Conduct disorder in children and adolescents

Article:

Each period of childhood is characterized by deviations from behavioral norms due to the age crisis.
However, when such deviations drag on, forming persistent destructive behavior, they speak of a behavioral disorder. Behavioral disorders are a stable pattern of actions characterized by a refusal to maintain the rules characteristic of a certain age, the norms of a given society, and also those that violate the rights of other people. Such a diagnosis is made very carefully. It is necessary to meet several criteria for behavioral disorganization, lasting at least 6 months. The age of the patient must be taken into account. For example, outbursts of rage are considered the norm for 3-year-old children, but in younger schoolchildren such a sign already makes them wary. Individual, episodic violations of the behavior pattern are not taken into account.

GENERAL REGULARITIES

Conduct disorder in children and adolescents is characterized by persistent antisocial, aggressive, and defiant behavior. They can manifest themselves only within family relationships or have a total character that extends to the entire environment.

To make a diagnosis, three or more criteria must be met during the previous year at least once in the last six months:

conflicts with parents, non-compliance with established generally accepted family rules;
aggressive attitude towards animals and people;
destructive actions, causing damage, theft;
deceit, duplicity, meanness.

Behaviors are so destructive that they cause disruption in relationships in the family, school, and other groups.

Behavioral defects are represented by several generalized groups:

open destructive behavior - fights, robberies, hooliganism;
hidden destructive - theft, deception, arson, vandalism;
hidden non-destructive – absenteeism, bad habits, addictions, obscene speech.

Behavioral disorders of childhood and adolescence include hyperactivity, as well as emotional changes that are closely related to behavior.

Behavioral defects are not the usual whims of children or the indiscipline of teenagers. Such deviations are severe, persistent changes that can leave a negative imprint on a person. As a rule, in adulthood, pathological manners are smoothed out, however, illuminating an early age, they can develop into psychopathy.

Behavioral defects are also a manifestation of various mental disorders. Then attention is focused on the underlying disease.

Psychiatry Psychiatry and psychopharmacotherapy named after. P.B. Gannushkina No. 06 2000

The ambiguity of the situation that has existed for many years in the field of assessing deviant human behavior, in determining its boundaries, manifestations, in classifying it as a mental pathology or a conditional norm has led to the fact that scientists began to bypass this area of the individual’s mental life and the scientific and practical section. Psychiatrists, who before the advent of the psychology of deviant behavior were engaged in the study of exclusively pathological mental activity, initially considered this area of knowledge to be of little significance in comparison with the doctrine of psychoses that filled psychiatric science and practice. In comparison with schizophrenia, gambling (passion for gambling) was considered as “mischief” that did not require the attention of a specialist, much less therapy. As the spheres of influence of psychiatry naturally narrowed due to the emergence of clinical psychology and the assignment of a significant part of the so-called minor psychiatry to its jurisdiction, “big psychiatry” began expansion into related scientific fields. Deviant forms of behavior, which were previously regarded by her as insignificant and of little significance, began to be considered as important in terms of predisposition to severe mental illnesses and were called prenosological (pre-morbid) forms of mental disorders. Precisely disorders, not psychological phenomena. Modern world psychiatry has revealed itself in a new international classification (5th chapter of ICD-10). From the previous classification (ICD-9) of mental illnesses (i.e., nosological forms), it has evolved into a classification of mental and behavioral disorders (i.e., symptoms). On the one hand, such a metamorphosis can be welcomed, since, finally, psychiatry began to move from orthodox to phenomenological positions; on the other hand, the inclusion in the scope of psychiatry of so-called behavioral disorders, which automatically became symptoms (after all, medicine deals with pathology and is not fully prepared to study health), should be considered at least controversial. Today, based on the new classification, a psychiatrist is able to make diagnoses such as: nose picking and finger sucking (code F98.8), excited speech (code F98.6) and nail biting. But the diagnostician is not provided with medical criteria to distinguish between, for example, behavioral disorder in the form of “nose picking” and “nose picking” habit. Of particular note is the fact that the psychiatrist is not prescribed, as before, to use scientific terms. A simple statement of fact, expressed in the form of ordinary expressions, is sufficient. Despite the fact that the medical approach to the terminological equipment of a specialist is traditionally distinguished by rigidity, accuracy and clarity. And about 80% of all terms used in medicine are of Latin or Greek origin, which is recognized as the only correct one and contributes to the separation of science from parascience or other sciences. Thus, it can be argued that a purely psychiatric paradigm in assessing deviant (not always related to symptoms and disorders) behavior is not capable of being objective and this path of development of the psychology of deviant behavior should be considered a dead end. Attempts by orthodox psychology, as opposed to psychiatry, to study behavioral deviations and organize assistance to people with such deviations should also be considered unsuccessful. The reason for the failures lies in the desire to a priori separate the psychology and psychopathology of deviant behavior

, in advance to separate mental and behavioral disorders, on the one hand, and deviations, on the other.
As a result, it was proposed to attribute to psychiatry the sphere of psychopathology of deviant behavior, and to psychology - to the conventional norm. Let us draw attention to the paradox that the problem lies precisely in diagnosis and subsequently in the methods of providing assistance. It is impossible to decide solely on the basis of external clinical signs of behavioral deviation whether the deviant is mentally ill or not. It is impossible to compile a register of uniquely psychopathological or completely psychologically caused deviations. Attempts to separate the psychology and psychopathology of deviant behavior before a specific case has been analyzed and the motives for a person’s choice of such a style of behavior have been determined are essentially nonsense. Moreover, orthodox psychology does not have a tool for scientifically based diagnosis and correction of observed behavioral characteristics. She suggests that the diagnostic paradigm should be as follows: first, psychiatrists must reject “their pathology,” and then psychologists analyze the case and provide psychological assistance to the sufferer. This report presents one of the views on solving the problem of analyzing and differentiating behavioral disorders from deviant forms of behavior, which does not pretend to be exclusive or indisputable. From our point of view, modern psychology of deviant behavior is an interdisciplinary field of scientific knowledge that studies the mechanisms of the emergence, formation, dynamics and outcomes of behavior deviating from various norms, as well as methods and methods of their correction and therapy. This discipline is at the intersection of clinical psychology and psychiatry and its mastery requires knowledge and skills from these scientific fields. The psychology of deviant behavior in this context is a typical example of a scientific field in which the knowledge acquired by scientists of various specialties has not yet led to the formation of a separate scientific discipline. The reason for this is the clash of opinions between orthodox psychological and orthodox psychiatric views on deviant behavior. The questions about whether behavioral deviations should be classified as pathologies (i.e., signs of mental disorders and diseases, designated as symptoms, syndromes) or whether they should be recognized as extreme variants of the norm remain by no means rhetorical; Are behavioral deviations stages of psychopathological disorders (i.e., prenosological mental disorders) or is there an abyss between behavioral pathological disorders and deviant forms of behavior; what are the causes (psychogenesis) of deviant forms of behavior: disorders of brain activity, adaptive behavior skills or social expectations; what measures are necessary to restore adequate behavior (if this is possible in principle): psychopharmacological therapy or psychological correction. Until recently, there was a tendency to distance the problems studied within the psychology of deviant behavior from the problems of related disciplines, which led and leads to a one-sided, biased view of complex theoretical and practical issues of behavior deviating from generally accepted standards. The most common attempt is to contrast the psychology and psychopathology of deviant behavior, to clearly separate the problems of healthy and sick mental activity, which, apparently, should be recognized as erroneous. The consequence of this approach is attempts to identify deviations “within the framework of the mental norm” and in psychopathological disorders, the latter of which are proposed to be designated by another term (not deviation). A striking example is the unsuccessful attempt to divide such a problem of deviant behavior as the use of narcotic substances into the actual psychological (when there is only psychological dependence on the drug) and medical (in the case of “abuse” of the drug, the formation of physical dependence and the disease - drug addiction). The above widespread approach, based on orthodox principles, does not allow, on the one hand, a comprehensive, objective and impartial analysis of the mechanisms of psychogenesis, i.e. mental processes responsible for the formation of deviations, on the other hand, it does not provide the opportunity to provide adequate and effective assistance. The conservatism of this position is reflected in the search for an alternative to responsibility for the formation and outcome of deviation. The subject of the study of the psychology of deviant behavior is situational reactions, mental states, and personality development that deviate from various norms, leading to maladaptation of a person in society and/or disruption of self-actualization and self-acceptance due to developed inadequate patterns of behavior. An essential parameter of deviant behavior is deviation in one direction or another, with varying intensity and for various reasons, from behavior that is recognized as normal and not deviant, regardless of the presence or absence of psychopathological disorders (see diagram). The characteristics of normal (normative) and harmonious behavior include: balance of mental processes (at the level of temperamental properties), adaptability and self-actualization (at the level of characterological characteristics) and spirituality, responsibility and conscientiousness (at the personal level). Just as the norm of behavior is based on these three components of individuality, so anomalies and deviations are based on their changes, deviations and violations. Thus, deviant human behavior can be defined as a system of actions or individual actions that contradict accepted norms in society and manifest themselves in the form of imbalance of mental processes, maladaptation, disruption of the process of self-actualization, or in the form of evasion of moral and aesthetic control over one’s own behavior. There are several approaches to assessing behavioral norms, pathology and deviations: social, psychological, psychiatric, ethnocultural, age, gender, professional and phenomenological. The social approach
is based on the idea of social danger or safety of human behavior.
In accordance with it, deviant behavior includes any behavior that is clearly or potentially dangerous to society and the people around a person. The emphasis is on socially approved standards of behavior, lack of conflict, conformism, and subordination of personal interests to public ones. When analyzing deviant behavior, the social approach is focused on external forms of adaptation and ignores individual-personal harmony, “adaptation to oneself,” self-acceptance and the absence of so-called psychological complexes and intrapersonal conflicts. The psychological approach,
in contrast to the social one, considers deviant behavior in connection with intrapersonal conflict, destruction and self-destruction of the individual.
This means that the essence of deviant behavior should be considered the blocking of personal growth and even personality degradation, which are the consequence and sometimes the goal of deviant behavior. The deviant, in accordance with this approach, consciously or unconsciously seeks to destroy his own self-worth, deprive himself of uniqueness, and not allow himself to realize his existing inclinations. Within the framework of the psychiatric approach,
deviant forms of behavior are considered as premorbid (pre-morbid) personality characteristics that contribute to the formation of certain mental disorders and diseases.
Deviations are often understood as behavioral deviations that have not reached pathological severity due to various reasons, i.e. those “sort of mental disorders” that do not fully meet generally accepted criteria for diagnosing symptoms or syndromes. Despite the fact that these deviations have not reached psychopathological qualities, they are still designated by the term disorder. The ethnocultural approach
implies the fact that deviations should be viewed through the prism of the traditions of a particular community of people.
It is believed that the norms of behavior accepted in one ethnocultural group or sociocultural environment may differ significantly from the norms (traditions) of other groups of people. As a result, taking into account the ethnic, national, racial, and religious characteristics of a person is considered essential. It is assumed that diagnosing a person’s behavior as deviant is possible only in cases where his behavior is not consistent with the norms accepted in his microsociety or he exhibits behavioral rigidity (inflexibility) and is not able to adapt to new ethnocultural conditions (for example, in cases of migration). The age-related approach
considers behavioral deviations from the perspective of age-related characteristics and norms.
Behavior that does not correspond to age patterns and traditions may be considered deviant. These can be quantitative (grotesque) deviations, lag (retardation) or advance (acceleration) of age-related behavioral norms, as well as their qualitative inversions. The gender approach
is based on the idea of the existence of traditional gender-role stereotypes of behavior, male and female styles.
Deviant behavior within the framework of this approach can be considered hyper-role behavior and inversion of gender style patterns. Gender deviations may also include psychosexual deviations in the form of changes in sexual preferences and orientations. A professional approach
to assessing behavioral norms and deviations is based on the idea of the existence of professional and corporate styles of behavior and traditions.
This means that the professional community dictates to its members the development of strictly defined patterns of behavior and response in certain situations. Failure to meet these requirements allows such a person to be classified as a deviant. A phenomenological approach
to the assessment of behavioral norms, pathology and deviations, in contrast to social, psychological or psychiatric ones, allows us to take into account all deviations from the norm (not only socially dangerous ones or those that contribute to the self-destruction of the individual).
Using it, you can diagnose behavioral deviations that are neutral, from the point of view of public morality and law (for example, autistic behavior), and even positively colored deviations (for example, workaholism). In addition, the phenomenological paradigm allows us to discern the mechanisms of psychogenesis behind each of the deviations in behavior, which further facilitates the selection of adequate and effective behavior correction tactics. Thus, workaholism as a behavioral deviation can be considered and interpreted as an addiction formed on the basis of the desire to escape from reality by fixing attention on a strictly defined type of activity, and as a manifestation of psychopathological characteristics, for example, within the framework of a manic syndrome. Only a phenomenological approach can impartially and objectively approach the analysis of deviant behavior and contribute to the understanding of the essential motives of human behavior. The basis for assessing a person’s deviant behavior is the analysis of his interactions with reality, since the dominant principle of the norm - adaptability - comes from adaptation (adaptability) in relation to something and someone, i.e. to the individual's real environment. The interaction between the individual and reality can be represented in five ways: adaptation, resistance or painful resistance, withdrawal and ignoring.
When
counteracting reality,
the individual actively tries to destroy the hated reality and change it in accordance with his own attitudes and values.
He is convinced that all the problems he encounters are caused by factors of reality, and the only way to achieve his goals is to fight reality, to try to remake reality for himself or to make the most of behavior that violates social norms. In this case, the response from reality in relation to such an individual also becomes opposition, expulsion or an attempt to change the individual, to adjust him to the requirements of reality. Confrontation with reality occurs in criminal and delinquent behavior. If we consider all types of interaction between an individual and reality using the example of drug addiction, then within the framework of confrontation, drug use can be considered as a protest, shocking behavior, and an unwillingness to put up with the surrounding reality. The so-called painful confrontation with reality
is caused by signs of mental pathology and psychopathological disorders, in which the surrounding world is perceived as hostile due to a subjective distortion of its perception and understanding.
Symptoms of mental illness impair the ability to adequately assess the motives of the actions of others and, as a result, effective interaction with the environment becomes difficult. If, when confronting reality, a healthy person consciously chooses the path of struggle with reality, then during a painful confrontation in a mentally ill person, this method of interaction is the only and forced one. Using the example of drug use as part of drug addiction, this type of interaction with reality can be interpreted as the use of these drugs, in particular, for the purpose of relieving psychopathological symptoms. The method of interaction with reality in the form of escaping reality
is consciously or unconsciously chosen by people who evaluate reality negatively and oppositionally, considering themselves unable to adapt to it.
They may also be guided by a reluctance to adapt to a reality that “does not deserve to be adapted to” due to imperfection, conservatism, uniformity, suppression of existential values, or frankly inhumane activities. Drug use in this case should be considered as an addiction - a departure from boring reality into a virtual world created by a chemical substance. Ignoring reality
is manifested by the autonomization of a person’s life and activity, when he does not take into account the requirements and norms of reality, existing in his own narrow professional world.
In this case, there is no collision, no opposition, no escape from reality. The parties exist as if on their own. This type of interaction with reality is quite rare and is found only in a small number of highly gifted, talented people with hyperabilities in any one area. The use of narcotic substances should be considered in this type of interaction with reality as a sign of “specialness”, chosenness, and involvement in bohemia. A harmonious person chooses to adapt to reality
.
However, one cannot unequivocally exclude from the list of harmonious individuals persons who use, for example, a method of escaping reality. This is due to the fact that reality, just like an individual, can be inharmonious. For example, voluntary adaptation to the conditions of an authoritarian regime, sharing its values and choosing appropriate behavior cannot be considered harmonious. Depending on the ways of interaction with reality and violation of certain norms of society, deviant behavior is divided into five types: delinquent, addictive, pathocharacterological, psychopathological and based on hyperabilities
.
Clinical forms (manifestations) are represented by: aggressive and auto-aggressive behavior, eating disorders, abuse of substances that alter the mental state, sexual deviations, overvalued hobbies, communicative, ethical and aesthetic deviations, or behavioral style disorders
(V.D. Mendelevich, 1998) .
Within each of the clinical forms, deviant behavior can be interpreted both as psychological (i.e., actually deviant)
and as
psychopathological (i.e., as a behavioral disorder).
Thus, an analysis of the current situation in the field of studying behavioral deviations allows us to assert that behavioral disorders and behavioral deviations, having phenomenological similarities and even identity, differ from each other etiopathogenetically. Underestimation of this circumstance in ICD-10 leads, on the one hand, to a blurring of the boundaries between mental and behavioral norms and pathology, and on the other hand, to discrediting the scientific nature of psychiatric science and practice. Considering the fact that, within the framework of deviant behavior, psychological and psychopathological mechanisms can be combined, in the field of assistance to this contingent, people should be combined with psychotherapy with psychotherapy.

CAUSES

There are a sufficient number of factors that provoke the development of the defect. It is impossible to talk about their determining effect, but these provocateurs are capable of preparing favorable soil.

A special role belongs to the family atmosphere in which a small family member is raised. For example, a relationship has been established between conduct disorder and parental divorce, the appearance of a stepparent, a large family, and poverty. Sometimes the mother's age is too young.

A destructive parenting style is considered to be a low level of control and insufficient participation in the life of a child, especially a teenager, as well as the unpredictability of parents’ reactions to their children’s actions.

There is a relationship between a defective way of acting and a low level of intelligence in children, the ability to organize and plan their own activities, and switch attention between goals.

Hereditary factors cannot be ignored. When one family member - parent, brother, sister - suffers from behavioral disorganization, there is a risk that the younger member of the family will adopt similar manners.

F63 Disorders of habits and inclinations.

F63.0 Pathological addiction to gambling.

A. Two or more episodes of gambling over a period of at least one year.

B. These episodes do not benefit the individual but continue despite the personal distress they cause or the harm they cause to personal functioning in daily life.

B. The individual attributes a difficult-to-control strong urge to gambling and reports that he is unable to stop gambling by force of will.

D. The individual is mentally preoccupied with the act of gambling and the circumstances surrounding it.

F63.1 Pathological burning (pyromania).

A. One or more arson or attempted arson attacks without apparent motive.

B. The individual describes a strong urge to set fires, with a feeling of tension before the act and relief after it.

B. The individual is mentally preoccupied with arson and the circumstances surrounding that act (eg, fire trucks or calling the fire brigade).

F63.2 Pathological theft (kleptomania).

A. Two or more instances of theft without apparent motive or benefit to the individual or other person.

B. The individual describes a strong desire to steal with a feeling of tension before committing the act and relief after it.

F63.3 Trichotillomania.

A. Marked loss of hair due to constant and repeated inability to resist the urge to pull out hair.

B. The individual describes a strong urge to pull out hair with increasing tension before and a feeling of relief afterward.

B. Absence of previous skin inflammation; not due to delusions or hallucinations.

F63.8 Other disorders of habits and impulses.

This rubric should be used for other types of persistent maladaptive behavior that are not secondary to an identified psychiatric syndrome and that show evidence of a recurrent inability to resist urges to engage in behaviors that characterize the behavior. There is a prodrome of tension and a feeling of relief when performing the action.

REACTIONAL FOUNDATIONS OF DISORGANIZATION OF ACTIONS

There are certain types of reactions characteristic of children with a disorganized manner of action.

For younger children these are:

protest. Occurs when there is increased imposition of something, or restriction of activity. Active protest is manifested by aggression, rudeness, and damage to property. Passive - hostility, deliberate silence, suicide attempts, starvation, running away from home. Physiological signs – enuresis, digestive disorders, hacking cough;
refusal is a reaction to dissatisfaction with the sense of security and communication in very young children. Manifestations: lack of activity, desire to communicate, lack of emotion. No response. There is no desire for gaming activities. Everything is not interesting, they are not able to enjoy sweets or favorite toys;
imitation - imitating the negative traits of authority figures. Children adopt bad habits and antisocial activities;
compensation - the child compensates for the failures of one activity with the achievements of another. Failures in educational activities are compensated by hooliganism and theft. Fears and timidity are replaced by bullying other children, extreme car and motorcycle riding.

Reactions in teenagers:

emancipation - resistance to the rules established by adults, rejection of help, disregard for advice and tips;
grouping - the creation of antisocial groups;
hobbies - aimed at satisfying interest in a specific activity. Excitement is satisfied by card or other games for money, leadership - by situations of leadership (gangster group). But even if hobbies are positive (sports, art, beauty), they can also destroy acceptable rules of action. They are provoked by refusal to attend school, carrying out illegal acts, making inappropriate acquaintances, ignoring relatives, and committing life-threatening acts.

Symptoms

Personality disorder is characterized by alternating periods of social compensation and decompensation.

Compensation is manifested by the individual’s temporary adaptation to society. During this period, a person does not have problems communicating with people around him, and personal deviations are hardly noticeable. During decompensation, pathological personality traits become pronounced, which contributes to a significant disruption of the adaptive capabilities of social interaction.

This period can take either a short period of time or last for a long time.

Personality disorders during exacerbation may be accompanied by symptoms such as:

distortion of perception of reality;
a feeling of emptiness and meaninglessness of existence;
hypertrophied reaction to external stimuli;
inability to establish relationships with other people;
asociality;
depression;
feeling of uselessness, increased anxiety, aggression.

The diagnosis of “Personality disorder” can be made only if there is a triad of Gannushkin-Kerbikov criteria for psychopathy, which includes the totality of personality disorders, the severity of the pathology, as well as the relative stability of the individual’s condition.

LEAST SEVERE TYPES OF BEHAVIORAL DISORDERS

One of the weaker malignant forms of disorganization of activity is behavioral disorder limited to the family. It is determined by the aggressive, rude, cruel actions of the patient exclusively in a family environment with respect to relatives or one of the household members. Outside the family, children behave in their usual way. Outsiders are unaware of the problem.

The pathological activities of a child are varied: damage to things, clothes, furniture, theft, aggression, use of physical force. Often inappropriate actions are directed at one of the family members.

The reason for such changes is the departure of one of the parents, the appearance of a stepfather or stepmother. Moreover, aggression is not necessarily directed specifically at the culprit - any family member can suffer.

Pathological acts can take on an extreme degree of development. It happens that children organize arson and other global damage to property.

Often this type of defect provokes the birth of the youngest, next child. Jealousy directs aggression against the new baby, then the offender breaks the “rival’s” toys, may hit, does not want to share, and is even capable of taking regressive forms of action: stop going to the potty, consuming the younger one’s food.

Children are also capable of directing aggression towards their parents, becoming angry, refusing to communicate, and engaging in opposition.

Oppositional defiant disorder is the mildest form of the disorder. Occurs among children under 10 years of age. Characterized by provocative, defiant, hostile forms of action, disobedience, rebellion. However, there is no aggression, cruelty, or antisocial acts that violate the law.

Patients are irritated, easily offended, and lose self-control. Characterized by a high level of frustration. They tend to blame other people for their own failures and mistakes. They ignore comments and requests from adults. Capable of deliberately annoying, doing out of spite. They are rude and often become provocateurs of quarrels.

Treatment

Treatment tactics depend on the causes of the pathology, the form and characteristics of the clinical picture. Only a psychiatrist can diagnose a personality disorder, and only a specialist should prescribe treatment measures. Self-prescribed therapy may not only not bring the desired results, but can also significantly aggravate the situation.

In a state of compensation, the patient does not need drug treatment. The basis of treatment measures in this case will be group or individual psychotherapy aimed at smoothing out pathological character traits. This method will allow the patient to learn how to respond correctly to certain life situations, which in turn will help him fully adapt to society.

During the period of decompensation, a person is considered disabled; if it lasts for a long period of time, there is a possibility of disability. Therefore, this condition requires immediate treatment. In this case, in addition to psychotherapeutic influences, drug therapy is prescribed to help relieve the symptomatic manifestations of the disorder.

To reduce anxiety, depression and other painful symptoms, selective serotonin reuptake inhibitors are usually prescribed. Anticonvulsants may be prescribed to control impulsivity and temper tantrums. To combat depersonalization and depression, drugs such as risperidone Risperdal are used.

The main goal of treatment is to eliminate the stressful state and isolate the patient from the external stimulus that caused the exacerbation of symptoms. This helps to reduce the severity of clinical manifestations - anxiety decreases, the feeling of hopelessness disappears, and depression is eliminated.

UNSOCIALIZED/SOCIALIZED CONDUCT DISORDER

Unsocialized behavior disorder is accompanied by aggression and antisocial acts directed at other children. This is the main distinguishing feature of the defect.

It is expressed by the inability to establish relationships with peers, rejection by children, and lack of close friends.

Relationships with adults are maintained or also disrupted. The child is rude and angry. He is an individualist who opposes authority. Typically:

hooliganism;
physical, mental violence, pugnacity;
cruelty towards children and animals;
damage to property.

Petya, 7 years old. Having entered the 1st grade, problems emerged in interacting with classmates. He was rude and confrontational. He did not establish friendly relations with anyone. I started about 15 quarrels a day. Overly cruel. During fights he inflicted serious injuries. Indifferent to other people's pain.

Violated discipline. He reacted to comments with verbal aggression. He was restless and talked in class. Uncontrollable, opposed to the regime. He called teachers villains. However, he showed high intellectual abilities and curiosity.

He was expelled from school for bad behavior. Refuses to study at home. He is interested in computer games and plays with a toy telephone. Fussy, hyperactive. Calms down when he finds something exciting to do. He loves to listen when his mother reads a book to him. He categorically does not want to return to school.

Socialized behavior disorder: characterized by aggressive, antisocial behavior of sociable adolescents who have long-term, established relationships with peers. They often become members of antisocial groups.

Illegal acts are typical: robbery, theft, assault.

Relationships with adults in power (teachers, parents) are disrupted, but with others they are able to maintain normal relationships.

Veronica, 13 years old, 7th grade student. Doesn't attend school. Absent from home for weeks. She is rude, aggressive, and confrontational with relatives.

Sloppy. He smokes, drinks, wears bright makeup. Takes up to 10 tablets of diphenhydramine to “catch glitches.” One day, my friend and I took pills, trying to commit suicide. Having experienced painful consequences, they did not repeat the attempt. They offered to try heroin, but she refused, fearing the outcome.

Takes money out of the house. One day I stole money from my mother at work. He is friends with older guys. Together they robbed my sister’s room, taking out money and jewelry, after a conflict with my sister’s husband.

The girl stopped attending the school her parents had recently transferred to when her classmates started calling her names. Then she set her older comrades against the offenders to intimidate them. Afterwards, Veronica visited the school to see if she would be teased further. Satisfied that there was no bullying, she never returned to school.

He mocks his younger brother and offends him. The girl's behavior changed after the death of her father and the birth of a brother from her mother's second marriage.

Personality disorder in children

In order to start treatment on time and prevent the pathological condition from worsening, you should be attentive to the psychological health of the child. As a rule, dependent and anxious personality disorders are the most common in childhood. Most often, the development of pathology is associated with a negative home or school environment, where moral as well as physical humiliation predominates.

The anxiety type of disorder is manifested by the following symptoms:

low self-esteem;
tendency to awkwardness;
hypertrophied perception of problems;
defensive behavior;
reluctance to communicate with peers;
increased anxiety.

If you have an addictive disorder, you may experience symptoms such as:

victim behavior;
excessive sensitivity to criticism;
shifting responsibility to others;
feeling of loneliness;
reluctance to make decisions independently;
lack of confidence in one's own strength;
unstable emotional state.

If any symptoms appear, it is advisable to contact a qualified professional. Treatment for mental disorders in children is selected as carefully as possible. As a rule, therapeutic measures are based on the use of gentle drug therapy, long-term work with a psychologist, and constant monitoring by a psychiatrist.

HYPERKINETIC DISORDER

Develops at an early age. Determined by excessive activity, difficulty concentrating, especially regarding intellectual tasks. The children's activities are poorly organized: they grab onto a new task without finishing the previous one.

Restless, restless, easily distracted by extraneous stimuli. Therefore, it is difficult for a hyperactive student to sit in school classes. He is lost in his own dreams and is inattentive. Learning problems make it difficult to learn new knowledge, causing delayed cognitive development.

Impulsivity is manifested by thoughtless, unexpected actions, sometimes of a dangerous nature. Children run out onto the roadway, climb onto roofs, and play with flammable objects. Impulsivity is also expressed in tactless, inappropriate language. The mood changes quickly. Patients are quick-tempered and unbalanced.

Subsequently, such children, rejected by their environment, become aggressive, express protest, and are involved in illegal acts.

F64 Gender identity disorders.

F64.0 Transsexualism.

A. The desire to live and be accepted as a member of the opposite sex, which is usually accompanied by the desire to bring one's body as closely as possible into conformity with the preferred sex through surgical methods and hormonal treatments.

B. Transsexual identification remains constant for at least two years.

B. It is not a symptom of another mental disorder, such as schizophrenia, and is not associated with a chromosomal abnormality.

F64.1 Double role transvestism.

A. Wearing clothes of the opposite sex for the temporary experience of belonging to the opposite sex.

B. Absence of any sexual motivation for cross-dressing.

B. Absence of any desire to change permanently to the opposite sex.

F64.2 Childhood gender identity disorder.

For girls:

A. Living as a girl causes constant and severe distress and there is a strong desire to be a boy (this desire is determined not only by the perceived cultural advantages of being male) or the girl insists that she is a boy.

B. One of two:

1) girls show a constant distinct aversion to ordinary women's clothing and insist on wearing generally accepted men's clothing, such as boys' underwear and others. 2) Girls consistently renounce female anatomical structures, as evidenced by at least one of the following: a) assertion that she has and will have a penis; b) refusal to urinate while sitting; c) a statement that she does not want her breasts to grow or to have menstruation.

B. The girl has not yet reached puberty.

D. The disorder must be observed for a minimum of 6 months.

For boys:

A. Living as a boy causes constant and severe distress and a strong desire to become a girl or, in more rare cases, a boy insisting that he is a girl.

B. One of two:

1) Engaging in activities common to women, as evidenced by a preference for women's clothing or making one's clothing appear feminine, or a strong desire to participate in girls' games or other forms of leisure and a refusal to engage in boyish toys, games and activities. 2) Boys constantly reject male anatomical structures, as indicated by at least one of the following repeated statements: a) that he will grow up to be a woman (not only by performing the role of a woman); b) that his penis or testicles are disgusting or that they will disappear; c) that it would be better not to have a penis or testicles. B. The boy has not yet reached puberty. D. The disorder must be observed for a minimum of 6 months.

F64.8 Other gender identity disorders.

F64.9 Gender identity disorder, unspecified.

DEPRESSIVE DISORDER

Certain age periods are distinguished by their own depressive disorders.

Young children, up to 3 years old, become sad and avoid eye contact. There is a delay in the acquisition of new skills and achievements according to the age period. Self-harming behavior is typical: biting, hitting oneself, hitting one's head. Calming movements include thumb sucking, rocking, and monotonous walking.

Younger schoolchildren become apathetic, irritable, and withdrawn. There is a loss of interests and a decrease in intellectual activity. Sleep is disturbed.

Adolescent depression is determined by negativism and rapid mood swings. Disturbing feelings of guilt, self-accusation. Sleep and eating disorders are typical. Negativism and aggressiveness provoke deterioration in relationships with friends and problems in educational activities. Suicide attempts are a common symptom.

Treatment of dissocial disorder in Alter

People with dissocial disorder almost never seek mental health help. But many sociopaths feel an inner emptiness that is formed due to the lack of attachments and harmonious relationships with others, and want to correct this.

Dissocial disorder is treated through a course of individual psychotherapy, sometimes cognitive behavioral therapy, and situational management. It is not easy for a specialist to find contact with such people, but the doctors of the Alter Mental Health Center know how to find an approach to each patient.

Treatment at Alter for patients with dissocial personality disorder is selected individually, depending on the overall clinical picture. Individual psychotherapy helps to achieve a strong positive effect, harmonizing the life of the patient and his loved ones, and is also aimed at correcting patterns of thinking and behavior, and impulse control. Pharmacotherapy is prescribed if sociopathy has concomitant mental disorders to relieve symptoms.

Patients with severe impulsivity, aggressiveness and affective lability benefit from treatment with cognitive behavioral therapy and medications.

It is possible to undergo treatment in Moscow for dissocial personality disorder at the Alter mental health center at Moscow, Vsevolozhsky lane, 2/2.

DESTRUCTION OF SEXUAL BEHAVIOR

Teenagers easily succumb to sexual destruction, given the incompleteness of their sexual identification and the unconscious increase in sexual desire. Typically, adolescent sexual perversions are determined by accelerated or delayed puberty.

Often children with delayed sexual development become victims of sexual perversion. They are unsure of themselves, slow, clumsy, uncollected.

Adolescents with accelerated sexual development are hot-tempered, aggressive, cruel and have sadistic tendencies. Suffer from sexual desire disorders. Most often noted:

visionism - hidden looking at naked people;
exhibitionism - nudity in public;
seduction of children;
sexual manipulation of animals;
group masturbation;
erotic fantasies, reasoning with masturbation;
sexual attraction to urine, feces.

Sexual deviations are considered to be sexual contact, petting - mutual caresses without sexual relations, occurring before puberty, promiscuity in adolescence - numerous sexual relations with different partners.

Sexual perversions are expressed by teenage homosexuality, which is situational in nature. Possible in closed single-sex educational institutions.

In adulthood, with adequate sexual life, sexual perversions disappear. Otherwise, they last a lifetime.

General prevention

Unfortunately, there is no specific standard for the prevention of various personality disorders, since each person is individual. However, it is still possible to prevent the development of mental disorders in a child. For this purpose, many mental health programs have been developed today to help parents and children solve family problems.

These types of programs are mainly educational in nature - they involve lectures and discussions aimed at understanding developmental psychology.

Adults suffering from a personality disorder should not neglect the services of a psychiatrist. If you are unable to control your emotions and reactions, it is advisable to consult with a competent specialist who will prescribe appropriate therapy.

Despite the fact that this kind of personality disorder is not a mental illness, during the period of decompensation a person is not able to independently overcome painful symptoms. Therefore, to avoid undesirable consequences, you should definitely seek medical help.