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THE CLINICAL CHARACTERISTICS OF PERSONALITY CHANGES IN
SECONDARY ALCOHOLISM
1
Sultanov Shoxrux Xabibullayevich
2
Turayev Bobir Temirpulotovich
3
Xamrakulova Kamilla Baxodirovna
1
Doctor of Science, SciencesDepartment of Therapeutic direction No.3, Tashkent State Dental
Institute, Tashkent, Uzbekistan
2
Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State
Medical University, Samarkand, Republic of Uzbekistan
3
Student of group 505 of the Faculty Medical Pedagogy of Samarkand State Medical University,
Samarkand, Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.14926648
Abstract.
The clinical characteristics of personality changes in secondary alcoholism
encompass a range of psychological, emotional, and behavioral alterations that develop as a
result of prolonged alcohol dependence. These changes may include increased emotional
instability, impaired impulse control, heightened aggression or irritability, diminished cognitive
functioning, and a progressive decline in social and occupational adaptability. Additionally,
individuals with secondary alcoholism often exhibit intensified anxiety, depressive symptoms, and
a tendency toward social withdrawal. The evolution of these personality changes is influenced by
underlying psychiatric conditions, the severity and duration of alcohol abuse, and the individual's
pre-existing personality traits. Understanding these clinical characteristics is essential for
developing effective therapeutic interventions and personalized treatment strategies aimed at
addressing both the addiction and its psychological consequences.
Keywords:
Clinical characteristics, personality changes, secondary alcoholism,
psychological alterations, anxiety, depressive symptoms.
Introduction.
In individuals with a premorbid asthenic disposition, a reaction of nervous
weakness is frequently observed, often manifesting in the presence of family members or friends,
and in some cases, at work or other public settings in response to any words or actions directed at
them. These individuals frequently experience doubts about their actions, particularly those
committed while intoxicated, leading to feelings of remorse. This remorse is often accompanied
by promises to stop drinking and to start a new way of life. Patients suffering from stage II
alcoholism frequently reported feelings of misunderstanding, underestimation, and discrimination,
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783
as well as complaints about an unsuccessful life. They exhibited obsessive-phobic and
hypochondriacal disorders, often accompanied by heightened emotional sensitivity and an
increased tendency to cry. These individuals commonly experienced a deep sense of
dissatisfaction, persistent anxiety, and preoccupation with their health, further exacerbating their
emotional instability and reinforcing their dependence on alcohol as a coping mechanism [1-7].
In individuals with premorbid stenic and excitable personality traits, explosive character
features were predominant. They were characterized by episodes of explosive or, in rare cases,
sullen anger, often accompanied by violent aggression toward loved ones and hostility toward
others. These individuals exhibited a heightened tendency toward emotional outbursts,
impulsivity, and confrontational behavior, which significantly impacted their interpersonal
relationships and social functioning. Unlike asthenic individuals, these patients attributed their
failures, including alcoholism, to their environment and external circumstances rather than
themselves. They became sullen, tense, envious, vengeful, and overly suspicious, often displaying
a heightened sense of resentment and blame toward others. Their emotional state was marked by
increased irritability and a persistent feeling of dissatisfaction with their surroundings [8-13].
In individuals with premorbid hysterical traits, personality changes were closely associated
with pronounced psychopathic symptoms, similar to the previous cases. They were characterized
by marked emotional instability, often accompanied by functional neurological and somatic
disorders, driven by a strong desire to attract attention to their problems. Their behavior was
dominated by dramatic expressions of distress, exaggerated emotional responses, and an increased
dependency on others for validation and support. These patients were characterized by a tendency
toward deception and exaggeration, sometimes reaching the level of pathological lying
(pseudologia fantastica). They often fabricated incredible stories and reasons to justify their
drinking habits. Their behavior was marked by manipulative tendencies and theatrical self-
presentation, which frequently led to the deterioration of relationships with their loved ones, whom
they often blamed for their problems [14-18].
Patients with a syntonic personality type exhibited an unreasonably elevated mood, often
characterized by optimism, boastfulness, and uninhibited behavior. They were pleased to escape
the depressive state that followed a psychotraumatic event. These individuals were excessively
sociable, sometimes inappropriately familiar, and constantly sought out drinking companions. For
these individuals, more than for others, the so-called "alcoholic humor" was characteristic,
primarily expressed through a tendency for crude jokes on alcohol-related topics. In conversation,
they spoke about themselves easily and became very open after a short interaction.
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784
At the same time, syntonic patients were sensitive and vulnerable when faced with
traumatic situations. In such cases, they could have sudden emotional outbursts, yell at others, and
then quickly apologize and regret their actions [19-23].
In individuals with an unstable personality type, the primary characteristic was a
susceptibility to external influences and dependency on others. They were distinguished by
instability in their interests and goals, an inability to engage in active, systematic work, and a
strong craving for entertainment. They failed to keep promises and commitments made to their
relatives and were unable to handle work responsibilities. These patients often left home,
especially when faced with any difficulties, and spent time in the company of antisocial individuals
for group drinking sessions. These patients often left home, especially when faced with any
difficulties, and spent time in the company of antisocial individuals for group drinking sessions.
Their attitude toward their illness was also unstable; they did not have a clear tendency to
blame either others or themselves for their condition. Instead, they frequently changed their
opinions, shifting between denial, indifference, and occasional acknowledgment of their problem.
Their perception of their illness was often superficial and inconsistent, making it difficult
for them to commit to treatment or take responsibility for their recovery [24-28].
Affective disorders in secondary alcoholism primarily manifest in an explosive type with
a dysphoric emotional tone. Patients experience short-term episodes of irritability, anger,
aggression, resentment, tearfulness, rudeness, and dysphoria, followed by exhaustion, apathy,
indifference, and a pessimistic outlook on the surrounding world. These emotional fluctuations are
often accompanied by feelings of regret and a strong craving for alcohol to alleviate their distress.
Such outbursts often arose without any apparent cause but were linked to previous
traumatic experiences, reminders of past events, interpersonal conflicts, work-related problems,
and health issues [29-36]. Patients became tense, suspicious, and hypersensitive, displaying a
tendency to blame others—primarily their relatives—for their problems. They withdrew from their
families due to hypochondriacal concerns, developing fears such as carcinophobia and
cardiophobia. Additionally, they suffered from numerous somatic complaints, persistently
doubting medical examination results and refusing to trust the conclusions of healthcare
professionals [37-42].
The euphoric tone of behavior and mood, commonly observed in the general population of
patients with alcoholism, was not characteristic of patients with PTSD. Even in cases where an
inappropriately euphoric mood and outwardly cheerful behavior predominated, a parallel
vulnerability within the syntonic personality domain was frequently noted.
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These individuals exhibited a hypersensitivity to words, a tendency to react painfully to
reminders of psychotraumatic experiences, and a mood that fluctuated easily—from euphoria to
dissatisfaction and even sudden outbursts of anger. These patients were not as careless as those
without PTSD; a general sense of tension, anxiety, and fear for their own lives was evident. They
often experienced depressive episodes triggered by memories or the re-experiencing of traumatic
events, commonly referred to as "flashbacks" [43-48].
In individuals with an asthenic disposition, personality degradation predominantly
followed a spontaneous type. They became lethargic, indifferent, and lost interest in everything,
yet remained highly sensitive to the words of their relatives. In daily life, they often adopted an
"ostrich position," lacking faith in the possibility of treatment and blaming themselves for their
addiction while re-experiencing psychological trauma. They were characterized by a depressed
mood, apathy, fear for their lives, and an expectation of impending problems. Tolerance to mental
and physical stress significantly decreased, and even minor overexertion led to nervous exhaustion
and, at times, aggression, often accompanied by self-blame and blaming others for both real and
imagined problems. Painful memories made patients tearful and vulnerable, causing them to
remain fixated on their past experiences for extended periods [49-53].
In general, personality degradation due to alcoholism developed against the background of
PTSD encompasses all the changes characteristic of patients with primary alcoholism. However,
affective disorders of the explosive type tend to dominate, manifesting as heightened emotional
instability, irritability, and aggression. These affective disturbances are further expressed in a
mosaic-like pattern of psychopathic traits, which vary depending on the individual's premorbid
personality structure [54-57]. However, in these cases, affective disorders of an explosive nature
tend to be more pronounced, often manifesting as intense emotional instability, heightened
irritability, and episodes of uncontrolled aggression. These affective disturbances do not present
uniformly but rather appear in a mosaic-like pattern of psychopathic traits, the specifics of which
depend on the individual's premorbid personality structure. As a result, this leads to a complex
interplay of emotional dysregulation, impulsivity, and maladaptive behavioral responses, further
complicating the clinical picture of secondary alcoholism in PTSD patients and differentiating it
from primary alcohol dependence. These disorders manifest as heightened emotional instability,
irritability, aggression, and impulsivity, creating a mosaic-like pattern of psychopathic traits that
vary based on the individual's premorbid personality [58-60].
Patients with different premorbid dispositions exhibit distinct patterns of behavioral and
emotional disturbances.
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786
Asthenic individuals display nervous weakness, heightened sensitivity, self-blame, and
depressive tendencies, while excitable and stenic personalities exhibit aggression, impulsivity, and
hostility toward others. Hysterical individuals tend to manipulate, exaggerate, and seek attention,
whereas syntonic patients display excessive sociability, boastfulness, and fluctuating emotions.
Unstable personality types are highly suggestible, struggle with responsibility, and
frequently change their perception of their illness, making commitment to treatment difficult [61,
62].
Conclusion:
Affective fluctuations, particularly explosive emotional outbursts, are
common and are often triggered by past trauma, interpersonal conflicts, and health concerns. PTSD
patients with alcoholism do not exhibit the characteristic euphoric behavior of primary alcoholics
but instead experience chronic tension, anxiety, and depressive episodes, often accompanied by
flashbacks and fears about their health.
Overall, the process of personality degradation in PTSD-related alcoholism is more severe
and complex than in primary alcoholism. It involves a greater degree of emotional dysregulation,
impulsivity, and maladaptive behaviors, reinforcing the cycle of alcohol dependence as a coping
mechanism. This differentiation highlights the need for targeted therapeutic approaches that
address both PTSD and alcohol use disorder simultaneously.
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