Mental Health Disorders: Review of Concept of Personality Development PDF

# Mental Health Disorders: Review of Concept of Personality Development ## Chapter 2 - Mental Health Disorders: Review of Concept of Personality Development Personality is the sum total of values, attitudes and consistent behavior patterns that are unique to one person. Although the hereditary fa...

# Mental Health Disorders: Review of Concept of Personality Development ## Chapter 2 - Mental Health Disorders: Review of Concept of Personality Development Personality is the sum total of values, attitudes and consistent behavior patterns that are unique to one person. Although the hereditary factors affect an individual personality to some degree, environmental factors are the most important determinant of an individual personality. Personality can also be defined as the sum of all traits that differentiate one individual from another, the total behavior pattern of an individual through which the inner interests are expressed. It is an individual's unique and distinctive way of behaving and interacting with others. ### Factors involved in personality development: 1. **Behavior** is a learned response that develops as a result of past experiences. * To protect the individual's emotional well-being, these experiences are organized in the psyche on three different levels: * **Conscious:** which is made up of past experiences, easily recalled, that create little, if any emotional discomfort and tends to be somewhere pleasant. * **Sub-conscious:** Composed of materials that have been deliberately pushed out of the conscious, but can be recalled with some effort. * **Unconscious:** Contains the largest body of materials, greatly influences behavior. This material cannot be deliberately brought back into awareness because it is usually unacceptable and painful. If recalled, it is usually disguised or distorted, as in dreams. However, it is capable of producing a good deal of anxiety. * **Sigmund Freud identified 3 parts of personality to include:** * **Id** - which contains the instincts, impulses and urges, which is totally self-centered and unconscious. * **Ego:** which is the conscious self (the “I”) that deals with reality, the part of personality that is shown to the environment. * **Super - Ego:** That controls, inhibits and regulates impulses and instincts whose uncontrolled expression would endanger the emotional well-being of the individual and the stability of the society. * **Sigmund Freud believed that a healthy personality spurs from successful transition through psycho - sexual stages of oral, anal, phalic, latency and genital stage; each stage has its particular conflict that must be overcome to attain a healthy personality.** - (even Erickson, Sullivan, and Piaget has similar concept) * **Personality of an individual develops in overlapping stages that shade and merge together.** Certain goals must be accomplished during each stage. If these goals are not met at specific periods, the basic structure of the personality of the individual will be weakened. Factors in each stage persist as a permanent part of the personality. Each stage has particular frustrations and major trauma that must be overcome. Successful resolution of the conflicts associated with each stage is essential to development. Unresolved conflicts remain in the unconscious and may at times result in mal-adaptive behavior. 2. **Humanity has certain basic needs that must be satisfied.** Examples; * Need to communicate to maintain contact with reality: An individual needs to validate findings with others to correctly interpret reality and develop a concept of self in relation to others. * Need for security = To feel secure as an assurance of survival but fear emerges when survival is threatened. * Need to move from dependence to independence - an individual must feel love, and security before reaching out to struggle with the problems of environment. Denial of the opportunity to learn or frustration in the drive for independence will produce emotional problem. * Need to develop a self-concept: Concept of the self is root of security and future developmental needs. Communication enhances the development of self. * A person's self-concept is the basis for emotional stability or instability. A secured person has strength and capacity for independence and becomes less anxious when circumstances require the help of others. * Need to find relief from organized discomfort: Through experience one learns the most satisfying ways of relieving discomfort, therefore, adjustment to illness depends on how the individual adjusts to life. * individual Needs at a given time will vary according to internal and external environmental factors. To attain psychological equilibrium and achieve need satisfaction, the individual attempts and maintains a feeling of safety and comfort in adapting to life's situations. This is often achieved by maintaining a feeling of worth and a feeling of being needed by others. * Conclusively, every person born of a woman, has some personality traits and lacks some others, which he will later develop by interacting with the environment. It is the combination of these trait that make us unique. A person with a healthy personality can accurately perceive reality, profit from past experiences and plan for the future while deriving satisfaction from work done and develop sound social relationship, feelings and expressing full rage of emotion and accepting oneself in a positive way. * The uniqueness of an individual spurs from our early childhood and continues throughout life and we are able to profit from new experiences, and change as long as we live. ### Patterns of Behavior Disorders: * All behaviors are motivated. Social motives are often changed through learning. Emotion act as motives for behavior because they often involve a reaction to some external situation. But behaviors are always accompanied and controlled by the emotion. Emotion on the other hand can facilitate or hinder learning process. Therefore, emotions exert strong influence on the thinking process. * Automatically, behaviors are the predetermined or repetitive type of behavior that has been used successfully in prior situations- This type of behavior requires little effort or thought and is adapted to definite situation and can be difficult to alter, if situation changes. * Life long behavior is a continual changing process and when these changes occur in areas of significance interest, they often produce rather distinct emotional responses. Some of these changes include: * **Resistance to change:** The individual quickly accepts or adapts to the change and may attempt to deny its occurrence or rejects its outcome. * **Regression:** The individual in this case returns to an earlier type of behavior that, at that time provides some satisfaction and gratification and now provides an escape from the unacceptable or anxiety-producing situation. * **Acceptance and progression:** The individual adapts to the change and expends energy on outside objects rather than self-centered aims. ### Examples of Patterns of Behavior Disorder * **Withdrawal behavior:** The person involved pathologically retreats from or avoids the world of reality. It is common in people with unhappy childhood period caused by conflicts, tension and anxiety in homes. It can also be seen in individuals with inconsistent relationships with parents (due to lack of firm standards for reward or punishment and variation in information). Also individuals who failed to develop a sense-image or where interpersonal relationships create a continuous source of anxiety. Consequent upon the above, the individual may develop extreme sensitivity, narcissism and introverted personality. * **Projective Behavior:** This behavior is marked with pathological denial of one's own feelings faults, failures and emotions while continually attributing them to others. This usually results from parents who set extremely high demands, goals and continually raises expected standard of performance or where expectations of failure are fostered, creating feelings of inadequacy and feelings of inferiority. * The individual may develop feelings of chronic insecurity, suspiciousness and extreme sensitivity with unimagined feeling of hostility. He lacks the ability to establish relationship with others, he therefore loses contact with reality. He also develops rigid, structured and narcissistic personality. * **Aggressive behavior:** This is a form of pathological angers and hostility that are turned outward unto others or inward on oneself. It may result from security chronically threatened, resulting in a continual struggle to maintain it or strong need for approval or failure to develop self-concept and self-esteem or chronic anxiety and tension, which are often increased by the real or imagined loss of a loved object. The person's demands and responsibilities are high. * **Neurotic Behavior:** it includes anxiety reactions, conversion reactions, phobic reaction and obsessive - compulsive reaction. This is a form of adjustive type of response characterized by many factors like fears, anxieties and/or physical symptoms. Causes include lack of stable family life and effective guidance, frequent over protection, the child then fails to acquire the necessary skills to cope with problems. He therefore, experiences chronic insecurity, anxiety and tension. * **Socially Aggressive Behavior:** It is a form of mal-adjustive response resulting from a defect in the development of the personality that is characterized by peculiar actions or misbehavior. Causes include approval and disapproval which do not appear sufficiently strong in childhood influence; the behavior along accepted patterns; there is long history of mal-adjustment that creates more problems as the child motives and standards for acceptable behavior are increased. These individuals may show a history of severe emotional traumas in early life that interferes with his emotional development. He may have grown up from the family where parents frequently provide a cold emotionally sterile environment. * **Addictive Behavior:** This is repeated or chronic use of alcohol, cigarette or drugs and other substances with a resulting dependency on these substances. Development factors include feeling of inadequacy in interpersonal relationship, which help to increase anxiety. He also experiences inability to delay satisfaction and struggle for independence, yet unconsciously desire to be dependent; impulsiveness and resentment of responsibility. Other influencing factors are peer pressure and drug availability, sexual conflict and family factors. * **Self-Destructive Behavior:** This is the act of chronic indulgence in self-destructive behavior by non - compliance with medical regimes, habitual abuse of food, drugs, alcohol, cigarettes or engaging in high risk activities. * **This behavior is seen in individuals that failed to develop a sense of -Insecurity and / or self - worth or those with superficial interpersonal relationships, or those exposed to inconsistent relationship with parents with fal variation between verbal and non - verbal communication or parents with slim who dack a firm standard for reward or punishment.** * **The individual lacks faith in the future and experiences anxiety in relation to difficulty in changing goals and expectation .They sense failure or shame when goals are not met and they also sense isolation. Hence they develop withdrawal, rigidity, fantasy, rationalization and denial as a compensatory mechanism.** ### Adaptive Process in Symptoms Formation: Individuals develop a number of techniques to overcome reactions that are intended to minimize stress by achieving an indirect satisfaction of a need. These defense reactions or adaptive processes are also referred to as defense mechanism. They are all learned behavior which are often used unconsciously. It helps the individual to make temporary adjustment because of the protection they offer from threats of insecurity. Individuals use them when they feel they must defend themselves from other people because of their current failure or the possibility of their future failure in a situation. Adaptive process or defense reactions are means to save face or justify individual actions. Occasional use of reactions is not harmful, however, They could assist people in coping with stress or may lead to mal-adaptive behavior depending upon the specific type of defense mechanism and its effect on the individual and others. Defense reaction might lead to mal-adjustment only when they interfere with objective self analysis and when they prevent a direct attack on a problem by cancelling the true nature of such a problem. ### Some of the Adaptive Processes Employed in Shaping of Human Actions: * **Sublimation:** This is the mechanism by which an individual changes his primitive animal love and hate into activities which the society approves. Substituting adult interests for infantile desire to splash things around or by such activities as painting is sublimation. Any person who does not sublimate is showing a sign of mental/emotional illness. * **Interjection:** This is the automatic absorption of many emotional attitudes, ideas, wishes, and feelings from one's parents and from people around. Every one gets most of his ideas from someone else. Your ideas about the type of government you have is nothing more than a case of interjection. If you live in an environment in which there is prejudice against ethnic group for instance, you are most likely to be prejudiced, like the people around you. Too often people really do not recognize when they interject because it is automatic. * **Identification:** The imitation of a model is identification, for instance, the copying of the dressing style or manner of speech of a person one admires, is a good example of identification. Although, sometimes, people become aware of what they are doing, without really knowing the real reason, most of the time, they do it, without realizing what is happening. Young girls imitating their mothers and young boys their fathers even when they play, the make-believe mother-father roles are simply instances of identification. * **Conversion:** The transference of the energy of a desire one cannot express into a physical symptom or complaint. It is a situation in which a lot of ideas or wishes that come from the unconscious, cannot be expressed because the conscious part of one's personality will not let them out. Each of these ideas has a considerable amount of emotions and force build up. Such amount of pressure that wants to escape in some way since it cannot get out directly because of the refusal of the unconscious to let it. It has to find an indirect way to get it out (eg when one has felt anxious and upset about something for a long-time, the person may develop headache whose cause cannot just be explained or excessive worry for seemingly insurmountable problem which manifested in stomach ulcer. * **Rationalization:** Finding reasons to justify actions or conditions in your own eyes and in the eyes of other people. (eg you may buy a new car only to keep up with your friends, but giving the excuse that the tyres of your old car are worn out). Actually what you need is new tyres not a new car. Rationalization is frequently used to defend one's hates as well as likes and to explain why one prefers one thing and not the other. * **Compensation:** Achievement of satisfaction in a round about way. Reducing a feeling of inferiority that has its origin from an undesirable trait by exaggerating a desirable one (eg a handicapped individual who achieves greatness excelling in sports, may be a compensation for lack of scholastic ability). Compensation can help every one but it's valuable to the physically handicapped person. Eg blind person developing her literacy ability in the writings of inspirational verse and poems. * **Compromise:** Reciprocal, give and take necessary in many relationships. used to salvage some part of the situation or the goal of the relationship. * **Idealization:** The over - hauling of something far beyond its real worth, one can idealize himself or others. Self idealization is a healthy thing to do because it becomes a powerful incentive to achievement because motivates him to live up to his idealization. ### Defence - Oriented Reaction to Stresses or Compensatory type Defence These behaviors are abnormal, but are looked at as symptoms of emotional problems. **They include**: * **Dissociation:** Divorcing ideas from the feelings that would naturally be associated with them and satisfying contradictory motives, (eg one who leads a normal existence in the midst of a chaotic world condition). * **Denial of Reality:** The refusal to face reality when reality is unpleasant eg changing direction in order to avoid meeting someone you are afraid of. * **Ego Centricity:** A pre-occupation with oneself, often involving attempts to increase the importance of the self (eg behavior ranging from temper tantrum to gaining public attention by attempting to jump across a wide river with a motor cycle). * **Fantasy:** An escape into a dream world to avoid reality. In fantasy, you imagine you are some one, you are not, such as a movie actor/actress, a football/tennis "star" or the owner of a lucrative business. * **Negativism:** The persistence of negative attitude towards constructive plans or suggestions such as the person who continuously is contradictory, stubborn or rebellious. * **Displacement:** A release of pent-up feelings of hostility on objects less dangerous than those which caused the emotion. * **Projection:** A denial of one's own weakness by shifting a problem or that blame for a situation on other persons (eg dishonest or immoral person who condemns tendencies to dishonesty or immorality in others). Or student who fails exams but blames the lecturer or an executive or boss who sacks an employee to cover up his own mistake. * **Regression:** A return to a former, somewhat primitive and rather childish type of reactions as in the case of an undergraduate who leaves school and returns home, because life is easier at home. He is unable to cope with college life. * **Repression:** Unconscious forgetfulness of aspects of the past or present that may cause pain or discomfort, such as feelings of horror, shame, guilt, or humiliation, (eg rape, robbery attack). * **Substitution:** Reduction of tension by changing from a frustrated activity to one that is easily accomplished, such as substituting journalistic achievement for athletic powers and vice versa. * **Sympathism:** Avoidance of a problem by seeking attention and expression of concern over difficulties.. * **Transference:** A positive or negative shifting of feelings from one person to another because one identifies with the two,(eg when a person to whom one is introduced resembles a friend, one tends to be attracted immediately to the new person). * **Withdrawal:** Avoidance of unpleasant situations by retiring from them or evading them (eg the person who secludes himself, preferring solitude to socialization with others and thus avoiding the chances of failure. * **Conclusively:** the above adaptive processes are either used for coping or mal-adjustive purposes, depending on their magnitude and frequency with which, they are employed. The use of these processes does not solve the underlying conflict of motives, which have triggered them off, in the first instance, because they are directed at the symptoms of anxiety rather than at the motivational conflict which has generated the anxiety. So they do not solve real problems. They only attract the symptoms while the problems are still present and will continue to produce anxiety until they are solved, thus removing the motivational conflict. ## Aetiology of Mental Illness In psychiatric, the study of the causation is complicated by the fact that some causes are often remote in time from the effects they produce. eg childhood experiences and the occurrence of neurosis in adult life. However, it is difficult to test this idea. The second thing that complicates the causative factor in psychiatry is the fact that a single causative factor may lead to several effects. Example, deprivation of parental affection in childhood may predispose to anti-social behavior, suicide, depressive disorders and several other disorders. Conversely, a single effect may arise from several causes. For the above mentioned reasons a scheme for classifying causes is required. A useful approach is to divide causes into predisposing, precipitating and perpetuating factors. * **Predisposing Factors:** These are factors operating from early life that determine a person's vulnerability to causes acting close to the time of illness. These factors include: * **Genetic endowment and environment of the baby in uterus.** * **Early childhood experience:** These include physical, psychological and social factors that influenced the child as he grew up, including the characteristics the child acquired later. Childhood unresolved conflicts * **The personality trait and pattern is always an essential element in the aetiololgy.** * **Body Constitution:** The individual's mental and physical make up. This make up changes as life goes on, under the influence of further physical, psychological and social factors. * **Precipitating Factors:** These are events that occur shortly before the onset of a disorder and it appears to have induced this disorder. These factors may be: * **Physical Factors:** Like head injury, cerebral tumour or drugs, physical stress etc. * **Psychological and social precipitants include personal misfortunes, such as loss of a job, loved ones, disappointment, failure, abandonment and other psycho - social stresses.** * **Perpetuating Factors:** These are factors which are responsible for aggravating or prolonging the diseases already existing in an individual. Therefore, attention should be given to such factors. They include: * **Demoralization and withdrawal from social activities, which will in turn help to prolong the original disorder.** * **Stigmatization and abandonment of the patient by the family and related others.** ### Another Way to Classify the Aetiology of Mental Disorder: 1. **Biological factors:** These factors include, genetic factors, biochemical and brain damage. * **Genetic (Hereditary) factors:** The proneness or risk for developing mental disorder is transmitted to an individual, but whether the individual would actually manifest the illness depends on many other factors. * **Bio - chemical Factors:** Bio - chemical abandonment in the brain are considered to be the cause of some psychological disorders. The disturbances in the release of neurotransmitters in the brain are found to play an important role here. * **Brain - Damage:** Any damage to the structure and functioning of the brain can give rise to mental illness. This damage may result from injury, infection, intoxication, vascular ( poor blood supply or bleeding), tumors, nutritional deficiency, degenerative changes or diseases and anoxia. 2. **Psycho - Social Factors:** The personality and temperament may play an important role here. Example, individuals who are unsociable and reserved (Schizoid) are vulnerable to schizophrenia, when they face adverse situation in life and people that have psycho - social stress may have problems later especially, if an individual is deprived of proper love and affection, suitable guidiance and encouragement at early life. * On the other hand, if an individual is exposed to frequent quarrels, misunderstanding, lack of warmth and trust among his fellow human beings, when the individual is faced with stressful situation, he can break down as he lacks the skills to adjust and control his emotion. 3. **Social Factors:** Factors like poverty, unemployment, injustice, insecurity and severe competition, migration and urbanization can result in mental distress. ## Major Signs and Symptoms of Mental Disorders: The symptoms and signs can begin suddenly (acute onset) or may emerge slowly over a period of months or even years, (insidious onset). Acute symptoms demand urgent recognition and treatment, while those with slow onset may become severely ill before it is discovered. Some mentally-ill persons will have many of these signs and symptoms while some may have few. These signs and symptoms include: 1. **Disorder of Perception:** Perception is the process of becoming aware of what is presented through the sense organs. While imagery is an experience within the mind. * **Illusion:** This is a perceptual disturbance with misinterpretation of a real sensory stimulus eg seeing a rope in the night and mistaking it for a snake. * **Hallucination:** This is a false perception that occurs without an external stimulus eg Hearing a voice when no one is around. This hallucination can affect any of the five senses: * **Auditory Hallucination:** Hearing voice when nobody is around. It occurs mostly in schizophrenics, paranoid disorders, epilepsy and in alcohol withdrawal state. * **Visual Hallucination:** Seeing figures objects, shadows, ghosts etc, where there is actually nothing on the focus. It occasionally occurs in schizophrenics, organic mental disorder especially epilepsy. * **Olfactory Hallucination:** Smelling pleasant or unpleasant odour in the absence of stimuli. This is very common in epilepsy (especially temporal lobe epilepsy). * **Gustatory Hallucination:** The individual experiences a peculiar taste in his mouth which is not real. Mostly seen in epilepsy and rarely in paranoid disorder. * **Tactile Hallucination:** A feeling of peculiar touch or insects crawling over the body as seen in people with cocaine intoxication. * **Autoscopic Hallucination** is the experience of seeing one's own body projected into external space usually in front of oneself, for short periods. The person may see himself as being double. * There may be reflex hallucination i.e. false sounds of music may provoke visual hallucination as seen in L.S.D addicts and schizophrenia * Also hypnagogic and hypnopompic hallucinations occurs at the point of falling asleep and of waking respectively. 2. **Disorder of thinking:** This is usually evidenced in the person's talk, at times he talks excessively or in contrast or gives answers that are not related to the question put forth, (irrelevant talk), meaningless talk or incoherent talk, the train of thought may stop suddenly in the middle of a sentence (thought block). Others may have thought insertion, thought broad casting or thought being controlled by an outside force. Flight of idea (i.e. moving from one topic to another). So that one train of thought is not completed before another appears. Thought preservation is the persistent and inappropriate repetition of the same thoughts, loosening of associations dealt with a lot of the normal structure of thinking. Derailment - transition from one topic to another at mid - sentence, with no - logical relationship between the two topics and with no form of association as seen in flight of ideas. 3. **Disorder of the content of thought (Delusions).** Delusion is a false fixed belief. (the patient is convinced about the particular belief), hence it cannot be corrected by reasoning or logic. This belief is not shared by the members of the same community. The belief is firmly held on inadequate grounds and is not affected by rational argument and is not a conventional belief. ### Types of Delusion * **Delusion of persecution:** The person is suspicious of people and believes that others are trying to harm him or trying to kill or poison him. * **Delusion of grandeur:** These are beliefs of exaggeration or self importance, belief that a person is extra ordinarily powerful, wealthy and a very important person. It is seen in mania and in schizophrenia. Delusions of reference are concerned with the idea that objects, events, or people have a personal significance for the patient. This delusion may relate to actions or gestures made by other people who are thought to convey something about the patient. * Nihilistic delusions are strictly speaking beliefs about the non-existence of some person or thing, but their meaning is extended to include pessimistic ideas, that the patient's career is finished or that he is about to die, or that he has no money or that the world is doomed or that his body parts are missing. * **Hypochondriacal delusion:** False belief that he has some incurable disease. * **Religious delusion** - The person holds apparently extreme ideas about divine punishment for minor sin * **Delusion of Jealousy:** Less intense jealous pre-occupation with some obsessional thought with doubts about the spouse's fidelity. He tries to find evidence supporting his beliefs and his search will continue. * **Delusion of guilt and worthlessness** seen in depressed individuals. This delusion might spur from prior infringement of the law in the past, which if discovered, will bring shame upon the patient or that his sinfulness will lead to divine retribution on his family. * **Disturbances of memory:** The ability to remember events can be affected in many psychiatric disorders. Memory disturbances include: * **Amnesia:** This is total failure of memory or total loss of memory for a certain period of a person's waking life. Period may vary from a few hours to many months, seen mostly in patients with organic disorder due to brain damage. This memory loss can be in the area of primary or short term memory and secondary or long term memory. * Memory loss may affect the recognition of materials presented to the person. * It may also affect the recall, without a clue of the information (this is a difficult type). * Some people, after a period of unconsciousness, may have poor memory of recent events that proceed the time of unconsciousness (otherwise called anterograde amnesia), while some especially following head injury and E.C.T may have inability to recall events of the past (termed retrograde amnesia). * **Some patients with extreme difficulty in remembering, may report events that have not taken place at all at the time in question from their memory (this is termed confabulation).** ## DISORDERS OF CONSCIOUSNESS: The awareness of self and environment are found within the conscious level. But its level may vary between extreme me alertness and coma. Also quality of consciousness may vary from sleep and stupor. * **Confusion:** This is the inability to think clearly. It usually occurs with partial impairment of consciousness, illusion, hallucination and delusion. Some of the affected individuals may wander around not really knowing where they are. * **Disorientation / Clouding of Consciousness:** The patient becomes drowsy and reacts incompletely to stimuli, with poor attention span, impaired memory and orientation to person, place and time is disturbed, thinking seems slow and muddled and events may be interpreted inaccurately. * **Stupor:** is a condition in which the patient is immobile, mute and unresponsive but appears to be fully conscious, usually have an eye open and trying to follow external objects. If the eyes are closed, he may resist attempts to open them. * **Disturbance of Affect or Mood/Emotion:** Abnormal fluctuation of mood may take the extreme form of total loss of emotion and inability to feel pleasure (apathy). Mood has a lot to do with the internal emotional state, while affect refers to the external expression of emotional content. The common abnormal mood states include: * **Elation or Extreme happiness:** There is marked cheerfulness associated with increased activities seen in mania. * **Depression:** State of extreme sadness without specific cause or when it becomes abnormally severe or prolonged. It is a state of dejection, hopelessness, sadness and misery. * **Anxiety:** is an unpleasant state of feeling with the anticipation of something harmful. It is a vague fear in the absence of immediate dangers. * **Apathy:** loss of interest in his surroundings and inability to express feelings. * **Incongruity of affect:** The patient's emotions do not work in harmony with his thought eg Laughing when describing the deat of his mother or loved one * **Inappropriate affect:** When a patient reacts with the wrong emotion to a particular event, * **Blunted or Flattened affect** when emotions change in an excessively rapid and abrupt way, the affect is said to be Labile, when the mood changes are very marked. It is termed emotional incontinence * **Phobias:** A persistent irrational fear of and wish to avoid a specific object, activity or situation. * **Disturbance of Motor Activities:** Abnormalities of social behaviours, facial expression and posture occur frequently in mental illness of all kinds. They include: * **Waxy Flexibility:** The person can be molded into a position which is then maintained for long periods whilst at the same time mug tone is uniformly increased * **Echopraxia:** is the imitation of the interviewer's movement automatically even when asked not to do so. * **Negativism:** Motiveless resistance to all attempts to be moved or to all instructions. * **Catalepsy:** A general term for immobile position that is constantly maintained * **Echolelia:** is the imitation of the interviewer's words automatically even when asked not to do. * **Posturing** is the adoption of unusual bodily postures continuously for a long time. The posture may have a symbolic meaning eg standing with both arms out stretched as if being crucified. * **Mannerism:** repeated movements that appear to have functional significance eg saluting. * **Stereotype behaviours:** Repeated movements that are regular and without obvious significance rocking to and for/fro * General behavioral symptoms and signs: * **Sleep disturbances:** Insomnia (Difficulty, in getting off to sleep or maintains sleep). * **Loss of appetite and refusal of food.** * **Personal appearance may be neglected, unwilling to shave, bath or change clothes.** * **Lack of interest in sex:** Some feel that they have lost their libido. This leads to reduced interest. * **Personal relationship:** They may have strained interpersonal relationship * **Interest in work, hobbies and surroundings decline.** * **Behaviour:** Patient is occasionally hyperactive, dull, slow in activities refusing to move even to do his personal works * **Insight:** Patient's awareness of his mental state is difficult to achieve. Insight is not simply present or totally absent, but rather a matters of degree. ### Classification of Mental Disorders Psychiatric disorder is characterized by disorder of thought, action and feeling. There are major difficulties in classification due to * **The difficulty in determining what is mental illness and when is a mental state abnormal.** * **Due to non-specific native of psychiatric symptoms and signs.** * **Delusion and hallucination occur in schizophrenia, mania and severe depression.** * **Depression can be the primary problem or part of another disorder eg agoraphobia.** * **There are no reliable biological makers** * **Psychiatrists charge their mind and cannot agree.** * Therefore, personal classification abounded depending on the place of thought. Example * **Organic Versus Functional** * **Psychotic Versus Neurotic** However, a good classification scheme permits reliable diagnosis of individual cases and enables rescuers to make studies of the way a particular problem develops and the treatment programmes that will be most effective- classification helps in better management. It gives clue for predicting the outcome. At present, there are two major internationally accepted classification available in psychiatry 1. **ICD - 10 Interventional Classification of Mental and behavioural Disorders by W.H.O.** 2. **D. S. M. IV: Diagnostic and statistical manual of mental disorder by American Psychiatric Association** * **The Major groups of mental disorders as found on ICD-10 are** * **Organic, including symptomatic mental disorders** * **Mental and behavioural disorders due to psycho - active substance abuse.** * **Schizophrenia, schizotypal and delusionai disorders.** * **Mood (Affective) disorder** * **Neurotic, stress related and somatoform disorders** * **Behavioral syndromes associated with physiological disturbances and physical factors** * **Disorders of adult personality and behaviour.** * **Mental retardation** * **Disorders of psychological development** * **Behavoural and emotional disorder with onset usually in childhood and adolescence-** * **Unspecified. mental disorders** * **D.S.M-IV-TR Classification Axes 1 and 11 categories and codes.** * **Disorders usually first diagnosed in infancy, childhood or adolescence** * **Mental retardation** * **Learning disorders** * **Motor skills disorders** * **Communication disorders** * **Pervasive developmental disorders** * **Attention-deficit and disruptive behaviour disorders** * **Feeling and eating disorders of infancy or early childhood.** * **Tic disorders** * **Elimination disorders** * **Other disorders of infancy, childhood or adolescence.** * **Delirium, Dementia and Amnestic and other cognitive disorders** * **Delirium** * **Dementia** * **Amnestic disorders** * **Others cognitive disorders** * **Mental Disorders due to a general medical condition not elsewhere classified.** * **Substance related disorders** * **Alcohol related disorders** Alcohol-use disorder, Alcohol induced disorders. * **Amphetamine related disorders** Amphetamine use and induced disorders. * **Caffeine - related disorder** eg cannabis use and induced disorders. * **Cocaine-related disorders** eg cocaine use and induced disorder. * **Hallucinogen related disorders** eg hallucinogen use and induced disorders * **Inhalant-related disorders** eg inhalant use and induced disorders. * **Nicotine-related disorder** (use and induced) * **Opioid-related disorders** (use and induced) * **Phenycyclidine related disorders** (use and induced) * **Sedative - Hypnotic or Anxiolytic related disorders** (use and induced) * **Poly substances related disorders** * **Others (unknown) substance related disorders.** * **Schizophrenia and other psychotic disorders -** paranoid disorganized, catatonic, undifferentiated and residual manic disorder * **Mood disorders** Depressive disorder and Bipolar disorder * **Anxiety disorders** eg panic disorder agoraphobia, specific phobia, social phobia, obsessive compulsive disorder post traumatic stress disorder, substance induced anxiety disorder * **Somatoform disorders** eg somatization disorder, undifferentiated somatoform disorder, conversion disorder, pain disorder, Hypochondriasis, body dysfunction disorder, somatoform disorders, Nos. * **Factitious disorders** * **Dissociative disorders** * **Sexual and gender identity disorders** eg. Sexual disfunctions sexual desire disorders, orgasmic disorders, sexual pain disorders, sexual dysfunction due to a general medical condition. * **Paraphilias** * **Gender identity disorders** * **Eating disorders** eg anorexia nervosa, bulimia nervosa, eating disorders. * **Sleep disorder** eg primary sleep disorders ( eg Dyssomnias, parasomnias). Sleep disorders related to another mental disorder, other sleep disorders eg insomnia, hypersomnia, parasomnia, mixed type. * **Impulse - control disorders not else where classified** eg intermittent explosive disorders, kleptomania, pyromania, pathological gambling, trichotillomania impulse control disorder. * **Adjustment disorders** eg Adjustment disorder with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct with mixed disturbance of emotions and conduct. * **Personality disorders** eg paranoid personality disorder, schizoid. schizotypal, antisocial or borderline, historionic, narcissistic, avoidant, dependent personality disorder, obsessive compulsive personality disorder. personality disorders. * **Other conditions that may be a focus of chemical attention** eg * **psychological factors affecting medical condition.** * **Medication induced movement disorders** * **Other medical induced disorders** * **Relational problems** * **Problems related to abuse or neglect** * **Additional conditions that may be focus of clinical attention.** * **Additional codes - unspecified mental disorders, no diagnosis or condition on Axis 1.**