Oppositional defiant disorder (ODD) – Symptoms and causes

Overview

Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

As a parent, you don’t have to go it alone in trying to manage a child with ODD. Doctors, mental health professionals and child development experts can help.

Behavioral treatment of ODD involves learning skills to help build positive family interactions and to manage problematic behaviors. Additional therapy, and possibly medications, may be needed to treat related mental health disorders.

Symptoms

Sometimes it’s difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It’s normal to exhibit oppositional behavior at certain stages of a child’s development.

Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:

• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Is often angry and resentful

Argumentative and defiant behavior:

• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehavior

Vindictiveness:

• Is often spiteful or vindictive
• Has shown spiteful or vindictive behavior at least twice in the past six months

ODD can vary in severity:

• Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate. Some symptoms occur in at least two settings.
• Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.

When to see a doctor

Your child isn’t likely to see his or her behavior as a problem. Instead, he or she will probably complain about unreasonable demands or blame others for problems. If your child shows signs that may indicate ODD or other disruptive behavior, or you’re concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in disruptive behavior problems.

Ask your primary care doctor or your child’s pediatrician to refer you to the appropriate professional.

Causes

There’s no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

• Genetics — a child’s natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function
• Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

• Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration
• Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision
• Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder
• Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends and relationships.

ODD may lead to problems such as:

• Poor school and work performance
• Antisocial behavior
• Impulse control problems
• Substance use disorder
• Suicide

Many children and teens with ODD also have other mental health disorders, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Depression
• Anxiety
• Learning and communication disorders

Treating these other mental health disorders may help improve ODD symptoms. And it may be difficult to treat ODD if these other disorders are not evaluated and treated appropriately.

Prevention

There’s no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child’s self-esteem and rebuild a positive relationship between you and your child. Your child’s relationships with other important adults in his or her life — such as teachers and care providers — also will benefit from early treatment.

Jan. 25, 2018

Intermittent explosive disorder – Symptoms and causes

Overview

Intermittent explosive disorder involves repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.

These intermittent, explosive outbursts cause you significant distress, negatively impact your relationships, work and school, and they can have legal and financial consequences.

Intermittent explosive disorder is a chronic disorder that can continue for years, although the severity of outbursts may decrease with age. Treatment involves medications and psychotherapy to help you control your aggressive impulses.

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Symptoms

Explosive eruptions occur suddenly, with little or no warning, and usually last less than 30 minutes. These episodes may occur frequently or be separated by weeks or months of nonaggression. Less severe verbal outbursts may occur in between episodes of physical aggression. You may be irritable, impulsive, aggressive or chronically angry most of the time.

Aggressive episodes may be preceded or accompanied by:

• Rage
• Irritability
• Increased energy
• Racing thoughts
• Tingling
• Tremors
• Palpitations
• Chest tightness

The explosive verbal and behavioral outbursts are out of proportion to the situation, with no thought to consequences, and can include:

• Temper tantrums
• Tirades
• Heated arguments
• Shouting
• Slapping, shoving or pushing
• Physical fights
• Property damage
• Threatening or assaulting people or animals

You may feel a sense of relief and tiredness after the episode. Later, you may feel remorse, regret or embarrassment.

When to see a doctor

If you recognize your own behavior in the description of intermittent explosive disorder, talk with your doctor about treatment options or ask for a referral to a mental health professional.

Causes

Intermittent explosive disorder can begin in childhood — after the age of 6 years — or during the teenage years. It’s more common in younger adults than in older adults. The exact cause of the disorder is unknown, but it’s probably caused by a number of environmental and biological factors.

• Environment. Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature.
• Genetics. There may be a genetic component, causing the disorder to be passed down from parents to children.
• Differences in how the brain works. There may be differences in the structure, function and chemistry of the brain in people with intermittent explosive disorder compared to people who don’t have the disorder.

Risk factors

These factors increase your risk of developing intermittent explosive disorder:

• History of physical abuse. People who were abused as children or experienced multiple traumatic events have an increased risk of intermittent explosive disorder.
• History of other mental health disorders. People who have antisocial personality disorder, borderline personality disorder or other disorders that include disruptive behaviors, such as attention-deficit/hyperactivity disorder (ADHD), have an increased risk of also having intermittent explosive disorder.

Complications

People with intermittent explosive disorder have an increased risk of:

• Impaired interpersonal relationships. They’re often perceived by others as always being angry. They may have frequent verbal fights or there can be physical abuse. These actions can lead to relationship problems, divorce and family stress.
• Trouble at work, home or school. Other complications of intermittent explosive disorder may include job loss, school suspension, car accidents, financial problems or trouble with the law.
• Problems with mood. Mood disorders such as depression and anxiety often occur with intermittent explosive disorder.
• Problems with alcohol and other substance use. Problems with drugs or alcohol often occur along with intermittent explosive disorder.
• Physical health problems. Medical conditions are more common and can include, for example, high blood pressure, diabetes, heart disease and stroke, ulcers, and chronic pain.
• Self-harm. Intentional injuries or suicide attempts sometimes occur.

Prevention

If you have intermittent explosive disorder, prevention is likely beyond your control unless you get treatment from a professional. Combined with or as part of treatment, these suggestions may help you prevent some incidents from getting out of control:

• Stick with your treatment. Attend your therapy sessions, practice your coping skills, and if your doctor has prescribed medication, be sure to take it. Your doctor may suggest maintenance medication to avoid recurrence of explosive episodes.
• Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm.
• Develop new ways of thinking (cognitive restructuring). Changing the way you think about a frustrating situation by using rational thoughts, reasonable expectations and logic may improve how you view and react to an event.
• Use problem-solving. Make a plan to find a way to solve a frustrating problem. Even if you can’t fix the problem right away, having a plan can refocus your energy.
• Learn ways to improve your communication. Listen to the message the other person is trying to share, and then think about your best response rather than saying the first thing that pops into your head.
• Change your environment. When possible, leave or avoid situations that upset you. Also, scheduling personal time may enable you to better handle an upcoming stressful or frustrating situation.
• Avoid mood-altering substances. Don’t use alcohol or recreational or illegal drugs.

Sept. 19, 2018

NIMH » Disruptive Mood Dysregulation Disorder

DMDD is a new diagnosis. Therefore, treatment is often based on what has been helpful for other disorders that share the symptoms of irritability and temper tantrums. These disorders include attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and major depressive disorder.

If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:

• Medication
• Psychological treatments
  • Psychotherapy
  • Parent training
  • Computer based training

Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.

It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.

Medication

Many medications used to treat children and adolescents with mental illness are effective in relieving symptoms. However, some of these medications have not been studied in depth and/or do not have U.S. Food and Drug Administration (FDA) approval for use with children or adolescents. All medications have side effects and the need for continuing them should be reviewed frequently with your child’s doctor.

For basic information about these and other mental health medications, you can visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website.

Stimulants

Stimulants are medications that are commonly used to treat ADHD. There is evidence that, in children with irritability and ADHD, stimulant medications also decrease irritability.

Stimulants should not be used in individuals with serious heart problems. According to the FDA, people on stimulant medications should be periodically monitored for change in heart rate and blood pressure.

Antidepressants

Antidepressant medication is sometimes used to treat the irritability and mood problems associated with DMDD. Ongoing studies are testing whether these medicines are effective for this problem. It is important to note that, although antidepressants are safe and effective for many people, they carry a risk of suicidal thoughts and behavior in children and teens. A “black box” warning—the most serious type of warning that a prescription can carry—has been added to the labels of these medications to alert parents and patients to this risk. For this reason, a child taking an antidepressant should be monitored closely, especially when they first start taking the medication.

Atypical Antipsychotic

An atypical antipsychotic medication may be prescribed for children with very severe temper outbursts that involve physical aggression toward people or property. Risperidone and aripiprazole are FDA-approved for the treatment of irritability associated with autism and are sometimes used to treat DMDD. Atypical antipsychotic medications are associated with many significant side-effects, including suicidal ideation/behaviors, weight gain, metabolic abnormalities, sedation, movement disorders, hormone changes, and others.

Psychological treatments

Psychotherapy

Cognitive-behavioral therapy, a type of psychotherapy, is commonly used to teach children and teens how to deal with thoughts and feelings that contribute to their feeling depressed or anxious. Clinicians can use similar techniques to teach children to more effectively regulate their mood and to increase their tolerance for frustration. The therapy also teaches coping skills for regulating anger and ways to identify and re-label the distorted perceptions that contribute to outbursts. Other research psychotherapies are being explored at the NIMH.

Parent Training

Parent training aims to help parents interact with a child in a way that will reduce aggression and irritable behavior and improve the parent-child relationship. Multiple studies show that such interventions can be effective. Specifically, parent training teaches parents more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert the outburst. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior.

Computer-based training

Evidence suggests that irritable youth with DMDD may be prone to misperceiving ambiguous facial expressions as angry. There is preliminary evidence that computer-based training designed to correct this problem may help youth with DMDD or severe irritability.

Disruptive Behavior Disorders | Boston Children’s Hospital

Overview

“Parents are an essential part of treatment for their child’s disruptive behavior disorder. The most effective interventions we’ve seen are parent-based. “

Eugene d’Angelo, PhD, chief of Children’s Division of Psychology

When a child is acting out—disrupting activities, ignoring rules, goading others or erupting in defiance at being told “no”—the entire family feels the impact. You may feel helpless to control your child’s restlessness or anger, unsure how to respond or at a loss as to how to return some sense of stability and normalcy to the family environment. You may also find yourself with more questions—What’s wrong with my child? How can we keep our family together in the midst of all this chaos?—than answers. 

Children’s Hospital Boston’s team clinicians are here to help. First, it might be beneficial to learn as much as you can about your child’s condition. 

• Disruptive behavior disorders are a group of behavioral problems. They are called “disruptive” because affected children literally disrupt the people and activities around them (including at home, at school and with peers).
   
• The most common types of disruptive behavior disorder are oppositional defiant disorder (ODD) and conduct disorder.
   
• Children with oppositional defiant disorder display a persistent pattern of angry outbursts, arguments and disobedience. While this behavior is usually directed at authority figures, like parents and teachers, it can also target siblings, classmates and other children.
   
• Conduct disorder is a far more serious condition that can involve cruelty to animals and people, other violent behaviors and criminal activity.

It may also help you to know that you’re not alone. Disruptive behavior disorders are relatively common in children, and with the right care, these conditions can be treated successfully.

How Boston Children’s Hospital approaches disruptive behavior disorders

Children’s Hospital Boston has a long history of pioneering important advances in behavioral and mental health for children and adolescents. Our Department of Psychiatry clinicians are committed to evidence-based treatments—therapies that have been tested and proven effective through careful scientific analysis, both here at our hospital and at top health centers around the world.

At the same time, we practice medicine that’s patient-focused and family-centered. We never lose sight of the fact that your child is, first and foremost, an individual—not merely a patient—and we include your family at every stage of the treatment process.

Here at Children’s, our clinicians use several techniques to treat disruptive behavior disorders, including:

• parenting modification strategies
• social and emotional skills training for children
• psychotherapy for the child and the family
• if necessary, the addition of medication to the therapy plan

Working with your clinician, you can make a difference for your child by learning and using new:

• communication skills
• parenting skills
• conflict resolution skills
• anger management skills

Disruptive behavior disorders: Reviewed by David R. DeMaso, MD
© Children’s Hospital Boston; posted in 2011

Causes, Signs, Diagnosis & Treatments

Overview

What is intermittent explosive disorder?

Intermittent explosive disorder is a lesser-known mental disorder marked by episodes of unwarranted anger. It is commonly described as “flying into a rage for no reason.” In an individual with intermittent explosive disorder, the behavioral outbursts are out of proportion to the situation.

How common is intermittent explosive disorder?

It is estimated that between one to seven percent of individuals will develop intermittent explosive disorder during their lifetime.

Who is affected by intermittent explosive disorder?

Intermittent explosive disorder usually begins in the early teens, but can be seen in children as young as six. It is most common in people under the age of 40.

Symptoms and Causes

What causes intermittent explosive disorder?

The cause of intermittent explosive disorder is unknown, but some contributing factors have been identified. They include:

• A genetic component (occurs in families)
• Being exposed to verbal and physical abuse in childhood
• Brain chemistry (varying levels of serotonin) can contribute to the disorder
• Having experienced one or more traumatic events in childhood
• A history of mental health disorders, including attention deficit hyperactivity disorder (ADHD), antisocial personality disorder, borderline personality disorder
• Nearly 82 percent of those with intermittent explosive disorder have also had depression, anxiety or substance abuse disorder

What are the signs of intermittent explosive disorder?

Intermittent explosive disorder manifests itself in what seems like adult temper tantrums. Throwing objects, fighting for no reason, road rage and domestic abuse are examples of intermittent explosive disorder. The outbursts typically last less than 30 minutes. After an outburst, an individual may feel a sense of relief – followed by regret and embarrassment.

What are the symptoms of intermittent explosive disorder?

Individual experiencing intermittent explosive disorder may display one of more of the following symptoms:

• Rage
• Irritability
• Increasing sense of tension
• Racing thoughts
• Increased energy
• Tremors
• Palpitations
• Chest tightness
• Temper tantrums
• Shouting
• Being argumentative
• Getting into fights
• Threatening others
• Assaulting people or animals
• Damaging property

Diagnosis and Tests

How is intermittent explosive disorder diagnosed?

Diagnosis begins with taking the individual’s general medical history, psychiatric history and conducting a physical and mental status exam. To be diagnosed with intermittent explosive disorder, an individual must display a failure to control aggressive impulses as defined by either of the following:

• Verbal aggression (temper tantrums, verbal arguments or fights) or physical aggression toward property, animals or individuals, occurring twice weekly, on average, for a period of 3 months. The aggression does not result in physical harm to individuals or animals or destruction of property. Or
• Three episodes involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

The degree of aggression displayed during the outbursts is greatly out of proportion to situation. In addition, the outbursts are not pre-planned; they are impulse and/or anger based. Also, the outbursts are not better explained by another mental disorder, medical condition, or substance abuse.

Management and Treatment

How is intermittent explosive disorder treated?

Intermittent explosive disorder may best be treated by a combination of cognitive behavioral therapy (which consists of relaxation training, changing the ways you think [cognitive restructuring] and coping skills training) and medications. In particular, fluoxetine is the most studied drug for intermittent explosive disorder. Other drugs that have been studied for the condition or have been recommended if fluoxetine fails include phenytoin, oxcarbazepine or carbamazepine. In general, the classes of medications that can be tried include antidepressants, anticonvulsants, antianxiety and mood regulators.

What are the complications of intermittent explosive disorder?

Intermittent explosive disorder can have a very negative impact on an individual’s health and life. It can lead to trouble in personal relationships and marriages. It can negatively impair a person’s relationships and judgment at work and school. Individuals with intermittent explosive disorder are more likely to have other psychiatric disorders, abuse drugs and alcohol, and engage in self harm. They also are at a higher risk of some medical conditions including stroke, diabetes, chronic pain, ulcers and high blood pressure. For these reasons, it is important to seek medical attention if you think you or someone you know has intermittent explosive disorder.

Prevention

Can intermittent explosive disorder be prevented?

People diagnosed with intermittent explosive disorder will learn a variety of coping techniques in therapy. These can help prevent episodes. They include:

• Relaxation techniques
• Changing the ways you think (cognitive restructuring)
• Communication skills
• Learning to change your environment and leaving stressful situations when possible
• Avoiding alcohol and recreational drugs

Outlook / Prognosis

What is the prognosis/outlook for patients who have intermittent explosive disorder?

Having intermittent explosive disorder can predispose an individual to depression, anxiety, and alcohol and drug abuse. It can also lead to severe personal and relationship problems. For that reason, it is essential to seek medical help if you feel you or a family member has intermittent explosive disorder. With cognitive therapy and medication, the condition can be successfully managed. However, according to studies, it is thought that intermittent explosive disorder is a long-term condition, lasting from 12 years to 20 years or even a lifetime.

Anger overload in children: diagnostic and treatment issues

Anger reactions in some children are quite frequent and troubling to parents and teachers who witness them. The child’ s intense anger may erupt quickly and intensely in reaction to limit setting by adults, to teasing or to seemingly minor criticism by peers or adults. This is a distinct psychological problem in children which is separate from diagnoses such as attention-deficit hyperactivity disorder, bipolar disorder, and oppositional defiant disorder. It can co-occur with ADHD or learning disabilities, but may also occur separately from these diagnoses.

At this time, the diagnostic manual, DSM-IV*, does not consider anger disorders as a separate category like depression and anxiety. However, many mental health professionals feel it is a category unto itself and are devising treatment strategies for anger problems. Daniel Goleman (in Emotional Intelligence) and John Ratey and Catherine Johnson (in Shadow Syndromes) offer cogent reviews of this literature. Goleman uses the term “anger rush” to describe anger problems in adults, while Ratey and Johnson refer to a shadow syndrome for “intermittent anger disorder” in adults. Anger disturbances in children need to be classified as a discrete psychological problem as well, and they require particular treatment strategies. This article defines the syndrome and outlines effective treatment strategies.

Diagnostic issues

The term anger overload is used to refer to the intense anger response which has been the presenting problem for a number of young children and preadolescents seen in a suburban outpatient practice. There is an intense and quick reaction by the child to a perceived insult or rejection. The rejection can seem quite minor to parents or others. For example, a parent saying “no” to something the child has been looking forward to doing can trigger an intense period of screaming and sometimes hitting, kicking or biting. Another common situation which can trigger anger overload may occur in a game with peers. It can involve a disagreement on how the game should be played or its outcome. Parents often explain to the mental health professional that these reactions have been going on since early childhood in one form or another. It is frequently reported that these children become sassy and disrespectful: they will not stop talking or yelling when they are upset. At other times, when their anger has not been stimulated, these children can be well-mannered and caring.

The problem is called anger overload because it is more severe than a temporary anger reaction lasting only a few minutes. With anger overload, the child becomes totally consumed by his angry thoughts and feelings. He or she is unable to stop screaming, or in some cases, acting out physically, even when parents try to distract the child or try to enforce limits and consequences. The anger can last as long as an hour, with the child tuning out the thoughts, sounds or soothing words of others.

Another significant characteristic is that these children are sometimes risk takers. They enjoy more physical play than their peers and like taking chances in playground games or in the classroom when they feel confident about their abilities. Other children are often in awe of their daring or scared of their seemingly rough demeanor. Perhaps most interesting is that these very same risk takers can be unsure of themselves and avoid engaging in other situations where they lack confidence. A number of these children have mild learning disabilities, and feel uncomfortable about their performance in class when their learning disability is involved. They prefer to avoid assignments where their deficits can be exposed, sometimes reacting with anger even if the teacher privately pushes them to do the work with which they are uncomfortable.

One diagnostic fallacy is to assume that these children have bipolar disorder. Dr. Dimitri and Ms. Janice Papolos recently devoted a full book to the disorder (The Bipolar Child, 1999). The rages of children with bipolar disorder are more intense and lengthy than for the children we are currently discussing. The Papoloses describe (page 13) that for children with bipolar, these angers can go on for several hours and occur several times a day. In children with bipolar, there is often physical destruction or harm to something or someone. In children with anger overload, the outburst is often brief, less than half an hour, and while there may be physical acting out, usually no one is hurt. In addition, children with bipolar have other symptoms such as periods of mania, grandiosity, intense silliness or hypersexuality.

Anger overload is also different from attention-deficit hyperactivity disorder. Children with ADHD have significant distractibility, which occurs regularly in school and/or the home. By contrast, children with brief outbursts of anger often pay attention well when they are not “overheated” emotionally. In addition, children with ADHD may have hyperactive movements throughout the day; whereas children with anger overload only seem hyperactive when they are overstimulated with feelings of anger. Finally, children with ADHD are often impulsive in a variety of situations, many of which have nothing to do with anger.

It is possible, however, for children to have symptoms of ADHD and anger overload. This combination is especially difficult for parents to manage. Behavioral strategies for ADHD are not as effective because the child becomes excessively angry despite efforts by others to focus his attention elsewhere. Sometimes, professionals then tell the parents or teachers that they are not applying behavior modification techniques properly. What may work for a child who has ADHD may not be as effective for a child who also has the problem of anger overload.

Another diagnostic category which can be differentiated from anger overload is oppositional defiant disorder. Oppositional children have a continuing pattern of disobedience to adult demands, whereas children with anger overload are only defiant when their anger is stimulated. The situations which trigger their anger are more restricted. There are certain areas which have special importance to them, such as winning a game, buying a toy or being seen as successful in school. In most other situations, they are described by their parents as sweet and cooperative. Few, if any, oppositional defiant children are described by their parents in this manner.

Treatment techniques: behavioral strategies

When these children first come to a professional’ s attention, there may be a tendency to think that the parents must learn to ignore their children’ s tantrums. But this will not work reliably for children with anger overload. Their angry outbursts will not be extinguished this way. Behavior therapy for these children involves working with the parents as much as, or more than, the children themselves. Parents and teachers can learn strategies to teach their child self-control in a shorter period of time than the therapist can teach the child alone. By coaching the parents, the therapist has an impact on the child throughout the week. In addition, children cannot apply therapeutic strategies themselves at home when the anger is building. They need someone to cue them on what to do – usually a parent or teacher.

The first strategy is for the adult to recognize when the child is about to experience anger. This is sometimes difficult for anyone to predict. However, over time, parents and teachers begin to recognize signs that an angry outburst is impending . The look in the child’ s eyes, the tone of his voice or the tightness in his body tell the adult that the child is beginning to get upset. The time from when the child gets upset to when he shows full-blown anger may only be a few seconds. If it is caught in time, the child is much more likely to achieve self-control than if the adult tries to intervene once the child is overflowing with emotion. It is as if the child’ s brain has reached overload then, and it takes some time to cool off.

One technique to use before reaching this point, is distraction. The parent should try to turn the child’ s attention to something else that is interesting to him/her. It is important that the distraction be interesting to the child – something he/she likes and that involves some action. The child is unlikely to immediately choose a quiet, sedentary activity like reading. A more effective distraction technique is going outside to ride a bike or playing catch. For example, if the family is at a park and the child does not want to leave the swings, then suggest he try the slide – which is an activity with a more natural ending point. Once he comes down the slide, the activity is at a possible stopping point. That is a good time to direct him to the car.

To help motivate the child, some behavior modification mechanism should be in place. Choose incentives and consequences that are brief and preferably immediate. A colorful chart or poster can be used to track two or three behaviors which the child needs to demonstrate during the day in order to earn a reward. Select one or two behaviors and review a behavior plan for these situations with your child.

The basic principle is to offer an alternative behavior that is more socially acceptable than an angry reaction. If the child does not use the alternative behavior, and moves into a rage, a negative consequence may be imposed. The principle for negative consequences is similar to rewards: brief and immediate, where possible. A brief consequence such as being grounded from going outside and/or playing computer games for a few hours (or up to a day long, depending on the severity of the offense) is helpful in getting the child to recognize the importance of using self-control. If, instead of using a strong verbal response, the child hits back when teased, a consequence will send a message better than trying to talk to the child. Children take consequences more seriously than “lectures.” They are more likely to remember a consequence later and to choose a more appropriate response the next time. Parents need to be firm about applying negative consequences because they send an important signal to the child. While such enforcers do not help shorten the immediate anger, they can help lower the frequency of angry outbursts in the future.

Another key principle when applying negative consequences is to eliminate discussion at the moment the child is raging. Giving the child attention, even talking, is a reward for negative behavior. Plus, the child who is raging is not rational at the moment, and the rage is likely to escalate further if consequences are mentioned while he is having a meltdown.

Therapy for ADHD and anger overload

If the child also has ADHD, problems like distractibility in the classroom or failure to complete assignments cannot be effectively dealt with until the child learns how to control his angry reactions. Otherwise, the child will likely react with extraordinary anger when teachers or caregivers give consequences or time outs for not working on or not completing class work. The child may feel criticized or embarrassed and not know how to control these feelings. Once anger control is learned, behavior modification aimed at goals like completing assignments is much more effective.

The issue of medication for ADHD has also been problematic at times for children who simultaneously have anger overload problems. Sometimes, stimulant medication will work for both problems, but it can also make it harder for a child to control his anger. In that case, medications other than stimulants should be considered. In some cases, a combination of a low dose of SSRI medication along with a low dose of stimulant medication can be helpful. However, the issue of medication for the dual problems of ADHD and anger overload needs further study.

Cognitive treatment strategies

One important point which affects how a child responds to a provocation is the way he or she percieves the problem situation: does he feel embarrassed, humiliated or rejected? If the child feels an insult to his sense of pride, or feels as if he was treated “unfairly,” he is more likely to exhibit rage. Teaching the child to respond assertively but in a controlled manner helps him not to feel humiliated or put down.

This approach is similar to cognitive therapy approaches, which aim to change the way a person experiences a situation. Sometimes the parent or therapist can suggest to an older child another way to look at the intentions of the other by whom the child feels put down. This is not always effective, as many children will insist on their interpretation of the situation. Instead, the adult helps the child to respond differently so that the child then “feels” differently about herself. By being assertive or learning new social skills, the child is less likely to feel embarrassed and upset.

Teaching the child one catch phrase is an effective cognitive strategy that can be used. For many children, one such phrase is, “everyone makes mistakes.” Children with anger overload often have high standards for themselves without even realizing it. They generally are not obsessive-compulsive by nature, but they also lack the social sense about what normal expectations are for children their age.

For example, one child frequently got upset when he made a written mistake in school. Another child raged when he could not find a puzzle piece, and another when his team lost a baseball game. Teaching these children that “everyone makes mistakes” really helps. They learn to say this phrase to themselves at the time of a mistake. Often we role play this scenario ahead of time in the therapist’ s office. This strategy, like the others we’ ve discussed, takes time to work. The child may not remember to use it when he or she is upset, and once it is finally used, may forget it altogether. But over time, it will become more automatic.

Another useful phrase to use is, “Is this a good risk?” Since children with anger overload are often risk takers, they like to try new challenges, including those that are dangerous or likely to provoke a negative response from adults. One child liked to make jokes in class when someone made a “funny” mistake. His classmates would laugh louder, and the teacher would get angry and give him a consequence. The child felt this was unfair and reacted with anger. The therapist helped the child to see the cause and effect of his actions, and taught the child to evaluate the risk before making his remark. The child also learned to let others take chances and make funny remarks, rather than always taking the lead and getting punished.

Nonverbal cues can also be effective in some situations. A nonverbal cue, such as the adult putting up his hand like a policeman does to stop traffic, is more likely to work when the child is becoming upset rather than moving toward a full-blown rage. Also, the signal needs to be prearranged with the child when he is calm in order to increase the chances that the child will see the signal as benign, not as a punishment.

Future research ideas

For parents, a key factor in working with angry children is patience and practice. The techniques described above take time for parents and children to learn. The child’ s problems are probably related to developmental lags or to subtle neurological deficits. In Emotional Intelligence (1995), Daniel Goleman summarizes research with adults which suggests that the limbic system of the person’ s brain goes into overdrive when anger occurs, causing catecholamines to release. One neurological hypothesis which needs further testing for children with anger overload is whether there is a lag or deficit in their limbic systems, so that catecholamines are released more quickly or in higher concentrations than for other children. Building new behavior patterns is possible, but again takes time. Parents should notice gradual improvements towards the goal of self-control rather than feeling defeated if there is not an immediate change. It is not the parent’ s fault if the child has problems with anger. Often if the parents review their family trees, they will notice some other relative, if not themselves, who had difficulty with anger as a child. In many cases, there most likely is a genetic component. This is not to say that anger overload cannot be changed. Internal mechanisms for self-control can be learned by the child. But the approach must be methodical and requires extreme patience. Parents will feel relieved once they begin using strategies that work and realize that their children are not destined to a lifetime of anger overload.

*The “DSM-IV: Diagnostic and Statistical Manual of Mental Disorders-IV,” published by the American Psychiatric Association is the standard reference source for mental health professionals.

More information about anger overload in children can be found and answered at Dr. David Gottieb’s blog.

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Updated: October 29, 2020

What Are Disruptive, Impulse-Control and Conduct Disorders?

Disruptive, Impulse-Control and Conduct Disorders

These are a group of disorders that are linked by varying difficulties in controlling aggressive behaviors, self-control, and impulses. Typically, the resulting behaviors or actions are considered a threat primarily to others’ safety and/or to societal norms.  Some examples of these issues include fighting, destroying property, defiance, stealing, lying, and rule breaking.

These disorders are:

• Oppositional defiant disorder
• Intermittent explosive disorder
• Conduct disorder
• Pyromania
• Kleptomania
• Other specified disruptive, impulse-control and conduct disorder
• Unspecified disruptive, impulse-control, and conduct disorder

Problematic behaviors and issues with self-control associated with these disorders are typically first observed in childhood and can persist into adulthood. In general, disruptive, impulse-control, and conduct disorders tend to be more common in males than females, with the exception of kleptomania.

Behavioral issues are a common reason for referral to psychiatrists or other mental health providers. It is important to note that it can be developmentally appropriate for kids to become disruptive or defiant at times. However, disruptive, impulse, and conduct disorders involve a pattern of much more severe and longer-lasting behaviors then what is developmentally appropriate. For instance, these behaviors are frequent, occur in various settings, and can have significant consequences (including legal repercussions). It is also important to consider that anger and defiance can be manifestations of other disorders.

One difference between disruptive behavioral disorders and many other mental health conditions is that with behavioral disorders, a person’s distress is focused outward and directly affects other people. With most other mental health conditions, such as depression and anxiety, a person’s distress is generally directed inward toward themselves.

Types of Disorders

Oppositional Defiant Disorder

Oppositional defiant disorder is a common disorder in children and adolescents who are referred to mental health providers for behavioral issues. Individuals with this disorder experience varying levels of dysfunction secondary to oppositionality, vindictiveness, arguments, and aggression (1).

Symptoms of oppositional defiant disorder include a pattern of:

• Angry/irritable mood—often loses temper, easily annoyed, often angry and resentful
• Argumentative/defiant behavior—often argues with authority figures or adults, often refuses to comply with requests or rules, deliberately annoys others, blames others for mistakes or misbehavior
• Vindictiveness—spiteful or vindictive

These behaviors are distressing to the individual and alarming to others. Anger, threatening behaviors, and spitefulness cause disruption at school or work and affect relationships with others. Of note, these behaviors do not include aggression towards animals or people, destruction, or theft (2). In other words, there are no violations to others or societal norms (1). Individuals with oppositional defiant disorder, will likely experience conflict with adults and authority figures.

To be diagnosed with Oppositional defiant disorder, the behaviors must occur with at least one individual who is not the person’s sibling. Signs of the disorder typically develop during preschool or early elementary school but can also begin in adolescence (3). For children under age 5, the behaviors occur on most days for at least six months. For people 5 and older, the behaviors occur at least once per week for at least six months. The severity of this illness is based on the number of settings in which these behaviors are observed.

The cause of oppositional defiant disorder is not fully understood. However, it is believed that ODD might be secondary to several biological, psychological, and social factors (1). There are several risks associated with the development of oppositional defiant disorder: having poor frustration tolerance, high levels of emotional reactivity, neglect during childhood, and inconsistent parenting (2). ODD tends to be more common in children who live in poverty and is more common in boys than girls prior to adolescence (3). The prevalence of oppositional defiant disorder is about 3.3%.

Many, but not all, children and adolescents who have been diagnosed with oppositional defiant disorder will later be diagnosed with Conduct Disorder, which is typically considered a more severe behavioral disorder. More information on Conduct Disorder to follow. However, oppositional defiant disorder is not necessarily a chronic condition. About 70% of individuals with oppositional defiant disorder will have resolution of the symptoms by the time they turn 18 years old (3). Furthermore, about 67% of children diagnosed with oppositional defiant disorder will no longer meet diagnostic criteria within a 3 year follow up (1). Of note, adults and adolescents who have been diagnosed with oppositional defiant disorder have a 90% chance of being diagnosed with another mental illness in their lifetime (3)- especially anxiety disorders, mood disorders, substance abuse, conduct disorder, antisocial personality disorder, and other personality disorders. Individuals with oppositional defiant disorder, have higher risk of dying by suicide then the general population (3).

Oppositional defiant disorder is diagnosed by a psychiatrist or other mental health professional based on information from the individual (child, adolescent, adult) and, for children/adolescents, from parents, teachers and other caregivers. The American Academy of Child and Adolescent Psychiatry (AACAP) notes that it’s important for a child to have a comprehensive evaluation to identify any other conditions which may be contributing to problems, such as ADHD, learning disabilities, depression or anxiety (1).

Treatment of oppositional defiant disorder often involves a combination of therapy and training for the child, and training for the parents. For children and adolescents, cognitive problem-solving training can teach positive ways to respond to stressful situations. Social skills training helps children and youth learn to interact with other children and adults in a more appropriate, positive way. In some cases, medications might be necessary.

Parent management training can help parents learn skills and techniques to respond to challenging behavior and help their children with positive behavior. The training focuses on providing supportive supervision and immediate, consistent discipline for problem behavior. According to ACAAP, on–time or short programs that try to scare or coerce children and adolescents into behaving, such as tough-love or boot camps, are not effective and may even be harmful (1).

If you’re concerned about your child’s behavior, talk to your child’s doctor or a mental health professional, such as a child psychiatrist or psychologist or a child behavioral specialist.

Conduct Disorder

Conduct disorder involves severe behaviors that violate the rights of others or societal norms. Behaviors may involve aggression towards others, animals, and/or destruction of property all of which could result in legal consequences (4). As stated in the oppositional defiant disorder section, many (but not all) children and adolescents with oppositional defiant disorder will eventually meet diagnostic criteria for conduct disorder. However, not all individuals who are diagnosed with Conduct Disorder were first diagnosed with ODD (5).

Symptoms of conduct disorder include varying patterns of:

• Aggression to people and animals (bullies, intimidates others, initiates fights, use of weapons, cruelty to others, cruelty to animals, stolen while confronting a victim, raped others)
• Destruction of property (deliberate fire setting, vandalization)
• Deceitfulness or theft (broken into properties, manipulates others, stolen)
• Serious violations of rules (runs away from home, truant from school, stays out at night)

Per the DSM5, these behaviors can first be observed in pre-school. However, the more significant symptoms tend to appear between middle childhood and middle adolescents. It is rare for these symptoms to first appear after the age of 16. Conduct disorder is only diagnosed in children and youth up to 18 years of age. Adults with similar symptoms may be diagnosed with antisocial personality disorder. Early treatment can help prevent problems from continuing into adulthood.

There are multiple risk factors for the development of conduct disorder, including: harsh parenting styles, exposure to physical or sexual abuse during childhood, unstable upbring, maternal substance use during pregnancy, parental substance use and criminal activity, and poverty (5).

These behaviors cause significant dysfunction in multiple settings such as at home, in school, in relationships, and in occupational settings. However, people with conduct disorder may deny or downplay their behaviors. Conduct disorder is generally considered more serious than ODD. It can be associated with criminal behaviors, dropping out of high school, and substance abuse (). About 40% of individuals who meet diagnostic criteria for conduct disorder, will later meet diagnostic criteria for 5antisocial personality disorder (4). The prevalence of conduct disorder is between 1.5% and 3.4%. It tends to be more common in males. About 16-20% of youth with conduct disorder also have ADHD (5). Of note, youth that have both ADHD and Conduct Disorder have higher risk of substance use.

Therapy can help children learn to change their thinking and control angry feelings. Treatment may include parent management training and family therapy, such as Functional Family Therapy. Functional Family Therapy helps families understand the disorder and related problems, teaches positive parenting skills and helps build family relationships. It can help families apply positive changes to other problem areas and situations.

Intermittent Explosive Disorder

Intermittent explosive disorder is a disorder associated with frequent impulsive anger outbursts or aggression- such as temper tantrums, verbal arguments, and fights (2). The observed behaviors result in physical assaults towards others or animals, property destruction, or verbal assaults (6). The aggressive outbursts:

• are out of proportion to the event or incident that triggered them
• are impulsive
• cause much distress for the person
• cause problems at work or home.

It is important to note that these aggressive behaviors are not planned, they are impulsive and anger based (7). They happen rapidly after being provoked and typically do not last longer than 30 minutes (2). These outbursts must be associated with subjective distress or social or occupational dysfunction (7). Affected individuals tend to have poor life satisfaction and lower quality of life (7).

In order to meet diagnostic criteria, affected individuals must be at least 6 years old or the developmental equivalent (2). However, this disorder is usually first observed in late childhood or adolescence (2). The one-year prevalence is 2.7% and lifetime prevalence is 7% (8).

Many risk factors have been identified with the development of Intermittent Explosive Disorder, such as: being male, young, unemployed, single, having lower levels of education, and being victim of physical or sexual violence (6). Intermittent explosive disorder is associated with anxiety and bipolar disorders (6). Individuals with this disorder have higher risks of developing substance use disorders than those without it (7).

Treatment typically involves cognitive behavioral therapy focusing on changing thoughts related to anger and aggression and developing relaxation and coping skills. Sometimes, depending on a person’s age and symptoms, medication may be helpful.

Pyromania

While fire setting can be a common issue among young individuals and a cause of significant destruction in the United States, it is different from pyromania which is a rare disorder that involves repeated impulses or strong desires to set intentional fires (9) Fire setting is typically motivated by curiosity and tends to occur in unsupervised children with access to lighters and matches (9). Individuals with pyromania, on the other hand, are fascinated by fire and its uses. Affected individuals engage in repeated and deliberate fire setting that is not motivated by external reasons (10). They experience strong urges to engage in dangerous fire setting. They also experience internal tension prior to setting fires that is followed by pleasure after fires are lit. These individuals set fires to release built-up inner emotional tension, not for any type of material gain or revenge.

Some known risk factors for pyromania are male gender, substance use, victim of abuse, being fascinated with fires, and having mental illness (11). The prevalence of pyromania is about 1% in the United States (9). It is associated with personality disorders or traits (especially antisocial personality disorder or antisocial behaviors), conduct disorder, and substance use disorders (9).

Treatment of pyromania usually involves cognitive behavioral therapy and education. The therapy can help people become more aware of the feelings of tension and find ways to cope. Every child should be taught about the dangers of playing with fire and possible consequences (9).

Kleptomania

Kleptomania is a rare disorder that involves involuntary, impulsive, and irresistible stealing of objects that are not needed for personal or other forms of use. This is different from shoplifting in that shoplifters steal for some form of gain and often plan out their actions (12). However, individuals with Kleptomania do not need what they have stolen. They often give away, return, hide, or hoard the stolen objects (13). People with kleptomania know what they are doing is wrong but cannot control the impulse to steal, leading to hasty and poorly thought-out stealing (12). They experience internal tension before stealing that is then relieved after the theft. While they experience pleasure or gratification from stealing, they tend to have guilt or sadness afterwards (13). Many people with this disorder may try to stop stealing but feel guilt and shame about their inability to do so (13). Unfortunately, many may be apprehended or jailed for these behaviors (13).

This disorder tends to appear in adolescence. However, its onset can vary significantly between childhood and old age (13). The prevalence of this disorder is not known, but it is believed to be a generally uncommon diagnosis (12) that may be more common in females and psychiatric patients (13). Many with this disorder also have substance use disorders, mood disorders, and first-degree relatives with substance use disorders and OCD (13). Symptoms tend to be more severe when patients also experience anorexia nervosa, bulimia nervosa, and obsessive-compulsive disorder (12). The disorder can be chronic if not treated (13). Treatment for this disorder varies between medications and therapy.

Other disorders in the category include pyromania and kleptomania. These involve problems with controlling for specific behaviors.

Pyromania involves repeatedly setting fires on purpose. People with pyromania may have an unusual interest in or fascination with fires. They set fires to release built-up inner emotional tension, not for any type of material gain or revenge.

Treatment of pyromania usually involves cognitive behavioral therapy. The therapy can help people become more aware of the feelings of tension and find ways to cope.

Kleptomania involves stealing objects that are not needed. People with kleptomania know what they are doing is wrong but cannot control the impulse. The disorder often begins in teenage years and is three times more common among women than men.

Related Conditions

References

1. Steiner H, Remsing L; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):126-141. doi: 10.1097/01.chi.0000246060.62706.af. PMID: 17195736
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 2013.
3. Riley M, Ahmed S, Locke A. Common Questions About Oppositional Defiant Disorder. Am Fam Physician. 2016 Apr 1;93(7):586-91. PMID: 27035043.
4. Steiner H, Dunne JE. Summary of the practice parameters for the assessment and treatment of children and adolescents with conduct disorder. J Am Acad Child Adolesc Psychiatry. 1997 Oct;36(10):1482-5. doi: 10.1097/00004583-199710000-00037. PMID: 9334562.
5. Lillig M. Conduct Disorder: Recognition and Management. Am Fam Physician. 2018 Nov 15;98(10):584-592. PMID: 30365289.
6. Scott, K. M., de Vries, Y. A., Aguilar-Gaxiola, S., et al. World Mental Health Surveys collaborators (2020). Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment, and suicidality. Epidemiology and psychiatric sciences, 29, e138. https://doi.org/10.1017/S2045796020000517
7. Rynar L, Coccaro EF. Psychosocial impairment in DSM-5 intermittent explosive disorder. Psychiatry Res. 2018 Jun; 264:91-95. doi: 10.1016/j.psychres.2018.03.077. Epub 2018 Mar 30. PMID: 29627702; PMCID: PMC5983894.
8. Fanning JR, Coleman M, Lee R, Coccaro EF. Subtypes of aggression in intermittent explosive disorder. J Psychiatr Res. 2019 Feb; 109:164-172. doi: 10.1016/j.jpsychires.2018.10.013. Epub 2018 Oct 19. PMID: 30551023; PMCID: PMC6699742.
9. Merrick J, Howell Bowling C, Omar HA. Fire setting in childhood and adolescence. Front Public Health. 2013 Oct 8;1:40. doi: 10.3389/fpubh.2013.00040. PMID: 24350209; PMCID: PMC3859988.
10. Blum AW, Odlaug BL, Grant JE. Cognitive inflexibility in a young woman with pyromania. J Behav Addict. 2018 Mar 1;7(1):189-191. doi: 10.1556/2006.7.2018.09. Epub 2018 Feb 21. PMID: 29464963; PMCID: PMC6035016.
11. Peters B, Freeman B. Juvenile Fire setting. Child Adolesc Psychiatry Clin N Am. 2016 Jan;25(1):99-106. doi: 10.1016/j.chc.2015.08.009. Epub 2015 Oct 21. PMID: 26593122.
12. Grant JE, Chamberlain SR. Symptom severity and its clinical correlates in kleptomania. Ann Clin Psychiatry. 2018 May;30(2):97-101. PMID: 29697710; PMCID: PMC5935224.
13. Grant JE. Understanding and treating kleptomania: new models and new treatments. Isr J Psychiatry Relat Sci. 2006;43(2):81-7. PMID: 16910369.

Physician Reviewed

Rana Elmaghraby, M.D. and
Stephanie Garayalde Parekh, M.D., M.P.H.
September 2021

90,000 Adolescent mental health

Introduction

Adolescence (10–19 years) is a unique period of personality formation. A wide variety of physical, emotional and social changes, including exposure to poverty, abuse or violence, can increase adolescents’ vulnerability to mental health problems. Improving the psychological well-being of adolescents and protecting them from severe shocks and risk factors that can affect their chances of successful development are essential for their well-being in adolescence and their physical and mental health in adulthood.

Determinants of mental health

Adolescence is a critical period in the development and establishment of social and emotional habits that are important for mental well-being. These include promoting healthy sleep patterns; regular physical activity; developing skills in overcoming difficult situations, problem solving and interpersonal communication; and fostering the capacity for emotional self-control. Favorable conditions in the family, school and the surrounding society in general are also important.Approximately 10–20% of adolescents worldwide have mental health problems that are not properly diagnosed and not adequately treated (1).

The mental health of a teenager is determined by a number of factors. The increase in the number of risk factors affecting adolescents exacerbates their potential mental health consequences. Factors that can increase stress levels in adolescence include a desire for greater autonomy, a desire to meet peer expectations, the search for sexual identity, and the increasing availability and use of technology.The influence of the media and gender norms can exacerbate the mismatch between the reality in which the adolescent lives and his aspirations or visions of the future. Other significant determinants of adolescent mental health are the quality of their family life and their relationships with peers. Recognized mental health risks are violence (including harsh parenting and peer bullying) and socioeconomic issues. Children and adolescents are particularly vulnerable to sexual abuse, which undoubtedly entails worsening mental health.

Some adolescents are at increased risk of mental health problems due to living conditions, stigma, discrimination or social exclusion, or lack of access to quality care and services. This applies to adolescents living in humanitarian crises and instability; adolescents suffering from chronic illness, autism spectrum disorder, mental retardation or other neurological disorders; pregnant adolescents, adolescents who have become parents or entered into an early and / or forced marriage; orphans; and adolescents from ethnic or sexual minorities or other discriminated groups.

Adolescents with mental health problems, in turn, are particularly vulnerable to such phenomena as social exclusion, discrimination, stigma (limiting their willingness to seek help), learning difficulties, risky behaviors, physical illness and human rights violations.

Emotional disorders

Emotional disorders often develop during adolescence. In addition to depression or anxiety, adolescents with emotional disorders may also experience increased irritability, frustration, or anger.Symptoms can resemble several emotional disorders at once and are characterized by rapid and unexpected mood swings and outbursts of emotion. Young adolescents may additionally experience emotionally related physical symptoms such as abdominal pain, headache, or nausea.

Depression ranks fourth in the world among the leading causes of morbidity and disability among adolescents aged 15-19 and 15th among those aged 10-14. Anxiety disorders are the ninth leading cause of mental health problems among adolescents aged 15–19 and the sixth leading cause of mental health problems among adolescents aged 15–19 years.Emotional distress can greatly affect, for example, school attendance and performance. Isolation and feelings of loneliness can be exacerbated by social alienation. In the most severe cases, depression can lead to suicide.

Childhood Behavior Disorders

Childhood Behavior Disorders are the second leading cause of disease burden among adolescents aged 10–14, and eleventh among adolescents aged 15–19.Childhood behavioral disorders include attention deficit hyperactivity disorder (which is characterized by problems concentrating, hyperactivity, and acting without regard for consequences that are unacceptable at that age) and conduct disorders (with symptoms of destructive or challenging behavior). Childhood behavioral disorders can negatively affect the learning of adolescents and can lead to unlawful behavior.

Eating disorders

Eating disorders usually occur during adolescence and adolescence.Eating disorders are more common in girls than in boys. Disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are characterized by unhealthy eating behaviors such as restricting calorie intake or eating out of control. Eating disorders are detrimental to health and are often associated with depression, anxiety disorders and / or substance abuse.

Psychotic disorders

Disorders characterized by psychotic symptoms most often occur in late adolescence or adolescence.Symptoms of psychosis can include hallucinations or delusional disorders. Psychotic episodes can seriously impair the adolescent’s ability to participate in daily life and receive education. In many cases, they lead to stigma or human rights violations.

Suicide and self-harm

An estimated 62,000 adolescents died from self-harm in 2016. Suicide is the third leading cause of death among older adolescents (15–19 years).Nearly 90% of the world’s adolescents live in low- and middle-income countries, and over 90% of adolescent suicide cases occur among adolescents living in these countries. Risk factors for suicide are diverse and include harmful use of alcohol, childhood abuse, stigmatization in seeking help, barriers to assistance, and the availability of means of committing suicide. Associated with this age group is a growing concern about the dissemination of information about suicidal behavior through the electronic media.

Risk Behaviors

Many health risk behaviors, such as substance use or risky sexual behavior, have their origins in adolescence. Risky behaviors can be both unsuccessful attempts to cope with mental health problems, or negative factors with dire consequences for the mental and physical well-being of the adolescent.

In 2016, the prevalence of heavy episodic alcohol use among adolescents aged 15-19 years worldwide was 13.6%, posing the greatest threat to boys and young men.

The use of tobacco and cannabis is also of particular concern. Cannabis is the most common drug among young people, having been used by 4.7% of young people aged 15-16 at least once in 2018. Many adult smokers tried their first cigarette before the age of 18.

Committing violence is a risky behavior that can increase the likelihood of low levels of education, injury, involvement in illegal activities, or death.In 2016, interpersonal violence was recognized as the second leading cause of death in older adolescents.

Mental health promotion and prevention

Mental health promotion and prevention are designed to strengthen a person’s ability to control their emotions, expand the range of alternatives to risky behaviors, develop resilience to successfully cope with difficult situations or adversities, and contribute to the formation of a supportive social environment and systems of social relationships.

These programs should be implemented at many levels using a wide variety of platforms, such as electronic media, health and social services, educational institutions or communities, and various strategies to ensure that they reach adolescents, especially among the most vulnerable groups.

Early detection and treatment

Responding to the needs of adolescents with identified mental health problems is essential.The basic principles for working with adolescents are to avoid institutionalization, prioritize the use of non-pharmacological methods and ensure that children’s rights are respected in accordance with the United Nations Convention on the Rights of the Child and other human rights instruments. The WHO Mental Health Gap Action Program (mhGAP) provides evidence-based guidance for non-professionals to better identify serious mental health disorders and provide care in low-resource settings.

WHO Action

WHO develops strategies, programs and tools to help governments provide adolescents with the health care they need. The main resources in this regard are:

For emergency response, WHO has developed tools for:

All of these publications deal with issues affecting young people.

(1) Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative.World Psychiatry 2007; 6: 168-76.

Aggressive behavior in mental disorders (biological mechanisms, symptoms, syndromological structure, nosological affiliation, therapy, rehabilitation, prevention)

Article published on p. 19-23 (World)

Aggressive behavior is a nonspecific phenomenon that is carried out according to psychological laws and is socially determined.The problem in clinical psychiatry is that various manifestations of aggression occur in 60% of patients with mental disorders. In a wide range of social manifestations of aggressive behavior in general, a certain place is occupied by the aggressiveness of persons with certain, frequently occurring mental disorders. During political crises and armed conflicts, the role of aggression in persons with adjustment disorders, post-traumatic stress disorder, and personality anomalies becomes socially significant.

The paper analyzes the issues of taxonomy, clinical diagnosis, treatment and prevention of aggressive behavior in various mental disorders and behavioral disorders.

The article is intended for psychiatrists, general practitioners – family medicine, clinical psychologists and social workers.

Definition of concepts [2, 6, 8, 11, 30, 35, 44, 52, 54]

Aggression is a social form of human behavior aimed at other objects and with the goal of causing harm.

Aggressiveness is a personality trait that can be defined as a stable attitude, attitude, readiness to commit aggressive actions.

Violence is an aggressive act of a physical or psychological nature that is undesirable for the victim, restricts her will and is considered illegal in the legal, psychological and moral sense.

Destruction is an extreme form of aggressive actions and aggressive behavior, and destructiveness is an extreme state of aggressiveness and cruelty, with a special tendency to destroy and destroy values ​​and people.

Vandalism is a strong aggressive desire to destroy cultural property, everything that is incomprehensible and unacceptable.

Frustration is a mental state in which a person finds himself when his purposeful activity is blocked. Unfavorable factors that impede this activity are called frustrators.

Interpersonal conflict – a form of mutually hostile interaction between people, based on the contradiction of the positions of opponents.

The purpose of this work is to analyze the general psychological structure of aggressive behavior, the features of its symptoms in mental disorders, syndromological and nosological specificity to substantiate recommendations for timely diagnosis, individually adequate treatment, rehabilitation and prevention of this disorder in mental illness.

Semiotics of aggressive behavior in psychology

Aggressive behavior includes two aspects [6, 9, 11, 30, 44, 52].

The intrinsic motivational aspect includes motives (for example, desires) and goals of aggressive actions, as well as feelings and emotions (for example, hatred, anger, anger, rage) that lead to destructive actions, determine their duration, intensity and destructive force.

The external or behavioral aspect includes aggressive actions, including speech, then we are talking about speech or verbal aggression, or physical destructive actions, which are defined as physical aggression.

Characterizing the general goals of aggressive behavior from the standpoint of the theory of frustration, it should be stated that aggression occurs when a person is affected by unfavorable environmental factors that block his purposeful activity. Such a factor is defined as a frustrator. Aggression is aimed at eliminating this unpleasant factor [2, 6, 20, 26, 30, 35, 40, 52].

Analyzing the motives of aggressive behavior, a number of options can be identified [2, 6, 9–11, 14, 17, 20, 30, 35, 40, 43, 52, 53].

First of all, aggression is a manifestation of agonistic behavior in a conflict. At the same time, a conflict situation is created by a contradiction in the positions of the parties. An event that is defined as an incident leads to an open conflict.

Envy is an important cause of aggression. This social attitude is associated with the experience of relative or absolute deprivation of the personality. At the same time, the successes of the other are compared with their own achievements, and this is assessed as a violation of the principle of justice.Envy includes a component of hostility.

The emotional components of aggression include a number of interrelated elements [6, 8, 14, 15, 17, 20, 30, 35, 41, 44, 52, 53].

First of all, it should be noted anger, rage and anger. They arise when an obstacle appears on the way to achieving the goal, and are directed against the frustrator. The actions of other people that cause these feelings are defined by the concept of stress-frustrating. First of all, they include insult and deception.

Disgust and contempt for the object of aggression are formed.

Anger gradually accumulates and at some point leads to an affective explosion with a cascade of aggressive actions. At the same time, against the background of the affect of rage, there is a kind of affective narrowing of consciousness with the concentration of mental activity on the object of aggression, a sharp decrease in the ability for awareness and volitional control of behavior.

A characteristic systemic complex of emotions arises, defined in psychology as a triad or a complex of hostility. In its structure, the leading emotion is anger (rage), and the factors contributing to an aggressive behavioral outburst are disgust and contempt, which is revealed in the affect of anger.

Hatred is an emotional-cognitive complex, a complex social attitude. The concept of “pathological hatred” is distinguished. This is such a level of this affect when it becomes a dominant relation both to oneself and to others.

As a result of repeated frustrations, some individuals accumulate in their psyche generalized anger, chronic anger. At the same time, neutral situations, objects and people are perceived as hostile. This phenomenon is defined as free-floating anger.

Aggressive behavior is determined by the system of cognitive components [2, 6, 8–11, 17, 20, 23, 26, 30, 33, 35, 40, 43, 47, 52, 53].

Ideological attitudes are significant, in particular, the attitude brought up in the course of social development to aggressive behavior as a means of achieving life goals. At the same time, the attitudes defining aggression obey the well-known paradox of R. Lapierre. It consists in the fact that very often the installation does not lead to appropriate actions.Moreover, people even do the opposite.

An important part of the cognitive processes leading to aggression is cognitive dissonance. At the same time, there is a contradiction between thoughts about one object, up to the opposite direction.

Its particular manifestation is the phenomenon of dissonance of injustice. At the same time, due to the violation of the subjective interpretation of the criteria of justice, the successes of the object of envy seem to be unfair.

Awareness is a significant component of cognitive activity that determines aggressive behavior.

Thus, a person is aware of his hatred, but does not analyze the underlying social attitudes, such as envy.

When envy is realized, a person admits his lag, incompetence, lack of ability. This creates an inferiority complex that creates a constant readiness to experience envy and intensifies envy.

An important cognitive mechanism of aggression is identification, when certain qualities are attributed to the object of aggression.Negative identification is characteristic, when the object is recognized as such that it is impossible, it is undesirable to be. Negative qualities are attributed to him from the point of view of the subject of aggression [6, 10, 11, 20, 30, 33, 35, 40, 41, 52].

A significant phenomenon in the psychology of aggression is the attribution of the victim, when negative traits and motives are attributed to the object of aggression.

In the case of direct conflict, one of the cognitive mechanisms supporting aggression is projective attribution, when the victim is blamed for the conflict.

The function of attention is of great importance. So, when a person manages to direct attention to his anger, ideas about the norms that control and restrain aggression manage to appear in his consciousness [6, 11, 14, 20, 30, 33, 35, 40, 41, 44, 53].

Closely related is the process of introspection with the concentration of mental activity on certain experiences. At the same time, intense introspection removes these experiences. Thus, pondering the norms of social behavior and anticipating the negative consequences of the forthcoming act of aggression destroy anger [6, 9–11, 17, 20, 30, 35, 40, 44, 50, 52, 53].

The development of a kind of regression phenomenon is characteristic of the dynamics of aggressive behavior. This is the process of returning the personality to previous, earlier and primitive levels of mental development of behavior, thinking and experiences [6, 8, 10, 17, 20, 30, 35, 44, 50, 52, 53].

The leading predispositional factor of aggressive behavior is the aggressiveness of the individual. In aggressive individuals, a hostile tendency prevails in interpersonal relationships, aggressive reactions are generalized [6, 8, 9, 11, 14, 15, 20, 30, 33, 35, 40, 41, 43, 52, 53].

Signs of high aggressiveness of a person are considered to be a tendency to destroy interpersonal ties, intolerance, a slight impulsive occurrence of acts of violence, irritability.

The so-called sensory hunger is characteristic – a constant thirst for new experiences. As a rule, there are strong, poorly controlled sexual desires. The late formation of the tidiness skill with the presence of neurosis-like nocturnal enuresis until early adolescence is described as a predictor of increased aggressiveness.

A number of personality traits are known that increase aggressiveness [6, 8, 9, 14, 15, 17, 20, 30, 33, 43, 52, 53].

This is anxiety with a constant expectation of problems and troubles, with a slight appearance of fear of specific objects and circumstances, up to the level of cowardice.

Aggressive assertiveness presupposes a tendency to act self-confidently and energetically, tirelessly strive for the goal, not disdaining the violation of the rights of others and the elimination of rivals from its path.

Mention should be made of the rigidity of cognitive processes, emotional states, attitudes and views with a low level of self-criticism and a tendency to one-sided, emotional, simplified assessment of the situation [8, 14, 15, 30, 35, 40, 41, 44, 47, 50, 52, 53 ].

An alternative to aggressive attitudes is created by empathy – the ability to empathize as a personality trait. Empathic ability and aggressiveness in the structure of the personality are in a state of so-called negative conjugation.The more aggressiveness is expressed, the less empathy is developed. With an increase in empathy, aggressiveness is weakened [6, 8, 9, 14, 15, 19, 20, 30, 33, 35, 40, 41, 44, 52, 53].

In the course of personality development, the suppression of certain features as unacceptable from the standpoint of social attitudes and life goals of a person is noted. Being subjected to the action of a well-known repression mechanism, these features lose their relevance, but do not disappear. A separate personality structure is formed, as a rule, alternative to the actual traits of a person’s character (the so-called “second self” of the individual).These repressed personality traits can be actualized in a state of emotional stress (in particular, envy, hatred, anger), contributing to the implementation of aggressive behavior [6, 8, 14, 20, 30, 35, 44, 50].

Characterizing the behavioral aspect of aggression, three types of aggression based on motives should be distinguished [6, 8, 11, 30, 35, 41, 43, 44].

Emotional (hostile) aggression comes from an internal emotional state (anger, hostility, hatred), the only purpose of aggressive actions is to harm another person.At the same time, it is practically significant to distinguish two types of emotional aggression.

Immediate impulse emotional aggression manifests itself immediately, violently and often irrationally, a person does not think about the consequences and expediency of his actions.

Delayed hostile (emotional) aggression: at the same time, the person’s internal mechanisms of prohibition are activated, and he postpones his aggression, temporarily suppresses it.

Instrumental (functional) aggression serves other non-aggressive purposes.The subject of aggression has a hierarchy of goals, including the main (non-aggressive) goal and secondary (aggressive) goals. Aggressive goal and aggressive behavior serve the main goal.

Mixed aggression (emotional and instrumental). Aggressive behavior has several equivalent (equally valuable for the individual) motives. One emotional goal can be combined with several important instrumental goals.

Forms of aggressive behavior should be classified on three scales [6, 9, 14, 30, 35, 41, 43, 44]:

a) physical – verbal;

b) active – passive;

c) direct – indirect (indirect).

With open aggression, aggressive actions are available for external observation.

Indirect aggression includes defamation, incitement of others to aggression, aggressive innuendo, refusal to comply with a request, causing harm.

A separate phenomenon is redirected (replacing) aggression, when the vector of aggression is directed not at the frustrator, but at another object that replaces it (the so-called “scapegoat”) [6, 11, 30, 35, 44].

In this case, the replacement object meets three criteria:

1) the similarity of the substitute object with a true frustrator;

2) the new object plays a role in the frustration;

3) the replacement object has a reduced ability to retaliate.

Verbal aggression pursues the following goals: devaluation of the personality, insult (discrediting), humiliation of dignity, expression of threat [6, 8, 9, 11, 14, 30, 35, 41, 50]. In this case, culturally formed invectives (swear words) are often used.

An essential component of the development of a conflict is verbal provocation in the form of insults and criticism.

The transition from verbal to physical aggression includes regular stages: insults – retaliatory insults – quarrel – mutual threats – physical attack [6, 9, 30, 40, 41, 43, 44].

Physical aggression itself includes complex complexes of non-verbal behavior, reflecting three stages in the development of a physical attack [6, 8, 14, 15, 41, 42].

Aggressive and warning elements: gaze, facial expressions of determination, gestures of threat, posture of aggression.

Aggressive conflict elements: approach, facial expressions of tension, sharp turn, gestures of threat.

Aggressive contact elements: attack, blow, bite.

Accordingly, the result of aggressive behavior can be destruction or violence [2, 6, 9, 30, 33, 40, 41, 50].

At the same time, there are four types of violence: physical, mental, sexual and informational (including media violence through the media) [2, 9, 11, 30, 33, 35, 50, 52].

Mechanisms of aggressive behavior

Psychoanalytic concepts of the causes of aggression include the theoretical provisions of Z. Freud about the presence of the death instinct in a person – thanatos as a constant source of aggressive impulses [6, 9, 30, 44, 50, 52].

In accordance with the teachings of K.Jung about the collective unconscious, archetypes as carriers of myths and legends carry the ideas of aggression and pansexuality [2, 20, 30, 35, 44, 50, 52].

The biological mechanisms underlying aggressive behavior include a number of interrelated components [6, 9, 11, 30, 35, 52].

Neurodynamic processes include the structures of the Papez-McLinney limbic-diencephalic circle. The activation of the temporal structures (amygdala and hippocampus), predominantly of the left hemisphere, is noted.In the future, the involvement of the centracephalic structures (primarily the reticular formation and diencephalic divisions) is noted. The activation of the diencephalic structures ensures the participation of the autonomic nervous system (mainly the sympathoadrenal region) and the activation of endocrine reactions with increased release of glucocorticoids by the adrenal cortex [5, 7, 34, 51].

Electrophysiological processes are characterized by hypersynchronous neuronal activation and increased theta rhythm. This is associated with a decrease in the inhibitory function of the structures of the right hemisphere and caudate nucleus [6, 11, 30].

In characterizing the neurochemical mechanisms of aggressive behavior, mention should be made of the increased aggressiveness upon activation of the dopaminergic and nor-adrenergic systems. Activation of the serotonergic system is accompanied by increased volitional control over aggressive impulses. The GABAergic system provides anxiolytic and general sedative effects [3, 4, 6, 10, 11, 13, 17, 26-30, 36, 39].

Various manifestations of aggressive behavior are characterized by regular changes in the individual profile of interhemispheric-diencephalic interaction [7, 13, 26, 51, 52].

Thus, a shift in the gradient of interhemispheric asymmetry towards activation of the left hemispheric-reticular structures correlates with an increase in psychomotor activity, muscle and emotional tension, an increase in anxiety with a facilitated occurrence of hypersthenic and explosive reactions, an increase in the catatimity of thinking with the emergence of persecutory ideas.

The activation of the right-hemispheric-diencephalic structures is accompanied by muscle and mental relaxation, a decrease in psychomotor activity, dominance in the spectrum of emotional responses of melancholy and apathetic components, with sadness about the past, a critical assessment of one’s own actions and capabilities.

Aggressive behavior in mental disorders

Symptoms of aggressive behavior in mental illness are rather nonspecific. Conventionally, two circles of symptoms can be distinguished [8, 14, 15].

Symptoms-predictors of aggressive behavior

Should be alarming: unexpected changes in behavior, the appearance of signs resembling intoxication, wearing sunglasses. Signs of possible upcoming aggression can be: excitement, restlessness, loud or quiet speech, anger, direct threats expressed aloud [11, 41, 43].

Immediate symptoms of aggression [8, 10, 11, 14, 15, 26, 40–43, 45, 47, 53]

Elementary signs of non-verbal behavior are analyzed separately. Frequent shallow breathing, malicious intonation of speech should be noted. Aggressive posture for contact in a standing position: fists clenched, arms bent and brought, shoulders raised; on contact in a sitting position: muscle tension in the shoulder girdle, hands in a fist, forward bend.

Simple complexes of non-verbal behavior during aggression include: reducing individual distance, tense facial expressions and facial expressions of determination, gaze from under the brow, gestures of threat and detachment.

Characterizing the syndromological features of aggressive behavior in mental disorders, it should be noted that there are qualitative differences in the structure of aggression in psychosis and non-psychotic disorders [8, 11, 13-15, 41, 47, 53].

In psychosis, aggressive behavior is mainly due to psychopathological symptoms. It should be noted that the emergence and realization of aggression is facilitated by the features of the symptom complex, known as differential diagnostic criteria for psychosis [8, 13–15, 41, 47, 53].

Positive symptom severity registers include syndromes with aggressive tendencies. These are states of confusion, catatonic and hebephrenic, para-phrenic, hallucinatory-paranoid, paranoid-delusional, psychotic affective, verbal hallucinosis [8, 13-15, 40, 41, 45, 47, 53].

In international diagnostic classifications and statistical manuals, these psychopathological formations are defined as psychotic symptoms, including: hallucinations and delusions, catatonic symptoms, psychomotor agitation or retardation [10, 12, 18, 21, 34, 43, 46, 54].

One of the leading signs of psychosis is the absence of a critical assessment of the disease state, while the awareness of the painful nature of psychopathological symptoms disappeared, the ability to give an ethical assessment of one’s actions and predict their consequences was lost.

An essential feature is the loss of the ability to volitional control of behavior when actions are determined by psychopathological symptoms.

In general psychopathology, the total nature of changes in almost all spheres of mental activity in psychosis is noted.The changes are in the nature of a qualitative leap with the appearance of a kind of new personality (bearing the features of the patient’s “second self”) [8, 13–15, 41, 45, 47, 53].

Of the syndromes of confusion of consciousness, aggressive behavior is most characteristic of the twilight disorder of consciousness. This syndrome occurs in the so-called special conditions in forensic psychiatric practice: subsonic state, pathological intoxication, pathological affect, short circuit reactions [8, 14, 15, 41, 45, 47].

The destructive nature of aggressive actions is due to: the affect of rage and horror, sharp epileptiform excitement, the persecutory content of hallucinatory delusional experiences with the theme of a threat to the life of the patient and his loved ones. The cruelty of actions does not correspond to the characterological characteristics and moral attitudes of the patients. After the recovery of consciousness, patients often claim that these actions were performed by someone else.

For delirious syndrome, aggressive actions are uncommon.Only with a threatening theme of hallucinations and delusions in the structure of hallucinatory behavior are defensive destructive actions possible [8, 14, 15].

Catatonic syndromes are often combined with aggressive behavior, which is often unmotivated, like parabulia. A significant clinical phenomenon is impulsivity with sudden committing of serious aggressive and auto-aggressive, destructive and destructive actions. Correlate with high aggressiveness stupor with numbness and negativism (especially with the phenomena of active negativism).Dangerous impulsive catatonic excitement, accompanied by destructive actions; hebephrenic arousal and stereotypical catatonic arousal with striking. Aggressive actions are often performed when the catatonic stupor is replaced by catatonic excitement [8, 13, 26, 41, 45, 47, 53].

The phenomena of the Kandinsky-Clerambault syndrome in some cases are accompanied by aggressiveness in the structure of hallucinatory and delusional behavior [8, 13-15, 26, 41, 45, 47, 53].

Verbal pseudo-hallucinations are accompanied by aggressive behavior in the case of interpretive pseudo-voices ordering destructive actions.Verbal pseudo-hallucinations in the form of voices that control the patient and forbid talking about the symptoms are dangerous.

Mental automatisms can include motor control with compulsion to commit destructive actions.

High aggressiveness of patients with illusory-delusional and illusory-fantastic depersonalization in combination with delusions of metamorphosis and obsession was noted. In this case, the patient is transformed into another negative fantastic entity, in the nature of which negative traits of the patient’s “second self” may appear [8, 13–15, 41, 45, 47].

Of the paraphrenic syndromes, the patient’s high aggressiveness is characterized by pseudo-hallucinatory paraphrenia with non-verbal symptoms of paranoid sarcasm and “satyr’s grin” [8, 13–15, 41, 45].

Aggressive behavior, often of an impulsive type, can be accompanied by acute sensory delusions of staging, accusations, persecution, exposure, especially in the structure of the acute Kandinsky-Clerambo syndrome and at the stage of the formation of a chronic variant of this syndrome [8, 13-15].

To predict aggressive behavior, characteristic non-verbal symptoms of a hallucinatory-paranoid symptom complex can be used: postures of focused attention, meditation and aggression; look into the eyes when the eyebrows are frowned and the palpebral fissure is widened; clenching the hand into a fist; tense speech; intense facial expressions of interest, attention, determination with dissociation of facial expressions of the top and bottom of the face [8, 13–15].

Acute interpretive delusions are often accompanied by aggressive behavior.It should be noted the tendency to aggression of patients with delusions of detective persecution in the form of surveillance using technical means [8, 13-15, 41, 45, 47].

Patients with acute interpretive delusions of exposure to specific persons from the immediate environment are aggressive.

Delayed aggression is common in Capgras syndrome with acute interpretive delusion of doubles and Fregoli’s symptom, when the patient, in accordance with the detective plot of delusional constructions, believes that persons from the immediate environment are replaced by doubles.

Aggressiveness of the patient increases with the appearance of an acute interpretive development of ideas of sensual delirium. A sign of this is a change in anxiety and confusion with demonstrative-pathetic behavior and a search for help by a state of suspicion with a hyponoic position of distrust, evasive answers, the appearance of hostility and malice when the interlocutor tries to detail the patient’s painful experiences.

Significant aggressiveness is characteristic of patients with chronic interpretive delusions.The most aggressive are patients with ideas of poisoning, causing a disease by magic using specific occult manipulations, and compromising the patient by spreading defamatory rumors [8, 13–15, 41, 45, 47].

A significant predictor of aggressive behavior is the detective behavior of a delusional patient, when he himself is observing, trying to hide from surveillance, and turning off eavesdropping devices.

Non-verbal signs of latent aggression in delirium are: prolonged gaze, glance from under the brows, lifting the shoulders, chewing movements with the lower jaw moving forward, clenching the hand into a fist [8, 13–15, 41, 42].

Verbal hallucinosis can be accompanied by aggressive behavior of the patient with threatening and imperative voices [8, 13–15, 41, 42, 47].

Therefore, the predictor of aggressive behavior should be considered the well-known non-verbal signs of auditory hallucinations: the patient listens, looks away, talks with an invisible interlocutor.

In paranoid syndrome, the features of aggressive behavior depend on the subject of pathological ideas [8, 13–15, 41, 42, 45, 47].

With the delirium of jealousy, there is a characteristic brutal aggressive behavior with a sadistic component of aggression. Detective behavior is noted with tracking the object, searching for evidence of treason. A practically specific feature is repeated prolonged and cruel interrogations of the object with the use of psychological and physical violence (essentially torture) with the desire at any cost to obtain a confession of a violation of sexual fidelity. These episodes are accompanied by sexual arousal of the patient, cause him a kind of pleasure and often end in intimacy with the object.Forced recognition of the object causes a temporary feeling of relief in the patient.

In most cases, physical aggression takes place as revenge for treason in relation to the patient’s partner, and in some cases, to the alleged adjuctor. The victims are seriously injured up to and including murder. Patients are characterized by suicidal activity in the form of affective self-destructive actions during interrogations or in the form of true suicidal attempts after reprisals against the victim.

In a paranoid syndrome with delusions of persecution and small-scale material damage, when the ideas of the struggle for justice dominate, indirect aggression dominates in the form of discrediting the object in the course of litigious activities. During direct conflicts, verbal aggression is more often used. Characterized by provocative behavior, when using verbal provocation, the object is pushed to the use of physical violence against the patient, which in the future is a precedent for litigation.Characterized by the transitivism of indirect aggression, when an increasing number of persons, including employees of administrative and legal structures, who analyzed the patient’s complaints, become the targets of litigious activities.

Manic syndrome can be accompanied by aggressive behavior within the symptom of abuse as a response to the restriction of the patient’s freedom. Most often, aggressive actions occur in a state of angry mania against the background of an ironic and critical attitude towards the environment. Aggression is more often verbal and redirected in nature and is realized in the form of short-term outbursts.Aggressive behavior is promoted by disinhibition of drives, superficial thinking with an inability to assess one’s actions and predict their results, and weak volitional control over emotional discharges [8, 13–15, 41, 42, 47].

Destructive actions in manic frenzy indicate the presence of a complex syndrome with the addition of catatonic excitement and impulsivity.

Depressive syndrome can be accompanied by destructive destructive actions in melancholic raptus within the dynamics of psychotic melancholy depression and as a result of agitation in anxious depression [8, 9, 14-16, 23, 27, 36, 52, 53].

A dramatic and, fortunately, a rare complication of psychotic depressions with fantastic delusions of depressive content is extended suicide, when the patient kills loved ones before suicide in order to relieve them of their torment.

A common feature of depressed patients is a cold attitude towards loved ones with hostility towards those who disturb the patient’s peace. Characterized by a cruel attitude towards children, traumatizing the psyche of minor family members.

Close to depression is a state of dysphoria with tension, gloomy anger, dissatisfaction with oneself and others, easy emergence of aggressive and autoaggressive actions [8, 14, 15, 41, 45].

In non-psychotic disorders, aggressive behavior is most often situationally conditioned and has the character of a response to an external stimulus. As a rule, aggressive reactions arise in a conflict situation [8, 11, 14, 15, 44, 52].

These behavioral responses become pathological under the influence of mechanisms known as sensitization. There are changes in the reaction-soil continuum. In this case, repeated reactions change the personality and characterological characteristics of the patient, and this, in turn, facilitates the development of subsequent aggressive reactions, which acquire a pathological character [8, 14, 15, 31, 35, 44, 50].

A conditionally normal reaction corresponds to the nature and strength of the stimulus that caused it. The pathological reactions arising in the future do not correspond in strength and content to the stimuli that caused them.

A pathological reaction is characterized by: the occurrence for various reasons by the type of cliché (generalization), the severity of the reaction exceeds the cause that caused it, the nature of the behavioral disturbances always exceeds the “threshold”, which under normal conditions is not violated, the pathological reaction always disrupts the patient’s social adaptation.

The development of behavioral reactions with aggressive behavior is preceded by the emergence of overvalued ideas with the theme of violated justice. These ideas are associated with such personality traits of the patient as rigidity, emotional immaturity, low criticality of thinking. Such overvalued ideas are emotionally saturated and occupy an undeservedly large place in the patient’s experiences. The theme always contains a component of envy of the achievements of others and hostility towards those persons who have the opposite opinion [6, 8, 11, 14, 15, 41, 44].

Accordingly, there are two levels of severity of reactions with aggressive behavior [8, 14, 15, 31, 32, 35, 41, 44, 50, 52].

Hypersthenic reactions are in the nature of an emotional outburst with demonstrative behavior, close in purpose to a plea for help, aggression is only verbal or redirected. Consciousness and criticism are not violated, self-control is generally preserved. The episode ends with exhaustion, the patient regrets what he had done, accuses himself of intemperance, there is a feeling of guilt in front of the victim.

Explosive reactions are in the nature of an affective explosion with a loss of self-control and affective narrowing of consciousness, aggression is not controlled, is not only verbal, but also physical in nature, directed against the offender. The explosion ends in prostration, the blame is completely placed on the object of aggressive behavior, there is no regret for what was done.

In non-psychotic disorders, destructive behavior is associated with certain personality traits that determine increased aggressiveness.Clusters of personality traits that contribute to the manifestation of violence are distinguished [8, 14, 15, 41, 45].

Paranoid traits include rigidity of attitudes, distrustfulness, catatim thinking with the easy emergence of overvalued ideas and uncriticality.

Unstable traits are associated with a lack of positive social attitudes, a sense of duty and empathy for others, a desire for entertainment and pleasure, an inability to repent, drawing conclusions from mistakes and punishment.

Stuck traits are characterized by strong manifestations of passion in emotional responses; a tendency to accumulate emotional experiences, primarily negative ones, with the appearance of affective outbursts; long preservation of negative affective states; the rapid development of opposite emotional relationships.

The completed systemic complex of these features is the structure of the epileptoid accentuation of the personality. It includes rigidity of thinking and attitudes, strong instincts, despotism, pettiness and stinginess, a tendency to accumulate resentment and suspicion, explosiveness with a loss of self-control, vindictiveness and cruelty, the polarity of emotional relationships from obsequiousness to anger, good tolerance of a regulated regime.

It should be noted that there are some nosological features of aggressive behavior in mental disorders.

In endogenous procedural disorders (schizophrenia, schizoaffective, delusional, acute transient polymorphic psychotic and schizotypal disorders) psychotic episodes are accompanied by aggressive behavior determined by psychopathological symptoms [13, 18, 21, 24, 26, 54].

Outside the psychotic state (schizotypal disorder, remission after psychotic episodes), situationally determined aggressive behavior is characteristic of affective-psychopathic syndromes [8, 13–15, 41, 45].

A typical representative of these symptom complexes is the heboid syndrome occurring in adolescence. It is characterized by a caricature intensification of the manifestations of a pubertal crisis with pretentious antisocial behavior, a desire to shock, terror towards individual (usually helpless) family members, a complete absence of criticism, destructive behavior of the type of “delusional actions” with perversion of drives [8, 13-15, 41, 45].

Endogenous affective disorders (manic, depressive, mixed episodes, bipolar affective, recurrent depressive disorder, cyclothymia and dysthymia) are characterized by aggressive behavior, mainly in manic episodes [10, 12, 16-18, 21, 24, 43, 46, 54] …

Prolonged depressive episodes due to the coldness of the patient towards loved ones, egocentrism, moodiness, dissatisfaction with help, and child abuse create a situation of an exam for the family (a strong family withstands it, and a weak one breaks up) [9, 16, 23, 27, 36].

Mental disorders due to organic brain damage are often accompanied by aggressive behavior [5, 7, 10, 17, 21, 24, 34, 40–42, 45, 46, 49, 54].

So, aggressiveness is noted with injuries in the area of ​​the medial temporal lobe, hypothalamus, interventricular septum.

The factors contributing to aggressive behavior in organic mental disorders were progressive cognitive decline, which makes it difficult to predict the consequences of destructive behavior, rigidity of thinking and emotional reactions with a decrease in criticality, affective explosiveness with a weakening of the possibility of volitional control of behavior, disinhibition of drives, dysphoria.

The opinion about the increased aggressiveness of patients with epilepsy is exaggerated. Most patients have rather sensitive, anxious-suspicious, pedantic, hypersocial features [10, 15, 17, 34, 41, 42, 45].

Increased aggressiveness is characteristic of patients with an unfavorable course of the disease, pathological activity of the left hemisphere-reticular structures, polymorphic frequent and serial paroxysms with complex postictal disorders, psychotic episodes and severe dysphoria, significant cognitive decline with the viscosity of thinking, characteristic epileptic changes in personality in the form of pettiness , rancor, vengefulness, cruelty, polarity of emotional reactions and relationships.

In patients with oligophrenia (mental retardation), destructive actions are performed during explosive reactions and dysphoria. However, in most cases, aggressive behavior is situational, often imitative, and is associated with the involvement of these individuals in asocial groups and delinquent activities [8, 10, 14, 15, 17, 34, 40, 41, 42, 45].

The factors contributing to the emergence of aggression are insufficient development of cognitive functions, higher emotions, the ability to predict, volitional control.Due to increased suggestibility and a tendency to uncritical imitation, patients easily fall under the influence of others.

The features of aggressive behavior are largely determined by the presence of a personality anomaly in the patient [6, 10–12, 17, 18, 21, 24, 40, 46, 54].

The International Statistical Classifications distinguish a number of pathological clusters of associated personality and behavioral disorders, defined as specific personality disorders that predispose to various forms of aggressive behavior.

This is a dissocial (antisocial) personality disorder, which is characterized by a gross discrepancy between behavior and prevailing social norms, heartless indifference to the feelings of others, irresponsibility and disregard for social rules and responsibilities, easy emergence of relationships and the inability to maintain them, low tolerance for frustration, low threshold of discharge aggression, inability to feel guilty, benefit from life experience and punishment.In a conflict with society, patients blame others and plausibly explain their behavior.

Emotionally unstable personality disorder is characterized by a pronounced tendency to act impulsively, without considering the consequences, combined with mood instability. The ability to plan and predict is minimal; behavioral outbursts are accompanied by aggression.

The disorder includes the impulsive type with a lack of impulsivity control and outbursts of aggression in response to judgments from others.

The second variant of the disorder is the borderline type with mood swings, changing preferences and intentions, leading to emotional crises, making relationships with people unstable and tense. There are long, perennial phases with a certain personality structure, which alternate with phases when the personality structure is radically different. Periods of good social adaptation with tolerance and positive social attitudes are replaced by periods of delinquent behavior and antisocial views with intolerance and increased aggressiveness.

It is worth mentioning paranoid personality disorder with constant dissatisfaction with someone, unwillingness to forgive insults, extreme sensitivity to rejection, distorted perception of facts with a tendency to interpret the actions of others as hostile, belligerent attitude towards violation of one’s own rights, constant suspicions of sexual infidelity of a partner, a sense of self-worth, a tendency to attribute what is happening to their own account, constant thoughts about the “conspiratorial” meaning of events.

Sadistic personality disorder, probably associated with sexual deviations, occupies a special place among personality anomalies that predispose to violence. It is characterized by: cruelty, aggressive and degrading behavior. Physical abuse and violence is noted to achieve dominance in relationships; humiliation of a person in the presence of others; cruelty towards those who depend on him; the pleasure of seeing the suffering of others; limiting the independence of loved ones; forcing them to do what they do not want; passion for weapons, martial arts, information about torture.

In the synopsis of US psychiatry, the rubric of intermittent explosive disorder (episodic disturbance of control) is separately distinguished. Moreover, during the episode, acts of aggression occur disproportionately to the stimuli. Behavior between episodes is not overtly impulsive.

In patients with neurotic and stress-related disorders, aggressive behavior is most often manifested in adaptation disorders. In particular, adaptation disorders with behavioral disorders and mixed disorders of emotions and behavior are distinguished [10, 12, 18, 21, 31, 32, 46, 54].

Aggressiveness is significantly increased in post-traumatic stress disorder. Aggressive behavior can occur with floods of memories of the postponed catastrophic event (flashbacks). Irritability and outbursts of anger reflect persistent symptoms of increased psychological sensitivity. The increased aggressiveness of the patient is facilitated by the feeling of emptiness and loneliness [10, 12, 17, 18, 21, 27, 31, 32, 34, 35, 40, 46, 52, 54].

With an unfavorable course of this disorder, aggressive character traits are recorded in the structure of persistent personality changes after a catastrophic experience.

Aggressive behavior is facilitated by a constantly existing hostile or distrustful attitude towards the whole world, social isolation with avoidance of contact with people, a constant feeling of emptiness and hopelessness, the experience of being “on the brink” or under constant threat, a sense of alienation (when the patient feels different from others people).

The most difficult adaptation reactions and post-traumatic stress disorders occur in military personnel who directly participated in hostilities, which gave rise to the use of the concept of combatant accentuation.

Treatment of patients with aggressive behavior

Treatment of patients with aggressive behavior involves the appointment of psychopharmacological therapy and non-drug treatment [21, 37, 38, 42, 49].

Treatment includes two tasks: relief of severe aggression within no more than 48 hours, long-term therapy of aggressive behavior [21, 37].

For the relief of aggressive behavior, or chemical restriction in accordance with the terminology of the synopsis in US psychiatry, high doses of benzodiazepines (diazepam, chlordiazepoxide, phenazepam) are used, mainly parenterally.High doses of conventional antipsychotics of general sedative (aminazine and tisercinum parenterally), selective antipsychotic (parenteral haloperidol) and general antipsychotic action (parenteral trisedil and mazheptil) are effectively used, of atypical antipsychotics, clopixol-akufin, 10 13, 17, 21, 22, 26, 29, 37, 39].

From the means of general biological action, the use of electroconvulsive therapy for catatonic symptoms and anxious agitated depression should be mentioned.Central lateral electroanalgesia is effectively used [1, 10, 11, 25, 26, 36, 39, 40, 45, 51].

For long-term treatment of patients with psychosis, conventional antipsychotics and atypical antipsychotic drugs of prolonged action are used: moditen-depot, haloperidol-decanoate, piportil L 4, clopixol-depot, rispolept-consta [1, 13, 26, 29, 39, 49].

Of the small antipsychotics that effectively eliminate psychopathic behavior, neuleptil, known as a universal behavior corrector, should be called.Thioridazine is effectively used to treat dysphoric conditions [1, 29, 35].

For depressive symptoms, long courses of antidepressants are used. In particular, long-term treatment with fluoxetine reduces aggression [16, 23, 27, 28, 36, 39].

In the presence of affective fluctuations, normotimics are shown. Eliminates aggressiveness with prolonged use of lithium salts. In aggressive patients, anticonvulsant thymostabilizers are effective: carbamazepine, sodium valproate, lamotrigine, topiramate [1, 3, 16, 21, 29].

High doses of sodium valproate are effectively used as a remedy for psychotic mania.

To correct aggressiveness in non-psychotic disorders, long-term courses of herbal sedatives (valerian, motherwort, lemon balm, passionflower, May lily of the valley) are effectively used, including in the form of homeopathic medicines (memoria and knott) [21, 35].

From the means of general biological action in paranoid schizophrenia, forced and potentiated insulinocomatous therapy can be used [1, 25, 40, 45, 51].

Of the methods of lateral therapy, low-frequency sub-sensory zonal-lateral electrical stimulation effectively reduces the aggressiveness of patients [26, 51, 52].

A positive effect is given by repeated courses of reflexology (including acupuncture and electrical stimulation of biologically active points, including unilateral) [35, 40, 41, 51].

At the stage of long-term treatment, electrical procedures can be used: d’arsnovization of the scalp and general franklinization.A good effect is given by repeated courses of balneotherapy: warm coniferous, iodine-bromine and sea baths [21, 35, 49].

From the methods of physiotherapy exercises, breathing exercises, jogging, swimming in the pool can be recommended [35, 41, 42].

Psychotherapy for a patient with increased aggressiveness involves psychological counseling with an assessment that allows you to create a model of the client’s problems.

Individual psychotherapy includes rational psychotherapy, individual desensitization, and Jacobson progressive muscle relaxation.

Group psychotherapy is eclectic in nature, focusing on the establishment of warm but strict relationships, the use of interpretation, role play, positive reinforcement of benevolent behavior, and anxiety induction when aggressiveness appears. A separate area is family psychotherapy in the form of behavioral therapy of family systems.

The general direction of psychotherapeutic intervention is cognitive-behavioral psychotherapy in the form of cognitive learning by the type of cognitive behavior modification [6, 11, 30, 35, 40, 44, 49, 52].

Rehabilitation of patients with increased aggressiveness is closely associated with psychotherapy. Intervention is aimed at developing self-awareness, which leads to personal growth by exercising the right to choose and accepting personal responsibility.

Reality therapy with transactional analysis of behavior is carried out using the principles of Rogers’ humanistic client-centered therapy.

The rehabilitation program includes training in social skills, primarily in interpersonal problem solving and self-control with cognitive restructuring of behavior.

At the same time, by training empathic skills, the egocentric level of cognitive development with a deficit of empathy and moral principles increases with the formation of the possibility of moral reasoning with the ability to accept perspectives.

The criterion for the effectiveness of rehabilitation measures should be considered the degree of the patient’s awareness of the leading position that “aggression does not solve problems.”

Accordingly, during the period of interpersonal conflict, the patient begins to avoid the style of competition with confrontation, preferring the styles of avoidance and compromise at the beginning of the conflict with the transition to styles of adaptation and cooperation to resolve the conflict situation [6, 11, 30, 35, 40, 44].

Prevention of aggressive behavior

Characterizing the prevention of aggressive behavior in mental illness, it is necessary to highlight the risk factors for aggressive behavior, which include: male gender, young age, cultural environment (presence of a criminal past), history of physical violence against the patient (especially in childhood).

Aggressive behavior should be carefully monitored in the patient’s history. All manifestations of aggressiveness should be taken into account in the clinical investigation of the patient.Treatment and rehabilitation tactics should include measures to reduce the level of aggressiveness of the patient [6, 11, 40–42].

In the case of aggressive behavior of the patient, the object of aggression must behave calmly and correctly. Arguments with the patient and threats against him are inadmissible. The object of aggression must maintain composure. At the stage of verbal aggression, it makes sense to choose a subordinate behavioral strategy, talk with the patient to identify his emotions and find out the reasons for aggressive behavior.

If aggressive actions continue, it is necessary to tell the patient that the object of aggression is going to call for help from other people and do it immediately. It is better for the object of aggression to leave the room in which the patient is.

Actions to limit physical aggression should be quick, decisive and well coordinated [6, 11].

Conclusion

Thus, aggressive behavior in mental disorders is non-specific.It should be noted that the cause of this behavior is almost always interpersonal conflict.

In psychotic disorders, the assessment of the object of aggression and the nature of the patient’s destructive actions can be determined by psychotic experiences.

The most important component of aggressive behavior is the patient’s aggressiveness as a tendency to respond to external stimuli with destructive actions. It is determined by the patient’s personal and characterological characteristics, his current emotional state and social attitudes.

Therapeutic and rehabilitative care for patients with mental disorders with aggressive behavior should include timely diagnosis of destructive activity, the appointment of psychopharmacological and non-drug treatment, rehabilitation of the patient with a decrease in the level of his aggressiveness.

The provision of medical and social assistance to patients with mental disorders prone to aggressive behavior should be based on the coordinated actions of a psychiatrist, medical psychologist, social worker and general practitioner – family medicine.

90,000 Borderline personality disorder

Olga Vladimirovna Plotnikova

Psychiatrist

Borderline personality disorder (hereinafter – BPD) is characterized by increased anxiety, emotional instability, a tendency to impulsive actions. All these components greatly affect the quality of life. In addition, people with borderline personality disorder often have antisocial behavior, self-harm, and an increased risk of suicide.

Reasons:

Genetics BPD has a proven hereditary factor. It would be more correct to say – predisposition. Like schizophrenia, BPD does not have a single gene that is responsible for the development of the disorder, but the influence of genetics is undeniable.

Neurophysiology or how does it work? Numerous studies using neuroimaging (fMRI) have compared BPD patients with healthy controls.Abnormalities were found: a decrease in serotonin levels, a decrease in the volume of the hippocampus, amygdala and other areas of the medial temporal lobe of the brain. Patient behavior and symptoms are a product of the special structure of their brain.

Environmental influences There are a lot of myths here. And, despite the emergence of neuroimaging data, for some reason they are still alive. The most common myth is the influence of childhood trauma on the occurrence of BPD. Indeed, studies of people with BPD suggest that they have had a history of domestic violence, but again, not everyone without exception.A case of childhood trauma can only provoke and awaken a hereditary predisposition to BPD, but this is not the reason for its development. It’s all about the structure of the brain.

Why is it important? When we talk about diabetes, we don’t think insulin levels can be changed with willpower. BPD is not a whim and is not treated by “education”, you need to learn to live with it.

Diagnostic Criteria for Borderline Personality Disorder:

1. Inclination to exert excessive effort to avoid real or imagined abandonment.
2. Inclination to engage in intense, tense and unstable relationships, characterized by alternating extremes – idealization and depreciation.
3. Identity disorder: noticeable and persistent instability of the image or feeling of I.
4. Impulsivity, which manifests itself in at least two areas that involve self-harm (for example, spending money, substance abuse, traffic violations, systematic overeating).
5. Recurrent suicidal behavior, hints or threats of suicide, acts of self-harm.
6. Affective instability, very changeable mood (for example, periods of intense irritability or anxiety, usually lasting from several hours to several days).
7. A constant feeling of emptiness.
8. Inadequate expressions of intense anger or difficulty in controlling feelings of anger (eg, frequent irritability.
9. Paranoid ideas.

How to treat?

The first line – psychoeducation of the patient and his loved ones. This is very important, as it helps to understand what is happening with the patient and outline the tactics of further action.

Scheme therapy for patients to learn how to properly respond to their symptoms and control them in the future.

Medication helps to cope with the severity of symptoms and gives strength to further combat BPD.
Special instructions that are important to consider when choosing a therapy

– Second-generation antipsychotics should be used in patients with thought disorder, paranoia, and identity disorder.

– In patients with mood disorders, outbursts of aggression, mood stabilizers (normotimics) should be used, not antidepressants.

SUMMARY:

BPD is an abnormality in brain structure, not bad parenting and complex temperament.

BPD must be correctly diagnosed using the most modern criteria.

Self-harm is an important but not the only diagnostic criterion. Self-tapping in adolescence can be a way to grab attention. But! If you have self-tapping screws, you need not scold the teenager, but figure out the reasons.

The symptoms of BPD can be brought into permanent remission and learned to live with them. The only proven way is to motivate the patient himself.

People with BPD need love and understanding, but it is very difficult with them, so relatives and friends may need the help of specialists.

90,000 Causes of aggression in men and women, treatment

Aggression: causes, types, help

Aggressiveness is a condition accompanied by destructive, deviant or abusive behavior. Aggressiveness can be direct or indirect, active or passive.Attacks of aggression are caused by both physiological abnormalities and psychological reasons. Treatment is prescribed by a doctor, taking into account all the characteristics of the patient’s condition and the reasons that caused the deviations in behavior.

Types of aggression

Aggression in humans is unhealthy behavior, accompanied by harm to people around, animals or objects, as well as to oneself. Two types of damage are possible:

1. physical;
2. psychological.

The manifestation of aggression has different forms: physical attack, destruction of any objects, psychological impact (verbal abuse and other actions that inflict moral trauma on another person).

Aggression can be motivated (when the patient is able to explain his actions) or spontaneous (when the patient is not able to explain his behavior).

What can cause aggression?

There are many reasons for the appearance of aggression.This behavior is often caused by physical disabilities:

• alcohol or drug addiction;
• brain damage;
• deficiency of macro- and microelements, vitamins;
• hormonal disruptions;
• chronic diseases.

A person may show aggression due to low levels of B vitamins, potassium or magnesium, hormonal imbalances. All these factors negatively affect the nervous system.Also, the causes of aggressive behavior are often dementia, brain tumors, trauma, and the presence of chronic diseases.

Psychological reasons:

• neurosis;
• Inability to control your emotions;
• health problems, rejection of frightening diagnoses;
• overwork, pressure from society or family;
• children’s psychological trauma, overly strict education;
• oppressive, traumatic events;
• Wrong self-defense tactics;
• unhealthy self-affirmation;
• the need for emotional release;
• depressed mood.

Thus, most often outbursts of anger are caused by physical and psychological reasons. And only in rare cases, attacks of aggression are the result of mental illness.

Aggression in men

Male aggression is often physical, expressed in an open form. Frequent causes of aggressive behavior in men are a hypertrophied desire to assert themselves, incorrectly developed behavioral patterns adopted in the family or environment.These factors are amenable to psychotherapy. Less commonly, the manifestation of aggression is the result of physical trauma, chemical dependence, and increased testosterone levels. These aggressive behaviors are also treatable.

Aggression among women

Women’s aggression is more often passive, verbal. Often it is caused by psychological reasons: overwork, depression, prolonged suppression of negative emotions. In addition, outbreaks of aggression can be associated with hormonal disorders, thyroid diseases, menopause.

Causes of aggression in children

The causes of aggression in children are usually age crises, problems in kindergarten or school, problems with family relationships. Also, aggressive behavior is a mechanism for learning about the world and the boundaries of what is permissible. Less commonly, outbursts of anger can signal illness.

Attacks of aggression in older women and men

Behavioral abnormalities in old age are often the result of chronic diseases and their consequences: fatigue from pain, inability to maintain a normal lifestyle.If outbursts of anger in an elderly person are accompanied by memory lapses, an increase in negative character traits, and suspicion, then aggressive behavior can signal the development of dementia.

Treatment of aggression

Aggressiveness becomes a threat to socialization, career growth, family relations, health and human life. Therefore, when it appears, you need to seek help.

For a successful cure, it is necessary to establish the causes of aggressive behavior, to find out in what circumstances outbursts of anger occur, what factor serves as a trigger.The psychologist helps patients change behavior patterns, learn how to properly respond to stressful situations. It is equally important to heal psychological trauma, to identify the underlying causes of aggression.

To clarify the diagnosis, you may need:

• consultation of a neurologist, endocrinologist;
• laboratory analyzes and apparatus research.

A full examination, psychotherapy and drug treatment will help identify and eliminate all causes of behavioral deviations, improve the patient’s quality of life.

90,000 Doctors say who is at risk of getting mental disorders after coronavirus

Several months after recovering from COVID-19, some patients begin to complain of emotional instability, depression, insomnia, and other mental disorders. Doctors explained to Gazeta.Ru that this may be due to hormonal disorders after an illness, as well as psychosomatics – the body thus reacts to the stress experienced. At the same time, doctors are sure: people with a stable psyche are not threatened with such pathologies.

The consequences of the coronavirus may include various mental disorders, Italian scientists have found. Their research is published in the Danish journal Brain, Behavior and Immunity.

According to their data, 55% of those who recovered within several months after the illness develop at least one mental disorder. The survey was conducted among 265 men and 137 women. According to his results, 28% of the recovered have post-traumatic stress disorder, 31% – depression, 42% – anxiety.In addition, 40% of patients suffered from insomnia.

According to Italian researchers, such consequences of COVID-19 may be caused by an immune response to the virus itself or by psychological stressors such as social isolation, the psychological impact of a new serious and potentially fatal disease, as well as fears of infecting others.

Psychiatrist Svetlana Chebotareva confirmed to Gazeta.Ru that the cause of mental disorders can indeed be the body’s immune response.“After all, cytokines (immune cells, -“ Gazeta.Ru ”) enhance the work of the hormonal system, as well as interferon-a (a protein released for the invasion of the virus,“ Gazeta.Ru ”), which ultimately causes a decrease in the production of the amino acid tryptophan, a precursor the hormone serotonin, which is often the cause of depression and anxiety, sleep disorders, ”said the expert.

War with covid leads to post-traumatic disorder

The head of the department of treatment of borderline mental disorders and psychotherapy of the N.N.Bekhtereva Tatyana Karavaeva.

“As a rule, this concerns a severe form of infection,” she told RIA Novosti, adding that most often this ailment occurs in combatants. According to her, the disorder may not appear immediately, but within six months after the event traumatizing the psyche.

According to psychiatrist Chebotareva, PTSD is a natural response of the nervous system to traumatic, stressful events. “In particular, we are talking about situations that violate the sense of human security and require efforts to overcome the consequences,” she said.

Often, PTSD includes fears or feelings of helplessness, obsessive memories of a negative event, dreams of what happened are possible, the doctor added. “It also reveals an inability to remember important aspects of trauma, a feeling of detachment or distance from other people, dulling of emotions, irritability or outbursts of anger, increased anxiety,” the specialist explained.

“Feeling of melancholy and powerlessness”

A distinctive feature of PTSD is that it develops about six months after recovery, Chebotareva noted.If the symptoms listed above occur earlier, then they may be signs of post-viral asthenia.

This ailment is most often accompanied by emotional instability, forgetfulness and difficulty concentrating, the chief researcher of the department of treatment of borderline mental disorders and psychotherapy of the National Medical Research Center for Psychiatry and Neurology named after N.I. Bekhtereva Anna Vasilieva.

Chebotareva, in turn, is sure that the cause of asthenia is stress.“When the very reaction to stress subsides, a person accepts his state, realizes that he has survived the illness, fears weaken or recede, and then the nervous system shows everything that has happened to the body during this time,” the psychiatrist said.

“For example, physical exhaustion, lack of amino acids, vitamins. Also, there is probably residual lung damage, which requires a lot of strength and resources of the body to recover, ”she added.

If you do not track your condition in time, it can develop into real depression, the doctor warned.“Loss of interest in the environment, a feeling of longing or powerlessness, loss of joy and emptiness inside,” Chebotareva listed the symptoms of this pathology.

Do not sleep for several days

Often recovered from COVID-19 complain about the inability to fall asleep on time, a short sleep for several hours and waking up in the morning, the doctor also said. According to her, some of those who have been ill may not sleep at all for several days, while some develop weakness after sleep.

People are worried about their health and are in anticipation of trouble.“This prevents falling asleep. Everything else has not been proven, ”the head of the Sleep Medicine Department of the First Moscow State Medical University named after N.I. Sechenov and Vice-President of the National Society for Somnology and Sleep Medicine Mikhail Poluektov.

“And what is everyone doing? They run to the Internet, and there the first links tell about melatonin, which not only does not help at all, but also can do harm, because post-infectious disorders do not depend on the production of melatonin in general, they depend only on the degree of mental reaction, which can only be assessed doctor, “- said Chebotareva.

She stressed: all mental disorders that have arisen after the coronavirus must be treated with a specialist. At the same time, the psychiatrist added that such pathologies occur only in those who were initially prone to them. “Many are convinced that before Covid they were completely healthy and did not bode well, but in fact, in most cases, they never attended a psychiatrist’s diagnosis. So where does such confidence come from then? ” – she concluded.

90,000 Schizoid Personality Disorder | Clinical Center “Psychiatry – Narcology”

Schizoid personality disorder is a withdrawal in oneself, avoidance of emotional attachments, a tendency to fantasize and immersion in one’s own inner world.People with schizoid disorder have difficulty communicating and making social connections. The help of a psychotherapist allows you to soften the sharp edges of interaction with the outside world.

The word “schizoid” is no coincidence consonant with schizophrenia: the manifestations of schizoid disorder are similar to the symptoms that are observed in patients with schizophrenia: isolation, peculiar thinking (due to the fact that a person is constantly alone with himself), emotional coldness, callousness.

However, with this disorder, a person adequately perceives reality (no delusions and hallucinations).Schizoid disorder is a character trait, a tendency to avoid interaction with the outside world through voluntary social isolation, isolation in oneself and one’s own fantasies.

Schizoid personality disorder: symptoms and manifestations

To establish a diagnosis of schizoid personality disorder, the therapist must see the general signs of schizoid personality disorder, as well as at least three specific criteria. Common features of personality disorder include:

• a person is detached from the world around him, has poor control over his emotions, often becomes irritated or angry;
• strange behavior that has existed for at least a year;
• difficulties affect all spheres of human life (at home, at work, interaction with strangers) and significantly disrupt adaptation to the norms of society;
• people oppose themselves to society and deliberately violate the norms of behavior in society;
• The disorder occurs during childhood or adolescence and flourishes during adulthood.

For schizoid personality disorder, at least three criteria from the list below are present. Symptoms specific to schizoid personality disorder are as follows:

1. Few things give pleasure – schizoid individuals usually have a limited, narrow circle of interests, where, however, they can achieve great success (for example, talented scientists, musicians).
2. Emotional coldness – women and men with schizoid disorder are stingy with emotions, both positive and negative.
3. Selfishness, self-centeredness – a person is immune to the opinions of others, both critical and praise.
4. Leaving for your own fantasies.
5. Inclination to solitude, lack of close friends (sometimes only friendly affection) and unwillingness to get close to others, decreased libido.

When making a diagnosis, the doctor conducts differential diagnostics with schizophrenia, paranoid and other personality disorders, schizotypal, depressive, bipolar affective and anxiety disorders.The diagnosis depends on what kind of therapy the specialist will offer – medication or mainly psychotherapeutic.

How is schizoid personality disorder treated?

Schizoid personality disorder is treated by a psychotherapist. The main method of treatment is individual psychotherapy combined with restorative and relaxing procedures (physiotherapy, massage, relaxation sessions). Medical treatment for schizoid disorder is rarely used if the person has symptoms of depression or neurosis.

During the course, the doctor does not set the task to completely change the character of the client, but only helps him to adapt to the world around him, to be professional, to maintain comfortable relations with others.

If left untreated, schizoid disorder symptoms (emotional coldness, detachment, and solitude) can significantly interfere with a fulfilling life. Seeing a psychotherapist can significantly improve the quality of life for people with schizoid disorder and their loved ones.

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GBUZ “OKSPB No. 1”

• Home
  • News
• About the hospital
  • About the hospital
  • Administration
  • Specialists
  • Legislation
  • History
  • Reception schedule
  • Jobs
  • Trade union (structure, documents, contacts)
  • Anti-corruption policy
    • Together against corruption!
    • Corruption hotline
    • Regulation on anti-corruption policy
    • Code of Ethics and Service Conduct for Employees of the State Budgetary Healthcare Institution “OKSPNB No. 1”
  • Forensic examination
  • Assessment of working conditions
    • Assessment of working conditions in 2019
• Patients and visitors
  • Medical examination by a psychiatrist (References, Conclusions)
  • Informing citizens
  • Information on preferential provision and the list of pharmacies that dispense medicines under the benefit
  • Doctor’s Schedule
    • For the adult population of St.Chelyabinsk
    • For the children’s population of Chelyabinsk
    • Adults and children population of Kopeisk city district
  • Compulsory psychiatric examination
  • In compliance with measures to prevent and reduce the risks of the spread of COVID-19
  • Paid services
  • Territorial program for 2019
  • Children’s service
    • Questionnaire for early detection of the level of psychological development of young children (16-24 months.)
    • Algorithm of action to prevent suicides.
  • Health Articles
    • “Pill” for the soul
    • Why is the soul out of place?
    • HLS
    • Movement is life
    • Adolescent injuries
    • Alcohol
  • FLU AND ARVI
    • What you need to know about the coronavirus
    • How to protect yourself from coronavirus 2019-nCoV
    • Prevention of influenza and coronavirus infection
    • Recommendations for the prevention of new coronavirus infection for those who are 60 and over
    • 7 steps to prevent new coronavirus infection (COVID-19)
    • Prevention of COVID-19 in organizations
    • Prevention of COVID-19 in the provision of medical care
    • Prevention, diagnosis and treatment of COVID-19
  • For disabled people
• Feedback
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