Psychological Disorders

Concepts Of Abnormality and Psychological Disorders

➢ Abnormality definition have certain common features, often called the four D’s: -
Deviance, Distress, Dysfunction and Danger.
➢ That is, psychological disorders are:-
1) Deviant (different extreme, unusual, even bizarre). 2) Distressing (unpleasant and
upsetting to the person and to others). 3) Dysfunctional (interfering with the person's ability
to carry out daily activities in a constructive way), and possibly 4) Dangerous (to the person
or to others).

Stigma
➢ If you talk to people around, you will see that they have vague ideas about psychological
disorders that are characterized by superstition, ignorance and fear.
➢ Again, it is commonly believed that psychological disorder is something to be ashamed of.
➢ The stigma (mark of disgrace associated to a disorder) attached to mental illness means
that people are hesitant to consult a doctor or psychologist because they are ashamed of
their problems.
➢ Psychological disorders which indicate a failure in adaptation can also be viewed as any
other illness.

Factors Underlying Abnormal Behavior

➢ In order to understand something as complex as abnormal behavior, psychologists used
different approaches.
➢ These approaches emphasize the role of different factors such as biological and genetic
factors.
➢ some of the approaches which are currently being used to explain abnormal behavior are
as follows:
1. Biological factors:
➢ Influence all aspects of our behavior. A wide range of biological factors, such as faulty
genes, endocrine imbalances, malnutrition, injuries and other conditions may interfere
with normal development and functioning of the human body.
➢ These factors may be potential causes of abnormal behavior.
➢ Abnormal behaviour has a biochemical or physiological basis. Biological researchers
have found that psychological disorders are often related to problems in the
transmission of messages from one neuron to another.
 ➢ A tiny space called synapse separates one neuron from the next, and the message must
move across that space. When an electrical impulse reaches a neuron’s ending, the
nerve ending is stimulated to release a chemical substance called Neurotransmitter.
➢ Studies indicate that, Abnormal activity by certain neurotransmitters can lead to
specific psychological disorders. Anxiety disorders have been linked to low activity of
the neurotransmitter gamma aminobutyric acid (GABA), Schizophrenia to excess
activity of Dopamine, and Depression to low activity of Serotonin.
2. Genetic factors:
➢ Have been linked to bipolar and related disorders, schizophrenia, intellectual disability
and other psychological disorders.
➢ Researchers have not, however, been able to identify the specific genes that are the
culprits.
➢ It appears that in most cases, no single gene is responsible for a particular behavior or
a psychological disorder.
➢ In fact, many genes combine to help bring about our various behaviors and emotional
reactions, both functional and dysfunctional.
➢ Although, there is sound evidence to believe that genetic factors are involved in mental
disorders as diverse as Schizophrenia, Depression, Anxiety, etc. Biology alone cannot
account for most mental disorders.

Major Psychological Disorders

I. Anxiety Disorders
➢ The term Anxiety is usually defined as a diffuse, vague, very unpleasant feeling of fear
and apprehension.
❖ There are 4 Types of Anxiety Disorders: To be studied only from table 4.1.

3. Additional note for reference - Specific Phobia: Irrational fears related to specific objects,
interaction with others (e.g.: social phobia), and unfamiliar situations (e.g.: agoraphobia).
 II. Obsessive-Compulsive and related Disorders
➢ People affected by Obsessive- Compulsive- Disorder are unable to control their
preoccupation with specific ideas or are unable to prevent themselves from repeatedly
carrying out a particular act or series of acts that affect their ability to carry out normal
activities.
➢ Obsessive behavior is the inability to stop thinking about a particular idea or topic
(mind chatter). The person involved often feels these thoughts to be unpleasant and
shameful.
➢ Compulsive behavior is the need to perform certain behaviors over and over again.
Many compulsions deal with counting, ordering, checking, touching, and washing.
➢ Other disorders included in this category are hoarding disorder, trichotillomania (hair
pulling disorder), excoriation (skin picking disorder).

III. Trauma and Stressor-related Disorders

➢ Very often people who have been caught in a natural disaster (such as tsunami) or have been
victims of bomb blasts by terrorists or even in a serious accident or in a war related situation
experience Post-Traumatic Stress Disorder (PTSD). PTSD symptoms vary widely, but may
include recurrent dreams, flashbacks, impaired concentration and emotional numbing.
➢ Adjustment disorders and Acute stress disorder are also included in this category.

IV. Somatic symptom and related Disorders & Dissociative Disorders

To be studied only from box 4.1.
❖ Additional note for reference - In general, both somatic symptom and illness anxiety
disorder are concerned with medical illnesses. But the difference lies in the way this concern
is expressed.
❖ In the case of somatic symptom disorder, this expression is in the terms of physical
complaints while in case of illness anxiety disorder, as the name suggests, it is the anxiety
which is the main concern.

V. Depressive Disorders
❖ One of the most widely prevalent and recognized of all mental disorders is depression.
❖ Depression covers a variety of negative moods and behavioral changes.
❖ Depression can refer to a symptom or a disorder. In day-to-day life, we often use the term
depression to refer to normal feelings after significant loss, such as the breakup of a
relationship, or the failure to attain a significant goal.
Major depressive disorder.: is defined as a period of depressed mood and/or loss
of interest or pleasure in most activities, together with other symptoms which may
include change in body weight, constant sleep problems, tiredness, inability to think
clearly, agitation, greatly slowed behavior, and thoughts of death and suicide. Other
symptoms include excessive guilt or feelings of worthlessness.

❖ Factors predisposing towards depression:

1) Genetic makeup, or hereditary is an important risk factor for major depression and other
depressive disorders.
2) Age is also a risk factor. For instance, women are particularly at risk during young
adulthood, while for men the risk is highest in early middle age.
3) Similarly, gender also plays a great role in this differential risk addition. For example,
Women, in comparison to men, are more likely to report a depressive disorder.
4) Other risk factors are experiencing negative life events and lack of social support.

VI. Bipolar and related Disorders

➢ Bipolar I disorder involves both Mania and Depression, which are alternately present
and sometimes interrupted by periods of normal mood.
➢ Manic episodes rarely appear by themselves; They usually alternate with depression.
➢ Bipolar mood disorders were earlier referred to as manic- depressive disorders.
➢ Some examples of types of bipolar and related disorders include Bipolar I Disorder,
Bipolar II Disorder and Cyclothymic disorder.

Suicide:
➢ Suicide takes place throughout the lifespan.
➢ Suicide is a result of complex interface of biological, genetic, psychological, sociological,
cultural and environmental factors.
➢ Some other risk factors are: i) having mental disorders (especially depression and alcohol
use disorders), ii) going through natural disasters, iii) experiencing violence, abuse or loss
and isolation at any stage of life, iv) Previous suicidal attempt is the strongest risk factor.
➢ Often, suicidal behavior indicates difficulties in problem solving, stress management, and
emotional expression.
➢ Suicidal thoughts lead to suicidal action only when acting on these thoughts seems to be
the only way out of a person’s difficulties. These thoughts are heightened under acute
emotional and other distress.
➢ The ramifications of suicide on social circle and communities tend to be devastating and
long lasting.
➢ The stigma surrounding suicide continues despite recent advances in research in this field.
Due to this, many people who are contemplating or even attempting suicide do not seek
help thus, preventing timely help from reaching them.
➢ Therefore, improving identification, referral, and management of behavior are crucial for
preventing suicide. Therefore, we need to identify vulnerability; comprehend the
circumstances leading to such behaviour and accordingly planned interventions.

➢ Suicides are preventable. There is a need for comprehensive multi sectorial approach where
the government, media and civil society all play important role as stakeholders.

❖ Some suicide prevention measures suggested by WHO include:

1) Limiting access to the means of suicide;
2) Reporting of suicide by media in a responsible way;
3) Bringing in alcohol- related policies;
4) Early identification, treatment and care of people at risk;
5) Training health workers in assessing and managing for suicide;
6) Care for people who attempted suicide and providing community support.

❖ Identifying students in distress:

➢ Any unexpected or striking change affecting the adolescent’s performance, attendance
or behaviour should be taken seriously, such as:
1) Lack of interest in common activities.
2) Declining grades.
3) Decreasing effort.
4) Misbehavior in the classroom.
5) Mysterious or repeated absence.
6) Smoking or Drinking, or Drug misuse.

❖ Strengthening student’s self-esteem:

➢ Having a positive self-esteem is important in face of distress and helps in coping
adequately.
➢ In order to foster positive self-esteem in children, the following approaches can be
useful:
1) Accentuating positive life experiences to develop positive identity. This increases
confidence in self.
2) Providing opportunities for development of physical, social and vocational skills.
3) Establishing a trustful communication.
4) Goals for the students should be specific, measurable, achievable, relevant, to be completed
within a relevant time frame.
VII. Neurodevelopmental Disorders
➢ A common feature of neurodevelopmental disorder is that they manifest in the early stage
of development (0-18 years).
❖ Types of Neurodevelopmental disorders:
1) Attention-Deficit-Hyperactive Disorder (ADHD):
➢ The three main features of ADHD are Inattention and Hyperactivity, Impulsivity.
• Children who are Inattentive find it difficult to sustain mental effort during work or
play.
➢ They have a hard time keeping their minds on any one thing or in following
instructions.
➢ Common complaints are that the child does not listen, cannot concentrate, does not
follow instructions, is disorganized, easily distracted, forgetful, does not finish
assignments and is quick to lose interest in boring activities.
• Children who are Impulsive seem 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 such as, knocking things over, are common whereas more serious
accidents and injuries can also occur.
• Hyperactivity, children with ADHD are in constant motion.
➢ Sitting still through a lesson is impossible for them.
➢ The child may fidget, squirm, climb and run around the room aimlessly.
➢ Parents and teachers described them as “driven by a motor”, always on the go, and
talk incessantly.

2) Autism spectrum Disorder:

➢ Autism disorder is characterized by widespread impairments in social interaction and
communication skills, and stereotyped patterns of behaviors, interests, and activities.
➢ Children with autism spectrum disorder have marked difficulties in social interaction, and
communication, a restricted range of interests and a strong desire for routine.
➢ About 70% of children with autism disorder have intellectual disabilities.
➢ Children with autism spectrum disorder experience profound difficulties in relating to other
people.
➢ They are unable to initiate social behavior and seem unresponsive to other people’s
feelings.
➢ They are unable to share experiences or emotions with others.
➢ They also show serious abnormalities in communication and language that persist
overtime.
➢ Many of them never develop speech, and those who do, have a repetitive and deviant speech
pattern.
 ➢ Such children often show narrow patterns of interest and repetitive behaviors such as,
lining up objects or stereotyped body movements such as rocking.
➢ These motor movements may be self-stimulatory such as hand flapping or self-injurious
such as banging their heads against the wall.
➢ Due to the nature of these difficulties in terms of verbal and nonverbal communication,
individuals with autism spectrum disorder tend to experience difficulties in starting,
maintaining and even understanding relationships.

VIII. Feeding and Eating Disorders

➢ Another group of disorders which are of special interest to young people are eating
disorders.
❖ Types of Eating Disorders:
1. Anorexia Nervosa: In anorexia nervosa, the individual has a distorted body image that
leads her or him to see themselves as overweight. Often refusing to eat, exercising
compulsively, and developing unusual habits such as, refusing to eat in front of others. The
person with anorexia may lose large amounts of weight and even starve herself or himself
to death.
2. Bulimia Nervosa: In bulimia nervosa, the individual may eat excessive amounts of food,
then purge her or his body by using medicines such as laxatives or diuretics or by vomiting.
The person often feels disgusted and ashamed when she or he binges and is relieved of
tension and negative emotions after purging.
3. Binge eating: Binge eating, there are frequent episodes of out-of-control eating. The
individual tends to eat at a higher speed than normal, and continues eating till she or he
feels uncomfortably full. In fact, large amount of food may be eaten even when the
individual is not feeling hungry.

IX. Schizophrenic spectrum and other Psychotic Disorders

➢ Schizophrenia is the descriptive term for a group of psychotic disorders in which personal,
social and occupational functioning deteriorates as a result of disturbed thought processes,
strange perceptions, unusual emotional states, and motor abnormalities. It is a debilitating
disorder.
➢ The social and psychological costs of schizophrenia are tremendous, both to patients as
well as to their families and society.

Symptoms of Schizophrenia:
➢ Below are the symptoms of schizophrenia that can be grouped into three categories-
Positive Symptoms (i.e., excesses of thought, emotion and behavior), Negative
Symptoms (I.e., deficits of thought, emotion and behavior), and Psychomotor Symptoms.
A. POSITIVE SYMPTOMS are ‘pathological excesses’ or ‘bizarre additions’ to a person’s
behavior. Delusions, Disorganized Thinking and Speech, Heightened Perception and
Hallucinations, and Inappropriate Affect are most often found in schizophrenia.
✓ Delusion is a false belief that is firmly held on inadequate grounds. It is not affected by
rational argument, and has no basis in reality.
Types of Delusions:
i. Delusions of persecution are the most common in schizophrenia. People with this
delusion believe that they are being plotted against, spied on, slandered, threatened,
attacked or deliberately victimized.
ii. People with Schizophrenia may also experience Delusion of reference in which they
attach special and personal meaning to the actions of others or to objects and events.
iii. In Delusion of grandeur, people believe themselves to be specially empowered
persons.
iv. Delusions of Control, they believe that their feelings, thoughts and actions are
controlled by others.

✓ Formal Thought Disorder is in which people with schizophrenia may not be able to think
logically and may speak in peculiar ways. These disorders can make communication
extremely difficult.
i. These include rapidly shifting from one topic to another so that the normal structure of
thinking is muddled and becomes illogical (loosening of associations, derailment),
ii. inventing new words or phrases (neologisms),
iii. and persistent and inappropriate repetition of the same thoughts (perseveration).

✓ Schizophrenics may have Hallucinations, i.e., perceptions that occur in the absence of
external stimuli.
Types of Hallucinations:
i. Auditory hallucinations are most common in schizophrenia. Patients hear sounds or
voices that speak words, phrases and sentences directly to the patient (second-person
hallucination) or talk to one another, referring to the patient as she or he (third-person
hallucination).
ii. Tactile hallucinations (i.e., forms of tingling, burning sensation).
iii. Somatic hallucinations (i.e., something happening inside the body such as a snake
crawling inside one’s stomach).
iv. Visual hallucinations (i.e., vague perceptions of color or distinct visions of people or
objects).
v. Gustatory hallucinations (i.e., food or drink, taste strange).
vi. Olfactory hallucinations (i.e., smell of poison, or smoke).
✓ People with schizophrenia also show Inappropriate Affect, i.e. emotions that are unsuited
to the situation.

B. NEGATIVE SYMPTOMS are ‘pathological deficits’ and include poverty of speech,

blunted and flat affect, loss of volition, and social withdrawal.
Types of negative symptoms:
i. People with schizophrenia show Alogia or poverty of speech, it is a reduction in speech
and speech content.
ii. Many people with schizophrenia show less anger, sadness, joy, and other feelings than
most people do. Thus, they have Blunted effect.
iii. Some show no emotions at all, a condition known as Flat effect.
iv. Also, patients with schizophrenia experience Avolition, or apathy, i.e. an inability to
start or complete a course of action. People with this disorder may withdraw socially
and become totally focused on their own ideas and fantasies.

C. People with schizophrenia also show PSYCHOMOTOR SYMPTOMS. They move less
spontaneously or make odd grimaces and gestures. These symptoms may take extreme
forms known as Catatonia.
Types of Catatonias:
i. People in a Catatonic Stupor, remain motionless and silent for long stretches of time.
ii. Some show Catatonic Rigidity, i.e., maintaining a rigid, upright posture for hours.
iii. Others exhibit Catatonic Posturing, that is assuming an awkward, bizarre positions
for long periods of time.

X. Substance related and Addictive Disorders

➢ Addictive behavior, whether it involves excessive intake of high calorie food resulting in
extreme obesity or involving the abuse of substances such as alcohol or cocaine, is one of
the most severe problems being faced by society today.
➢ Disorders relating to maladaptive behaviors resulting from regular and consistent use of
the substance involved, are called Substance related and addictive Disorders.
➢ These disorders include problems associated with the use and abuse of alcohol, cocaine,
tobacco and opioids among others, which alter the way people think, feel and behave.
❖ Three frequently used substances:
a) Alcohol:
➢ People who abuse alcohol drink large amounts regularly and rely on it to help them
face difficult situations.
➢ Eventually the drinking interferes with their social behavior and ability to think and
work.
➢ Their bodies build up a tolerance for alcohol and they need to drink even greater
amounts to feel its effects.
➢ They also experience withdrawal responses when they stop drinking.
➢ 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 thus seriously damage physical health.

b) Heroin:
➢ Heroin intake interferes with social and occupational functioning.
➢ Most abusers 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 centers in the brain, almost paralyzing breathing, and in many cases
causing death.

c) Cocaine:
➢ Regular use of cocaine may lead to a pattern of abuse in which the person may be
intoxicated throughout the day and function 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 effect, and stopping it results in feelings
of depression, fatigue, sleep problems, irritability and anxiety.
➢ Cocaine poses serious dangers. It has dangerous effects on psychological functioning
and physical well-being.