Organic and symptomatic mental disorders

Affective personality disorders are understood as a group of mental diseases accompanied by disturbances of affect.
They are characterized by instability of mood, its decline (depression) or rise (manic state). At the same time, the intellectual and motor activity of the human brain changes. Affect is a vivid manifestation of feelings and emotions: facial expressions, gestures, anger, joy, etc. It can be adequate, that is, corresponding to the situation, or inadequate, in which behavior does not coincide with the thoughts expressed (an individual laughs when talking about the death of a loved one person).

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Organic personality disorder —changes in personality and behavior due to damage to brain tissue.

Any damaging effect on the nervous system causes changes in the mental state. But for a personality disorder to develop, the harmful effects must be long-lasting or leave behind irreversible changes in the form of neuronal death. atrophy of brain tissue, growth of neoplasms (cysts and brain tumors), impaired blood supply to the brain.

Danger to yourself and others

The social significance of the clinical picture is great. If at the asthenic stage patients can take care of themselves, and many are able to work, then with increasing severity of the disease they can first become dangerous for people around them (explosive, euphoric stage), and later for themselves (apathetic stage) due to pronounced apathy and helplessness.

Therefore, organic mental disorders require timely correction. If there is one or another option, you need to contact a psychiatrist.

All materials on the site are presented for informational purposes only, approved by certified physician Mikhail Vasiliev, diploma series 064834, in accordance with license No. LO-77-005297 dated September 17, 2012, by a certified specialist in the field of psychiatry, certificate number 0177241425770.

Causes

Organic personality and behavior disorder develops after mechanical damage to the brain due to:

• Traumatic brain injuries.
• Chronic alcohol and drug poisoning.
• Prolonged oxygen starvation.
• Disturbances of blood flow to the brain. Strokes and cerebral infarctions.
• Epilepsy.
• Nervous system infections.
• Cerebral palsy.
• ADHD.
• Atrophy or neoplasm of brain tissue.
• Encephalopathies of any origin.

Borderline personality disorder

If we focus borderline personality disorder (BPD) into one point, then we can say that this is a person suffering from instability of his internal impulses and feelings. People with BPD can experience intense feelings, from love to hate, but the peculiarity is that these feelings arise only in the process of interaction with other people. And these impulses are the way by which contact with the world is established.

Symptoms of Borderline Personality Disorder

When looking at the symptoms of borderline disorder, the first and main symptom is a constant, desperate attempt to avoid rejection, both real and imagined. Loneliness is unbearable for them. More precisely, not loneliness, but abandonment. They can be alone with themselves, but cannot stand it when someone leaves them.

The second symptom grows out of the first - very high intensity and instability of personal relationships. A person with BPD either idealizes or devalues ​​their partner, and this can happen almost simultaneously.

The third symptom is that these people don’t know who they are. Their self-image is unstable. There is no understanding of what is happening to them and what is really important to them. Today it may be one thing, and tomorrow it may be another. Instability can manifest itself both in relationships with oneself and with other people.

The fourth symptom is impulsivity. Instability pushes them towards it. The peculiarity of this impulsiveness is that it harms themselves. For example, they may engage in sexual excesses, or spend large amounts of money, or get drunk to the point of unconsciousness, and then abstain for many months.

The fifth symptom is attempts at suicide and often successful ones. This also includes driving at high speeds, using alcohol and drugs, abusing health, getting into dangerous situations, and more.

The sixth symptom is emotional instability. Their mood can change very quickly and dramatically. One minute they feel depressed, an hour later they feel irritated, and a couple of hours later they feel anxious.

The seventh symptom is a chronic feeling of inner emptiness that haunts them. And looking for external stimuli, pushes in the form of sex, drugs and other things, is a way to get in touch with your feelings.

The eighth symptom is anger inappropriate to the situation. They show it off often. They may even hit you if they feel like the person is bothering them.

The ninth symptom is paranoid imagination or symptoms of dissociation. They feel that other people want to control them and harm them. Or they may become trapped in internal dissociation, experiencing feelings and impulses simultaneously without being aware of them. Please note that in our Center you can conduct experimental psychological research and diagnose a person’s personality.

If you look at these symptoms, you can distinguish three main groups:

1. Pulse intensity.
2. Instability.
3. Impulsivity of behavior that is subject to dynamic impulses.

In this way, the borderline personality is filled with more energy. But for them it is real suffering. Acting under the influence of impulses, they do not make decisions about their behavior; it is as if something is happening to them. They may not want to behave this way, but the impulses are so strong that they must obey them or explode.

And now we will go from the surface to the depths to understand the essence of their suffering.

What are they missing, what are they looking for? They are looking for themselves. They are constantly looking for themselves within themselves and cannot find it. Their feelings tell them they don't exist. I can work, think, communicate, but do I really exist? Who am i?

And, of course, it is very difficult to live in such a state. You can treat yourself rationally, but this inner feeling makes it difficult to live. A person wants to get out of this state of internal dullness and emptiness.

How does he try to resolve this situation? He strives to experience some kind of experience that will save his emptiness. And first of all, this is an experience in relationships. Only when they are in a relationship do they have life, they feel that now I exist. They need someone next to them who makes them feel like they are themselves.

But if there is no other person nearby and they are in a difficult situation, then the body comes to the rescue. They may cut themselves with knives or blades, stub out cigarettes on their skin or pierce it with a needle, or drink strong alcohol that burns from the inside. At such moments, the feeling of pain brings pleasure. Because when I experience pain, I have the feeling that I exist. I live. Here I am.

So, a person with BPD suffers because they have no self-image or sense of self. He does not have an internal structure of the Self; he constantly needs an affective impulse. Without impulse, he cannot build a structure. And there is a feeling that if I don’t feel, then I don’t live. And if I don’t feel, then I’m not me, I’m not myself. And this is true, if we do not feel, we cannot understand who we are; such a reaction to the lack of feelings itself is normal.

But the method they choose gives relief here and now, but does not give access to their feelings. And a person with BPD may experience fireworks of feelings, and then again dark nights. Because they use the wrong ways to experience feelings, such as to satisfy their emotional hunger, they may abuse the relationship.

One might imagine that borderline patients are close to depressed, but there is a difference. A depressed person has a feeling that life itself is not good. He also lacks life. But life itself is not good. Whereas a person with BPD may have the feeling that life is good, life may be very wonderful, but how to achieve it?

Let's go a little deeper.

Where does instability come from, the transition from opposite to opposite, from black to white?

People with BPD have positive encounters and experience them as very valuable. When they feel love, they feel more life inside them, just like we all do. For example, when they are praised in front of a group of people, they may feel very good and begin to feel good about themselves. We all react to these situations in this way - they bring us closer to ourselves.

But we are normally in a fairly close relationship with ourselves. Whereas a person with BPD starts from scratch. Either there is emptiness inside him, complete nothingness, then he experiences love, praise and suddenly approaches himself. Then he had nothing, no sensation, and suddenly it was so bright. And this approach to himself arises only due to the fact that there is someone else. This is not his own process rooted in him, but a process that depends on something external. And this person is something like a hologram: you look at it and it seems like it’s something real, but it’s just the effect of external intersecting rays.

And then the people who love him praise him, are perceived as absolutely good, ideal, because they make him feel so good. But what happens if these people suddenly say something critical? And a person from this height suddenly falls not just to where he was, but somewhere even deeper. He begins to feel that the other person is destroying him, destroying him. It destroys his sense of self and causes pain.

And, of course, it is reasonable to imagine that a person who does such nasty things is simply a bad person. The same person who seemed like an angel suddenly seems like a devil. And this experience can be called hellish, because the person again does not understand who he is. When he falls out of this symbiosis with people who give him good feelings, and falling out of this symbiosis is so painful that this experience must be separated. To divide, to break something that is connected with this feeling.

He can divide another person in time, for example, a father or mother - he used to be so wonderful, but now he is a devil, because internally these experiences are very difficult to combine with one person. At one point, the father praises and says something good. But then how can you imagine that the same father can say at another moment, but now you have this nonsense, rubbish, please change this.

And if normally we understand that criticism and praise, positive and negative are all partly a common reality, then for a borderline person it is impossible to combine them together. Because one moment they have an excellent relationship with themselves, and the next there is emptiness and only pain inside. And the person he just loved, he suddenly begins to hate. And this hatred causes a lot of anger and he may become aggressive or have impulses to hurt himself. And this separative dissociative reaction is characteristic of borderline personalities.

This separation is due to the fact that they do not want to experience the feelings they experience when they are criticized. The criticism is so painful that they feel like they are melting away. And they protect themselves by trying to maintain this symbiosis. To return to the state when they were loved, praised, because this is the state in which they can live. But this internal positive feeling of self is artificial, in the sense that it depends entirely on the other person. They have no internal idea of ​​themselves, so they project everything outward and try to understand something externally.

You can compare this to the behavior of a five-year-old child: he can close his eyes and think that it is no longer there. A borderline person does the same thing on a psychological level: he separates something and it seems to no longer exist.

What does the phenomenological approach and existential analysis tell us? What leads a person to lose himself?

This loss of self is due to two things.

On the one hand, they constantly experience violence and some kind of inconstancy of others, in whose power they are. They may have a history of traumatic experiences involving emotional or sexual abuse. When a person simply cannot understand when their good relative behaved this way. These opposing experiences associated with people important to them seem to tear them in different directions. Often these are people who grew up in families where there was a lot of tension, scandals, and ambivalence.

The experience gained from childhood can be formulated phenomenologically as follows.

An adult, or someone from the outside environment tells them: be here, do something. You may be here, but you have no right to live. Those. borderline children feel that they have the right to be, but to be only as an object, a means for solving some other people’s problems. They are not needed as a person who has his own feelings, who wants to react to life in his own way, to enter into a relationship with it. They are needed only as tools.

And this is the very first form of this internal division, when a person grows up with such a message, with such an experience, and this is the basis of his future division.

But in response to this reality, he has an internal impulse: but I want to live, I want to be myself! But he is not allowed to be himself. And this inner voice is suppressed, drowned out. And it remains just an impulse.

And these impulses of a borderline person are completely healthy impulses directed against external aggression. Against external reality, which forces him to be torn, divided, not to be himself. Those. From the outside they are separated from themselves, separated, and from within there is a kind of rebellion against this situation.

And from here comes constant tension.

Borderline disorder is associated with very powerful internal tension. And this tension gives intensity to their lives. They need this tension, it is important to them. Because when they experience this tension, they feel life a little. And they don’t even sit relaxed, calmly, they always seem to be a little suspended, their muscles are tense. He sits in his own space, on his own support.

And thanks to this internal tension, he protects himself from internal pain. When he has no tension, when he is in a state of complete relaxation, he begins to feel pain because of who he is. How painful it is to be yourself! And this internal tension, on the one hand, gives him life, and on the other, protects him from internal pain.

We thought about how a person comes to this state of separation, rupture, and we saw that his life experience leads him to such a situation. Life itself was contradictory for him.

Another feature is the development of some images. Instead of seeing reality as it is, a person with BPD creates an ideal image of reality for themselves. His emotional vacuum is filled with thoughts and imagination. And these imaginary images give the borderline person some stability. And if someone begins to destroy this internal image or if reality does not correspond to it, then he reacts impulsively. Because this is a loss of stability. Any change in the way the father or mother behaves leads to a feeling of loss of support.

What happens when this image is destroyed or changed? Then the image of the ideal person is replaced by another. And in order to make sure that such a loss of ideal will not happen again, they turn the image of a person who was ideal into the complete opposite. And thanks to this change, the image of the devil will no longer have to be changed, you can be calm.

Those. images replace those feelings, thoughts and reactions to reality that help to live and deal with this reality. Ideal images become more real than reality. Those. they cannot accept what is given to them, what actually is. And this emptiness, due to the fact that they do not accept reality, they fill with images.

The borderline patient's deepest experience is pain. The pain is that if you leave, then I lose myself. Therefore, this encourages them to drag other people into relationships and not let them out. Do you understand the essence of the borderline patient's pain? The basic idea is that if someone else leaves me or I stop feeling pain, then I lose touch with myself, it’s like a kind of amputation of feelings. Feelings fade, everything becomes dark inside and the person loses contact with himself. He feels that he is not accepted, not seen, not loved for who he is, and this experience in the past leads to the fact that he does not accept and does not love himself.

Their behavior in relationships can be described as “I’m not with you, but I’m not without you.” They can only be in relationships when they dominate in these relationships and when these relationships correspond to their ideal internal image. Because they have a lot of anxiety, and when the other person leaves them or does something else, it causes even more anxiety.

For them, life is a constant battle. But life should be simple and good. They have to constantly fight and it's not fair. They find it difficult to manage their own needs. On the one hand, they have a feeling that they have a right to their needs. They are impatient and greedy with their needs. But at the same time, they are not able to do anything good for themselves; they can only do it impulsively. They don't understand who they are, and therefore they provoke other people.

So, borderline patients are very often aggressive when they feel abandoned or unloved, but when they feel loved and treated well, they are very warm, kind, and sweet.

And if, for example, after a couple of years of marriage, the partner says, “I want to get a divorce,” then the borderline can change his behavior in such a way that life in marriage becomes wonderful. Or he may react impulsively and be the first to file for divorce or break up. And it is very difficult to predict exactly how he will behave, but it will obviously be extreme.

They live extreme lives, they can work hard, drive at full speed, or exercise to the point of exhaustion. For example, one of my patients was riding a mountain bike and going down the mountain at such a speed that he knew that if something got in his way, he would break his neck. And in the same way he drove his BMW, and felt that if there were leaves on the road, he would be blown off the road. Those. it is a constant game with death.

How can we help a borderline person in therapy?

First of all, they need confrontation. Those. you need to meet them face to face and show yourself to them. Stay in touch with them, but don't let them react impulsively. Resist their impulses and say things like, “I want to discuss this, but I want to discuss it calmly.” Or, “Do you really need to be so aggressive, we can discuss it quite calmly.”

Those. on the one hand, remain in a relationship with them, continue to extend your hand to them, but do not allow them to treat you as their impulses dictate. And this is the best way for borderline patients to learn to switch their impulses and make contact.

The worst thing you can do is reject or push them away when confronted. And this stimulates their psychopathology. Only if you combine this confrontation with maintaining contact and continue to talk to them, then they can withstand this confrontation.

Show them your respect. For example, “I see that you are now very irritated, furious, this is probably something important for you, let’s talk about it. But first, calm down and after that we will talk about it.”

And this helps the borderline patient understand how he can be, who he can be in a situation where another person comes to him and allows him to make contact. And this is a very important resource that can be used in relationships with borderline people, who are colleagues and partners for us. It cannot cure them, it is not enough, but it is a behavior that does not stimulate their disorder further. This gives them the opportunity to calm down a little and enter into a dialogue with him.

You can work with a borderline person on the same team for decades if you know how to deal with that person. And if you yourself are strong enough as an individual. And this is the second important thing. If you are weak, or you have a traumatic experience with aggression, you feel traumatized, then you will find it very difficult to be in a relationship with a borderline patient. Because when dealing with him, you need to constantly be rooted in yourself. And it's not easy, you have to learn it.

And the second thing that borderline patients must learn is to endure themselves and endure their pain.

And if you look very briefly at the psychotherapeutic process, it always begins with advisory work. To help at the first stage to find some relief from internal tension, relief in a life situation. We work as consultants with their specific relationship problems in their life, at work. We help them make decisions, gain perspective in life, and in a sense this is educational work. We help them learn to notice their aggression.

This work continues for the first couple of months, six months, sometimes more. This work at the advisory level is necessary to gain access to a deeper level. For a borderline patient, pharmacological agents and medications are not very helpful.

And after the first stage of facilitating work related to counseling on life problems, we move to a deeper level. We teach them to take a stand. Position in relation to ourselves. Better to see yourself. For example, we can ask, “what do you think about yourself, about your behavior?” And usually they answer something like, “I haven’t thought much about it, I’m not valuable enough to think about it.” And in the process of work, you try to understand how this happened and how they can come to respect themselves.

And the first part of this work is working with yourself. And the second part is working on relationships with other people and biographical experience. And during therapy, their pain may increase and suicidal impulses may arise. They experience the amputation of loss of senses. And we can give them information that the pain you are experiencing cannot kill you, just try to bear it. It is very important to help them enter into the process of internal dialogue with themselves. Because the therapeutic relationship is a mirror that reflects how they feel inside, how they treat themselves.

Psychotherapy with a borderline patient is a complex art, it is one of the most difficult diagnoses in terms of working with them. Over the course of many years, they may have suicidal impulses, they may treat the therapist aggressively, and they may slip back into their disorder. This therapy continues for 5-7 years, initially with weekly meetings, then once every 2-3 weeks.

But they need time to grow up, because when they come to therapy, they are like little children of 4-5 years old. And how long does it take for a child to grow up and become an adult? We grow up in 20-30 years, and they should grow up in 4-5 years. And in most cases, they also have to cope with difficult life situations that cause great violence to them. Those. they need to make a very great effort to deal with their suffering and remain in therapy.

And the therapist himself can also learn a lot, we also grow with them. This makes working with borderline patients worthwhile. Source: https://kseniyapanyukova.com/ya-nenavizhu-tebya-no-ne-ostavlyaj-menya-pogranichnoe-rasstrojstvo-lichnosti/

Symptoms

These signs should be observed for a long time (at least six months):

• Unstable mood , rapid change of emotions (from tears to laughter in an instant), attacks of melancholy-angry mood (dysphoria), a tendency to an increased stupid and blissful mood (euphoria) without external reasons for this.
• Loss or decrease in the ability to foresee the consequences of one's actions. Incontinence of drives and needs.
• Difficulty learning.
• Decreased memory and attention.
• Thinking in detail (getting stuck on little things).

Treatment

Three directions of treatment:

• Therapy of the underlying disease - organic damage to the nervous system.
• Restoration of not yet dead, preserved nerve cells.
• Psychotherapeutic work aimed at developing a critical attitude towards one’s condition, learning to control emotions and cognitive training.
• Psychological work with the patient’s loved ones.

Medication, physiotherapeutic, psychotherapeutic methods, biofeedback therapy, diet therapy, reflexology, exercise therapy and other methods are used.

Diagnostics

Psychiatrists and psychotherapists also note that the priority is to identify the internal experiences of a person that torment him. They will need to be eliminated. But first, identify the reasons behind them. Doctors specializing in the cognitive-behavioral field usually point out to patients their mistakes in life, teach them to see prospects for the future, especially with regard to inappropriate behavior, point out to patients the futility of life's realities and try to instill in them a more suitable behavioral option.

Patients with behavior prone to dramatic behavior (it can be described as borderline, asocial, staged, narcissistic behavior) need an active, sometimes involuntary, harsh, prohibitive attitude of a psychotherapist. Sometimes people with antisocial personality disorder cannot receive outpatient treatment; they must be forcibly placed in specialized hospitals.

There are two groups of psychotherapists who treat borderline patients receiving treatment for personality disorders. Some are confident in the effectiveness of occupational therapy treatment, while others are inclined to believe that the patient must be treated now. In both cases, treatment of patients is often stopped for a long time because the patient feels anger towards his doctor, when he is suicidal or has a psychotic decompensation and needs to be urgently hospitalized.

But such aggressive, in some way, cruel tactics towards the patient can be replaced with a more gentle, bright one, treat the patient with understanding, that is, find a friendly approach.

Duration of psychotherapeutic treatment

Psychotherapeutic treatment for personality disorder usually lasts a very long time, for several years.

But, despite such a difficult, long path to improving the patient’s condition, improvements are still observed, and a lot, but there is almost no control over the data. Therefore, problems still remain unresolved in terms of the effectiveness of diagnosis and basic psychotherapeutic approaches to treatment and identification of the sources of the disease.

Current recommendations for the treatment of personality disorder include comprehensive neurometabolic therapy. For example, patients with borderline disorders with frequently changing moods and lack of control often find relief from taking tricyclic antidepressants and MAO inhibitors. For patients with disorders of the cognitive process and adaptation, components of aggression and obsessions, antipsychotics are recommended in small dosages.