Chapter-4

Psychological
Disorders
 Concept of Abnormality

▶ Deviance – Different, extreme, unusual,

bizarre.
▶ Distressing- Unpleasant & Upsetting to
others.
▶ Dysfunctional- Interfering routine
activities.
▶ Dangerous- To self and others.
 Approaches distinguishing Normal &
Abnormal Behaviours
1. Deviation from Social Norms
▶ “Abnormal”- any behaviour which is deviant from social expectations/norms.
▶ Norms- stated or unstated rules for proper conduct.

2. Maladaptive
▶ Society accepts behaviour which fosters well-being of self and group.
▶ “Well- being”- is not just maintenance & survival but it includes growth &
fulfilment.
▶ Therefore behaviour is maladaptive if it interferes with optimal functioning &
growth.
 Historical Background
▶ Supernatural or Magical Forces ( Exorcism)
▶ Middle Ages
Demonology- a belief that people with mental problems were evil & there
were numerous instances of witch-hunts.

▶ Renaissance Period-
Johann Weyer emphasised on psychological conflict & disturbed
interpersonal relations as cause of disorders.He also focused on medical
treatment instead of theological treatment.

▶ 17th & 18th Centuries ( Age of enlightenment )-

Growth of scientific attitude towards disorders.
Compassion for people who suffered disorders.
Classification of Psychological Disorders

▶ Diagnostic and statistical Manual of Mental Disorders ( DSM - V)

By American Psychiatric Association ( APA )
Diagnosis is based on Three different Axis

▶ International Classification Of Diseases ( ICD – 10 )

By World Health Organisation ( WHO )
Diagnosis is based on symptoms
 Factors underlying abnormal behaviour
▶ Biological and Genetic factors
Faulty genes, malnutrition, injuries, and endocrine imbalances,imbalances
in neurotransmitters.
 Models Underlying Abnormal
Behaviour

Psychological Models
▶ Maternal Deprivation
▶ Lack of warmth by parents
▶ Faulty Parenting
( over protection , rejection etc)
▶ Maladaptive Family structures
 1. Psychodynamic Model
▶ Abnormal Behaviour- result of Conflict
between 3 internal forces:-
1. Id- drives and impulses
2. Ego- rational thinking
3. Superego- moral standards

▶ Therefore abnormal behaviour is a

symbolic expression of unconscious
mental conflicts that can be traced back
to childhood.
 2. Behavioural Model

▶ Both Abnormal and Normal

Behaviour is learnt.
▶ Therefore Psychological Disorders
are the result of learning maladaptive
behaviour, through:-
1. Classical Conditioning
2. Operant Conditioning
3. Social Learning/Imitation
 3. Cognitive Model
▶ Abnormal Behaviour results
from:-
1. Holding Irrational assumptions
about self

2. Repeatedly thinking in illogical

ways

3. Making overgeneralisations
 4. Humanistic-Existential Model
▶ Humanists believe that human beings are
born with natural tendency to be friendly,
cooperative and constructive, & are driven
to self-actualise.
▶ Existentialists believe that from birth we
have total freedom to give meaning to our
life or to avoid that responsibility
▶ Those who avoid this responsibility would
live empty, inauthentic, & dysfunctional
lives.
 5. Socio-Cultural Model
▶ Behaviour is shaped by societal forces like family structure and
communication, social network, societal conditions, societal labels , roles etc.
6. Diathesis-Stress Model
Major Psychological
Disorders
 A. Anxiety Disorders
▶ Anxiety- Diffuse,vague,very unpleasant
feeling of fear and apprehension.

▶ Symptoms- Rapid heart rate, shortness of

breath, Diarrhoea, loss of appetite, fainting,
dizziness, sweating, sleeplessness, frequent
urination & tremors etc.

▶ High levels of anxiety that are distressing &

interfere with effective functioning indicate
presence of anxiety disorder.
 Types of Anxiety Disorder
1. Generalised Anxiety Disorder –
Consists of prolong, vague,
unexplained and intense fears that are
not attached to any particular object.

Symptoms-Worry & apprehensive feelings

about future, hyper vigilance( constant
scanning of environment), motor tension,
restless, shaky and tense.
 2. Panic Disorder
▶ Recurrent anxiety attacks in which
person experiences intense terror.
▶ Panic attack denotes an abrupt surge of
intense anxiety rising to its peak
when thoughts of a particular stimuli
are present.
Symptoms- Shortness of breath, dizziness,
trembling, palpitations, choking, nausea,
chest pains, fear of loosing control or
dying.
 3. Phobias
▶ Are irrational fears related to specific objects, people or situations.
▶ Usually begin with GAD.
▶ Phobias are of three types:-
1. Specific phobias- includes irrational fears such as intense fear of certain
type of animal or being into enclosed spaces.
2. Social Phobias- Intense & incapacitating fear & embarrassment when
dealing with others in public.
3. Agoraphobia- When people develop a fear of entering into unfamiliar
situations. They are also afraid of leaving their home, because of which
they cant carry normal life activities.
 4. Separation Anxiety Disorders
▶ Individuals
with separation anxiety disorder are fearful
and anxious about separation from attachment figures to
an extent that is developmentally not appropriate.
▶ To avoid separation, children with SAD may fuss, scream,
throw severe tantrums, or make suicidal gestures.
▶ Infant- show sadness by being passive and unresponsive
▶ Pre-schooler- may appear withdrawn and inhibited
▶ School-age- child may be argumentative and combative
▶ Teenager- may express feelings of guilt and hopelessness.
Obsessive- Compulsive And other related
Disorder (OCD)
People with OCD are unable to control their preoccupations with
specific ideas or are unable to prevent themselves from repeatedly
carrying out a particular act, which affect their ability to carry out
normal activities.
Obsessive Behaviour- inability to stop thinking about a particular
idea or topic.
Compulsive Behaviour- is the need to perform certain behaviours
over and over again. For eg. Counting, touching, checking, washing
etc.
 Trauma & Stress related Disorder
▶ People who are caught in natural
disasters, bomb blasts, or have
been in a serious accidents and
rape, or in a war situation,
experience PTSD.

▶ Symptoms- Recurrent dreams,

flashbacks, impaired
concentration, & emotional
numbing.
Somatic symptoms and other related
Disorders
▶ Are conditions in which there are
physical symptoms in the
absence of a physical diseases.

▶ The individual has psychological

difficulties & complains of
physical symptoms, for which
there is no biological cause.
 Types of Somatoform Disorders

Somatic Symptom Disorder : The person

experiences body-related symptoms in the
absence of any medical condition (or even if
medical condition is present, it is not as
serious as the symptoms presented).
Illness Anxiety Disorder : The person
experiences worry about the possibility of
developing a serious medical condition.
 Contd...
▶ People with these disorder have multiple &
recurrent or chronic bodily complaints

▶ Presented in dramatic & exaggerated ways.

▶ Common Complaints- Headaches, fatigue, heart

palpitations, fainting spells, vomiting & allergies.

▶ Provide long & detailed histories of illness.

▶ Take large quantities of medicines.

 Conversion Disorders
▶ Symptoms- Reported loss of a body
part or some basic bodily functions.

▶ For e.g Paralysis, blindness, deafness,

difficulty in walking etc.

▶ These symptoms often occur after

stressful experience & may be quite
sudden.
 Illness Anxiety Disorder
▶ People with this disorder have
persistent belief that they have a
serious illness, despite medical
reassurance & lack of physical
findings.

▶ They have an obsessive preoccupation

& concern with condition of their body
organs.

▶ Continually worry about their health.

 Dissociative Disorders

▶ Dissociation- involves feelings of

unreality, estrangement,
depersonalisation & sometimes loss or
shift of identity.

▶ Dissociative Disorders- Sudden

temporary alterations of consciousness
that blot out painful experiences.
 Types of Dissociative Disorders
1. Dissociative Amnesia-

▶ Is characterised by extensive but

selective memory loss that has
known organic cause( head injury).
▶ Some people cannot remember
anything about their past , others
don’t remember specific events,
people, places and objects, while
other memories remain intact.
▶ It is associated with overwhelming
stress.
 2. Dissociative Fugue
▶ An unexpected travel away from home and
workplace.

▶ Assumption of a new identity

▶ Inability to recall previous identity

▶ Fugue usually ends when the person

suddenly wakes up with no memory of
events that occurred during fugue.
 3.Dissociative Identity Disorder
▶ Also known as Multiple
Personality Disorder.

▶ Associated with traumatic

experiences in childhood.

▶ The person assumes alternate

personalities that may or may
not be aware of each other.
 4. Depersonalisation
▶ Involves a dream like state in which
the person has a sense of being
separated from both self and reality.

▶ There is a change of self- perception,

& the person’s sense of reality is
temporarily lost.
 D. Mood Disorders
▶ Mood disorders are characterized by disturbances in mood or prolonged emotional state.

▶ Mood Disorders are of following 3 types:-

1. Major Depressive disorder-
is defined as a period of depressed mood &/or loss of interest or pleasure in most of the activities
together with other symptoms which may include change in body weight constant sleep problems,
tiredness, inability to think clearly, agitation, greatly slowed behavior,
thoughts of death & suicide, excessive guilt or feelings of worthlessness.
Factors predisposing towards depression-
▪ Age - For eg. Woman are at risk during young adulthood & men during middle age.
▪ Heredity – is a major risk factor predisposing people to mood disorders.
▪ Gender- For. Eg woman in comparison to men are likely to be more depressed.
▪ Other factors- For eg. Negative life events and lack of social support.
2. Mania –
People suffering from mania become
Euphoric (high), extremely active,
extremely active, excessively talkative,
and easily distractible.
3. Bipolar Mood Disorder I& II
▪ Manic episodes rarely appear by
themselves, they usually alter with
depression.
▪ Such a mood disorder, in which both mania and
depression are alternatively present, is
sometimes interrupted by periods of normal
mood, this is known as Bipolar Mood Disorder.
Hypo Mania (BP II)And Hyper Mania( BP I)
 Suicide
▶ Symptoms of Suicide
1. Changes in eating & sleeping habits.
2. Withdrawal from friends family and regular
activities.
3. Violent actions, rebellious behavior, running away
4. Drug and alcohol abuse.
5. Marked personality change
6. Persistent boredom
7. Difficulty in concentration
8. Complaints about physical symptoms
9. Loss of interest in pleasurable activities.
Some measures suggested by WHO
include:
▶ limiting access to the means of suicide;
▶ reporting of suicide by media in a responsible way; • bringing in
alcohol-related policies;
▶ early identification, treatment and care of people at risk; • training
health workers in assessing and managing for suicide;
▶ care for people who attempted suicide and providing community
support.
▶ Identifying students in distress
▶ Strengthening students’ self-esteem by accentuating positive life
experiences to develop positive identity
 Factors leading to suicide
1. Mental health issues like mood disorders are a
major factor leading to suicide.
2. Age- Teenagers & young adults are as much at
risk for suicide, as those who are 70 years and
above.
3. Gender- Men have higher rate of contemplated
suicide than women.
4. Other factors- Cultural attitude towards suicide.
For eg. In Japan Suicide is the culturally
appropriate way to deal with suicide. Therefore
suicide rate in Japan is much higher than that in
Muslim countries where committing suicide is a
sin.
 Schizophrenia Spectrum & other Psychotic
Disorders
Schizophrenia describes a group of psychotic
disorders in which personal, social, & occupational
functioning deteriorates as a result of disturbed
thought processes, strange perceptions, unusual
emotional states & motor abnormalities. It is a
debilitating disorder.
Symptoms of schizophrenia-
1. Positive symptoms- Excesses of thoughts
emotions, and behavior.
2. Negative symptoms- Deficits of thought,
emotions, and Behaviour.
3. Psychomotor Symptoms-
 Positive Symptoms
1. Delusions- delusion is a false belief that is firmly
held on inadequate grounds, are irrational and has
no basis in reality. Folowing are the different types
of delusions:-
▪ Delusion of Persecution- People with this delusion
believe that they are being plotted against, spied on,
slandered, threatened or deliberately victimized.
▪ Delusion of Refence- in this they attach special
meaning to actions of others.
▪ Delusion of Grandeur- they believe themselves to
be specially empowered people.
▪ Delusion Of Control- believe that their feelings ,
thoughts & actions are controlled by others.
2. Formal Thought Disorder- People with these
symptoms are unable to think logically and may speak
in peculiar ways.
It includes rapid shifting from one topic to another,
inventing new words and phrases( neologisms), &
persistent and inappropriate repetition of same
thought (persevration).

3. Hallucinations- perceptions that occur in the

absence of external stimuli. Following are the
different types of hallucinations:-
▪ Auditory hallucinations- are most common. Patients
hear sounds or voices that speak words, pharses or
sentences directly to patient, or they talk to one
another.
▪ Tactile Hallucination- for eg. Tingling , burning
etc.
▪ Somatic Hallucinations- Something happening
inside the body for eg. Snake crawling inside the
stomach.
▪ Visual Hallucinations- For eg. Vague perception
of colours or distinct vision of people or object.
▪ Gustatory hallucination- For eg. Food or drinks
taste strange.
▪ Olfactory Hallucination- For eg smell of poison
or smoke.

4) Inappropriate affect- Emotions that are unsuited

to the situation.
 Negative symptoms
▶ Alogia- Poverty of speech i.e reduction in speech
and speech content.

▶ Blunted Effect- show less anger, sadness, joy &

other feelings than most people do.

▶ Flat effect- Show no emotions at all.

▶ Avolition/Apathy- inability to start or complete a

course of action.

▶ Withdraw socially and remain in their own fantasy

world
 Psychomotor symptoms
▶ People with schizophrenia move less
spontaneously or make odd grimaces
and gestures. These symptoms may
take extreme form known as
catatonia.
1. Catatonic Stupor- remain motionless
& silent for long time.
2. Catatonic Rigidity- maintaining a
rigid upright postures for hours.
3. Catatonic Posturing- assuming
Awkward bizarre positions for long
periods.
 Sub-types of Schizophrenia
1. Paranoid Type- Preoccupation with delusions or auditory hallucinations; No disorganized
speech ,behavior, or affect.

2. Disorganised Type- Disorganised speech & behavior; inappropriate or flat affect, no

catatonic symptoms.

3. Catatonic Type- Extreme motor immobility, excessive motor activity, extreme negativism or
mutism.

4. Undifferentiated Type- Does not fit in any sub-types.

5. Residual Type- has experience atleast one episode of schizophrenia, no positive symptoms
but shows negative symptoms.
 Neuro Developmental Disorders
▶ They manifest in the early stage of
development. Often the symptoms
appear before the child enters school or
during the early stage of schooling.

▶ These disorders result in hampering

personal, social, academic and
occupational functioning. These get
characterised as deficits or excesses in a
particular behaviour or delays in
achieving a particular age-appropriate
behaviour.
 Prominent Externalising Disorders
1) Attention-deficit Hyperactivity Disorder (ADHD)-
▶ Inattentive- Find it difficult to sustain mental effort during
work or play or in following instructions. Cannot
concentrate, is disorganized, easily distracted, forgetful,
does not finish assignments, and is quick to lose interest in
boring activities.
▶ Impulsive- unable to control their immediate reactions or to
think before they act. They find it difficult to wait or take
turns, have difficulty resisting immediate temptations or
delaying gratification. Minor mishaps or more serious
accidents and injuries can also occur.
▶ Hyperactivity – They are in constant motion. Sitting still
through a lesson is impossible for them. The c may fidget,
squirm, climb and run around the room aimlessly. Parents
and teachers describe them as ‘driven by a motor’, always
on the go, and talk incessantly. Boys are four times more
likely to be given this diagnosis than girls.
2) Oppositional Defiant Disorder (ODD)- display
age-inappropriate amounts of stubbornness, are irritable, defiant,
disobedient, and behave in a hostile manner. Unlike ADHD, the
rates of ODD in boys and girls are not very different.

3) Conduct Disorder and Antisocial Behaviour refer to age

inappropriate actions and attitudes that violate family expectations,
societal norms, and the personal or property rights of others. The
behaviours typical of conduct disorder include aggressive actions
that cause or threaten harm to people or animals, non-aggressive
conduct that causes property damage, major deceitfulness or theft,
and serious rule violations.

Types of aggressive behaviour

▶ Verbal aggression (i.e. name-calling, swearing), Physical
aggression (i.e. hitting, fighting),
▶ Hostile aggression (i.e. directed at inflicting injury to others)
▶ Proactive aggression (i.e. dominating and bullying others
without provocation).
2. Autism-
difficulties in social interaction and communication,
a restricted range of interests, and strong desire for
routine. About 70 per cent of children with autism
are also mentally retarded.
▶ They are unable to initiate social behaviour and
seem unresponsive to other people’s feelings.
They are unable to share experiences or
emotions with others.
▶ Many autistic children never develop speech
and those who do, have repetitive and deviant
speech patterns.
▶ repetitive behaviours such as lining up objects or
stereotyped body movements such as rocking,
which can be self- injurious.
 Specific Learning Disorder
▶ Individual experiences difficulty in
perceiving or processing information
efficiently and accurately.

▶ Individual encounters problems in basic

skills in reading, writing and/or
mathematics.

▶ Different types of SLD’s are

▶ Dyslexia ( Most Common)
▶ Dyscalculia
▶ Dysgraphia
▶ Dyspraxia
Feeding And Eating Disorders-
▶ Anorexia Nervosa- the individual has a distorted body
image that leads her/him to see herself/himself as
overweight. Often refusing to eat, exercising
compulsively. may lose large amounts of weight and
even starve herself/himself to death.

▶ Bulimia nervosa- the individual may eat excessive

amounts of food, then purge her/ his body of food by
using medicines such as laxatives or diuretics or by
vomiting. A sense of tension and negative emotions
after purging.

▶ Binge eating- there are frequent episodes of

out-of-control eating.
 Substance-Related and Addictive Disorders
Addictive beh
▶ Disorders relating to maladaptive behaviours resulting
from regular and consistent use of the substance involved
are called substance abuse disorders.
1) Substance dependence- there is intense craving for the
substance to which the person is addicted, and the person
shows :-
▪ Tolerance- the person has to use more and more of a
substance to get the same effect.
▪ Withdrawal- physical symptoms that occur when a
person stops or cuts down on the use of a psychoactive
substance.
2) Substance abuse- People who regularly ingest drugs
damage their family and social relationships, perform poorly
at work, and create physical hazards.
 Alcohol Abuse and Dependence
▶ Drinking interferes with their social behaviour and ability to think
and work.

▶ their bodies build up a tolerance for alcohol, and may show

withdrawal symptoms.

▶ Alcoholism destroys millions of families, social relationships and

careers. Intoxicated drivers are responsible for many road
accidents.

▶ It also has serious effects on the children of persons with this

disorder. These children have higher rates of psychological
problems, particularly anxiety, depression, phobias and
substance-related disorders.

▶ Excessive drinking can seriously damage physical health.

Heroin Abuse and Dependence
▶ interferes with social and occupational functioning.
▶ Most abusers further develop a dependence on heroin, revolving their lives
around the substance, building up a tolerance for it, and experiencing a
withdrawal reaction when they stop taking it.
▶ The most direct danger of heroin abuse is an overdose, which slows down the
respiratory centres in the brain, almost paralysing breathing, and in many
cases causing death.

Cocaine Abuse and Dependence

▶ Regular use of cocaine may lead to functioning poorly in social
relationships and at work. It may also cause problems in short-term
memory and attention.
▶ Dependence may develop, so that cocaine dominates the person’s life, more
of the drug is needed to get the desired effects, and stopping it results in
feelings of depression, fatigue, sleep problems, irritability and anxiety.
▶ It has dangerous effects on psychological functioning and physical
well-being.