Violation of Self-Regulation as the Basis of the Syndrome of Delusional States in Personality Disorder and Schizophrenia
Stepanenko V
Published on: 2023-12-28
Abstract
Super-valuable and delusional states were considered not just as pathological ideas, but as complex psychopathological phenomena with underlying disorders of self-regulation. The features of their structure, phenomenological heterogeneity, and dynamic variability are highlighted. This report focuses on the mechanisms of syndromogenesis, reflecting different variants of regulatory disorders.
Keywords
Delusional state; Personality disorder; SchizophreniaIntroduction
The Purpose of the Study
To study the mechanisms of syndrome formation of super-valuable and delusional states, taking into account regulatory violations. Material: Out of 53 examined, 24 subexperts with super-values were selected (17 were diagnosed with personality disorder, 4 with organic personality disorder, 3 with schizophrenia) and 29 with delusional states (with schizophrenia).
Methods
Psychopathological and statistical.
The Results and their Discussion
Super-valuable and delusional states were considered not just as pathological ideas, but as complex psychopathological phenomena with underlying disorders of self-regulation. The features of their structure, phenomenological heterogeneity, and dynamic variability are highlighted. This report focuses on the mechanisms of syndromogenesis, reflecting different variants of regulatory disorders. Within the framework of the studied states, according to traditional ideas about self-regulation, the motivational (semantic) and operational - technical levels of self-regulation, which are in a strict hierarchical relationship, were evaluated. Delusional states in paranoid schizophrenia were represented by sensory and imaginative variants of it, which could act as different stages of a single process with a natural complication of syndrome formation and an increase in the polymorphism of the clinical picture. The mechanism of syndrome formation consisted in the formation of a pathological "personal meaning" (according to Leontiev A.N.), contradicting the patient's past experience and affecting various levels of cognition (perception, representation, thinking). Thus, deeper violations of the semantic level of personal self-regulation were identified, and violations of the operational and technical level (goal setting, modelling, programming, evaluation of results and their correction) were already secondary in nature and also depended on the severity of a specific endogenous defect. With sensory delirium, mainly sensory cognition was disrupted. With imaginative delirium, the initial mechanisms of delusional formation did not disappear, but violations of imagination were added. Further complication of delusional symptoms occurred due to the "secondary" delusional interpretation of the mental automatisms formed by that time, which led to the formation of delusions of influence. The main mechanism of delusional formation expressed the dysfunction of certain links of self-regulation: giving pathological personal meaning to the patient's perception of the surrounding reality, behind which there was a pathology of the motivational (semantic) sphere, which led to a pathological assessment of the environment, setting a goal corresponding to the painful experience, flaws in the formulation of an action program. Evaluating the results of one's actions also proved impossible due to semantic distortions, which led to uncorrectable delusional behavior. In super-valued conditions, the severity of regulatory disorders was different and was determined by many factors: nosological non-specificity; the predominance of an ideational, emotional or behavioural component in the psychopathological structure; the influence of psychogenic or constitutional factors in the genesis of the syndrome; variability of dynamic characteristics. Many of these factors have caused the clinical heterogeneity of super-values, which is expressed in the identification of the following varieties: affective, interpretative and hypersthene super-valuable states, constitutionally personal and psychogenically conditioned super-valuable states; super-valuable states within the framework of a stationary state, reaction or pathoharacterological development. Super-values were formed under the influence of catalytic mechanisms that contribute to the consolidation of affectively charged, passionate experiences, which are becoming increasingly important for the personality. The fixation of the condition occurred either in a psychogenic situation, or against the background of initial flaws in the personal structure caused by a developmental defect (for example, our patients were more often diagnosed with a personality disorder), or against the background of acquired personality changes due to some kind of mental disorder (for example, organic personality disorder, schizophrenia). Quantitative changes in both the semantic and operational-technical level of self-regulation were revealed here. With prolonged exposure to catalytic mechanisms, the hierarchical structure of the motivational-need sphere changed with the actualization of a certain super-significant need, which revealed the peculiarities of the functioning of the semantic level of self-regulation. The latter, in turn, led to the predominance of appropriate motives in the personality's activity, contributing to the restriction of an arbitrary choice of goal. At the operational and technical level of self-regulation, difficulties were observed in modelling significant conditions and evaluating performance. This led to the preparation of an incorrect action program with unrealistic plans, and an incorrect assessment of performance results created obstacles to building corrective actions with the inability to change the action program in accordance with the changed conditions. In some cases, regulatory violations were aggravated in conditions of frustration, as well as with negative dynamics in the case of a transition of super-value within the framework of a reaction to super-value within the framework of pathocharacterological development. There was a psychotic disorganization of the psyche, which is a consequence of the regression of conscious semantic regulatory processes with simplification and narrowing of the meaning of activity by the mechanism of "shifting motive to goal" (according to Zeigarnik B.V.) and the transition to lower automated levels of functioning. The regression of mental activity was accompanied by gross persistent defect-like personality disorders. The personality became a hostage to the operational attitude and could not return to conscious self-regulation.
Conclusions
- Delusional and super-valuable states are not so much pathological ideas as complex psychopathological formations, the genesis of which involves various regulatory disorders, which can be used in their differentiation.
- Delusional states are based on a violation of the functioning of the semantic level of regulation of mental activity, which consists in giving a pathological "personal meaning" that contradicts the past experience of the individual at various levels of cognition, which is of paramount importance. Other regulatory defects of the operational and technical level are secondary in nature and may differ depending on the type of delirium and the severity of deficiency disorders.
- Super-values occupy a special place at the boundary of non-psychotic and psychotic disorders, are characterized by morbid nonspecificity, clinical diversity and variability of dynamic characteristics, which causes a difference in the accompanying violations of self-regulation.
- The formation of super-valuable states is based on a catalytic mechanism that contributes to a change in the hierarchical structure of the motivational need sphere with the actualization of a certain need, which, in the case of negative dynamics, can lead to simplification and narrowing of the meaning of activities according to the mechanism of "shifting the motive to the goal" with the acquisition of an increasingly automated and unconscious character.