Upset emotionally volitional sphere of recovery. Emotional-volitional disorders. The main causes of violations of the emotional-volitional sphere of the child

emotional-volitional disorders can manifest themselves in different ways:

1. Increased excitability. Children of this type are restless, fussy, irritable, prone to displaying unmotivated aggression. They are characterized by sharp mood swings: they are either overly cheerful, then suddenly start to be capricious, seem tired and irritable.

Affective arousal can arise even under the influence of ordinary tactile, visual and auditory stimuli, especially intensifying in an unfamiliar environment for the child.

2. Passivity, lack of initiative, excessive shyness. Any situation of choice confuses them. Their actions are characterized by lethargy, slowness. Such children with great difficulty adapt to new conditions, it is difficult for them to make contact with strangers. This syndrome, as well as a joyful, elated mood with a decrease in criticism (euphoria), is noted with lesions of the frontal lobes of the brain.

Phobic syndrome, or fear syndrome, is characteristic of many children with cerebral palsy. Increased impressionability in combination with emotional excitability and affective inertia creates a favorable background for the emergence of anxiety neurosis. Fear can arise even under the influence of insignificant psychogenic factors - an unfamiliar situation, short-term separation from loved ones, the appearance of new faces and even new toys, loud sounds, etc. and in both cases it is accompanied by pronounced vegetative-vascular reactions - paleness or redness of the skin, hyperhidrosis, increased heart rate and respiration, sometimes chills, fever. When fear arises in a child, salivation and movement disorders (spasticity, hyperkinesis, ataxia) increase. Possible psychogenically conditioned obsessive phobias in the form of fear of loneliness, height, movement; in adolescence - fear of illness and death.

Fears that arise spontaneously, without connection with any psychogenic factors, are called neurosis-like; they are caused by organic brain damage. These include undifferentiated night fears that appear sporadically during sleep and are accompanied by screaming, crying, general agitation, and autonomic disorders. They are typical for children with hypertensive-hydrocephalic syndrome, often occur against the background of hyperthermia. If fears appear suddenly, against the background of somatic well-being, at a certain time of night sleep, at regular intervals, accompanied by motor automatisms, they should be distinguished from paroxysms of epileptic genesis, which can also be observed in infantile cerebral palsy.

3. But there are a number of qualities characteristic of both types of development. In particular, sleep disorders can often be observed in children with musculoskeletal disorders. They are tormented by nightmares, they sleep anxiously, have difficulty falling asleep.

4. Increased sensitivity. In part, this can be explained by the effect of compensation: the child's motor activity is limited, and against the background of this, the sense organs, on the contrary, receive high development. Thanks to this, they are sensitive to the behavior of others and are able to catch even minor changes in their mood. However, this impressionability is often painful; completely neutral situations, innocent statements can cause a negative reaction in them.

5. Increased fatigue is another distinctive feature characteristic of almost all children with cerebral palsy. In the process of correctional and educational work, even with a high interest in the task, the child quickly gets tired, becomes whiny, irritable, refuses to work. Some children become restless as a result of fatigue: the pace of speech accelerates, while it becomes less intelligible; there is an increase in hyperkinesis; aggressive behavior is manifested - the child can scatter nearby objects and toys.

6. Another area in which parents can face serious problems is the volitional activity of the child. Any activity that requires composure, organization and purposefulness causes difficulties for him. Mental infantilism, inherent in most children with cerebral palsy, leaves a significant imprint on the child's behavior. For example, if the proposed task has lost its attractiveness for him, it is very difficult for him to make an effort on himself and finish the work he has begun.

Children with cerebral palsy are more likely to experience negative emotions, such as fear, anger, shame, suffering, etc., than children without this disease. The dominance of negative emotions over positive ones leads to frequent experiences of states of sadness, sadness with frequent overstrain of all body systems.

Emotions in a person act as a special class of mental states, which are reflected in the form of a positive or negative attitude towards the world around, other people and, above all, oneself. Emotional experiences are determined by the corresponding properties and qualities formed in objects and phenomena of reality, as well as to certain needs and requirements of a person.

The term emotion comes from the Latin name emovere, which means movement, excitement and excitement. The key functional component of emotions is the inducement to activity, as a result of which the emotional sphere is called in another way emotional-volitional.

At the moment, emotions play a significant role in ensuring the interaction between the body and the environment.

Emotions are mainly the result of reflecting human needs and assessing the likelihood of their satisfaction, which is based on personal and genetic experience.

How pronounced is the emotional state of a person depends on the importance of needs and the lack of necessary information.

Negative emotions are manifested as a result of a lack of necessary information, which is required to satisfy a number of needs, and positive emotions are characterized by the full presence of all the necessary information.

Today, emotions are divided into 3 main parts:

1. Affect characterized by an acute experience of a certain event, emotional stress and excitement;
2. Cognition (awareness of one's condition, its verbal designation and assessment of further prospects for meeting needs);
3. Expression characterized by external bodily motility or behavior.

A relatively stable emotional state of a person is called mood. The sphere of human needs includes social needs that arise on the basis of cultural needs, which later became known as feelings.

There are 2 emotional groups:

1. Primary (anger, sadness, anxiety, shame, surprise);
2. Secondary, which includes processed primary emotions. For example, pride is joy.

The clinical picture of emotional-volitional disorders

The main external manifestations of violations of the emotionally volitional sphere include:

• Emotional stress. With increased emotional tension, there is a disorganization of mental activity and a decrease in activity.
• Rapid mental fatigue (in a child). It is expressed by the fact that the child is not able to concentrate, and is also characterized by a sharp negative reaction to certain situations where it is necessary to demonstrate his mental qualities.
• A state of anxiety, which expresses the fact that a person in every possible way avoids any contact with other people and does not strive to communicate with them.
• Increased aggressiveness. Most often it occurs in childhood, when a child demonstratively defies an adult, experiences constant physical and verbal aggression. Such aggression can be expressed not only in relation to others, but also to oneself, thereby causing harm to one's own health.
• Lack of the ability to feel and comprehend the emotions of other people, to empathize. This symptom, as a rule, is accompanied by increased anxiety and is the cause of mental disorder and mental retardation.
• Lack of desire to overcome life's difficulties. In this case, the child is in a constantly lethargic state, he has no desire to communicate with adults. The extreme manifestations of this disorder are expressed in the complete disregard of parents and other adults.
• Lack of motivation for success. The main factor of low motivation is the desire to avoid possible failures, as a result of which a person refuses to take on new tasks and tries to avoid situations where even the slightest doubts about ultimate success arise.
• Expressed distrust of other people. Often accompanied by such a sign as hostility towards others.
• Increased impulsivity in childhood. It is expressed by such signs as a lack of self-control and awareness of their actions.

Classification of violations in the emotional-volitional sphere

Violation of the emotional sphere in adult patients is distinguished by such features as:

• Hypobulia or decreased volitional qualities. Patients with this disorder do not have any need to communicate with other people, irritability occurs in the presence of a number of strangers, the lack of ability or desire to maintain a conversation.
• Hyperbulia. It is characterized by increased attraction in all spheres of life, often expressed in increased appetite and the need for constant communication and attention.
• Abulia. It stands out in that a person's volitional drives are sharply reduced.
• Compulsive attraction is an overwhelming need for something or someone. This disorder is often compared with animal instinct, when a person's ability to over-awareness his actions is significantly suppressed.
• Obsessive attraction is a manifestation of obsessive desires that the patient is not able to control on his own. Failure to satisfy such desires leads to depression and deep suffering of the patient, and his thoughts are filled with the idea of ​​their realization.

Emotional-volitional disorders syndromes

The most common forms of disorders of the emotional sphere of activity are depressive and manic syndromes.

1. Depressive syndrome

The clinical picture of depressive syndrome is described by its 3 main features, such as:

• Hypotomy, characterized by decreased mood;
• Associative retardation (mental retardation);
• Motor retardation.

It is worth noting that it is the first point listed above that is a key sign of a depressive state. Hypotomy can be expressed in the fact that a person constantly yearns, feels depressed and sad. In contrast to the established reaction, when sadness arises as a result of an experienced sad event, then with depression, a person loses connection with the environment. That is, in this case, the patient does not show a reaction to joyful and other events.

Depending on the severity of the condition, hypotomy can occur with varying intensity.

Mental retardation in its mild manifestations is expressed in the form of a slowdown in monosyllabic speech and long pondering over the answer. A difficult course is characterized by an inability to comprehend the questions asked and to solve a number of the simplest logical problems.

Motor retardation manifests itself in the form of stiffness and slowness of movements. In severe depression, there is a risk of a depressive stupor (a state of complete depression).

1. Manic syndrome

Manic syndrome is often associated with bipolar disorder. In this case, the course of this syndrome is characterized by paroxysmal, in the form of separate episodes with certain stages of development. The symptomatic picture, which stands out in the structure of a manic episode, is characterized by variability in one patient, depending on the stage of development of the pathology.

Such a pathological condition as manic syndrome, as well as depressive, is distinguished by 3 main signs:

• Increased mood for hyperthymia;
• Mental irritability in the form of accelerated thought processes and speech (tachypsia);
• Motor excitement;

An abnormal increase in mood is characterized by the fact that the patient does not feel such manifestations as melancholy, anxiety and a number of other signs characteristic of a depressive syndrome.

Mental excitability with an accelerated thinking process arises up to a jump of ideas, that is, in this case, the patient's speech becomes incoherent, due to excessive distraction, although the patient himself is aware of the logic of his words. It also highlights the fact that the patient has ideas of his own greatness and denial of the guilt and responsibility of other people.

Increased physical activity in this syndrome is characterized by disinhibition of this activity in order to obtain pleasure. Consequently, patients with manic syndrome tend to consume large amounts of alcohol and drugs.

The manic syndrome is also characterized by such emotional disorders as:

• Strengthening instincts (increased appetite, sexuality);
• Increased distractibility;
• Reassessment of personal qualities.

Methods for correcting emotional disorders

Features of the correction of emotional disorders in children and adults are based on the use of a number of effective techniques that can almost completely normalize their emotional state. As a rule, emotional correction in relation to children consists in the use of play therapy.

Often in childhood, emotional disorders are caused by a lack of play, which significantly inhibits mental and mental development.

The systematic motor and speech factor of the game allows you to reveal the child's capabilities and feel positive emotions from the game process. Working out various situations from life in play therapy allows the child to adapt much faster to real life conditions.

There is another therapeutic approach, namely psychodynamic, which is based on the method of psychoanalysis, aimed at resolving the patient's internal conflict, awareness of his needs and the experience gained from life.

The psychodynamic method also includes:

• Art therapy;
• Indirect play therapy;
• Fairytale therapy.

These specific effects have proven themselves not only for children, but also for adults. They allow patients to relax, show creative imagination and present emotional disorders as a specific image. The psychodynamic approach also stands out for its ease and ease of conduct.

Also, the common methods include ethnofunctional psychotherapy, which allows you to artificially form the duality of the subject, in order to become aware of your personal and emotional problems, as if focusing your gaze from the outside. In this case, the help of a psychotherapist allows patients to transfer their emotional problems to an ethnic projection, work through them, become aware and let them pass through themselves in order to finally get rid of them.

Prevention of emotional disorders

The main goal of preventing violations of the emotionally volitional sphere is the formation of dynamic balance and a certain margin of safety for the central nervous system. This state is due to the absence of internal conflicts and a stable optimistic attitude.

Sustained optimistic motivation makes it possible to move towards the intended goal, overcoming various difficulties. As a result, a person learns to make informed decisions based on a large amount of information, which reduces the likelihood of error. That is, the key to an emotionally stable nervous system is the movement of a person along the path of development.

Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective total assessment of incoming signals, the well-being of a person's internal state and the current external situation.

An overall favorable assessment of the present situation and the 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, longing, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characterization 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, and the term "apathy" refers to weakness or no emotion at all (indifference). In some cases, a person does not have sufficient information to assess a particular stimulus - this can cause vague emotions of surprise and bewilderment. Healthy people rarely, but there are conflicting feelings: love and hate 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 the external expression of emotions: facial expressions, gestures, intonation, autonomic 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, tone of expression. In this case, facial expressions and intonation make it possible to assess the true attitude to what was said. Statements of patients about love for relatives, desire to get a job, combined with monotony of speech, lack of proper affect, testify to unfounded statements, the prevalence of indifference and laziness.

Emotions are characterized by some dynamic features. The term “ mood", Which in a healthy person is quite mobile 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 illness, 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, therefore, good news against the background of sorrowful experiences cannot evoke an immediate response in 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 one, 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 not to waste time on logical analysis of irrelevant stimuli. Emotions generally signal us about the presence of any need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - from the feeling of boredom. The second important function of emotion is communicative. Emotion helps us communicate and act together. The collective activity of people presupposes such emotions as sympathy, empathy (mutual understanding), distrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, misunderstanding. Finally, one of the most important functions of emotion is behavior formation 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. So, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from the audience, fear Ha- flee. It is important to take into account that emotion does not always accurately reflect the true state of internal homeostasis and features of the external situation. Therefore, a person, experiencing hunger, can eat more than is necessary for the body, experiencing fear, he avoids a situation that is not really dangerous. On the other hand, the 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. The loss of the ability to experience emotions in mental illness naturally leads to inaction. Such a person does not read books and does not watch TV, because he does not feel bored, does not monitor clothes and cleanliness of the body, because he does not feel ashamed.

According to the influence on behavior, emotions are divided into stenic(prompting for action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). One and the same traumatic situation can cause excitement, flight, fury or, conversely, numbness in different people ("the legs buckled from fear"). So, emotions give the necessary impetus for action. Direct conscious planning of behavior and the implementation of behavioral acts is done by will.

Will is the main regulatory mechanism of behavior that allows you to consciously plan activities, overcome obstacles, satisfy needs (drives) in a form that facilitates greater adaptation.

Attraction is a state of a specific need of a person, a need for certain conditions of existence, dependence on their presence. We call conscious drives desires. It is practically unrealistic to list all the probable types of needs: their set is unique for each person, subjective, however, several needs that are most important for most people should be indicated. These are physiological needs for food, safety (self-preservation instinct), sexual desire. In addition, a person as a social being often needs communication (an affiliation need), and also seeks to take care of loved ones (parental instinct).

A person always has several competing needs that are relevant to him at the same time. 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 decreasing its relevance. The inability to realize an urgent need for a person causes an emotionally unpleasant feeling - frustration. Trying to avoid it, a person is forced to either satisfy his need later, when conditions change to more favorable (as, for example, a patient with alcoholism does when he receives a long-awaited salary), or to make an attempt to change his attitude to need, i.e. to apply psychological defense mechanisms(see section 1.1.4).

Weakness of will as a personality trait or as a manifestation of a 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 realization of any desire that has arisen in a form that contradicts the norms of society and causes maladjustment.

Although in most cases it is impossible to associate mental functions with any particular neural structure, it should be mentioned that experiments indicate the presence of certain centers of pleasure (a number of regions of the limbic system and septal region) and avoidance in the brain. In addition, it has been observed that damage to the frontal cortex and pathways leading to the frontal lobes (for example, during a lobotomy operation) often leads to a 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 the states of melancholy, 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). The pathology of the emotional sphere should be discussed when emotional manifestations deform the patient's behavior as a whole, cause serious maladjustment.

Hypotimia - persistent painful low mood. The concept of hypothymia corresponds to sadness, melancholy, depression. In contrast to the natural feeling of sadness associated with an unfavorable situation, hypothymia in mental illness is surprisingly resilient. Regardless of the momentary situation, patients are extremely pessimistic about their current state and existing prospects. It is important to note that this is not only an intense feeling of longing, but also an inability to experience joy. Therefore, a person in such a state cannot be amused by either a witty anecdote or good news. Depending on the severity of the disease, hypothymia can take the form from mild sadness, pessimism to deep physical (vital) feelings experienced as "mental pain", "chest tightness", "stone in the heart." Such a feeling is called vital (atrial) longing, it is accompanied by a sense of catastrophe, hopelessness, collapse.

Hypotimia as a manifestation of strong emotions is referred to as productive psychopathological disorders. This symptom is not specific and can be observed with an exacerbation of any mental illness, it is often found in severe somatic pathology (for example, in malignant tumors), and is also part of the structure of obsessive-phobic, hypochondriac and dysmorphomanic syndromes. However, first of all, this symptom is associated with the concept depressive syndrome, for which hyoothymia is the main syndromic disorder.

Hyperthymia - persistent painful mood elevation. Vivid positive emotions are associated with this term - joy, fun, delight. Unlike situationally conditioned joy, hyperthymia is characterized by persistence. For weeks and months, patients constantly maintain amazing optimism, a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither sad news, nor obstacles to the realization of ideas violate their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings that reach the degree ecstasy. This condition may indicate the formation of oneiric confusion (see section 10.2.3).

A special variant of hyperthymia is the condition euphoria, which should be viewed not so much as an expression of joy and happiness, but as a complacent, carefree affect. Patients do not show initiative, are inactive, prone to empty talk. Euphoria is a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive disintegrating extracerebral neoplasms, severe lesions of hepatic and renal function, myocardial infarction, etc.) and can be accompanied by delusional ideas of greatness (with paraphrenic syndrome, in patients with progressive paralysis).

The term moria denote silly careless babbling, laughter, unproductive excitement in deeply retarded patients.

Dysphoria they call sudden attacks of anger, anger, irritation, discontent with others and with oneself. In this state, patients are capable of cruel, aggressive actions, cynical insults, rude 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 included in the structure of the aura and twilight clouding of consciousness. Dysphoria is one of the manifestations of the psychoorganic syndrome (see section 13.3.2). Dysphoric episodes are often also 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 the feeling of an impending undefined threat, internal excitement. Anxiety is a sthenic emotion: accompanied by throwing, restlessness, anxiety, muscle tension. As an important signal of trouble, it can appear in the initial period of any mental illness. With obsessive-compulsive disorder and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, panic attacks, manifested by acute attacks of anxiety, have been identified as an independent disorder. A powerful, unreasonable feeling of anxiety is one of the early symptoms of the onset of acute delusional psychosis.

In acute delusional psychoses (syndrome of acute sensory delirium), anxiety is extremely pronounced and often reaches a degree confusion in which it is combined with uncertainty, misunderstanding of the situation, impaired perception of the surrounding world (derealization and depersonalization). Patients are looking for support and explanations, their look expresses surprise ( the affect of bewilderment). Like the state of ecstasy, such a disorder indicates the formation of a oneyroid.

Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hate, attachment and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, leads to contradictory, inconsistent actions ( ambitiousness). The Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition to be 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 a sharp decrease in the severity of emotions, indifference, indifference. Patients lose interest in relatives and friends, are indifferent to events in the world, 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 those around them do not cause them any offense, embarrassment, or surprise. They may claim that they have 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. Especially clearly the emotionlessness of patients is manifested in a situation requiring emotional choice ("What food do you like the most?", "Who do you love more: dad or mom?"). Their lack of feelings prevents them from expressing any preference.

Apathy refers to negative (deficiency) symptoms. Often it serves as a manifestation of end states in schizophrenia. It should be borne in mind that apathy in schizophrenic patients is constantly growing, going through a number of stages that differ in the 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. morbid mental numbness (anesthesiapsychicadolorosa, mournful insensibility). The main manifestation of this symptom is considered not the absence of emotions as such, but a painful feeling of one's own immersion in egoistic experiences, the consciousness of the inability to think about someone else, often combined with delusions of self-accusation. Hypeesthesia often occurs (see section 4.1). Patients complain / that they have become “like a piece of wood”, that they have “not a heart, but an empty tin can”; lament that they do not feel anxiety for young children, are not interested in their success in school. A vivid emotion of suffering testifies to the severity of the state, to the reversible productive nature of the disorders. Anesthesiapsychicadolorosa is a typical manifestation of a depressive syndrome.

Symptoms of disturbed dynamics of emotions include emotional lability and emotional rigidity.

Emotional lability - this is extreme mobility, instability, ease of occurrence and change of emotions. Patients easily move from tears to laughter, from fussiness to careless relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed with stupefaction syndromes (delirium, oneiroid).

One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by a rapid change in mood, but also by an inability to control the external manifestations of emotions. This leads to the fact that every (even insignificant) event is experienced vividly, often causes tears that arise not only during sad experiences, but also expressing emotion, delight. Faint-heartedness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but it can also occur as a personality trait (sensitivity, vulnerability).

A 69-year-old patient with diabetes mellitus and severe memory impairments is clearly experiencing her helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now a dough of dough. Whatever my daughter says, I don't remember anything, I have to write everything down. My legs do not walk at all, I can hardly crawl around the apartment ... ". The patient says all this, constantly wiping her eyes. When the doctor asked who else lives with her in the apartment, he replies: “Oh, our house is full of people! It is a pity that the deceased husband did not survive. My son-in-law is hard-working and caring. The granddaughter is intelligent: she dances, and draws, and she has English ... And the grandson will go to college next year - he has such a special school! " The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them off with her hand.

Emotional rigidity - stiffness, stuck emotions, a tendency to long-term experience of feelings (especially emotionally unpleasant). Expressions of emotional rigidity are rancorousness, stubbornness, perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to discussing another topic until he has fully expressed himself about the question of interest to 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 impulses

Disorders of will and drives are manifested in clinical practice as behavioral disorders. It should be borne in mind that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological drives, 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 the analysis of the actions performed. So, the statement of the patient about the desire to get a job looks unfounded if he has not been working for several years and does not make attempts to find a job. It should not be taken as an adequate statement by the patient that he likes to read if he read the last book several years ago.

Allocate quantitative changes and perversions of drives.

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 the patients, being in the department, immediately eat the parcel brought by them and sometimes cannot refrain from taking food from someone else's bedside table. Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention to themselves with bright makeup, flashy clothes, stand by the Mirror for a long time, tidying up their hair, and can engage in numerous casual sexual intercourse. There is a pronounced craving for communication: any conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people seek to provide patronage to any person, distribute their belongings 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 gross illegal actions, sexual violence. Although such people usually do not pose a danger, they can interfere with others with their obsession, fussiness, behave inadvertently, and improperly dispose of property. Hyperbulia is a characteristic manifestation manic syndrome.

Tipobulia - a general decrease in will and drives. It should be borne in mind that in patients with hypobulia, all basic drives, including physiological ones, are suppressed. There is a decrease in appetite. The doctor can convince the patient 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 for communication, are burdened by the presence of strangers and the need to maintain a conversation, they ask to be left alone. Patients are immersed in the world of their own suffering and cannot take care of loved ones (the behavior of a mother with postpartum depression, who is unable to force herself to take care of a newborn, looks especially surprising). Suppression of the instinct for self-preservation is expressed in suicidal attempts. A feeling of shame for their inaction and helplessness is characteristic. Hypobulia is a manifestation depressive syndrome. Drive suppression in depression is a temporary, transient disorder. Stopping an attack of depression leads to a renewed interest in life and activity.

At abulia suppression of physiological drives is usually not observed, the disorder is limited to a sharp decrease in will. The laziness and lack of initiative of persons with abulia is combined with a normal need for food, a distinct sexual desire, which are satisfied in the simplest, not always socially acceptable ways. So, a hungry patient, instead of going to the store and buying the food he needs, asks the neighbors to feed him. The patient satisfies his sexual desire by continuous masturbation or makes absurd claims to his mother and sister. In patients suffering from abulia, higher social needs disappear, they do not need communication, entertainment, they can spend all their days inactive, they 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 constitutes a single apathy-abulic syndrome, characteristic of end-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 his job in the workshop, because he considered it too difficult for himself. I asked to be accepted as a photographer in the city newspaper, as I used to do a lot of photography. Once, on behalf of the editorial board, he was supposed to compose a report on the work of collective farmers. I came to the village in city shoes and, in order not to get my boots dirty, did not approach the tractors in the field, but took only a few pictures from the car. He was dismissed from the editorial office for laziness and lack of initiative. I didn’t take another job. At home he refused to engage in any household chores. He stopped looking after the aquarium, which he made with his own hands before the illness. All day I lay in bed dressed and dreamed of moving to America, where everything is easy and accessible. He did not mind when relatives turned to psychiatrists with a request to formalize his disability.

Many symptoms described perversion of drives (parabulium). Manifestations of mental disorders can be a perversion of appetite, sexual desire, the desire for asocial actions (theft, alcoholism, vagrancy), self-harm. Table 8.1 lists the main ICD-10 terms for impulse disorders.

Parabulia is not considered as an independent disease, but is only a symptom. The reasons for the emergence

Table 8.1. Clinical variants of impulse disorders

ICD-10 code	Disorder name	The nature of the manifestation
	Pathological
	passion for gambling
	games
	Pyromania	The desire to commit arson
	Kleptomania	Pathological theft
	Trichotillomania	Attraction to pull out at myself
	Picacism (pica)	The desire to eat the inedible
	»In children	(as a variety, copropha-
		gia- eating excrement)
	Dipsomania	Craving for alcohol
	Dromomania	Longing for vagrancy
	Homicidomania	A senseless pursuit with
		commit murder
	Suicidomania	Suicidal drive
	Oniomania	Shopping urge (often
		unnecessary)
	Anorexia nervosa	The desire to limit yourself in
		eating, losing weight
	Bulimia	Overeating attacks
	Transsexualism	Desire to change gender
	Transvestism	The desire to wear pro clothes
		of the opposite sex
	Paraphilias,	Sexual predisposition
	including:	reverence
	fetishism	Getting Sexual Satisfaction
		delight from contemplation before
		intimate wardrobe met
	exhibitionism	Passion for nudity
	voyeurism	Passion for spying on
		acquired
	pedophilia	Attraction to minors
		in adults
	sadomasochism	Achieving Sexual Satisfaction
		fulfillment by inflicting
		pain or mental suffering
	homosexuality	Attraction to their own faces

Note. Terms for which the code is not given are not included in the ICD-10.

pathological drives there are gross violations of the intellect (mental retardation, total dementia), various forms of schizophrenia (both in the initial period and at the final stage with the so-called schizophrenic dementia), as well as psychopathy (persistent personality disharmony). In addition, impulse disorders are a manifestation of metabolic disorders (for example, eating inedible during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, abulia in hypothyroidism, violations of sexual behavior with 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 (compulsive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Attractions that are clearly at odds with the requirements of ethics, morality and legality, in this case, are never realized and are suppressed as unacceptable. However, the refusal to satisfy the drive gives rise to strong feelings in the patient; in spite of the will, thoughts of an unsatisfied need constantly persist in my head. If it is not clearly antisocial, the patient carries it out as soon as possible. So, a person with an obsessive fear of pollution will restrain the urge to wash his hands for a short time, but he will be sure to thoroughly wash them when no strangers are looking at him, because all the time he endures, he constantly painfully thinks about his need. Obsessive drives are included in the structure of the obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).

Compulsive attraction - a more powerful feeling, since in strength it is comparable to such vital needs as hunger, thirst, the instinct of self-preservation. Patients realize the perverse nature of attraction, try to restrain themselves, but with an unmet need, an unbearable feeling of physical discomfort arises. A pathological need occupies such a dominant position that a person quickly stops internal struggle and satisfies his attraction, even if this is associated with rude asocial actions and the possibility of subsequent punishment. Compulsive attraction can lead to repeated abuse and serial murder. A striking example of compulsive attraction is the desire for a drug in case of withdrawal symptoms in those suffering from alcoholism and drug addiction (physical dependence syndrome). Compulsive drives are also a manifestation of psychopathies.

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 the subsequent partial amnesia. Among impulsive actions, absurd, devoid of any meaning prevail. Often, patients subsequently cannot explain the purpose of the deed. Impulsive actions are a common manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also prone to committing impulsive actions.

From disorders of drives should be distinguished actions due to the pathology of other areas of the psyche. So, refusal to eat is caused not only by a decrease in appetite, but also by the presence of delirium of poisoning, imperative hallucinations that prohibit the patient from eating, as well as a gross disorder of the motor sphere - 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 the window, believing that this is a door).

8.3. Emotional-volitional disorders syndromes

The most striking manifestations of the disorder of the affective sphere are depressive and manic syndromes (Table 8.2).

8.3.1. Depressive syndrome

The clinical picture is typical depressive syndrome it is customary to describe it in the form of a triad of symptoms: decreased mood (hypothymia), slowed down thinking (associative inhibition) and motor inhibition. However, it should be borne in mind that it is a decrease in mood that is the main syndrome-forming sign of depression. Hypotimia can be expressed in complaints of melancholy, depression, sadness. Unlike the natural sadness response to a sad event, depression in depression loses connection with the environment; patients show no reaction either to good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself with feelings of varying intensity - from mild pessimism and sadness to a heavy, almost physical feeling of a "stone on the heart" ( vital longing).

Manic syndrome

Table 8.2. Symptoms of manic and depressive syndromes

Depressive syndrome

Depressive triad: decreased mood ideational retardation motor retardation

Lowered self-esteem

pessimism

Delirium of self-accusation, self-deprecation, hypochondriacal delirium

Suppression of impulses: decreased appetite, decreased libido, avoidance of contacts, isolation, devaluation of life, desire for suicide

Sleep disorders: decreased duration of early awakening, lack of feeling of sleep

Somatic disorders: dry skin, decreased turmoil, brittle hair and nails, lack of tears, constipation

tachycardia and increased blood pressure dilated pupil (mydriasis) weight loss

Manic triad: mood enhancement, thinking acceleration, psychomotor agitation

Inflated self-esteem, optimism

Delirium of greatness

Disinhibition of drives: increased appetite hypersexuality desire for communication the need to help others, altruism

Sleep Disorder: Shortening the duration of sleep without causing fatigue

Somatic disorders are not common. Patients have no complaints, they look young; the increase in blood pressure corresponds to the high activity of patients; body weight decreases with pronounced psychomotor agitation

Slowing down of thinking in mild cases is expressed by slowed down monosyllabic speech, long pondering over the answer. In more severe cases, patients find it difficult to comprehend the question asked, are unable to cope with the solution of the simplest logical tasks. They are silent, there is no spontaneous speech, but there is usually no complete mutism (silence). Motor retardation is detected in stiffness, sluggishness, sluggishness; in severe depression, it can reach the degree of stupor (depressive stupor). The posture of stupid patients is quite natural: lying on your back with outstretched arms and legs, or sitting, bowing your head, leaning your elbows on your knees.

The statements of depressed patients reveal sharply low self-esteem: they describe themselves as worthless, worthless people, devoid of talents. Surprised that the doctor

devotes his time to such an insignificant person. Pessimistic assessments are made not only of their present state, but also of the past and future. They declare that they could not do anything in this life, that they brought a lot of troubles to their family, were not a joy for their parents. They make the saddest predictions; 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. The sick consider themselves deeply sinful before God, guilty of the death of elderly parents, of the cataclysms taking place in the country. They often blame themselves for the loss of the ability to empathize with others (anesthesiapsychicadolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; are afraid of infecting loved ones.

Suppression of drives, as a rule, is expressed by isolation, loss of appetite (less often by bouts 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 menstrual irregularities and even prolonged amenorrhea. Patients avoid any kind of communication, among people they feel awkward, inappropriate, someone else's laughter only emphasizes their suffering. Patients are so immersed in their experiences that they cannot take care of anyone else. Women stop doing housework, cannot take care of young children, and do not pay any attention to their appearance. Men cannot cope with their favorite work, are unable to get out of bed in the morning, get ready and go to work, lie awake all day. Patients do not have access to entertainment, they do not read or watch TV.

The greatest danger in depression is the predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although the thought of withdrawing from life is inherent in almost all 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 are described, when a person kills his children in order to "save them from impending torment."

One of the most painful experiences of depression is persistent insomnia. Patients do not sleep well at night and cannot rest during the day. Awakening in the early morning hours (sometimes at 3 or 4 o'clock) is especially characteristic, after which the patients no longer fall asleep. Sometimes patients insist that they did not sleep a minute at night, never closed their eyes, although relatives and medical staff saw them asleep ( lack of a sense 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, pupil dilation, and constipation ( triad Protopopov). Attention is drawn to the appearance of patients. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears ("I cried out all my eyes"). Hair loss and brittle nails are often noted. A decrease in skin turgor is manifested in the fact that wrinkles deepen and patients look older than their age. An atypical fracture of the eyebrow may occur. Fluctuations in blood pressure with a tendency to increase are recorded. Disorders of the gastrointestinal tract are manifested not only by constipation, but also by impaired digestion. As a rule, body weight is noticeably reduced. Frequent various pains (headache, heart, abdomen, joints).

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. During the examination, no pathology was revealed, but the man assured him that he had cancer and confessed to the doctor that he intended to commit suicide. Didn't mind being transferred to a psychiatric hospital. On admission he is depressed, answers the questions in monosyllables; declares that he "doesn't care anymore!" In the department he does not communicate with anyone, most of the time lies in bed, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 am. Once, during a morning examination, a strangulation groove was found on the patient's neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, 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.

The somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is due to their appeal to a therapist and long-term, unsuccessful treatment for "ischemic heart disease", "hypertension", "biliary dyskinesia", "vascular dystonia", etc. In this case, they talk about masked (larvated) depression, described in more detail in Chapter 12.

The brightness of emotional experiences, the presence of delusional ideas, signs of hyperactivity of 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 a spontaneous exit from this state.

The most common symptoms of depression have been described above. In each case, their set may differ significantly, but a depressed, melancholy mood always prevails. Advanced depressive syndrome is considered a psychotic 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. Mild, non-psychotic depression is referred to as subdepression. When conducting scientific research to measure the severity of depression, special standardized scales are used (Hamilton, Tsunga, etc.).

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 psychogenias. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more characteristic; an important symptom of endogenous depression is a special daily dynamics of the state with increased melancholy in the morning and some weakening of experiences in the evening. It is the morning hours that are considered as 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 have been described.

Anxious (agitated) depression differs in the absence of pronounced stiffness and passivity. The stenic 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. A premonition of imminent catastrophe does not allow patients to sleep, they may attempt to commit suicide in front of others. At times, the excitement of patients reaches a degree of fury (melancholic raptus, raptusmelancholicus), when they tore their clothes, emit terrible screams, bang their heads against the wall. Anxiety depression is more common in the involutionary age.

Depressive-delusional syndrome, in addition to a melancholy mood, it is manifested by such delusions of delirium as delusions of persecution, staging, exposure. Patients are sure of severe punishment for their misdeeds; “Notice” constant self-observation. Fear that their guilt will result in harassment, punishment or even 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 typical not for MDP, but for 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, do not express any complaints. Their only desire is to be left alone. This condition differs from apathy-abulic syndrome by instability and reversibility. Most often, apathetic depression occurs in people with schizophrenia.

8.3.2. Manic syndrome

It is manifested primarily by an increase in mood, accelerated thinking and psychomotor agitation. Hypertension in this condition is expressed by constant optimism, disregard for difficulties. Any problem is denied. Patients are constantly smiling, do not make any complaints, do not consider themselves sick. Acceleration of thinking is noticeable in fast, prancing speech, increased distraction, superficiality of associations. With pronounced mania, speech becomes so disorganized that it resembles "verbal okroshka." The pressure of speech is so great that patients lose their voice, saliva, whipped into foam, accumulates in the corners of the mouth. Their activity, due to pronounced distraction, becomes chaotic and unproductive. They cannot sit still, try to leave home, ask to be released from the hospital.

Overestimation of one's own abilities is observed. Patients consider themselves surprisingly charming and attractive, continually boast about their supposedly existing talents. They try to compose poetry, demonstrate their vocal abilities to others. A sign of extreme mania is delusion of grandeur.

An increase in all basic drives is characteristic. Appetite sharply increases, sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for companionship. In a conversation with doctors, they do not always observe the necessary distance, turning easily - "brother!" Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, clothes try to emphasize their sexuality. An increased interest in the opposite sex is expressed in compliments, immodest offers, 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 your own family. They waste money, make unnecessary purchases. With excessive activity, none of the cases can be completed, because each time new ideas arise. Attempts to hinder the realization of their drives cause a reaction of irritation, indignation ( angry mania).

The 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 engage in vigorous activity, but they never complain of fatigue, they claim that they sleep quite enough. Such patients usually cause many inconveniences to others, harm their material and social situation, however, as a rule, they do not pose a direct threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it can be accompanied by a consciousness of the unnaturalness of the condition; delirium is not observed. Patients can make a favorable impression with their ingenuity and wit.

Physically, manic sufferers appear to be completely healthy, somewhat rejuvenated. With pronounced psychomotor agitation, they lose weight, despite the ravenous appetite. With hypomania, a significant increase in body weight can be observed.

A 42-year-old patient has been suffering from attacks of inadequately elevated mood since the age of 25, the first of which arose 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, accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, was passionately engaged in scientific work, 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. She attended all his lectures for students. Once, in the presence of all the staff of the department, on my knees, I asked him to marry her. Was hospitalized. Upon completion of the seizure, she could not finish work on her dissertation. During the next attack, she fell in love with a young actor. I went to all his performances, gave flowers, secretly from her husband invited him to her dacha. She bought a lot of wine in order to give her beloved drink and thereby overcome his resistance, she herself drank a lot and often. To the bewildered questions of her husband, she admitted everything with ardor. After hospitalization and treatment, she married her lover, went to work for him in the theater. In the interictal period, she is calm, rarely drinks alcohol. He speaks warmly of her former husband, regrets a little about the divorce.

Manic syndrome is most often a manifestation of TIR and schizophrenia. Manic states caused by organic brain damage or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.) are rare. Mania is a symptom of acute psychosis. The presence of vivid productive symptoms makes it possible to count on a complete reduction of painful disorders. Although individual attacks can be quite prolonged (up to several months), they are still often shorter than the attacks of depression.

Along with typical mania, atypical syndromes of a 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, megalomanic delusions of grandeur ( acute paraphrenia). Patients claim that they are called to "save the whole world", that they are endowed with incredible abilities, for example, they are "the main weapon against the mafia" and the criminals are trying to destroy them for this. Such a disorder does not occur in TIR and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiric confusion can be observed.

8.3.3. Apatico-abulic syndrome

It is manifested by a pronounced emotional and volitional impoverishment. Indifference and indifference make patients calm enough. They are inconspicuous in the department, spend a lot of time in bed or sitting alone, and can also spend hours watching TV. At the same time, it turns out that they did not remember a single program they watched. Laziness shows through in all their behavior: they do not wash, do not brush their teeth, refuse to go to the shower and cut their hair. They go to bed dressed because they are too lazy to take off and put on their clothes. They cannot be brought into action by calling them responsibility and a sense of duty, because they are not ashamed. The patients are not interested in the conversation. They speak monotonously, 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 symptomatology is often combined with disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of shyness leads them to attempts 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 get to the toilet.

Apatico-abulic syndrome is a manifestation of negative (deficient) symptoms and does not tend to reverse development. The most common cause of apathy and abulia are end states in schizophrenia, in which the emotional-volitional defect grows gradually - from mild indifference and passivity to states of emotional dullness. Another cause of apathy-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 a person's emotional response. In some cases, the form of manifestation of affect is surprisingly violent and even dangerous for others. There are well-known cases of the murder of a spouse on the basis of jealousy, violent fights between football fans, violent disputes between political leaders. The psychopathic disposition of the personality (excitable psychopathy - see section 22.2.4) can contribute to the gross asocial manifestation of affect. Still, we have to admit that in most cases such aggressive actions are committed deliberately: participants can talk about their feelings at the time of the act, repent of their intemperance, try to smooth out the bad impression by appealing to the severity of the offense 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 a short-term psychosis that occurs suddenly after the action of psychotrauma and is accompanied by a clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the occurrence of pathological affect indicates that the traumatic event becomes the trigger for the implementation of the existing epileptiform activity. Often, patients have a history of severe head injuries or signs of organic dysfunction since childhood. The clouding of consciousness at the moment of psychosis is manifested by the fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Others are unable to correct the patient's actions, since he does not hear them. The psychosis lasts several minutes and ends with severe exhaustion: the patients suddenly collapse exhausted, sometimes falling into deep sleep. Upon coming out of psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, they cannot believe others. It should be recognized that disorders with pathological affect can only be conditionally attributed to the range of emotional disorders, since the most important expression of this psychosis is dimness of consciousness(see section 10.2.4). Pathological affect serves as the basis for the recognition of the patient as insane and release from responsibility for the crime.

BIBLIOGRAPHY

Izard K. Human emotions. - M .: Publishing house of Moscow State University, 1980.

Numer Yu.L., Mikhalenko I.N. Affective psychoses. - L .: Medicine, 1988 .-- 264 p.

Psychiatric diagnosis / Zavilyanskiy I.Ya., Bleikher V.M., Kruk I.V., Zavilyanskaya L.I. - Kiev: Vyscha School, 1989.

Psychology emotions. Texts / Ed. V.K. Vilyunas, Yu.B. Gippenreiter. - M .: Moscow State University, 1984 .-- 288 p.

Psychosomatic disorders in cyclothymic and cyclothymic states. - Proceedings of the MIP., Vol. 87. - Resp. ed. S.F.Semenov. - M .: 1979 .-- 148 p.

Reikovsky J. Experimental psychology of emotions. - M .: Progress, 1979.

Sinitskiy V.N. Depressive states (Pathophysiological characteristics, clinical picture, treatment, prevention). - Kiev: Naukova Dumka, 1986.

Quite often, parenting is primarily focused on the physical health of their child, while the emotional component is largely neglected. This is due to the fact that most parents consider the early onset of symptoms of emotional disorders as temporary and therefore harmless.

The place of emotional disorders in the mental development of a child seems to be one of the key aspects of his life, due to the fact that these disorders 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 to aggressive behavior.

· 1 Causes

· 2

· 3 Diagnostics of violations

· 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 establish the final diagnosis when registering 3 signs of emotional instability.

The most common causes of emotional disturbance are as follows:

· Physical characteristics, taking into account the transferred diseases in the infancy;

· Inhibition of mental and mental development;

· Improper upbringing of the child in the preschool period;

· Improper 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 a characteristic type of the nervous system. For example, in the presence of attention deficit disorder, the child may subsequently develop a pathological process in the brain, which is formed as a result of the severe course of 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 of communicating with an age group of 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 being denied by adults, then he unconsciously begins to repress the information received, which comes from the environment.

The emergence of new experiences that do not coincide with his conceptual structure begin to be perceived by him negatively, which ultimately form a certain stress for him.

In the absence of understanding on the part of peers, the child develops emotional experiences (rage, resentment, disappointment), which are characterized by severity and duration. Also, constant conflicts in the family, requirements for the child, lack of understanding of his interests, also causes emotional disturbances in the mental development of the child.

Classifications of emotional disorders and their symptoms

The difficulty in identifying emotional-volitional disorders led to the fact that a number of psychologists formed different views on these types of disorders. For example, the scientist-psychologist G. Sukhareva noted that emotional disturbances in primary school age are often observed in children suffering from neurasthenia, which was distinguished by his excessive excitability.

Psychologist Y. Milanich had a different idea about these violations. 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 itself 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 opposite order.

However, the most detailed clinical picture of emotional disorders was made 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, its decrease.

The first group includes such states as:

· Euphoria, which is characterized by inadequate mood elevation. A child in this state, as a rule, has heightened impulsivity, impatience and a desire to dominate.

· Dysphoria - the opposite form of euphoria, characterized by the manifestation of such emotions as: anger, irritability, aggressiveness. It is a type of depressive syndrome.

· Depression is a pathological condition characterized by the manifestation of negative emotions and behavioral passivity. A child in this state feels a depressed and dreary mood.

· Anxiety syndrome - a condition in which a child feels unreasonable anxiety and severe nervous tension. It is expressed in a constant change of mood, tearfulness, lack of appetite, increased sensitivity. This syndrome often develops into a phobia.

· Apathy is a serious condition in which the child feels indifference to everything that happens around him, and is also characterized by a sharp decrease in initiative functions. Most psychologists claim that the loss of emotional responses 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 particular emotion is accompanied by external manifestations of completely opposite emotions. It is often observed in children with schizophrenia.

The second group includes:

· Attention deficit hyperactivity disorder, which is distinguished by symptoms such as motor disorientation, impulsivity. It follows that the key features of this syndrome are distraction and excessive physical 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 to be corrected. However, before correcting pathological manifestations, first of all, the main cause of the disease is identified.

Diagnostics of violations

For the subsequent therapy of disorders and its effectiveness, it is very important to timely diagnose the emotional development of the child and his disorders. There are many special techniques and tests that assess the development and psychological state of a child, taking into account his age characteristics.

Diagnostics of preschool children includes:

· Diagnostics of the level of anxiety and its assessment;

· Research of psychoemotional 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 school, communication with peers, behavior, or he has certain phobias.

Also, parents should pay attention if the child experiences any emotional experiences, feelings, and also if his condition is characterized as depressed.

Ways to correct emotional disorders

A number of domestic and foreign scientists in the field of psychology identify a number of techniques that allow correcting emotionally volitional disorders in children. These methods are usually divided into 2 main groups: individual and group, but this division does not reflect the main goal of the correction of mental disorders.

Mental correction of affective disorders in children is an organized system of psychological influences. This correction is mainly aimed at:

Alleviating emotional discomfort,

Increased activity and independence

· Suppression of secondary personality reactions (aggressiveness, 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 allow suppressing 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 vice versa, suppresses non-adaptive forms of behavior, if any. It includes such methods of influence as behavioral and psycho-regulatory trainings, which allow the baby to consolidate the 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 the child has intrapersonal disorders, then the use of play therapy (not computer) would be an excellent way, 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 you to optimize interpersonal relationships. When choosing a method, the severity of the child's emotional instability must be taken into account.

Such methods of psychological correction as game therapy, fairy tale therapy, etc. work effectively if they correspond to the mental characteristics of the child and the therapist.

The child's age 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 is rapidly developing.

Volitional qualities develop mainly due to conscious control over behavior, while retaining certain behavioral rules in memory.

The development of these qualities is characterized as the general development of the personality, that is, mainly, forming the will, emotions and feelings.

Therefore, for the successful emotional and volitional upbringing of a child, parents and teachers need to pay particular attention to creating a positive atmosphere of mutual understanding. Therefore, many experts recommend that parents form the following criteria for their child:

· In communicating with a child, it is necessary to maintain absolute calmness and show your benevolence in every possible way;

· You should try to communicate with the child more often, ask him about something, empathize, and be interested in his hobbies;

· Joint physical labor, play, drawing, etc. will have a good effect on the condition of the child, so try to pay as much attention to him as possible.

· It is necessary to ensure that the child does not watch films and does not play games with elements of violence, as this will only aggravate his emotional state;

· Support your child in every way and help him build self-confidence and self-confidence.

Part I. Violations in the development of the emotional-volitional sphere in children and adolescents

Educational 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 and volitional sphere.

3. Psychopathy in children and adolescents.

4. Accentuation of character as a factor contributing to the emergence of emotional-volitional disorders.

5. Children with early autism (RDA).

1. The concept of violation of the emotional-volitional sphere in defectology defines neuropsychic disorders (mainly mild and moderate). *

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 you know, the personality of a child 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 is necessary, so 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), education of correct self-esteem, as well as, along with the development of independence in actions and behavior), adult guidance, which includes, in addition to love and care, a certain set of prohibitions. Only with the correct balance of 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 that will surely find its place in society.

The versatility of emotional needs that ensure the development of a child, in itself, indicates the possibility of a significant number of unfavorable factors of 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 defined 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 (MS) is the syndrome of hyperactivity, which appears against the background of a “prolonged” state of general mental excitability and psychomotor disinhibition. The causes of MS can be varied. So, the circumstances traumatizing the child's psyche include such a psychophysiological disorder as enuresis (bedwetting, persisting or often repeated after the 3rd year of life), often observed in somatically weak and nervous children. Enuresis can occur after a severe nervous shock, fright, after a somatic illness that depletes the body. In the occurrence of enuresis, such reasons as conflict situations in the family, excessive severity of parents, too deep sleep, etc. are noted. Reactive states during enuresis are aggravated by ridicule, punishment by the hostile attitude of others to the child.

The presence of certain physical and psychophysiological defects in a child (strabismus, limb deformities, lameness, severe scoliosis, etc.) can lead to a reactive state, especially with the wrong attitude of others.

A common cause of psychogenic reactions in young children is a sudden strong irritation of a frightening nature (fire, attack of an angry dog, etc.). An increased susceptibility to mental trauma is observed in children with residual effects after infections and injuries, in children who are excitable, weakened, and emotionally unstable. The most susceptible to mental trauma are children belonging to the weak type of higher nervous activity, easily excitable children.

The main distinguishing feature of MS is inadequate (over-expressed) personal reactions to influences from the surrounding (primarily social) environment. For reactive states, the state is characteristic psychological stress and discomfort... MS can manifest as depression (a melancholy, 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 (clouding of consciousness, disorientation in the environment), unreasonable fear, temporary "loss" of some functions (deafness, mutism).

Despite the difference in manifestations, a common symptom that connects all cases of reactive states is a severe, oppressive psychoemotional state, which causes an overstrain of nervous processes and a violation of their mobility. This largely determines the increased propensity for affective reactions.

Mental developmental disorders can be associated with severe internal conflict experiences, when in the mind of the child there are opposing attitudes towards close people or to a particular social situation that is of great personal importance for the child. Conflict experiences (as a psychopathological disorder) are of a long-term, socially conditioned nature; they acquire dominant importance in the mental life of a child and sharply negatively affect 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, alcoholism of the parents, etc.). Conflict experiences can arise in children abandoned by their parents, adopted and in other cases. Another reason for persistent conflict experiences can be the above-mentioned shortcomings of psychophysical development, in particular, stuttering.

Manifestations of severe conflict experiences are most often withdrawal, 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 cognitive development of the child.

Persistent conflict experiences are often accompanied by violations ( deviations) behavior. Quite often, the cause of behavioral disorders in this category of children is the improper upbringing of the child (excessive custody, excessive freedom or, on the contrary, lack of love, excessive severity and unreasonable exactingness, without taking into account his personal - intellectual and psychophysical capabilities, determined by the stage of age development). A particularly serious mistake in the upbringing of a child is the constant derogatory comparison of him with children with the best 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 often punished may develop feelings of inferiority, reactions of fear, timidity, resentment and hatred. Such children who are under constant stress often have enuresis, headaches, fatigue, 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 personality and psychological characteristics of children (the state of the nervous system, personal aspirations, range of interests, impressionability, etc.), as well as the conditions of upbringing and development.

Also, a rather complex neuropsychiatric disorder is psychasthenia- disturbance of mental and intellectual activity, caused by weakness and disturbance of the dynamics of the processes of higher nervous activity, a general weakening of neuropsychic and cognitive processes. The causes of psychasthenia can be severe somatic health disorders, disorders of general constitutional development (due to dystrophy, metabolic disorders in the body, hormonal disorders, etc.). At the same time, factors of hereditary causation, dysfunctions of the central nervous system of various origins, the presence of minimal cerebral dysfunction, etc. play an important role in the onset of psychasthenia.

The main manifestations of psychasthenia are: a decrease in general mental activity, slowness and rapid exhaustion of mental and intellectual activity, a decrease in working capacity, the phenomenon of mental retardation and inertia, increased fatigue during psychological stress. Psychoasthenic children are extremely slow to engage in educational work and get tired very quickly when performing tasks related to the performance of mental and mnemonic actions.

Children of this category are distinguished by such specific character traits as indecision, heightened impressionability, a tendency to constant doubts, timidity, suspiciousness, anxiety. Often, symptoms of psychasthenia are also a state of depression and autistic manifestations. Psychopathic development by psychasthenic type in childhood is manifested in increased suspiciousness, in obsessive fears, in 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 imbalance of behavior, poor adaptability to changing environmental conditions, inability to obey external requirements, increased reactivity. Psychopathy is a distorted version of personality formation, it is a disharmonious development of the personality with sufficient (as a rule) preservation of the intellect. 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 psychopathies are due to external pathological factors that acted in utero or in early childhood. The most common causes of psychopathy are: infections - general and cerebral, craniocerebral trauma - intrauterine, birth and acquired in the first years of life; toxic factors (for example, chronic gastrointestinal diseases), intrauterine developmental disorders due to alcohol intoxication, exposure to radiation, etc. Pathological heredity also plays a role in the formation of psychopathy.

At the same time, for the development of psychopathy, along with the main ( predisposing) the reason that causes congenital or early acquired insufficiency of the nervous system, the presence of another factor is also necessary - the dysfunction of the social environment and the absence of corrective influences in the upbringing of a child.

Purposeful positive impact of the environment can, to a greater or lesser extent, correct the deviations in the child, 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,prerequisites that can cause psychopathic personality development; the decisive role is played by social factors, mainly conditions for the upbringing and development of the child.

Psychopathy is very diverse in its manifestations, therefore, 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, gross affective reactions. The underdevelopment of the emotional-volitional sphere is also manifested in a certain decrease in working capacity associated with the inability to concentrate, to overcome difficulties encountered when completing tasks.

The most pronounced violations of the emotional-volitional sphere are expressed in organic psychopathy, which is based on organic damage to the subcortical cerebral systems. Clinical manifestations in organic psychopathy are different. In some cases, the first manifestations of a mental disorder are detected at an early age. In the anamnesis of these children, there is a pronounced fearfulness, fear of harsh sounds, bright light, unfamiliar objects, people. This is accompanied by intense and prolonged screaming and crying. At an early and preschool age, psychomotor anxiety, increased sensory and motor excitability come to the fore. In primary school age, psychopathic behavior manifests itself in the form of unbridledness, protest against the rules of social behavior, any regime, in the form of affective outbursts (pugnaciousness, running around, noisyness, and later school truancy, a tendency to vagrancy, etc.).

In other cases of organic psychopathy, attention is drawn to the following feature of the behavioral reactions of children, which sharply distinguishes them from their peers already in preschool age. Relatives and educators note the extreme unevenness of their mood; along with increased excitability, excessive mobility in these children and adolescents, a low, gloomy-irritable mood is often noted. Children of older preschool and primary school age often complain of vague pain sensations, refuse to eat, sleep poorly, often quarrel and fight with their peers. Increased irritability, negativism in various forms of its manifestation, an unfriendly attitude towards others, aggressiveness towards them form a pronounced psychopathological symptomatology of organic psychopathy. These manifestations are especially pronounced at an older age, in the pubertal period. They are often accompanied by a slower pace of intellectual activity, memory loss, and increased fatigue. In some cases, organic psychopathy is combined with a delay in the child's psychomotor development.

G.E. Sukhareva distinguishes two main groups of organic psychopathies: excitable(explosive) and unbraked.

At the first (excitable) type, unmotivated mood swings are observed in the form dysphoria... In response to the slightest remarks, children and adolescents have violent reactions of protest, leaving home and school.

For organic psychopaths of the non-braking type, an increased background of mood, euphoria, and uncriticality are characteristic. All this is a favorable background for the formation of pathology of drives, 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 initially preserved intelligence and the absence of typical signs of epilepsy (seizures, etc.), the following behavior and character features are noted: irritability, irascibility, poor switching from one type of activity to another, "stuck" on their experiences, aggressiveness, egocentrism. Along with this, thoroughness and perseverance are characteristic when completing educational assignments. These positive features must be used as a support in the process of correctional work.

With a hereditary burden of schizophrenia, schizoid personality traits can form in children. 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, little need to communicate with others. The core property of their personality is egocentrism and autistic manifestations. They are characterized by a kind of asynchrony of mental development from early childhood. The development of speech overtakes the development of motor skills, and therefore, children often lack self-care skills. When playing games, children prefer being alone or interacting 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 found 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 sufficiently 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, in increased suggestibility, in demonstrative behavior. This variant of psychopathic development is based on mental immaturity. It manifests itself in the thirst for recognition, in the inability of the child and adolescent to volitional effort, which is the essence of mental disharmony.

Specific traits hysteroid psychopathy manifest themselves in a pronounced egocentrism, in the constant demand for increased attention to oneself, in the desire to achieve the desired in any way. In social communication, there is a tendency to conflict, to lie. When faced with life's difficulties, hysterical reactions arise. Children are very capricious, like to play a team role in a peer group and show aggressiveness if they fail. Extreme instability (lability) of mood is noted.

Psychopathic development by unstable type can be observed in children with psychophysical infantilism. They are distinguished by immaturity of interests, superficiality, instability of attachments, impulsiveness. Such children have difficulties in long-term purposeful activity, they are characterized by irresponsibility, instability of moral principles, socially negative forms of behavior. This variant of psychopathic development can be both constitutional and organic.

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. So, the characterological traits of excitable psychopaths often arise with the so-called "hypo-care" 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, 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 admiration and admiration, when the child's relatives fulfill any of his wishes and whims (the phenomenon of "family idol").

4.In adolescence there is an intensive transformation of the teenager's psyche. Significant shifts are observed in the formation of intellectual activity, which is manifested in the desire for knowledge, the formation of abstract thinking, in a creative approach to solving problems. Volitional processes are intensively formed. A teenager is characterized by persistence, perseverance in achieving the set goal, the ability to purposeful volitional activity. Consciousness is being actively formed. This age is characterized by disharmony of mental development, which often manifests itself in accentuation character. According to A.E. Lichko, the accentuation (sharpness) of individual character traits in students of different types of schools varies from 32 to 68% of the total contingent of schoolchildren (A.E. Lichko, 1983).

Character accentuation – 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 of psychologists have shown that the degree of disharmony in adolescents is different, and the accentuation of character itself has different qualitative characteristics and manifests itself in different ways in the characteristics of adolescents' behavior. The main options for character accentuations include the following.

Dysthymic personality type. The features of this type of accentuation are periodic fluctuations in mood and vitality in adolescents. During the period of mood elevation, adolescents of this type are sociable and active. During a period of depression, they are laconic, pessimistic, begin to feel burdened by noisy society, become dull, lose their appetite, and suffer from insomnia.

Adolescents of this type of accentuation feel comfortable among a small circle of close people who understand them and provide support. The presence of long-term, stable attachments and hobbies is important for them.

Emotive personality type. Adolescents of this type are characterized by mood variability, depth of experience, and increased sensitivity. Emotive adolescents have developed intuition, are sensitive to the assessments of others. They feel comfortable in the family circle, understanding and caring adults, constantly strive for confidential communication with significant adults and peers.

Anxious type The main feature of this type of accentuation is anxious suspiciousness, constant fear for yourself and your loved ones. During childhood, anxious adolescents often have a symbiotic relationship with their mother or other relatives. Teens have a strong fear of new people (teachers, neighbors, etc.). They need a warm, caring relationship. The adolescent's confidence that he will be supported, helped in an unexpected, non-standard situation, contributes to the development of initiative and activity.

Introverted type... In children and adolescents of this type, there is a tendency to emotional isolation, isolation. They, as a rule, lack the desire to establish close, friendly relations with others. They prefer individual activities. They have a weak expressiveness, a desire for loneliness, filled with reading books, fantasizing, all sorts of hobbies. These children need warm, nurturing 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. Excitable adolescents, 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 affective irascibility, impulsivity, unmotivated cruelty towards loved ones. Excited teens need warm, emotional relationships with those around them.

Demonstrative type. Adolescents of this type are distinguished by pronounced egocentrism, a constant desire to be in the center of attention, 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 is in the center of attention and is 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 according to the hysteroid type - attracting special attention to oneself by demonstrative behavior, a tendency to lie and fantasize is manifested as a protective mechanism.

Pedantic type... As E.I. 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 reasonable limits, and in these cases, the advantages associated with a tendency towards solidity, clarity, completeness are often affected. The main features of this type of character accentuation in adolescence are indecision, a tendency to reason. Such adolescents are very careful, conscientious, rational, and responsible. However, in some adolescents, with increased anxiety, there is indecision in the decision-making situation. Their behavior is characterized by some rigidity, emotional restraint. Such adolescents are characterized by an 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, first of all, in the educational or work activity of a teenager. However, in the process of entertainment, such adolescents can be very active. In unstable adolescents, there is also an increased suggestibility, and therefore, their social behavior largely depends on the environment. Increased suggestibility and impulsivity against the background of the immaturity of the higher forms of volitional activity often contributes to the formation of their tendency towards additive (dependent behavior): alcoholism, drug addiction, computer addiction, etc. The child has no desire to learn at all, unstable behavior is observed. In the personality structure of unstable adolescents, inadequate self-esteem is observed, which manifests itself in an inability to self-analysis, corresponding to an assessment of their actions. Unstable adolescents are prone to imitative activity, which makes it possible, under favorable conditions, to form socially acceptable forms of behavior in them.

Affective-labile type... An important feature of this type is extreme mood variability. Frequent mood swings are combined with a significant depth of experience. The state of health of the teenager, his ability to work, depends on the mood of the moment. Against the background of mood swings, conflicts with peers and adults, short-term and affective outbursts are possible, but then rapid remorse follows. In a period of good mood, labile adolescents are sociable, easily adapt to a new environment, responsive to requests. They have a well-developed intuition, they are distinguished by sincerity and depth of affection for relatives, loved ones, friends, they deeply experience rejection from emotionally significant persons. With a benevolent attitude on the part of teachers and others, such adolescents feel comfortable and are active.

It should be noted that manifestations of psychopathic development do not always end with the complete formation of psychopathy. For all forms of psychopathic behavior, provided early focused corrective action in combination (if necessary) with therapeutic measures, significant success can be achieved in compensating for the deviating development in this category of children.

3. Children with early childhood autism syndrome.

Early Childhood Autism (EDA) is one of the most difficult mental development disorders. This syndrome is formed in its full form by the age of three. RDA manifests itself in the following clinical and psychological signs:

• violation of the ability to establish emotional contact;

· Stereotyped 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 an object; monotonous games, stereotyped interests.

Specific disorders of speech development ( mutism, echolalia, speech cliches, stereotypical monologues, the absence of first-person pronouns in speech, etc.), leading to a violation of verbal 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 everyday sounds and tactile stimuli), as well as a focus on unpleasant impressions. With insufficient activity aimed at examining the surrounding world, and limiting various sensory contact with it, there is a pronounced "capture", fascination with certain certain impressions - tactile, visual, auditory, vestibular, which the child seeks to receive again and again. For example, a child's favorite pastime for six months or more may be rustling with a plastic bag, observing the movement of a shadow on the wall; the strongest impression can be the light of a lamp, etc. The fundamental difference in autism is the fact that a loved one almost never manages to engage in the actions with which the child is "enchanted".

· Violation of the sense of self-preservation is noted in most cases already up to a year. It manifests itself both in over-caution and in the absence of a sense of danger.

Violation of affective contact with the immediate environment is expressed:

· In the peculiarities of the relationship to the hands of the mother. Many autistic children lack anticipating pose (stretching the handles towards the adult when the child is looking at him). Such a child may also not feel comfortable in the mother's arms: either "hangs like a bag" or is excessively tense, resists caresses, etc .;

· The peculiarities of fixing the gaze on the mother's face. Normally, the child early reveals an interest in the human face. Communication with the help of a glance 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 face of an adult);

· Features of an early smile. The timely appearance of a smile and its orientation to a loved one is a sign of the successful effective development of a 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 (braking, bright color of the mother's clothes, etc.).

· Features of the formation of attachment to a loved one. Normally, they manifest themselves as an obvious preference for one of the persons caring for the child, most often the mother, in feelings of separation from her. An autistic child most often does not use positive emotional responses to express affection;

· Difficulties in making a request. In many children, a directed gaze and gesture is normally formed at an early stage of development - stretching the hand in the right direction, which at subsequent stages was transformed into an index one. In the autistic child, even at later stages of development, such a transformation of the gesture does not occur. Even at an older age, when expressing his desire, an autistic child takes the hand of an adult and places it on the desired object;

Difficulties in the arbitrary organization of the child, which can be expressed in the following tendencies:

· The absence or inconsistency of the baby's response to an adult's address to him, in his own name;

· Lack of following the direction of an adult's gaze, ignoring his pointing gesture;

• lack of expression of imitative reactions, and more often their complete absence; difficulty in organizing autistic children for simple games that require imitation and demonstration ("okay");

· Great dependence of the child on the influences of the surrounding "mental field". If the parents are more persistent and active in trying to attract attention to themselves, then the autistic child either protests or withdraws from contact.

Violation of contact with others, associated with the peculiarities of the development of the forms of the child's appeal to an adult, find expression in the difficulty of expressing their own emotional state. Normally, the ability to express one's emotional state, to 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 down. Mothers of autistic children often have difficulty even understanding the emotional state of their babies.

Part II. The main content of complex correctional work with children, suffering from emotional and volitional disorders

Educational 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 and volitional disorders provides for the solution of 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 this child, behavioral disorders, reasons that contributed to the emergence of affective reactions. Figuring out conditions for education and development child in the family.

Elimination (if possible) or weakening of psycho-traumatic moments (including negative psycho-traumatic factors of a social plan, for example, unfavorable living conditions and activities of a child in a family, an 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 purposeful child behavior; the formation of adequate behavior in various social situations.

· Establishing a positive close emotional contact with the child, including him in exciting activities (together with the teacher and other children) - taking into account his interests and inclinations. Maintaining positive contact with the child during the entire period of pedagogical work in this educational institution.

Smoothing and gradual overcoming of negative personality traits in children with emotional-volitional disorders (isolation, negativism / including speech negativism /, irritability, sensitivity / in particular, increased sensitivity to failures /, indifference to the problems of others, to their position in children's collective, etc.).

· It is important to overcome and prevent neurotic reactions and pathocharacterological disorders: egocentrism, infantilism with constant dependence on others, lack of confidence in one's abilities, etc. For this purpose, it is provided:

- prevention of affective reactions, reactive behavior; preventing the emergence of social situations, options for interpersonal contacts between children, provoking affective reactions in the child;

- rational, clear, thoughtful verbal regulation of the child's activity;

- prevention of educational (psychological) overload and overwork, timely switching the child's attention from a given conflict situation to another type of activity, to discuss a "new" issue, etc.

No less important is attached to other areas of correctional pedagogical and correctional psychological work. These include:

· Formation of socially positive personal qualities: sociability, social activity, the ability to volitional efforts, the desire to overcome the difficulties encountered, to self-affirmation in the team, combined with a benevolent, correct attitude towards others;

· Formation of correct relationships between children in the children's team (first of all, the normalization or establishment of correct interpersonal relationships between a child suffering from emotional and volitional disorders and other children of the educational 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 and volitional disorders game, subject-practical(including artistic and visual), educational and elementary labor activity; carrying out on this basis a systematic multifaceted pedagogical work on the moral, aesthetic education of children, the formation of positive personality traits.

Ordering and development of orienting-research activities (based on the purposeful formation of sensory perception, visual and auditory gnosis, analysis operations of a perceived object and a holistic objective situation, etc.);

Introduction to collective activities, involving the child in joint play, subject-practical and educational activities with other children. Formation of the child's skills for working in a team: the ability to take into account common regulations and the goals of this type of activity, the interests of other children, the ability to obey the requirements of the team, correlate their actions with the work of others, etc.

The development of cognitive interests and needs, the formation of a conscious, responsible attitude to their duties, educational assignments, social assignments, etc.

Formation sustainable motives educational and subject-practical activities, age-appropriate. The development of verbal communication in the course of joint activities with the teacher, with other children (educational, play, practical).

Upbringing purposefulness and orderliness activity, the formation of inhibitory ("restraining") reactions, correct self-assessment of one's own activity and behavior.

Active involvement of children in the preparation and conduct of holidays, excursions, cultural and sports events.

Development of motor functions, general and fine manual motor skills, including in the formation of substantive and practical activity in its various forms. Preparation for mastering the motor act of writing.

For this purpose, it is envisaged:

- Development of the cognitive activity of children;

- The use of various methods and techniques in the process of correctional and pedagogical work with children, specifically aimed at the formation of the activity and independence of children in educational and subject-practical activities (educational tasks with elements of competition, tasks of a creative nature using bright, colorful didactic material; exercises, built on the principle of "small steps", "climbing stairs", etc.);

- Regular classes in a variety of circles, sections, clubs of interest.

Educational and educational sessions should be dynamic, diverse, interesting and, at the same time, should not contain unnecessary information, a large number of difficult tasks for independent fulfillment, which often causes negative emotions, fatigue, and negative behavioral reactions in children.

Psychological * and psychological-pedagogical correction violations of the emotional-volitional sphere observed 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 of great importance 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 are relevant to him personally. In the process of playing, the child learns adequate relationships with the people around him. Of great importance is the differentiated selection of plots for games that contribute to the adaptation of the child to his environment (for example: "My family", where children play the role of parents, and dolls play the role of children; "Our little friends", "We are builders", "Cosmonauts", "Our House", "Play on the Playground", etc.)

The implementation of a complex of medical and health-improving measures includes:

Medical advice (teachers and parents),

· Proper nutrition, diet therapy and herbal medicine;

Medical treatment,

Physiotherapy,

· Hydrotherapy and hardening procedures;

Medical gymnastics and massage, etc. *

Pedagogical work with the child's family includes a number of activities:

· Identification and assessment of 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 a family (education in conditions of overprotection, lack of educational influence of others / hypocrisis /, overestimated or underestimated requirements for a child on the part of adults when organizing various types of his activities, etc.).

· Development of a single (for teachers and parents) and adequate understanding of the child's problems.

- Determination (together with parents) of the correct pedagogical approach to the upbringing and education of a child, taking into account his individual personality and psychological characteristics.

- Formation of a favorable "psychological climate" in the family (normalization of interpersonal relationships within the family - between parents and a child, between a child and other children in the family).

– Teacher Education parents; teaching them some of the available methods of correctional and pedagogical work. Inclusion of parents (as well as close relatives) in correctional and pedagogical work with a child (conducting correctional and developmental classes at home), etc.

A particularly attentive, calm and tactful attitude towards a child with psychopathological personality traits is required from teachers and parents. In pedagogical work, one should rely on the positive characterological traits of the child's personality, the active use of techniques encouragement, education on positive examples, distraction from adversely acting moments and sides of the surrounding life. When working with children suffering from emotional and volitional disorders, a calm, even tone, benevolence combined with exactingness, the absence of multidirectional attitudes in organizing the child's activities and behavior is required.

For the rehabilitation of autistic children in complex correctional work, the following areas of correctional work are being implemented.

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, overcoming negative forms of behavior. The work on this section is carried out by a psychologist.

Pedagogical correction. Depending on the level of development of the nervous system, knowledge and skills of the autistic child, the nature of his preferences and interests, an individual training program is created. Based on the data of the psychologist's research, the teacher conducts his own examination, determines the specific training tasks, and develops a method of work.

Revealing and development of creative abilities of children. Music is an important area of ​​life for an autistic child, giving him a lot of positive emotions, and singing is often the most important factor in the appearance and development of speech.

Development of general motor skills. Physiotherapy exercises in corrective work with autistic children is very important. In connection with the underdevelopment of the functions of the vestibular apparatus, exercises for balance, coordination of movements, and orientation in space are of particular importance.

Working with parents of autistic children. The complex of work with parents includes: psychotherapy of family members, familiarizing parents with a number of mental characteristics of a child with RDA, teaching methods of raising an autistic child, organizing his regime, developing self-service 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 urgent psycho-traumatic problems. In working with children and adolescents suffering from emotional-volitional disorders, the following psychotherapy methods 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 to manage emotions, restore strength, performance, relieve tension, overcome stressful conditions. Behavioral psychotherapy is based on the principles of behaviorism, helps to change the child's behavior under the influence of a positive stimulus, relieves discomfort, inadequate response. Training as a type of behavioral psychotherapy, teaches you to manage your emotions, make a decision, teaches communication, self-confidence. Rational psychotherapy as a method includes techniques of explanation, suggestion, emotional impact, study, personality correction, logical argumentation. Occupational therapy is actively used as a link connecting a person with social reality. In fact, this is a treatment with employment, protection from personal breakdown, creating conditions for interpersonal communication.

Of particular interest in psychocorrectional work with adolescents with disorders of emotional regulation of behavior is tiered approach proposed by prof. V.V. Lebedinsky (1988). The interaction of a person with the world around him, the realization of his needs can occur at different levels of activity and the depth of emotional contact of a child (adolescent) with the environment. There are four main levels of such interaction.

First level field reactivity- primary connection with the most primitive, passive forms of mental adaptation. Affective experiences at this level do not yet contain a positive or negative assessment, they are associated only with a general self-feeling of comfort or discomfort.

At an older age of the child and in adults, this level is performed 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 great and its underestimation entails significant costs in the psychocorrectional process. Tonic emotional regulation with the help of special daily psychotechnical techniques has a positive effect on different levels of “basal affectivity”. Therefore, various psycho-regulatory training using sensory stimuli ( sound, color, light, tactile touch) are of great importance in psycho-correction of behavior.

Second - level of stereotypes- plays an important role in regulating the behavior of the child in the first months of life, in the formation of adaptive reactions - food, 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 evaluated affectively: 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 the most complex forms of human behavior. The activation of this level of emotional regulation in the process of psychocorrectional work is achieved when the child (adolescent) concentrates on sensory (muscle, gustatory, tactile and other) sensations, perception and reproduction of simple rhythmic stimuli. This level, like the first, helps to stabilize a person's affective life. Various psychotechnical techniques, widely used by psychologists, such as rhythmic repetitions, "ritual actions", jumping, swinging, etc., occupy an important place in the psychocorrectional process, especially in the first stages of classes. They act 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 - expansion level- is the next stage of a person's emotional contact with the environment. Its mechanisms gradually begin to be mastered by the child 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 it was at the second level, but with the achievement of the desired. They are distinguished by great strength and polarity. If on the second level the instability of the situation, uncertainty, danger, unsatisfied desire causes anxiety, fear, then on the third they mobilize the subject to overcome difficulties. At this level of affective organization of activity and behavior, the child is curious about an unexpected impression, excitement in overcoming danger, anger, the desire to overcome the difficulties that arise. In the process of psychocorrection, the level of affective expansion is stimulated under the influence of experiences arising in the process of a fascinating game, risk, rivalry, overcoming difficult and dangerous situations, playing "frightening" plots containing a real prospect of their successful resolution.

Fourth level - level emotional control(the 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 subject's behavioral act is already becoming deed- an action that is built taking into account the attitude of another person towards him. If adaptation fails, the subject at this level no longer responds to a situation that is significant for him with either withdrawal, motor activity, or directed aggression, as is possible at previous levels - he turns to other people for help. At this level, the improvement of affective "orientation in oneself" takes place, 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 highlighted levels of affective organization implement qualitatively different adaptation tasks. Weakening or damage to one of the levels leads to a general affective maladjustment of a child or adolescent in the surrounding society.

The structural-level study of the basal emotional organization of the personality is of great importance in solving the problem of the formation of individual behavior in children and adolescents and the development of effective methods for its correction.

5.2 Behavioral disorders in children and adolescents with developmental disharmony are often based on the lack of voluntary regulation of activity. Relying on activity principle in psychology, the main blocks of the structure of human behavior can be distinguished.

Motivational block- includes the ability of a child (adolescent) to highlight, realize and accept the goal of behavior.

Operational and regulatory unit- the ability to plan actions to achieve the goal (both in content and in terms of implementation of activities).

Control unit- the ability to control their behavior and make the necessary adjustments.

Difficulties in comprehending their behavior are characteristic of many children and adolescents with mental disharmony. They are manifested in weak reflection, in ignorance of their "strong" and "weak" personal qualities, as well as in underestimation of a particular psycho-traumatic situation by a teenager, promoting

Often, parental care is mainly focused on the physical health of children, when sufficient attention is not paid to the emotional state of the child, and some early alarming symptoms of disorders in the emotional-volitional sphere are perceived as temporary, age-specific, and therefore not dangerous.

Emotions play a significant role from the very beginning of a baby's life, and serve as an indicator of his attitude towards his parents and what surrounds him. Currently, along with general health problems in children, experts note with concern the growth of emotional-volitional disorders, which translate into more serious problems in the form of low social adaptation, a tendency to antisocial behavior, and learning difficulties.

External manifestations of violations of the emotional-volitional sphere in childhood

Despite the fact that it is not worthwhile to independently make not only medical diagnoses, but also diagnoses in the field of psychological health, but it is better to entrust this to professionals, there are a number of signs of violations of the emotional-volitional sphere, the presence of which should be the reason for contacting specialists.

Violations in the emotional-volitional sphere of the child's personality have characteristic features of age-related manifestations. So, for example, if adults systematically note in their baby at an early age such behavioral characteristics as excessive aggressiveness or passivity, tearfulness, "getting stuck" on a certain emotion, then it is possible that this is an early manifestation of emotional disorders.

In preschool age, in addition to the above symptoms, an inability to follow the norms and rules of behavior, insufficient development of independence may be added. At school age, these deviations, along with the listed ones, can be combined with self-doubt, impaired social interaction, decreased purposefulness, and inadequacy of self-esteem.

It is important to understand that the existence of violations should be judged not by the presence of a single sign, which may be the child's reaction to a specific situation, but by the combination of several characteristic symptoms.

The main external manifestations are as follows:

Emotional tension. With increased emotional tension, in addition to well-known manifestations, difficulties in organizing mental activity, a decrease in play activity characteristic of a particular age can also be clearly expressed.

• Rapid mental fatigue of the child in comparison with peers or with earlier behavior is expressed in the fact that it is difficult for the child to concentrate, he can demonstrate a clear negative attitude towards situations where the manifestation of mental and intellectual qualities is necessary.
• Increased anxiety. Increased anxiety, in addition to the known signs, can be expressed in the avoidance of social contacts, a decrease in the desire for communication.
• Aggressiveness. Manifestations can be in the form of demonstrative disobedience to adults, physical aggression and verbal aggression. Also, his aggression can be directed at himself, he can hurt himself. The child becomes disobedient and with great difficulty succumbs to the educational influences of adults.
• Lack of empathy. Empathy is the ability to feel and understand the emotions of another person, to empathize. With violations of the emotional-volitional sphere, this symptom, as a rule, is accompanied by increased anxiety. An inability to empathize can also be a warning sign of mental illness or intellectual retardation.
• Unwillingness and unwillingness to overcome difficulties. The child is lethargic, with displeasure in contact with adults. Extreme manifestations in behavior can look like complete ignorance of parents or other adults - in certain situations, a child can pretend not to hear an adult.
• Low motivation for success. A characteristic sign of low motivation for success is the desire to avoid hypothetical failures, so the child takes on new tasks with displeasure, tries to avoid situations where there is even the slightest doubt about the result. It is very difficult to persuade him to try to do something. A common answer in this situation is: "it won't work", "I can't." Parents can mistakenly interpret this as a manifestation of laziness.
• Expressed distrust of others. It can manifest itself as hostility, often associated with tearfulness, school-age children can show this as excessive criticism of the statements and actions of both peers and surrounding adults.
• Excessive impulsiveness of a child, as a rule, is expressed in weak self-control and lack of awareness of their actions.
• Avoiding close contact with people around you. The child may repel others with remarks expressing contempt or impatience, insolence, etc.

Formation of the emotional-volitional sphere of the child

Parents observe the manifestation of emotions from the very beginning of the child's life, with their help there is communication with the parents, so the baby shows that he is good, or he experiences unpleasant sensations.

Later, in the process of growing up, the child faces problems that he has to solve with varying degrees of independence. Attitude to a problem or situation evokes a certain emotional response, and attempts to influence the problem - additional emotions. In other words, if a child has to be arbitrary in the implementation of any actions, where the fundamental motive is not “I want”, but “must”, that is, a volitional effort is required to resolve the problem, in fact this will mean the implementation of a volitional act.

As they grow older, emotions also undergo certain changes and develop. Children at this age learn to feel and are able to demonstrate more complex expressions of emotion. The main feature of the correct emotional-volitional development of a child is the increasing ability to control the manifestation of emotions.

The main causes of violations of the emotional-volitional sphere of the child

Child psychologists place particular emphasis on the statement that the development of a child's personality can only occur harmoniously with sufficient confidential communication with close adults.

The main reasons for violations are:

1. transferred stresses;
2. lag in intellectual development;
3. lack of emotional contact with close adults;
4. social and domestic reasons;
5. films and computer games not intended for his age;
6. a number of other reasons that cause internal discomfort and feelings of inferiority in the child.

Violations of the children's emotional sphere are manifested much more often and brighter during periods of the so-called age crises. Striking examples of such points of growing up can be the crises "I myself" at the age of three years and the "Crisis of adolescence" in adolescence.

Diagnostics of violations

To correct violations, timely and correct diagnosis is important, taking into account the reasons for the development of deviations. In the arsenal of psychologists there are a number of special techniques and tests for assessing the development and psychological state of a child, taking into account his age characteristics.

For preschoolers, as a rule, projective diagnostic methods are used:

• drawing test;
• Luscher color test;
• Beck's anxiety scale;
• questionnaire "Feelings, activity, mood" (SAN);
• Phillips' school anxiety test and many others.

Correction of violations of the emotional-volitional sphere in childhood

What if your baby's behavior makes you suspect a similar disorder? First of all, it is important to understand that these violations can and should be corrected. You should not rely only on specialists, the role of parents in correcting the behavioral characteristics of a child's character is very important.

An important point that allows you to lay the foundation for a successful solution to this problem is the establishment of contact and trusting relationship between the parents and the child. In communication, one should avoid critical assessments, show a benevolent attitude, remain calm, praise adequate manifestations of feelings more, one should be sincerely interested in his feelings and empathize.

Seeing a psychologist

To eliminate violations of the emotional sphere, you should contact a child psychologist who, with the help of special classes, will help you learn how to respond correctly when stressful situations arise and control your feelings. Another important point is the work of a psychologist with the parents themselves.

In psychology, many ways of correcting children's disorders in the form of play therapy are currently described. As you know, the best learning happens with the attraction of positive emotions. Learning to behave properly is no exception.

The value of a number of methods lies in the fact that they can be successfully applied not only by specialists themselves, but also by parents interested in the organic development of their baby.

Practical correction methods

These are, in particular, the methods of fairy tale therapy and puppet therapy. Their main principle is the identification of the child with the character of a fairy tale or his favorite toy during the game. The child projects his problem onto the main character, the toy and, in the course of the game, resolves them according to the plot.

Of course, all these methods imply the obligatory direct involvement of adults in the very process of the game.

If parents in the process of upbringing pay sufficient and due attention to such aspects of the development of a child's personality as the emotional-volitional sphere, then in the future this will make it much easier to survive the period of adolescent formation of the personality, which, as many know, can introduce a number of serious deviations in the behavior of the child.

The work experience accumulated by psychologists shows that not only taking into account the peculiarities of age-related development, a thorough selection of diagnostic methods and techniques of psychological correction, allows specialists to successfully solve the problems of violation of the harmonious development of a child's personality, the decisive factor in this area will always be parental attention, patience, care and love. ...

Psychologist, psychotherapist, personal well-being specialist

Svetlana Buk

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1. Question:
   Hello! Our child was diagnosed with Violation of the emotional-volitional sphere of the sphere. What to do? He is in the 7th grade, I'm afraid if we send him to school at home, he will get even worse.
   Answer:
   Hello dear mommy!

   A child with a violation of the emotional-volitional sphere may have melancholy, depression, sadness, or a painfully elevated mood up to euphoria, fits of anger or anxiety. And all this is within the framework of one diagnosis.

   A competent psychotherapist does not work with a diagnosis, but with a specific child, with his individual symptoms and situation.

   First of all, it is important for you to align your condition. Parents' fears and concerns negatively affect any child.

   And to engage in correction, to solve the problem. Homeschooling is just an adaptation to a problem (i.e. a way to somehow live with it). For a solution, you need to come to an appointment with a psychologist-psychotherapist together with medical help.

   
   

2. Question:
   Hello. I am a mother. My son is 4 years 4 months old. We were first diagnosed with STD, yesterday this diagnosis was withdrawn by a neuropathologist and diagnosed as ‘a disorder of the emotional sphere against the background of the formation of the emotional sphere’. What should I do? How to correct? And what literature will you advise for behavior correction. My name is Marina.
   Answer:
   Hello Marina!
   Imagine that your smartphone or TV is somehow not working like that.
   Will it ever occur to someone to start repairing these devices according to books or the recommendations of specialists (take a soldering iron and replace the 673 transistor and 576 resistor). And the human psyche is much more complicated.
   Here you need versatile classes with a psychologist-psychotherapist, speech therapist, defectologist, psychiatrist.
   And the earlier you start classes, the more effective the correction will be.

   
   

3. Question:
   What are the diagnostic techniques for detecting disorders in the emotional-volitional sphere of children 6 - 8 years old?

   Answer:
   Classification M. Bleikher and L. F. Burlachuk:
   1) observation and methods close to it (study of biography, clinical conversation, etc.)
   2) special experimental methods (modeling certain types of activities, situations, some hardware techniques, etc.)
   3) personality questionnaires (methods based on self-assessment)
   4) projective methods.

   
   

4. Question:
   Hello Svetlana.
   The violations of the children's emotional sphere, described in this article, I observed in many children about 90% - aggressiveness, lack of empathy, unwillingness to overcome difficulties, unwillingness to listen to another (now headphones are very helpful in this) are the most frequent. The rest are less common but present. I am not a psychologist and perhaps I am mistaken in my observations, therefore I want to ask: is it true that 90% of there are violations of the emotional-volitional sphere?

   Answer:
   Hello dear reader!
   Thank you for your interest in the topic and the question.
   The manifestations you noticed - aggressiveness, lack of empathy, unwillingness to overcome difficulties, unwillingness to listen to another are just signs. They can serve as a reason for contacting a specialist. And their presence is not a reason for the diagnosis of “Violations of the emotional-volitional sphere”. To one degree or another, every child tends to experience aggressiveness, for example.
   And in this sense, your observations are correct - most children show the above symptoms from time to time.

   
   

5. Question:
   Hello Svetlana!
   I would like to consult with you about the behavior of my son. We have a family of grandparents, son and me (mother). The son is 3.5 years old. I am divorced from my father, we parted with him when the child was a little over a year old. We do not see each other now. The son was diagnosed with dysarthria, intellectual development is normal, very active and sociable, but in the emotional and volitional sphere, serious violations are evident.
   For example, it happens that he says (in the kindergarten one boy began to do this) sometimes some syllable or sound is repeated and monotonous, and when they tell him to stop doing this, he may start doing something else out of spite, for example, making a face ( as he was forbidden to do so). At the same time, in a calm tone, we explained to him that this is what "sick" boys or "bad" boys do. First, he begins to laugh, and after another explanation and reminder that this may be fraught with some kind of punishment, especially when an adult breaks down and raises his tone, crying begins, which is abruptly replaced by laughter (unambiguously, already unhealthy), and so laughter and crying can change several times within minutes.
   Also, in the behavior of our son, we observe that he can throw toys (often (in the sense within a month or two), breaks a car or toys, abruptly throwing and breaking it. At the same time, he is very naughty (hears, but does not listen), often every day brings close people.
   We all love him very much and want him to be a healthy and happy boy. Please tell me what to do with us in such a situation when he does something in spite of him? What methods of conflict resolution would you recommend? How to wean a son from the habit of pronouncing these "articulate sounds"?
   Grandparents are intelligent people, I have the education of a teacher, economist, educator. We consulted a psychologist about a year ago, when this picture was just beginning to appear. The psychologist explained that these are signs of a crisis. But, currently having a diagnosis of dysarthric, we are forced to explain his behavior in a different way, which, by the way, did not improve, despite our compliance with the advice of a psychologist, but worsened.
   Thanks in advance
   Best regards, Svetlana

   Answer:
   Hello Svetlana!

   I recommend that you come for a consultation.
   We can preliminarily contact by skype or phone.
   It is important to switch the child, distract him to some interesting activity at such moments.
   Punishments, explanations, and raising the tone are not effective.
   You write “despite our following the advice of a psychologist” - what exactly did you do?