Emotional and volitional disorders in children and adolescents, psychological support. Disorders of the emotional-volitional sphere Emotional volitional disorders how to work


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 "emotions" 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 of 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 the 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 seek 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 strangers nearby, and 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 the 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 the 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

The peculiarities 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 their 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 certain image. The psychodynamic approach also stands out for its ease and ease of conduct.

Also 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, realize and 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 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, vegetative reactions. In this sense, the terms "affective" and "emotional" are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient's speech and the facial expression, 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 passion (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 emotions 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 the peculiarities 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 ("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 almost unrealistic to list all the probable types of needs: their set for each person is unique, subjective, but several needs that are most important for most people should be indicated. These are the physiological needs for food, safety (self-preservation instinct), sexual desire. In addition, a person as a social being often needs communication (an affiliate 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 mental illness, on the one hand, does not allow a person to systematically satisfy his needs, and on the other hand, leads to the immediate implementation of any desire that 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 noticed 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 depression of mood. The concept of hypothymia corresponds to sadness, melancholy, depression. Unlike the natural feeling of sadness associated with an unfavorable situation, hypothymia in mental illness is remarkably 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 a deep physical (vital) feeling 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 state 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 mentally 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 uncertain 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?", "Whom do you love more: dad or mom?"). Their lack of feelings prevents them from expressing any preference.

Apathy refers to negative (deficient) 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. The phenomenon of hypoesthesia 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 pass 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 each (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 live. My son-in-law is hard-working and caring. The granddaughter is a wise girl: 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 on the basis of an 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 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 cosmetics, 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 things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and 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. The relief of 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

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 (peak)

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,

Disorders of sexual pre

including:

reverence

fetishism

Getting sexual pleasure

delight from contemplation before

intimate wardrobe met

exhibitionism

Passion for nudity

voyeurism

Passion for peeping

acquired

pedophilia

Attraction to minors

in adults

sadomasochism

Achieving Sexual Satisfaction

fulfillment by inflicting

pain or mental suffering

homosexuality

Attraction to the faces of his own

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

pathological drives 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, sexual behavior disorders with 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 wash them thoroughly 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. The 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 the 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 the 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 in 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 pupil dilation (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 have difficulty comprehending the question asked, 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. Not only their present state, but also past and future are evaluated pessimistically. 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. Patients 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, decreased 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 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 everyone 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. It is especially characteristic of awakening in the early morning hours (sometimes at 3 or 4 o'clock), 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 is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupil, 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 break 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, however, 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 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 confessed 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", "vegetative 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, special standardized scales (Hamilton, Zung, etc.) are used to measure the severity of depression.

Depressive syndrome is not specific and can be a manifestation of a wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and 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, impact. 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. This atypical delusional symptomatology is 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 state 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 alleged 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, since new ideas arise every time. 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, significant weight gain 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 insufficiently affectionate attitude 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 clouding of consciousness 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 conversation does not arouse interest in patients. 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 go 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 moment of committing an act, repent of their intemperance, try to smooth out a bad impression, appealing to the severity of the insult inflicted on them. No matter how serious the crime committed, in such cases it is considered as physiological affect and entails legal liability.

Pathological affect is called 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 onset 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. Clouding of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Others are unable to correct the patient's actions, since he does not hear them. The psychosis lasts several minutes and ends in severe exhaustion: the patients suddenly collapse exhausted, sometimes falling into a 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 dim confusion(see section 10.2.4). Pathological affect serves as the basis for the recognition of the patient as insane and exemption 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. - Moscow: 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.

adolescents

Educational questions.

    Typology of disorders in the development of the emotional-volitional sphere.

    Psychological and pedagogical characteristics of children and adolescents with disabilities

emotional and volitional sphere.

    Psychopathy in children and adolescents.

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

    Children with early autism (RDA).

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

The main types of disorders in the development of the emotional-volitional sphere in children and adolescents include reactive states (hyperactivity syndrome), conflict experiences, psychasthenia and psychopathy (psychopathic forms of behavior), early childhood autism.

As 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 adverse environmental influences can cause temporary behavioral disturbances, 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 the emotional needs that ensure the development of the child already 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.

    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 hyperactivity syndrome, which appears against the background of a “prolonged” state of general mental excitability and psychomotor disinhibition. The causes of MS can be varied. 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.). Increased susceptibility to mental trauma is observed in children with residual effects after infections and injuries, in children who are excitable, weakened, 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, 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 overstrain of nervous processes and a violation of their mobility. This largely determines the increased propensity for affective reactions.

Mental disorders can be associated with severe internal conflict experiences, when in the mind of a 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 the 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). An especially 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 inhibition 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, increased 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. Studies of domestic scientists (V.A.Gilyarovsky, V.R.Myasishchev, G.E.Sukhareva, V.V.Kovalev, etc.) have shown 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: bobdim(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 hysterical psychopathy are manifested 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 group of peers 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. Thus, 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 accentedness 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 among 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 adults and peers that are significant to them.

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, caring relationships from loved ones. Their psychological comfort increases when adults accept and support their most unexpected hobbies.

Excitable type... With this type of character accentuation in adolescents, there is an imbalance between excitatory and inhibitory processes. 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 temper, impulsiveness, unmotivated cruelty towards loved ones. Excited teens need warm, emotional relationships with those around them.

Demonstrative type. Adolescents of this type are distinguished by a 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, an 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 their 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 specific 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, watching the movement of a shadow on the wall; the strongest impression may be the light of a lamp, etc. The fundamental difference in autism is the fact that a loved one almost never succeeds in engaging in the actions with which the child is "enchanted".

    Violation of the sense of self-preservation is noted in most cases for 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 .;

    features of fixing a look at 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, 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 of the child's arbitrary organization, 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 the adult's gaze, ignoring his pointing gesture;

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

    great dependence of the child on the influences of the surrounding "mental field". If parents are more persistent and active in trying to attract attention, 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 complexity 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.

It is very difficult for babies to fall asleep during this period. They become restless at night and often wake up. A child can react violently to any stimuli, especially if he is in an unfamiliar environment.

Adults also largely depend on their mood, which can change for seemingly unknown reasons. Why is this happening and what is important to know about it?

Determination of the emotional-volitional sphere

For the corresponding development in society, as well as normal life, the emotional and volitional sphere is important. Much depends on her. And this applies not only to family relations, but also to professional activities.

The process itself is very complex. Various factors influence its origin. It can be both social conditions of a person and his heredity. This area begins to develop at an early age and continues to form until adolescence.

From birth, a person overcomes the following types of development:

Emotions are different ...

As well as their manifestations in life

What are the reasons for the failure?

There are a number of reasons that can affect the development of this process and cause emotional volitional disturbances. The main factors include:

Along with this, you can name any other reasons that can cause internal discomfort and feelings of inferiority. At the same time, a child will be able to develop harmoniously and correctly only if he has a trusting relationship with his family.

Spectrum of violations of will and emotions

Emotional volitional disorders include:

  • hyperbulia;
  • hypobulia;
  • abulia;
  • obsessive-compulsive disorder.

With a general increase in will, hyperbulia develops, which is capable of affecting all major drives. This manifestation is considered characteristic of manic syndrome. So, for example, a person's appetite will increase, if he is in the department, he will immediately eat the food that is brought to him.

Both will and impulses decrease with hypobulia. In this case, the person does not need communication, he is burdened by strangers who are nearby. It is easier for him alone. Such patients prefer to immerse themselves in their own world of suffering. They do not want to take care of their relatives.

When there is a decrease in will, this indicates abulia. Such a disorder is considered persistent, and together with apathy, a syndrome of apathetic-abulic nature is compiled, which, as a rule, manifests itself during the period of the final state of schizophrenia.

With an obsessive drive, the patient has desires that he is able to control. But when he begins to give up his instincts, then this gives rise to a serious experience in him. He is haunted by thoughts of a need that has not been satisfied. For example, if a person has a fear of pollution, then he will try not to wash his hands as often as he wants, but this will make him painfully think about his own need. And when no one is looking at him, he will wash them thoroughly.

Stronger feelings include compulsive attraction. It is so strong that it is compared to instinct. The need becomes pathological. Her position is dominant, so the internal struggle stops very quickly and the person immediately grants his desire. This can be a rude antisocial act followed by punishment.

Volitional disorders

Will is the mental activity of a person, which is aimed at a specific goal or overcoming obstacles. Without this, a person will not be able to realize his intentions or solve life problems. Volitional violations include hypobulia and abulia. In the first case, volitional activity will be weakened, and in the second, it will be absent altogether.

If a person is faced with hyperbulia, which is combined with distraction, then this may indicate a manic state or delusional disorder.

The craving for food and self-preservation are violated in the case of parabulia, that is, with the perversion of the volitional act. The patient, refusing to eat normal foods, begins to eat inedible foods. In some cases, pathological gluttony is observed. When the sense of self-preservation is disturbed, the patient can seriously injure himself. This includes sexual perversion, in particular, masochism, exhibitionism.

The spectrum of volitional qualities

Emotional disorders

Emotions are different. They characterize the relationship of people to the world around them and to themselves. There are many emotional disorders, but some of them are considered urgent reasons to see a specialist. Among them:

  • depressed, dreary mood, repetitive, lingering nature;
  • constant change of emotions, for no serious reason;
  • uncontrollable emotional states, affects;
  • chronic anxiety;
  • stiffness, uncertainty, shyness;
  • high emotional sensitivity;
  • phobias.

Emotional disorders include the following pathological abnormalities:

  1. Apathy is like emotional paralysis. A person is completely indifferent to everything around him. This is accompanied by inactivity.
  2. Hypotimia, in which the mood decreases, and the person feels depression, melancholy, hopelessness, therefore, fixes his attention only on negative events.
  3. Depression is characterized by such a triad as hypothymia, slowing down of thinking, motor retardation. At the same time, the patient has a melancholic mood, he feels deep sadness, heaviness in the heart and the whole body. In the early morning, the state of health deteriorates significantly. During this period, there is a high probability of suicide.
  4. In the case of dysphoria, the mood is also low, but it has a tensely angry character. This deviation is short-lived. Typically occurs in people with epilepsy.
  5. Dysthymia is also not protracted. It takes place over a relatively short period of time. This condition is characterized by mood disorder. A person feels despondency, anxiety, anger.
  6. The opposite of the above deviations is considered hyperthymia, in which a person is overly cheerful, he is happy and cheerful, energetic and overestimates his own capabilities.
  7. A person in a state of euphoria is complacent and careless, but at the same time differs in passivity. This often happens in the case of organic brain disease.
  8. During ecstasy, the patient plunges into himself, he experiences delight, extraordinary happiness. Sometimes this condition is associated with positive visual hallucinations.

When the child is overly aggressive or withdrawn

Emotional volitional disorders, which are most pronounced in children:

  1. Aggressiveness. Almost every child can show aggression, but here it is worth paying attention to the degree of the reaction, its duration and the nature of the reasons.
  2. Emotional disinhibition. In this case, there is a too violent reaction to everything. Such children, if they cry, they do it loudly and defiantly.
  3. Anxiety. With such a violation, the child will hesitate to express his emotions clearly, he does not talk about his problems, he feels discomfort when they pay attention to him.

In addition, the violation happens with increased emotionality and decreased. In the first case, it concerns euphoria, depression, anxiety syndrome, dysphoria, fears. With a decrease, apathy develops.

Violation of the emotionally volitional sphere and behavior disorder is observed in a hyperactive child who experiences motor restlessness, restlessness, impulsivity. He cannot concentrate.

A modern perspective on correction

Hippotherapy is distinguished as one of the main methods of soft correction. It involves communicating with horses. This procedure is suitable not only for children, but also for adults.

It can be used for the whole family, which will help to unite it, improve trusting relationships. This treatment will allow you to say goodbye to a depressive mood, negative experiences, and reduce anxiety.

If we are talking about the correction of disorders in a child, then a variety of psychological methods can be used for this. Among them it is worth highlighting:

  • game therapy, which involves the use of games (this method is considered especially effective for preschoolers);
  • body-oriented therapy, dance;
  • fairy tale therapy;
  • art therapy, which is divided into two types: perception of the finished material or independent drawing;
  • music therapy, in which music is used in any form.

It is better to try to prevent any disease or deviation. To prevent disorders of the emotionally volitional sphere, it is worth listening to these simple tips:

  • if an adult or a child is emotionally traumatized, then those nearby should be calm, show their benevolence;
  • people need to share their experiences, feelings as often as possible;
  • you need to do physical labor or draw;
  • follow the daily routine;
  • try to avoid stressful situations, excessive experience.

It is important to understand that a lot depends on those who are nearby. You do not need to share your experiences with everyone around you, but you need to have such a person who will help in a difficult situation, support and listen. In return, parents must show patience, care, and boundless love. This will preserve the mental health of the baby.

Emotionally volitional disturbances

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 role of emotions in human life

The term "emotions" 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 of the body and the environment.

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 and emotions that arise on the basis of social and cultural needs, which later became known as feelings.

There are 2 emotional groups:

  1. Primary (anger, sadness, anxiety, shame, surprise);
  2. Secondary, which includes the 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 seek 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.

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 strangers nearby, and 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 the 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.

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 the 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.

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).

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

The peculiarities 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.

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 their needs and the experience gained from life.

The psychodynamic method also includes:

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 certain image. The psychodynamic approach also stands out for its ease and ease of conduct.

Also 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, realize and 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.

what is volitional disorder?

All of the above - it is ... does not arise, by itself ... As a rule, it is accompanied by the following diseases:

True, sometimes ... whisper that there are all sorts of special techniques, impacts and suppression ...

And 1% of cases - yes, there are ... But the rest, of course, is provincial theater.)

The task of physicians is to .... everyone was safe and sound ... And for those who are unwell - to the utmost, to make their existence easier ... True, the question was asked in the "Psychology" category. But what psychologist does not dream of being named ... doctor.)

Unwillingness to engage in familiar activities

Emotional volitional disorders

The birth of a child in a family with certain deviations from normal development is always stressful for both parents. It is very good when relatives, friends or psychological rehabilitation specialists help them cope with the problem.

The first signs of a violation of the emotional-volitional sphere begin to appear during the period of active communication in a peer group, which is why you should not ignore any deviations in the child's behavior. These disorders are rarely noted as an independent disease, often they are precursors or components of rather serious mental disorders:

A decrease in intellectual activity in children is manifested in the form of insufficiently complete regulation of emotions, inappropriate behavior, a decrease in morality, and a low level of emotional coloring of speech. Mental retardation in such patients can be veiled by inappropriate behavior in its extreme expression - apathy, irritability, euphoria, etc.

Classification of violations in the emotional-volitional sphere

Among the disorders in the sphere of emotional and volitional expression of personality in adults, there are:

1. Hypobulia - a decrease in will. Patients with such a violation have absolutely no need to communicate with people around them, they are annoyed by the presence of strangers nearby, they are unable and do not want to maintain a conversation, they can spend hours in an empty dark room.

2. Hyperbulia - increased attraction in all spheres of human life, more often this violation is expressed in increased appetite, the need for constant communication and attention.

3. Abulia - a sharp decrease in volitional drives. In schizophrenia, this disorder is included in a single symptom complex "apathic-abulic".

4. Compulsive attraction - an irresistible need for something, someone. This feeling is commensurate with the animal instinct and makes a person commit acts that, in most cases, are criminally punishable.

5. Obsessive attraction - the emergence of obsessive desires that the patient cannot control on his own. An unsatisfied desire leads to deep suffering for the patient, all his thoughts are filled only with ideas about his embodiment.

The main deviations in the emotional and volitional sphere in children are:

1. Emotional hyperexcitability.

2. Increased impressionability, fears.

3. Motor retardation or hyperactivity.

4. Apathy and indifference, indifference to others, lack of compassion.

6. Increased suggestibility, lack of independence.

Soft correction of emotional-volitional disorders

Hippotherapy all over the world has received a lot of positive feedback both in the rehabilitation of adults and in the rehabilitation of children. Communication with a horse is a great pleasure for children and their parents. This method of rehabilitation helps to unite the family, strengthen the emotional connection between generations, and build trusting relationships.

Thanks to hippotherapy classes in adults, children and adolescents, the processes of excitation and inhibition in the cerebral cortex are normalized, motivation to achieve the set goals increases, self-esteem and vitality increase.

With the help of horseback riding, each rider can learn to control his emotions smoothly and without breaking from the psyche. In the process of training, the severity of fears gradually decreases, there is confidence that communication with the animal is necessary for both participants in the process, and the self-importance of closed individuals increases.

A trained and understanding horse helps children and adults to cope with their goals, acquire new skills and knowledge, and become more open to society. In addition, hippotherapy develops higher nervous activity: thinking, memory, concentration.

Constant tension of the muscles of the whole body and maximum concentration during riding lessons improves balance, coordination of movements, self-confidence, even for those students who cannot make a single decision without the help of outsiders.

Various types of hippotherapy help reduce anxiety and depressive mood, forget about negative experiences and increase cheerfulness. Upon achieving the set goals in the classroom, they allow you to develop will and endurance and break down the internal barriers of your insolvency.

Some of the students enjoy communicating with the animal so much that they are happy to start playing equestrian sports at a school for the disabled. In the process of training and in competitions, the volitional sphere develops perfectly. They become more assertive, purposeful, self-control and endurance improve.

Violation of the emotionally volitional sphere

General information

For normal life and development in society, the emotional and volitional sphere of the individual is of great importance. Emotions and feelings play an important role in a person's life.

The will of a person is responsible for the ability that manifests itself during the regulation of his activities. From birth, a person does not possess it, since, basically, all his actions are based on intuition. With the accumulation of life experience, volitional actions begin to appear, which become more and more difficult. What is important is that a person not only recognizes the world, but also tries to somehow adjust it for himself. This is what volitional actions are, which are very important indicators in life.

The volitional sphere of the personality most often manifests itself when various difficulties and trials are encountered on the path of life. The last stage in the formation of will is the actions that must be taken to overcome external and internal obstacles. If we talk about history, then volitional decisions at different times were formed due to certain work activities.

Under what diseases there is a violation of the emotional-volitional sphere:

Certain social conditions can be attributed to external stimuli, and heredity to internal ones. Development takes place from early age to adolescence.

Characteristics of the volitional sphere of personality

Volitional actions can be divided into two groups:

Simple actions (do not require the expenditure of certain forces and additional organization).

Complex actions (imply a certain concentration, perseverance and skill).

In order to understand the essence of such actions, it is necessary to understand the structure. A volitional act consists of the following elements:

method and means of activity;

Emotional-volitional disorders

Hyperbulia, a general increase in will and drives, affecting all the basic drives of a person. For example, an increase in appetite leads to the fact that patients, being in the department, immediately eat the food brought to them. Hyperbulia is a characteristic manifestation of the manic syndrome.

Disorders of mature personality and behavior in adults (psychopathies)

DISORDERS OF MATURE PERSONALITY AND BEHAVIOR IN ADULTS (psychopathy) - an anomaly of personality development with a predominant deficiency in the emotional-volitional sphere, persistent disorders of adaptation in behavior, starting from childhood and adolescence and persisting throughout later life. This anomaly of character, leading in the structure of personality, according to P.B. Gannushkin is characterized by a triad: the totality of violations, their persistence and severity to the level of social maladjustment. At the same time, the person with a disharmonious personality and the people around him suffers. Subjects with personality disorders generally tend to refuse psychiatric care and deny the disorder they have.

In case of personality disorders, subjects are not exempt from criminal liability (in a forensic psychiatric examination), are recognized as unfit for military service, with regard to them there are restrictions in their choice of profession.

According to available data, the prevalence of these disorders is 2-5% among the adult population, 4-5% among those hospitalized in psychiatric hospitals, the prevalence among psychopathic personalities of men compared to women (2: 1-3: 1).

Causes

Genetic, biochemical and social factors predispose to the emergence of disorders of mature personality and behavior in adults.

Genetic factors. Among monozygotic twins, the concordance for personality disorders was several times greater than for dizygotic twins. The characteristics of temperament (character), manifested from childhood, are more clearly traced in adolescence: fearful children in the future can detect avoidance behavior. Small disorders of an organic nature on the part of the central nervous system in children are subsequently most common in antisocial and borderline personalities.

Biochemical factors. People with impulsive features often have elevated levels of the hormones 17-estradiol and estrone. Low levels of the platelet monoamine oxidase enzyme correlate to a certain extent with social activity. Dopaminergic and serotonergic systems have an activating effect on psychophysical activity. High levels of endorphins, contributing to the suppression of the activation reaction, are found in passive, phlegmatic subjects.

Social factors. In particular, the discrepancy between the temperament (character) of a mother with anxiety traits and the upbringing approach leads to the development of increased anxiety in the child, a greater susceptibility to his personality disorders than in the case of his upbringing by a calm mother.

Symptoms

Disharmony of personality and behavior is manifested in several areas: in cognitive (providing cognitive activity of a person) - the nature of perception of the environment and oneself changes; in the emotional - the range, intensity and adequacy of emotional reactions (their social acceptability) change; in the field of control of drives and satisfaction of needs; in the sphere of interpersonal relations - when resolving conflict situations, the type of behavior significantly deviates from the cultural norm, manifests itself in a lack of flexibility, insufficient adaptability in various situations. If in childhood there are pathocharacterological radicals (excessive excitability, aggressiveness, tendency to escape and vagrancy, etc.), then in adolescence they may be transformed into a pathocharacterological personality formation, then in adulthood - into psychopathy. Here, the diagnosis of a personality disorder can be made from the age of 17.

Character accentuations are extreme variants of the norm, in which certain character traits are overly strengthened. At the same time, there is a selective vulnerability in relation to certain mental influences with good and even increased resistance to others. At least 50% of the population of developed countries have accentuated character traits. The severity of personality disorders (severe, severe, moderate) is determined by the severity of compensatory mechanisms. Among the types of disorders of mature personality and behavior in adults, the following are distinguished.

Schizoid personality disorder, in addition to general diagnostic criteria for psychopathies, is characterized by anhedonia, when there is little pleasure, emotional coldness, an inability to show warm feelings or anger towards other people, a weak response to praise and criticism, little interest in sexual contact with another person, increased preoccupation with fantasies, a constant preference for solitary activities, ignorance of social norms and conventions prevailing in society, a lack of close friends and trusting ties.

Emotionally unstable personality disorder is characterized by a pronounced tendency to act impulsively, without considering the consequences, along with mood instability. There are two types of this personality disorder: the impulsive type with outbursts of cruelty and threatening behavior, especially in response to condemnation by others; borderline type, which is characterized by a chronic feeling of emptiness, disorder and uncertainty of the self image, intentions and internal preferences, including sexual ones (a risk factor for the formation of sexual perversions), a tendency to engage in intense and unstable relationships, excessive efforts to avoid solitude. If such persons are left alone, there may be suicidal threats or acts of self-harm due to the insignificant subjective value of life.

Hysterical personality disorder is characterized by theatricality of behavior, exaggerated expression of emotions, increased suggestibility, superficiality and lability of emotions, a tendency to mood swings, a constant desire for activities in which the individual is in the center of attention, inadequate seduction in appearance and behavior, increased concern about his physical attractiveness.

Anankastic (obsessive-compulsive) personality disorder is manifested by an excessive tendency to doubt and caution, preoccupation with details, rules, lists, order, organization or schedules; the pursuit of excellence that prevents task completion; excessive conscientiousness; scrupulousness and inadequate preoccupation with productivity at the expense of pleasure and interpersonal connections; increased pedantry and adherence to social norms (conservatism); rigidity and stubbornness; insufficiently substantiated, according to insistent demands on others to act as it seems right to the anankast; the appearance of persistent and unwanted thoughts and drives.

Anxious (evading) personality disorder is characterized by a constant general feeling of tension and heavy forebodings and ideas about one's own social inability, personal unattractiveness, and humiliation in relation to others; increased concern with criticism, her unwillingness to enter into relationships without guarantees to please; limited lifestyle due to the need for physical safety; avoiding social or professional activities for fear of being criticized or rejected.

Dependent personality disorder is characterized by active or passive shifting to others of most of the decisions in one's life; submission of one's own needs to the needs of other people, on whom the patient depends and inadequate compliance with their desires; unwillingness to make even reasonable demands on people on whom the patient is dependent; feeling uncomfortable or helpless in loneliness due to excessive fear of being unable to live independently; the fear of being abandoned by a person with whom there is a close connection, and being left on his own; limited ability to make day-to-day decisions without strong advice and encouragement from others.

Dissocial personality disorder (antisocial psychopathies - according to PB Gannushkin, "type of congenital criminal" - according to Lombroso) is manifested by heartless indifference to the feelings of others; a rude and persistent attitude of irresponsibility and disregard for social rules and responsibilities; inability to maintain relationships in the absence of difficulties in their formation; extremely low tolerance to frustration, as well as a low threshold for the discharge of aggression, including violence; an inability to feel guilty and benefit from life experiences, especially punishment; a pronounced tendency to blame others or put forward plausible explanations for their behavior, leading the subject to conflict with society.

Paranoid personality disorder is characterized by: excessive sensitivity to failure and rejection; the tendency to be constantly dissatisfied with someone; suspicion; militant and scrupulous attitude to issues related to individual rights, which does not correspond to the actual situation; recurring unjustified suspicions about the sexual fidelity of a spouse or sexual partner; a tendency to experience their increased significance, which is manifested by the constant attribution of what is happening at their own expense, the embrace of insignificant "conspiratorial" interpretations of events occurring with a given person.

Diagnostics

It is placed on the basis of dynamic observation of the subject's behavior and the results of psychological testing.

Treatment

Various methods of psychotherapy, in a state of decompensation biological methods of therapy (neuroleptics, antidepressants, tranquilizers).

Psychogenic pathocharacter-shogic personality formation in children and adolescents, which deserve attention due to social significance and relative frequency. In their origin, they are associated with a chronic traumatic situation in the microenvironment and improper upbringing. In an unfavorable combination of circumstances, the pathocharacterological formation of a personality can lead to the formation of "acquired" psychopathy by the age of 17-18. At the same time, personal reactions are consolidated (protest, refusal, imitation, overcompensation and other characterological and pathocharacterological reactions that arise in response to psycho-traumatic influences) and direct stimulation by incorrect education of undesirable character traits (excitability, timidity, incontinence, etc.). Allocate (according to V.V. Kovalev) the following options: 1) affectively excitable; 2) decelerated; 3) hysterical and 4) unstable.

Children and adolescents with an affectively excitable variant of psychogenic pathocharacterological personality formation are characterized by a tendency to affective discharges (irritation, anger) with aggressive actions, inability to restrain oneself, anger, oppositional attitude towards adults, increased readiness for conflicts with others. These character traits are especially often formed and consolidated in conditions of hypo-care or neglect (single-parent family, alcohol or drug addiction of parents), with a prolonged conflict situation in the microenvironment (family, school children's collective, etc.). The formation of pathological character traits is accelerated by microsocial and pedagogical neglect caused by leaving school, home, and absence from classes.

For the inhibited variant, self-doubt, timidity, resentment, and a tendency to asthenic reactions are typical. Non-frankness, deceit, dreaminess are also possible. This option is formed in the conditions of improper upbringing such as "overprotection" with the despotism of the parents, the humiliation of the child, the use of constant prohibitions and restrictions, physical punishment.

The hysteroid variant is manifested by demonstrativeness, a desire to attract attention to oneself, an egoistic attitude. It is more often formed in families with an only child under conditions of upbringing as a “family idol”. The most susceptible to it are children with signs of mental immaturity.

The unstable variant is characterized by the absence of volitional delays, dependence of behavior on momentary desires, increased subordination to outside influence, unwillingness to overcome the slightest difficulties, lack of skill and interest in work. It is promoted by "greenhouse education", when a child from early childhood is protected from overcoming difficulties on his own, performing all duties for him (caring for personal belongings, preparing homework, cleaning the bed, etc.). Due to the immaturity of emotional and volitional properties, there is an increased tendency to imitate negative forms of behavior of others (leaving school, petty theft, drinking alcohol, psychoactive substances, etc.), when the phenomena of microsocial and pedagogical neglect are added. As a result - the path to delinquency.

The following stages of dynamics of pathocharacterological formations of personality are distinguished: 1) characterological and pathocharacterological reactions (primary school age); 2) the leading pathocharacterological syndrome (prepubertal age 10-12 years); 3) pubertal polymorphism; 4) post-pubertal dynamics. At the last stage, either the formation of the psychopathic personality structure is completed, or there is a tendency to smooth out pathological character traits (depsychopathization).

Favorable dynamics are facilitated by the resolution of a traumatic situation, the emergence of new interests (educational, professional, sexual, etc.) associated with the approach of physical, mental and social maturity, a way out of the negative educational influence of the family, the emergence of a more mature self-awareness, a critical assessment of one's actions, directed correctional and pedagogical influences.

Emotional-volitional disorders

Emotions are one of the most important mechanisms of mental activity. It is emotions that produce a sensually colored summary assessment of the incoming information from the inside and from the outside. In other words, we evaluate the external situation and our own internal state. Emotions should be assessed along two axes: strong-weak and negative-positive.

Emotion is a feeling, an internally subjective experience, inaccessible to direct observation. But even this deeply subjective form of manifestation can have disorders called emotional-volitional disorders.

Emotional-volitional disorders

The peculiarity of these disorders is that they combine two psychological mechanisms: emotions and will.

Emotions have an external expression: facial expressions, gestures, intonation, etc. By the external manifestation of emotions, doctors judge the internal state of a person. A long-term emotional state is characterized by the term "mood". A person's mood is quite mobile and depends on several factors:

  • external: luck, defeat, obstacle, conflicts, etc.;
  • internal: health, activity.

Will is a mechanism for regulating behavior that allows you to plan activities, satisfy needs, and overcome difficulties. Needs that facilitate adaptation are commonly called "drives." Attraction is a special state of human need in certain conditions. Conscious attraction is usually called desires. A person always has several urgent and competing needs. If a person does not have the opportunity to realize his needs, then an unpleasant condition occurs, called frustration.

Symptoms of emotional-volitional disorders

Emotional disorders themselves are excessive manifestations of natural emotions:

  • Hypotimia is a persistent, painful drop in mood. Hypotimia corresponds to melancholy, depression, sadness. Unlike feelings of sadness, hypothymia is highly persistent, but at the same time it can have a different qualitative expression: from mild sadness to severe "mental pain".
  • Hyperthymia is a painful, elevated mood. Vivid positive emotions are associated with this concept: fun, delight, joy. For several weeks or even months, patients remain optimistic and happy. People are usually very energetic, show initiative and interest. At the same time, the general high spirits cannot be spoiled by either sad events or difficulties. Hyperthymia is a characteristic manifestation of the manic syndrome. A variant of hyperthymia is euphoria, which is viewed not so much as an expression of joy and happiness, but also as a complacent, carefree affect. Patients are absolutely inactive. All their conversations are empty.
  • Dysphoria is sudden bouts of anger, irritation, and anger. In this state, people are capable of violent acts of aggression, sarcasm, insults and bullying.
  • Anxiety is an emotion associated with a need for security. Anxiety is expressed by a feeling of impending uncertain threat, excitement, throwing, anxiety, muscle tension.
  • Ambivalence is the simultaneous coexistence of two opposite emotions: love and hate, attachment and disgust, etc.
  • Apathy is a decrease in the severity of emotions, indifference, indifference to everything. Patients lose interest in friends, do not react to events in the world, are not interested in their own appearance and state of health.
  • Emotional lability is an extreme mobility of mood, which is characterized by the ease of occurrence of mood changes: from laughter to tears, from relaxation to active fussiness, etc.

Disorders of will and impulses

In clinical practice, disorders of will and drives are manifested by behavioral disorders:

  • Hyperbulia - an increase in drives and will, which affect all basic needs: increased appetite, hypersexuality, etc.
  • Hypobulia - a decrease in drives and will. All basic needs, including physiological ones, are suppressed in patients.
  • Abulia is a condition in which there is a sharp decrease in willpower. At the same time, individual needs remain normal.
  • Perversion of drives is an altered manifestation of ordinary needs: appetite, sexual desire, the desire for antisocial actions (theft, alcoholism, etc.).
  • Obsessive (obsessive) attraction - the emergence of desires that are at odds with the norms of morality, but controlled by the efforts of the will. In this case, a person is able to suppress desires as unacceptable. However, refusal to satisfy instincts can cause strong feelings, and the thought of an unsatisfied need arises and remains in the head.
  • Compulsive attraction is a powerful feeling comparable to the needs of life (hunger, thirst, self-preservation instinct).
  • Impulsive actions are committed immediately with the manifestation of a painful attraction, while the stages of the struggle of motives and decision-making are completely absent.

Emotional volitional disorders need treatment. Drug therapy in combination with psychotherapy is often effective. For effective treatment, the choice of a specialist plays a decisive role. Trust only real professionals.

Chapter 8. Disorders of the emotional and volitional sphere

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 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, vegetative reactions. In this sense, the terms "affective" and "emotional" are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient's speech and the facial expression, 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 extra time on logical analysis of insignificant 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 emotions 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 realization. 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 the peculiarities 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 look after 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 ("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 almost unrealistic to list all the probable types of needs: each person's set is unique, subjective, but several needs that are most important for most people should be indicated. These are the physiological needs for food, safety (self-preservation instinct), sexual desire. In addition, a person as a social being often needs communication (an affiliate 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 noticed 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 depression of mood. The concept of hypothymia corresponds to sadness, melancholy, depression. Unlike the natural feeling of sadness associated with an unfavorable situation, hypothymia in mental illness is remarkably 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 a deep physical (vital) feeling 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 sense 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, reaching a degree ecstasy. This state 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 mentally 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 uncertain 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?", "Whom do you love more: dad or mom?"). Their lack of feelings prevents them from expressing any preference.

Apathy refers to negative (deficient) 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. The phenomenon of hypoesthesia 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 pass 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 each (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 live. My son-in-law is hard-working and caring. The granddaughter is a wise woman: 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 on the basis of an 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 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 things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and 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. The relief of 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 fired 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

First of all, take a closer look at your child: how he sleeps, how he behaves with peers, adults and animals, what games he likes, whether he has any fears. There are deviations in the child's behavior, tendencies and symptoms, which, according to psychologist E. Murashova, should alert parents and serve as a reason to visit a psychologist.

Here are some warning signs she advises to pay attention to:

  • there is a birth injury or any neurological diagnosis;
  • the baby is constantly disturbed by the daily regimen, sleep and appetite;
  • a child under one year old is more than two months behind his peers in any of the psychomotor indicators;
  • low speech activity - by the age of two, the child utters only a few words; at three years old does not speak in sentences;
  • the child is overly aggressive, often hits children, animals, parents; does not react to persuasion;
  • the child has difficulty adapting to the disciplinary requirements of the preschool institution;
  • the baby has many fears, does not sleep well at night, wakes up with a loud cry, is afraid to be alone even in a bright room;
  • the child often suffers from colds, has a number of functional disorders;
  • it seems to you that the child is inattentive, disinhibited, excessively distracted, does not bring anything to the end;
  • a younger student has learning problems even after extra classes;
  • the child has no friends or regular friends;
  • at school, they make unfair, as it seems to you, claims against the child;
  • frequent family conflicts;
  • complete lack of initiative, dislike of everything new.

None of the above signs in itself can serve as a reliable criterion for the presence of behavioral abnormalities in a child, but serves as a basis for visiting a specialist - a neurologist, psychotherapist or psychologist. A conversation with a doctor of this profile has a number of features.

Ask specialists in detail about all the diagnoses they make! Do not expect them to tell you something: at best, they will name the diagnosis out loud and give a small description. And you need to ask until everything becomes clear to you (even very complex things can be explained in an accessible way and, believe me, doctors know how to do this).

So what you need to find out:

  • What exactly does this diagnosis mean?
  • Which system (organ, organ systems) is affected by it?
  • How does this disease manifest? Are there any symptoms that may appear after a while?
  • What can be done so that they do not appear or are not pronounced?
  • What modern treatments are there? How are they similar and what is their difference?
  • How do prescribed medications work? What is their feature and what are the side effects?
  • Is non-drug therapy possible?
  • What is the prognosis of this disease?
  • What literature can be read on this topic?

And if the child has speech abnormalities, attention deficit disorder, hyperactivity or mental retardation, do not despair - correctional work on your part, classes with a psychologist (speech therapist) and competent medication will give good results.

  1. Kvols K. The joy of education. How to bring up children without punishment.-SPb .: IG Ves, 2006.-272s .- (Family library: health and psychology).
  2. Koneva E.A., Rudametova N.A. Psychomotor correction in the complex rehabilitation system for children with special educational needs. - Novosibirsk, 2008.-116s.
  3. E.V. Murashova Children - "mattresses" and children - "catastrophes": Hypodynamic and hyperdynamic syndrome / E.V. Murashova.-2nd ed., Add. - Yekaterinburg, 2007. - 256 pp. (Series "Psychology of Childhood").
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