Psychological Disorders PDF

PSYCHOLOGICAL DISORDERS After reading this chapter, you would be able to: 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 beh...

PSYCHOLOGICAL DISORDERS After reading this chapter, you would be able to: 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, and describe the major psychological disorders. Introduction Concepts of Abnormality and Psychological Disorders Classification of Psychological Disorders Factors Underlying Abnormal Behaviour Major Psychological Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders Somatic Symptom and Related Disorders Dissociative Disorders Salient Features of Somatic Symptom and Related Disorders CONTENTS and Dissociative Disorders (Box 4.1) Depressive Disorders Bipolar and Related Disorders Schizophrenia Spectrum and Other Key Terms Psychotic Disorders Summary Neurodevelopmental Disorders Review Questions Disruptive, Impulse-Control and Conduct Disorders Project Ideas Feeding and Eating Disorders Weblinks Substance - Related and Addictive Disorders Pedagogical Hints Effects of Alcohol : Some Facts (Box 4.2) Commonly Abused Substances (Box 4.3) 69 Chapter 4 Psychological Disorders 2024-25  You must have come across people who are unhappy, troubled and dissatisfied. Their minds and hearts are filled with sorrow, unrest and tension and they feel that they are unable to move ahead in their lives; they feel life is a painful, uphill struggle, sometimes not worth living. Famous analytical psychologist Carl Jung has quite remarkably said, “How can I be substantial without casting a shadow? I must have a dark side, too, if I am to be whole and by becoming conscious of my shadow, I remember once more that I am a human being like any other”. At times, some of you Introduction may have felt nervous before an important examination, tense and concerned about your future career or anxious when someone close to you was unwell. All of us face major problems at some point of our lives. However, some people have an extreme reaction to the problems and stresses of life. In this chapter, we will try to understand what goes wrong when people develop psychological problems, what are the causes and factors which lead to abnormal behaviour, and what are the various signs and symptoms associated with different types of psychological disorders? The study of psychological disorders has intrigued and mystified all cultures for more than 2,500 years. Psychological disorders or mental disorders (as they are commonly referred to), like anything unusual may make us uncomfortable and even a little frightened. Unhappiness, discomfort, anxiety, and unrealised potential are seen all over the world. These failures in living are mainly due to failures in adaptation to life challenges. As you must have studied in the previous chapters, adaptation refers to the person’s ability to modify her/his behaviour in response to changing environmental requirements. When the behaviour cannot be modified according to the needs of the situation, it is said to be maladaptive. Abnormal Psychology is the area within psychology that is focused on maladaptive behaviour – its causes, consequences, and treatment. way), and possibly dangerous (to the CONCEPTS OF ABNORMALITY AND person or to others). PSYCHOLOGICAL DISORDERS This definition is a useful starting point Although many definitions of abnormality from which we can explore psychological have been used over the years, none has abnormality. Since the word ‘abnormal’ won universal acceptance. Still, most literally means “away from the normal”, it definitions have certain common features, implies deviation from some clearly defined often called the ‘four Ds’: deviance, norms or standards. In psychology, we distress, dysfunction and danger. That is, have no ‘ideal model’ or even ‘normal psychological disorders are deviant model’ of human behaviour to use as a (different, extreme, unusual, even bizarre), base for comparison. Various approaches distressing (unpleasant and upsetting to have been used in distinguishing between the person and to others), dysfunctional normal and abnormal behaviours. From (interfering with the person’s ability to these approaches, there emerge two basic carry out daily activities in a constructive and conflicting views: 70 Psychology 2024-25  The first approach views abnormal prefers to remain silent even when s/he behaviour as a deviation from social has questions in her/his mind. Describing norms. Many psychologists have stated behaviour as maladaptive implies that a that ‘abnormal’ is simply a label that is problem exists; it also suggests that given to a behaviour which is deviant from vulnerability in the individual, inability to social expectations. Abnormal behaviour, cope, or exceptional stress in the thoughts and emotions are those that differ environment have led to problems in life. markedly from a society’s ideas of proper If you talk to people around, you will functioning. Each society has norms, see that they have vague ideas about which are stated or unstated rules for psychological disorders that ar e proper conduct. Behaviours, thoughts and characterised by superstition, ignorance emotions that break societal norms are and fear. Again it is commonly believed called abnormal. A society’s norms grow that psychological disorder is something to from its particular culture — its history, be ashamed of. The stigma attached to values, institutions, habits, skills, mental illness means that people are technology, and arts. Thus, a society whose hesitant to consult a doctor or psychologist culture values competition and because they are ashamed of their assertiveness may accept aggressive problems. Actually, psychological disorder behaviour, whereas one that emphasises which indicates a failure in adaptation cooperation and family values (such as in should be viewed as any other illness. India) may consider aggressive behaviour as unacceptable or even abnor mal. A Activity Talk to three people: one of your society’s values may change over time, friends, a friend of your parents, and 4.1 causing its views of what is psychologically your neighbour. abnor mal to change as well. Serious Ask them if they have seen questions have been raised about this someone who is mentally ill or who has definition. It is based on the assumption mental problems. Try to understand that socially accepted behaviour is not why they find this behaviour abnormal, what are the signs and abnormal, and that normality is nothing symptoms shown by this person, what more than conformity to social norms. caused this behaviour and can this The second approach views abnormal person be helped. behaviour as maladaptive. Many Share the information you elicited psychologists believe that the best criterion in class and see if there are some for determining the normality of behaviour common features, which make us label others as ‘abnormal’. is not whether society accepts it but whether it fosters the well-being of the individual and eventually of the group to Historical Background which s/he belongs. Well-being is not simply maintenance and survival but also To understand psychological disorders, we includes growth and fulfilment, i.e. the would require a brief historical account of actualisation of potential, which you must how these disorders have been viewed over have studied in Maslow’s need hierarchy the ages. When we study the history of theory. Accor ding to this criterion, abnormal psychology, we find that certain conforming behaviour can be seen as theories have occurred over and over again. abnormal if it is maladaptive, i.e. if it One ancient theory that is still interferes with optimal functioning and encountered today holds that abnormal growth. For example, a student in the class behaviour can be explained by the 71 Chapter 4 Psychological Disorders 2024-25 operation of supernatural and magical body fluids, viz. blood, black bile, yellow forces such as evil spirits (bhoot-pret), or bile, and phlegm. Each of these fluids was the devil (shaitan). Exorcism, i.e. removing seen to be responsible for a different the evil that resides in the individual temperament. Imbalances among the through countermagic and prayer, is still humours were believed to cause various commonly used. In many societies, the disorders. This is similar to the Indian shaman, or medicine man (ojha) is a notion of the three doshas of vata, pitta person who is believed to have contact with and kapha which were mentioned in the supernatural forces and is the medium Atharva Veda and Ayurvedic texts. You through which spirits communicate with have already read about it in Chapter 2. human beings. Through the shaman, an In the Middle Ages, demonology and afflicted person can learn which spirits are superstition gained renewed importance in responsible for her/his problems and what the explanation of abnormal behaviour. needs to be done to appease them. Demonology related to a belief that people A recurring theme in the history of with mental problems were evil and there abnormal psychology is the belief that are numerous instances of ‘witch-hunts’ individuals behave strangely because their during this period. During the early bodies and their brains are not working Middle Ages, the Christian spirit of charity properly. This is the biological or organic prevailed and St. Augustine wrote approach. In the modern era, there is extensively about feelings, mental anguish evidence that body and brain processes and conflict. This laid the groundwork for have been linked to many types of modern psychodynamic theories of maladaptive behaviour. For certain types of abnormal behaviour. disorders, correcting these defective The Renaissance Period was marked biological processes results in improved by increased humanism and curiosity functioning. about behaviour. Johann Weyer Another approach is the psychological emphasised psychological conflict and approach. According to this point of view, disturbed interpersonal relationships as psychological problems are caused by causes of psychological disorders. He also inadequacies in the way an individual insisted that ‘witches’ were mentally thinks, feels, or perceives the world. disturbed and required medical, not All three of these perspectives — theological, treatment. supernatural, biological or organic, and The seventeenth and eighteenth psychological — have recurred throughout centuries were known as the Age of the history of Western civilisation. In the Reason and Enlightenment, as the ancient Western world, it was philosopher- scientific method replaced faith and physicians of ancient Greece such as dogma as ways of understanding Hippocrates, Socrates, and in particular abnormal behaviour. The growth of a Plato who developed the organismic scientific attitude towards psychological approach and viewed disturbed behaviour disorders in the eighteenth century as arising out of conflicts between emotion contributed to the Reform Movement and and reason. Galen elaborated on the role to increased compassion for people who of the four humours in personal character suffered from these disorders. Reforms of and temperament. According to him, the asylums were initiated in both Europe material world was made up of four and America. One aspect of the reform elements, viz. earth, air, fire, and water movement was the new inclination for which combined to form four essential deinstitutionalisation which placed 72 Psychology 2024-25 emphasis on providing community care clinical features or symptoms, and of for recovered mentally ill individuals. other associated features including In recent years, there has been a diagnostic guidelines is provided in this convergence of these approaches, which scheme. has resulted in an interactional, or bio- psycho-social approach. Fr om this perspective, all three factors, i.e. biological, Certain behaviours like eating sand Activity would be considered abnormal. But not 4.2 psychological and social play important if it was done after being stranded on roles in influencing the expression and a beach in a plane crash. outcome of psychological disorders. Listed below are ‘abnor mal’ behaviours followed by situations where the behaviours might be CLASSIFICATION OF PSYCHOLOGICAL considered normal. DISORDERS (i) talking to yourself - you are praying. In order to understand psychological (ii) standing in the middle of the street disorders, we need to begin by classifying waving your arms wildly - you are them. A classification of such disorders a traffic policeman. consists of a list of categories of specific Think about it and list similar examples. psychological disor ders grouped into various classes on the basis of some shared characteristics. Classifications are useful because they enable users like FACTORS UNDERLYING ABNORMAL psychologists, psychiatrists and social BEHAVIOUR workers to communicate with each other In order to understand something as about the disor der and help in complex as abnor mal behaviour, understanding the causes of psychological psychologists use different approaches. disorders and the processes involved in Each approach in use today emphasises a their development and maintenance. different aspect of human behaviour, and The American Psychiatric Association explains and treats abnormality in line (APA) has published an official manual with that aspect. These approaches also describing and classifying various kinds emphasise the role of different factors such of psychological disorders. The current as biological, psychological and version of it, the Diagnostic and interpersonal, and socio-cultural factors. Statistical Manual of Mental Disorders, We will examine some of the approaches 5 th Edition (DSM-5), presents discrete which are currently being used to explain clinical criteria which indicate the abnormal behaviour. presence or absence of disorders. Biological factors influence all aspects The classification scheme officially of our behaviour. A wide range of biological used in India and elsewhere is the tenth factors such as faulty genes, endocrine revision of the International imbalances, malnutrition, injuries and Classification of Diseases (ICD-10), other conditions may interfere with normal which is known as the ICD-10 development and functioning of the human Classification of Behavioural and body. These factors may be potential Mental Disorders. It was prepared by the causes of abnormal behaviour. We have World Health Organisation (WHO). For already come across the biological model. each disorder, a description of the main Accor ding to this model, abnor mal 73 Chapter 4 Psychological Disorders 2024-25 behaviour has a biochemical or warmth and stimulation during early physiological basis. Biological years of life), faulty parent-child researchers have found that psychological relationships (rejection, overprotection, disorders are often related to problems over-permissiveness, faulty discipline, etc.), in the transmission of messages from one maladaptive family structures (inadequate neuron to another. You have studied in or disturbed family), and severe stress. Class XI, that a tiny space called synapse The psychological models include the separates one neuron from the next, and psychodynamic, behavioural, cognitive, the message must move across that and humanistic-existential models. The space. When an electrical impulse psychodynamic model is the oldest and reaches a neuron’s ending, the nerve most famous of the modern psychological ending is stimulated to release a models. You have already read about this chemical, called a neuro-transmitter. model in Chapter 2 on Self and Studies indicate that abnormal activity Personality. Psychodynamic theorists by certain neuro-transmitters can lead to believe that behaviour, whether normal specific psychological disorders. Anxiety or abnormal, is determined by disorders have been linked to low activity psychological forces within the person of of the neurotransmitter gamma which s/he is not consciously aware. aminobutyric acid (GABA), schizophrenia These internal forces are considered to excess activity of dopamine, and dynamic, i.e. they interact with one depression to low activity of serotonin. another and their interaction gives shape Genetic factors have been linked to to behaviour, thoughts and emotions. bipolar and related disorders, Abnormal symptoms are viewed as the schizophrenia, intellectual disability and result of conflicts between these forces. other psychological disorders. Researchers This model was first formulated by Freud have not, however, been able to identify who believed that three central forces the specific genes that are the culprits. shape personality — instinctual needs, It appears that in most cases, no single drives and impulses (id), rational thinking gene is responsible for a particular (ego), and moral standards (superego). behaviour or a psychological disorder. Freud stated that abnormal behaviour is Infact, many genes combine to help bring a symbolic expression of unconscious about our various behaviours and mental conflicts that can be generally emotional reactions, both functional and traced to early childhood or infancy. dysfunctional. Although there is sound Another model that emphasises the role evidence to believe that genetic/ of psychological factors is the behavioural biochemical factors are involved in mental model. This model states that both normal disorders as diverse as schizophrenia, and abnormal behaviours are learned and depression, anxiety, etc. but biology alone psychological disorders are the result of cannot account for most mental disorders. learning maladaptive ways of behaving. The There are several psychological model concentrates on behaviours that are models which provide a psychological learned through conditioning and proposes explanation of mental disorders. These that what has been learned can be models maintain that psychological and unlearned. Learning can take place by interpersonal factors have a significant classical conditioning (temporal association role to play in abnormal behaviour. These in which two events repeatedly occur close factors include maternal deprivation together in time), operant conditioning (separation from the mother, or lack of (behaviour is followed by a reward), and 74 Psychology 2024-25 social learning (learning by imitating others’ abnormal functioning in individual behaviour). These three types of members. Some families have an conditioning account for behaviour, enmeshed structure in which the whether adaptive or maladaptive. members are overinvolved in each other’s Psychological factors are also activities, thoughts, and feelings. emphasised by the cognitive model. This Children from this kind of family may model states that abnormal functioning have difficulty in becoming independent can result from cognitive problems. in life. The broader social networks in People may hold assumptions and which people operate include their social attitudes about themselves that are and professional relationships. Studies irrational and inaccurate. People may have shown that people who are isolated also repeatedly think in illogical ways and and lack social support, i.e. strong and make overgeneralisations, that is, they fulfilling interpersonal relationships in may draw broad, negative conclusions on their lives are likely to become more the basis of a single insignificant event. depressed and remain depressed longer Another psychological model is the than those who have good friendships. humanistic-existential model which Socio-cultural theorists also believe that focuses on broader aspects of human abnormal functioning is influenced by the existence. Humanists believe that human societal labels and roles assigned to beings are born with a natural tendency troubled people. When people break the to be friendly, cooperative and constructive, norms of their society, they are called and are driven to self-actualise, i.e. to fulfil deviant and ‘mentally ill’. Such labels this potential for goodness and growth. tend to stick so that the person may be Existentialists believe that from birth we viewed as ‘crazy’ and encouraged to act have total freedom to give meaning to our sick. The person gradually learns to existence or to avoid that responsibility. accept and play the sick role, and Those who shirk from this responsibility functions in a disturbed manner. would live empty, inauthentic, and In addition to these models, one of the dysfunctional lives. most widely accepted explanations of In addition to the biological and abnormal behaviour has been provided by psychosocial factors, socio-cultural the diathesis-stress model. This model factors such as war and violence, group states that psychological disorders prejudice and discrimination, economic develop when a diathesis (biological and employment problems, and rapid predisposition to the disorder) is set off by social change, put stress on most of us a stressful situation. This model has and can also lead to psychological three components. The first is the problems in some individuals. According diathesis or the presence of some to the socio-cultural model, abnormal biological aberration which may be behaviour is best understood in light of inherited. The second component is that the social and cultural forces that the diathesis may carry a vulnerability influence an individual. As behaviour is to develop a psychological disorder. This shaped by societal forces, factors such as means that the person is ‘at risk’ or family structure and communication, ‘predisposed’ to develop the disorder. The social networks, societal conditions, and third component is the presence of societal labels and roles become more pathogenic stressors, i.e. factors/ important. It has been found that certain stressors that may lead to family systems are likely to produce psychopathology. If such “at risk” persons 75 Chapter 4 Psychological Disorders 2024-25 are exposed to these stressors, their include worry and apprehensive feelings predisposition may actually evolve into a about the future; hypervigilance, which disorder. This model has been applied to involves constantly scanning the several disorders including anxiety, environment for dangers. It is marked by depression, and schizophrenia. motor tension, as a result of which the person is unable to relax, is restless, and MAJOR PSYCHOLOGICAL DISORDERS visibly shaky and tense. Another type of anxiety disorder is Anxiety Disorders panic disorder, which consists of recurrent anxiety attacks in which the One day while driving home, Deb felt his person experiences intense terror. A panic heart beating rapidly, he started sweating attack denotes an abrupt surge of intense profusely, and even felt short of breath. He anxiety rising to a peak when thoughts of was so scared that he stopped the car and a particular stimuli are present. Such stepped out. In the next few months, these thoughts occur in an unpredictable attacks increased and now he was hesitant manner. The clinical features include to drive for fear of being caught in traffic shortness of breath, dizziness, trembling, during an attack. Deb started feeling that palpitations, choking, nausea, chest pain he had gone crazy and would die. Soon he or discomfort, fear of going crazy, losing remained indoors and refused to move out control or dying. of the house. You might have met or heard of We experience anxiety when we are someone who was afraid to travel in a lift waiting to take an examination, or to visit or climb to the tenth floor of a building, or a dentist, or even to give a solo refused to enter a room if s/he saw a performance. This is normal and expected lizard. You may have also felt it yourself or and even motivates us to do our task well. seen a friend unable to speak a word of a On the other hand, high levels of anxiety well-memorised and rehearsed speech that are distressing and interfere with before an audience. These kinds of fears effective functioning indicate the presence are termed as phobias. People who have of an anxiety disorder — the most common phobias have irrational fears related to category of psychological disorders. specific objects, people, or situations. Everyone has worries and fears. The Phobias often develop gradually or begin term anxiety is usually defined as a with a generalised anxiety disorder. diffuse, vague, very unpleasant feeling of Phobias can be grouped into three main fear and apprehension. The anxious types, i.e. specific phobias, social phobias, individual also shows combinations of the and agoraphobia. following symptoms: rapid heart rate, Specific phobias are the most shortness of breath, diarrhoea, loss of commonly occurring type of phobia. This appetite, fainting, dizziness, sweating, group includes irrational fears such as sleeplessness, frequent urination and intense fear of a certain type of animal, or tremors. There are many types of anxiety of being in an enclosed space. Intense and disorders (see Table 4.1). They include incapacitating fear and embarrassment generalised anxiety disorder, which when dealing with others characterises consists of prolonged, vague, unexplained social anxiety disorder (social phobia). and intense fears that are not attached Agoraphobia is the term used when to any particular object. The symptoms people develop a fear of entering 76 Psychology 2024-25 unfamiliar situations. Many people with going to school alone, are fearful of agoraphobia are afraid of leaving their entering new situations, and cling to and home. So their ability to carry out normal shadow their parents’ every move. To avoid life activities is severely limited. separation, children with SAD may fuss, Separation anxiety disorder (SAD) is scream, throw severe tantrums, or make another type of anxiety disorder. suicidal gestures. Individuals with separation anxiety disorder are fearful and anxious about Obsessive-Compulsive and Related separation from attachment figures to an Disorders extent that is developmentally not Have you ever noticed someone appropriate. Children with SAD may have washing their hands everytime they difficulty being in a room by themselves, touch something, or washing even things like coins, or stepping only within the patterns on the floor or road while Activity walking? People affected by obsessive- Recall how you felt before your 4.3 Class X Board examination. How did compulsive disorder are unable to you feel when the examinations were control their preoccupation with specific drawing near (one month before the ideas or are unable to prevent themselves examinations; one week before the from repeatedly carrying out a particular examinations; on the day of the act or series of acts that affect their examination, and when you were ability to carry out normal activities. entering the examination hall)? Also try to recollect what you felt when you Obsessive behaviour is the inability to were awaiting your results. Write down stop thinking about a particular idea or your experiences in terms of bodily topic. The person involved, often finds symptoms (e.g. ‘butterflies in the these thoughts to be unpleasant and stomach’, clammy hands, excessive shameful. Compulsive behaviour is the perspiration, etc.) as well as mental need to perform certain behaviours over experiences (e.g. tension, worry, and over again. Many compulsions deal pressure, etc.). Compare your symptoms with those of your with counting, ordering, checking, classmates and classify them as Mild, touching and washing. Other disorders Moderate, or Severe. in this category include hoarding Table 4.1 : Major Anxiety Disorders and their Symptoms 1. Generalised Anxiety Disorder : prolonged, vague, unexplained and intense fears that have no object, accompanied by hypervigilance and motor tension. 2. Panic Disorder : frequent anxiety attacks characterised by feelings of intense terror and dread; unpredictable ‘panic attacks’ along with physiological symptoms like breathlessness, palpitations, trembling, dizziness, and a sense of loosing control or even dying. 3. Specific Phobia : irrational fears related to specific objects, interactions with others, and unfamiliar situations. 4. Separation Anxiety Disorder : extreme distress when expecting or going through separation from home or other significant people to whom the individual is immensely attached to. 5. Other disorders included under this category are Selective Mutism, Substance/Medication- Induced Anxiety Disorder, Anxiety Disorder Due to Another Medical condition, etc. 77 Chapter 4 Psychological Disorders 2024-25 disorder, trichotillomania (hair -pulling disorder are overly concerned about disorder), excoriation (skin-picking) undiagnosed disease, negative diagnostic disorder etc. results, do not respond to assurance by doctors, and are easily alarmed about Trauma- and Stressor-Related Disorders illness such as on hearing about someone Very often people who have been else's ill-health or some such news. caught in a natural disaster (such as In general, both somatic symptom tsunami) or have been victims of bomb disorder and illness anxiety disorder are blasts by terrorists, or been in a serious concerned with medical illnesses. But, accident or in a war-related situation, the difference lies in the way this concern experience post-traumatic stress is expressed. In the case of somatic disorder (PTSD). PTSD symptoms vary symptom disorder, this expression is in widely but may include recurrent dreams, terms of physical complaints while in flashbacks, impaired concentration, and case of illness anxiety disorder, as the emotional numbing. Adjustment name suggests, it is the anxiety which Disorders and Acute Stress Disorder are is the main concern. also included under this category. The symptoms of conversion disorders are the reported loss of part Somatic Symptom and Related or all of some basic body functions. Disorders Paralysis, blindness, deafness and These are conditions in which there are difficulty in walking are generally among physical symptoms in the absence of a the symptoms reported. These symptoms physical disease. In these disorders, the often occur after a stressful experience individual has psychological difficulties and may be quite sudden. and complains of physical symptoms, for which there is no biological cause. These Dissociative Disorders include conversion disorders, somatic Dissociation can be viewed as severance symptom disorder, and illness anxiety of the connections between ideas and disorder among others. emotions. Dissociation involves feelings of Somatic symptom disorder involves unreality, estrangement, depersonalisation, a person having persistent body-related and sometimes a loss or shift of identity. symptoms which may or may not be Sudden temporary alterations of related to any serious medical condition. consciousness that blot out painful People with this disorder tend to be overly experiences are a defining characteristic preoccupied with their symptoms and they of dissociative disorders. Conditions continually worry about their health and included in this are Dissociative Amnesia, make frequent visits to doctors. As a Dissociative Identity Disorder, and result, they experience significant distress Depersonalisation/Derealisation Disorder. and disturbances in their daily life. Salient features of somatic symptom and Illness anxiety disorder involves related disorders and dissociative disorders persistent preoccupation about developing are given in Box 4.1. a serious illness and constantly worrying Dissociative amnesia is characterised about this possibility. This is by extensive but selective memory loss that accompanied by anxiety about one’s has no known organic cause (e.g., head health. Individuals with illness anxiety injury). Some people cannot remember 78 Psychology 2024-25  Salient Features of Somatic Symptom and Related Disorders and Dissociative Disorders Box 4.1 Somatic Symptom and Related Disorders Dissociative Disorders Somatic Symptom Disorder : The person Dissociative amnesia : The person is unable experiences body-related symptoms in the to recall important, personal information absence of any medical condition (or even often related to a stressful and traumatic if medical condition is present, it is not as report. The extent of forgetting is beyond serious as the symptoms presented). normal. Illness Anxiety Disorder : The person Depersonalisation/Derealisation Disorder : experiences worry about the possibility of The person experiences a change in the developing a serious medical condition. person's sense of reality and perception of self. Conversion : The person suffers from a loss or impairment of motor or sensory function Dissociative identity (multiple personality) (e.g., paralysis, blindness, etc.) that has no Disorder : The person exhibits two or more physical cause but may be a response to separate and contrasting personalities, stress and psychological problems. generally associated with a history of abuse. anything about their past. Others can no Depressive Disorders longer recall specific events, people, places, One of the most widely prevalent and or objects, while their memory for other recognised of all mental disorders is events remains intact. A part of dissociative depression. Depression covers a variety amnesia is dissociative fugue. Essential of negative moods and behavioural feature of this could be an unexpected changes. Depression can refer to a travel away from home and workplace, the symptom or a disorder. In day-to-day life, assumption of a new identity, and the we often use the term depression to refer inability to recall the previous identity. The to normal feelings after a significant loss, fugue usually ends when the person suddenly ‘wakes up’ with no memory of the such as the break-up of a relationship, or events that occurred during the fugue. This the failure to attain a significant goal. disorder is often associated with an Major depressive disorder is defined as overwhelming stress. a period of depressed mood and/or loss of Dissociative identity disorder, often interest or pleasure in most activities, referred to as multiple personality, is the together with other symptoms which may most dramatic of the dissociative include change in body weight, constant disorders. It is often associated with sleep problems, tiredness, inability to traumatic experiences in childhood. In think clearly, agitation, greatly slowed this disorder, the person assumes behaviour, and thoughts of death and alternate personalities that may or may suicide. Other symptoms include excessive not be aware of each other. guilt or feelings of worthlessness. Depersonalisation/Derealisation Factors Predisposing towards disorder involves a dreamlike state in Depression : Genetic make-up, or heredity which the person has a sense of being is an important risk factor for major separated both from self and from reality. depression and other depressive In depersonalisation, there is a change disorders. Age is also a risk factor. For of self-perception, and the person’s sense instance, women are particularly at risk of reality is temporarily lost or changed. during young adulthood, while for men 79 Chapter 4 Psychological Disorders 2024-25 the risk is highest in early middle age. of life. Previous suicidal attempt is the Similarly gender also plays a great role strongest risk factor. in this differential risk addition. For Often, suicidal behavior indicates example, women in comparison to men difficulties in problem-solving, stress are more likely to report a depressive management, and emotional expression. disorder. Other risk factors ar e Suicidal thoughts lead to suicidal action experiencing negative life events and lack only when acting on these thoughts seems of social support. to be the only way out of a person’s difficulties. These thoughts are Bipolar and Related Disorders heightened under acute emotional and Bipolar I disorder involves both mania other distress. The ramifications of and depression, which are alternately suicide on social circle and communities present and sometimes interrupted by tend to be devastating and long-lasting. periods of normal mood. Manic episodes The stigma surrounding suicide rarely appear by themselves; they continues despite recent advances in usually alternate with depression. research in this field. Due to this, many Bipolar mood disorders were earlier people who are contemplating or even referred to as manic-depressive disorders. attempting suicide do not seek help thus, Some examples of types of bipolar and preventing timely help from reaching related disorders include Bipolar I them. Therefore improving identification, Disorder, Bipolar II disorder and referral, and management of behaviour Cyclothymic Disorder. are crucial for preventing suicide. Every suicide is a misfortune. Suicide Therefore we need to identify takes place throughout the lifespan. vulnerability; comprehend the Suicide is a result of complex interface circumstances leading to such behaviour of biological, genetic, psychological, and accordingly plan interventions. sociological, cultural and environmental Suicides are preventable. There is a factors. need for comprehensive multi-sectoral Some other risk factors are having approach where the government, media mental disorders (especially depression and civil society all play important role and alcohol use disorders), going through as stakeholders. Some measures natural disasters, experiencing violence, suggested by WHO include: abuse or loss and isolation at any stage limiting access to the means of suicide; reporting of suicide by media in a responsible way; Activity You may have got some bad news in bringing in alcohol-related policies; 4.4 the family (for example, death of a early identification, treatment and close relative) or watched your care of people at risk; favourite character dying in a film or training health workers in assessing got less marks than you hoped for or and managing for suicide; lost your pet. This may have made you sad and depressed and hopeless care for people who attempted suicide about the future. Try and recall such and providing community support. incidents in your life. List the situations that led to this reaction. Identifying students in distress : Any Compare your list and reactions with unexpected or striking change affecting those of others in class. the adolescent’s performance, attendance 80 Psychology 2024-25 or behaviour should be taken seriously, positive symptoms (i.e. excesses of such as: thought, emotion, and behaviour), negative symptoms (i.e. deficits of lack of interest in common activities thought, emotion, and behaviour), and declining grades psychomotor symptoms. decreasing effort Positive symptoms are ‘pathological misbehavior in the classroom excesses’ or ‘bizarre additions’ to a mysterious or repeated absence person’s behaviour. Delusions, smoking or drinking, or drug misuse disorganised thinking and speech, Strengthening students’ self-esteem : heightened perception and hallucinations, Having a positive self-esteem is important and inappropriate affect are the ones most in face of distress and helps in coping often found in schizophrenia. adequately. In order to foster positive self- Many people with schizophrenia esteem in children the following develop delusions. A delusion is a false approaches can be useful: belief that is firmly held on inadequate grounds. It is not affected by rational accentuating positive life experiences argument, and has no basis in reality. to develop positive identity. This Delusions of persecution are the most increases confidence in self. common in schizophrenia. People with providing opportunities for this delusion believe that they are being development of physical, social and plotted against, spied on, slandered, vocational skills. establishing a trustful communication. Can you list some characters in films Activity goals for the students should be you have seen or books you have read 4.5 specific, measurable, achievable, who suffered from any of the disorders relevant, to be completed within a we have studied here like depression relevant time frame. or schizophrenia showing some of these delusions? Schizophrenia Spectrum and Other Can you identify which kind of delusion each of these is? Psychotic Disorders 1. A person who believes that s/he Schizophrenia is the descriptive term for is going to be the next President of a group of psychotic disorders in which India. 2. One who believes that the personal, social and occupational intelligence agencies/police are functioning deteriorate as a result of conspiring to trap her/him in a spy disturbed thought processes, strange scandal. perceptions, unusual emotional states, 3. One who believes that s/he is the and motor abnormalities. It is a incarnation of God and can make debilitating disorder. The social and things happen. 4. One who believes that the tsunami psychological costs of schizophrenia are occurred to prevent her/him from tremendous, both to patients as well as enjoying her/his holidays. to their families and society. 5. One who believes that her/his actions are controlled by the Symptoms of Schizophrenia satellite through a chip implanted in her/his brain by some The symptoms of schizophrenia can be extraterrestrial beings. grouped into three categories, viz. 81 Chapter 4 Psychological Disorders 2024-25 threatened, attacked or deliberately People with schizophrenia also show victimised. People with schizophrenia inappropriate affect, i.e. emotions that may also experience delusions of are unsuited to the situation. reference in which they attach special Negative symptoms are ‘pathological and personal meaning to the actions of deficits’ and include poverty of speech, others or to objects and events. In blunted and flat affect, loss of volition, delusions of grandeur, people believe and social withdrawal. People with themselves to be specially empowered schizophrenia show alogia or poverty of persons and in delusions of control, they speech, i.e. a reduction in speech and believe that their feelings, thoughts and speech content. Many people with actions are controlled by others. schizophrenia show less anger, sadness, People with schizophrenia may not be joy, and other feelings than most people able to think logically and may speak in do. Thus they have blunted affect. Some peculiar ways. These formal thought show no emotions at all, a condition disorders can make communication known as flat affect. Also patients with extremely difficult. These include rapidly schizophrenia experience avolition, or shifting from one topic to another so that apathy and an inability to start or the normal structure of thinking is complete a course of action. People with muddled and becomes illogical (loosening this disorder may withdraw socially and of associations, derailment), inventing new become totally focused on their own ideas words or phrases (neologisms), and and fantasies. persistent and inappropriate repetition of People with schizophrenia also show the same thoughts (perseveration). psychomotor symptoms. They move less People with schizophrenia may have spontaneously or make odd grimaces and hallucinations, i.e. perceptions that gestures. These symptoms may take occur in the absence of external stimuli. extreme forms known as catatonia. Auditory hallucinations are most People in a catatonic stupor remain common in schizophrenia. Patients hear motionless and silent for long stretches sounds or voices that speak words, of time. Some show catatonic rigidity, phrases and sentences directly to the i.e. maintaining a rigid, upright posture patient (second-person hallucination) or for hours. Others exhibit catatonic talk to one another referring to the posturing, i.e. assuming awkward, patient as s/he (third-person hallucination). bizarre positions for long periods of time. Hallucinations can also involve the other senses. These include tactile Neurodevelopmental Disorders hallucinations (i.e. forms of tingling, A common feature of the burning), somatic hallucinations (i.e. neurodevelopmental disorders is that something happening inside the body they manifest in the early stage of such as a snake crawling inside one’s development. Often the symptoms appear stomach), visual hallucinations (i.e. before the child enters school or during vague perceptions of colour or distinct the early stage of schooling. These visions of people or objects), gustatory disorders result in hampering personal, hallucinations (i.e. food or drink taste social, academic and occupational strange), and olfactory hallucinations functioning. These get characterised as (i.e. smell of poison or smoke). deficits or excesses in a particular 82 Psychology 2024-25 behaviour or delays in achieving a have marked difficulties in social interaction particular age-appropriate behaviour. and communication across different We will now discuss several disorders contexts, a restricted range of interests, and like Attention-Deficit/Hyperactivity strong desire for routine. About 70 per cent Disorder (ADHD), Autism Spectrum of children with autism spectrum disorder Disorder, Intellectual Disability, and have intellectual disabilities. Specific Lear ning Disorder. These Children with autism spectrum disorders, if not attended, can lead to disorder experience profound difficulties more serious and chronic disorders as in relating to other people. They are the child moves into adulthood. unable to initiate social behaviour and The two main features of ADHD are seem unresponsive to other people’s inattention and hyperactivity- feelings. They are unable to share impulsivity. Children who are experiences or emotions with others. inattentive find it difficult to sustain They also show serious abnormalities in mental effort during work or play. They communication and language that have a hard time keeping their minds on persist over time. Many of them never any one thing or in following develop speech and those who do, have instructions. Common complaints are repetitive and deviant speech patterns. that the child does not listen, cannot Such children often show narrow concentrate, does not follow instructions, patterns of interests and repetitive is disorganised, easily distracted, behaviours such as lining up objects or forgetful, does not finish assignments, stereotyped body movements such as and is quick to lose interest in boring rocking. These motor movements may be activities. Children who are impulsive self-stimulatory such as hand flapping seem unable to control their immediate or self-injurious such as banging their reactions or to think before they act. They head against the wall. Due to the nature find it difficult to wait or take turns, have of these difficulties in terms of verbal difficulty resisting immediate temptations and non-verbal communication, or delaying gratification. Minor mishaps individuals with autism spectrum such as knocking things over are common disorder tend to experience difficulties whereas more serious accidents and in starting, maintaining and even injuries can also occur. Hyperactivity understanding relationships. also takes many forms. Children with You have already read about ADHD are in constant motion. Sitting still variations in intelligence in Chapter 1. through a lesson is impossible for them. Intellectual disability refers to below The child may fidget, squirm, climb and average intellectual functioning (with an run around the room aimlessly. Parents IQ of approximately 70 or below), and and teachers describe them as ‘driven by a motor’, always on the go, and talk deficits or impairments in adaptive incessantly. behaviour (i.e. in the areas of Autism Spectrum Disorder is communication, self-care, home living, characterised by widespread impairments social/interpersonal skills, functional in social interaction and communication academic skills, work, etc.) which are skills, and stereotyped patterns of manifested before the age of 18 years. behaviours, interests and activities. Table 4.2 describes characteristics of the Children with autism spectrum disorder intellectually disabled persons. 83 Chapter 4 Psychological Disorders 2024-25  In case of specific learning disorder, the name-calling, swearing), physical individual experiences difficulty in aggression (i.e. hitting, fighting), hostile perceiving or processing information aggression (i.e. directed at inflicting efficiently and accurately. These get injury to others), and proactive manifested during early school years and aggression (i.e. dominating and bullying the individual encounters problems in basic others without provocation). skills in reading, writing and/or mathematics. The affected child tends to Feeding and Eating Disorders perform below average for her/his age. Another group of disorders which are of However, individuals may be able to reach special interest to young people are acceptable performance levels with eating disorders. These include anorexia additional inputs and efforts. Specific nervosa, bulimia nervosa, and binge eating. learning disorder is likely to impair In anorexia nervosa, the individual functioning and performance in activities/ has a distorted body image that leads her/ occupations dependent on the related skills. him to see herself/himself as overweight. Often refusing to eat, exercising Disruptive, Impulse-Control and compulsively and developing unusual Conduct Disorders habits such as refusing to eat in front of The disorders included under this others, the person with anorexia may lose category are Oppositional Defiant large amounts of weight and even starve Disorder, Conduct Disorder and others. herself/himself to death. In bulimia Children with Oppositional Defiant nervosa, the individual may eat excessive Disorder (ODD) display age-inappropriate amounts of food, then purge her/his body amounts of stubbornness, are irritable, of food by using medicines such as defiant, disobedient, and behave in a laxatives or diuretics or by vomiting. The hostile manner. Individuals with ODD do person often feels disgusted and ashamed not see themselves as angry, when s/he binges and is relieved of oppositional, or defiant and often justify tension and negative emotions after their behaviour as reaction to purging. In binge eating, there are circumstances/demands. Thus, the frequent episodes of out-of-control eating. symptoms of the disorder become The individual tends to eat at a higher entangled with the problematic speed than normal and continues eating till s/he feels uncomfortably full. In fact, interactions with others. The terms large amount of food may be eaten even conduct disorder and antisocial when the individual is not feeling hungry. behaviour refer to age-inappropriate actions and attitudes that violate family Substance-Related and Addictive expectations, societal norms, and the Disorders personal or property rights of others. The behaviours typical of conduct disorder Addictive behaviour, whether it involves include aggressive actions that cause or excessive intake of high calorie food threaten harm to people or animals, non- resulting in extreme obesity or involving aggressive conduct that causes property the abuse of substances such as alcohol damage, major deceitfulness or theft, and or cocaine, is one of the most severe serious rule violations. Children show problems being faced by society today. many different types of aggressive Disorders relating to maladaptive behaviour, such as verbal aggression (i.e. behaviours resulting from regular and 84 Psychology 2024-25  Table 4.2 : Characteristics of Individuals with Different Levels of Intellectual Disability Area of Mild Moderate Severe Functioning (IQ range = 55 to (IQ range = 35–40 (IQ range = 20–25 to approximately 70) to approximately approximately 35–40) 50–55) and Profound (IQ = below 20–25) Self-help Skills Feeds and dresses Has difficulties and No skills to partial self and cares for requires training but skills, but some can own toilet needs can learn adequate care for personal needs self-help skills on limited basis Speech and Receptive and Receptive and Receptive language Communication expressive language expressive language is limited; is adequate; is adequate; expressive language understands has speech problems is poor communication Academics Optimal learning Very few academic No academic skills environment; third skills; first or second to sixth grade grade is maximal Social Skills Has friends; can Capable of making Not capable of having learn to adjust friends but has real friends; no social quickly difficulty in many interactions social situations Vocational Can hold a job; Sheltered work Generally no Adjustment competitive to semi- environment; usually employment; usually competitive; primarily needs consistent needs constant care unskilled work supervision Adult Living Usually marries, Usually does not No marriage or has children; needs marry or have children; always help during stress children; dependent dependent on others consistent use of the substance involved and ability to think and work. Their bodies are included under substance related and then build up a tolerance for alcohol and addictive disorders. These disorders they need to drink even greater amounts to include problems associated with the use feel its effects. They also experience and abuse of alcohol, cocaine, tobacco withdrawal responses when they stop and opiods among others, which alter the drinking. Alcoholism destroys millions of way people think, feel and behave. While families, social relationships and careers. there are many disorders listed under Intoxicated drivers are responsible for many this category, few frequently used road accidents. It also has serious effects on substances are discussed below: the children of persons with this disorder. These children have higher rates of Alcohol psychological problems, particularly anxiety, depression, phobias and substance-related People who abuse alcohol drink large disorders. Excessive drinking can seriously amounts regularly and rely on it to help damage physical health. Some of the ill- them face difficult situations. Eventually the effects of alcohol on health and psychological drinking interferes with their social behaviour functioning are presented in Box 4.2. 85 Chapter 4 Psychological Disorders 2024-25  Box Effects of Alcohol : Some Facts 4.2 All alcohol beverages contain ethyl alcohol. This chemical is absorbed into the blood and carried into the central nervous system (brain and spinal cord) where it depresses or slows down functioning. Ethyl alcohol depresses those areas in the brain that control judgment and inhibition; people become more talkative and friendly, and they feel more confident and happy. As alcohol is absorbed, it affects other areas of the brain. For example, drinkers are unable to make sound judgments, speech becomes less careful and less clear, and memory falters; many people become emotional, loud and aggressive. Motor difficulties increase. For example, people become unsteady when they walk and clumsy in performing simple activities; vision becomes blurred and they have trouble in hearing; they have difficulty in driving or in solving simple problems. Heroin and function poorly in social relationships and at work. It may also Heroin intake significantly interferes cause problems in short-term memory with social and occupational and attention. Dependence may develop, functioning. Most abusers further so that cocaine dominates the person’s develop a dependence on heroin, life, more of the drug is needed to get revolving their lives around the the desired effects, and stopping it substance, building up a tolerance for results in feelings of depression, fatigue, it, and experiencing a withdrawal sleep problems, irritability and anxiety. reaction when they stop taking it. The Cocaine poses serious dangers. It has most direct danger of heroin abuse is dangerous effects on psychological an overdose, which slows down the functioning and physical well-being. respiratory centres in the brain, almost Some of the commonly abused paralysing breathing, and in many substances are given in Box 4.3. cases causing death. Cocaine Regular use of cocaine may lead to a pattern of abuse in which the person may be intoxicated throughout the day Box Commonly Abused Substances (Following the DSM-5 Classification) 4.3 Alcohol Stimulants: dextroamphetamines, metaamphetamines, cocaine Caffeine: coffee, tea, caffeinated soda, analgesics, chocolate, cocoa Cannabis: marijuana or ‘bhang’ Hallucinogens: LSD, mescaline Inhalants: gasoline, glue, paint thinners, spray paints, typewriter correction fluid, sprays Tobacco: cigarettes, bidi Opioid: morphine, heroin, cough syrup, painkillers (analgesics, anaesthetics) Sedatives, Hypnotics or Anxiolytics : sleeping pills, anti-anxiety medication 86 Psychology 2024-25 Key Terms Abnormal psychology, Antisocial behaviour, Anxiety, Autism spectrum disorder, Bipolar and related disorders, Deinstitutionalisation, Delusions, Depressive disorders, Diathesis-stress model, Feeding and eating disorders, Genetics, Hallucinations, Hyperactivity, Intellectual disability, Neurodevelopmental disorders, Neurotransmitters, Norms, Obsessive-compulsive disorders, Phobias, Schizophrenia, Somatic symptom and related disorders, Substance related and addictive disorders. Abnormal behaviour is behaviour that is deviant, distressing, dysfunctional, and dangerous. Those behaviours are seen as abnormal which represent a deviation from social norms and which interfere with optimal functioning and growth. In the history of abnormal behaviour, the three perspectives are, i.e. the supernatural, the biological or organic, and the psychological. In interactional or bio-psycho-social approach, all three factors, viz. biological, psychological and social play important roles in psychological disorders. Classification of psychological disorders has been done by the WHO (ICD-10) and the American Psychiatric Association (DSM-5). A variety of models have been used to explain abnormal behaviour. These are the biological, psychodynamic, behavioural, cognitive, humanistic-existential, diathesis- stress systems, and socio-cultural approaches. The major psychological disorders include anxiety, obsessive-compulsive and related, trauma-and stressor-related, somatic symptom and related, dissociative, depressive, bipolar and related, schizophrenia spectrum and other psychotic, neurodevelopmental, disruptive, impulse-control and conduct, feeding and eating, and substance related and addictive disorders. Review Questions 1. Identify the symptoms associated with depression and mania. 2. Describe the characteristics of children with hyperactivity. 3. What are the consequences of alcohol substance addiction? 4. Can a distorted body image lead to eating disorders? Classify the various forms of it. 5. “Physicians make diagnosis looking at a person’s physical symptoms”. How are psychological disorders diagnosed? 6. Distinguish between obsessions and compulsions. 7. Can a long-standing pattern of deviant behaviour be considered abnormal? Elaborate. 8. While speaking in public the patient changes topics frequently, is this a positive or a negative symptom of schizophrenia? Describe the other symptoms of schizophrenia. 9. What do you understand by the term ‘dissociation’? Discuss its various forms. 10. What are phobias? If someone had an intense fear of snakes, could this simple phobia be a result of faulty learning? Analyse how this phobia could have developed. 11. Anxiety has been called the “butterflies in the stomach feeling”. At what stage does anxiety become a disorder? Discuss its types. 87 Chapter 4 Psychological Disorders 2024-25  1. All of us have changes in mood or mood swings all day. Keep a small diary or notebook with Project you and jot down your emotional experiences over 3–4 days. As you go through the day (for Ideas instance, when you wake up, go to school/college, meet your friends, return home), you will observe that there are many highs and lows, ups and downs in your moods. Note down when you felt happy or unhappy, felt joy or sadness, felt anger, irritation and other commonly experienced emotions. Also note down the situations which elicited these various emotions. After collecting this information, you will have a better understanding of your own moods and how they fluctuate through the day. 2. Studies have shown that current standards of physical attractiveness have contributed to eating disorders. Thinness is valued in fashion models, actors, and dancers. To study this, observe the people around you. Select at least 10 people (they may include your family, friends and other acquaintances), and rate them in terms of Large, Average and Thin. Then pick up any fashion or film magazine. Look at the pictures of models, winners of beauty competitions, and film stars. Write a paragraph or two describing the magazine’s message to its readers about the normal or acceptable male or female body. Does this view match what you see as normal body types in the general population? 3. Make a list of movies, TV shows, or plays you have seen where a particular psychological disorder has been highlighted. Match the symptoms shown to the ones you have read. Prepare a report. Weblinks http://www.mental-health-matters.com/disorders http://psyweb.com http://mentalhealth.com Pedagogical Hints 1. The contents on psychological disorders have to be handled sensitively. After becoming familiar with various kinds of disorders and their symptoms, students may begin to feel and may express that they are suffering from one or more of the given disorders. It is important to explain to the students, not to draw any definite conclusions on the basis of some signs/symptoms experienced. 2. Students need to be made aware that mere knowledge and information about psychological disorders do not provide the necessary skills for either diagnosing or treating psychological disorders. 3. Students should be discouraged from attempting to treat each other, as they are not qualified to do so. Specialised training in clinical psychology/counselling is required to undertake psycho- diagnostic testing. 88 Psychology 2024-25