PSYCHOLOGICA

L DISORDERS
CHAPTER 4
 LEARNING OUTCOMES
 Understand the basic issues in abnormal behaviour
and the criteria used to identify such behaviours.

 Appreciate the factors which cause abnormal

behaviour.

 Explain the different models of abnormal behaviour.

 Describe the major psychological disorders.

ABNORMALITY VS
NORMALITY
 CONCEPTS OF ABNORMALITY
 Abnormality have certain common features, often called the
‘four Ds’: deviance, distress, dysfunction and danger.

 Psychological disorders are:

 Deviant (deviation from normal, different, extreme, unusual,
even bizarre),
 Distressing (behaviours experiencing are unpleasant and
upsetting to the person and to others- stressful),
 Dysfunctional (interfering with the person’s normal functioning,
i.e., their ability to carry out daily activities in a constructive
way), and possibly
 Dangerous (to the person or to others- aggression, suicide,
violence).
 APPROACHES TO UNDERSTAND
ABNORMAL BEHAVIOUR
DEVIATION FROM SOCIAL MALADAPTIVE
NORMS
Based on the assumption that Normality of behaviour focuses on
socially accepted behaviour is the well-being of the
not abnormal, and that normality individual and of the group to
is conformity to social norms. which s/he belongs.

Abnormal behaviour, thoughts Behaviour can be seen as

and emotions are those that abnormal if it is maladaptive,
differ markedly from a i.e. if it interferes with optimal
society’s ideas of proper functioning and growth.
functioning.
Each society has norms (stated or
unstated rules for proper conduct).
Behaviours, thoughts and
emotions that break societal
norms are called abnormal.
 HISTORICAL BACKGROUND

 Supernatural Approach:
 Abnormal behaviour can be explained by the operation of
supernatural and magical forces such as evil spirits
(bhoot-pret), or the devil (shaitan). Exorcism, i.e.
removing the evil that resides in the individual through
countermagic 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.
 HISTORICAL BACKGROUND

 Biological/Organic Approach:
 Individuals behave strangely because their bodies and their
brains are not working properly.
 There is evidence that body and brain processes have been
linked to many types of maladaptive behaviour (not adjusting
appropriately and adequately to the demands of the environment
or situation).
 For certain types of disorders, correcting these defective
biological processes results in improved functioning

 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.
 Examples: negative thinking, self-defeating pattern.
 HISTORICAL BACKGROUND

 Organismic Approach:
 Hippocrates, Socrates, and in particular Plato
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. Imbalances among
the humours were believed to cause various disorders.
 HISTORICAL BACKGROUND
 Middle Age:
 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.

 Renaissance Period:
 It 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 (religious) treatment.
 HISTORICAL BACKGROUND
 Age of Reason and Enlightenment:
(Seventeenth and Eighteenth Centuries)
 It was known as the Age of Reason and Enlightenment, as the
scientific method replaced faith and dogma as ways of
understanding abnormal behaviour.
 This period contributed to the Reform Movement and to
increased compassion for people who suffered from these
disorders.
 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 totality it is known as Bio-psycho-social approach or

the Interactional Approach.
 CLASSIFICATION OF
PSYCHOLOGICAL DISORDERS
 The American Psychiatric Association (APA) has published an
official manual describing and classifying various kinds of
psychological disorders.
The classification scheme
officially used in India and
The current version of it, the elsewhere is the tenth
Diagnostic and Statistical revision of the
Manual of Mental International Classification
Disorders, 5 th Edition of Diseases (ICD-10), which
(DSM-5), presents discrete is known as the ICD-10
clinical criteria which indicate Classification of
the presence or absence of Behavioural and Mental
disorders. Disorders. It was prepared
by the World Health
Organisation (WHO).
 FACTORS UNDERLYING
ABNORMAL BEHAVIOUR
 Psychologists use different approaches to understand
abnormal behaviour.
 Each approach in use today emphasises a different aspect of
human behaviour, and explains and treats abnormality in line
with that aspect.
 These approaches also emphasise the role of different factors
suchBIOLOGICAL
as: GENETIC
PSYCHOLOGICA
L&
INTERPERSONA
L
SOCIO- DIATHESIS
CULTURAL STRESS MODEL
 BIOLOGICAL FACTORS
 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.

 Psychological disorders are often related to problems in the

transmission of messages from one neuron to another.

 Abnormal activity 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.
 GENETIC FACTORS
 It has been linked to bipolar and related
disorders, schizophrenia, intellectual
disability and other psychological disorders.

 It appears that in most cases, 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.
 PSYCHOLOGICAL MODEL
 These models maintain that psychological and
interpersonal factors have a significant role to play
in abnormal behaviour.

 These factors include:

 Maternal deprivation (separation from the mother, or lack of
warmth 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)
 Severe stress

 The psychological models include the

psychodynamic, behavioural, cognitive, and
humanistic-existential models.
 PSYCHOLOGICAL MODEL
Psychodynamic Model:
 Psychodynamic theorists believe that behaviour, whether
normal or abnormal, is 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.
 PSYCHOLOGICAL MODEL
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 imitating others’ behaviour).
 PSYCHOLOGICAL MODEL
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.
 PSYCHOLOGICAL MODEL

Humanistic-Existential Model:
 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.
 SOCIO-CULTURAL MODEL
 Socio-cultural factors such as war and violence, group
prejudice and discrimination, economic and
employment problems, and rapid social change, put
stress on most of us and can also lead to psychological
problems in some individuals.

 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.

 Certain family systems are likely to produce abnormal

functioning in individual members.
 SOCIO-CULTURAL MODEL
 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.

 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.

 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.
 DIATHESIS-STRESS MODEL.
 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
 ANXIETY DISORDERS
 Normal Anxiety: We experience anxiety when we are
waiting to take an examination, or to visit a dentist, or
even to give a solo performance. This is normal and
expected and even motivates us to do our task well.

 Abnormal Anxiety: On the other hand, high levels of

anxiety that are distressing and interfere with effective
functioning indicate the presence of an anxiety disorder
— the most common category of psychological disorders.

 The term anxiety is usually defined as a diffuse

(Spread out over a large area), vague (not clearly
expressed), very unpleasant feeling of fear and
apprehension (fear that something bad will happen).
 SYMPTOMS OF ANXIETY
 Rapid heart rate
 Shortness of breath
 Diarrhea
 Loss of appetite
 Fainting
 Dizziness
 Sweating
 Sleeplessness
 Frequent urination
 Tremors
TYPES OF ANXIETY DISORDERS

 There are many types of anxiety disorders:

 Generalised Anxiety Disorder

 Panic Disorder
 Phobia
 Separation Anxiety Disorder (SAD)
GENERALISED ANXIETY DISORDER

 It consists of prolonged, vague, unexplained and

intense fears that are not attached to any
particular object.

 The symptoms include worry and apprehensive

feelings about the future; hypervigilance, which
involves constantly scanning the environment for
dangers.

 It is marked by motor tension, as a result of which the

person is unable to relax, is restless, and visibly
shaky and tense.
 PANIC DISORDER
 It consists of recurrent anxiety attacks in which the
person experiences intense terror.

 A panic attack denotes an abrupt surge

(outpouring) of intense anxiety rising to a
peak when thoughts of a particular stimuli are
present. Such thoughts occur in an
unpredictable manner.

 The clinical features include shortness of breath,

dizziness, trembling, palpitations, choking,
nausea, chest pain or discomfort, fear of
going crazy, losing control or dying.
 PHOBIA
 People who have phobias have irrational fears related to
specific objects, people, or situations. Phobias often
develop gradually or begin with a generalised anxiety
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 anxiety disorder (social phobia): 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 people with
agoraphobia are afraid of leaving their home. So their ability to
carry out normal life activities is severely limited.
SEPARATION ANXIETY DISORDER

(SAD)
Individuals with separation anxiety disorder are
fearful and anxious about separation from
attachment figures to an extent that is
developmentally not appropriate.

 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.
 OBSSESSIVE-COMPULSIVE

DISORDER (OCD)
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 hoarding disorder,

trichotillomania (hair-pulling disorder), excoriation (skin-picking)
disorder etc.
 TRAUMA- AND STRESSOR-
RELATED DISORDERS
 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 vary widely but may include

recurrent dreams, flashbacks, impaired
concentration, and emotional numbing.

 Adjustment Disorders and Acute Stress Disorder are

also included under this category.
 SOMATIC SYMPTOM AND
RELATED DISORDERS
 These are conditions in which there are physical
symptoms in the absence of a physical disease.

 In these disorders, the individual has psychological

difficulties and complains of physical symptoms,
for which there is no biological cause.

 These include conversion disorders, somatic

symptom disorder, and illness anxiety disorder
among others.
 SOMATIC SYMPTOM AND RELATED DISORDERS

 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 and they continually worry about their
health and make frequent visits to doctors.
 As a result, they experience significant distress and
disturbances in their daily life.
 Illness anxiety disorder:
 Involves persistent preoccupation about developing a
serious illness and constantly worrying about this
possibility. This is accompanied by anxiety about one’s health.
 Individuals with illness anxiety disorder are overly concerned
about undiagnosed disease, negative diagnostic results,
do not respond to assurance by doctors, and are easily
alarmed about illness such as on hearing about someone
else's ill-health or some such news.
SOMATIC SYMPTOM AND RELATED DISORDERS

 Both somatic symptom disorder 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 terms of
physical complaints while in case of illness anxiety
disorder, as the name suggests, it is the anxiety which
is the main concern.

 Conversion Disorder:
 The symptoms 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.
 DISSOCIATIVE DISORDERS
 Dissociation involves feelings of unreality, estrangement
(separated from the social group), depersonalization (not
belonging to oneself), 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.

 Conditions included in this are:

 Dissociative Amnesia
 Dissociative Identity Disorder
 Depersonalisation/Derealisation Disorder.
 DISSOCIATIVE DISORDERS
 Dissociative amnesia:
 Characterised 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.
 A part of dissociative amnesia is dissociative fugue.
Essential feature of this could be 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. This disorder is often associated with an
overwhelming stress.
 DISSOCIATIVE DISORDERS
 Dissociative identity disorder:
 It is often referred to as multiple personality.
 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.

 Depersonalisation/Derealisation disorder:
 It 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.
 DEPRESSIVE DISORDERS
 Depression:
 Depression covers a variety of negative moods and
behavioural 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 a significant loss, such as the break-up of a
relationship, or the failure to attain a significant goal.

 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 change in body weight,
constant sleep problems, tiredness, inability to think
clearly, agitation (nervousness), greatly slowed behaviour,
and thoughts of death and suicide. Other symptoms
include excessive guilt or feelings of worthlessness.
 DEPRESSIVE DISORDERS
 Factors Predisposing towards Depression:

 Genetic make-up, or heredity is an important risk factor

for major depression and other depressive 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.
 BIPOLAR AND RELATED
DISORDERS
 Bipolar I disorder involves both mania (great excitement
of euphoria) and depression, which are alternately present
and sometimes interrupted by periods of normal mood.
 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.
 Some other risk factors are having mental disorders
(especially depression and alcohol use disorders), going
through natural disasters, experiencing violence, abuse
or loss and isolation at any stage of life. Previous
suicidal attempt is the strongest risk factor.
 SUICIDAL BEHAVIOUR
 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 stigma surrounding suicide continues and therefore
they don’t seek help timely. Therefore it is required to identify
vulnerability; comprehend the circumstances leading to
such behaviour and accordingly plan interventions.
 Suicides are preventable. There is a need for
comprehensive multi-sectoral approach where the
government, media and civil society all play important role as
stakeholders.
 SUICIDAL BEHAVIOUR
 Some measures to prevent suicide as 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.
 SUICIDAL BEHAVIOUR
 Identifying students in distress :
Any unexpected or striking change affecting the
adolescent’s performance, attendance or
behaviour should be taken seriously, such as:

 Lack of interest in common activities

 Declining grades
 Decreasing effort
 Misbehavior in the classroom
 Mysterious or repeated absence
 Smoking or drinking, or drug misuse
 SUICIDAL BEHAVIOUR
 Strengthening students’ 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:

 Accentuating (emphasise) positive life experiences to

develop positive identity. This increases confidence in self.
 Providing opportunities for development of physical, social
and vocational skills.
 Establishing a trustful communication.
 Goals for the students should be specific, measurable,
achievable, relevant, to be completed within a relevant
time frame.
 SCHIZOPHRENIA SPECTRUM
AND OTHER PSYCHOTIC
DISORDERS
 Schizophrenia is the descriptive term for a group of psychotic
disorders in which personal, social and occupational
functioning deteriorate as a result of disturbed thought
processes, strange perceptions, unusual emotional states,
and motor abnormalities.
 People with this disorder may withdraw socially and become
totally focused on their own ideas and fantasies.

 Symptoms of Schizophrenia: The symptoms of schizophrenia

can be grouped into three categories, viz.
 Positive symptoms (i.e. excesses of thought, emotion, and
behaviour)
 Negative symptoms (i.e. deficits of thought, emotion, and
behaviour)
 Psychomotor symptoms.
SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
Positive symptoms
 Positive symptoms are ‘pathological excesses’ or
‘bizarre additions’ to a person’s behaviour.
 The symptoms include: Delusions, disorganised
thinking and speech, heightened perception and
hallucinations, and inappropriate affect.
 Delusion: 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.
 Delusions of persecution
 Delusions of reference
 Delusions of grandeur
 Delusions of control
SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
DELUSIONS OF
DELUSIONS OF
PERSECUTION
REFERENCE
People believe that they
People attach special
are being plotted
and personal meaning
against, spied on,
to the actions of others
slandered, threatened,
or to objects and
attacked or deliberately
events.
victimised.

DELUSIONS OF DELUSIONS OF
GRANDEUR CONTROL
People believe People believe that their
themselves to be feelings, thoughts and
specially empowered actions are controlled
persons. by others.
 SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
Positive symptoms:

 Formal Thought Disorder:

 People with schizophrenia may not be able to think logically and may
speak in peculiar ways.
 It 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).

 Inappropriate Affect:
 People with schizophrenia also show inappropriate emotions that are
unsuited to the situation.
 SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
Positive symptoms

 Hallucinations: Perceptions that occur in the absence of external

stimuli.
 Auditory hallucinations are most common. 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).
 Tactile hallucinations (i.e. forms of tingling, burning)
 Somatic hallucinations (i.e. something happening inside the body
such as a snake crawling inside one’s stomach)
 Visual hallucinations (i.e. vague perceptions of colour or distinct
visions of people or objects)
 Gustatory hallucinations (i.e. food or drink taste strange)
 Olfactory hallucinations (i.e. smell of poison or smoke).
 SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
Negative Symptoms:
These are ‘pathological deficits’ and include poverty of speech,
blunted and flat affect, loss of volition, and social withdrawal.

 Alogia/Poverty of speech:
 A reduction in speech and speech content.
 Blunted Affect:
 Many people with schizophrenia show less anger, sadness, joy, and other
feelings than most people do. Thus they have blunted affect.
 Flat Affect:
 Some show no emotions at all, a condition known as flat affect .
 Avolition:
 Also patients with schizophrenia experience avolition, or apathy and an
inability to start or complete a course of action.
SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDERS

Psychomotor Symptoms:
 They move less spontaneously or make odd grimaces
and gestures.

 These symptoms may take extreme forms known as

catatonia.
 People in a catatonic stupor remain motionless and silent for
long stretches of time.
 Some show catatonic rigidity, i.e. maintaining a rigid, upright
posture for hours.
 Others exhibit catatonic posturing, i.e. assuming awkward,
bizarre positions for long periods of time.
 NEURODEVELOPMENTAL
DISORDERS
 Neurodevelopmental disorders 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.
 We will now discuss several disorders like
Attention-Deficit/Hyperactivity Disorder (ADHD), Autism
Spectrum Disorder, Intellectual Disability, and Specific
Learning Disorder.
 These disorders, if not attended, can lead to more serious and
chronic disorders as the child moves into adulthood.
 ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER (ADHD)
The two main features of ADHD are inattention and hyperactivity-
impulsivity.

 Inattention:
 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 disorganised, easily distracted, forgetful, does not finish
assignments, and is quick to lose interest in boring activities.
 Impulsive:
 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.
 ATTENTION-DEFICIT/HYPERACTIVITY
DISORDER (ADHD)

 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 describe them as ‘driven by a motor’,
always on the go, and talk incessantly.
 AUTISM SPECTRUM DISORDER
 It is characterised by widespread impairments (deterioration in
functioning) in social interaction and communication skills, and
stereotyped patterns of behaviours, interests and activities.

 Children with autism spectrum disorder have marked difficulties in

social interaction and communication across different contexts, a
restricted range of interests, and strong desire for routine.

 About 70 per cent of children with autism spectrum disorder have

intellectual disabilities.

 Children with autism spectrum disorder 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.
 AUTISM SPECTRUM DISORDER
 They also show serious abnormalities in communication and language
that persist over time. Many of them never develop speech and those
who do, have repetitive and deviant (departing from accepted
standards) speech patterns.

 Such children 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.

 Due to the nature of these difficulties in terms of verbal and non-verbal

communication, individuals with autism spectrum disorder tend to
experience difficulties in starting, maintaining and even understanding
relationships.
 INTELLECTUAL DISABILITY
 It refers to below average intellectual
functioning (with an IQ of approximately 70 or
below), and deficits or impairments in
adaptive behaviour (i.e. in the areas of
communication, self-care, home living,
social/interpersonal skills, functional academic
skills, work, etc.) which are manifested before
the age of 18 years.
 SPECIFIC LEARNING DISORDER

 The individual experiences difficulty in perceiving or

processing information efficiently and accurately.
 These get manifested during early school years and
the individual encounters problems in basic skills in
reading, writing and/or mathematics.
 The affected child tends to perform below average for
her/his age.
 However, individuals may be able to reach
acceptable performance levels with additional
inputs and efforts.
 Specific learning disorder is likely to impair functioning
and performance in activities/ occupations
dependent on the related skills.
DISRUPTIVE, IMPULSE-CONTROL
AND CONDUCT DISORDERS

 The disorders included under this category

are:
 Oppositional Defiant Disorder
 Conduct Disorder
 OPPOSITIONAL DEFIANT DISORDER (ODD)
CONDUCT DISORDER

 Children with ODD display age-inappropriate amounts of stubbornness, are

irritable, defiant (resist), disobedient, and behave in a hostile manner.
 Individuals with ODD do not see themselves as angry, oppositional, or
defiant and often justify their behaviour as reaction to
circumstances/demands.
 The terms 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 include aggressive actions that cause or threaten
harm to people or animals, nonaggressive conduct that causes
property damage, major deceitfulness or theft, and serious rule
violations.
 Children show many different types of aggressive behaviour, such as verbal
aggression (i.e. name-calling, swearing), physical aggression (i.e.
hitting, fighting), hostile aggression (i.e. directed at inflicting injury to
others), and proactive aggression (i.e. dominating and bullying others
without provocation).
 FEEDING AND EATING
 DISORDERS
These include anorexia nervosa, bulimia nervosa, and binge
eating.
 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 person with
anorexia may lose large amounts of weight and even starve
herself/himself to death.
 In 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. The person often feels
disgusted and ashamed when s/he binges and is relieved of
tension and negative emotions after purging(rid of).
 In 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 s/he feels uncomfortably full. In fact,
large amount of food may be eaten even when the individual is
not feeling hungry.
 SUBSTANCE RELATED AND
ADDICTIVE DISORDERS

 substance related and addictive disorders:

Includes disorders relating to maladaptive
behaviours resulting from regular and consistent
use of the substance.
 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.
 SUBSTANCE RELATED AND ADDICTIVE DISORDERS

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 behaviour
and ability to think and work.
 Their bodies then 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 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.
 SUBSTANCE RELATED AND ADDICTIVE DISORDERS

Heroin:
 Intake significantly 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.
 SUBSTANCE RELATED AND ADDICTIVE DISORDERS

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 effects, 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.