CHAPTER 4

PSYCHOLOGICAL DISORDERS
CONCEPTS OF ABNORMALITY AND PSYCHOLOGICAL DISORDERS
Q. Discuss the concept of Abnormality, Psychological disorders, 4D’s.

 Most definitions have certain common features, often called the ‘four Ds’: deviance,
distress, dysfunction and danger. (flowchart)
 Psychological disorders are deviant (different, extreme, unusual, even bizarre)
 distressing (unpleasant and upsetting to the person and to others)
 dysfunctional (interfering with the person’s ability to carry out daily activities in a
constructive way)
 Possibly dangerous (to the person or to others).
 The word ‘abnormal’ literally means “away from the normal”, it implies deviation from some
clearly defined norms or standards.
Various approaches have been used in distinguishing between normal and abnormal behaviours. The two
basic and conflicting views are:
 The first approach views abnormal behaviour as a deviation from social norms.
 Abnormal behaviour, thoughts and emotions are those that differ markedly from a society’s ideas
of proper functioning.
 Each society has norms, which are stated or unstated rules for proper conduct.
Behaviours, thoughts and emotions that break societal norms are called abnormal.
 A society’s norms grow from its particular culture — its history, values, inst itutions,
habits, skills, technology, and arts.
 Thus, a society whose culture values competit ion and assertiveness may accept
aggressive behaviour, whereas one that emphasises cooperation and family values (such as in
India) may consider aggressive behaviour as unacceptable or even abnormal.
 A society’s values may change over time, causing its views of what is psychologically
abnormal to change as well.
 The second approach views abnormal behaviour as maladaptive.
 Many psychologists believe that the best criterion for determining the normality of behaviour is
not whether society accepts it but whether it fosters the well-being of the individual and
eventually of the group to which s/he belongs.
 Well-being is not simply maintenance and survival but also includes growth and fulfilment,
i.e. the actualisation of potential. According to this crit erion, conforming behaviour
can be seen as abnormal if it is maladaptive, i.e. if it interferes with optimal functioning
and growth.
 The stigma attached to mental illness means that people are hesitant to consult a doctor or
psychologist because they are ashamed of t heir problems. Actually, psychological disorder
which indicates a failure in adaptation should be viewed as any other illness.

HISTORICAL BACKGROUND
Q. Write a short note on historical background of abnormality.
 One ancient theory that is st ill encountered today holds that abnormal behaviour can
be explained by t he operation of supernatural and magical forces such as evil spirits
(bhoot-pret), or the devil (shaitan).

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  Exorcism, i.e. removing the evil that resides in the individual through counter magic
and prayer, is still commonly used.
 In many societies, the shaman, or medicine man (ojha) is a person who is believed to
have contact with supernatural forces and is the medium through which spirits
communicate with human beings. Through the shaman, an afflicted person can learn
which spirits are responsible for her/his problems and what needs to be done to appease
them.
 A recurring theme in the history of abnormal psychology is the belief that individuals
behave strangely because their bodies and their brains are not working properly. This is the
biological or organic approach. In the modern era, there is evidence that body and brain
processes have been linked to many types of maladaptive behaviour. For certain types of
disorders, correcting these defect ive biological processes results in improved
functioning.
 Another approach is the psychological approach. According to this point of view,
psychological problems are caused by inadequacies in the way an individual thinks,
feels, or perceives the world.

All three of these perspectives — supernatural, biological or organic, and psychological —

have recurred throughout the history of Western civilisation.

 In the ancient Western world, it was philosopher- physicians of ancient Greece such as
Hippocrates, Socrates, and in particular Plato who developed the organismic approach and
viewed disturbed behaviour as arising out of conflicts between emotion and reason.
 Galen elaborated on the role of the four humours in personal character and temperament.
According to him, the material world was made up of four elements, viz. earth, air, fire,
and water which combined to form four essential body fluids, viz. blood, black bile,
yellow bile, and phlegm. Each of these fluids was seen to be responsible for a different
temperament. Imbalances among the humours were believed to cause various disorders.
 In the Middle Ages, demonology and superstition gained renewed importance in the
explanation of abnormal behaviour. Demonology related to a belief that people with mental
problems were evil and there are numerous instances of ‘witch-hunts’ during this period.
During the early Middle Ages, the Christian spirit of charity prevailed and St. August ine
wrote extensively about feelings, mental anguish and conflict.
 The Renaissance Period was marked by increased humanism and curiosity about
behaviour. Johann Weyer emphasised psychological conflict and disturbed interpersonal
relationships as causes of psychological disorders. He also insisted that ‘witches’ were
mentally disturbed and required medical, not theological, treatment.
 The seventeenth and eighteenth centuries were known as the Age of Reason and
Enlightenment, as the scientific method replaced faith and dogma as ways of
understanding abnormal behaviour.
 The growth of a scientific attitude towards psychological disorders in the eighteenth
century contributed to the Reform Movement and to increased compassion for people who
suffered from these disorders. Reforms of asylums were initiated in both Europe and
America.
 One aspect of the reform movement was the new inclination for deinstitutionalisation
which placed emphasis on providing community care for recovered mentally ill
individuals.
 In recent years, there has been a convergence of these approaches, which has resulted in an
interactional or bio- psycho-social approach. From t his perspective, all three factors, i.e.
biological, psychological and social play important roles in influencing the expression and

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 outcome of psychological disorders.
CLASSIFICATION OF PSYCHOLOGICAL DISORDERS
Q. How psychological disorders are classified?

 Classifications are useful because they enable users like psychologists, psychiatrists and social
workers to communicate with each other about the disorder and help in understanding the causes
of psychological disorders and the processes involved in their development and maintenance.
 The American Psychiatric Association (APA) has published an official manual describing
and classifying various kinds of psychological disorders. The Diagnostic and Statistical
Manual of Mental Disorders, 5th Edition (DSM-5), presents discrete clinical criteria which
indicate the presence or absence of disorders.
 The classification scheme officially used in India and elsewhere is the tenth revision of the
International Classification of Diseases (ICD-10), which is known as the ICD-10
Classification of Behavioural and Mental Disorders. It was prepared by the World Health
Organisation (WHO). For each disorder, a description of the main clinical features or
symptoms and of other associated features including diagnostic guidelines is provided in this
scheme.

FACTORS UNDERLYING ABNORMAL BEHAVIOUR

Q. What are the factors underlying Abnormal behavior? / Discuss Biological, Genetic,
Psychological-psychodynamic, behavioral, cognitive, humanistic-existential, socio-cultural and
diathesis stress model)

A. Biological factors influence all aspects of our behaviour. 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.
Studies indicate t hat abnormal act ivit y by certain neuro- transmitters 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
 Depression to low activity of serotonin.
B. Genetic factors have been linked to mood disorders, schizophrenia, mental retardat ion and
other psychological disorders.
 No single gene is responsible for a particular behaviour or a psychological disorder. Infact,
many genes combine to help bring about our various behaviours and emotional reactions, both
functional and dysfunctional.
 Although there is sound evidence to believe that genet ic/ biochemical factors are involved in
mental disorders as diverse as schizophrenia, depression, anxiety, etc. and biology alone cannot
account for most mental disorders.
C. Psychological models explain that psychological and interpersonal factors have a significant
role to play in abnormal behaviour.
 These factors include maternal deprivat ion (separation from the mother, or lack of warmt h
and stimulation during early years of life), faulty parent-child relationships (rejection,
overprotection, over- permissiveness, faulty discipline, etc.), maladaptive family structures
(inadequate or disturbed family), and severe stress.
The psychological models include the psychodynamic, behavioural, cognitive, and humanistic-
existential models.
i. The psychodynamic model is the oldest and most famous of the modern psychological
models.
 Psychodynamic theorists believe that behaviour, whether normal or abnormal, is

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 determined by psychological forces within the person of which s/he is not consciously
aware. These internal forces are considered dynamic, i.e. they interact with one another
and their interaction gives shape to behaviour, thoughts and emotions.
 Abnormal symptoms are viewed as the result of conflicts between these forces. This
model was first formulated by Freud who believed that three central forces shape
personality — instinctual needs, drives and impulses (id), rational thinking (ego),
and moral standards (superego).
 Freud stated that abnormal behaviour is a symbolic expression of unconscious mental
conflicts that can be generally traced to early childhood or infancy.
ii. Another model that emphasises the role of psychological factors is the behavioural model.
 This model states that both normal and abnormal behaviours are learned and psychological
disorders are the result of learning maladaptive ways of behaving.
 The model concentrates on behaviours that are learned through conditioning and
proposes that what has been learned can be unlearned.
 Learning can take place by classical conditioning (temporal association in which two events
repeatedly occur close together in time), operant conditioning (behaviour is followed by
a reward), and social learning (learning by imit ating others’ behaviour).
iii. Psychological factors are also emphasised by the cognitive model.
 This model states that abnormal functioning can result from cognitive problems. People
may hold assumptions and attitudes about themselves that are irrational and
inaccurate.
 People may also repeatedly think in illogical ways and make overgeneralisations, that is,
they may draw broad, negative conclusions on the basis of a single insignificant event.
iv. Another psychological model is the humanistic-existential model which focuses on broader
aspects of human existence.
 Humanists believe that human beings are born with a natural tendency to be friendly,
cooperative and constructive, and are driven to self-actualise, i.e. to fulfil this potential
for goodness and growth.
 Existentialists believe that from birth we have total freedom to give meaning to our
existence or to avoid that responsibility. Those who shirk from this responsibility would live
empty, inauthentic, and dysfunctional lives.
D. According to the socio- cultural model, abnormal behaviour is best understood in light of the
social and cultural forces that influence an individual.
 As behaviour is shaped by societal forces, factors such as family structure and
communication, social networks, societal conditions, and societal labels and roles become
more important. It has been found that certain family systems are likely to produce abnormal
functioning in individual members.
 Some families have an enmeshed structure in which the members are overinvolved in each
other’s activities, thoughts, and feelings. Children from this kind of family may have
difficulty in becoming independent in life.
 The broader social networks in which people operate include their social and professional
relationships. Studies have shown that people who are isolated and lack social support, i.e.
strong and fulfilling interpersonal relationships in their lives are likely to become more
depressed and remain depressed longer than those who have good friendships.
 Socio-cultural theorists also believe that abnormal functioning is influenced by the societal
labels and roles assigned to troubled people.
 When people break the norms of their society, they are called deviant and ‘mentally ill’.
Such labels tend to stick so that the person may be viewed as ‘crazy’ and encouraged to act
sick. The person gradually learns to accept and play the sick role, and functions in a
disturbed manner
E. In addition to these models, one of the most widely accepted explanations of abnormal behaviour
has been provided by the diathesis-stress model.

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  This model states that psychological disorders develop when a diathesis (biological
predisposition to the disorder) is set off by a stressful situation. This model has three
components.
 The first is the diathesis or the presence of some biological aberration which may be
inherited.
 The second component is that the diathesis may carry a vulnerability to develop a
psychological disorder. This means that the person is ‘at risk’ or ‘predisposed’ to develop
the disorder.
 The third component is the presence of pathogenic stressors, i.e. factors/stressors that may
lead to psychopathology. If such “at risk” persons are exposed to these stressors, their
predisposition may actually evolve into a disorder.
 This model has been applied to several disorders including anxiety, depression, and
schizophrenia.

MAJOR PSYCHOLOGICAL DISORDERS (flowchart for every disorder)

A. ANXIETY DISORDER
i) Generalised anxiety disorder
ii) Panic disorder
iii) Specific Phobia
iv) Separation anxiety disorder
B. OBSESSIVE – COMPULSIVE AND RELATED DISORDERS
C. TRAUMA AND RELATED DISORDER
D. SOMATIC SYMPTOM AND RELATED DISORDER
i) Somatic symptom disorder
ii) Illness anxiety disorder
1. iii) Conversion
ANXIETY disorder
DISORDER
I. Generalised anxiety
E. DISSOCIATVE DISORDER disorder
II.i) Dissociative
Panic disorder
amnesia
III.ii) Dissociative
Specific Phobia
identity disorder
IV. Separation anxiety disorder
iii) Depersonalisation / Derealisation disorder
V. Other anxiety disorders
F. DEPRESSIVE DISORDER
G.
2. BIPOLAR
OBSESSIVE AND RELATED DISORDER
– COMPULSIVE AND RELATED DISORDERS
H. SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC
3. DISORDERS
TRAUMA AND RELATED DISORDERS
I. NEURODEVELPMENTAL DISORDERS
i) Attention deficit / Hyperactivity Disorder
ii) Autism Spectrum disorder
iii) Intellectual Disability
iv) Specific Learning Disorder
J. DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS
i) Oppositional Defiant Disorder
ii) Conduct disorder and Anti-social behavior
K. FEEDING AND EATING DISORDER
L. SUBSTANCE REALTED AND ADDICTIVE DISORDER

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A. ANXIETY DISORDERS
i) Generalised anxiety disorder
ii) Panic disorder
iii) Specific Phobia
iv) Separation anxiety disorder

 The term anxiety is usually defined as a diffuse, vague, very unpleasant feeling of fear
and apprehension.
 The anxious individual also shows combinations of the following symptoms:
o rapid heart rate o dizziness
o shortness of breath o sweating
o diarrhoea o sleeplessness
o loss of appetite o frequent urination and
o fainting tremors

i) GENERALISED ANXIETY DISORDER (GAD) consists of prolonged, vague,

unexplained and intense fears that are not attached to any particular object. The
symptoms:
o worry and apprehensive feelings about the future
o hypervigilance, which involves constantly scanning the environment for dangers.
o It is marked by motor tension, as a result of which the person is unable to relax, is
restless, and visibly shaky and tense.

ii) PANIC DISORDER consists of recurrent anxiety attacks in which the person experiences
intense terror.
 A panic attack denotes an abrupt surge of intense anxiety rising to a peak when thoughts
of particular stimuli are present. Such thoughts occur in an unpredictable manner. The
clinical features include:
o shortness of breath o nausea
o dizziness o chest pain or discomfort
o trembling o fear of going crazy
o palpitations o losing control or dying
o choking

iii) PHOBIAS are irrational fears related to specific objects, people, or situations. Phobias
often develop gradually or begin with a generalised anxiet y disorder. Phobias can be
grouped into three main types, i.e. specific phobias, social phobias, and agoraphobia.

 Specific phobias are the most commonly occurring type of phobia. This group
includes irrational fears such as intense fear of a certain type of animal, or of being in an
enclosed space.
 Social phobias refer to the intense and incapacitating fear and embarrassment when
dealing with others.
 Agoraphobia is the term used when people develop a fear of entering unfamiliar
situations. Many agoraphobics are afraid of leaving their home. So their ability to carry
out normal life activities is severely limited.

iv) SEPARATION ANXIETY DISORDER

 Individuals with SAD are fearful and anxious about separation from attachment figures
to an extent that is developmentally not appropriate.

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  Children with SAD may have difficulty being in a room by themselves, going to school
alone, are fearful of entering new situations, and cling to and shadow their parents’ every
move.
 To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or make
suicidal gestures.

B. 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 behaviour is the inability to stop thinking about a particular idea or topic.
The person involved, often finds these thoughts to be unpleasant and shameful.
 Compulsive behaviour is the need to perform certain behaviours over and over
again. Many compulsions deal with counting, ordering, checking, touching and
washing.
 Other disorders in this category include: Hording disorder, trichotillomania (hair pulling
disorder), excoriation (Skin Picking) disorders.

C. TRAUMA AND RELATED DISORDER

 Very often people who have been caught in a natural disaster (such as tsunami) or have
been victims of bomb blasts by terrorists, or been in a serious accident or in a war-
related situation, experience post- traumatic stress disorder (PTSD).
 PTSD symptoms may include
o recurrent dreams
o flashbacks
o impaired concentration
o emotional numbing
 Other Disorders in this category are: Adjustment disorders and Acute stress disorder.

D. SOMATIC SYMPTOM AND RELATED DISORDER

 These are conditions in which there are physical symptoms in the absence of a
physical disease.
 In somatoform disorders, the individual has psychological difficulties and complains
of physical symptoms, for which there is no biological cause.
 Somatoform disorders include:
i) Somatic symptom disorder
ii) Illness anxiety disorder
iii) Conversion disorder

i) Somatic symptom Disorder:

 Involves a person having persistent body-related symptoms which may or may not be
related to any serious medical condition.
 People with this disorder tend to be overly preoccupied with their symptoms
 They continuously worry about their health
 Make frequent visit to doctors
 Therefore experience significant distress and disturbance in their daily life.

ii) Illness anxiety disorder

 Involves preoccupation about developing a serious illness and continuously worry about
this possibility.
 High anxiety about one’s health
 Are overly concerned about undiagnosed disease, negative diagnostic results

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  Do not respond to assurance by doctors
 Easily alarmed about illness such as hearing about someone else’s ill health or some such
news

 Difference between Somatic symptom Disorder and Illness anxiety disorder: In the case of
somatic symptom disorder the expression is in terms of physical complaints while in case of
illness anxiety disorder it is the anxiety which is the main concern.

iii)Conversion Disorder
 The symptoms of conversion disorders are the reported loss of part or all of some basic
body functions.
 Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms
reported.
 These symptoms often occur after a stressful experience and may be quite sudden.

E. DISSOCIATIVE DISORDERS
 Dissociation can be viewed as severance of the connections between ideas and
emotions.
 Dissociation involves feelings of unreality, estrangement, depersonalisation, and
sometimes a loss or shift of identity. Sudden temporary alterations of consciousness that
blot out painful experiences are a defining characteristic of dissociative disorders.
i) Dissociative amnesia
ii) Dissociative fugue
iii)Dissociative identity disorder
iv) Depersonalisation/Derealisation

i) Dissociative amnesia
 It is characterized by extensive but selective memory loss that has no known organic
cause (e.g., head injury).
 Some people cannot remember anything about their past others can no longer recall
specific events, people, places, or objects, while their memory for other events remains
intact. This disorder is often associated with an overwhelming stress.

ii) Dissociative fugue

 An unexpected travel away from home and workplace, the assumption of a new identity,
and the inability to recall the previous identity.
 The fugue usually ends when the person suddenly ‘wakes up’ with no memory of the
events that occurred during the fugue.

iii)Dissociative identity disorder

 Often referred to as multiple personality, is the most dramatic of the dissociative disorders.
 It is often associated with traumatic experiences in childhood.
 In this disorder, the person assumes alternate personalities that may or may not be
aware of each other.

iv) Depersonalisation/ Derealisation

 Involves a dreamlike state in which the person has a sense of being separated both from
self and from reality.
 In depersonalisation, there is a change of self-perception, and the person’s sense of reality
is temporarily lost or changed.

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 F. DEPRESSIVE DISORDER
 Depression can refer to a symptom or a disorder.
i) Major depressive disorder
 It 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:
o change in body weight o greatly slowed behavior
o constant sleep problems o thoughts of death and suicide
o tiredness o change in appetite
o inability to think clearly o excessive guilt or feelings of worthlessness
o agitation

Factors Predisposing towards Depression:

 Genetic make-up or heredity is an important risk factor for major depression and bipolar
disorders.
 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.
 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.
 Other risk factors are experiencing negative life events and lack of social support.

G. BIPOLAR AND RELATED DISORDERS

 Bipolar I disorder involves both Mania and depression.
 They are alternately present, sometimes interrupted by periods of normal mood.
 This disorder was earlier referred to as manic-depressive disorder.
 E.g. Bipolar I Disorder, Bipolar II disorder, Cyclothymic disorder.

SUICIDE
 Result of complex interface of biological, genetic, psychological, sociological, cultural and
environmental factors.
 Risk factors are: natural disaster, loss, isolation etc.
 Suicidal behaviour often indicates - difficulties in problem solving, stress management,
emotional expression.
 Suicidal thoughts lead to suicidal actions.
 Ramification of suicide on social circle and communities tend to be devastating.
 Stigma around seeking help for having suicidal thoughts is very strong. Thus people don’t
seek help.
 For PREVENTION of suicide some crucial things are:
o Improving identification
o Referral
o Management of behavior
o Identify vulnerability

Comprehensive Multi-Sectoral approach for Prevention

o All three: Government, Media, civil society play imp role

Prevention measures suggested by WHO:

 Limited access to the means of suicide
 Reporting of suicide by media in responsible way
 Bringing in alcohol related policies
 Early identification, treatment and care of people at risk
 Training health workers in assessing and managing suicide
 Care for people who attempted suicide and providing community support

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Identifying students in distress:
 Any unexpected or striking change affecting the adolescents performance, attendance or
behavior should be taken seriously such as:
o Lack of interest in common activities
o Declining grades
o Decreasing effort
o Misbehavior in the classroom
o Mysterious or repeated absence
o Smoking or drinking or drug abuse

Strengthening students’ self esteem

 Forster positive self-esteem using following approach-
o Accentuating positive life experiences to develop positive identity
o Providing opportunities for development of physical, social and vocational skills
o Establishing a trustful communication
o Goals for the students should be specific, measurable, achievable, relevant, to be
completed within a time frame.

H. SCHIZOPHRENIA SPECTRUM AND OTHER RELATED PSYCHOTIC DISORDERS

(https://www.youtube.com/watch?v=u3FES9W8P04&list=PLfPsXhD4lStYpGd6Ktwd8
_xPtmwHZp3uX&index=10&t=0s)
 Schizophrenia is the descriptive term for a group of psychotic disorders in which
personal, social and occupat ional functioning deteriorate 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
i) Positive symptoms (i.e. excesses of thought, emotion, and behaviour)
ii) Negative symptoms (i.e. deficits of t hought, emotion, and behaviour)
iii) Psychomotor symptoms

i) Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to a person’s behaviour.

They include:
a) Delusions (Delusions of persecution, delusions of reference, delusions of grandeur
and delusions of control)
b) disorganized thinking and speech
c) Height ened perception and hallucinations (Auditory, tactile, somatic, visual,
gustatory and olfactory hallucinations)
d) Inappropriate affect are the ones most often found in schizophrenia.

a) A 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.
o 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 victimised.
o People with schizophrenia may also experience delusions of reference in which
they attach special and personal meaning to the actions of others or to objects and
events.
o In delusions of grandeur, people believe themselves to be specially empowered
persons.
o Delusions of control, they believe that their feelings, thoughts and actions are

10
 controlled by others. People with schizophrenia may not be able to think logically
and may speak in peculiar ways.
b) These formal thought disorders can make communication extremely difficult. 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), inventing new words
or phrases (neologisms), and persistent and inappropriate repetition of the same thoughts
(perseveration).
c) Schizophrenics may have hallucinations, i.e. perceptions that occur in the absence of
external stimuli.
o 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 s/he (third- person
hallucination).
o Hallucinations can also involve the other senses. These include tactile hallucinations
(i.e. forms of tingling, burning)
o Somatic hallucinations (i.e. something happening inside the body such as a snake
crawling inside one’s stomach)
o Visual hallucinations (i.e. vague perceptions of colour or distinct visions of people or
objects)
o Gustatory hallucinations (i.e. food or drink taste strange)
o Olfactory hallucinations (i.e. smell of poison or smoke).
d) People with schizophrenia also show inappropriate affect, i.e. emotions that are unsuited to
the situation.

ii) Negative symptoms are ‘pathological deficits’ and include:

a) poverty of speech
b) blunted affect
c) flat affect
d) loss of volition, and social withdrawal

a) People with schizophrenia show alogia or poverty of speech, i.e. a reduction in

speech and speech content.
b) Many people with schizophrenia show less anger, sadness, joy, and other feelings than
most people do. Thus they have blunted affect.
c) Some show no emotions at all, a condition known as flat affect.
d) Also patients with schizophrenia experience avolition, or apathy and 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.

iii) 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. They include:
a) catatonic stupor
b) catatonic rigidity
c) catatonic posturing

a) People in a catatonic stupor remain motionless and silent for long stretches of
time.
b) Some show catatonic rigidity, i.e. maintaining a rigid, upright posture for hours.
c) Others exhibit catatonic posturing, i.e. assuming awkward, bizarre positions for
long periods.

I. NEURODEVELOPMENTAL DISORDERS
 It is manifested in early stage of development
 Often symptoms appear before child enters school or during early stage of schooling

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  They hamper personal, social, academic, and occupational functioning.
 If these disorders are not attended they can lead to more serious and chronic disorders as
child moves into adulthood.
It is characterized by:
 Deficit or excess in a particular behavior
 Delay in achieving a particular age-appropriate behavior
It includes:
i) Attention Deficit Hyperactivity Disorder (ADHD)
ii) Autism Spectrum Disorder
iii) Intellectual Disability
iv) Specific Learning Disorder

i) Attention Deficit Hyperactivity Disorder (ADHD): it includes

a) inattention
b) hyperactivity
c) impulsivity

a) Children who are inattentive

 They 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:
o that the child does not o easily distracted, and
listen, o forgetful
o cannot concentrate, o does not finish assignments
o does not follow instructions o is quick to lose interest in boring
o is disorganised activities

b) 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.

c) Hyperactivity also takes many forms.

 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 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.

ii) Autism Spectrum Disorder (ASD)

 Autistic disorder or autism is one of the most common of these disorders.
 Children with autistic disorder have marked 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.
 Children with autism experience profound difficulties in relating to other people.
 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.
 They also show serious abnormalities in communication and language that persist
over time.
 Many autistic children never develop speech and those who do, have repetitive and
deviant speech patterns.

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  Children with autism often show narrow patterns of interests and repetitive
behaviours 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 head against the wall.
 They have difficulties in starting, maintaining and even understanding relationships.

iii) Intellectual Disability

 It refers to average intellectual functioning (IQ below70)
 Deficit or impairment in adaptive behaviour (Communication, Self-care, Home living,
Social and interpersonal function, work, functional academic skills)
 Manifested before the age of 18 years.
 Refer table 4.2 page 85 book briefly

iv) Specific Learning Disorder

 The individual experience difficulty in perceiving or processing information efficiently
and accurately.
 Gets manifested during early school years Individual encounter problems in basic skills
in reading, writing and or mathematics. Child performs below average for his/her age.
 May be able to reach acceptable levels with extra inputs.
 Impair function and performance in activities/occupations dependent on the related skills.

J. DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS

 It includes:
a) Oppositional defiant disorder (ODD)
b) Conduct disorder and Anti-social behavior

a) Oppositional defiant disorder

 display age-inappropriate amounts of stubbornness
 are irritable
 defiant
 disobedient
 behave in hostile manner
 often justify their hostile behavior as reaction to circumstances
 Face problematic interactions with others.

b) Conduct disorder and Anti-social behavior

 Refer to age-inappropriate actions and attitudes that violate family expectations, societal
norm and personal or property rights of others.
 Aggressive actions
 Major deceitfulness or theft
 Serious rule violation

Types of aggressive behaviors:

i) Verbal aggression: name calling, swearing
ii) Physical aggression: Hitting, Fighting
iii) Hostile aggression: Directing at inflicting injury to others
iv) Proactive aggression: dominating and bullying others without provocation

K. FEEDING AND EATING DISORDER

 These include:
a) anorexia nervosa

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 b) bulimia nervosa
c) binge eating
a) In 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 and developing unusual habits
such as refusing to eat in front of others, the anorexic may lose large amounts of weight and
even starve her /him to death.
b) In bulimia nervosa
 The individual may eat excessive amounts of food, and then purge her/ his body of food by
using medicines such as laxatives or diuretics or by vomiting. The person often feels
disgusted and ashamed when s/he binges and is relieved of tension and negative emotions
after purging.
c) In binge eating
 There are frequent episodes of out-of-control eating. The individual tends to eat at higher
speed, continues eating till feels uncomfortably full. Eat large amount of food even if he/she
is not hungry.

L. SUBSTANCE RELATED AND ADDICTIVE DISORDER

 Disorders relating to maladaptive behaviors resulting from regular and consistent use of
the substance involved are including under this category.
 Problems associated with the use and abuse of alcohol, cocaine, tobacco which alter the
way people think, feel, and behave.
 It includes:
a) Alcohol
b) Heroin
c) Cocaine

a) Alcohol
 people who abuse alcohol drink large amounts regularly
 rely on it to help the face difficult situations
 their drinking interfere with social behavior and ability to think and work
 Bodies develop tolerance for alcohol i.e. they need to drink even greater amounts to
feel its effect.
 Experience withdrawal responses-i.e. When they stop drinking they feel high anxiety
and craving
Effects of alcohol

 Destroys millions of families, social relationships, careers

 Intoxicated drivers cause road accidents
 Affect child’s upbringing
 Lead Psychological problems like depression
 Affect physical health

b) Heroin
 Interferes with social and occupational functioning
 Develop dependence, tolerance and withdrawal reactions.
 Overdose effects brain
 Paralysis breathing
 Cause death
Effects of Heroin
 It slows down the respiratory centers in the brain, almost paralyzing breathing and may
cause death.

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 c) Cocaine
 Intoxicated throughout the day
 Poor social relationship and work
 Problem in Short term memory
 Results in feelings of depression, fatigue, sleep problems, irritability and anxiety
 Abuse, tolerance and withdrawal symptoms
Effects of Cocaine
 Danger to life, psychological functioning and well being

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