bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2025-4-1084bekhterev-1233Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWРасстройства личности: от исторических аспектов к современным представлениямPersonality disorders: from historical aspects to contemporary viewshttps://orcid.org/0000-0002-9154-4104ШишковскаяТ. И.ShishkovskaiaT. I.

Шишковская Татьяна Игоревна – кандидат медицинских наук, младший научный сотрудник Отдела по изучению эндогенных психических расстройств и аффективных состояний 

115522, г. Москва, Каширское шоссе, дом 34

Tatiana I. Shishkovskaia 

Moscow

ttnszy@gmail.comhttps://orcid.org/0000-0003-2353-4905ЛеоноваА. В.LeonovaA. V.

Леонова Алена Владимировна - кандидат медицинских наук, доцент кафедры психологии

628400, Ханты-Мансийский Автономный округ – Югра АО, г. Сургут, проспект Ленина, дом 1

Alena V. Leonova 

Surgut 

a.v.kononova@gmail.comhttps://orcid.org/0000-0003-4096-6208ПетроваН. Н.PetrovaN. N.

Петрова Наталия Николаевна – доктор медицинских наук, профессор, заведующий кафедрой психиатрии и наркологии

199034, г. Санкт-Петербург, Университетская набережная, дом 7–9

Natalia N. Petrova

Saint Petersburg 

petrova_nn@mail.ruНаучный центр психического здоровьяРоссияMental Health Research CenterRussian FederationСургутский государственный университетРоссияSurgut State UniversityRussian FederationСанкт-Петербургский государственный университетРоссияSaint Petersburg State UniversityRussian Federation2025090120265943744Copyright © Шишковская Т.И., Леонова А.В., Петрова Н.Н., 20262026Шишковская Т.И., Леонова А.В., Петрова Н.Н.Shishkovskaia T.I., Leonova A.V., Petrova N.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/1233

В данной статье представлен нарративный обзор ключевых теоретических и клинических подходов к пониманию расстройств личности. Рассматривается историческая эволюция самого понятия, начиная с первых психиатрических описаний и до современных классификаций в рамках DSM-5 и МКБ-11. Обсуждаются различия в определении расстройств личности, а также плюсы и минусы категориальных и дименсиональных систем диагностики. Особое внимание уделяется сопоставлению психодинамического, когнитивно-поведенческого и нейробиологического подходов, включая их влияние на выбор стратегий лечения. В статье подробно анализируются нейробиологические модели личностных расстройств, включая данные о структурных и функциональных изменениях головного мозга, нейрохимических дисбалансах и генетических факторах, а также обсуждаются их потенциал для дальнейшего развития биомаркеров и индивидуализированной терапии. Кроме того, излагаются принципы психотерапевтического лечения в зависимости от теоретической модели: от психоаналитически ориентированной терапии и схема-терапии до диалектической поведенческой терапии. Освещены также возможности и ограничения фармакотерапии, включая современные данные о её эффективности и применимости при различных типах личностной патологии. Обзор направлен на комплексное представление о современном состоянии проблемы и может быть полезен как специалистам в области психиатрии и психотерапии, так и исследователям, интересующимся развитием интегративных моделей диагностики и лечения расстройств личности.

This article presents a narrative review of the key theoretical and clinical approaches to understanding personality disorders. It traces the historical evolution of the concept, from early psychiatric descriptions to its current formulations in the DSM-5 and ICD-11 classifications. The review discusses differences in the definition of personality disorders and evaluates the advantages and disadvantages of categorical versus dimensional diagnostic systems. Special attention is given to comparing psychodynamic, cognitive-behavioral, and neurobiological models, including their influence on treatment strategies. The article provides a detailed analysis of neurobiological models of personality disorders, including data on structural and functional brain changes, neurochemical imbalances, and genetic factors, as well as their potential for the development of biomarkers and individualized therapies. Furthermore, it outlines the principles of psychotherapeutic interventions according to different theoretical frameworks—from psychoanalytically oriented therapy and schema therapy to dialectical behavior therapy. The review also examines the possibilities and limitations of pharmacotherapy, including current data on its efficacy and applicability across various types of personality pathology. This comprehensive overview aims to present the current state of the field and may be of interest to professionals in psychiatry and psychotherapy, as well as researchers exploring the development of integrative models for the diagnosis and treatment of personality disorders.

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The authors declare that there are no conflicts of interest present.