking medications. In addition, most drugs that affect the psyche are addictive, and psychopathic individuals are already prone to substance abuse.

Therefore, resorting to treatment with folk remedies, especially after consulting with a doctor or herbalist, may not be the worst idea.

Hyperactive personality traits can be somewhat corrected with the help of calming herbs: motherwort, peony, valerian root, marsh cudweed, dandelion, mint, lemon balm and other herbs. Each herb can be brewed separately, or herbal mixtures can be made. In this case, the effect will be stronger.

You can make baths with infusions of calming herbs or use essential oils of the same plants.

For example, some aromas are believed to promote calm concentration, greater focus and perseverance. These are sandalwood, eucalyptus and jasmine essential oils.

The aromas of juniper and ylang-ylang set the tone for productive activity.

Excitable individuals are contraindicated to the aromas of cloves, nutmeg, thyme, and cinnamon.

For inhibited psychopaths, in particular, asthenic type personalities, infusions of ginseng, echinacea, licorice, calamus, elecampane, and angelica are recommended.

Aromatherapy with oils of oregano, mimosa, lemon balm, mint, valerian, iris, anise, coriander, geranium will first strengthen the nervous system, then you can use stimulating aromas: orange, basil, cloves and cinnamon.

Depressive reactions to stressful situations are relieved by herbs such as chamomile, peppermint, lemon balm, soapwort, and valerian.

Aromatherapy helps to cope with fits of anger or despondency, eliminate bad mood, excessive excitement, activate the intellect, clear the mind and even strengthen spirituality. Sandalwood, rose, juniper, cedar oil, myrrh and frankincense are endowed with such properties.

Mix at least three oils and spray the aroma in the room; the composition of the oils sometimes needs to be changed.

Geranium, lavender, chamomile and tuberose oils will help excitable psychopaths calm down; jasmine, ylang-ylang and angelica herb will help depressives to escape from depression and improve their mood.

For hyperthymics, it is recommended to reduce emotional background and normalize mood with geranium, chamomile and rose oil, replacing them with a composition of clary sage, thyme and ylang-ylang.

Anxiety and anxiety, lack of self-confidence are relieved by the aromas of sage, fern, rosemary, and oregano. Severe fatigue will go away from an aromatic composition of sage, clove, and marjoram oils. Also, hypothymics and psychasthenics (asthenics) will find their vitality and mood lifted by the aromas of fern, sage, oregano, and rosemary oils.

Juniper, marjoram, ginger, clove and cinnamon oils restore lost strength and vitality.

All alternative means are good for combating psychopathy: yoga therapy (preferably under the guidance of an experienced yoga therapist, at least at first), meditation, mineral therapy, color resonance therapy, and others.

Prevention

It is important for any child to grow up in a supportive environment, especially for children with constitutionally conditioned psychopathic personality traits.

Adults need to strive to avoid negative external influences that provoke the emergence of antisocial character traits, especially at the age when behavioral norms and moral principles accepted in society are formed.

At the initial stages of personality development, the most important role in preventing psychopathies is given to pedagogical influence, later joined by social adaptation and professional orientation taking into account individual characteristics.

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Forecast

There are known cases where, in a favorable environment, individuals genetically prone to psychopathy grew up to be quite socially adapted and respectable citizens.

The most unfavorable prognosis is given by specialists in the case of hysterical psychopathy, although suitable conditions of existence lead to stable compensation in adulthood. Hysteroids can socialize and acquire some skills for productive activity. Pathological liars practically do not adapt from this group of psychopaths.

Psychopaths are responsible for their illegal actions and are not considered disabled. Psychopathy and disability are incompatible concepts, at least in modern society. Perhaps in the future, when this phenomenon is better studied and explained, they will be included in the disabled population. In cases of severe decompensation, a sick leave certificate may be issued, certifying the temporary inability to work.

When persistent signs of mental illness appear on the basis of long-term decompensation, then the VTEK can recognize the psychopath as a group III disabled person with certain recommendations for organizing his work regime.

According to R. Heyer, one of the leading experts on psychopathy, psychopathic movie characters are far from real characters, although, of course, such developments are also possible. Movies that play on psychopathy as a phenomenon do not pretend to have a scientific approach and are made for the sake of box office receipts. Their heroes are more likely members of a “select club” than typical characters.

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