PSYCHOLOGICAL DISORDERS

 WHAT IS ABNORMALITY?
Any patterns of behaviour that causes people significant distress, causes them to harm
themselves or others, or harm their ability to function in daily life.

 ANXIETY DISORDERS
The category of anxiety disorders includes all the disorder in which the most dominant
symptom is excessive or unrealistic anxiety and fearfulness. Anxiety can take very specific
forms, such as fear of a specific object, or it can be a very general emotion, such as that
experienced by someone who is worried and doesn’t know why.
There’s difference between anxiety that is realistic and has known source and the kind of
anxiety found in disorders. If final exams are coming up and a student hasn’t studied
enough, that student’s anxiety is understandable and realistic. But a student who has
studied, has done well on all the exams, and is very prepared who worries excessively about
passing in showing an unrealistic amount of anxiety. People who are in danger of losing
their job might experience quite a bit of anxiety, but its sources is obvious and
understandable. But people whose life is going well and for whom nothing bad is looming in
the future who still feel extremely anxious may be experiencing an anxiety disorder.
Freefloating anxiety is the term given to anxiety that seems to be unrelated to any realistic,
known factor, and it is often a symptom of an anxiety disorder.

 PHOBIC DISORDERS
One of the more specific anxiety disorder is a phobia, an irrational, persistent fear of
something. The “something” might be an object or a situation or a social activity.
It’s important to note the difference between everyday anxiety and a phobia:

Everyday Anxiety Phobia

Feeling queasy while climbing a tall ladder Refusing to attend your best friend’s wedding because
it’s on the 25th floor of a hotel

Worrying about taking off in an airplane during lighting Turning down a big promotion because it involves air
storm travel

Feeling anxious around your neighbour’s pit bull Avoiding visiting your neighbour’s for fear of seeing a
dog

SOCIAL PHOBIA
Also called Social Anxiety Disorder, social phobias involve the fear of interacting with others
or being in social situation that might lead to a negative evaluation. They are some of the
most common phobias people experience. Since people with Social phobia are afraid of
being evaluated in some negative way in others, they tend to avoid situations that could
lead to something embarrassing or humiliating. As a result, they tend to be very self-
conscious. Common types of Social phobia: Stage fright, fear of public speaking and fear of
urinating in public restroom.
Many people with social anxiety disorder feel that there is “something wrong” but don’t
recognize their feeling as a sign of illness.
Symptoms

 Intense anxiety in social situations

 Avoidance of social situations
 Intense fear of being scrutinized and negatively evaluated by others in social or
performance situations
Physical symptoms

 Confusion
 Pounding heart
 Sweating
 Shaking
 Blushing
 Muscle tension
 Upset stomach
 Diarrhoea

 SPECIFIC PHOBIA

A specific phobia is an irrational fear of some object or specific situations or events, such as
a fear of dogs, or fear of being n small, enclosed space (claustrophobia). Other specific
phobia include a fear of injection (trypanophobia), fear of dental work (odontophobia), fear
of blood (hematophobia) and fear of heights (acrophobia).

Symptoms

 Excessive or irrational fear of specific object or situation

 Avoiding the object or situation or enduring it with great distress

Physical symptoms

 Pounding heart
 Nausea or diarrhoea
 Sweating
 Trembling or shaking
 Numbness or tingling
 Problems with breathing (shortness of breath)
  Feeling dizzy or lightheaded
 Feeling like you are choking
 Anticipatory anxiety, which involves becoming nervous ahead of time about being in certain
situations or coming into contact with object of your phobia; for example, a person with fear
of dogs may become anxious about going for a walk because he or she may see a dog along
the way.

AGORAPHOBIA

A third type of phobia called Agoraphobia, a Greek that literally means “fear of the marketplace.”
Although it sounds like a social phobia, it’s actually a little more complicated. It is a fear of being in a
place or situation (social or not) from which escape is difficult to impossible if something should go
wrong (APA, 2000). So agoraphobia are often afraid of not only crowds but also crossing bridges,
travelling in a car or plane, eating in a restaurants, and sometimes even leaving the house. To be in
any of these situations or to even think about being in such situations can lead to extreme feelings of
anxiety and panic attacks.

Symptoms:

 Fear of being alone in any situation

 Fear of being in crowded places
 Fear of losing control in a public place
 Fear of being in places where it may be hard to leave, such as elevator or train
 Inability to leave your home (housebound) or only able to leave it if someone else goes with
you
 Sense of helplessness
 Overdependence on others

In addition, you may have signs and symptoms of a panic attack, such as:

 Rapid heart rate

 Excessive sweating
 Trouble breathing
 Feeling shaky, numb or tingling
 Chest pain or pressure
 Light headedness or dizziness
 Sudden flushing or chills
 Upset stomach or diarrhoea
 Feeling a loss of control
 Fear of dying

OBSESSIVE-COMPUSIVE DISORDERS

Obsessive compulsive disorder or OCD, a disorder in which intruding thoughts that occur again and
again (obsessions, such as fear that germs are on one’s hands) are followed by some repetitive,
ritualistic behaviour (compulsion, such as repeated hand washing) meant to lower the anxiety
caused by the thought.
Some other examples of obsessive thought and compulsive behaviour include: An obsession with
having left something undone, resulting in the constant checking and rechecking of one’s work or
thinking that one might do something to harm a loved one, leading to counting and recounting the
knives in the kitchen.

Symptoms

Obsessions often have themes to them such as:

 Fear of contamination or dirt

 Needing things orderly and symmetrical
 Aggressive or horrific thoughts about harming yourself or others
 Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

 Fear of being contaminated by touching objects others have touched

 Doubts that you’ve locked the door or turned off the stove
 Intense stress when objects aren’t orderly or facing a certain way
 Images of hurting yourself or someone else that are unwanted and make you uncomfortable
 Thoughts about shouting obscenities or acting inappropriately that are unwanted and make
you uncomfortable
 Avoidance of situations that can trigger obsessions, such as shaking hands

As with obsessions, compulsions typically have themes such as:

 Washing and cleaning

 Checking
 Counting
 Orderliness
 Following a strict routine
 Demanding reassurances

Examples of compulsion signs and symptoms include:

 Hand-washing until your skin becomes raw

 Checking doors repeatedly to make sure they’re locked
 Checking the stove repeatedly to make sure it’s off
 Counting in certain patterns
 Silently repeating a prayer, word or phrase
 Arranging your canned goods to face the same way

PANIC DISORDER

Panic disorder is an anxiety disorder characterized by recurrent, unexpected panic attacks. It is a

serious condition that strikes without reason or warning. People with panic disorder experience
spontaneous seemingly out-of-the-blue panic attacks and are preoccupied with the fear of a
recurring attack.

Many people who have a panic attack think they are having a heart attack and can experience pain
as well as panic, but panic attack is not as diagnosable medial disorder. Psychologically, the person
having a panic attack is in a state of terror, thinking that this is it, death is happening and many
people feel a need to escape. The attack happens without warning and quite suddenly. Although
some panic attacks can last as long as half an hour, some last one a few minutes, with most attacks
peaking within 10 to 15 minutes.

Symptoms:

 Racing heart
 Rapid breathing
 A sensation of being “out of one’s body”
 Dulled hearing and vision
 Sweating
 Dry mouth
 Tingling or numbness in fingers and toes
 Intense feeling of dread
 Shortness of breath
 Sensation of choking or smothering
 Trembling or shaking
 Nausea and stomach ache
 Chills or hot flashes
 A fear that you are losing control or about to die

Regardless of age of onset, it is only when panic attacks become so frequent that they affect a
person’s ability to function in day-to-day life that they become a panic disorder.

When fear of leaving one’s familiar surroundings because one might have a panic attack in a public
place prevents the person from going out into unfamiliar or exposed places, it is called panic
disorder with agoraphobia.

GENERALISED ANXIETY DISORDER

The kind of anxiety experienced by people that has no real source is called generalised anxiety
disorder. It is characterised by excessive anxiety and worries (apprehensive expectations) that occur
more days than not for at least six months. People with this disorder may also experience anxiety
about a number of events or activities (such as work or school performance). These feelings of
anxiety persist six months or more and have no real source that can be pinpointed, nor can the
person control the feelings even if an effort is made to do so.

People with this disorder are just plan worriers. They worry about money, their children, their lives,
their friends, their dog and anything else that they think might possibly go wrong. They are
constantly stressed and the problem is that the stress comes from their worrying rather than any
real external source. General anxiety disorder is often found occurring with other anxiety disorders
and depression.

Once again, it is a matter of degree and source: people with generalised anxiety disorder worry more
excessively than people who are normal worries, and they are worried over things that would cause
other people no real concern.

Symptoms:

 An unrealistic view of problems

  Excessive, ongoing worry and tension
 Tense and edgy
 Get tired easily
 Have trouble concentrating
 Muscle ache and tension
 Sleeping problems (trouble falling asleep or sleeping to much)
 Irritability
 Trembling
 Being easily startled
 Headaches
 Nausea
 Sweating

SOMATOFORM DISORDERS

Somatoform originates from the Greek word ‘soma’ which means ‘body’ therefore, Somatoform
disorders take the form of bodily illnesses and symptoms but for which there are no real physical
disorders. There are three disorders that fall under this category.

1. HYPOCHONDRIASIS- a somatoform disorder in which the person is terrified of being sick.

People with this disorder are often called hypochondriasis.

Symptoms:

 Constant and excessive worry about getting ill.

 Preoccupation with real or imagined bodily symptoms and sensations
 Fear that minor symptoms indicates something serious
 Repeatedly searching for and visiting doctors to confirm their apparent sickness with a
diagnosis (doctor shopping)
 Repetitive checking of the body for symptoms and Multiple medical tests of an alleged
medical condition
 Habitual internet searching for information about illnesses and their symptoms (also
known as ‘Cyberchondria’)

2. SOMATIZATION DISORDER- a somatoform disorder in which the person dramatically

complains of a specific symptom such as nausea, difficulty swallowing, or pain for which there is
no real physical cause.

Symptoms:

 People with this disorder also visit the doctor frequently, except they show less worry but
are more dramatic
 Very emotional while describing their symptoms. Use phrases such as “unbearable” and
“beyond description” to describe their pain or vague symptoms.
 Tend to become very dependent on medical professionals
 Demand extreme attention and even threatens suicide to get attention in some cases
  The symptoms they complain about also tend to shift or multiply. For example, the main
symptom can be pain one day but shortness of breath on the next

3. CONVERSION DISORDER- a somatoform disorder in which the person experiences a specific

symptom in the somatic nervous system’s functioning, such as blindness, paralysis, or numbness for
which there is no physical cause.

Symptoms:

 Loss of certain motor and/or sensory functions, without any external origin
 Exhibit a kind of indifference or lack of concern about the symptom
 Symptom is usually anatomically impossible. For example, blindness without any damage to
eye, optic nerve, or parts of the brain responsible for vision
 Conversion disorder symptoms seem to be absent when the individual is asleep, hypnotized
under anaesthesia or unconscious
 Problems may occur along with some other psychological disorder such as depression or can
even occur due to a stressful situation that has happened or is threatening to happen. For
example, a soldier returning from combat.

It must be noted that people with somatoform disorders are not just creating symptoms just to fool
others. Although it may not be obvious, the magnitude of the pain is usually severe but no amount
of treatment may help. Individuals with these disorders often struggle to see the connection
between their anxiety and their resulting bodily symptoms.

DISSOCIATIVE DISORDERS

Dissociative disorders are disorders in which there is a break in conscious awareness, memory, the
sense of identity, or some combination.

The “split” that happen in these disorders is similar to the ones we experience when we are driving
in a sort of “automatic pilot” mode (not quickly realizing we arrived at our destination); however, in
the disorders the dissociation is much more pronounced and involuntary.

a. DISSOCIATIVE AMNESIA (WHO AM I?)

Definition: it is the loss of memory for personal information, either partial or complete.

In dissociative amnesia, one cannot remember personal information such as one’s own name or
specific personal events-the kind of information contained in episodic long-term memory. It can be a
loss of memory for only one small segment of time, or it can involve a total loss of one’s past
personal memories. E.g.: a soldier might be able to remember being in combat but cannot
remember witnessing a friend get killed, or a person might forget his/her entire life.

These memories usually resurface on their own or after being triggered by something in the
surroundings; sometimes quickly, and sometimes after a long delay. For example: a veteran of WW2
had amnesia for the time during which he was captured, tortured, and escaped. He did not recall
these memories until 37 years later.
Symptoms:

Since dissociative amnesia involves breakdown of memory, consciousness, awareness, identity,

and/or perception; when or more of these functions is disrupted, symptoms can result.

 The primary symptom of this disorder is the sudden inability to remember past experiences
or personal information. A person blocks out certain information, usually associated with a
stressful or traumatic event (such as rape or childhood abuse), leaving him or her unable to
remember important personal information. The degree of memory loss goes beyond normal
forgetfulness and includes gaps in memory for long periods of time or of memories involving
the traumatic event.
 Some people with this disorder also might appear confused and suffer from depression
and/or anxiety.

These symptoms can interfere with a person’s general functioning, including social and work
activities, and relationships.

Dissociative Amnesia and Retrograde Amnesia

Even though dissociative amnesia and retrograde sound extremely similar, they differ in its cause. In
retrograde amnesia, the memory loss is typically caused by a physical injury such as a blow to the
head. In dissociative amnesia, the cause is psychological rather than physical. The “blow” is a mental
one, not a real one. People with dissociative amnesia do not forget how to drive or any of the skills
they previously had, and they can still talk and use the kind of information found in sematic memory.
It is only the personal information that is supressed. The memories still exist but are deeply buried
within the person’s mind and cannot be recalled.

b. DISSOCIATIVE FUGUE (WHO AMM I AND HOW DID I GET HERE?)

The Latin word fugere means “flight” and is the word from which the term fugure is taken. People
with dissociative figure temporarily lose their sense of personal identity and impulsively wander or
travel away from their homes or places of work. They often become confused about who they are
might even create new identities. Outwardly, the people with this disorder show no sign of illness,
such as strange appearance or odd behaviour.

Definition: travelling away from familiar surroundings with amnesia for the trip and possible
amnesia for personal information.

Symptoms:

A figure I progress is difficult for others to recognize because the person’s outward behaviour
appears normal. However, symptoms of dissociative figure might include the following:

 Sudden and unplanned travel away from home

 Inability to recall past events or important information from the person’s life
 Confusion or loss of memory about his or her identity, possibly assuming a new identity to
make up for the loss
 Extreme distress and problem with daily functioning (due to the fugure episodes)

Dissociative fugue is linked to severe stress, which might be the result of traumatic events (such as
war, abuse, accidents, disasters, or extreme violence) that the person has experienced or witnessed.
The inability to deal with this stress is also a contributing factor. These causes are best represented
in the case of John Doe, a lawyer who has been criminally charged with embezzling from his clients.
Unable to cope with the present (“I don’t know if I can take much more of this without losing my
mind”, he had told his wife), he was found on a park bench in a town 500 miles away from his own.
He looked physically healthy, in his forties, and was neatly dressed.

The use or abuse of alcohol and certain drugs also can cause fugue-like states, such as alcohol-
induced blackouts.

c. DISSOCIATIVE IDENTITY DISORDER [DID] (HOW MANY AM I?)

Dissociative identity disorder, formerly known as multiple personality disorder, is a disorder

occurring when a person seems to have two or more distinct personalities within one body.

There may be “core” personality, who usually knows nothing about the other personalities and is the
one who experiences
“blackouts” or losses of memory and time. Fugues are common in DID, with the core personality
experiencing unsettling moments of “awakening” in an unfamiliar place or with people who call the
person by another name(Kluft, 1984).

Other symptoms of DID may include headache, amnesia, time loss, trances, and “out of body
experiences”. Some people with DID have a tendency toward self-persecution, self-sabotage, and
even violence (both self-inflicted and outwardly directed). Some describe this feeling as being a
passenger in their body rather than the driver; they truly believe they have no choice.333

MOOD DISORDERS

Definition: the word ‘affect’ is used to refer to ’emotion’ or ‘mood’’. Mood disorders are categorized
by a significant and severe disturbance in motion and are also referred to as affective disorders.
Mood disorders can be relatively mild or extreme. There are two relatively mild mood disorders.

1. Dysthymia- the word originates from the Greek word meaning ‘bad spirit’ and form of mild,
chronic depression that lasts for at least two years or more and is typically a reaction to
some external stressor.
2. Cyclothymia: it means ‘spirit that moves in circles’ and it is a disorder that consists of mood
swings from moderate depression to hypomania (short episodes of elation or low mania)
and lasts two years or more. It is a constant cycle of sad and happy.

Both dysthymia and Cyclothymia can be triggered by an external stressful event. However, the
prolonged nature of these mild disorders cannot be considered as normal reactions that need no
treatment or attention. There are two major Mood Disorders.
 1. Major Depression or Unipolar Disorder- a severe mood disorder characterized by a deeply
disturbed mood that comes fairly suddenly and without any external cause for sadness.

Symptoms:

 Experiences extreme sadness for most part of each day

 Take little to no pleasure in previously enjoyed activities (also known as anhedonia)
 Difficulty in sleeping, sleeping too much or disturbed sleep
 Experiences increased fatigue throughout the day
 Reduced or increased appetite and change in weight
 Have trouble concentrating for even short period of time
 Indecisiveness and restlessness
 Excessive feeling of guilt, worthlessness, helplessness and hopelessness
 In serious cases, the individual may also experience delusions and hallucinations
 May have thoughts of self-injury and suicide, including attempts to hurt oneself

2. Bipolar disorders- Disorder characterized by severe mood swings between major depressive
episode and manic episodes. This disorder exists at two ‘poles’ or emotional ranf=ges and is
hence called Bipolar Disorder.

The depressive phases of a person with bipolar disorder are indistinguishable from major
depression but they often give way to mania episodes that may last for prolonged period of
time. (Mania- a high quality of excessive excitement, energy and elation or irritability- when they
swing into mania state.) Unlike Cyclothymia there is no external cause for the ups and downs
that a person with bipolar experiences.

Symptoms of Mania:

 Feelings of europhia with no cause

 Have silly desires and grand plans. When they are not allowed to fulfil them, they tend
to become aggressive
 Inability to sit still or remain inactive
 Rapid speech ; jump from one topic to another
 Oddly creative
 Irrational thinking
 Restlessness that causes risky behaviour
 Seemingly unlimited energy

SCHIZOPHRENIA

Definition- Schizophrenia is a severe disorder in which the person suffers from disordered thinking,
bizarre behaviour, hallucinations, and is unable to distinguish between fantasy and reality.

Eugen Bleuler, a Swiss psychiatrist, renamed the disorder schizophrenia (earlier known as dementia
praecox) to better illustrate the division within the brain among thoughts, feelings, and behaviour
that seems to take place in people with this disorder (Bleuler, 1911; Moller & hell, 2002). The term
schizophrenia literally means “split mind” but should not be confused with dissociative identity
disorder (formerly known as split personality disorder).
Schizophrenia is a psychotic disorder, i.e., there is an inability to distinguish what is real from fantasy
as well as disturbances in thinking, emotions, behaviour, and perception. It involves a severe break
with reality.

Symptoms:

According to the American psychiatrist Association (APA) (2000), at least two or more of the
following symptoms must be present to frequently for at least one month to diagnose schizophrenia:

1. Delusion

These are disorders in thinking and are a common symptom. Delusions are false beliefs about the
world that are person holds and that tend to remain fixed and unshakable even in the face of
evidence that disapproves the delusion.

Common schizophrenia delusion include:

a) Delusion of persecution-in which people believe that others are trying to hurt them in some
way
b) Delusions of reference- in which people believe that other people, television characters, and
even books are specifically talking to them
c) Delusion of influence- in which people believe that they are being controlled by external
forces, such as the devil, aliens, or cosmic forces
d) Delusion of grandeur- in which people are convinced that they are powerful people who can
save the world or have a special mission

For example: The 2001 movie A Beautiful Mind follows the life story and recovery from
schizophrenia of Dr. John Nash, a famous mathematician who won the Noble Prize for
mathematician in 1994. Nash once suffered from a form of schizophrenia in which he experienced
delusions of persecution and reference

2. Speech disturbances

Schizophrenia people make up words, repeat words or sentences persistently, string words,
together on the basis of sounds (called clanging, e.g.: “come into house, louse, mouse, mouse
and cheese, please, sneeze”), and experiences sudden interruptions in speech or thought. They
also have a hard time linking their thoughts together in a logical fashion.

3. Hallucinations
Hallucinations refer to false sensory perceptions. People with schizophrenia may hear voices
or see things that are not really true. However, hearing voices is more common and one of
the key symptoms in making a diagnosis of schizophrenia. Other hallucinations involving
touch, smell, and taste are less common but also possible.

4. Emotional disturbances
They are a key feature of schizophrenia. Flat affect is a condition in which the person shows
little or no emotion, i.e., it is a lack of emotional responsiveness. Emotions can also be
excessive and/ or inappropriate-person might laugh when it would be more appropriate to
cry or show sorrow.
 5. Disturbances behaviour
In schizophrenia, a person’s behaviour may also become disorganized and extremely odd.
For example, some forms of schizophrenia are accompanied by periods of complete
immobility, whereas still others may involve weird facial grimaces and odd gesturing.

Even though it is not officially recognized in the diagnosis of schizophrenia by the APA, attention is
also a problem for many schizophrenics. They seem to have trouble screening out information and
stimulation that they don’t really need, causing them to be unable to focus on information that is
relevant (Asarnow et al., 1991).

TYPES AND CATEGORIES OF SCHIZOPHRENIA

Although all the schizophrenia share the symptoms already discussed a certain degree, the way in
which these symptoms show up in behaviour can be used to distinguish among several different
types of schizophrenia. There are five basic categories and two major types of schizophrenia (APA,
2000).

 THE TYPES
The two types differ in the kind of symptoms that predominate.
i. Positive-symptom schizophrenia: positive symptoms of schizophrenia that are
excesses of behaviour or occur in addition to normal behaviour, hallucinations,
delusions, and distorted thinking

These symptoms are associated with over- activity in the dopamine area of the
brain. Dopamine- reducing drugs used to treat schizophrenia are usually effective on
these symptoms and outlook for recovery is generally good.

ii. Negative –symptom schizophrenia: Negative symptoms are symptoms of

schizophrenia that are less normal behaviour or an absence of normal behaviour;
poor attention, flat affect, and poor speech production.

These symptoms, unlike positive symptoms, are associated with lower than normal activity in the
dopamine system of the brain and problems in functioning of the frontal lobe. Unfortunately, this
also means that the outlook for recovery from negative-symptom schizophrenia is not good, as these
symptoms do not respond well to medications that are affective with positive-symptom
schizophrenia.

 THE CATEGORIES

a) Disorganized
 Disorganized schizophrenics are very confused in speech, have vivid and frequent
hallucinations, and tend to have very inappropriate affect (emotion) or flat affect,
they are very socially impaired, unable to engage in the normal social rituals of daily
life.

b) Catatonic
It involves very disturbed motor behaviour. It is schizophrenia in which the person
experiences periods of statue-like immobility mixed with occasional bursts of
energetic, frantic movement and talking.

c) Paranoid
It is schizophrenia in which the person suffers delusions of persecution, grandeur,
and jealousy, together with hallucinations. Although their thinking is not as scattered
as that of disorganizes schizophrenic, their delusions tend to be bizarre but very
systematic.

d) Undifferentiated
Undifferentiated schizophrenia is a category of schizophrenia in which the person
shows no particular pattern, shifting from one pattern to another, and cannot be
neatly classified as disorganized, paranoid, or catatonic.

e) Residual
After a major episode of schizophrenia ends, if the person no longer shows the
major symptoms of delusions and hallucinations but still has some residual (leftover)
symptoms such as negative beliefs, poor language skills, or some unusual ideas and
perceptions, they might be given the label of residual schizophrenic. They would be
able to function in daily life, unlike a person who is suffering from an active episode
of schizophrenia.