How to treat personality disorder? Hello, beloved patients and clients! Hello, dear colleagues! Personality accentuation (according to the paranoid type, schizoid type, epileptoid type, etc., etc.) should not be confused by psychologists with persistent personality disorder F60... (according to the paranoid type, schizoid type, epileptoid type, etc. etc.). Accentualization of personality is only a feature of the individual’s character; it is successfully and thoroughly corrected by psychologists. And the prognosis for the formation of a socio-psychologically successful individual in the case of personality accentuation is favorable. About persistent personality disorder F60..., its diagnosis and treatment. This is not only a theory, but also my (and my fellow psychiatrists) practical experience. Personality disorder F60... is something that develops by the age of 15-18. And earlier, in Soviet times, psychiatrists dealt with such comrades. It was easier. Sorry, there were much fewer of them (F60...) than there are now. The disease was called "transient personality disorder." Transitional means temporary. If a transient personality disorder was not compensated by psychotherapy and medications by the age of 30-35, then the patient was diagnosed with psychopathy and registered in a mental health clinic. And they, psychopaths, believe me, never became TOP managers, not because they were not allowed into such positions, but simply because they were unable to occupy any more or less significant position or the status of a non-conflict, sociable, serious , an attentive specialist. And since 1992, psychopaths have been completely abandoned to their fate (along with the entire population of Russia). And since 1999, ICD-10 (by the way, was supposed to come into force in 1994, but the Russian Federation could not master it for a long time) generally abolished psychopathy as a manifestation of mental pathology. Only dissociative identity disorder was given the right to be called psychopathy. Diagnostics: So, in order for a person to be diagnosed with persistent (that is, incurable chronic) personality disorder, there must be 3 main criteria common to all types of persistent personality disorder F60...: 1) Age from 30 years and older (with the understanding that this pathology had already formed by the age of 15-18), with the understanding that this disease is incurable, 2) The presence of disorders of the emotional-volitional sphere, leading to even unstable and mild cognitive impairment. By the way, the differential diagnosis of psychopathic-like schizophrenia with schizoid psychopathy is carried out, among other things, according to the criterion that in psychopathic-like schizophrenia, cognitive impairments are primary, and then a persistent defect in the emotional-volitional sphere occurs, and in schizoid psychopathy, disorders of the emotional-volitional sphere are primary, and cognitive impairments secondary, unstable and not severe. 3) Problems with interpersonal communications, and persistent disorders (violations) of socialization resulting from this. There is also the Gannushkin-Kerbikov triad of psychopathy from 1933-1961, consisting of the following provisions: 1) manifestation of personality disorder and behavior in the form of stable social maladjustment, 2) relative constancy and low convertibility of the personality disorder. That is, a personality disorder cannot be cured, it can only be compensated or subcompensated, 3) the comprehensiveness of the manifestations of a personality disorder, affecting all aspects of the personality, starting from needs, drives and ending with the ideals, worldview and values ​​of the individual. Due to the fact that a patient with a personality disorder ( persistent, or transient for up to 30 years) there are clearly expressed defects in interpersonal communications, and a persistent disorder in the socialization process, then we can say with confidence that if a top manager turned to a psychologist for help with serious problems, or not very serious ones, then he has 100% there is not and cannot be a persistent personality disorder - psychopathy by the old name (F60....). And he does not and cannot even have transient personality disorder. He maybe anything, for example, accentuation of personality (organization, from the position of a psychiatrist-psychoanalyst) according to........ type (mixed, epileptoid, emotionally unstable, passive-aggressive, paranoid, schizoid, anxious-suspicious, explosive-explosive , dissociative, etc.), but not F60...., not persistent personality disorder (psychopathy). Psychopaths do not become TOP managers, ever. Gentlemen, psychologists, successfully treat psychological pathology - accentualization (organization - this is for psychoanalysts) of personality of any type, yourself, without a psychiatrist. Treatment: Now about psychopathy (persistent personality disorder). Psychopathy is a Greek word. In Russian it literally sounds like “suffering of the soul.” How to treat suffering of the soul? Psychopathy was treated in Russia from the 1890s to the 1990s using the method of psychiatrist Korsakov. It was he who organized a neurosis clinic, where he treated patients with personality disorders with occupational therapy, sociotherapy, psychoprophylaxis, group and individual psychotherapy, with moderate success. After all, there were no medications. And now these 4 pillars of treatment for psychopathy remain the main ones in the treatment of personality disorder, and are used by me, as a psychotherapist, in the following sequence: 1) Psychoprophylaxis and teaching patients psychoprophylaxis skills. Everything that I write now at this point should “settle firmly in the brain” through suggestion, teaching and self-teaching. The patient must not only understand my main principle of psychoprophylaxis “don’t do now or in the future what can harm your psyche now or in the future,” but also confess, literally confess at the level of an unconditional constant, at the level of “existential prayer,” 86,400 seconds per day commandment “do not do now or in the future anything that can harm your psyche now or in the future.” The patient must know that “in a healthy body there is a healthy mind”, that you must constantly be busy with useful and rational activities, that you need to get enough sleep, that Do not use drugs or toxins (caffeine, alcohol, etc.). The patient should know that a full 7-9 hours of sleep is the most important thing that is easy and pleasant. The patient should know that if he goes to bars, or that if he goes to nightclubs, or is on duty at night, then no antidepressants or mood stabilizers will help him, and psychopathy will progress constantly, leading to a deterioration in the functioning of the emotional-volitional sphere and cognitive functions, difficulty falling asleep, sleep phases, early awakening, or problems with the initiation of wakefulness, eating and sexual behavior disorders, dysthymia, hypobulia, and other affective disorders, including depression, with or without agitation, with thoughts about the meaninglessness of life , to anxiety disorders of the widest spectrum, up to psychotic inclusions. 2) Healthy sleep 7-9 hours. Not only think about it, but also do it. 3) Sports, physical education, occupational therapy, sociotherapy, art therapy. Art therapy is very popular and useful, it helps to realize oneself and socialize, but do not forget about the health of the body and about sports, physical education, occupational therapy. 4) Psychotherapy, group and individual. 100% of psychopaths need psychotherapy. Gentlemen, psychologists, treat (correct, I don’t guarantee success) persistent personality disorder of any type together with psychiatrists! Psychiatrists can’t cope without you! There are too many psychopaths and too few psychiatrists. Well, not all psychiatrists (even paid ones) engage in psychotherapy. And, I repeat, a psychopath needs not only personal psychotherapy, but also group psychotherapy. But the group, of course, is only at the stage of subcompensation, compensation. During the period of decompensation, only personal psychotherapy. As for psychopharmacotherapy. This is not the main element in the treatment of psychopathy. But sometimes it is impossible to do without psychopharmacocorrection, especially if the psychopathy is severe, or there is a comorbid background - concomitant diseases and conditions (acquired diseases: somatic diseases, neurological diseases, drug addiction.