PSYCHOLOGIAL

DISORDERS
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Contents -
- Introduction
- Concepts of abnormality and psychological disorders
- Classification of psychological disorders
- Major psychological disorders
- Anxiety disorders
- Obsessive compulsive and related disorders
- Trauma and stressor related related
- Somatic symptom and related
- Dissociative disorder
- Depressive disorder
- Bipolar and related
- Schizophrenic spectrum
- Neurodevelopmental disorders
- Disruptive, impulse- control and conduct disorders
- Eating disorders
- Substance related and addictive disorders
Concept Of Abnormality -
- There are many definitions of abnormality but none has universal
acceptance.
- Most definitions have certain common features called four D’s: deviance,
distress, dysfunction and danger.
- The word abnormal literally means away from normal.

Psychological disorders are:

• Deviant- different, extreme , unusual, even bizarre

• Distressing – unpleasant and upsetting to the person and to

others.

• Dysfunction- interfering with the person’s ability to carry out

daily activities in a constructive way

• And possibly dangerous to the person or to others.

First approach
- Abnormal behaviour as a deviation from social norms.
- Many psychologists have stated that ‘abnormal’ is simply a label that is given to a behaviour which
is deviant from social expectations.
- Each society has norms, which are stated or unstated rules for proper conduct.
- Behaviours, thoughts and emotions that break social norms are called abnormal.
- A society’s norms grow from its particular culture- its history, values, institutions, habits, skills,
technology and arts.
- Thus, a society whose culture values competition and assertiveness may accept aggressive
behaviour as normal whereas.

Second approach
- Abnormal behaviour as maladaptive
- Many psychologists believe that the best criterion for determining the normality
of behaviour is not whether society accepts it but whether it fosters the well-
being of the individual and eventually of the group to which he/she belongs.
- Well- being is not simply maintenance and survival but also includes growth and
fulfillment, i.e. the actualization of potential.
- According to this criterion, conforming behaviour can be seen as abnormal if it is
maladaptive, i.e. if it interferes with optimal functioning and growth.
- Describing behaviour as maladaptive implies that a problem exists.
HISTORICAL BACKGROUND OF PSYCHOLOGICAL DISORDER

The history of abnormal psychology has been viewed through different periods of history.

The Ancient Theory

- It states that abnormal behaviour can be explained by the operation of supernatural and magical forces such
as evil spirits (bhoot- pret). Or the devil ( shaitan).
- Exorcism, i.e. removing the evil that resides in the individual through counter magic and prayer, is still
commonly used.
- In many societies, the shaman or medicine man (ojha) is a person who is believed to have contact with
supernatural forces and is the medium through which spirits communicate with human beings.
- Through the shaman, an afflicted person can learn which spirits are responsible for her/his problems and
what needs to be done to appease them.

The biological / organic approach

- A recurring (persistent) thing in the history of abnormal psychology is; the belief that
individuals behave strangely because their bodies and brains aren’t functioning properly.
- In the modern era, there is evidence that body and brain processes have been linked to
many type of maladaptive behaviour.
- For certain types of disorders, correcting these defective biological processes results in
better improved functioning.
The Psychological Approach
- Psychological problems are caused by inadequacies in the way an individual thinks, feels, or
perceives the world.
- All three of these perspectives _ supernatural, biological or organic, and psychological have
recurred throughout the history of western civilization.

Factors Underlying The Abnormal Behaviour

- Psychologists used different approaches.
- Each approach in use today emphasizes a different aspect of human behaviour, and explains and
treats abnormality in line with that aspect.
- These approaches also emphasize the role of different factors such as biological, psychological and
interpersonal and socio- cultural factors.

l. Biological factors
• Influence all aspects of our behaviour.
• Biological factors such as faulty genes, endocrine imbalances, malnutrition, injuries and other
conditions may interfere with normal development and functioning of the human body. These
factors may be potential causes of abnormal behaviour.
• According this biological model, abnormal behaviour has a biochemical or physiological basis.
• Biological researchers have found that psychological disorders are often related to problems in
the transmission of messages from one neuron to another.
• A tiny space called synapse separates one neuron from the next, and message must move across that
space. When an electrical impulse reaches the neuron ending, the nerve ending is stimulated to release a
chemical, called a neurotransmitter.
• Studies have shown that abnormal activity by certain neurotransmitter can lead to specific psychological
disorders.

ll. Genetic factors

• Linked to mood disorders, schizophrenic, mental retardation and psychological disorders.
• Researchers have not been able to identify the specific genes that are responsible for abnormal behaviour.
• It appears that no single gene is responsible for a particular behaviour or psychological disorder.
• In fact many genes combine to help bring about our various behaviours and emotional reaction, both functional
and dysfunctional.
• Although there is sound evidence to believe that genetic biochemical factors are involved in mental disorders
as diverse as schizophrenia, depression, anxiety, etc. and biology alone cannot account for most mental
disorders.

o PSYCHOLOGICAL MODEL
• Provides a psychological explanation of mental disorder.
• As per this model psychological and interpersonal factors play an
important role in abnormal behaviour. These factors include -maternal
deprivation
- Faulty parent child relationships
- Maladaptive family structures’
- Severe stress

• These psychological model include the psychodynamic, behavioural, cognitive and humanistic- existential models.

lll. Socio – cultural factors (war, violence, group prejudice and discrimination, economic and employment problems)

(i) Family system likely or produce abnormal functioning in individual members, e.g., enmeshed structure in which
members are over involved in each other’s activities- children have difficulty becoming independent.
(ii) Social networks in which people operate (social and professional relationships)- people isolated and lacking social
support are likely to become depressed.
(iii) Societal labels and roles assigned to troubled people which influences their abnormal functioning.

lV. Diathesis – stress model

Psychological disorders develop when a diathesis ( biological predisposition to disorder ) is triggered by a
stressful situation; three components—

(i) Diathesism presence of a biological aberration which may be inherited . This carries a vulnerability to
develop a psychological disorder– person is ‘at risk’ or ‘predisposed’ to develop the disorder.
(ii) Presence of pathogenic stressors, i.e., factors/ stressors that may lead to psychopathology-
if an ‘at risk’ is exposed to these stressors, predisposition may evolve into a disorder. E.g., anxiety,
depression, schizophrenia.
V. Interactional approach
i.e. biological, psychological and social factors in combination cause mental disorders.

Anxiety disorder: high levels of anxiety that are distressing and interfere with effective functioning also get
prolonged for long time indicate the presence of an anxiety disorder.
Anxiety is different from worry. In worry the cause is known but in anxiety the patient finds no
apparent cause of the discomfort. General symptoms in anxiety disorders;

• Rapid heart rate • Shortness of breath

• Diarrhea • Loss of appetite
• Fainting • Dizziness
• Sweating • Sleeplessness
• Frequent urination • tremors

Types of anxiety disorders

Generalised anxiety disorder
Panic disorder
Phobic disorder
Separation anxiety disorder
1. Generalised anxiety disorder; consists prolonged, vague, unexplained and intense fears that are not attached to any
particular object.
Symptoms-
• Worry • Apprehensive feelings • Hyper vigilance
• Restlessness • Consistently scanning the environment • Motor tension
• Shaky • tense

2. Panic disorder: recurrent attacks of anxiety causing intense terror, unpredictable, lasts only for 6-7 minutes
Symptoms-
• Shortness of breath • Chest pain • Dizziness
• Palpitations • Choking • Nausea
• Fear of going crazy • Losing control or feeling of dying • trembling

3. Phobias: Irrational fear

Types-
Specific phobias – most common. Fear of animal, enclosed spaces.
Social anxiety phobia- intense and incorporating fear and embarrassment when dealing with others.
Eg- fear of attending telephonic calls, attending a party.
Agoraphobia- refers to fear of unfamiliar people and unfamiliar places. Such people have very
limited social life. In new places these people throw themselves under house arrest situation.
4. Separation anxiety disorder (SAD)- individual with SAD are fearful and anxious about separation from
attachment figures to an extent that is developmentally appropriate.
• Children may have difficulty in a room alone.
• Difficulty in going to school alone.
• Fearful in entering new situations.
• Tendency to cling and shadow their parents.
• These children/ individual of suffer from insecurity of losing their parents.
• To avoid separation children with SAD may fuss, scream, throw severe tantrums or even make suicidal gestures.
ll. Obsessive compulsive and related disorders
• People affected are unable to control their preoccupations with specific ideas or are unable to prevent themselves
from repeatedly carrying out or series of acts that affect their ability to carry out normal activities.
(a) Obsessive behaviour- it refers to the inability to stop thinking about a particular idea or topic. These thoughts are
usually unpleasant and shameful.
(b) Compulsive behaviour- it refers to the need to perform certain behaviours repeatedly. Many compulsions deal with
counting, ordering, checking, touching and washing.
(c) Hoarding disorders
(d) Trichotillomania (hair pulling disorder)
(e) Excoriation (skin picking disorder)
lll. Trauma stressor- related disorder
1. PTSD- it refers to a distinct pattern of symptom that develop as a result of some
traumatic event such as natural disaster, victims of bomb explosion of terrorists, been
in a serious accident or in war.
symptoms-
• Recurrent dreams
• Flashbacks
• Impaired concentration
• Emotional numbing
2. Adjustment disorders
3. Acute stress disorder
lV. Somatic symptoms and related disorder: It refers to the condition in which there are physical symptoms in
the absence of a physical disease.
Patient has psychological difficulties and complains of physical symptoms for which there in no biological cause.
Types
Somatic symptom disorder
Illness anxiety disorder
Conversion disorder

1. Somatic symptom disorder- patient having persistent body- related symptoms which may or
may not be related to any serious medical conditions.
Symptoms-
• Overly preoccupied with their symptoms • Ready for all sorts of check ups
• Continuous worry about their health • Experience significant distress and
• Make frequent visits to doctor disturbances in their life
2. Illness anxiety disorders
• Involves persistent preoccupation about developing serious illness and constantly worrying about this possibility.
• Patient suffers from anxiety about one’s health
• Patient becomes obsessed about undiagnosed diseases and negative diagnosis

3. Conversion disorders- it refers to loss or impairment of motor or sensory functions without physical cause but may
be in response to stress and psychological problems.
Symptom-
• Reported loss of part or all of some basic bodily functions
• Paralysis
• Blindness
• Deafness
• Difficulty in walking

V. Dissociative disorder-
• These disorders can be viewed as severance (lack of coordination) of the connections between ideas and
emotions.
• Sudden temporary alterations of consciousness that blot out painful experiences are defining characteristics of
dissociative disorder.
Main symptoms-
• Feeling of unreality
• Estrangement
• Depersonalization
• Loss or shift of personality
Conditions included in dissociative disorders-
1. Dissociative amnesia- this disorder is characterized by extensive but selective memory loss that has no
known organic cause (eg- head injury). Patient / person may forget his whole past, part of the post or
immediate past.
They can no longer recall specific events, people, places or objects.
• A part of dissociative amnesia is dissociative fugue.
• Main feature of dissociative fugue refers to an unexpected travel away from house or work place.
• Patient/ person in between may assume a new identity and shows inability to recall the previous identity.
• The fugue usually ends when the person suddenly ‘wake up’ with no memory of the events that occurred during the fugue.

2. Dissociative identity disorder-

• Often referred to as multiple personality.
• Most dramatic dissociative disorder.
• It’s mostly associated with traumatic experiences in childhood.
• Patient/ person assumes alternate personalities that may or may not be aware for each other.
3. Depersonalisation/ derealisation disorder
• Most widely prevalent disorder, depression may refer to a symptom or a disorder.
symptoms
- weight variation
- constant sleep problems
- tiredness
- inability to think clearly
- agitation
- All activities cognitive or behavioural slowed down
- Suicidal tendencies
- Excessive guilt
- Feeling of worthlessness
- Low energy
- Break up in a relationship
- Finds no purpose in life.

Risk factors predisposing towards depression-

1.) Genetic factors makeup heredity
2.) age- women are particularly at risk during young adulthood. Men on other hand are a highest risk in early middle age.
3.) gender- women in comparison to men are more likely too report a depression disorder.
4.) other risk factors: negative life events, lack of social support.

Bipolar and related disorders:

• Bipolar involves both mania and depressions
• These are cyclic- alternately present with episodes for normal interval
• Manic disorder was rarely appear by themselves referred to as manic depression disorders.
• Bipolar disorder was earlier
• Types of bipolar disorder includes Bipolar 1 disorder, bipolar 2 disorder and cyclothymic disorder.
• Depression and other related disorder may lead to suicide
• Suicidal behaviour is influenced by social factors, psychological factors, cultural factors.
Prevention-
- Improving identification vulnerability
- Referral
- Management of behaviour

Vll. Schizophrenic spectrum and other psychotic disorders

• Schizophrenic and the other psychotic disorder are some of the most impairing forms of psychopathology.
• The spectrum of psychotic disorders include schizophrenia, schizoaffective disorder, delusional disorder, schizotypal
disorder as well as psychosis associated with substance use or medical conditions.
• The primary clinical features of these disorder, describe the known cognitive and these biological changes associated
with schizophrenia, describe potential risk factors and/or causes for the development of schizophrenia.
• These psychotic disorders in schizophrenic spectrum show symptoms like delusions, hallucinations, disorganized
speech and behaviour, abnormal motor behaviour including catatonia and negative symptoms like avolition, blunted
affect, flat affect and alogia
• Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational
functioning deteriorate as a result of –

(i) disturbed thought processes (ii) strange perceptions

(iii) Unusual emotional states (iv) motor abnormalities
Vlll. Neurodevelopmental Disorder

• These disorders get manifested in early years of life. Symptoms may be observed during pre-
school age or during the early stage of schooling.
• These disorders are pervasive because they hamper personal, social, academic and
occupational functioning.
• These disorders get characterized as deficient or excesses in a particular behaviour.
• Children may show delay in achieving a particular age appropriate behaviour such as
walking, speaking etc.

Types
ADHD
Autism
Intellectual disability
Specific learning disorder
1. Attention deficit hyperactivity disorder (ADHD)
The two main features of ADHD are :
(a) Inattention
(b) Hyperactivity impulsivity

Inattentive children show following symptoms-

• Difficult to sustain mental effort for long time
• Difficulty in following instruction
Impulsivity
• Unable to control their immediate reactions
• Find difficult to wait
• Difficulty in immediate temptation or delaying gratification
• Minor mishaps are common although serious injuries can also occur

Hyperactivity

• Hyperactive children are constantly in motion

• Cannot sit at one place
• Fidgit
• Climb and seen roaming around room aimlessly
• Too talkative
2. Autism spectrum disorder
(a) Characterised by widespread impairment in communicational skills.

- Autistic children because of communication problem find difficult in starting maintaining and
understanding relationships
- Many of them never develop speech. Some times repetitive and deviant speech although their vocal
cord is perfect

(b) Marked difficulty in social interaction

- Profound difficulty in relation to other people
- Cannot imitate social behaviour and seem unresponsive to others feelings
- Unable to share emotions and experiences
- Marked difficulty in communication- both active as well as passive

(c) Stereotyped pattern of behaviour- this behaviour can be called as ritualistic and repetitive behaviour
(d) They have restricted range of interest. Mostly interested in non-living things particularly moving objects.
(e) 70% of autistic children suffer from intellectual deficiency/ disabilities.
(f) Stereotyped body movement as rocking hand flapping, jumping, clapping is common

• Self harm such as banging the head against a wall in rhythmic way is common.
3. Intellectual disability

• Refers to the below average intellectual functioning

• IQ less than 70
• Deficits or impairment in adaptive behaviour such as areas of communication, self care, home living, social-
interpersonal skills functional academic skill, work etc.
• This deficit gets manifested before the age of 18 years.
• Intellectual disability can get manifested at 4 levels

mild ( iq 55-70 ) moderate ( iq 35- 40- 54)

severe (iq 20-25-35-40) profound (iq below 20-25 )

At mild level, the self help skills, speech and communication, academics, social, skills vocational adjustment is slightly
disturbed.
At moderate level, these areas of functioning gets significantly impaired. Academics 1 st- 2nd grade is possible.
At severe and profound level, these areas are impaired. Language, self help skills, social interaction is very limited . No
academic skills.
4. Specific learning disorders;

• Individual experience difficulty in perceiving or processing information.

• Difficulty in learning basic skills such as reading, writing or mathematics.
• Problem starts at early school years
• performance of such children in below average although additional help may improve performance.

lX. Disruptive, Impulse- control and Conduct disorder

Symptoms of oppositional defiant disorder
- Age inappropriate amount of stubbornness
- Show irritable conduct and are defiant mostly
- High on hostility
Symptoms of conduct disorder (anti social behaviour):-
- Age inappropriate actions and attitudes
- Violate family expectations
- Violate societal norms
- No respect for other person and their right for property
- Major theft
These people manifest aggression and non- aggressive behaviour. Aggressive
behaviour include harm to people and animals. Non – aggressive cause
damage to property, theft and serious rule violation
- People with ODD don’t see themselves as angry / oppositional/ defiant
- Often justify their behaviour upon the environmental circumstance/ demands

X. Feeding and eating disorders

• Anorexia nervosa- a distorted body image that leaks him/ her to see himself /
herself as overweight – refuses to eat, exercises compulsively, develops unusual
habits such as refusing to eat in front of others, may lose large amounts of weight
and even starve himself/ herself to death

• Bulimia nervosa- may eat excessive amounts of food, then purge his/ her body of
food by using medicines such as laxatives or diuretics or by vomiting- feels
disgusted and ashamed when he/she binges and is relieved of tension and
negative emotions after purging

• Binge eating- frequent episodes of out-of- control eating. They eat with higher
speed than normalcy. Continue eating till feels uncomfortably full. Person
consumes excessive amount of food without feeling hungry.
Xl. Substance related and addictive disorders
• Consistent use of substance may lead to addictive disorders which causes maladaptive behaviour.
• These disorders may include problems associated with;
abuse of alcohol abuse of cocaine
abuse of tobacco abuse of heroin
Alcohol

• Drinking affects with social behaviour and ability to think and work.
• It may lead to tolerance i.e. a particular dose becomes unaffected to provide the desired effect and so
the person wants more.
• Alcoholic also experience withdrawal responses when they stop drinking.
Heroin

• Significantly interferes with social and occupational functioning.

• It can lead to dependence on heroin. It mean s the person is using the drug so consistently that now
he/ she has become addict to it. The person now cannot live without it, cannot work without consuming
it and if deprived, shows tolerance and withdrawal symptoms/ reactions
• Overdose of heroin sows the respiratory centres in the brain causing paralysis.
Cocaine

• Causes problem in short term memory and attention span reduction

• Cocaine causes serious effects on psychological functioning and physical wellbeing