Psychopathology of Will

The term “will” means the conscious, purposeful control of a person by his activity; It should be noted that volitional activity is characteristic only for humans. The behavior of animals due to instincts and conditioned-reflex connections.

In the process of sociohistorical development, man has formed forms of adaptation to the environment on the basis of differentiated conditioned reflex reactions and arbitrary control of instincts.

In the formation of volitional process there are the following steps:

1) motivation, awareness of the goal and the desire to achieve it;
2) awareness of a number of opportunities to achieve the goal;
3) the struggle of motives and choice;
4) adoption of one of the possible decisions;
5) the implementation of the decision.

With the totality of desires, motives, aspirations, acquiring the character of motivational activity, is the motivational sphere. The motivational sphere includes both conscious (volitional) and insufficiently conscious actions based on various motives (drives, attitudes, etc.).

Willful violations can relate both to the level of motivations for activity and awareness of the goal, that is, the formation of motive, the adequacy of the motives to the personality traits and the situation, and the decision-making, appropriate behavior at all stages of the volitional process.

Symptoms of volitional disorders

Abulia ( dysbulia ) is characterized by a pathological lack of desire and motivation for activity. Abulin is replaced by adynamia, manifested by a decrease or complete cessation of the motor activity of the organism or organ.
Abulia is detected in various pathological processes, very often in schizophrenia, frontal lesions and depression.
Decreased volitional activity can lead to the release of lower actions – automated and instinctive.

Hypobulia is characterized by a decrease in volitional activity, impoverishment poverty, inactivity, lethargy, a decrease in motor activity, and a lack of desire to communicate. These features are often noted in depressive states, schizophrenia. Weakening of attention, impoverishment of thinking, slowing down of speech can be observed in conditions of stupor .

Hyperbulia , in contrast to hypobulae , is characterized by increased activity due to a significant number of motivations for activity, which often change in order to implement them. Hyperbulla is observed in manic states, paranoiac syndrome.

In a manic state, the productivity of activity is usually low due to the rapid distractibility of patients, the rapid change of motives. When paranoid syndrome activity unilateral, due to delusional motives.
The term parabulia should be understood as a perversion or change in volitional activity. The motivations of the activity, its motivations and goals of realization are perverted in connection with the psychopathological symptoms of the disease that the patient has, so the auditory hallucinations of an intimidating nature induce him to aggressive activities.

Impulse disorders
Instincts play a significant role in human life, with age they are subjected to the control of volitional activity. Violations of instinctive reactions, as a rule, are formed in children and adolescents. Among them are shared eating disorders, self-preservation instinct, disorders of sexual desire.

Disorder of food cravings
Bulimia – increased craving for food – pathological, sharply increased hunger, often accompanied by general weakness and pain in the abdomen. It is observed in hyperinsulinism and mental illness, in mental retardation, defective states in schizophrenia.

At a certain stage of anorexia nervosa, against the background of refusal to eat, an irresistible craving for food appears, accompanied by eating huge amounts of it with subsequent induction of vomiting. Sometimes bulimia develops in certain states of emotional stress, when eating large amounts of food removes it.

Anorexia is characterized by a loss of hunger, as well as lack of appetite in the presence of physiological nutritional needs.

At puberty, with anorexia nervosa, the first refusal to eat occurs for the purpose of losing weight, then the feeling of hunger fades away and even aversion to food appears.

The loss of hunger is observed in mental illness: depression, catatonic stupor, severe alcohol withdrawal. Anorexia with significant weight loss is observed in Simmonds and Sheehan syndromes .

  • Polydipsia is caused by increased fluid intake, indomitable thirst, which occurs, as a rule, in endocrine diseases.
  • Parorexia is manifested by a perversion of appetite spreading to inedible substances.
  • Coprophagy – the desire to eat their own excrement.

Violations of the instinct of self-preservation. These disorders can be manifested by an exacerbation of protective reactions, heightened alertness and readiness for panic reactions, fears under the action of various stimuli, especially pain.

The weakening of the self-preservation reflex – the disappearance of the reaction when a real danger arises, with pain stimulation, the distortion of the defensive reflex with mental diseases manifests itself in self-harm and suicidal behavior. Violations of various drives are described in more detail in Section 9 of Part 2 – “Disorders of biological needs”.

Impulsive drives and impulsive actions

Impulsive drives are caused by an irresistible attraction to achieve goals that are inadequate to the real situation, achieved without resistance, but with subsequent critical evaluation. An impulsive action is performed swiftly, as a rule, it is an unmotivated action that lasts a second or a minute; showing a sign of pronounced mental disorder.

Dromomania is an indomitable impulsive attraction to a change of location. Under dromomania it is commonly understood to be attracted to shoots from home, wandering and changing places, observed in various mental illnesses. In the formation of dromomania , a reactive stage is singled out – the first departure from home due to mental trauma, then the departures become habitual, fixed, and any habitual unfavorable situation results in a familiar reaction – departure from home.

In the future, leaving the house becomes non-motivated , unexpected, becomes impulsive.
Dromomania is most typical for children and adolescents, but there are cases when, having arisen in childhood, dromomania persists in adult men and women, and a woman does not stop having young children, whose health is at risk during vagrancy.

Dipsomania – unrestrained attraction to drunkenness, accompanied by severe alcoholic excesses. The craving for alcohol is so strong that, despite the critical attitude towards it, at first it is impossible to overcome the craving. In this state, patients commit all sorts of unseemly deeds – deception, theft, aggression – in order to get the desired alcohol. In some cases, it is possible to identify a mood change preceding an attack of dipsomania.

Pyromania is a craving for arson, not motivated by anything, suddenly developing, but not accompanied by a change in consciousness.
Kleptomania – unmotivated attraction to theft.

Coprolalia is characterized by impulsive pronouncing of swear words. This symptom may occur when the disease F Ile de la Tourette.
Mythomania manifests itself as an irresistible attraction to lies , deceit, and is characteristic of hysterical individuals to attract attention.

Violations of volitional activity

Violations of volitional activity are possible at the decision-making level and at the level of transition to the implementation of the decision taken.
Obsessive doubts. The patient after a struggle of motives – to go to the cinema or to friends makes the decision to go to the cinema, but after this decision, doubts arise again, and so endlessly.
Rigidity of the decision means the absence of its correction and flexibility in accordance with the changed situation. The patient, because of these peculiarities, cannot proceed to the implementation of the decision, since the situation has already changed, and he cannot make another decision considering the situation. This is observed in rigid epileptoid personalities.

Attention disorders

The manifestations of volitional activity include the ability to focus on objects of perception. Concentration can be passive and active, peculiar only to a person and expressed in the fact that a person consciously focuses on certain phenomena, turning off, distracting from other events and phenomena.
Disturbances of attention are manifested in distractibility, while the person cannot focus on the desired object, there is a weakening of active attention and passive prevails.
Rigidity , attention zastroyemost observed in depression. Patients cannot switch to other events, all thoughts and memories are concentrated on unhappiness (if it is a question of reactive depression) and their melancholy experiences.
The exhaustion of attention is observed in organic diseases and asthenic conditions. When attention is exhausted, patients at the beginning of the conversation answer the questions correctly, and then as the exhaustion increases, the answers become less productive. This clearly appears when counting, for example, when a patient is asked to subtract 7 or 17 from a hundred.

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