Quite often, parental care is mainly focused on physical health your child, while the emotional component remains virtually unattended. This is due to the fact that most parents consider early symptoms of emotional disorders to be temporary and therefore harmless.
The place of emotional disturbances in the mental development of a child seems to be one of the key aspects of his life, due to the fact that these disturbances affect his attitude towards his parents and the environment in general. Today there is a tendency towards an increase in emotional disorders in children, in the form of decreased social adaptation and a tendency towards aggressive behavior.
· 1 Causes
· 2
· 3 Diagnosis of disorders
· 4
There are many reasons for the occurrence of emotional disorders in a child, so parents should be especially careful when various pathological signs appear. As a rule, specialists make a final diagnosis when registering 3 signs of emotional instability.
The most common causes of emotional disturbances are:
· Physical characteristics, taking into account diseases suffered in infancy;
· Inhibition of mental and mental development;
· Improper upbringing of a child in the preschool period;
· Poor nutrition, namely insufficient intake of necessary substances, which significantly affects the development of the baby;
Also, these above reasons are divided into two large groups:
1. Biological.
This causal group includes characteristic type nervous system. For example, if attention deficit disorder is present, the child may subsequently experience pathological process in the brain, formed as a result of severe pregnancy and childbirth of his mother.
2. Social
This group determines the process of interaction of the child with other people and the environment. For example, if a child already has experience communicating with age group people, his peers and the primary group for him - his family, then in some cases such socialization can also harm him.
If a child is constantly subjected to denial by adults, then he unconsciously begins to repress the received information that comes from the environment.
The emergence of new experiences that do not coincide with his conceptual structure begins to be perceived negatively by him, which ultimately creates a certain stress for him.
In the absence of understanding from peers, the child develops emotional experiences (rage, resentment, disappointment), which are characterized by severity and duration. Also, constant conflicts in the family, demands on the child, lack of understanding of his interests, also cause emotional disturbances in the mental development of the child.
Classifications of emotional disorders and their symptoms
The difficulty in identifying emotional-volitional disorders has resulted in the fact that a number of psychologists have formed different views on these types of disorders. For example, the scientist-psychologist G. Sukhareva noted that emotional disturbances at primary school age are often observed in children suffering from neurasthenia, which was characterized by excessive excitability.
Psychologist J. Milanich had a different idea about these disorders. He found that emotional-volitional disorders include 3 groups of emotional disorders;
Acute emotional reactions, which are characterized by the coloring of certain conflict situations, which manifested themselves in aggression, hysteria, reactions of fear or resentment;
A state of increased tension – anxiety, fearfulness, decreased mood.
Dysfunction of the emotional state, which manifested itself in a sharp transition from positive emotional phenomena to negative ones and also in the reverse order.
However, the most detailed clinical picture of emotional disorders was compiled by N.I. Kosterina. She divides emotional disorders into 2 large groups, which are characterized by an increase in the level of emotionality and, accordingly, a decrease in it.
The first group includes such conditions as:
· Euphoria, which is characterized by an inadequate increase in mood. A child in this condition, as a rule, has increased impulsiveness, impatience and a desire for dominance.
· Dysphoria is the opposite form of euphoria, characterized by the manifestation of such emotions as: anger, irritability, aggressiveness. It is a type of depressive syndrome.
· Depression – pathological condition characterized by the manifestation of negative emotions and behavioral passivity. A child in this state feels depressed and sad.
· Anxiety syndrome is a condition in which a child feels causeless anxiety and severe nervous tension. It is expressed in constant mood swings, tearfulness, lack of appetite, and increased sensitivity. Often this syndrome develops into a phobia.
· Apathy is a serious condition in which the child feels indifferent to everything that happens around him, and is also characterized by a sharp decrease in initiative functions. Most psychologists argue that the loss of emotional reactions is combined with a decrease or complete loss of volitional impulses.
· Paratamia is a characteristic disorder of the emotional background, in which the experience of one specific emotion is accompanied by external manifestations of completely opposite emotions. Often observed in children suffering from schizophrenia.
The second group includes:
· Attention deficit hyperactivity disorder, characterized by symptoms such as motor disorientation and impulsivity. It follows that the key signs of this syndrome are distractibility and excessive motor activity.
· Aggression. This emotional manifestation is formed as part of a character trait or as a reaction to environmental influences. In any case, the above violations need correction. However, before adjusting pathological manifestations, first of all, the main causes of diseases are identified.
Diagnosis of disorders
For subsequent therapy of disorders and its effectiveness, it is very important timely diagnosis emotional development child and his disorders. There are many special methods and tests that assess the development and psychological state of a child, taking into account his age characteristics.
Diagnosis of preschool children includes:
· Diagnosis of anxiety level and its assessment;
· Study of psycho-emotional state;
· Luscher color test;
· Study of self-esteem and personal characteristics of the child;
· Study of the development of volitional qualities.
Seeking psychological help is necessary if a child experiences certain difficulties in learning, communicating with peers, behavior, or has certain phobias.
Parents should also pay attention if the child experiences any emotional experiences, feelings, and also if his condition is characterized as depressed.
Methods for correcting emotional disorders
A number of domestic and foreign scientists in the field of psychology identify a number of techniques that make it possible to correct emotional-volitional disorders in children. These methods are usually divided into 2 main groups: individual and group, but such a division does not reflect the main goal of correcting mental disorders.
Mental correction of affective disorders in children is an organized system psychological effects. This correction is mainly aimed at:
Alleviation of emotional discomfort
· Increased activity and independence
· Suppression of secondary personal reactions (aggression, excessive excitability, anxiety, etc.).
· Correction of self-esteem;
· Formation of emotional stability.
World psychology includes 2 main approaches to the psychological correction of a child, namely:
· Psychodynamic approach. Advocates for the creation of conditions that make it possible to suppress external social barriers, using methods such as psychoanalysis, play therapy and art therapy.
· Behavioral approach. This approach allows you to stimulate the child to assimilate new reactions aimed at the formation of adaptive behavioral forms and, conversely, suppresses non-adaptive forms of behavior, if any. Includes such methods of influence as behavioral and psychoregulatory training, which allow the child to consolidate learned reactions.
When choosing a method of psychological correction of emotional disorders, one should proceed from the specifics of the disorder, which determines the deterioration of the emotional state. If a child has intrapersonal disorders, then an excellent way would be to use play therapy (not computer therapy), and the method of family psychocorrection has also proven itself well.
If there is a predominance of interpersonal conflicts, group psychocorrection is used, which allows optimizing interpersonal relationships. When choosing any method, the severity of the child’s emotional instability must be taken into account.
Methods of psychological correction such as game therapy, fairytale therapy, etc. work effectively if they correspond to the mental characteristics of the child and the therapist.
The age of a child up to 6 years (preschool period) is the most important period of his development, since it is during this period that the child’s personal foundations, volitional qualities are formed, and the emotional sphere also rapidly develops.
Volitional qualities develop mainly due to conscious control over behavior, while maintaining certain behavioral rules in memory.
The development of these qualities is characterized as the general development of personality, that is, mainly by shaping the will, emotions and feelings.
Consequently, for the successful emotional-volitional upbringing of a child, parents and teachers need to especially pay attention to creating a positive atmosphere of mutual understanding. Therefore, many experts recommend that parents formulate the following criteria for their child:
· When communicating with a child, it is necessary to maintain absolute calm and show your goodwill in every possible way;
· You should try to communicate with your child more often, ask him about anything, empathize, and be interested in his hobbies;
· Joint physical labor, games, drawing, etc. will have a positive effect on the child’s condition, so try to pay him as much attention as possible.
· It is necessary to ensure that the child does not watch films or play games with elements of violence, as this will only aggravate his emotional state;
· Support your child in every possible way and help him build confidence in himself and his abilities.
Part I. Disturbances in the development of the emotional-volitional sphere in children and teenagers
Study questions.
1. Typology of disorders in the development of the emotional-volitional sphere.
2. Psychological and pedagogical characteristics of children and adolescents with disorders of the emotional-volitional sphere.
3. Psychopathy in children and adolescents.
4. Accentuations of character as a factor contributing to the emergence of emotional-volitional disorders.
5. Children with early-onset autism (EDA).
1. The concept of violation of the emotional-volitional sphere in defectology defines neuropsychic disorders (mainly mild and medium degree severity). *
The main types of disorders in the development of the emotional-volitional sphere in children and adolescents include reactive states (hyperactivity syndrome), conflict experiences, psychasthenia and psychopathy (psychopathic forms of behavior), early childhood autism.
As is known, a child’s personality is formed under the influence of hereditarily determined (conditioned) qualities and factors of the external (primarily social) environment. Since the development process largely depends on environmental factors, it is obvious that unfavorable environmental influences can cause temporary behavioral disorders, which, once established, can lead to abnormal (distorted) personality development.
As for normal somatic development, an appropriate amount of calories, proteins, minerals and vitamins, and for normal mental development the presence of certain emotional and psychological factors is necessary. These include, first of all, the love of neighbors, a sense of security (provided by the care of parents), the cultivation of correct self-esteem, and also, along with the development of independence in actions and behavior), the guidance of adults, which includes, in addition to love and care, a certain set of prohibitions. Only when correct ratio attention and prohibitions, appropriate connections are formed between the child’s “I” and the outside world, and the little person, while maintaining his individuality, develops into a personality who will definitely find his place in society.
The versatility of the emotional needs that ensure the development of a child already in itself indicates the possibility of a significant number of unfavorable factors in the external (social) environment, which can cause disturbances in the development of the emotional-volitional sphere and deviations in the behavior of children.
2. Reactive states are determined in special psychology as neuropsychiatric disorders caused by unfavorable situations (developmental conditions) and not associated with organic damage to the central nervous system. The most striking manifestation of reactive states (RS) is hyperactivity syndrome, which appears against the background of a “prolonged” state of general mental excitability and psychomotor disinhibition. The causes of MS can be varied. Thus, circumstances traumatic for a child’s psyche include such a psychophysiological disorder as enuresis (bedwetting, which persists or often recurs after the 3rd year of life), often observed in somatically weakened and nervous children. Enuresis can occur after a severe nervous shock, fright, or after a somatic illness that debilitates the body. The occurrence of enuresis also includes such reasons as conflict situations in the family, excessive strictness of parents, too deep sleep, etc. Reactive states with enuresis are aggravated by ridicule, punishment, and the unkind attitude of others towards the child.
A reactive state can be caused by the presence of certain physical and psychophysiological defects in a child (strabismus, deformities of the limbs, lameness, severe scoliosis, etc.), especially if the attitude of others is incorrect.
A common cause of psychogenic reactions in young children is a sudden strong irritation of a frightening nature (fire, attack angry dog and etc.). Increased susceptibility to mental trauma is observed in children with residual effects after suffering infections and injuries, in children who are excitable, weakened, and emotionally unstable. The most susceptible to mental trauma are children belonging to a weak type of higher nervous activity, and children who are easily excitable.
The main distinguishing feature of MS is inadequate (excessively pronounced) personal reactions to influences from the environment (primarily social) environment. Reactive states are characterized by the state psychological stress And discomfort. MS can manifest itself in the form of depression (sad, depressed state). In other cases, the main symptoms of MS are: psychomotor agitation, disinhibition, and inappropriate behavior and actions.
In severe cases, there may be a disorder of consciousness (confusion, loss of orientation in the environment), unreasonable fear, temporary “loss” of certain functions (deafness, mutism).
Despite the differences in manifestations, a common symptom that connects all cases of reactive states is a severe, depressing psycho-emotional state that causes overstrain of nervous processes and disruption of their mobility. This largely determines the increased tendency to affective reactions.
Mental development disorders may be associated with severe internal conflict experiences when in the child’s mind there are opposing attitudes towards close people or to a particular social situation that has great personal significance for the child. Conflict experiences (as a psychopathological disorder) are long-term, socially conditioned; they acquire dominant value in mental life child and have a sharply negative impact on his characterological characteristics and behavioral reactions. The causes of conflict experiences are most often: the unfavorable position of the child in the family (conflicts in the family, family breakdown, the appearance of a stepmother or stepfather, parental alcoholism, etc.). Conflict experiences can arise in children abandoned by their parents, adopted, and in other cases. Another reason for persistent conflict experiences may be the above-mentioned shortcomings. psychophysical development, in particular, stuttering.
Manifestations of severe conflict experiences most often include isolation, irritability, negativism (in many forms of its manifestation, including speech negativism), depressive states; in some cases, the consequence of conflict experiences is a delay in the child’s cognitive development.
Persistent conflict experiences are often accompanied by disturbances ( deviations) behavior. Quite often, the cause of behavioral disorders in this category of children is improper upbringing of the child (excessive care, excessive freedom or, on the contrary, lack of love, excessive severity and unreasonable demands, without taking into account his personal - intellectual and psychophysical capabilities, determined by the stage of age development). A particularly serious mistake in raising a child is the constant derogatory comparison of him with children who have better abilities and the desire to achieve great achievements from a child who does not have pronounced intellectual inclinations. A child whose dignity is humiliated and who is often punished may develop feelings of inferiority, reactions of fear, timidity, bitterness and hatred. Such children, who are constantly stressed, often experience enuresis, headaches, fast fatiguability etc. At an older age, such children may rebel against the dominant authority of adults, which is one of the reasons for antisocial behavior.
Conflict experiences can also be caused by traumatic situations in the school community. Of course, the occurrence and severity of conflict situations is influenced by the individual personal and psychological characteristics of children (state of the nervous system, personal aspirations, range of interests, impressionability, etc.), as well as the conditions of upbringing and development.
Also quite a complex neuropsychic disorder is psychasthenia– disturbance of mental and intellectual activity, caused by weakness and disruption of the dynamics of processes of higher nervous activity, a general weakening of neuropsychic and cognitive processes. The causes of psychasthenia can be severe violations somatic health, disorders of general constitutional development (due to dystrophy, metabolic disorders in the body, hormonal disorders, etc.). At the same time, factors of hereditary conditioning, dysfunction of the central nervous system of various origins, the presence of minimal brain dysfunction, etc. play a large role in the occurrence of psychasthenia.
The main manifestations of psychasthenia are: a decrease in general mental activity, slowness and rapid exhaustion of mental and intellectual activity, decreased performance, phenomena of mental retardation and inertia, increased fatigue under psychological stress. Psychoasthenic children are extremely slow to engage in academic work and get tired very quickly when performing tasks related to mental and mnemonic actions.
Children in this category are distinguished by such specific character traits as indecision, increased impressionability, a tendency to constant doubts, timidity, suspiciousness, and anxiety. Often, symptoms of psychasthenia also include depression and autistic manifestations. Psychopathic development according to psychasthenic type in childhood manifests itself in increased suspiciousness, obsessive fears, and anxiety. At an older age, obsessive doubts, fears, hypochondria, and increased suspiciousness are observed.
3.Psychopathy(from Greek - psyche- soul, pathos– disease) is defined in special psychology as pathological character, manifested in unbalanced behavior, poor adaptability to changing environmental conditions, inability to obey external demands, and increased reactivity. Psychopathy is a distorted version of personality formation; it is a disharmonious development of personality with (as a rule) sufficient preservation of intelligence. Research by domestic scientists (V.A. Gilyarovsky, V.R. Myasishchev, G.E. Sukhareva, V.V. Kovalev, etc.) showed the dialectical interaction of social and biological factors in the origin of psychopathy. Most psychopathy is caused by external pathological factors that acted in utero or in early life. childhood. The most common causes of psychopathy are: infections - general and brain, traumatic brain injuries - intrauterine, birth and acquired in the first years of life; toxic factors (for example, chronic gastrointestinal diseases), intrauterine development disorders due to alcohol intoxication, exposure to radiation, etc. Pathological heredity also plays a certain role in the formation of psychopathy.
However, for the development of psychopathy, along with the main ( predisposing) the cause that causes congenital or early acquired insufficiency of the nervous system, it is necessary to have another factor - the unfavorable social environment and the lack of corrective influences when raising a child.
Targeted positive influence of the environment can, to a greater or lesser extent, correct the child’s existing deviations, while under unfavorable conditions of upbringing and development, even mild deviations in mental development can transform into a severe form of psychopathy (G.E. Sukhareva, 1954, etc.). In this regard, biological factors are considered as starting points,preconditions, which can cause psychopathic personality development; acquire a decisive role social factors, mainly conditions for child upbringing and development.
Psychopathy is very diverse in its manifestations, so the clinic distinguishes its various forms (organic psychopathy, epileptoid psychopathy, etc.). Common to all forms of psychopathy is a violation of the development of the emotional-volitional sphere, specific character anomalies. Psychopathic personality development is characterized by: weakness of will, impulsiveness of actions, rough affective reactions. Underdevelopment of the emotional-volitional sphere also manifests itself in a certain decrease in performance associated with the inability to concentrate and overcome difficulties encountered when performing tasks.
Violations of the emotional-volitional sphere are most clearly expressed when organic psychopathy, which is based on organic damage to the subcortical brain systems. Clinical manifestations with organic psychopathy are different. In some cases, the first manifestations of a mental disorder are detected at an early age. The anamnesis of these children indicates pronounced timidity, fear of sharp sounds, bright light, unfamiliar objects, and people. This is accompanied by intense and prolonged screaming and crying. In early and preschool age, psychomotor restlessness and increased sensory and motor excitability come to the fore. At primary school age, psychopathic behavior manifests itself in the form of uncontrollability, protest against the rules of social behavior, any regime, in the form of affective outbursts (pugnaciousness, running around, noisiness, and later - school truancy, a tendency to vagrancy, etc.).
In other cases of organic psychopathy, the following feature of the behavioral reactions of children attracts attention, sharply distinguishing them from their peers already at preschool age. Relatives and teachers note the extreme unevenness of their mood; Along with increased excitability and excessive mobility, these children and adolescents often experience a low, gloomy, irritable mood. Children of senior preschool and primary school age often complain of vague painful sensations, refuse to eat, sleep poorly, often quarrel and fight with peers. Increased irritability, negativism in various forms of its manifestation, hostile attitude towards others, aggressiveness towards them form pronounced psychopathological symptoms of organic psychopathy. These manifestations are especially pronounced at an older age, during puberty. They are often accompanied by a slow pace of intellectual activity, decreased memory, and increased fatigue. In some cases, organic psychopathy is combined with delayed psychomotor development of the child.
G.E. Sukhareva identifies two main groups of organic psychopathy: excitable(explosive) and brakeless.
At the first (excitable) type, unmotivated mood swings are observed in the form of dysphoria. In response to the slightest remarks, children and adolescents have violent reactions of protest, leaving home and school.
Organic psychopaths of the uninhibited type are characterized by elevated mood levels, euphoria, and uncriticality. All this is a favorable background for the formation of a pathology of desires and a tendency to vagrancy.
With a hereditary burden of epilepsy in children, personality traits characteristic of epileptoid psychopathy. This form of psychopathy is characterized by the fact that in children, with primary intact intelligence and the absence of typical signs of epilepsy (seizures, etc.), the following behavioral and character traits are noted: irritability, short temper, poor switchability from one type of activity to another, “getting stuck” on their experiences, aggressiveness, egocentrism. Along with this, thoroughness and perseverance in completing educational tasks are characteristic. These positive traits must be used as support in the process of correctional work.
With a hereditary burden of schizophrenia, children may develop schizoid personality traits. These children are characterized by: poverty of emotions (often underdevelopment of higher emotions: feelings of empathy, compassion, gratitude, etc.), lack of childlike spontaneity and cheerfulness, and little need to communicate with others. The core property of their personality is egocentrism and autistic manifestations. They are characterized by a peculiar asynchrony of mental development already from early childhood. The development of speech outpaces the development of motor skills, and therefore children often have undeveloped self-care skills. In games, children prefer loneliness or communication with adults and older children. In a number of cases, the peculiarity of the motor sphere is noted - clumsiness, motor awkwardness, inability to perform practical activities. General emotional lethargy, which is detected in children from an early age, lack of need for communication (autistic manifestations), lack of interest in practical activities, and later - isolation, self-doubt, despite a fairly high level of intellectual development, create significant difficulties in education and teaching this category of children.
Hysterical psychopathic development is more common in childhood than other forms. It manifests itself in pronounced egocentrism, increased suggestibility, and demonstrative behavior. This variant of psychopathic development is based on mental immaturity. It manifests itself in a thirst for recognition, in the inability of a child and adolescent to exert volition, which is the essence of mental disharmony.
Specific features hysterical psychopathy manifest themselves in pronounced egocentrism, in the constant demand for increased attention to oneself, in the desire to achieve what they want by any means. In social communication there is a tendency to conflicts and lies. When colliding with life's difficulties hysterical reactions occur. Children are very capricious, love to play a commanding role in a group of peers and become aggressive if they fail to do so. Extreme instability (lability) of mood is noted.
Psychopathic development according to unstable type can be observed in children with psychophysical infantilism. They are distinguished by immaturity of interests, superficiality, instability of attachments, and impulsiveness. Such children have difficulties in long-term, purposeful activity; they are characterized by irresponsibility, instability of moral principles, and socially negative forms of behavior. This variant of psychopathic development can be of either constitutional or organic origin.
In practical special psychology, a certain relationship has been established between incorrect approaches to raising children, pedagogical errors and the formation of psychopathic character traits. Thus, the characterological traits of excitable psychopaths often arise during so-called “hypoguardianship” or direct neglect. The formation of “inhibited psychopaths” is favored by the callousness or even cruelty of others, when the child does not see affection and is subjected to humiliation and insults (the social phenomenon of “Cinderella”). Hysterical personality traits are most often formed in conditions of “overprotection”, in an atmosphere of constant adoration and admiration, when the child’s loved ones fulfill any of his desires and whims (the “family idol” phenomenon).
4. B adolescence An intensive transformation of the adolescent’s psyche occurs. Significant changes are observed in the formation of intellectual activity, which is manifested in the desire for knowledge, the formation of abstract thinking, and a creative approach to problem solving. Volitional processes are intensively formed. A teenager is characterized by persistence, perseverance in achieving a goal, and the ability to engage in purposeful volitional activity. Consciousness is actively being formed. This age is characterized by disharmony of mental development, which often manifests itself in emphasis character. According to A.E. Lichko, the accentuation (sharpening) of individual character traits in students of different types of schools varies from 32 to 68% of the total student population (A.E. Lichko, 1983).
Character accentuations – These are extreme variants of a normal nature, but at the same time they can be a predisposing factor for the development of neuroses, neurotic, pathocharacterological and psychopathic disorders.
Numerous studies by psychologists have shown that the degree of disharmony in adolescents is different, and the accentuation of character itself has different qualitative features and manifests itself differently in the behavioral characteristics of adolescents. The main options for character accentuations include the following.
Dysthymic personality type. Features of this type of accentuation are periodic fluctuations in mood and vitality in adolescents. During periods of high mood, adolescents of this type are sociable and active. During a period of decline in mood, they are laconic, pessimistic, begin to be burdened by noisy society, become sad, lose their appetite, and suffer from insomnia.
Teenagers of this type of accentuation feel conformed among a small circle of close people who understand them and provide support. It is important for them to have long-term, stable attachments and hobbies.
Emotive personality type. Adolescents of this type are characterized by variability of moods, depth of experiences, and increased sensitivity. Emotive teenagers have developed intuition, sensitive to the assessments of others. They feel conformed to their family, understanding and caring adults, and constantly strive for confidential communication with adults and peers who are significant to them.
Anxious type The main feature of this type of accentuation is anxious suspiciousness, constant fear for oneself and one’s loved ones. In childhood, adolescents of the anxious type often have a symbiotic relationship with their mother or other relatives. Teenagers experience a strong fear of new people (teachers, neighbors, etc.). They need warm, caring relationships. A teenager’s confidence that he will be supported and helped in an unexpected, non-standard situation contributes to the development of initiative and activity.
Introverted type. Children and adolescents of this type tend to be emotionally withdrawn and withdrawn. They, as a rule, lack the desire to establish close, friendly relationships with others. They prefer individual activities. They have weak expressiveness, a desire for solitude filled with reading books, fantasizing, and various hobbies. These children need warm, caring relationships from loved ones. Their psychological comfort increases when adults accept and support their most unexpected hobbies.
Excitable type. With this type of character accentuation in adolescents, there is an imbalance between excitatory and inhibitory processes. Adolescents of the excitable type, as a rule, are in a state of dysphoria, which manifests itself in depression with the threat of aggressiveness towards the entire outside world. In this state, an excitable teenager is suspicious, inhibited, rigid, prone to emotional irascibility, impulsiveness, and unmotivated cruelty towards loved ones. Excitable teenagers need warm emotional relationships with others.
Demonstrative type. Teenagers of this type are distinguished by pronounced egocentrism, a constant desire to be the center of attention, and a desire to “make an impression.” They are characterized by sociability, high intuition, and the ability to adapt. Under favorable conditions, when a “demonstrative” teenager finds himself in the center of attention and accepted by others, he adapts well, is capable of productive, creative activity. In the absence of such conditions, there is a disharmony of personal properties of the hysterical type - attracting special attention to oneself through demonstrative behavior, and a tendency to lie and fantasize as a defense mechanism.
Pedantic type. As E.I. emphasizes Leonhard, pedantry as an accentuated character trait is manifested in the behavior of the individual. The behavior of a pedantic personality does not go beyond the bounds of reason, and in these cases the advantages associated with the tendency towards thoroughness, clarity, and completeness are often felt. The main features of this type of character accentuation in adolescence are indecision and a tendency to reasoning. Such teenagers are very careful, conscientious, rational, and responsible. However, some adolescents with increased anxiety experience indecisiveness in decision-making situations. Their behavior is characterized by some rigidity and emotional restraint. Such teenagers are characterized by increased fixation on their health.
Unstable type. The main characteristic of this type is the pronounced weakness of the volitional components of the personality. Lack of will manifests itself primarily in educational or labor activity teenager However, in the process of entertainment, such teenagers can be highly active. Unstable adolescents also have increased suggestibility, and therefore their social behavior largely depends on their environment. Increased suggestibility and impulsiveness against the background of immaturity of higher forms of volitional activity often contributes to the formation of a tendency towards additive (dependent) behavior: alcoholism, drug addiction, computer addiction, etc. Unstable accentuation manifests itself already in the elementary grades of school. The child has a complete lack of desire to learn and exhibits unstable behavior. In the personality structure of unstable adolescents, inadequate self-esteem is observed, which is manifested in the inability to self-analysis, corresponding to the assessment of their actions. Unstable adolescents are prone to imitative activities, which makes it possible, under favorable conditions, to form socially acceptable forms of behavior in them.
Affectively labile type. An important feature of this type is extreme mood variability. Frequent mood changes are combined with a significant depth of their experience. The well-being of a teenager and his ability to work depend on the mood of a given moment. Against the background of mood swings, conflicts with peers and adults, short-term and affective outbursts are possible, but then quick repentance follows. During periods of good mood, labile adolescents are sociable, easily adapt to new surroundings, and are responsive to requests. They have well-developed intuition, they are distinguished by their sincerity and depth of attachment to family, loved ones, and friends, and they deeply experience rejection from emotionally significant persons. With a friendly attitude from teachers and others, such teenagers feel comfortable and are active.
It should be noted that manifestations of psychopathic development do not always end with the full formation of psychopathy. For all forms of psychopathic behavior, provided early targeted Corrective action in combination (if necessary) with therapeutic measures can achieve significant success in compensating for deviant development in this category of children.
3. Children with early childhood autism syndrome.
Early childhood autism (ECA) is one of the most complex mental development disorders. This syndrome develops in its full form by the age of three. RDA manifests itself in the following clinical and psychological signs:
· impaired ability to establish emotional contact;
· stereotypical behavior. It is characterized by the presence of monotonous actions in the child’s behavior - motor (swinging, jumping, tapping), speech (pronouncing the same sounds, words or phrases), stereotypical manipulations of any object; monotonous games, stereotypical interests.
· specific speech development disorders ( mutism, echolalia, speech cliches, stereotypical monologues, absence of first-person pronouns in speech, etc.), leading to a violation of speech communication.
Early childhood autism is also characterized by:
· Increased sensitivity to sensory stimuli. Already in the first year of life, there is a tendency to sensory discomfort (most often to intense household sounds and tactile irritations), as well as a focus on unpleasant impressions. With insufficient activity aimed at examining the surrounding world and limiting diverse sensory contact with it, there is a pronounced “capture”, fascination with certain specific impressions - tactile, visual, auditory, vestibular, which the child strives to receive again and again. For example, a child’s favorite pastime for six months or more may be rustling a plastic bag, watching the movement of a shadow on the wall; the strongest impression may be the light of a lamp, etc. The fundamental difference in autism is the fact that a loved one almost never manages to join in the actions with which the child is “fascinated.”
· Violation of the sense of self-preservation is observed in most cases before the age of one year. It manifests itself both in hyper-caution and in the absence of a sense of danger.
· Violation of affective contact with the immediate environment is expressed by:
· in particular the relationship to the hands of the mother. Many autistic children lack anticipating posture (stretching arms towards an adult when the child looks at him). Such a child may also not feel comfortable in the mother’s arms: he either “hangs like a bag”, or is overly tense, resists caresses, etc.;
· features of fixation of gaze on the mother's face. Normally, a child early shows an interest in the human face. Communication through gaze is the basis for the development of subsequent forms of communicative behavior. Autistic children are characterized by avoidance of eye contact (looking past the face or “through” the adult’s face);
· features of an early smile. The timely appearance of a smile and its direction to a loved one is a sign of the successful and effective development of the child. The first smile in most autistic children is not addressed to a person, but rather in response to sensory stimulation that is pleasant for the child (inhibition, the bright color of the mother’s clothes, etc.).
Features of the formation of attachment to to a loved one. Normally, they manifest themselves as an obvious preference of one of the persons caring for the child, most often the mother, in experiences of separation from her. The autistic child most often does not use positive emotional reactions to express affection;
· in difficulties in expressing a request. Many children normally develop a directed gaze and gesture at an early stage of development - extending their hand in the right direction, which at subsequent stages transformed into a pointing gesture. In an autistic child and at later stages of development, such a transformation of gesture does not occur. Even at an older age, when expressing his desire, an autistic child takes the adult’s hand and places it on the desired object;
Difficulties in the voluntary organization of the child, which can be expressed in the following trends:
· absence or inconstancy of the baby’s response to an adult addressing him using his own name;
· failure to follow the direction of an adult’s gaze with his eyes, ignoring his pointing gesture;
· lack of expression of imitative reactions, and more often their complete absence; difficulty in organizing autistic children into simple games that require imitation and demonstration (“okay”);
· the child’s great dependence on the influences of the surrounding “psychic field”. If parents show great persistence and activity, trying to attract attention, then the autistic child either protests or withdraws from contact.
Violation of contact with others, associated with the developmental features of the child’s forms of addressing an adult, is reflected in the difficulty of expressing one’s own emotional state. Normally, the ability to express one’s emotional state and share it with an adult is one of the earliest adaptive achievements of a child. It usually appears after two months. The mother perfectly understands the mood of her child and therefore can control it: comfort the child, relieve discomfort, calm him down. Mothers of autistic children often have difficulty even understanding the emotional state of their children.
Part II. The main content of complex correctional work with children, suffering from emotional-volitional disorders
Study questions.
1. The main directions of correctional pedagogical work.
4. Medical and health-improving activities.
5. Methods of psychological correction of emotional-volitional disorders.
Psychological and pedagogical assistance to children suffering from emotional-volitional disorders involves solving a number of organizational and pedagogical problems and the practical implementation of the following areas of correctional work.
· Comprehensive study reasons violations of the emotional-volitional sphere in a given child, behavioral disorders, reasons that contributed to the emergence of affective reactions. Finding out conditions of education and development child in the family.
· Elimination (if possible) or weakening of psychotraumatic moments (including negative psychotraumatic social factors, for example, unfavorable living conditions and activities of the child in the family, incorrect pedagogical approach to raising a child, etc.).
· Definition and practical implementation of the rational (taking into account the individual characteristics of the child) daily routine and educational activities. Organization of goal-directed behavior of the child; formation of adequate behavior in various social and everyday situations.
· Establishing positive close emotional contact with the child, including him in exciting activity(together with the teacher and other children) - taking into account his interests and inclinations. Maintaining positive contact with the child throughout the entire period of teaching work in a given educational institution.
· Smoothing and gradual overcoming of negative personality traits in children with emotional-volitional disorders (withdrawal, negativism /including speech negativism/, irritability, sensitivity /in particular, increased sensitivity to failures/, indifferent attitude to the problems of others, to one’s situation in children's group, etc.).
· It is important to overcome and prevent neurotic reactions and pathocharacterological disorders: egocentrism, infantility with constant dependence on others, lack of self-confidence, etc. For this purpose, the following is provided:
– prevention of affective reactions, reactive behavior; preventing the emergence of social situations and variants of interpersonal contacts between children that provoke affective reactions in the child;
– rational, clear, thoughtful verbal regulation of the child’s activities;
– prevention of educational (psychological) overload and fatigue, timely switching of the child’s attention from a given conflict situation to another type of activity, to discussing a “new” issue, etc.
No less importance is attached to other areas of correctional pedagogical and correctional psychological work. These include:
· Formation of socially positive personal qualities: sociability, social activity, ability to willpower, desire to overcome encountered difficulties, to self-affirmation in a team, combined with a benevolent, correct attitude towards others;
· Formation of correct relationships between children in the children's team (first of all, normalization or establishment of correct interpersonal relationships between a child suffering from emotional-volitional disorders and other children in the teaching group/class); carrying out explanatory work with the children around the child. Teaching the child to cooperate with other children and adults;
· Purposeful formation in children with emotional-volitional disorders game, subject-practical(including artistic and visual), educational and elementary labor activity; on this basis, carrying out systematic, diverse pedagogical work on the moral and aesthetic education of children, and the formation of positive personality traits.
Streamlining and development of orientation-research activities (based on the targeted formation of sensory perception, visual and auditory gnosis, operations of analysis of the perceived object and the holistic subject situation, etc.);
Joining collective forms of activity, involving the child in play, subject-related practical and educational activities together with other children. Formation of a child’s teamwork skills: the ability to take into account common rules and the goals of this type of activity, the interests of other children, the ability to obey the requirements of the team, relate their actions to the work of others, etc.
Development of cognitive interests and needs, formation of a conscious, responsible attitude towards one’s responsibilities, completed educational tasks, public assignments, etc.
Formation sustainable motives educational and subject-practical activities appropriate to age. Development of verbal communication in the course of joint activities with the teacher and other children (educational, play, practical).
Upbringing purposefulness and planning activities, the formation of inhibitory (“restraining”) reactions, correct self-assessment of one’s own activities and behavior.
Actively involving children in the preparation and holding of holidays, excursions, cultural and sporting events.
Development motor functions, general and fine manual motor skills, including in the formation of substantive and practical activities in its various types. Preparation for mastering the motor act of writing.
For this purpose the following are provided:
– Development of children’s cognitive activity;
– The use of various methods and techniques in the process of correctional pedagogical work with children, specifically aimed at developing the activity and independence of children in educational and subject-related practical activities (educational tasks with elements of competition, creative tasks using bright, colorful didactic material; exercises, built on the principle of “small steps”, “climbing steps”, etc.);
– Regular classes in various clubs, sections, and interest clubs.
Conducted training and educational activities should be dynamic, varied, interesting and at the same time – should not contain unnecessary information, large number tasks that are difficult to complete independently, which often causes negative emotions, fatigue, and negative behavioral reactions in children.
Psychological* and psychological-pedagogical correction disorders of the emotional-volitional sphere noted in children includes: correctional and developmental classes, psychological training, classes according to the system art correction(carried out by means play therapy, music therapy, visual arts: drawing, modeling, applique, etc.). Play psychotherapy is important when working with children of senior preschool and primary school age. For role-playing games, social and everyday situations are selected that are well understood by the child and relevant to him on a personal level. During the game, the child learns adequate relationships with the people around him. Great importance has a differentiated selection of plots for games that contribute to the child’s adaptation to his environment (for example: “My Family”, where children act as parents, and dolls play the “role” of children; “Our little friends”, “We are builders”, “Cosmonauts” ”, “Our house”, “Playing on the playground”, etc.)
The implementation of a complex of therapeutic and health-improving measures includes:
· medical consultation (teachers and parents),
· proper nutrition, diet therapy and herbal medicine;
· drug treatment,
· physiotherapy,
· hydrotherapy and hardening procedures;
· therapeutic exercises and massage, etc. *
Pedagogical work with the child's family includes a number of activities:
· identification and assessment of the social and living conditions in which the child’s family lives;
· study and analysis of the conditions for the upbringing and development of a child in the family;
· identification and elimination of incorrect approaches to raising a child in the family (upbringing in conditions of overprotection, lack of educational influence of others /hypoprotection/, excessive or underestimated demands on the child from adults when organizing various types of his activities, etc.).
· Development of a unified (for teachers and parents) and adequate understanding of the child’s problems.
– Determination (together with parents) of the correct pedagogical approach to raising and educating a child, taking into account his individual personal and psychological characteristics.
– Formation of a favorable “psychological climate” in the family (normalization of interpersonal relationships within the family - between parents and child, between the child and other children in the family).
– Teacher Education parents; teaching them some accessible methods of correctional pedagogical work. Inclusion of parents (as well as immediate relatives) in correctional and pedagogical work with the child (conducting correctional and developmental classes at home), etc.
Teachers and parents are required to have a particularly attentive, calm and tactful attitude towards a child with psychopathological personality traits. In pedagogical work, one should rely on the positive characterological traits of the child’s personality, the active use of techniques encouragement, education based on positive examples, distraction from unfavorable moments and aspects of the surrounding life. When working with children suffering from emotional-volitional disorders, a calm, even tone, goodwill combined with exactingness, and the absence of multidirectional attitudes when organizing the child’s activities and behavior are necessary.
For the rehabilitation of autistic children, the following areas of correctional work are implemented in comprehensive correctional work.
Psychological correction, which includes establishing contact with adults, mitigating the background of sensory and emotional discomfort, anxiety and fears, stimulating mental activity aimed at influencing adults and peers, forming purposeful behavior, and overcoming negative forms of behavior. Work on this section is carried out by a psychologist.
Pedagogical correction. Depending on the level of development of the nervous system, the knowledge and skills of an autistic child, the nature of his passions and interests, an individual educational program is created. Based on the psychologist’s research data, the teacher conducts his own examination, determines specific teaching objectives, and develops a working methodology.
Identification and development of children's creative abilities. Music is an important area of life for an autistic child, giving him a lot of positive emotions, and singing often acts as most important factor the appearance and development of speech.
Development of general motor skills. Therapeutic physical education in correctional work with autistic children is very important. Due to the underdevelopment of the functions of the vestibular apparatus, exercises on balance, coordination of movements, and orientation in space become of particular importance.
Working with parents of autistic children. The complex of work with parents includes: psychotherapy of family members, familiarization of parents with a number of mental characteristics of a child with RDA, training in methods of raising an autistic child, organizing his regime, developing self-care skills, preparing for schooling.
5. Basic forms and methods of psychological correction of emotional-volitional disorders
5.1 The main goal of psychological correction of behavioral disorders in children and adolescents with disharmonious development is the harmonization of their personal sphere, family relationships and the solution (elimination) of current psycho-traumatic problems. When working with children and adolescents suffering from emotional-volitional disorders, the following methods of psychotherapy are widely used: suggestive psychotherapy, group, behavioral, family, rational, self-hypnosis. Psychoanalysis, transactional analysis, Gestalt therapy, autogenic training, etc. are often used. Autogenic training is the orderly use of special exercises and psychological relaxation, helps manage emotions, restore strength, performance, relieve tension, and overcome stressful conditions. Behavioral psychotherapy is based on the principles of behaviorism, helps change the child’s behavior under the influence of a positive stimulus, relieves discomfort and inadequate reactions. Training as a type of behavioral psychotherapy teaches you how to manage your emotions, make decisions, teaches communication, and self-confidence. Rational psychotherapy as a method includes techniques of explanation, suggestion, emotional influence, study, personality correction, and logical argumentation. Occupational therapy is actively used as a link connecting a person with social reality. In essence, this is treatment by employment, protection from personal disintegration, and the creation of conditions for interpersonal communication.
Of particular interest in psychocorrectional work with adolescents with disorders of emotional regulation of behavior is level approach, proposed by prof. V.V. Lebedinsky (1988). The interaction of an individual with the outside world and the realization of his needs can occur at different levels of activity and depth of emotional contact of a child (adolescent) with the environment. There are four main levels of such interaction.
First level field reactivity– primarily associated with the most primitive, passive forms of mental adaptation. Affective experiences at this level do not yet contain a positive or negative evaluation; they are associated only with a general sense of comfort or discomfort.
In older children and adults, this level performs background functions in the implementation of emotional and semantic adaptation to the environment. It provides a tonic response to affective processes. The role of this level in the regulation of behavior is extremely large and its underestimation entails significant costs in the psychocorrection process. Tonic emotional regulation with the help of special daily psychotechnical techniques has a positive effect on different levels of “basal affectivity.” Therefore, various psychoregulatory training using sensory stimuli ( sound, color, light, tactile touch) are of great importance in psychocorrection of behavior.
Second - level of stereotypes– plays an important role in regulating the child’s behavior in the first months of life, in the formation of adaptive reactions - nutritional, defensive, establishing physical contact with the mother. At this level, signals from the surrounding world and the internal environment of the body are already consciously assessed, sensations of all modalities are affectively assessed: auditory, visual, tactile, gustatory, etc. The type of behavior characteristic of this level of affective adaptation is stereotypical reactions. Affective stereotypes are a necessary background for ensuring the most complex forms of human behavior. Activation of this level of emotional regulation in the process of psychocorrectional work is achieved when the child (teenager) focuses on sensory (muscle, taste, tactile and other) sensations, perception and reproduction of simple rhythmic stimuli. This level, like the first, helps to stabilize a person’s affective life. A variety of psychotechnical techniques widely used by psychologists, such as rhythmic repetitions, “ritual actions,” jumping, swinging, etc., occupy an important place in the psychocorrection process, especially in the first stages of classes. They perform and how relaxing, And How mobilizing a means of influence in correcting the behavior of children and adolescents.
The third level of affective organization of behavior is expansion level– is the next stage of a person’s emotional contact with the environment. The child gradually begins to master its mechanisms in the second half of the first year of life, which contributes to the formation of active adaptation to new conditions. Affective experiences of the third level are associated not with the satisfaction of the need itself, as was the case at the second level, but with the achievement of what is desired. They are distinguished by great strength and polarity. If at the second level the instability of the situation, the unknown, danger, unsatisfied desire causes anxiety and fear, then at the third they mobilize the subject to overcome difficulties. At this level of affective organization of activity and behavior, the child experiences curiosity about unexpected experiences, excitement in overcoming danger, anger, and a desire to overcome emerging difficulties. In the process of psychocorrection, the level of affective expansion is stimulated under the influence of experiences that arise in the process exciting game, risk, competition, overcoming difficult and dangerous situations, playing out “frightening” stories containing a real prospect of their successful resolution.
Fourth level - level emotional control(highest level of the system basal emotional regulation) – is formed on the basis of “subordination”, complementarity and socialization of all previous levels. Adaptive affective behavior at this level rises to the next level of complexity. At this level, the affective basis for the voluntary organization of human behavior is laid. The behavioral act of the subject is already becoming act- an action that is built taking into account the attitude of another person towards it. If adaptation fails, the subject at this level no longer reacts to a situation that is significant to him either by leaving, or by physical activity, or by directed aggression, as is possible at previous levels - he turns to other people for help. At this level, the affective “self-orientation” is improved, which is an important prerequisite for the development of self-esteem. Affective experience at this level is associated with empathy for another person. Correction of the emotional-intellectual organization of behavior requires the mandatory inclusion of such psychotechnical techniques as cooperation, partnership, reflection, which contributes to the formation of personal reactions humanism, empathy, self-control.
The identified levels of affective organization implement qualitatively different adaptation tasks. Weakening or damage to one of the levels leads to general affective maladjustment of the child or adolescent in the surrounding society.
The structural-level study of the basal emotional organization of the individual is important in solving the problem of shaping the individual behavior of children and adolescents and developing effective ways to correct it.
5.2 The basis for behavioral disorders in children and adolescents with developmental disharmony is often a lack of voluntary regulation of activity. Relying on activity principle in psychology, we can identify the main blocks of the structure of human behavior.
Motivational block– includes the ability of a child (adolescent) to identify, realize and accept the goal of behavior.
Operational and regulatory block– the ability to plan actions to achieve a goal (both in terms of content and time of implementation of the activity).
Control unit– the ability to control one’s behavior and make the necessary adjustments to it.
Difficulties in understanding one's behavior are common to many children and adolescents with disharmony of mental development. They manifest themselves in weak reflection, ignorance of their “strong” and “weak” personal qualities, as well as in the teenager’s underestimation of one or another psychotraumatic situation, which contributes to
Violations and their causes in alphabetical order:
violation of the emotional-volitional sphere -
Violations of the emotional-volitional sphere include:
Hyperbulia is a general increase in will and drives, affecting all the basic drives of a person. For example, an increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them. Hyperbulia - characteristic manifestation manic syndrome.
Hypobulia is a general decrease in will and drives. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones.
Abulia is a disorder limited to a sharp decrease in will. Abulia is a persistent negative disorder; together with apathy, it forms a single apathetic-abulia syndrome, characteristic of the final conditions of schizophrenia.
Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Refusal to satisfy an instinct gives rise to strong feelings in the patient, and thoughts of an unsatisfied need constantly persist. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome.
Compulsive drive is a more powerful feeling because it is comparable in strength to instincts. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment.
What diseases cause a violation of the emotional-volitional sphere:
Schizophrenia
Manic syndrome
Depressive syndrome
Obsessive-phobic syndrome
Psychopathy
Alcoholism
Addiction
Which doctors should you contact if there is a violation of the emotional-volitional sphere:
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Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective summary assessment of incoming signals, the well-being of a person’s internal state and the current external situation.
A general favorable assessment of the current situation and existing prospects is expressed in positive emotions - joy, pleasure, tranquility, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, melancholy, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characteristics of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term “depression” refers to strong negative emotions, while the term “apathy” indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have sufficient information to evaluate a particular stimulus - this can cause vague emotions of surprise and bewilderment. Healthy people rarely experience conflicting feelings: love and hatred at the same time.
Emotion (feeling) is an internally subjective experience that is inaccessible to direct observation. The doctor judges the emotional state of a person by affect (in the broad sense of this term), i.e. by external expression of emotions: facial expressions, gestures, intonation, vegetative reactions. In this sense, the terms “affective” and “emotional” are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient’s speech and the facial expression and tone of the statement. Facial expressions and intonation in this case make it possible to assess the true attitude to what was said. Statements by patients about love for relatives, desire to get a job, combined with monotony of speech, lack of proper affect, indicate the unfoundedness of the statements, the predominance of indifference and laziness.
Emotions are characterized by some dynamic features. Prolonged emotional states correspond to the term “ mood", which in a healthy person is quite flexible and depends on a combination of many circumstances - external (success or failure, the presence of an insurmountable obstacle or expectation of a result) and internal (physical ill health, natural seasonal fluctuations in activity). A change in the situation in a favorable direction should lead to an improvement in mood. At the same time, it is characterized by a certain inertia, so joyful news against the background of sorrowful experiences cannot evoke an immediate response from us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of affect (in the narrow sense of the word).
There are several main functions of emotions. The first of them, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment, based on a general impression, is not completely perfect, but it allows you to avoid wasting unnecessary time on the logical analysis of unimportant stimuli. Emotions generally signal to us about the presence of some kind of need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - through a feeling of boredom. The second important function of emotions is communicative. Emotionality helps us communicate and act together. The collective activity of people involves emotions such as sympathy, empathy (mutual understanding), and mistrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, and misunderstanding. Finally, one of the most important functions of emotions is shaping behavior person. It is emotions that make it possible to assess the significance of a particular human need and serve as an impetus for its implementation. Thus, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from spectators, fear Ha- flee. It is important to consider that emotion does not always accurately reflect the true state of internal homeostasis and the characteristics of the external situation. Therefore, a person, experiencing hunger, can eat more than the body needs; experiencing fear, he avoids a situation that is not actually dangerous. On the other hand, a feeling of pleasure and satisfaction (euphoria) artificially induced with the help of drugs deprives a person of the need to act despite a significant violation of his homeostasis. Loss of the ability to experience emotions during mental illness naturally leads to inaction. Such a person does not read books or watch TV because he does not feel bored, and does not take care of his clothes and body cleanliness because he does not feel shame.
Based on their influence on behavior, emotions are divided into: sthenic(inducing action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). The same psychotraumatic situation can cause excitement, flight, frenzy or, conversely, numbness (“my legs gave way from fear”) in different people. So, emotions provide the necessary impetus for taking action. Direct conscious planning of behavior and the implementation of behavioral acts is performed by the will.
Will is the main regulatory mechanism of behavior, allowing one to consciously plan activities, overcome obstacles, and satisfy needs (drives) in a form that promotes greater adaptation.
Attraction is a state of specific human need, a need for certain conditions of existence, dependence on their presence. We call conscious attractions desires. It is almost impossible to list all possible types of needs: each person’s set of needs is unique and subjective, but several of the most important needs for most people should be indicated. These are physiological needs for food, safety (instinct of self-preservation), sexual desire. In addition, a person, as a social being, often needs communication (affiliative need), and also strives to take care of loved ones (parental instinct).
A person always simultaneously has several competing needs that are relevant to him. The choice of the most important of them on the basis of an emotional assessment is carried out by the will. Thus, it allows you to realize or suppress existing drives, focusing on the individual scale of values - hierarchy of motives. Suppressing a need does not mean reducing its relevance. The inability to fulfill a need that is urgent for a person causes an emotionally unpleasant feeling - frustration. Trying to avoid it, a person is forced either to satisfy his need later, when conditions change to more favorable ones (as, for example, a patient with alcoholism does when he receives a long-awaited salary), or to attempt to change his attitude towards the need, i.e. apply psychological defense mechanisms(see section 1.1.4).
Weakness of will as a personality trait or as a manifestation of mental illness, on the one hand, does not allow a person to systematically satisfy his needs, and on the other hand, leads to the immediate implementation of any desire that arises in a form that is contrary to the norms of society and causes maladjustment.
Although in most cases it is impossible to associate mental functions with any specific neural structure, it should be mentioned that experiments indicate the presence of certain centers of pleasure (a number of areas of the limbic system and the septal region) and avoidance in the brain. In addition, it has been noted that damage to the frontal cortex and pathways leading to the frontal lobes (for example, during lobotomy surgery) often leads to loss of emotions, indifference and passivity. In recent years, the problem of functional asymmetry of the brain has been discussed. It is assumed that the emotional assessment of the situation mainly occurs in the non-dominant (right) hemisphere, the activation of which is associated with states of melancholy and depression, while when the dominant (left) hemisphere is activated, an increase in mood is more often observed.
8.1. Symptoms of Emotional Disorders
Emotional disorders are an excessive expression of a person’s natural emotions (hyperthymia, hypothymia, dysphoria, etc.) or a violation of their dynamics (lability or rigidity). One should speak about the pathology of the emotional sphere when emotional manifestations deform the patient’s behavior as a whole and cause serious maladjustment.
Hypotymia - persistent painful depression of mood. The concept of hypothymia corresponds to sadness, melancholy, and depression. Unlike the natural feeling of sadness caused by an unfavorable situation, hypothymia in mental illness is surprisingly persistent. Regardless of the immediate situation, patients are extremely pessimistic about their current state and existing prospects. It is important to note that this is not only a strong feeling of sadness, but also an inability to experience joy. Therefore, a person in such a state cannot be cheered up by either a witty anecdote or good news. Depending on the severity of the disease, hypothymia can take the form of mild sadness, pessimism to a deep physical (vital) feeling, experienced as “mental pain,” “tightness in the chest,” “stone on the heart.” This feeling is called vital (pre-cardiac) melancholy, it is accompanied by a feeling of catastrophe, hopelessness, collapse.
Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors), and is also part of the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, first of all, this symptom is associated with the concept depressive syndrome for which hypothymia is the main syndrome-forming disorder.
Hyperthymia - persistent painful increase in mood. This term is associated with bright positive emotions - joy, fun, delight. Unlike situationally determined joy, hyperthymia is characterized by persistence. Over the course of weeks and months, patients constantly maintain amazing optimism and a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither sad news nor obstacles to the implementation of plans disturb their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. This condition may indicate the formation of oneiric stupefaction (see section 10.2.3).
A special variant of hyperthymia is the condition euphoria, which should be considered not so much as an expression of joy and happiness, but as a complacent and carefree affect. Patients do not show initiative, are inactive, and are prone to empty talk. Euphoria can be a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive disintegrating extracerebral neoplasms, severe damage to hepatic and renal function, myocardial infarction, etc.) and can be accompanied by delusional ideas of grandeur (with paraphrenic syndrome, in patients with progressive paralysis).
The term Moria denote foolish, careless babbling, laughter, and unproductive agitation in deeply mentally retarded patients.
Dysphoria are called sudden attacks of anger, malice, irritation, dissatisfaction with others and with oneself. In this state, patients are capable of cruel, aggressive actions, cynical insults, crude sarcasm and bullying. The paroxysmal course of this disorder indicates the epileptiform nature of the symptoms. In epilepsy, dysphoria is observed either as an independent type of seizures, or is part of the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of psychoorganic syndrome (see section 13.3.2). Dysphoric episodes are also often observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of abstinence.
Anxiety - the most important human emotion, closely related to the need for security, expressed by a feeling of an impending uncertain threat, internal excitement. Anxiety is a sthenic emotion: accompanied by tossing, restlessness, restlessness, and muscle tension. As an important signal of trouble, it can arise in the initial period of any mental illness. In obsessive-compulsive neurosis and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, suddenly occurring (often against the backdrop of a traumatic situation) panic attacks, manifested by acute attacks of anxiety, have been identified as an independent disorder. A powerful, unfounded feeling of anxiety is one of the early symptoms of incipient acute delusional psychosis.
In acute delusional psychoses (syndrome of acute sensory delirium), anxiety is extremely expressed and often reaches the degree confusion, in which it is combined with uncertainty, misunderstanding of the situation, and impaired perception of the surrounding world (derealization and depersonalization). Patients are looking for support and explanations, their gaze expresses surprise ( affect of bewilderment). Like the state of ecstasy, such a disorder indicates the formation of oneiroid.
Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hatred, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, and leads to contradictory, inconsistent actions ( ambition). Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition a nonspecific symptom, observed, in addition to schizophrenia, in schizoid psychopathy and (in a less pronounced form) in healthy people prone to introspection (reflection).
Apathy - absence or sharp decrease in the expression of emotions, indifference, indifference. Patients lose interest in loved ones and friends, are indifferent to events in the world, and are indifferent to their health and appearance. The patients' speech becomes boring and monotonous, they do not show any interest in the conversation, their facial expressions are monotonous. The words of others do not cause them any offense, embarrassment, or surprise. They may claim that they feel love for their parents, but when meeting with loved ones they remain indifferent, do not ask questions and silently eat the food brought to them. The unemotionality of patients is especially pronounced in a situation that requires an emotional choice (“What food do you like best?”, “Who do you love more: dad or mom?”). Lack of feelings prevents them from expressing any preference.
Apathy refers to negative (deficit) symptoms. It often serves as a manifestation of final states in schizophrenia. It should be taken into account that apathy in patients with schizophrenia is constantly increasing, going through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness, emotional dullness. Another cause of apathy is damage to the frontal lobes of the brain (trauma, tumors, partial atrophy).
A symptom should be distinguished from apathy painful mental insensibility (anaesthesiapsychicadolorosa, mournful insensibility). The main manifestation of this symptom is not considered to be the absence of emotions as such, but a painful feeling of one’s own immersion in selfish experiences, the consciousness of the inability to think about anyone else, often combined with delusions of self-blame. The phenomenon of hypoesthesia often occurs (see section 4.1). Patients complain that they have become “like a piece of wood”, that they “don’t have a heart, but an empty tin can”; They lament that they do not feel worried about their young children and are not interested in their successes at school. The vivid emotion of suffering indicates the severity of the condition, the reversible productive nature of the disorders. Anaesthesiapsychicadolorosa is a typical manifestation of the depressive syndrome.
Symptoms of disturbances in the dynamics of emotions include emotional lability and emotional rigidity.
Emotional lability - this is extreme mobility, instability, ease of emergence and change of emotions. Patients easily move from tears to laughter, from fussiness to carefree relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed in syndromes of stupefaction (delirium, oneiroid).
One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by rapid changes in mood, but also by the inability to control external manifestations of emotions. This leads to the fact that every (even insignificant) event is experienced vividly, often causing tears that arise not only from sad experiences, but also express tenderness and delight. Weakness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but can also occur as a personal trait (sensitivity, vulnerability).
A 69-year-old patient with diabetes mellitus and severe memory disorders vividly experiences her helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now kneading kneading. Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs can’t walk at all, I can barely crawl around the apartment...” The patient says all this while constantly wiping her eyes. When the doctor asks who else lives in the apartment with her, he answers: “Oh, our house is full of people! It's a pity my dead husband didn't live long enough. My son-in-law is hard-working and caring. The granddaughter is smart: she dances, and draws, and speaks English... And her grandson will go to college next year - his school is so special!” The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them with her hand.
Emotional rigidity - stiffness, stuckness of emotions, tendency to experience feelings for a long time (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, and perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to discussing another topic until he fully speaks out about the issue that interests him. Emotional rigidity is a manifestation of the general torpidity of mental processes observed in epilepsy. There are also psychopathic characters with a tendency to get stuck (paranoid, epileptoid).
8.2. Symptoms of disorders of will and desires
Disorders of will and drives manifest themselves in clinical practice as behavioral disorders. It is necessary to take into account that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological desires and are ashamed to admit to others, for example, their laziness. Therefore, the conclusion about the presence of violations of the will and drives should be made not on the basis of declared intentions, but based on an analysis of the actions performed. Thus, a patient’s statement about his desire to get a job looks unfounded if he has not worked for several years and has not attempted to find a job. A patient’s statement that he likes to read should not be taken as adequate if he read the last book several years ago.
Quantitative changes and distortions of drives are distinguished.
Hyperbulia - a general increase in will and drives, affecting all the basic drives of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else’s nightstand. Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention with bright cosmetics, flashy clothes, stand for a long time in front of the Mirror, tidying up their hair, and can engage in numerous casual sexual relationships. There is a pronounced desire to communicate: every conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and grossly illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. Hyperbulia is a characteristic manifestation manic syndrome.
Tipobulia - general decrease in will and drives. It should be borne in mind that in patients with hypobulia, all basic drives are suppressed, including physiological ones. There is a decrease in appetite. The doctor can convince the patient of the need to eat, but he takes food reluctantly and in small quantities. A decrease in sexual desire is manifested not only by a drop in interest in the opposite sex, but also by a lack of attention to one’s own appearance. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones (the behavior of a mother with postpartum depression, who is unable to bring herself to care for her newborn, is especially surprising). Suppression of the instinct of self-preservation is expressed in suicidal attempts. Characteristic is a feeling of shame for one’s inaction and helplessness. Hypobulia is a manifestation depressive syndrome. Suppression of impulses in depression is a temporary, transient disorder. Relieving an attack of depression leads to renewed interest in life and activity.
At abulia Usually there is no suppression of physiological drives; the disorder is limited to a sharp decrease in will. The laziness and lack of initiative of people with abulia are combined with a normal need for food and a clear sexual desire, which are satisfied in the simplest, not always socially acceptable, ways. Thus, a patient who is hungry, instead of going to the store and buying the food he needs, asks his neighbors to feed him. The patient satisfies her sexual desire with continuous masturbation or makes absurd demands on her mother and sister. In patients suffering from abulia, higher social needs disappear, they do not need communication or entertainment, they can spend all their days inactive, and are not interested in events in the family and in the world. In the department, they do not communicate with their ward neighbors for months, do not know their names, the names of doctors and nurses.
Abulia is a persistent negative disorder, together with apathy it forms a single apathetic-abulic syndrome, characteristic of final states in schizophrenia. With progressive diseases, doctors can observe an increase in the phenomena of abulia - from mild laziness, lack of initiative, inability to overcome obstacles to gross passivity.
A 31-year-old patient, a turner by profession, after suffering an attack of schizophrenia, left work in the workshop because he considered it too difficult for himself. He asked to be hired as a photographer for the city newspaper, since he had done a lot of photography before. One day, on behalf of the editors, I had to write a report about the work of collective farmers. I arrived in the village in city shoes and, in order not to get my shoes dirty, did not approach the tractors in the field, but only took a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. I didn’t apply for another job. At home he refused to do any household chores. I stopped caring for the aquarium that I had built with my own hands before I got sick. All day long I lay in bed dressed and dreamed of moving to America, where everything was easy and accessible. He did not object when his relatives turned to psychiatrists with a request to register him as disabled.
Many symptoms described perversions of drives (parabulia). Manifestations of mental disorders may include perversion of appetite, sexual desire, desire for antisocial behavior (theft, alcoholism, vagrancy), and self-harm. Table 8.1 shows the main terms denoting impulse disorders according to ICD-10.
Parabulia is not considered as an independent disease, but is only a symptom. The reasons arose
Table 8.1. Clinical variants of impulse disorders
|
Code according to ICD-10 |
Name of disorder |
Nature of manifestation |
|
Pathological | ||
|
passion for gambling | ||
|
games | ||
|
Pyromania |
The desire to commit arson |
|
|
Kleptomania |
Pathological theft |
|
|
Trichotillomania |
The urge to snatch at myself |
|
|
Pica (pica) |
The desire to eat inedible things |
|
|
» in children |
(as a variety, coprofa- |
|
|
Gia- eating excrement) |
||
|
Dipsomania |
Craving for alcohol |
|
|
Dromomania |
The desire to wander |
|
|
Homicidomania |
A senseless desire to |
|
|
commit murder |
||
|
Suicidemania |
Suicidal impulse |
|
|
Oniomania |
The urge to shop (often |
|
|
unnecessary) |
||
|
Anorexia nervosa |
The desire to limit oneself |
|
|
food, lose weight |
||
|
Bulimia |
Binges of overeating |
|
|
Transsexualism |
The desire to change gender |
|
|
Transvestism |
The desire to wear clothes |
|
|
opposite sex |
||
|
Paraphilias, |
Sexual predilection disorders |
|
|
including: |
respects |
|
|
fetishism |
Getting sexual pleasure |
|
|
joy from contemplating before |
||
|
intimate wardrobe items |
||
|
exhibitionism |
Passion for nudity |
|
|
voyeurism |
Passion for peeping |
|
|
married |
||
|
pedophilia |
Attraction to minors |
|
|
in adults |
||
|
sadomasochism |
Achieving sexual pleasure |
|
|
creation by causing |
||
|
pain or mental distress |
||
|
homosexuality |
Attraction to one's own person |
|
Note. Terms for which a code is not provided are not included in ICD-10.
Pathological drives include gross intellectual impairments (mental retardation, total dementia), various forms of schizophrenia (both in the initial period and at the final stage with so-called schizophrenic dementia), as well as psychopathy (persistent personality disharmony). In addition, desire disorders are a manifestation of metabolic disorders (for example, eating inedible things during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, abulia in hypothyroidism, sexual behavior disorders due to an imbalance of sex hormones).
Each of the pathological drives can be expressed to varying degrees. There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions.
Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Attractions that clearly diverge from the requirements of ethics, morality and legality are in this case never implemented and are suppressed as unacceptable. However, refusal to satisfy the drive gives rise to strong feelings in the patient; against your will, thoughts about an unfulfilled need are constantly stored in your head. If it is not clearly antisocial in nature, the patient carries it out as soon as possible. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).
Compulsive drive - a more powerful feeling, since its strength is comparable to such vital needs as hunger, thirst, and the instinct of self-preservation. Patients are aware of the perverted nature of the desire, try to restrain themselves, but when the need is unsatisfied, an unbearable feeling of physical discomfort arises. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment. Compulsive drives can be a cause of repeated violence and serial killings. A striking example of a compulsive desire is the desire for a drug during withdrawal syndrome in those suffering from alcoholism and drug addiction (physical dependence syndrome). Compulsive drives are also a manifestation of psychopathy.
Impulsive actions are committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a decision-making stage. Patients can think about their actions only after they have been committed. At the moment of action, an affectively narrowed consciousness is often observed, which can be judged by subsequent partial amnesia. Among impulsive actions, absurd ones, devoid of any meaning, predominate. Often patients subsequently cannot explain the purpose of what they did. Impulsive actions are a frequent manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also prone to commit impulsive actions.
Actions caused by pathology in other areas of the psyche should be distinguished from impulse disorders. Thus, refusal to eat can be caused not only by a decrease in appetite, but also by the presence of delusions of poisoning, imperative hallucinations that prohibit the patient from eating, as well as a severe motor disorder - catatonic stupor (see section 9.1). Actions that lead patients to their own death do not always express a desire to commit suicide, but are also caused by imperative hallucinations or clouding of consciousness (for example, a patient in a state of delirium, fleeing from imaginary pursuers, jumps out of a window, believing that it is a door).
8.3. Syndromes of emotional-volitional disorders
The most striking manifestations of affective disorders are depressive and manic syndromes(Table 8.2).
8.3.1. Depressive syndrome
Clinical picture of a typical depressive syndrome usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression. Hypotymia can be expressed in complaints of melancholy, depression, and sadness. Unlike the natural reaction of sadness in response to a sad event, melancholy in depression is deprived of connection with the environment; patients do not react either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself as feelings of varying intensity - from mild pessimism and sadness to a severe, almost physical feeling of “a stone on the heart” ( vital melancholy).
Manic syndrome
Table 8.2. Symptoms of manic and depressive syndromesDepressive syndrome
Depressive triad: decreased mood, ideational retardation, motor retardation
Low self-esteem
pessimism
Delusions of self-blame, self-abasement, hypochondriacal delusions
Suppression of desires: decreased appetite, decreased libido, avoidance of contacts, isolation, devaluation of life, suicidal tendencies
Sleep disorders: decreased duration, early awakening, lack of sense of sleep
Somatic disorders: dry skin, decreased skin tone, brittle hair and nails, lack of tears, constipation
tachycardia and increased blood pressure, pupil dilation (mydriasis), weight loss
Manic triad: increased mood, accelerated thinking, psychomotor agitation
High self-esteem, optimism
Delusions of grandeur
Disinhibition of drives: increased appetite, hypersexuality, desire for communication, need to help others, altruism
Sleep disorder: reduction sleep duration, does not cause a feeling of fatigue
Somatic disorders are not typical. Patients have no complaints, look young; increased blood pressure corresponds to high activity of patients; body weight decreases with pronounced psychomotor agitation
Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases, patients have difficulty comprehending the question asked and are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on their backs with their arms and legs outstretched, or sitting with their heads bowed and their elbows resting on their knees.
The statements of depressed patients reveal sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents. Surprised that the doctor
devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery. In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesiapsychicadolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; They are afraid of infecting their loved ones.
Suppression of desires, as a rule, is expressed by isolation, decreased appetite (less often, attacks of bulimia). Lack of interest in the opposite sex is accompanied by distinct changes physiological functions. Men often experience impotence and blame themselves for it. In women, frigidity is often accompanied by menstrual irregularities and even prolonged amenorrhea. Patients avoid any communication, feel awkward and out of place among people, and the laughter of others only emphasizes their suffering. Patients are so immersed in their own experiences that they are unable to care for anyone else. Women stop doing housework, cannot care for young children, and do not pay any attention to their appearance. Men cannot cope with the work they love, are unable to get out of bed in the morning, get ready and go to work, and lie awake all day long. Patients have no access to entertainment; they do not read or watch TV.
The greatest danger with depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of death are common to almost all people suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide have been described, when a person kills his children in order to “save them from future torment.”
One of the most difficult experiences of depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Waking up in the early morning hours (sometimes at 3 or 4 o'clock) is especially typical, after which patients no longer fall asleep. Sometimes patients insist that they did not sleep a minute at night and never slept a wink, although relatives and medical staff saw them sleeping ( lack of feeling of sleep).
Depression, as a rule, is accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation ( Protopopov's triad). The appearance of the patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted. A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Gastrointestinal disorders are manifested not only by constipation, but also by deterioration of digestion. As a rule, body weight decreases noticeably. Various pains are frequent (headaches, heartaches, stomach pains, joint pains).
A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. The examination did not reveal any pathology, but the man insisted that he had cancer and admitted to the doctor his intention to commit suicide. He did not object to being transferred to a psychiatric hospital. Upon admission he is depressed and answers questions in monosyllables; declares that he “doesn’t care anymore!” He does not communicate with anyone in the department, lies in bed most of the time, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 a.m. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from 2 handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.
Somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is the reason why they contact a therapist and undergo long-term, unsuccessful treatment for “ischemic heart diseases”, “hypertension”, “biliary dyskinesia”, “vegetative-vascular dystonia”, etc. In this case we talk about masked (larved) depression, described in more detail in Chapter 12.
The brightness of emotional experiences, the presence crazy ideas, signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state.
The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a psychotic level disorder. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting scientific research, special standardized scales (Hamilton, Tsung, etc.) are used to measure the severity of depression.
Depressive syndrome is not specific and can be a manifestation of a variety of mental illness: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker endogenous depression the dexamethasone test is considered positive (see section 1.1.2).
In addition to the typical depressive syndrome, a number of atypical variants of depression are described.
Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others. At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible screams, and bang their heads against the wall. Anxious depression is more often observed at involutionary age.
Depressive-delusional syndrome, in addition to the melancholy mood, it is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more characteristic not of MDP, but of an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).
Apathetic depression combines the affects of melancholy and apathy. Patients are not interested in their future, they are inactive, and do not express any complaints. Their only desire is to be left alone. This condition differs from apathetic-abulic syndrome in its instability and reversibility. Most often, apathetic depression is observed in people suffering from schizophrenia.
8.3.2. Manic syndrome
It manifests itself primarily as an increase in mood, acceleration of thinking and psychomotor agitation. Hyperthymia in this condition is expressed by constant optimism and disdain for difficulties. Denies the presence of any problems. Patients constantly smile, do not make any complaints, and do not consider themselves sick. The acceleration of thinking is noticeable in fast, jumping speech, increased distractibility, and superficiality of associations. With severe mania, speech is so disorganized that it resembles “verbal hash.” The pressure of speech is so great that patients lose their voice, and saliva, whipped into foam, accumulates in the corners of the mouth. Due to severe distractibility, their activities become chaotic and unproductive. They cannot sit still, they want to leave home, they ask to be released from the hospital.
There is an overestimation of one's own abilities. Patients consider themselves surprisingly charming and attractive, constantly boasting about their supposed talents. They try to write poetry, demonstrate their vocal abilities to others. A sign of extremely pronounced mania is delusions of grandeur.
An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, and declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. At excessive activity It is not possible to complete any of the tasks, because new ideas arise every time. Attempts to prevent the realization of their drives cause a reaction of irritation and indignation ( angry mania).
Manic syndrome is characterized by a sharp decrease in the duration of night sleep. Patients refuse to go to bed on time, continuing to fuss at night. In the morning they wake up very early and immediately get involved in vigorous activity, but they never complain of fatigue and claim that they sleep quite enough. Such patients usually cause a lot of inconvenience to others, harm their financial and social situation, but, as a rule, they do not pose an immediate threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it may be accompanied by awareness of the unnaturalness of the state; no delirium is observed. Patients can make a favorable impression with their ingenuity and wit.
Physically, those suffering from mania look completely healthy, somewhat rejuvenated. With pronounced psychomotor agitation they lose weight, despite their voracious appetite. With hypomania, significant weight gain may occur.
The patient, 42 years old, has been suffering from attacks of inappropriately elevated mood since the age of 25, the first of which occurred during her postgraduate studies at the Department of Political Economy. By that time, the woman was already married and had a 5-year-old son. In a state of psychosis, she felt very feminine and accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, passionately engaged in scientific work, and paid little attention to her son and household chores. I felt a passionate attraction to my supervisor. I sent him bouquets of flowers in secret. I attended all his lectures for students. One day, in the presence of all the department staff, on her knees she asked him to take her as his wife. She was hospitalized. After the attack ended, she was unable to finish her dissertation. During the next attack, I fell in love with a young actor. She went to all his performances, gave flowers, and secretly invited him to her dacha, secretly from her husband. She bought a lot of wine to get her lover drunk and thereby overcome his resistance, and she drank a lot and often. In response to her husband’s perplexed questions, she ardently confessed everything. After hospitalization and treatment, she married her lover and went to work for him in the theater. During the interictal period she is calm and rarely drinks alcohol. She speaks warmly about her former husband and regrets the divorce a little.
Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally, manic states caused by organic brain damage or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.) occur. Mania is a sign of acute psychosis. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.
Along with typical mania, atypical syndromes of complex structure are often encountered. Manic-delusional syndrome, in addition to the affect of happiness, it is accompanied by unsystematized delusional ideas of persecution, staging, and megalomaniacal delusions of grandeur ( acute paraphrenia). Patients declare that they are called upon to “save the whole world,” that they are endowed with incredible abilities, for example, they are “the main weapon against the mafia,” and criminals are trying to destroy them for this. A similar disorder does not occur in MDP and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiric stupefaction can be observed.
8.3.3. Apathetic-abulic syndrome
It manifests itself as a pronounced emotional-volitional impoverishment. Indifference and indifference make patients quite calm. They are hardly noticeable in the department, spend a lot of time in bed or sitting alone, and can also spend hours watching TV. It turns out that they did not remember a single program they watched. Laziness is evident in their entire behavior: they don’t wash their face, don’t brush their teeth, refuse to take a shower or cut their hair. They go to bed dressed, because they are too lazy to take off and put on clothes. It is impossible to attract them to activities by calling them to responsibility and a sense of duty, because they do not feel shame. The conversation does not arouse interest among patients. They speak monotonously and often refuse to talk, declaring that they are tired. If the doctor manages to insist on the need for dialogue, it often turns out that the patient can talk for a long time without showing signs of fatigue. During the conversation, it turns out that the patients do not experience any suffering, do not feel sick, and do not make any complaints.
The described symptoms are often combined with disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of modesty leads them to try to realize their needs in the simplest, not always socially acceptable form: for example, they can urinate and defecate right in bed, because they are too lazy to go to the toilet.
Apathetic-abulic syndrome is a manifestation of negative (deficient) symptoms and has no tendency to develop reversely. Most often, the cause of apathy and abulia are the final states of schizophrenia, in which the emotional-volitional defect increases gradually - from mild indifference and passivity to states of emotional dullness. Another reason for the occurrence of apathetic-abulic syndrome is organic damage to the frontal lobes of the brain (trauma, tumor, atrophy, etc.).
8.4. Physiological and pathological affect
The reaction to a traumatic event can proceed very differently depending on the individual significance of the stressful event and the characteristics of the person’s emotional response. In some cases, the form of manifestation of affect can be surprisingly violent and even dangerous for others. There are well-known cases of murder of a spouse due to jealousy, violent fights between football fans, heated disputes between political leaders. A grossly antisocial manifestation of affect can be facilitated by a psychopathic personality type (excitable psychopathy - see section 22.2.4). Still, we have to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the moment of committing the act, repent of their incontinence, and try to smooth out a bad impression by appealing to the severity of the insult inflicted on them. No matter how serious the crime committed, in such cases it is considered as physiological affect and entails legal liability.
Pathological affect is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction from childhood. The confusion of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Those around him are unable to correct the patient’s actions because he does not hear them. Psychosis lasts several minutes and ends with severe exhaustion: patients suddenly collapse without strength, sometimes falling into deep sleep. Upon emerging from psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, and cannot believe those around them. It should be recognized that disorders of pathological affect can only conditionally be classified as emotional disorders, since the most important expression of this psychosis is twilight darkness consciousness(see section 10.2.4). Pathological affect serves as the basis for declaring the patient insane and releasing him from responsibility for the crime committed.
BIBLIOGRAPHY
Izard K. Human emotions. - M.: Moscow State University Publishing House, 1980.
Numer Yu.L., Mikhalenko I.N. Affective psychoses. - L.: Medicine, 1988. - 264 p.
Psychiatric diagnosis / Zavilyansky I.Ya., Bleikher V.M., Kruk I.V., Zavilyanskaya L.I. - Kyiv: Vyshcha School, 1989.
Psychology emotions. Texts / Ed. V.K.Vilyunas, Yu.B.Gippen-reuter. - M.: MSU, 1984. - 288 p.
Psychosomatic disorders in cyclothymic and cyclothymic-like conditions. - Proceedings of MIP., T.87. - Answer. ed. S.F. Semenov. - M.: 1979. - 148 p.
Reikovsky Ya. Experimental psychology of emotions. - M.: Progress, 1979.
Sinitsky V.N. Depressive states (pathophysiological characteristics, clinical picture, treatment, prevention). - Kyiv: Naukova Dumka, 1986.
The most striking manifestations of affective disorders are depressive and manic syndromes (Table 8.2).
Depressive syndrome
Clinical picture of a typical depressive syndrome usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression. Hypotymia can be expressed in complaints of melancholy, depression, and sadness. Unlike the natural reaction of sadness in response to a sad event, melancholy in depression is deprived of connection with the environment; patients do not react either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself as feelings of varying intensity - from mild pessimism and sadness to a heavy, almost physical feeling of a “stone on the heart” (vital melancholy).
Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases, patients have difficulty comprehending the question asked and are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on their backs with their arms and legs outstretched, or sitting with their heads bowed and their elbows resting on their knees.
The statements of depressed patients reveal sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents.
Table 8.2. Symptoms of manic and depressive syndromes
We are surprised that the doctor devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery. In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesia psychica dolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; They are afraid of infecting their loved ones.
Suppression of desires, as a rule, is expressed by isolation, decreased appetite (less often, attacks of bulimia). Lack of interest in the opposite sex is accompanied by distinct changes in physiological functions. Men often experience impotence and blame themselves for it. In women, frigidity is often accompanied by disorders menstrual cycle and even prolonged amenorrhea. Patients avoid any communication, feel awkward and out of place among people, and the laughter of others only emphasizes their suffering. Patients are so immersed in their own experiences that they are unable to care for anyone else. Women stop doing housework, cannot care for young children, and do not pay any attention to their appearance. Men cannot cope with the work they love, are unable to get out of bed in the morning, get ready and go to work, and lie awake all day long. Patients have no access to entertainment; they do not read or watch TV.
The greatest danger with depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of death are common to almost all people suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide have been described, when a person kills his children in order to “save them from future torment.”
One of the most difficult experiences of depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Waking up in the early morning hours (sometimes at 3 or 4 o'clock) is especially typical, after which patients no longer fall asleep. Sometimes patients insist that they did not sleep a minute at night and never slept a wink, although relatives and medical staff saw them sleeping ( lack of feeling of sleep).
Depression is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation (Protopopov triad) . The appearance of the patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted. A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Gastrointestinal disorders are manifested not only by constipation, but also by deterioration of digestion. As a rule, body weight decreases noticeably. Various pains are frequent (headaches, heartaches, stomach pains, joint pains).
A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. The examination did not reveal any pathology, but the man insisted that he had cancer and admitted to the doctor his intention to commit suicide. He did not object to being transferred to a psychiatric hospital. Upon admission he is depressed and answers questions in monosyllables; declares that he “doesn’t care anymore!” He does not communicate with anyone in the department, lies in bed most of the time, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 a.m. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from two handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.
Somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is the reason why they turn to a therapist and undergo long-term, unsuccessful treatment for “coronary heart disease,” “hypertension,” “biliary dyskinesia,” “vegetative-vascular dystonia,” etc. In this case, they speak of masked (larved) depression, described in more detail in Chapter 12.
The intensity of emotional experiences, the presence of delusional ideas, and signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics depressive states. In most cases, depression lasts several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state.
The most typical symptoms depression. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a psychotic level disorder. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting scientific research, special standardized scales (Hamilton, Tsung, etc.) are used to measure the severity of depression.
Depressive syndrome is not specific and can be a manifestation of a wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).
In addition to the typical depressive syndrome, a number of atypical variants of depression are described.
Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety causes patients to fuss, constantly turning to others asking for help or demanding an end to their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others. At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make scary screams, banging their heads against the wall. Anxious depression more often observed at involutionary age.
Depressive-delusional syndrome , in addition to a melancholy mood, is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more characteristic not of MDP, but of an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).
Apathetic depression combines the affects of melancholy and apathy. Patients are not interested in their future, they are inactive, and do not express any complaints. Their only desire is to be left alone. This condition differs from apathetic-abulic syndrome in its instability and reversibility. Most often, apathetic depression is observed in people suffering from schizophrenia.
The birth of a child in a family with certain deviations from normal development is always stressful for both parents. It is very good when relatives, friends or psychological rehabilitation specialists help them cope with the problem.
The first signs of a violation of the emotional-volitional sphere begin to appear during a period of active communication in a group of peers, which is why you should not ignore any deviations in the child’s behavior. These disorders are quite rarely noted as an independent disease; they are often harbingers or components of quite serious mental disorders:
Schizophrenia;
Depression;
Manic syndrome;
Psychopathy;
Autism.
A decrease in intellectual activity in children manifests itself in the form of insufficient regulation of emotions, inappropriate behavior, decreased morality, and a low level of emotional coloring of speech. Mental retardation in such patients can be veiled by inappropriate behavior in its extreme expression - apathy, irritability, euphoria, etc.
Classification of disorders in the emotional-volitional sphere
Among the disorders in the sphere of emotional-volitional expression of personality in adults are:
1. Hypobulia - decreased will. Patients with this disorder have absolutely no need to communicate with people around them, they are irritated by the presence of strangers nearby, are unable and unwilling to carry on a conversation, and can spend hours in an empty dark room.
2. Hyperbulia is an increased desire in all areas of human life; more often this disorder is expressed in increased appetite, the need for constant communication and attention.
3. Abulia - a sharp decrease in volitional drives. In schizophrenia, this disorder is included in a single symptom complex “apathetic-abulic”.
4. Compulsive attraction is an irresistible need for something or someone. This feeling is comparable to animal instinct and forces a person to commit acts that, in most cases, are criminally punishable.
5. Obsessive desire is the occurrence of obsessive desires that the patient cannot independently control. An unsatisfied desire leads to deep suffering for the patient; all his thoughts are filled only with ideas about its embodiment.
The main deviations in the emotional and volitional sphere in children are:
1. Emotional hyperexcitability.
2. Increased impressionability, fears.
3. Motor retardation or hyperactivity.
4. Apathy and indifference, indifferent attitude towards others, lack of compassion.
5. Aggressiveness.
6. Increased suggestibility, lack of independence.
Gentle correction of emotional-volitional disorders
Hippotherapy around the world has received a lot of positive feedback both in the rehabilitation of adults and in the rehabilitation of children. Communication with a horse brings great pleasure to children and their parents. This method of rehabilitation helps to unite the family, strengthen the emotional connection between generations, and build trusting relationships.
Thanks to adults, children and adolescents, the processes of excitation and inhibition in the cerebral cortex are normalized, motivation to achieve goals is enhanced, self-esteem and vitality increase.
With the help of horse riding, every rider can learn to control their emotions smoothly and without mental breakdown. During the training, the severity of fears gradually decreases, confidence appears that communication with the animal is necessary for both participants in the process, and the self-worth of introverted individuals increases.
A trained and understanding horse helps children and adults achieve their goals, acquire new skills and knowledge, and become more open to society. In addition, hippotherapy develops higher nervous activity: thinking, memory, concentration.
Constant tension of the muscles of the whole body and maximum composure during horse riding lessons improves balance, coordination of movements, and self-confidence even in those students who cannot make a single decision without the help of others.
Various types of hippotherapy help reduce anxiety and depressive mood, forget about negative experiences and increase morale. When achieving your goals, classes allow you to develop will and endurance and break down the internal barriers of your inadequacy.
Some students enjoy interacting with animals so much that they are happy to start equestrian sports at a school for the disabled. During training and competitions, the volitional sphere develops well. They become more assertive, purposeful, self-control and endurance improve.
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