Dysthymia - symptoms, treatment, types

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Children with a dysthymic character type are always sad and serious. In a large company, they are constantly silent and prefer to remain in the shadows.

Their special personality traits are:

slowness;
responsibility;
humility;
thoughtfulness.

They spend most of their time thinking. However, their thoughts are often occupied with the negative, dark or sad aspects of life. Therefore, fun for them remains illusory and unattainable. All attempts to cheer them up come to nothing. Nevertheless, they are very hardworking and carry out tasks of any complexity with special zeal.

IMPORTANT! Children belonging to the dysthymic type of temperament are extremely sensitive to any manifestations of injustice. Therefore, psychologists advise handling them very delicately and carefully.

Symptoms of dysthymia

Dysthymia can be easily recognized by its characteristic symptom – low mood. This may be accompanied by other signs:

or drowsiness.
Increased or decreased appetite.
Fatigue, lack of energy.
Decreased concentration.
Low self-esteem, loser complex.
Feeling hopeless.
Difficulty in making decisions.
- loss of feeling of pleasure.
Pessimism.
Blues.
Irritability.
Low mood.
Sadness.
Reduced need for communication.
Depression.
Thoughts about the futility of effort and the meaninglessness of life.
A pessimistic view of the future and a negative assessment of the past.

The symptoms are similar in many ways to depression, but are not as pronounced. Dysthymia may manifest itself in the following physical symptoms:

Dyspnea.
Constipation.
Malaise.
Sleep disturbance.
Anxiety.
Cardiopalmus.
Tearfulness.
Increased sweating.
Bad feeling.
Shiver.

Dysthymia is diagnosed if a person has had symptoms for about 2 years. The disease usually develops at a young age. However, its manifestation in childhood makes a person think of himself as a depressed person who simply has certain character traits. In this case, dysthymia is detected very late.

Dysthymia is characterized by short-term (up to 2 months) periods of happiness and a surge of energy. Both depressed state and elevated mood are not associated with taking medications, drugs or alcohol.

Doctors do not diagnose dysthymia if a person has the following symptoms:

Hypomania.
Schizophrenia.
Manias.
Hypofunction of the thyroid gland.
Depression.
Cyclothymia.
Hormonal imbalance.

People who suffer from dysthymia are more likely to develop depression. Up to 75% of patients have psychological disorders or chronic pathologies of organic origin. Dysthymia can be combined with:

Social phobia.
Somatic diseases.
Panic attack.
Generalized anxiety.

Doctors note that the cause of the development of the disease in question is genetic inheritance, when a person is constitutionally prone to depression. There is also a disruption in the production of serotonin in the brain, which causes the corresponding mood. Factors favorable for the development of dysthymia are conflict situations, stress, loss of vital values, contributing individual qualities and structure of the nervous system, non-compliance with the daily routine, social isolation, and improper parenting.

Dysthymia: diagnosis

As a rule, dysthymia is diagnosed long after its onset. This is due to the fact that most patients attribute the main symptom (depression) to character traits and do not seek specialized medical help. Timely diagnosis of the disorder is also complicated by the simultaneous manifestation of dysthymia with other mental pathologies.

Routine examinations of patients with dysthymia have shown that over 80% of people with this diagnosis have a history of some kind of chronic disease of an organic nature or other mental pathology. Dysthymia is often combined with disorders such as:

Anxious-phobic (frequent panic attacks, generalized anxiety);
Conversion (sudden disruption of motor and sensory function);
Somatic diseases (diabetes mellitus, hypertension, rheumatoid arthritis, etc.);
Drug addiction;
Alcoholism.

At the Yusupov Hospital, the diagnosis of dysthymia is made by a psychotherapist after a clinical and anamnestic examination, which includes:

symptom assessment;
the order of their appearance;
connection with events in a person’s life - stress, overload, trauma, infectious or other diseases.

Then, to confirm the diagnosis, a clinical psychologist performs a pathopsychological examination. It provides a conclusion about the patient’s personality characteristics and identifies deviations in cognitive processes (thinking, memory, attention). For differential diagnosis, instrumental and laboratory studies are carried out:

EEG - with organic damage to the nervous system;
Neurophysiological test system and Neurotest with endogenous diseases (schizophrenia, schizotypal disorder).

Causes of dysthymia

The disorder usually occurs in childhood and adolescence and is more common in women. Dysthymia is characteristic of constitutionally depressed personality types, but not only. At the initial stage, stressful situations, conflicts, and loss of loved ones can provoke the development of symptoms. For children, the reason for the development of such a depressed state may be hostile relations between parents, parents’ censure of the manifestation of children’s emotions (joy, fun, laughter).

Dysthymia is divided into two main types

Characterological dysthymia

People with this disorder are characterized by anhedonia, increased sensitivity to minor stimuli, pessimism, expectation of only negative events in the future, loss of meaning in life, and self-criticism about past mistakes.

They are unable to take initiative and give the impression of gloomy, taciturn pessimists.

Somatized dysthymia

It is characterized by the development of asthenic conditions in patients. They usually complain of physical weakness, lethargy, and decreased activity. Patients with this diagnosis often experience shortness of breath without exercise, interrupted sleep, tearfulness, and anxiety. Their depressed mood is weakly expressed.

Dysthymia: main types

Experts divide all patients with persistent depressive disorders into two main groups, which include the following:

somatized dysthymia;
characterological dysthymia.

With the somatized (hypochondriacal) type of disorder, the patient presents with characteristic complaints:

general poor health;
increased heart rate;
shortness of breath without exercise;
constipation;
tearfulness;
Insomnia.

As the disease progresses, asthenic syndrome comes to the fore: decreased activity, lethargy, physical weakness, or abnormal bodily sensations worsen.

Patients with characterogenic dysthymia are always gloomy, gloomy, dissatisfied and silent individuals. They unconsciously push away not only strangers, but also close people. Also, with this type of dysthymia, external manifestations of a depressed state become noticeable: patients have drooping corners of the mouth, a leisurely gait, stingy gestures, and apathetic facial expressions. People with dysthymic disorder are not capable of long-term volitional efforts; they are extremely indecisive, suspicious and unable to take initiative. Any work will be unpleasant, uninteresting and quickly tire them. In addition, despite the highly developed intellectual sphere, any mental work causes enormous stress and leads to extreme fatigue.

What is dysthymia?

Since people do not use this concept, we should consider what dysthymia is. This is a state of disturbed mood when a person feels sad, depressed, and despondent. Other names for this condition are “chronic subdepression” or “minor depression” - conditions in which the manifested symptoms do not allow a diagnosis of “depression” to be made due to the lack of expression and invisibility of their occurrence.

The concept of “dysthymia” was introduced by Robert Spitzer, who proposed replacing the already existing concepts of “neurasthenia”, “neurotic depression” and “psychasthenia”.

Dysthymia is a depressive disorder, but not so severe as to reach a state of severe depression. Dysthymia is characterized by periodic improvements in mood that can last up to 2 months. If the mood remains good for more than 2 months, then we are not talking about dysthymia, but about recurrent depression.

Many psychologists understand dysthymia as protracted depression of a chronic nature. The diagnosis is made if a depressed state with periods of remission is observed for 2 years. People in this state tend to be pessimists and skeptical about explaining the cheerful behavior of others.

Dysthymia occurs in 4.5% of the total population, more often in females. Among Russians, about 20% of people over the age of 18 suffered from this disorder. The transition from dysthymia to a cheerful, elated mood is a common occurrence (occurs in 20% of cases), which is called manic-depressive psychosis. Sometimes dysthymia can develop into recurrent depressive disorder - a state of periodic depression without transition to an elevated mood when you want to do something.

Dysthymia is a condition of young and middle-aged people. When it occurs, the symptoms of depression are mild, and somatovegetative disorders predominate. It does not paralyze the mental, physical, mental, and motor activity of a person, as happens with the clinical manifestation of depression. However, it affects the somatic and mental state, affecting the standard of living.

If dysthymia lasts more than 3 years, depressive syndrome may accompany it. In this case we will talk about “double depressions”.

Dysthymic type

The dysthymic type is the direct opposite of the hyperthymic type. Dysthymic types appear serious and focused on the sad aspects of life. Let us repeat that situational sadness caused by specific life circumstances is known to most people, but sadness as the predominant mood background is characteristic of dysthymics and precisely because of the specific hormonal balance in the body. Pushkin’s famous “quiet, sad, silent”, said about Tatyana Larina, very accurately characterizes the behavior of people of this type.

The serious mood characteristic of a dysthymic person activates in him subtle, sublime feelings that are incompatible with egoism and selfishness and contributes to the formation of a serious ethical position. It is easy for a dysthymic to understand the feelings of another person who finds himself in a difficult, crisis situation, because... his own perception of life is dramatic. Therefore, it is precisely such people who are more prone to sympathy, empathy and willingness to help, and this is the positive side of their character.

Another “plus” of dysthymic is his reliability and diligence in business. It evokes a feeling of trust and really justifies it. Wherever such a person works, the manager is usually satisfied with him. Let us refer to a recent study by Canadian psychologists who experimentally tried to clarify the correlation between the background mood (increased or slightly decreased) and labor productivity. It turned out that people with a low mood were able to “get the hang of things” more easily, worked for a long time and concentratedly, with good concentration, making almost no mistakes. At the same time, the elevated mood encouraged people to constantly be distracted (remember the tendency to deviate from the topic of conversation), they were absent-minded and made twice as many mistakes as the “sad” ones.

However, some passivity in actions, lack of energy, including weak career activity prevent them from organizing life as they wish. Often their career achievements are much more modest than their real professional level would allow.

The strategy of interaction with people of this type includes both a human understanding of their life situation and an active increase in their self-esteem, motivation to set and achieve serious collective and individual career goals.

Dysthymia - symptoms and signs

Dysthymia has a number of characteristic features: low levels of energy and mobility, low self-esteem and an extremely low potential for pleasure in everyday life. Mild dysthymia can be a way to relieve stress and an option to avoid failure. In more severe cases of dysthymia, people may even withdraw from daily activities. Patients typically find little pleasure in normal activities and games. Diagnosing dysthymia can be difficult due to the subtle nature of the symptoms and patients may often hide them in social situations, making the diagnosis difficult and difficult to detect.

In addition, dysthymia often occurs at the same time as other psychological disorders, which adds a level of complexity in determining the presence of dysthymia, particularly since there is often overlap between symptoms of the disorders. In addition, there is a high incidence of comorbidities in patients with dysthymia. Suicidal behavior is a particular problem in these patients

It is important to look for signs of major depression, panic disorder, generalized anxiety disorder, alcohol and drug abuse, and personality disorders.

Causes of dysthymia

Signs of subdepression arise due to changes in the human psyche. This condition typically develops in those who suffer from seasonal depressive disorder. Such people are characterized by depression and frequent mood swings. Their body does not produce enough serotonin (the “happiness” hormone), which helps a person overcome stressful situations. If it is deficient, it is difficult for a person to cope with life's difficulties. The result is a condition called dysthymia.

Researchers also note the role of hereditary factors in the development of subdepression. Those people whose relatives have had this mental disorder suffer from symptoms of dysthymia. If a person has a predisposition to this disorder, then if provoking factors arise, dysthymia may well develop.

When identifying the causes leading to the development of this mental disorder, much attention is paid to how the patient’s childhood passed. After all, subdepression could arise due to the suppression of the child by parents, violence suffered in childhood, or lack of attention from parents

The result of all this is a tendency towards pessimism, decreased self-esteem, disappearance of positive emotions, and constant worries.

What is character accentuation? Who opened it? What was it called before?

The concept of character accentuation was introduced by the German psychiatrist Karl Leonhard in the mid-20th century to designate people who have a clearly inharmonious character, but still not to such an extent that they lose the ability to adapt to society or pose a danger to it. Those. accentuation is not yet psychopathy (personality disorder), but it is no longer a normative standard. To put it simply, accentuation is a pronounced individuality, which, however, does not throw its bearer out of society; only makes him significantly more vulnerable and problematic in some situations, and more successful and productive in others.

There is no special discovery in this - the fact that each character is in some way special, individual, and that the degree of expression of this individuality also varies, was clear at all times. Many people have also tried and are trying to classify characters, creating a typology of personal characteristics. Leonhard only proposed the term and his own classification, which “took root” in Western and then Russian psychiatry. What were accentuations called before? Whatever you like, according to the characterological “shift”, emphasis - an infantile dreamer, an unfortunate poet, a court jester, a power-hungry dictator, a wandering philosopher, a lonely inventor, a two-faced artist, a cunning merchant... Visually highlighting personal characteristics was more the task of writers and playwrights than doctors.

Where does a person get this or that accentuation? What factors give rise to it, contribute to its formation and consolidation?

Accentuation is, as it were, an overly “protruding”, “convex”, noticeable, even conspicuous character trait. It comes from the same place as all the individual characterological characteristics that make us unique and different from each other - from our parents and from the environment in which we grow up. All living nature has its own genotype and phenotype - i.e. what is inherited in genes and what is formed under the influence of the environment. And a person also has a psychotype. So, for example, the fact that an apple tree is an apple tree and not a pear is determined by its hereditary code - genotype. And the fact that from the seeds of the same apple, one apple tree grew on poor soil in the small and weak shade, and another on good soil in the sun became lush and fruitful, is determined by the conditions of its growth - the phenotype.

A person’s personality is made up of genes, and from the influence of the environment (family, school, social conditions), and from the influence of the psychological characteristics of parents - their life principles, credo, moral, ethical and cultural values, rules, beliefs, mental and spiritual needs that together determine the personal psychotype. Popular proverbs like “The apple doesn’t fall far from the tree”, “Oranges don’t come from aspen trees” answer this question with all clarity - human character, incl. accentuated, consists of what is inherited biologically, and of what is formed by social and living conditions, and of what is transmitted by parents in everyday communication.

Studies of the characters of identical twins separated after birth and raised in different families help to differentiate between the influence of genetic inheritance and external factors. As a rule, it is impossible for a person’s direct relatives to be completely harmonious individuals, and he himself would be an accentuant, and vice versa - for a characterologically harmonious child to grow up in a family with accentuants, or, moreover, individuals with psychopathic tendencies. In early Soviet times, the development of genetics was suppressed in order to present the social ideals of Marxism-communism as superior in importance to heredity. What this led to is described in M. Bulgakov’s novel “The Heart of a Dog.”

Character formation, incl. accentuated, is always determined by a complex of reasons, and it is impossible to give preference to some to the detriment of others. However, it can be said that the more constant and persistent any personality trait is, the greater the role heredity takes in its formation, and what is caused primarily by the external environment can be corrected by the new environment. Therefore, the influence of abnormal genetic factors determines the appearance of personality disorders (psychopathy) to a greater extent than accentuations, and accentuations to a greater extent than harmonious characters.

Causes of dysthymia and risk factors

Modern psychiatry does not know biological causes that could be structured consistently in relation to all cases of dysthymia, which suggests a diverse origin of the disease. There are some indications that there is a genetic predisposition to dysthymia—the incidence of the disorder in families of patients with dysthymia is as high as fifty percent for early stages of the disease. Other factors associated with dysthymia include stress, social isolation, and lack of social support.

At least three-quarters of patients with dysthymia also have a chronic physical illness or other mental health condition, such as an anxiety disorder, cyclothymia, drug addiction, or alcoholism. Common comorbid conditions include major depression (up to 75%), personality disorders (up to 40%), somatoform disorders (up to 45%), and substance abuse (up to 50%). Patients with dysthymia have a high likelihood of developing major depression. In a 10-year study, it was found that 95% of patients suffering from dysthymia had a history of a major depressive episode. The combination of these two pathologies is called double depression.

Double depression occurs when a person experiences a major depressive episode on top of a pre-existing condition of dysthymia. It is difficult to treat, and sufferers accept major depressive symptoms as a natural part of their personality or as part of their lives that is beyond their control. Because patients can accept these symptoms and live with them, worsening is inevitable and may delay treatment

Even if such patients seek treatment, therapy may not be sufficiently effective if only the symptoms of severe depression are taken into account

Patients with dual depression tend to report significantly higher levels of hopelessness. This may be a useful symptom for doctors to focus on treating the condition. Additionally, cognitive therapies can be effective in treating patients with dual depression to help change negative thinking patterns and give the person a new way of seeing themselves and their environment.

The best way to avoid double depression is to treat dysthymia. A combination of antidepressants and cognitive therapy may be helpful in preventing major depressive symptoms. In addition, exercise and good sleep hygiene are believed to have an additional effect in treating dysthymia and preventing its worsening.

How to get rid of dysthymia?

Before starting treatment for subdepression, it is necessary to correctly diagnose it. The specialist determines whether the patient has symptoms of dysthymia, and based on them, the development of this disease can be judged. In the process of establishing a diagnosis, the doctor must make sure whether the symptoms really indicate dysthymia, since they may be a consequence of alcoholism or drug addiction. Also, such symptoms are caused by some diseases, for example, hypothyroidism

If a person feels depressed, bad mood and apathy for two or more weeks, he should definitely consult a doctor for advice. No special tests are used for diagnosis.

Treatment of dysthymia is a complex process, but you need to understand that the disease can still be treated with the right approach

It is important to identify the disease as early as possible and provide correct and comprehensive treatment for dysthymia. Complex therapy includes medication and psychotherapy

During treatment through psychotherapy sessions

specialists teach the patient to effectively overcome daily negative feelings and deal with their own bad emotions. As a rule, individual therapy sessions are prescribed. But group therapy can also be practiced among people with the same disease. The ultimate goal of psychotherapy is to teach a person to cope with negativity, increase his self-esteem and teach him to love himself.

As a rule, the doctor prescribes antidepressants

. The doctor tries to select the drug so that it gives maximum effect with minimal side effects. When selecting the optimal antidepressant, the patient’s condition – both mental and physical – must be taken into account. Taking medications, as a rule, is practiced for at least six months. The patient does not feel its effect immediately, so the result of treatment for dysthymia appears only a few weeks after starting to take the drug. When quitting antidepressants, this process must also be carried out gradually, so the patient must inform the doctor of this desire.

It should also be taken into account that many antidepressants have side effects with long-term use. Some drugs can reduce libido, cause insomnia, etc.

In modern medicine, subdepression is also treated using some alternative methods. This is phototherapy, electroconvulsive therapy, etc. Sometimes the doctor considers it advisable to prescribe mood stabilizers. In particular, this is practiced in cases of manic behavior.

In addition to the described treatment methods for subdepression, it is recommended to adhere to a healthy lifestyle, ensure that your diet is nutritious and varied, exercise regularly, and avoid smoking and alcohol.

The psychological climate in communication with family and friends also matters: it is important that it be friendly and friendly

In everyday life, people use two concepts: “depressed mood” and “depression.” The first concept is often used when considering the symptoms of dysthymia. The second concept speaks only about the clinical manifestation of dysthymia, when it begins its transition to. Treatment for dysthymia is easier and faster than for depression. It depends on the types of condition.

It is common for all people to feel depressed sometimes. It is often preceded by certain events that cause sadness, melancholy, pessimism and other emotions. Dysthymia is diagnosed when a person experiences a number of symptoms for 2 years or more. At the same time, the individual can maintain working capacity, social adaptability and other necessary qualities and skills. The only difference is his internal mood, which is consistently depressed.

We are not talking about depression in this case, since dysthymia can be called a mild form of depression, during which all its symptoms are not clearly expressed. A person has not yet developed depression, but he is in the stage of its development. If he does not help himself to heal, if he does not seek the help of specialists, then the condition may worsen.

The first consultation can be obtained on the psychological help website. Here are useful recommendations that will help you get rid of the developing disease yourself.

DYSTHYMIC PERSONALITIES

Dysthymic temperament (with a more severe manifestation, subdepressive) is the opposite of hyperthymic. Personalities of this type are serious by nature and usually focus on the gloomy, sad aspects of life to a much greater extent than on the joyful ones. Events that have deeply shaken them can bring this serious pessimistic mood to a state of reactive depression, especially in cases where there are pronounced subdepressive features. Stimulation of vital activity in dysthymic temperament is weakened, thought works slowly. In society, dysthymic people hardly participate in conversation, only occasionally inserting remarks after long pauses.

A serious mood brings to the fore subtle, sublime feelings that are incompatible with human egoism. A serious attitude leads to the formation of a serious ethical position. It is already significant that in both cases we use the definition “serious”. This indicates an internal closeness between these manifestations. It is in them that we see the positive side of dysthymic temperament. Passivity in actions and slow thinking, in cases where they go beyond the norm, are among the negative properties of this temperament.

Subdepressive temperament is easy to connect with depressive mental illness, but, as with hyperthymia, this connection is by no means necessary. This temperament very often corresponds to the mental norm.

I give one of the descriptions from our collective work (doctor Unger).

Horst H., born 1931 The father is a calm, reserved person. The mother is more lively by nature, but is constantly sick. X. has two brothers, both of whom are more relaxed than X.

Already as a child, X. was very reserved. Studying was not easy, but conscientiousness helped; X. was not a repeater. He did not have a close friend at school, as, indeed, in subsequent years. X. considered his fellow students to be hooligans and was indignant when they did not take the teachers’ demands seriously. At home he loved to tinker and dreamed of becoming a cabinetmaker, but after graduating from school he received a place as a turner's apprentice. A year later he left this job, after which he worked as a laborer until 1949. In 1949 he began working in the mining industry and became a foreman. On weekends, he preferred solitary long walks to the entertainment enjoyed by his workmates; in winter he went skiing alone. After a year and a half, they wanted to transfer him to another mine, but he refused, because this mine had a bad reputation, and went to work as an auxiliary worker. Two friends convinced him to apply to police school.

X. graduated from the school of police officers (albeit with C grades) and became the head of the unit. His work did not satisfy him in any way, he did not like to command, did not like to overcome someone's resistance. “There was no joy in the work,” he said, “and life itself seemed meaningless.” At X.'s request, he was transferred to a unit with fewer people. However, the opinion at work about him was good. X.'s greatest desire was to move to another job, but police discipline did not allow this.

The first intimate relationship with the girl lasted 2 years. He left her for the reason that she used to tell him about invitations from other men. “What especially hurt me was that she was so flattered by it, that she was so proud of it,” said X.

In 1962, he married someone the same age, but he and his wife “didn’t get along.” His wife always dragged him to dances and group outings in the countryside, but he preferred to stay at home with the children. If his wife invited guests, he remained silent the entire evening. He preferred solitude and a book to any reception. “But I don’t blame her, her nature is different.” In 1965, “by mutual consent,” they filed for divorce. His wife invited him to live in the same apartment after the divorce (“it’s easier to look after the children together”), X. agreed. He explained it this way: “The hopes still did not come true, whether I leave or stay - this, in essence, does not change things.” He decided that he would move out of this apartment if his wife found a new life friend.

X. peppered his story about himself with the following remarks: “I always see the bad in everything,” “I’ve never had a really good life,” “I can’t communicate with anyone, I’m somehow inferior.” At first he refused to talk about himself at all: “What is this for?”

This person undoubtedly has positive traits. He takes his responsibilities seriously, no matter where he works, they are always happy with him. He is tactful and fair. But lack of activity prevented him from organizing his life in such a way as to feel satisfaction. A constant pessimistic attitude aggravates the situation; the subject tries to “start something else”, to join a new profession, but does not find joy or even balance.

Characteristics of temperament can, as a rule, be established already in childhood. Hyperthymic temperament in children is easy to determine, perhaps easier than in adults, since the natural liveliness of children is accompanied by liveliness of temperament. In my work “Children's Neuroses and Children's Personality” I described such “super-active”, “super-fast” children. Dysthymic temperament in children is also easy to recognize. Such children stand out from others by their timidity and indecisiveness. This is evidenced by the case described by Zeller in our book.

Karl S., 12 years old. He came to us to undergo a course of inpatient treatment. The mother is an unbalanced woman, “she sometimes cries and sometimes laughs,” and is sometimes strict and self-possessed. My father is a baker, a lively person by nature, a conscientious worker. The mother constantly helps in the bakery, the father goes to bed very early (due to working conditions), so the children are essentially left to their own devices.

Of the six children, Karl is the quietest and slowest, although he can hardly be called timid. The boy is always very serious, never laughs heartily. With strangers, Karl is timid, shy, and begins to stutter. He is afraid to go shopping: “you have to talk to the sellers there.” Neat in clothes. He often quarrels with his older brother, whom his parents love more than him, and then his brother and his friends beat him.

Karl had a hard time at school; he even repeated the second year once. He studied conscientiously, but it took twice as much time to prepare his lessons as other children. In class everyone made fun of him, no one ever defended him. He was friends with elementary school students: “they are not so impudent and do not fight.”

In the department, Karl was timid, inhibited, constantly depressed, and tears often came to his eyes. There was no trace of childish laughter or cheerfulness; he spoke very quietly. He was often offended by children, but easily came to reconciliation. I was sincerely grateful for any kind of attention. Questions about his older brother made him very excited. Our children's team did not “accept” him. Karl was happy when he found a boy who became friends with him. He submitted to this boy in everything, for his sake he even committed offenses that he himself condemned (missing classes at the school at the clinic). Age-related intelligence indicators, determined by special tests, are normal.

Karl exhibits the whole complex of subdepressive temperament. He does not have childish carelessness or gaiety; he rather gives the impression of a depressed child. Added to this is slowness and clumsiness. His thinking is probably slow, as evidenced by his poor performance at school. Despite his normal intelligence, depression and slowness of reactions caused him to lag behind his peers. Therefore, Karl’s peers made fun of him, but he was angry and offended by them.

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Diagnosis of the disorder

An essential feature of dysthymia is the individual feeling of depression on most days of the patient's life for at least two consecutive years. Low energy levels, sleep disturbances, appetite disturbances and low self-esteem contribute to the clinical picture of the disease. Sufferers often experienced dysthymia for many years before the disease was diagnosed. People around patients often describe sufferers in terms similar to “just a moody person.”

And specialists need to pay attention to the following diagnostic criteria:

For two or more years, the adult patient reports and displays low mood or depression almost daily.
Decreased or increased appetite.
The quality and continuation of sleep decreases or increases (insomnia or drowsiness).
Fatigue and low energy levels.
Decreased self-esteem.
Decreased concentration and problems in decision making.
Feelings of hopelessness and pessimism.
During the two-year period, the above symptoms were never absent for more than two consecutive months.
During the two-year period, the patient may experience a persistent depressive episode.
The patient did not have any history of manic, hypomanic, or mixed episodes.
The patient never showed criteria for cyclothymic disorder.
Depression does not exist solely as part of chronic psychosis (schizophrenia or delusional disorder).
Symptoms are often not directly caused by physical illness or metabolic disorders, including drug or other drug abuse.
Symptoms may cause significant problems in social adjustment, work, school, or other major areas of life functioning.
In children and adolescents, the mood may be irritable, and the duration must be at least one year, as opposed to the two years required for diagnosis in adults.

Early onset of the disorder (diagnosis before age 21) is associated with more frequent relapses, psychiatric hospitalization, and more comorbid conditions. For young adults with dysthymia, there are more co-occurrences of personality abnormalities and symptoms are more likely to be chronic. However, in older adults suffering from dysthymia, psychological symptoms are related to illness or stressful events.

Dysthymia can be compared to major depressive disorder based on the severity of symptoms. Dysthymic disorder is much more chronic (long-lasting) than major depressive disorder, in which symptoms may only be present for a couple of weeks. Dysthymia also often develops at an earlier age than major depressive disorder.

Socionics and other typologies

Dysthymic personalities

A serious mood brings to the fore subtle, sublime feelings that are incompatible with human egoism. A serious attitude leads to the formation of a serious ethical position. It is already significant that in both cases we use the definition “serious”. This indicates an internal closeness between these manifestations. It is in them that we see the positive side of dysthymic temperament. Passivity in actions and slow thinking in cases where they go beyond the norm are among the negative properties of this temperament.

I give one of the descriptions from our collective work (doctor Unger).

Horst H., born in 1931. The father is a calm, reserved person. The mother is more lively by nature, but is constantly sick. X has two brothers, both of whom are more relaxed than X.

Already as a child, Kh. was very reserved. Studying was not easy, but conscientiousness helped; Kh. was not a repeater. He did not have a close friend at school, as, indeed, in subsequent years. Kh. considered his fellow students to be hooligans and was indignant when they did not take the teachers’ demands seriously. At home he loved to tinker and dreamed of becoming a cabinetmaker, but after graduating from school he received a place as a turner's apprentice. A year later he left this job, after which he worked as a laborer until 1949. In 1949 he began working in the mining industry and became a foreman. On weekends, he preferred solitary long walks to the entertainment enjoyed by his workmates; in winter he went skiing alone. After a year and a half, they wanted to transfer him to another mine, but he refused, because this mine had a bad reputation, and went to work as an auxiliary worker. Two friends convinced him to apply to police school.

Kh. graduated from the school of police officers (albeit with C grades) and became the head of the unit. His work did not satisfy him in any way, he did not like to command, did not like to overcome someone's resistance. “There was no joy in the work,” he said, “and life itself seemed meaningless.” At Kh.’s request, he was transferred to a unit with fewer people. However, the opinion at work about him was good. X.’s greatest desire was to move to another job, but police discipline did not allow this.

In 1962, he married someone the same age, but he and his wife “didn’t get along.” His wife always dragged him to dances and group outings in the countryside, but he preferred to stay at home with the children. If his wife invited guests, he remained silent the entire evening. He preferred solitude and a book to any reception. “But I don’t blame her, her nature is different.” In 1965, “by mutual consent,” they filed for divorce. His wife invited him to live in the same apartment after the divorce (“it’s easier to look after the children together”), Kh. agreed. He explained it this way: “The hopes still did not come true, whether I leave or stay - this, in essence, does not change things.” He decided that he would move out of this apartment if his wife found a new life friend.

Kh. peppered his story about himself with the following remarks: “I always see the bad in everything,” “I have never had a really good life,” “I can’t communicate with anyone, I’m somehow inferior.” At first he refused to talk about himself at all: “What is this for?”

Karl S, 12 years old. He came to us to undergo a course of inpatient treatment. The mother is an unbalanced woman, “she sometimes cries and sometimes laughs,” and is sometimes strict and self-possessed. My father is a baker, a lively person by nature, a conscientious worker. The mother constantly helps in the bakery, the father goes to bed very early (due to working conditions), so the children are essentially left to their own devices.

Author - Karl Leonhard "Accented Personalities"

New articles:

Emotive Personalities
Extroverted Personalities
Anxious Personalities
Pedantic personalities
Introverted Personalities
Stuck Personalities

Old articles:

Demonstrative personalities
Hypertensive individuals
Excitable Personalities
Affectively exalted individuals
Affectively labile individuals

Why does dysthymia occur?

Symptoms of dysthymia appear in a person due to changes in his psyche. Subdepression often develops in people who suffer from seasonal symptoms. They are characterized by mood swings and depression. As a rule, such people do not produce enough of the hormone in their bodies, which is called the joy hormone. Serotonin allows the body to effectively cope with stressful situations. Accordingly, if it is lacking, it is difficult for a person to overcome any troubles. If at the same time some unpleasant events occur in a person’s life - personal problems, difficulties at work, etc., then dysthymia may develop against this background. Also, speaking about the reasons for this phenomenon, the factor of genetic predisposition should be noted. That is, those people whose relatives suffered from dysthymia are more likely to get sick. If a person is prone to developing this disease, then even minor stress can trigger the development of symptoms of dysthymia.

When determining the reasons why the disease develops, experts also pay attention to how the person spent his childhood. After all, dysthymia could be a consequence of violence, pressure from relatives, and those who did not receive enough attention from their parents may also suffer from such a disorder

As a result, a person’s self-esteem decreases, positive emotions disappear, constant worries begin, and a tendency toward pessimism is noted.

Some chronic diseases and treatment with certain medications also lead to dysthymia. However, experts still do not know exactly the reasons for the development of this condition in humans.

Positive and negative traits of dysthymic children

Closedness is the most basic problem of such individuals. During the conversation they mostly remain silent. Only a pause that is too long can force them to express their opinion.

When troubles happen in life, dysthymic children experience them very hard. Why? They carry all negative thoughts within themselves, rarely sharing their feelings with others. As a result, they develop a pessimistic mindset, which leads to deep depression.

At the same time, the positive aspects of dysthymic individuals include:

conscientious attitude to work;
high morality;
a heightened sense of justice;
accuracy and scrupulousness;
tact;
lack of selfishness.

Thanks to their perseverance, diligence and diligence, they reach extraordinary heights in their careers. This applies only to those activities where energy, sociability and speed in decision making are not needed. Although such teenagers are often offended, they still do not give vent to their feelings. They maintain good relationships with teachers and peers because these students always occupy socially desirable positions.

IMPORTANT! The positive side of dysthymic temperament is the formation in the child’s mind of a serious ethical and moral position. Such children always take into account the feelings of others, so it is easy to raise them into full-fledged members of society.

Treatment of dysthymia

Before starting treatment for dysthymia, an accurate diagnosis must be made. In this case, the doctor must make sure that the symptoms of the disorder are not a consequence of taking medications or a specific disease, for example, drug addiction, alcoholism, or hypothyroidism.

Treatment of this mental disorder is a rather complex and lengthy process, but with the right approach it can be treated. Treatment of dysthymia involves the use of drug therapy and psychotherapy.

The goal of psychotherapy is to teach the patient how to effectively overcome daily negative feelings and bad emotions, increase self-esteem, develop self-confidence, and develop interpersonal communication skills. Typically, a patient with dysthymia is prescribed individual psychotherapy sessions, but it is also possible to attend group trainings for people with a similar disorder.

The basis of drug therapy is taking antidepressants for at least 6 months. Typically, tricyclic antidepressants are prescribed for dysthymia: amitriptyline, imipramine, clomipramine. Recently, the use of selective serotonin reuptake inhibitors has also become widespread.

In addition, enotherapy, amytal-caffeine disinhibition, nootropic therapy, nitrous oxide sessions, and intravenous novocaine are used in the treatment of dysthymia.

People with subdepression are also recommended to lead a healthy lifestyle, eat well and regularly, exercise, and avoid alcohol and smoking.

Dysthymia is a fairly stable mental health disorder that makes a person’s life difficult and joyless, which cannot but lead to disruptions in the functioning of internal organs and body systems

Therefore, it is so important to prevent the development of dysthymia in childhood, increasing the level of self-esteem and self-esteem of the child, developing his skills to cope with stressful situations

Dysthymia: treatment

After confirming the diagnosis of dysthymia, specialists at the Yusupov Hospital prescribe individual treatment, which includes three main areas:

Psychotherapy (cognitive therapy);
Drug support (tricyclic antidepressants, selective serotonin reuptake inhibitors);
Treatment of associated diseases.

The uniqueness of the programs for the treatment and rehabilitation of patients with persistent depressive disorders at the Yusupov Hospital is that, on the one hand, they are clearly structured and staged. On the other hand, they take into account the individual characteristics of each person who seeks help, and the treatment program is selected taking into account the needs and requests of the client.

For more complete information, you should sign up for a consultation online on the website or call by phone.

Types of disorder

Dysthymia is divided into primary, which has nothing to do with a previous mental illness, and secondary, which usually develops against the background of another somatic or mental illness.

The primary form of the disease is characterized by an earlier onset. Secondary disorder is often associated with external traumatic circumstances. The secondary category also includes endoreactive dysthymia, identified due to the vital nature of the clinical picture with hypochondriacal and anxious experiences. Based on symptoms, the following forms of dysthymia are distinguished: characterological and somatized. The somatized form of the disorder is distinguished by the fact that the patient mainly complains of poor health, unpleasant physical sensations in the heart or gastrointestinal tract. Somatic symptoms come to the fore: interruption of sleep, tearfulness, tachycardia, intestinal obstruction, shortness of breath. The characteristic type of dysthymia is characterized by the predominance of a person’s depressive outlook on life. Such people are convinced pessimists, they do not know how to have fun and are constantly moping. Previously, such traits were considered a feature of temperament. Today this point of view is questioned; most psychiatrists consider such manifestations to be a consequence of early dysthymia.

Dysthymia types

Somatized (cathesthetic) dysthymia is marked by complaints of satisfactory health, shortness of breath, palpitations, constipation, poor sleep, tearfulness, depression, anxiety, melancholy, burning in the larynx, intestines, coldness in the pit of the stomach. Gradually, external events cease to influence the dynamics of clinical manifestations.

Characterological (characterogenic) dysthymia is expressed in persistent, persistent disorders in the form of anhedonia, melancholy, pessimism, reasoning about the meaninglessness of life, and the formation of a depressive worldview. It's based on a loser complex. The picture of the world appears before them in a mournful light; patients see gloomy sides in everything and are born pessimists. Every joyful event appears before them as fragile joy, and they expect nothing from the future except difficulties and unhappiness. Past memories bring remorse when making mistakes. Patients are sensitive to troubles. They are in anxious anticipation of misfortune. They are constantly in a gloomy, gloomy state, silent and sad. Their behavior often repels people who care about them. Facial expressions and entire behavior convey lethargy: limply hanging hands, drooping facial features, slow gait, sluggish gestures. Those who are sick quickly become tired and despair. They are indecisive and lack initiative, they are intellectuals, but mental work is accompanied by a feeling of great tension for them.

What are the causes of dysthymia?

The development of dysthymia, like any affective disorder, can be influenced by both endogenous and external factors.

Chronic depressive mood is largely associated with biochemical processes in the brain, namely the production and transmission of serotonin. The reasons for the functioning of neurotransmitter systems that differ from the norm can be purely genetic or situational in origin. In the first case, dysthymic disorder can begin even in early childhood, and its symptoms are often mistaken for personality traits of the child. But the onset of the disease in adulthood is usually caused by psychogenic situations, for example, the loss of someone close or severe stress. This form of disorder, such as endoreactive dysthymia, develops due to the interaction of endogenous and psychogenic causes. The following factors increase the risk of developing dysthymia:

violation or absence of normal rest and work patterns;
poor nutrition, lack of vitamins and minerals for the normal functioning of the body;
childhood psychological trauma (lack of parental love, family conflicts, growing up in a single-parent family, cruel treatment and increased demands);
special personality traits (pedanticity, a tendency to pessimism, low activity and energy), the nature of a neurotic disposition, features of the functioning of the nervous system;
chronic physiological diseases;
life in a stressful environment.

Dysthymia and Cyclothymia

Dysthymia must be differentiated from cyclothymia, which is accompanied by manifestations of a mental, affective disorder, which is characterized by mood swings between manifestations close to dysthymia and hyperthymia with episodes of hypomania.

With cyclothemia, pathological changes occur as separate or double episodes, separated by mental health conditions or alternating continuously. The concept of cyclothymia was originally used to describe bipolar disorder, and the traditional classification considers it as a mild and unexpressed variant of general cyclophrenia.

Prognosis for dysthymia

The main danger of dysthymia in the prognosis for a person’s life is systematic suicide attempts, which sooner or later may be crowned with “success”. Therefore, if symptoms worsen, relatives or close people need to show the patient to a psychiatrist as quickly as possible, since the person may no longer be aware of his actions on his own.

In the absence of adequate treatment for dysthymia, psychological social adaptation is gradually disrupted

Patients cannot perform their professional duties efficiently and pay attention to their family. As a result of this, they lose their jobs and loved ones and are plunged into loneliness.

This should not be allowed under any circumstances, since the prognosis for dysthymia is clearly negative.

What types of character accentuation are there? What is characteristic of them?

In Russia, two main types of character accentuations are used - according to Karl Leonhard, the founder of the concept of accentuated character; and according to the Soviet psychiatrist A.E. Lichko, who slightly modified Leonhard’s system so that it was more consistent with the classification of psychopathy (personality disorders) already existing in Russia at that time according to P.B. Gannushkin.

According to Leonard there are:

hyperthymic (hyperactive, hypersocial, cheerful) type;

dysthymic (sad, dissatisfied, irritable) type;

affectively labile (emotionally unstable, dependent on external assessment and circumstances) type;

affectively-exalted (emotionally hyperexcitable, easily inspired, “living by emotions”) type;

anxious (fearful, insecure, submissive, easily manipulated) type;

emotive (emotionally sensitive, impressionable, vulnerable, suspicious) type;

demonstrative (self-centered, self-confident, inclined to manipulate others) type;

pedantic (conscientious, picky, petty) type;

stuck (suspicious, emotionally rigid, difficult to switch, “heavy” type);

excitable (hot-tempered, explosive, irritable, impulsive) type;

extroverted (oriented towards external events and values) type;

introverted (oriented towards inner-spiritual processes and values) type.

According to A.E. Lichko:

hyperthymic (hyperactive, hypersocial, cheerful) type;

cycloid (emotionally unstable, with cyclically alternating periods of melancholy and joy) type;

labile (emotionally unstable, dependent on momentary mood) type;

astheno-neurotic (stress-resistant, quickly exhausted, anxious, nervous, weak-willed) type;

sensitive (highly sensitive, emotionally impressionable, vulnerable, suspicious) type;

psychasthenic (doubting, insecure, self-critical, over-careful, picky) type;

schizoid (emotionally cold, indifferent, closed, withdrawn, not compassionate type);

epileptoid (vindictive, vindictive, petty, meticulous, authoritarian) type;

hysterical (demonstrative, egocentric, self-confident, inclined to manipulate others) type;

unstable (indulgent, pleasure-seeking, undisciplined, inconsistent type)

conformist (extremely law-abiding, passive, submissive, avoiding the slightest confrontation and defending his position) type.

What are the degrees of accentuation? Are there people without accentuation?

It seems to me unnecessary to divide character accentuations into degrees, since accentuation itself already represents a mild degree of personal deformation, as if preceding a personality disorder. Although formally there is a gradation of accentuators into obvious and hidden ones, in my opinion, this division is unnecessary. An accentuated personality, outside of frustrating circumstances, is already in a “hidden” state, but if the situation changes in an unfavorable way, then the characterological imbalance immediately becomes “explicit.” The simplest example is when a person accentuated by the hysterical type is healthy and is in comfortable conditions for herself, then this feature of her character does not manifest itself in any way, but as soon as she gets sick or faces stress, it becomes noticeable even to a non-specialist that demonstrativeness, manipulativeness, her egocentricity, pretentiousness and emotional exaltation clearly exceed the average level for such situations.

Are there people without accentuation? Of course - everyone else, except accentuators and psychopaths (persons with personality disorders). All this “gray mass” of more or less smooth, socially adapted people living according to the generally accepted rules of human society with well-predicted and consciously controlled emotional and behavioral reactions.

Is it possible to get rid of accentuation if it is unpleasant or bothers its owner, change your type of accentuation to some other one, or at least weaken it? Is she being treated? What should people do if they have some type of character accentuation that is unpleasant for them or those around them?

Of course, accentuation, unlike a personality disorder (psychopathy), can be gotten rid of; moreover, depending on life circumstances, accentuated traits can not only eliminate themselves, but also be replaced by one another. After all, accentuation is simply a striking character trait; there is no need to present it as a personal anomaly, much less a painful one. We know that a person's character itself changes over the course of life. Its changes are especially negatively affected by being in a situation of war or natural disaster, restriction of freedom, stressful work conditions, inappropriate behavior of a marriage partner, etc. Social and psychological well-being, on the contrary, can significantly smooth out sharp characterological “angles.” Accentuation is not a painful process, people do not get sick with it, they acquire it; it cannot be treated, but with due effort it can be influenced, it can be changed like the tone and intonation of the voice, gestures, gait, vocabulary, habits, preferences, behavioral stereotypes, etc.

If a person has the intention to “work through” his accentuation in an accelerated mode, then psychotherapy or, as they also say in Russia, psychological correction is suitable for this, like nothing else. Personally, in my opinion, psychotherapy in such cases is much more appropriate, useful and effective than for psycho-emotional disorders and, especially, diseases. It is precisely the character that an antidepressant will not correct, and, in most cases, the accentuator himself will not want to use it, since he will rightfully not perceive his peculiarity as something painful and subject to treatment. As something subject to correction, correction, improvement, perfection, transformation, development - yes, but not treatment.

Almost any direction of psychotherapy is suitable - psychoanalysis, gestalt, psychodrama, cognitive-behavioral, body-oriented, transpersonal, existential, emotional stress, holotropic, NLP, and art therapy, as in individual , and in group performance, as long as the person is sufficiently immersed in the psychotherapeutic process and achieves the changes desired for himself during it.

Who are extroverts and introverts? How does this fit with types of accentuation?

As you have already noticed, these are types from the classification of Karl Leonhard. When manifestations of extra- or introversion are clearly expressed, then they themselves are types of accentuation. Of course, their characteristics can be correlated with other types of accentuation. Thus, hyperthymic, demonstrative, hysterical, conformal types, highly dependent on the environment and oriented towards the outside world, will have practically no manifestations of introversion. And schizoid, stuck, psychasthenic types, on the contrary, can be extroverted only to a very small extent.

However, the point here is not in the intricacies of different characterological features, but in the fact that all of humanity is really quite noticeably divided into two main parts - those who work primarily on the external component of our world (statesmen, politicians, military leaders, city planners, businessmen, managers, production workers, marketers, lawyers, judges, etc.) are typical extroverts; and those who “nourish” the inner side of the soul (philosophers, historians, poets, artists, musicians, playwrights, theologians, psychoanalysts) are typical introverts. Extraversion and introversion are one of the typical manifestations of the duality of our world, like matter and idea, body and soul, left and right hemispheres, exact sciences and humanities, business and creativity, etc.

How does the type of accentuation affect people’s lifestyle, success, ability to communicate and health?

Accentuation can greatly influence both success in life and health if the accentuator’s lifestyle and occupation are built in accordance with the prominent feature of his character, and not in opposition to it. For example, a hyperthymic type can be a successful salesman, dealer, volunteer, psychotherapist, actor, speaker, politician, etc. He will be at his best in all areas where it is important to be active, to contact people, to charge them with his independent, constantly positive attitude and always overflowing energy. But if parents want at all costs to turn their hyperthymic child into a musician-violinist, mathematician-programmer, bank clerk or laboratory scientist-researcher, forced to concentrate on monotonous activities for a long time alone, then not only will nothing come of it, but sooner or later a person will begin to “break down” - drink, or become neurotic, or get sick, or, losing control, “go to all kinds of troubles.”

For example, you can also imagine how a conformist person ideally performs the functions of a notary, accountant, safety instructor or kindergarten teacher, but if she finds herself forced to make quick and non-standard decisions, look for a way out of controversial and conflict situations, violate formal rules and restrictions, to act in unpredictable conditions, faces a moral and ethical choice, then in the near future she will be expected to experience emotional breakdowns, anxiety-depressive disorders and psychosomatic diseases. The epileptoid type can become an unsurpassed “hunter” of terrorists, a riot policeman, but if he has to be a primary school teacher, then woe to everyone, especially the students. A schizoid personality can turn out to be a magnificent and even great mathematician, inventor, programmer, master with golden hands, but where you need to effectively interact with people - trade, treat, lead, perform on stage, invite people to political parties, etc. - he will suffer a complete failure, most likely, he will not even be able to begin this type of activity, and in forced circumstances he will begin to suffer psycho-emotionally or physically.

There are special areas in psychology - vocational selection and career guidance. In high school, most schoolchildren undergo special testing to determine professional qualities. The essence of this testing is to determine the graduate’s character and the professions most appropriate to him. This process is now completely computerized.

What is the connection between certain types of character accentuation and talent? Is it true that many geniuses in different fields were schizoid? The same goes for super-gifted and unconventional “indigo children.” Is there a connection or is it a myth?

Schizoid sounds like a psychiatric diagnosis, so I wouldn't use that concept in relation to the people you're asking about. Yes, and psychologists themselves in such cases often speak not about schizoidism, but about some autistic or introverted personality, i.e. the ability to attach equal or greater importance to the inner world than to the outer one. Schizoidity sounds like inferiority, morbidity, and to be terminologically accurate, it means not so much detachment from the world as the emotional coldness of its perception. I personally don’t associate a typical schizoid with genius, but autism and introversion do, if only because they imply the direction of the vector of intellectual interest and emotional value inward, no less than outward.

In general, there is, of course, no direct connection between accentuation and talent. You just need to understand that accentuation does not in any way interfere with giftedness, but it clearly does not contribute to it. Giftedness can equally manifest itself in a harmonious or an accentuated personality, and even in a psychopathic one. In neither one, nor the other, nor the third case does the intellect suffer. The question is how this talent will be used, how adequately it will find expression and what purposes it will serve.

Accentuators may appear more gifted simply because they are more visible. If harmonious, i.e. an unaccented personality, even a very gifted one, in order to make him noticeable, needs, in modern language, “PR”, then the life path of an accentuated personality, even if not gifted, by will or by will, consists, in fact, of nothing but uncontrollable “PR” shares" of a larger or smaller scale. The more intellectually gifted an accentuator is, the greater the success of his “PR campaigns” he can achieve, the less risk his visibility will turn into “black PR” for himself. The less intellectual talent, the more the accentuator will look like just a “primitive upstart” or “a person with an oddity.”

Who are psychopaths or psychopaths?

The concept of not only “psycho”, but even “psychopath” today is crude and outdated. Officially, instead of psychopathy, the term is used - personality disorder or personality disorder - this is the same as, for example, the concept of mental retardation is now replaced by delayed intellectual development.

As we have already said, psychopathy differs from accentuation in its obvious pathology and inadequacy, regardless of whether a person is in favorable or unfavorable conditions for himself. If the accentuator in most communities is treated only as a person with a “highlighted individuality”, or “zest”, or “sharpened temperament”, then the psychopath will simply be shunned or avoided as a person who is clearly “strange”, “unpredictable”, “inadequate” ”, it is possible that it is simply “dangerous”, at best - “not of this world”.

It is very important to understand that psychopathy (personality disorder) is in no way a mental illness like schizophrenia or manic-depressive psychosis, which can worsen in some periods, not manifest itself in others, take a more severe or mild course, and in in most cases these days it is good to be treated. Nothing like this happens with personality disorders; there is nothing in common between a psychopath and a mentally ill person, for example, a schizophrenic. A schizophrenic gets sick one day and can be cured. A psychopath is born this way and cannot be cured. This is very easy to imagine by saying that a psychopath’s character is initially pathologically altered and stable in this immutability, just as with mental retardation (oligophrenia) intelligence is initially reduced, and this decline is constant and incurable throughout life. An oligophrenic, alas, is born that way, he will not become smarter and will not become dumber than he is, his intellectual development will always correspond to his own level, regardless of external circumstances, it is useless to treat him, you can only try to adapt him to some suitable environment for him . All the same applies to a psychopath, with the only difference being that it is not his intellect that has suffered (which can be very high!), but his character, and this characterological pathology is immutable and incurable. But a sufferer who has fallen ill with schizophrenia, epilepsy or manic-depressive psychosis, through therapeutic measures, can be put into a stable long-term remission, in which he will represent a completely harmonious personality with completely preserved intellect and moral and ethical qualities, without signs of any or accentuation, and sometimes even neuroticism.

What types are characteristic of sociopaths?

It is not correct to associate sociopathy with accentuation; sociopaths are psychopaths, people with personality disorders, not accentuators. It's easy to remember simply by consonance.

Each type of accentuation, of course, is capable of exhibiting some sociopathic traits - if behavior inappropriate for his character is imposed on him, he will protest, conflict, express irritation, indignation, overreact emotionally, etc. In a stressful situation, even an unaccented person can behave this way. It is not accentuators, but psychopaths, who display an obvious antisocial orientation.

The accentuator only in an uncomfortable situation acquires neurotic symptoms, from which he himself mainly suffers. A psychopath, under almost any circumstances, behaves inappropriately, causing others to suffer, and with additional stress, his reactions can acquire psychotic features, resembling the behavior of a mentally ill person.

Interviewed by Alexander Herts, “Healing Letters” newspaper

Treatment of dysthymia

Dysthymia is treated, the results of which largely depend on the persistence of the acquired depressed mood. Psychologists can work with a patient for a long time, but his persistent tendency toward depressed mood and pessimism will provoke dysthymia.

There are positive effects from using Sertraline at a dosage of 50 mg per day. You can also use antidepressants, but they should be taken strictly in doses and at the right time:

Clomipramine.
Amitriptyline.
Amelipramine.
Anafralin.
Imipramine.
Prozac.
Cipramil.
Aurorix.

Doctors may prescribe antipsychotics, the dosage of which should also be observed:

Amisulpriid.
Sulpiride.
Haloperidol decanoate.
Fluanxol-depot.

Psychotherapy plays an important role. It is carried out in the following directions:

Cognitive psychotherapy.
Group psychotherapy.
Family psychotherapy.
Individual psychotherapy.
Interpersonal therapy.
A support group where a person can express themselves openly, increase self-confidence and develop interpersonal communication skills.

The emphasis is on ensuring that a person develops an objective attitude towards himself, responds adequately to external manifestations of the world around him, and also changes his outlook on life in general. If dysthymia develops against the background of certain character traits, then the psychotherapist helps in re-educating the patient.

Features of the course of the disease

Dysthymic disorder most often begins in youth, sometimes even in childhood.

Although some forms of the disease, for example, endoreactive dysthymia, can begin even during the period of involution. This chronic depressive mood usually lasts for more than two years, sometimes much longer. In its course, dysthymia resembles, however, it does not reach it in terms of clinical signs. Low mood and other subdepressive symptoms last for months, while relatively positive periods are much shorter (a few days or weeks). With early onset of dysthymia, relapses with severe symptoms occur more often. After three years of the disorder, most patients develop single or recurring major depressive episodes. It is noteworthy that about 75% of patients additionally suffer from another mental or chronic physical illness, for example, alcohol or drug addiction, dissociation, social phobia, anxiety or panic disorder. For dysthymia, as for , it is characteristic that the person as a whole maintains a normal level of functioning in the family and society.

How to determine the presence of dysthymia? The most characteristic symptoms are identical to classic depressive symptoms - anhedonia (inability to experience pleasure), low self-esteem and depressed mood. However, they are not so clearly expressed, so dysthymia, like masked depression, sometimes hides behind somatic manifestations and general malaise, which complicates diagnosis and treatment. During the course of the disease, the following somatic, mental and cognitive symptoms are most often observed:

taciturnity, avoidance of social contacts;
tendency to think and regret about the past, pessimistic assessment of prospects;
decreased ability to perform daily activities;
despair, self-doubt, feeling of hopelessness;
loss of interest in previously favorite activities;
decreased concentration, activity, and energy levels;
sleep and appetite disturbances, tearfulness, chronic fatigue syndrome.

Abstract on the topic: “Description of types of accentuations”

Description of types of accentuations

HYPERTENSIVE TYPE. A notable feature of the hypertemic personality type is a constant (or frequent) stay in an elevated mood, even if there is no external reason for this. An elevated mood is combined with high activity and a thirst for activity. Hyperthemes are characterized by sociability and increased talkativeness. They look at life with optimism, without losing this quality even when obstacles arise. Difficulties are often overcome without much difficulty due to the activity and activity that is organically inherent in them.

PIPE TYPE. The stuck personality type is characterized by high stability of affect, duration of emotional reaction and experiences. An insult to personal interests and dignity, as a rule, is not forgotten for a long time and is never forgiven just like that. In this regard, they often characterize others as vicious and vindictive people. There are reasons for this: the experience of affect is often combined with fantasies that carry a plan of revenge on the criminal. The painful sensitivity of these people is usually clearly visible. They can also be called sensitive and easily vulnerable, although in combination with the above.

EMOTIONAL GUY. The main features of an emotional personality are high sensitivity and deep reactions in the field of subtle emotions. Characterized by meekness, kindness, sincerity, emotional responsiveness, high

empathy develops. All these traits, as a rule, are clearly visible and constantly appear in the external reactions of the individual in various situations. A characteristic feature is increased tears (as they say, “wet eyes”).

PEDANTIC TYPE. Clearly visible external manifestations of this type are increased accuracy, craving for order, indecisiveness and caution. Before you do anything, think long and carefully about everything. It is obvious that behind the external pedantry there is a reluctance and inability to make quick changes and take responsibility. These people do not change their workplace unless necessary, only in the most extreme cases, and then with great difficulty. They love their production, their usual work, and are conscientious in everyday life.

ANXIETY TYPE. The main feature of this kind is an increased fear of possible mistakes, concern for one’s own fate and the fate of one’s loved ones. In this case, as a rule, there are no objective reasons for such concern or they are insignificant. They are distinguished by shyness, sometimes showing submissiveness. Constant wariness of external circumstances is combined with self-doubt.

CYCLOTHYMIC TYPE. The main feature of the Zyklothym type of conditions is the transition from the bullish Hyper to Themis Chen and dystemischen. Such changes are frequent and systematic. In the hyperthymic phase of behavior, joyful events cause not only joyful emotions, but also a thirst for activity, increased hunger and activity. Sad events not only cause grief, but also depression. This condition is characterized by a slowdown in reactions and thinking, a slowdown and a decrease in emotional response.

DEMONSTRATIVE GUY. The central feature of a demonstrative personality is the need and constant desire to impress, attract attention, and be the center of attention. This manifests itself in vain, often deliberate behavior, especially in qualities such as loyalty, perception and self-image as the central character of any situation. Much of what such a person says about himself is often a figment of his imagination or a highly embellished picture of events.

EXCITABLE TYPE. A feature of an excitable personality is pronounced impulsiveness of behavior. The nature of communication and behavior does not depend on logic or a rational understanding of your actions, but rather is based on impulses, drives, instincts or uncontrollable urges. In the sphere of social interaction, this type of representatives is characterized by extremely low tolerance, which can be considered no tolerance at all.

DISTHYMIC TYPE. Dysthymic personality is the antipode of hyperthymic personality. Dysthymics tend to focus on the dark, sad aspects of life. This manifests itself in everything: in behavior, in communication, and in the peculiarities of perception of life, events and other people (especially more socially perceived). Usually these people are serious by nature. Activity and especially hyperactivity are completely alien to them.

EXALTED TYPE. The main feature of an exalted personality is burnaa, an exalted reaction to what is happening. You easily become elated at happy events and despair at sad events. They are characterized by exceptional influence on an event or fact. At the same time, inner impressionability and a tendency to experience find a clear external expression in your behavior.

Why did dysthymia occur?

The system-vector psychology of Yuri Burlan will help us understand this.

The conditions described above occur only in owners of the sound vector. The sound vector is the only one that does not have material desires; it is interested in the spiritual, mental. Our patient had been observing people's behavior since childhood, trying to understand their motives. I read philosophy and psychology, even psychiatry. And I couldn’t find an answer to my questions.

The main question of the sound vector: “What is the meaning of life? What am I living for? What is the purpose of everything that exists?” Finding answers is the primary need of the sound vector, which overshadows all other desires. And until there is an answer, there is no point in anything else for a sound person. Our heroine was also looking for information about how the human psyche and soul works. “Tell me, the body is not the soul, because the soul is eternal?” During the conversation it became clear that these topics were close to her like no other. She “didn’t see the point in talking about others.”

Exact sciences, such as mathematics and physics, are the talent of a sound engineer. The girl could have received a higher education, but even at that time the lack of sound vector was so strong that she did not see the point in studying. And now her abilities, especially the sound vector, are not realized. Therefore, she developed dysthymia.

Dysthymia, like clinical chronic depression, is a manifestation of an unsatisfied sound vector. When the sound and anal vectors are combined, the result is such a viscous, viscous, rigid state, from which it is neither here nor there.

A person develops selective contact - communicates with only a few people, avoids worldly bustle and conversations, hides from society. And he sees no way out. Does he exist?

DYSTHYMIC PERSONALITIES

I give one of the descriptions from our collective work (doctor Unger).

Horst H., born 1931 The father is a calm, reserved person. The mother is more lively by nature, but is constantly sick. X. has two brothers, both of whom are more relaxed than X.

Bottom line

Dysthymia is a progressive mental illness. Even though it is a mild form of depression, if you do not treat your condition, it will progress to major depressive disorder. The outcome depends on the measures that the patient takes to eliminate his depressed mood. The absence of any measures gives unfavorable prognoses.

The following are preventive measures to prevent the development of dysthymia:

Increasing self-esteem and self-esteem.
Lifestyle changes.
Timely consultation with a doctor if dysthymia is detected.

It is very important that a person eats right, does moderate exercise, communicates with pleasant people and knows how to relax. It is also necessary to treat all diseases in a timely manner and give up bad habits.

Dysthymia: causes

Dysthymic disorder often begins in childhood or adolescence and is more common among women. The exact causes of persistent depressive disorders remain unknown to specialists. There are just some assumptions:

It is believed that people suffering from dysthymia have some differences in the structure of their brain. This issue has not been fully studied, but researchers hope that work in this direction will help shed more light on the causes of the disease and find new treatments;
In people suffering from depression, the proper functioning of neurotransmitters (serotonin deficiency) - substances that transmit signals in the human brain - is impaired. As a result, the mechanisms responsible for stabilizing mood are damaged;
Heredity also plays a role. Statistics show that the risk of chronic depressive disorder is increased in people who have relatives with a similar illness. It is quite possible that this is due to some genes that have yet to be discovered;
The onset of the disease is usually provoked by various negative events in the patient’s life, namely: traumatic events, physical injuries and serious illnesses, bereavements, severe and chronic stress.

Although the causes of dysthymia are not fully known, there are many effective treatments for this mental illness.