Psychopathy in women, men and children

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

In the last International Classifier of Diseases, the usual boundary categories were replaced by the collective term "personality disorders". Pathological personality characteristics of a particular individual, bringing suffering to himself or the society in which he lives, are referred to psychopathies. Note that this is anomalies, not character traits.

Psychopathy is not an authorized name for the condition of a certain anomaly of human nature. Psychopaths often refer to people as being excitable, inadequately reacting sharply to unpleasant events, which are not always able or willing to control their behavior. They can not critically evaluate their not always adequate actions and look at them from other people. However, this behavior can be the result of serious errors in education and a completely healthy person.

Is psychopathy a disease or a character?

For a long time, psychiatry ignored antisocial disorders, they were dealt with by criminologists and judicial bodies. Psychopaths, who did not violate the law, were considered to be people with a serious character.

The very term "psychopathy" means "a disease of the mind", nevertheless, most experts do not view it as an ordinary mental disorder.

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

French psychiatrist F. Pinel, two centuries ago, describing the model of behavior of a psychopathic personality, called psychopathy "a mental illness without insanity."

To perceive psychopathy as a disease of the soul began long ago, even in ancient times, but to study 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 have the opportunity to study the biological underpinnings of antisocial behavior.

With psychopathy, mental retardation is not progressing, psychotherapist sessions allow patients to hone their ability to manipulate people. His main anomaly of the psyche - the lack of empathy and absolute egocentrism psychopaths can perfectly hide, and do not get hung up on it. Psychopathy is more difficult to recognize than other disorders of the psyche. Until now, these people do not condescend to the court, in general, fairly believing that they are able to realize their actions.

Currently, personality disorders are related to mental illness, however, the line between the disease and the norm is very thin. It is believed that they are based on any distortion in the development of the central nervous system, often not obvious, which was influenced by adverse external stimuli.

Some pedagogical errors are not enough for the formation of psychopathy. Explosive temperament and antisocial behavior are not grounds for enrolling a person in the ranks of psychopaths. For accentuated individuals whose abnormalities are sufficiently compensated and do not reach the pathological level, the diagnosis of a psychotic disorder is also considered to be unjustified.

So psychopathy is a disorder of higher nervous activity, which means that after all, a disease usually manifested in the absence of a balance between the processes of excitation and inhibition, expressed by the predominance of one of them.

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

Among the psychopaths are many people who have a good education, successful career growth, they are called socialized. Specific feature of psychopaths is considered intellectual safety and lack of ability to empathize with both negative and positive emotions of another person. This disease state is not characterized by a progredient course with the degradation of the personality and the development of dementia. Nevertheless, the normal intellect of a psychopath under the influence of unfavorable external factors dissonances with its emotional and volitional sphere, which leads to social disadaptation, and acute mental trauma is fraught with serious violations of social principles.

Psychopaths constitute a significant detachment of people with criminal inclinations, which is facilitated by a 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, repentance, affection, love are unknown to them. Although under favorable conditions, psychotic disorders do not manifest themselves, which is confirmed by the history of American neuroscientist J. Fallon. But any deviation from the expected, the appearance of any problems often leads the patient to an emotional breakdown.

Epidemiology

Statistical information on the frequency of occurrence of psychopathies is significantly different due to the lack of a unified approach for different authors in isolating this disease.

Using the estimated criteria of the International Classification of Diseases of the tenth edition, on average, about 5% of the world's population suffers from various types of personality disorders. Another 10% has some psychopathic traits, however, until the diagnosis of psychopathy falls short.

Scientists-psychiatrists give several other figures. They believe that about 1% of the planet's population corresponds to the clinical criteria of psychopathy, and the higher figures from 3 to 5% reflect their prevalence in the business world, where psychopathic personality traits occur more often.

Among patients receiving psychiatric care outpatient, a part of psychopaths is from 20 to 40%, in hospitals - half of patients with personal disorders.

In places of deprivation of liberty, psychopathy is found in 78% of male prisoners and half in women, while in other sources they refer to figures of 20-30% and 15%, respectively.

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

Carrying this gene is much more common among peoples, where aggression and militancy among the representatives of the male are encouraged. Among the inhabitants of Africa, the rage gene is found in 59% of the population, with New Zealand native (56%) and Chinese (54%) almost behind them. In today's civilized world, aggressiveness has lost its high status - carriers of the MAO-A gene are just over one-third of the representatives of the European race (34%).

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of the psychopathies

There are several assumptions about the etiology of the formation of a psychopathological personality. Unity is achieved in that the main impact of hypothetical causes refers to the early period of development.

Among the reasons considered: the conception of an embryo with a hereditary predisposition; gene modifications during this period; the impact of negative factors on intrauterine development; trauma in labor or early postnatal period, infections or intoxications provoking inferiority of the central nervous system.

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

Then, according to experts, the susceptibility to unfavorable external factors is somewhat reduced, however, before the child reaches the age of three, he develops complex adaptive behavioral skills. Therefore, the stress factors acting at this stage of development violate the development of a normal standard of behavior.

The psychodynamic concept, common in Britain and the US, is built on the teachings of Sigmund Freud. The leading role in the development of psychopathy is assigned to the violation of the relationship of the parents (guardians) and the child at the earliest stages of its development (again to three years), which provokes the formation of pathological complexes in a child who are mostly of a sexual color. Psychopathy in this case is considered as a protective reaction of the body. The drawbacks of this concept are 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, relations within the family are analyzed in isolation.

In the XIX century, when the notion of "psychopathy" became widely used, doctors began to notice that members of one family often had similar features of a psychopathic personality, expressed in varying degrees. Even then, scientists were interested in whether psychopathy was inherited. Studies of identical twins, even separated in early childhood and lived with different parents, said that hereditary predisposition still takes place.

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

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

Canadian Professor R. Heir notes that the treatment of the emotional component in the brain of a psychopath occurs, as physiological MRI shows, not as in a healthy person. Deficiency of his perception concerns the entire emotional sphere, positive and negative. The site of the brain responsible for emotions is simply not activated.

At present, psychopathies of origin are divided into three main groups.

Congenital psychopathy (nuclear, constitutional) is due to hereditary predisposition. In these cases, one of the blood relatives traces the anomalies of character characteristic of psychopaths. Hypothetically, such qualities are inherited by daughters from both parents and sons from mothers, although precise mechanisms for the transfer of genetic information have not been identified. The MAO-A gene is located in the X chromosome, so the males receive it from the mother, and since this chromosome is unpaired, its effect is completely affected.

Women have a pair of X-chromosomes. Having inherited the psychopathy gene from one of the parents paired with "clean", the woman practically does not feel his action. The presence of a gene for aggression in both chromosomes has not yet been investigated.

Acquired psychopathy is divided, in turn, into organic and marginal. The first, as the name suggests, is the result of a deficiency of the cerebral organs caused by the damaging effect of infectious agents, intoxications or brain injuries during fetal development, infancy or early childhood.

The second species is acquired due to the prolonged impact of the very unfavorable pedagogical atmosphere surrounding the child in childhood and adolescence. "Unadvised", emotionally rejected children acquire asthenic character traits, total control and hypertrophied care leads to the development of a psychoasthenia, permissiveness and unconditional admiration for the "family idol" form the child's hysterical features, lack of control and reasonable restrictions in combination with parental indifference contributes to the development of increased excitability . The marginal acquired psychopathy develops at a later age than the constitutional and organic ones, they are considered less stable and deep.

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

[10], [11]

Risk factors

Investigations of patients with psychopathological traits, and in the field of view of scientists usually persons with an extreme degree of psychopathy, who are imprisoned after committing criminal acts, get to the conclusion that the probability of developing psychopathy increases in people:

• with a specific genetic set;
• with a decreased activity in the temporal and frontal sectors of the cerebral membranes, responsible for the ability to empathize, observe ethical norms and social values;
• with intrauterine damages;
• injured during childbirth;
• who suffered brain damage at an early age (from birth to three years);
• pedagogically neglected, neglected or brought up in the atmosphere permissiveness;
• exposed to the negative social environment.

Risk factors for the birth of a child psychopath is the presence in the family history of syphilis, drug addiction, 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, which he witnessed.

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

Psychopathy refers to multifactorial pathologies, the development mechanism of which is different in origin.

[12], [13], [14], [15], [16], [17]

Pathogenesis

To date, there is no single and universally accepted concept for the formation of a psychotic personality.

But all scientists recognize the importance of the early period of development, including the moment of conception, when a future child can inherit a set of genes with a propensity for psychopathy, unfavorable course of pregnancy in his mother, severe childbirth and external interference in the natural gene adaptation program for the formation of normal behavior from a common human point of view, violating 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 constant and persist throughout the life of the individual.

For example, there is a noticeable lag in the development of children brought up from birth to two years in children's boarding schools (orphanages), next to which there was no key attachment figure - the mother or the person who replaced it. Asocial behavior of the mother, her indifference to the child or, on the contrary, excessive custody also increases the likelihood of primary mental personality disorders. In children with a hereditary predisposition, psychopathy is sometimes manifested very early - in two or three years.

An important pathogenetic link is the social factor. His independent role in shaping marginal psychopathies is also recognized. Against the backdrop of unfavorable conditions, psychopathy decompensates, while a favorable background helps normalize the behavior of the individual.

Age 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 aspect of the mechanism of the development of psychopathy is revealed in the concept of IP Pavlov about 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 mismatch of nervous processes, signaling systems, interaction of the subcortex and the cortex of the brain. The basis for the formation of psychopathy of an excitable type is the absence of inhibitory processes, the psychoasthenic form develops with the predominant influence of the second signal system over the first and the weakness of the cerebral subcortex, and the hysteroid form, on the contrary, when the former prevails over the second, and also the cerebral cortex over the subcortex. The pathophysiological basis of the asthenic form of the disease consists in the weakness of higher nervous activity, paranoid - in the tendency to form foci of stagnation in the second signaling system.

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

[18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28]

Symptoms of the psychopathies

The first signs of psychopathy with hereditary predispositions appear from childhood, sometimes, early enough in two or three years. When the child is raised in a benevolent environment, the pathological traits of the character are smoothed out. Compensated psychopathy is a perfectly acceptable phenomenon in society, although the tendency of the individual to unusual, often euphoric behavior, causeless changes of mood, some hardness of heart and recklessness is noted. However, socialized psychopaths find their place in society, often have families, children, friends, who evaluate them sufficiently positively.

Behavior in psychopathy is different depending on its shape and accentuation. However, specialists of different conceptual directions distinguish three main features, characteristic for all types of psychopathies, expressed in different degrees:

• fearlessness, insolence - psychopaths have a lowered sense of fear and danger combined with high stress resistance, they are confident in their own strengths, have great perseverance and try to dominate the society;
• disinhibition - impulsive, easily give in to an impulse, have a need to satisfy their desires "here and now", not thinking about the consequences and not confining themselves to the generally accepted behavioral norms;
• meanness and heartlessness - are not capable of empathy, they use any means up to violence to get what they want immediately, are prone to exploitation, disobedience, manipulation by other people.

Such a triaric model of behavior (the triad of psychopathy) is typical for people with a psychopathic personality.

Other researchers emphasize the addiction of psychopaths to narcissism, noting that they are almost always very pleased with themselves. Communication with other people is reduced to their exploitation, manipulative actions, ignoring other people's interests and feelings. Non-compliance with a psychopath can provoke a very violent, aggressive reaction.

Such personality traits as psychopathy, narcissism and a complete lack of principles, called the dark triad, have many common characteristics among themselves. To these negative traits often add a tendency to sadism.

Psychopathies in the psychiatric hierarchy occupy an intermediate place, delineating the extreme version of the norm, called accentuation of character, which implies some more pronounced traits of a person's character, manifested in connection with traumatic situations for a short time in the form of psychosis or neurosis, and progressive mental pathologies.

Psychopathy of personality does not fit into the general boundaries of the description of the illnesses of the psyche, therefore it has long been attributed to borderline morbid conditions, not recognizing the disease, but you can not name a healthy personality of the psychopath as well. The accentuation of character and personality psychopathy are separated from each other by a ghostly trait, which even experienced psychiatrists can not always discern. The main difference is the constancy of psychopathy, it accompanies a person all his life, the accentuation also looks like accents on some character traits that are more prominent than others, and from this dissonant on the general background. These accents are not constantly manifested, but under the influence of some psychotraumatic situations. Accentuation of certain features does not prevent a person from leading a normal life in society.

The average psychological portrait of a psychopath looks like this: at first glance it is an enterprising, energetic, charming person who does not suffer from an inferiority complex; later features such as cunning and ability to manipulate others, falsity, soullessness and callousness come to light. 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 way of life, or he can be a successful businessman or a politician. Psychopath usually does not really set real goals and objectives, does not plan 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 sight of psychopaths, nothing expressing the eyes of "rotten fish." Many in the past may have criminal records, several conjugal unions and a lot of broken hearts, noticeably contempt for public foundations.

In institutions and organizations, psychopaths, as a rule, are charming and executive before the authorities, however, they are rude, offensive and aggressive towards the employees standing below their hierarchical staircase. Their business qualities are usually highly appreciated. Courage, the ability to take risks and make quick decisions, sometimes non-trivial, from the point of view of the average person, basically bring good dividends to psychopaths, manipulative abilities allow you to achieve a lot from employees and lead them along. Although their lack of principle and the lack of morality are more likely to be judged negatively, it is considered that the harm brought by a psychopath who occupies a high leadership level is much higher than his.

Psychopathy in the family

It is not easy to work with a psychopath, but it is much worse when a family member becomes a psychopath. There are no recipes, the best way 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 circumstances in which he grew up. A socialized psychopath will perform his duties, educate children, support a family, simply because he is so much easier, more comfortable and more comfortable, 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, this person can not be relied on. And his wife will have to put up with many of the strangeness of her husband.

A psychopathic wife is also not a gift, and in this case, there is a connection with her upbringing. Loving her husband and children, she will not, because she can not, she does not appear to be responsible to them either. But a socialized psycho can well go for a caring mother - do lessons with the children, take them to additional classes, play games, and play the role of a devoted wife, especially if the husband meets her expectations.

Psychopaths, well-off and socialized, prefer to communicate with grown-up children, small children, who require hourly care and presence, simply annoy them. If possible, such parents will try to shift the care of young children to nannies, grandmothers or other relatives. Fathers, "burning" at work, usually cause respect, mothers, businesswomen, careerists, also in the modern world - not uncommon.

Much worse than the antisocial psychopaths, who grew up in an unfavorable situation, who 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, can be mocked physically and morally, even dragged into illegal actions.

Psychopathy in men is better studied, because they are much more among psychopathic personalities, and also in places of deprivation of liberty, where, in the main, research is conducted.

The symptomatology of psychopathy does not depend on gender, and the difference in manifestations is determined by its appearance, as well as by differences in the assessment of the behavior of men and women by society.

For example, if many authors, describing women psychopaths, call them sexually dissolute, then, speaking of men, they mention a lot of connections, marriages or broken hearts, which in fact characterizes psychopaths of any sex, as sexually active and, in their own way, attractive , as well as irresponsible and soulless manipulators who are able to get what they want without having to worry about the prospect.

And, you see, the vagabond and / or alcoholic woman also causes a somewhat different reaction in the society than the man who leads the same way of life.

Psychopathy in women is characterized by less aggressiveness and the use of physical violence, which is simply characteristic of the female in general. They are much less likely to commit criminal acts in a state of affect, among them there are often kleptomaniacs, but in terms of psychological sadism, a psychotic woman will give any man a hundred points ahead. In general, some experts believe that in fact, the female psycho is not less, they just need to be evaluated differently.

Psychopaths of either sex are egocentric, they are all guided only by their immediate desires, ignoring the interests of others and even those closest to them. A psychopathic mother in most cases poses a serious threat to the mental health of her children, much greater than the psychopathic father, because with the mother, children, especially small children, spend most of their time in most families.

Almost always note that a psychopathic husband is a huge mental trauma for his wife, and often - and a high probability of physical bullying.

Female psychopaths are also uncontrollable in family life. Lack of self-control, long-term goals, callousness and a propensity to abuse psychoactive substances, deceit and meanness can ruin the life of any normal man.

The parasitism of psychopaths is assessed differently by society, in this capacity, men are often blamed, simply because a woman who is supported by her husband and helped by her parents does not cause public condemnation.

Psychopathy in children

The first signs of inherited psychopathy are already apparent in two or three years. Young children are emotionally unstable, they have no feeling of pity for animals, peers and relatives, they are difficult to achieve sympathy, repentance for cruel acts. Basically, the first thing parents pay attention to is cruelty to other children and / or animals, the desire to necessarily dominate, to command other children, to use force against the dissenters.

Pre-school psychopathy is diagnosed by S. Scott (Institute of Psychiatry, London) on the following grounds:

• frequent insults to the people around (regardless of persons and kinship);
• regular attempts to cause pain to any living beings (prick, pinch, pinch, pull), older children try to exert moral influence;
• total disobedience, attempts to escape, so as not to obey the rules;
• the child never feels guilty;
• you can achieve an adequate perception only through remuneration;
• in any failure the child blames others, himself - never;
• does not react to remarks and is not afraid of punishment.

It is worth pondering if the children of the senior preschool and primary school age are constantly fighting, taking other people's things without demand, trying to set something on fire or blow it up.

A real squall rages on parents when children reach adolescence. They rude, run away from home, do not want to obey, they can not be intimidated by any threats. The teenagers do not feel guilty and responsible, reacting violently to the punishment. Feelings of other people's psychopaths are not interested in any age.

It is in adolescents that problems with the law usually begin, they can start drinking, taking drugs, committing crimes.

Psychopathy in adolescents proceeds in severe form, this is the critical age of hormonal adjustment and personality formation. It is during this period that it is more difficult for parents to cope with a psychotic child. Basically, of course, such children are distinguished by increased excitability, stubbornness, there may be sudden transitions from merriment to depression, hysteria, tearfulness and even fainting.

The transition to adulthood can be marked by the so-called metaphysical intoxication - attempts to solve any complex unsolvable problems and thus make humanity happy.

At about the age of 20 years, usually the state of compensation comes, the well-being of psychopaths stabilizes the mood and adaptation takes place in society.

Stages

While there is no progression for psychopathy, as for other diseases of the psyche and diseases in general, it has its own dynamics. This is not a static state, it is developing, and it has certain stages of development.

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

Psychopaths are distinguished by two states: compensated, when the individual is in peace with society (usually achieved at the expense of comfortable conditions of his existence), and decompensated when the pathological psychogenic reaction develops (decompensation most often occurs with adverse external influences). For each type of psychopathy decompensatory effect has various factors. And reactions can also be unambiguous kind of psychopathy, such last for a short time - sometimes several hours, sometimes several days. After very significant mental trauma, decompensation may occur, which manifests itself in the form of a reaction that was not previously dominant in a given individual, for example, asthenia in an excitable psychopath or, conversely, a depressive manifesting an explosive temperament.

Ambiguous structural changes in the character of the psychopath are usually more prolonged, but still reversible when the causes causing the given state are eliminated. The symptomatology of such shifts is not represented by psychotic symptoms, but by characterological reactions - for some time an individual can absorb some passion, he may have a state of unmotivated aggression, hopeless longing, a desire to take his life. If the traumatic situation is not resolved, the reaction can take a protracted character, gain a foothold, and eventually develop severe psychopathy.

Regardless of the type of psychopathy, they develop according to one cyclical scenario. Personal anomalies of the psychopath lead to the creation of a conflict situation, as a result of which the patient develops a psychopathic reaction that lasts more or less long. After its termination, psychopathy is aggravated.

[29], [30], [31], [32], [33]

Complications and consequences

The danger to society and the psychopath itself is the decompensation of psychopathy, leading to an increase in personality anomalies that hinder natural adaptation in society.
The clinical course of decompensation looks like an aggravation of abnormal personal qualities of the individual, specific for a particular kind of psychopathy - hysterical attacks, affective antics, depression, hypochondria, acute delusional syndromes, reformism, litigating.

Psychopathy develops throughout the life of a person, the impact of society is of great importance in its dynamics. Favorable - helps to smooth out psychopathic manifestations, their compensation. On the contrary, under the influence of many permanent unfavorable factors an antisocial personality is formed, which can cause significant damage to the society.

Complications of personality disorder does not exist - with him a person will live a lifetime. However, over time, it can both smooth out and become worse. Frequent decompensations increase the course of psychopathy, which can greatly worsen the quality of life of the individual, become a concrete threat to his life or those around him. Quite often there are different forms of attacks of aggression and antisocial behavioral reactions on the part of psychopaths, some are quite harmless, others may pose a real danger. Not in vain in places of deprivation of liberty, psychopaths comprise from one third to one half of all prisoners.

Oscillations of the hormonal background - adolescence, pregnancy, menstruation, menopause, and - the crisis age stages contribute to decompensation of the disease and weighting its course.

Especially dangerous is the adolescence, when in addition to changes in the hormonal background, the maturation and personality formation take place. During this period, individuals with psychopathic traits intensify stubbornness, unwillingness to obey, impulsiveness. For teenagers, emotional instability is characteristic - unmotivated transitions from bursts of fun to tearfulness, depression, sadness; outbursts of rage or aggression without any reason, tantrums, tearfulness, fainting. Teenagers often flee from home, begin to wander, lead an antisocial lifestyle.

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

During the period of extinction of the sexual function, again the psychopathic personality characteristics become aggravated, the emotional balance is disturbed, the individual becomes more impulsive, angry, irritable and / or whiny. When the involution coincides with a change in the way of life, for example, retirement, the decompensation of psychopathy can worsen: there is anxiety, depression, depression combined with hypochondria and hysteria, adherence and conflictiveness increase.

[34], [35], [36], [37], [38], [39], [40], [41]

Diagnostics of the psychopathies

Methods for studying patients with personality disorders include a variety of studies. Firstly, in the field of view of specialists in the field of psychiatry, socially maladjusted individuals usually come into view. Socialized psychopaths, who do not have problems with adaptation in society, are quite happy with themselves, and they and their relatives never seek medical help. Attention is drawn to the long-term decompensated psychopathy, but in order to establish a diagnosis of personality disorder, it is necessary to exclude the common causes of mental disorders.

To do this, laboratory tests are carried out to give an idea of the overall health of the patient, some specific tests may be prescribed.

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

The diagnosis of psychopathy is based on interviews with the patient, in which psychiatrists and psychologists, using a set of specific techniques and methods, reveal violations of the human psyche.

Psychiatrists conduct a clinical interview and are guided for the diagnosis by the criteria of the latest edition of the disease classifier.

The medical psychologist uses in his work various tests and interviews that make it possible to identify the symptom complex - a stable combination of positive and negative features of the psyche that exist as a whole.

When diagnosing a personality disorder, the Minnnesota multidimensional personality test is used, and its adapted version is popular in the post-Soviet space - Standardized multifactorial personality research. These questionnaires have clinical scales that allow us to establish the kind of personality disorder - to identify the patient's proximity to a certain type of person (paranoid, asthenic, schizoid), the degree of sexual identification, anxiety and propensity to antisocial actions. Additional scales allow to estimate sincerity of the patient, and also to correct his unreliable answers.

The scale of psychopathy (sociopathy) - the fourth in the Minnesota multidimensional personal test evaluates the tested and its similarity to the antisocial personality disorder. Collected high scores on this scale indicate the inability of the individual to live in a society of their own kind. They characterize the tested as impulsive, angry, conflicting, not observing the moral and ethical rules adopted in human society. Their mood is subject to fluctuations, they are very susceptible to resentment, aggressively reacting to the offender and losing control over their behavior.

The test of R.Heir on psychopathy is very popular, the questionnaire includes twenty basic characterological features of the psychopath. Each item is evaluated at a maximum of three points, if the subject receives more than 30 points, he is predisposed to psychopathy. An interview is attached to the questionnaire, in which the examinee sets out his biography: he talks about education, work places, describes his marital status and possible frictions with the law. Since psychopaths are notorious liars, the data from the interview must be documented. R. Hare's test was designed to detect psychopathy in persons who committed criminal offenses, although it can be used in other cases.

In psychiatric practice, different evaluation methods are used to determine the patient's self-esteem, the quality of his relationships with other people, explore cognitive functions, the level of perception, attention, and memory.

The basis for the recognition of a person as a psychopath are such criteria of psychopathy Gannushkina:

• stability (stability) of anomalous character traits, that is, they accompany the patient all his life.
• the psychopathic feature is comprehensive, that is, it completely determines the character structure of the individual (totality);
• pathological anomalies of character are so noticeable that they make it difficult, if not altogether, to allow an individual to adapt to life in society.

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

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

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

On the Internet they also ask Dante's test for psychopathy. He does not give a specific answer if you have a mental disorder. And other tests for self-diagnosis can not replace a trip to the doctor.

[42], [43], [44], [45], [46], [47]

Differential diagnosis

Pathological anomalies in psychopathies should be total and stable in nature, and individual, albeit markedly abnormal character, do not reach the level of pathology, refer to accentuated character traits. Types of accentuations correspond to the types of psychopathies, however, accentuations usually appear temporarily, under the influence of the psychotraumatic factor, during the growing up period, later they are smoothed out and they do not lead to disadaptation in the society. Differences of accentuation from psychopathy, in the opinion of many authors, have a quantitative character and consist in their dosage, which is not perceived as pathology.

Differentiation of personality disorder is carried out with psychopathic conditions after brain trauma, infections and intoxications with central nervous system damage, endocrinopathies and other diseases. One of the criteria for the difference is the fact that before the emergence of a psychopathic condition in diseases or traumas, the personality developed quite normally.

Differentiate also constitutional or nuclear psychopathies with marginal, that is, psychogenic and pathocharacterological developments that can occur at any age under the influence of psychotrauma. From the congenital they are distinguished by a clear beginning, in the first case, a personality disorder is seen from early childhood. Abnormal features of the character of a psychopath differ by a constant presence.

Sociopathy also stands out as the result of the influence of adverse living conditions and differentiates from the nuclear forms of psychopathy leading to the development of antisocial attitudes in the individual.

Affective psychosis and some of its manifestations resemble decompensated affective psychopathy, however, at the end of the affect phase, patients undergo an intermission of psychosis and all mental functions are normalized. Whereas the psychopathic characteristics of the individual are not completely smoothed out and in the period of compensation. The affective phases - depressive, manic, manic-depressive, last no less than one or two weeks (sometimes several years), occur periodically and spontaneously, completely disrupt the life of the patient and cause the need to seek medical help.

Intellectual insufficiency and psychopathy have many common features, in particular, in their pathogenesis, there is underdevelopment of the frontal and temporal lobes, in the manifestations - the infantilism of thinking. Both are related to border states. However, in patients with personality disorders, cognitive functions are not impaired, and according to Wexler's test, the intellectual level is often even higher than the average. It is most difficult to differentiate psychopathy from intellectual insufficiency caused by pedagogical neglect. In such individuals, the lack of intelligence may well be combined with the traits of a psychopathic personality.

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

Narcissism as a character trait is inherent in psychopaths in general, their egocentrism, narcissism, overestimated self-esteem, and often - and sexual deviation is seen in the symptomatic complex of psychopathies. However, in itself 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, to sympathize with his experiences, to "tune" to the one with him. It is believed that this property is unknown to psychopaths, this is one of the main characteristics of psychopathies. People can have different levels of empathy, and in psychopathic personalities this ability is absent, in all kinds of psychopathies. Cyclotimics or affective psychopaths, able to sense the mood of others, in the new classifier already belong to patients with mild forms of manic-depressive psychoses. To psychopaths they are no longer considered.

Schizophrenia is characterized by the presence of mania, delirium, hallucinations, sound and visual. In schizophrenics incoherent speech, meager emotions, slovenly appearance, inadequate reactions and actions. However, such symptoms are characteristic of severe schizophrenia. A sluggish process is virtually indistinguishable from schizoid psychopathy. The mediastinal course and, as a rule, the later manifestation of schizophrenia will be the main difference from schizoid personality disorder.

Neurosis, like psychopathy, was previously seen as a borderline 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 mutually connected, their symptoms and causes overlap with each other. In decompensation the leading role is assigned to psychogenic reasons, there is no progression of dementia, delirium and hallucinations. Both disorders are reversible.

With neurosis, there is usually a strong connection with the stress factor and the appearance of a neurosis. Prior to this event, the patient was absolutely normal, whereas the psychopath of strangeness always manifested itself. Timely treatment of neurosis contributes to the normalization of the patient's condition, whose personality structure is normalized.

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

Psychoasthenic psychopathy is mainly manifested at an early age and accompanies a person all his life, and acquired disorders manifest after a psychotrauma, and after treatment the nervous system of the patient is usually restored.

[48], [49]

Treatment of the psychopathies

Psychopathy in the stage of decompensation is almost always accompanied by social and personal disadaptation. It is in such periods that it is necessary to help the patient to find firm ground underfoot.

The preferred method is to provide psychotherapy. Psychotherapy of psychopathy is carried out with the purpose of correction of personal attitudes of an individual and compensation of anomalous characterological deviations, formation at it of understanding of necessity of observance of moral norms and rules in relations with other people, and also activization of aspirations to productive activity.

Psychopathic Compensation

The doctor selects the method of working with the patient individually, based on the type of personality disorder and degree of decompensation. Begin the course with individual studies with the predominance of activation of rational attitudes. Classes are held in the form of explanations and discussions.

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

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

Family sessions are held, helping to normalize relations between family members, to find compromise solutions, to achieve mutual understanding.

Drug treatment is not welcome, however, in some cases, it can not be dispensed with, with 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.

So, to compensate for inhibited psychopathy, antidepressants are used. In the state of subdepression, amitriptyline, a tricyclic antidepressant, blocking the cholinergic receptors of the central and peripheral nervous system, can be prescribed, so that the patient improves mood, anxiety and anxiety disappear. The daily dose of the drug is approximately 75-100 mg.

Maprotiline, a fairly powerful drug with a tetracyclic structure. It is used in patients with hypertrophied sense of guilt. Has a noticeable thymonoanaleptic effect, eliminates melancholia, inhibition, stops splashes of excitement. It is allowed to use the drug in pediatrics. Usually, not more than 75 mg per day is prescribed.

These drugs are contraindicated after-effect patients, with decompensated hypertension and heart muscle insufficiency, men with benign prostatic cancer, pregnant and lactating women.

In the case of hypomagnesium syndrome, the antipsychotic Clozapine (Leponex) is prescribed, characterized by a powerful and rapid soothing effect. In patients taking the drug, the number of suicide attempts decreases. However, prolonged use can significantly affect blood composition.

An alternative to clozapine may be Finlepsin (in a daily dose of 0.4-0.6 g) or drops of haloperidol (in a daily dose of 10-15 mg).

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

Patients are usually treated as outpatients. During the course of psychotropic medicines, it is necessary to completely abandon the use of alcohol, since these drugs are incompatible with alcohol. This combination is fraught with the development of negative effects up to a lethal outcome. Also during treatment it is not recommended to get behind the wheel of the car and perform other works that require concentration of attention.

Indications for emergency hospitalization in a psychiatric clinic (without patient consent) are severe stages of psychopathy, decompensation in the form of psychoses. For example, twilight consciousness in the hysteroid, psychosis with delirium in paranoids, dysphoric disorders in epileptoids, in addition - cases of aggressive behavior, presenting a danger to others or attempting suicide, causing damage to themselves.

To cure psychopathy, especially congenital, it is impossible, however, it is quite possible to achieve a long-term compensation of the individual's condition.

Treatment of psychopathy by alternative means

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

Alternative medicine has less harmful effects on the body, although it can also lead to side effects, one of which is a variety of allergic reactions. But the severity of side effects from herbal medicines is not comparable to the undesirable effects of taking medications. In addition, most of the drugs that act on the psyche are addictive, and psychopathic individuals are so prone to substance abuse.

Therefore, resort to treatment with alternative means, especially after consulting with a doctor or herbalist, may not be the worst idea.

The hyperactive properties of a person can be somewhat corrected with the help of soothing herbs: motherwort, peony evasion, valerian root, marsh swine, dandelion, mint, lemon balm and other herbs. Each grass can be brewed separately, and it is possible to make herbal mixtures. In this case, the effect will be stronger.

With the infusions of soothing herbs, you can make baths or use essential oils of the same plants.

For example, it is believed that some flavors contribute to calm concentration, greater concentration and perseverance. These are essential oils of sandalwood, eucalyptus and jasmine.

The productive activities are tuned by the scents of juniper and ylang-ylang.

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

Inhibited psychopaths, in particular, individuals of asthenic type, are recommended infusions of ginseng, echinacea, licorice, ayr, elecampane, angelica.

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

Depressive reactions to stressful situations are stopped by herbs such as chamomile, peppermint, lemon balm, medicinal soap, valerian.

Aromatherapy helps to cope with bouts of anger or despondency, to eliminate bad mood, excessive excitement, activate intelligence, clarify consciousness and even strengthen spirituality. These properties are endowed with sandalwood, pink, juniper, cedar oil, myrrh and incense.

Mix at least three oils and spray the fragrance in the room, the composition of the oils sometimes need to be changed.

Calmed with excitable psychopaths will help the oil of geranium, lavender, chamomile, tuberose; to distract from depression and improve the mood depressive - jasmine, ylang-ylang, herb angelica.

Hypertymics reduce the emotional background and normalize the mood recommend geranium, chamomile and rose oil, replacing them with a composition of muscatine sage, thyme and ylang-ylang.

Anxiety and anxiety, lack of confidence in their own strength, are suppressed by the scents of sage, fern, rosemary, oregano. Strong fatigue will leave from the aromatic composition of the oils of sage, cloves and marjoram. Also, hypothymics and psychasthenics (asthenics), the vitality and mood lift the aromas of fern, sage, oregano, and rosemary oils.

Restore the lost strength and vitality juniper, marjoram, ginger, clove, cinnamon oil.

To combat psychopathy, all alternative means are good: yogotherapy (preferably under the guidance of an experienced yogotherapist, at least initially), meditation, mineralotherapy, color-resonance therapy, and others.

Prevention

It is important for any child to grow up in a supportive environment, and especially for children with constitutionally conditioned features of a psychotic personality.

Adults need to strive for the absence of negative external influences that provoke the emergence of antisocial properties of character, especially at the age when the behavioral norms and moral standards adopted in the society are formed.

At the initial stages of the development of the personality, the pedagogical influence is given the most important role in the prevention of psychopathy, social adaptation and professional orientation are then added to it, taking into account individual characteristics.

[50], [51], [52], [53], [54], [55], [56], [57]

Forecast

There are cases when, in a supportive environment, people who are genetically prone to psychopathy are grown up by socially adapted and respectable citizens.

The most unfavorable prognosis is given by specialists with hysterical psychopathy, although suitable living conditions lead to a sustainable compensation in adulthood. The asteroids can socialize and acquire some skills for productive activities. Practically not adapt from this group of psychopaths pathological liars.

Psychopathists are responsible for their illegal actions and are not considered invalids. Psychopathy and disability concepts are incompatible, at least in modern society. Perhaps in the future, when this phenomenon will be better studied and explained, and ranked among the disabled population. With pronounced decompensations, a sick leave sheet can be issued that certifies a temporary lack of ability to work.

When on the basis of long-term decompensation there are stable signs of mental illness, then VTEK can recognize a psychopath as a group III invalid with certain recommendations on the organization of its labor regime.

Cinema characters-psychopaths, according to R. Heyer, one of the leading experts in psychopathy, are far from real characters, although, of course, such developments are also possible. Films in which psychopathy is played as a phenomenon do not pretend to be a scientific approach and are withdrawn for the sake of box office fees. Their heroes are more likely to be members of the "club of favorites" than typical povsonazhi.

[58], [59], [60]