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GRADE 12 NOTES
SUBJECT: PSYCHOLOGY (037)
SESSION 2020-21

CH-4: PSYCHOLOGICAL DISORDERS

Adaptation refers to a person’s ability to modify her/his behavior in response to the changing
environmental requirements.
When the behavior 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 behavior –
its causes, consequences, and treatment.
OR
Abnormal psychology is the scientific study of abnormal behavior in order to describe, predict,
explain and change abnormal patterns of functioning.

CONCEPT OF ABNORMALITY
• Although many definitions of abnormality have been used over the years, none has won
universal acceptance. Still, most definitions have certain common features, often called the
‘four Ds’:

Deviance Distress Dysfunction Danger

Deviant (different, extreme, unusual, even bizarre),

Distressing (unpleasant and upsetting to the person and to others),
Dysfunctional (interfering with the person’s ability to carry out daily activities in a constructive
way)
Dangerous (to the person or to others).
DISTINGUISHING BETWEEN NORMAL AND ABNORMAL BEHAVIOUR

The word ‘abnormal’ literally means “away from the normal”. it implies deviation from some
clearly defined norms or standards. In psychology, we have no ‘ideal model’ or even ‘normal
model’ of human behavior to use as a base for comparison. Various approaches have been used in
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distinguishing between normal and abnormal behaviors. From these approaches, there emerge two
basic and conflicting views:
1. Abnormal behavior as a deviation from social norms
• Many psychologists have stated that ‘abnormal’ is simply a label that is given to a behavior
which is deviant from social expectations.
• Abnormal behavior, thoughts and emotions are those that differ markedly from a society’s
ideas of proper functioning.
• Each society has norms, which are stated or unstated rules for proper conduct.
• Behaviors, thoughts and emotions that break societal 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 behavior, whereas one that emphasizes cooperation
and family values (such as in India) may consider aggressive behavior as unacceptable or
even abnormal.
• A society’s values may change over time, causing its views of what is psychologically
abnormal to change as well. E.g. Sati Pratha, Homosexuality.
• Serious questions have been raised about this definition. It is based on the assumption that
socially accepted behavior is not abnormal, and that normality is nothing more than
conformity to social norms.
Each culture has its own norms and hence a better parameter is needed to define abnormal
behavior.

2. Abnormal behavior as maladaptive

• Many psychologists believe that the best criterion for determining the normality of
behaviour is whether it fosters the well-being of the individual and eventually of the group
to which s/he belongs.
• Well-being is not simply maintenance and survival but also includes growth and
fulfillment, i.e. the actualization of potential (proposed by Maslow’s need hierarchy
theory).
• 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.
• For example, a student in the class prefers to remain silent even when s/he has questions
in her/his mind. Describing behaviour as maladaptive implies that a problem exists; it also
suggests that vulnerability in the individual, inability to cope, or exceptional stress in the
environment have led to problems in life.

WHY ARE PEOPLE HESITANT TO CONSULT A PSYCHOLOGIST?

If you talk to people around, you will see that they have vague ideas about psychological disorders
that are characterized by superstition, ignorance and fear. It is commonly believed that
psychological disorder is something to be ashamed of. The stigma attached to mental illness means
that people are hesitant to consult a doctor or psychologist because they are ashamed of their
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problems. Actually, psychological disorder which indicates a failure in adaptation should be
viewed as any other illness.

HISTORICAL BACKGROUND
To understand psychological disorders, we would require a brief historical account of how these
disorders have been viewed over the ages. The three perspectives of looking at abnormal behavior
are:

1. Supernatural Perspective
• This theory holds that abmoemal behaviour can be explained by the operation of
supernatural and magical forces such as evil spirits (bhoot-pret) or the devil
(shaitan)
• Exorcism that is, removing the evil that resides in the individual through counter
magic and prayer is still 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.

2. Biological or Organic Perspective

• It believes that individuals behave strangely because their bodies and their brains
are not working properly.
• In the modern era, there is evidence that body and brain processes have been linked
to many types of maladaptive behavior.
• For certain types of disorders, correcting these defective biological processes
results in improved functioning.

3. Psychological Approach

• According to this point of view, psychological problems are caused by inadequacies

in the way an individual thinks, feels, or perceives the world.

Evolution of understanding of Abnormal Behaviour

All three of these perspectives — supernatural, biological or organic, and psychological — have
recurred throughout the history of Western civilisation.
ANCIENT AGE
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• In the ancient Western world, it was philosopher-physicians of ancient Greece such
as Hippocrates, Socrates, and in particular Plato who developed the Organismic
approach and viewed disturbed behavior as arising out of conflicts between
emotion and reason.
• Galen elaborated on the role of the four humours in personal character and
temperament.
• According to him, the material world was made up of four elements, viz. earth, air,
fire, and water which combined to form four essential body fluids, viz. blood, black
bile, yellow bile, and phlegm.
• Each of these fluids was seen to be responsible for a different temperament.
Imbalances among the humours were believed to cause various disorders.
• This is similar to the Indian notion of the three doshas of vata, pitta and kapha which
were mentioned in the Atharva Veda and Ayurvedic texts.

MIDDLE AGES
Demonology and superstition gained renewed importance in the explanation of abnormal behavior.
Demonology related to a belief that people with mental problems were evil and there are numerous
instances of ‘witch-hunts’ during this period.
• During the early Middle Ages, the Christian spirit of charity prevailed and St. Augustine
wrote extensively about feelings, mental anguish and conflict. This laid the groundwork
for modern psychodynamic theories of abnormal behavior.

THE RENAISSANCE PERIOD

• It was marked by increased humanism and curiosity about behaviour.
• Johann Weyer emphasized psychological conflict and disturbed interpersonal
relationships as causes of psychological disorders. He also insisted that ‘witches’ were
mentally disturbed and required medical, not religious, treatment.

THE SEVENTEENTH AND EIGHTEENTH CENTURIES

• Were known as the Age of Reason and Enlightenment, as the scientific method replaced
faith and dogma as ways of understanding abnormal behavior.
• The growth of a scientific attitude towards psychological disorders in the eighteenth
century contributed to the Reform Movement and to increased compassion for people who
suffered from these disorders.
• Reforms of asylums were initiated in both Europe and America.
• One aspect of the reform movement was the new inclination for deinstitutionalization
which placed emphasis on providing community care for recovered mentally ill
individuals.

INTERACTIONAL APPROACH/BIO-PSYCHO-SOCIAL APPROACH

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• According to this perspective, all three factors, i.e. biological, psychological and social
interact with each other and play important roles in influencing the expression and
outcome of psychological disorders.
• Biological – injury/ neurotransmitter or hormonal imbalances/malnutrition
• Psychological –irrational thoughts/ maladaptive behavior/intra-psychic conflicts
• Social- war/poverty/unemployment/illiteracy/being isolated from society

CLASSIFICATION OF PSYCHOLOGICAL DISORDERS

In order to understand psychological disorders, we need to begin by classifying them. A
classification of such disorders consists of a list of categories of specific psychological disorders
grouped into various classes on the basis of some shared characteristics.
• Classifications are useful because they enable users like psychologists, psychiatrists and
social workers to communicate with each other about the disorder
• They help in understanding the causes of psychological disorders and the processes
involved in their development and maintenance.
• Currently two systems of classification of psychological disorders are used:
1. The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the The
American Psychiatric Association (APA). It is currently in its Vth Edition (DSM-V).
• It evaluates the patient on five axes or dimensions rather than just one broad
aspect of ‘mental disorder’.
• These dimensions relate to biological, psychological, social and other aspects.
2. International Classification of Diseases (ICD), which is known as the ICD-10
Classification of Behavioral and Mental Disorders. It was prepared by the World Health
Organisation (WHO).
• It is in its tenth revision (ICD-10)
• For each disorder, a description of the main clinical features or symptoms, and
of other associated features including diagnostic guidelines is provided in this
scheme.
• It is used in India

Factors Underlying Abnormal Behaviour / Causes Of Abnormal

Behaviour/Models To Explain Abnormal Behaviour

To understand something as complex as abnormal behaviour, psychologists use different

approaches. Each approach emphasizes a different aspect of human behaviour, and explains and
treats abnormality according to that aspect.
These approaches also emphasize the role of different factors such as:
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Causes of
Abnormal
Behavior

Psychological
Socio-cultural Diathesis-stress
and
Biological interpersonal
factors model

BIOLOGICAL FACTORS
According to this model, abnormal behaviour has a biochemical or physiological basis. A wide
range of biological factors may interfere with normal development and functioning of the human
body. These factors may be potential causes of abnormal behavior. These factors are:
• neurotransmitter imbalances
• faulty genes
• endocrine imbalances
• Malnutrition
• injuries

*) 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 the message must move across that space. When an electrical
impulse reaches a neuron’s ending, the nerve ending is stimulated to release a chemical, called a
neurotransmitter. Studies indicate that abnormal activity by certain neurotransmitters can lead to
specific psychological disorders.
• Anxiety disorders have been linked to low activity of the neurotransmitter gamma amino
butyric acid (GABA)
• Depression is attributed to low activity of serotonin.
• Schizophrenia is attributed to excess activity of dopamine

Genetic factors:
• have been linked to mood disorders, schizophrenia, mental retardation and other
psychological disorders. Researchers have not, however, been able to identify the specific
genes that are the culprits.
• In most cases, no single gene is responsible for a particular behavior or a psychological
disorder. Many genes combine to help bring about our various behaviors and emotional
reactions, both functional and dysfunctional.
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• Although there is sound evidence to believe that genetic/ biochemical factors are involved
in mental disorders as diverse as schizophrenia, depression, anxiety, etc. but biology alone
cannot account for most mental disorders.

PSYCHOLOGICAL MODELS
These models maintain that psychological and interpersonal factors have a significant role to
play in abnormal behaviour. These factors include:
• maternal deprivation (separation from the mother, or lack of warmth and stimulation during
early years of life)
• faulty parent-child relationships (rejection, overprotection, overpermissiveness, faulty
discipline, etc.)
• maladaptive family structures (inadequate or disturbed family)
• severe stress.

Psychological
model

Humanistic-
Psychodynamic Behavioral
Cognitive model Existential
model model model

Psychodynamic model
• Psychodynamic theorists believe that behaviour, whether normal or abnormal, is
determined by psychological forces within the person of which s/he is not consciously
aware.
• These internal forces are considered dynamic, i.e. they interact with one another and their
interaction gives shape to behaviour, thoughts and emotions.
• Abnormal symptoms are viewed as the result of conflicts between these forces.
• This model was first formulated by Freud who believed that three central forces shape
personality — instinctual needs, drives and impulses (id), rational thinking (ego), and
moral standards (superego). Freud stated that abnormal behaviour is a symbolic expression
of unconscious mental conflicts that can be generally traced to early childhood or infancy.
Behavioral model
• This model states that both normal and abnormal behaviours are learned.
• Psychological disorders are the result of learning maladaptive ways of behaving.
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• The model concentrates on behaviours that are learned through conditioning. It proposes
that what has been learned can be unlearned. Learning can take place by :

Classical conditioning (temporal association in which two events repeatedly occur close together
in time)
Operant conditioning (behaviour is followed by a reward),
Social learning (learning by imitating others’ behaviour).
These three types of conditioning account for behaviour, whether adaptive or maladaptive.

Cognitive model
• This model states that abnormal functioning can result from cognitive problems.
• People may hold assumptions and attitudes about themselves that are irrational and
inaccurate.
• People may also repeatedly think in illogical ways and make overgeneralizations, that is,
they may draw broad, negative conclusions on the basis of a single insignificant event.

Humanistic-existential model
• It focuses on broader aspects of human existence.
• Humanists believe that human beings are born with a natural tendency to be friendly,
cooperative and constructive, and are driven to self-actualise, i.e. to fulfill this potential for
goodness and growth.
• Existentialists believe that from birth we have total freedom to give meaning to our
existence or to avoid that responsibility. Those who shirk from this responsibility would
live empty, inauthentic, and dysfunctional lives.

SOCIO-CULTURAL MODEL
• According to this model, abnormal behavior is best understood in light of the social and
cultural forces that influence an individual. The broader social networks in which people
operate include their social and professional relationships.
• Socio-cultural factors such as war and violence, group prejudice and discrimination,
economic and employment problems, and rapid social change, put stress on most of us and
can also lead to psychological problems in some individuals.
• As behavior is shaped by societal forces, factors such as family structure and
communication, social networks, societal conditions, and societal labels and roles become
more important. It has been found that certain family systems are likely to produce
abnormal functioning in individual members.
• Some families have an enmeshed structure in which the members are overinvolved in each
other’s activities, thoughts, and feelings. Children from this kind of family may have
difficulty in becoming independent in life.
• Research shows that individuals who lack social support and are isolated are likely to
become more depressed and remain depressed longer than those who have good
relationships.
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• It is believed by the socio cultural theorists that abnormal functioning is influenced by the
societal labels and roles assigned to troubled people. When people break the norms of their
society, they are labeled as deviant and “mentally ill”. These labels stay with the affected
individual for almost their entire lifetime. Such individuals may be seen as “crazy” and be
encouraged to act sick. The person lea

DIATHESIS STRESS MODEL (CBSE 2016-6 m)

According to this model, psychological disorders develop when a diathesis (biological

predisposition) is set off by a stressful situation. The three components of this model are:
The presence of a diathesis/biological aberration, which may be inherited For example, low
activity of serotonin.
The diathesis may carry a vulnerability to develop a psychological disorder, that is , the
person is at risk or predisposed to develop the disorder. For example, an individual with
low activity of serotonin is predisposed towards depression.
The presence of pathogenic stressor, that is, stressors/factors that may lead to
psychopathology. If such at risk individuals are exposed to these stressors, their
predisposition may develop into a disorder. For example, when this individual is faced with
a stressor (eg. excessive work stress), s/he may get depressive disorder.

MAJOR PSYCHOLOGICAL DISORDERS

Anxiety Disorders
Anxiety refers to a diffuse, vague, very unpleasant feeling of fear and apprehension.
Anxiety Disorders- the disorders characterized by clear and overt presence of marked anxiety
(diffuse, vague, very unpleasant feeling of fear and apprehension.)
Difference between normal and abnormal anxiety
We experience anxiety when we are waiting to take an examination, or to visit a dentist, or even
to give a solo performance. This is normal and expected and even motivates us to do our task well.
On the other hand, high levels of anxiety that are distressing and interfere with effective
functioning indicate the presence of an anxiety disorder. Everyone has worries and fears. The
anxious individual also shows combinations of the following symptoms:

• rapid heart rate,

• shortness of breath,
• diarrhea,
• loss of appetite,
• fainting,
• dizziness,
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• sweating,
• sleeplessness,
• frequent urination
• tremors

Generalized Anxiety Disorder (GAD)

❖ Consists of prolonged, vague, unexplained and intense fears that are not attached to any
particular object.
❖ The symptoms include
• worry and apprehensive feelings about the future;
• hypervigilance, which involves constantly scanning the environment for dangers
• Motor tension, as a result of which the person is unable to relax, is restless, and
visibly shaky and tense.

Panic Disorder
• Consists of repeated anxiety attacks in which a person experiences extreme terror.
• a panic attack starts when the thoughts of a particular stimulus/situation come to the
mind of the patient. This leads to a sudden increase in anxiety levels.
The symptoms are as follows:
• Shortness of breath
• Dizziness
• Trembling
• Palpitations
• Choking
• Nausea
• Chest pain/discomfort
• Fear of going crazy
• Losing control/dying

Phobias (CBSE 2018-6m- A person has a phobia of cockroaches. Explain this phobia from a
social learning perspective and a psychoanalyst’s viewpoint, giving examples)

• Are Intense , Irrational fears attached to specific objects, people or situations

• Often develop gradually or begin with a generalized anxiety disorder
• Are of 3 main types: Specific, Social, Agoraphobia
• Specific Phobias: include intense, irrational fears such as fear of a certain animal or
situation or entity. Eg. Fear of lizards, fear of being in enclosed space, fear of water/
heights.
• Social Phobias: include intense, irrational fear and embarrassment when required to deal
with other people. Eg. Inability to speak a word of a well learnt poem/speech before an
audience
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• Agoraphobia: in this people develop an intense, irrational fear of entering unfamiliar
situations. Many agoraphobics are afraid of leaving their home. Thus, their ability to carry
out normal life activities is very insufficient.

Separation Anxiety Disorder (SAD) (CBSE 2018-2m)

1. Excessive anxiety or even panic experienced by children at being separated from their
parents.
2. being in a room by themselves, going to school alone,
3. are fearful of entering new situations,
4. Cling to and shadow their parents’ every move.
5. To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or make
suicidal gestures.

Obsessive Compulsive Disorder (OCD) and related disorders

• Includes the inability to control one’s fixation with specific ideas AND prevent
oneself from repeatedly carrying out a particular act /series of acts
• Which obstruct the ability to carry out normal activities.
• Obsessive thoughts: is the inability to stop thinking about a particular idea or
topic. The person involved often finds these thoughts to be unpleasant and
shameful. Eg. repeated thoughts of germs, dirt, being robbed.
• Compulsive Behavior: is the need to perform certain behaviors over and over
again so as to stop the obsessive thoughts. Eg. Repeatedly counting, checking,
washing

Mostly, obsessions and compulsions occur together, but one can occur in the absence of
the other.
Obsessive Thoughts Compulsive Behavior
Repeated thoughts of germs Repeatedly washing hands/ cleaning
surroundings
Repeated thoughts of being robbed Repeatedly checking belongings,
counting money , checking doors and
windows
Repeated thoughts of a fire starting and Repeatedly checking the stove
causing destruction

Include Table 4.1 NCERT

Trauma and Stressor related Disorders

Include PTSD +Adjustment Disorders and Acute stress disorder

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Post Traumatic Stress Disorder (PTSD)
• Individuals who have been caught in disasters (natural or man-made) experience PTSD.
• Those who’ve been caught in earthquakes are survivors of bomb blasts/accidents or war
related situations often experience this.
• They experience the following symptoms:
-Recurrent dreams
-Flashbacks
-Poor concentration
-May become emotionally numb /unresponsive/disoriented

Dissociative Disorders
Dissociation: refers to the breaking of the link between ideas and emotions. Involves a
feeling of unreality, estrangement/ separation, loss or shift of identity.

Dissociative disorders: are characterized by sudden temporary alterations of

consciousness that blot out painful experiences.

Box 4.1- to do

Dissociative Amnesia
[Link] but selective memory loss that has NO known organic cause (eg. Head
injury)
[Link] people can’t remember anything about their past
iii. In some cases, people’s memories for certain events is complete but they can’t recall
specific events, people, places, objects
[Link] associated with excessive stress
A part of this disorder is Dissociative Fugue, the symptoms of which are -
i. There is unexpected travel away from home and workplace.
ii. The individual assumes a new identity and is not able to recall the previous
identity
iii. The fugue ends when the person suddenly “wakes up” and can’t recall anything
that happened during the fugue state.
iv. Often associated with very high stress levels

Dissociative Identity Disorder

i. Is also called Multiple Personality Disorder
ii. Often associated with traumatic experience in childhood
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iii. Person assumes alternate personalities that may or may not be aware of each other

Depersonalization/ Derealization Disorder

i. Involves a dreamlike state in which the person has a sense of being separated
from both self and from reality
ii. There is a change of self-perception.
iii. The person’s sense of reality is temporarily lost or changed

Schizophrenia Spectrum And Other Psychotic Disorders

i. Schizophrenia is the descriptive term for a group of psychotic disorders in

which personal, social and occupational functioning decline because of
disturbed thought processes, strange perceptions, unusual emotional states,
and motor abnormalities.
ii. It is a debilitating disorder. The social and psychological costs of
schizophrenia are huge- both to patients as well as to their families and
society.

POSITIVE SYMPTOMS NEGATIVE SYMPTOMS PSYCHOMOTOR

SYMPTOMS

i. are pathological excesses’ or i. ‘pathological i. Severe motor

‘bizarre additions’ to a deficits -deficits of abnormalities.
person’s behavior- excesses thought, emotion, ii. People with
of thought, emotion, and and behaviour schizophrenia
behavior move less
spontaneously or
make odd
grimaces and
gestures.
Include : Include : These symptoms may
take extreme forms
i. Delusions, i. poverty of speech,
known as catatonia.
ii. disorganized thinking and ii. blunted and flat
speech, affect,
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iii. heightened perception and iii. loss of volition,
hallucinations, iv. Social withdrawal.
[Link] affect
Delusions. Alogia Types of Catatonia:

• A delusion is a false belief that People with schizophrenia

is firmly held on inadequate show alogia or poverty of
grounds. i. People in a
speech, i.e. a reduction in
• It is not affected by rational catatonic stupor
speech and speech remain motionless
argument, and has no basis in
content. and silent for long
reality.
stretches of time.
ii. Some show
Types of delusions catatonic rigidity,
i.e. maintaining a
Delusions of persecution are the most rigid, upright
common in schizophrenia. People with posture for hours.
this delusion believe that they are iii. catatonic
being plotted against, spied on, posturing, i.e.
slandered, threatened, attacked or assuming
deliberately victimized. awkward, bizarre
positions for long
[Link] of reference in which periods
people attach special and
personal meaning to the actions
of others or to objects and
events.

[Link] of grandeur- people

believe themselves to be
specially empowered persons
[Link] of control- people
believe that their feelings,
thoughts and actions are
controlled by others.
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Disorganized thinking and speech

• People with schizophrenia may Blunted and flat affect

not be able to think logically and
may speak in peculiar ways. i. blunted affect-
• These formal thought disorders Many people with
can make communication schizophrenia
extremely difficult. show less anger,
These include : sadness, joy, and
other feelings than
[Link] of associations, most people do.
derailment: rapidly shifting ii. flat affect - Some
from one topic to another show no emotions
so that the normal structure at all
of thinking is muddled and
becomes illogical
ii. neologisms; inventing new
words or phrases
iii. Perseveration: persistent and
inappropriate repetition of
the same thoughts
Loss of volition (volition -
ability to make decisions)
Hallucinations,
i. patients with
perceptions that occur in the schizophrenia
absence of external stimuli. experience
avolition, or apathy
and an inability to
start or complete a
Types :
course of action.
i. Auditory hallucinations are
most common in
schizophrenia. Patients hear
sounds or voices that speak
words, phrases and
sentences directly to the
patient (secondperson
hallucination) or talk to one
another referring to the
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patient as s/he (thirdperson
hallucination).
ii. tactile hallucinations (i.e.
forms of tingling, burning),
iii. somatic hallucinations (i.e.
something happening inside
the body such as a snake
crawling inside one’s
stomach),
iv. visual hallucinations (i.e.
vague perceptions of colour
or distinct visions of people
or objects),
v. gustatory hallucinations (i.e.
food or drink taste strange),
vi. olfactory hallucinations (i.e.
smell of poison or smoke).
Inappropriate affect Social withdrawal

People with schizophrenia also People with this disorder

show inappropriate affect, i.e. may withdraw socially and
emotions that are unsuited to the become totally focused on
situation. their own ideas and
fantasies.

Feeding and Eating Disorders (CBSE 2020- 4m)

Eating
Disorders

Anorexia Bulimia Binge

Nervosa Nervosa Eating

1. In anorexia nervosa,
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the individual has a distorted body image that leads her/him to see herself/himself as
overweight
Often refuse to eat,
exercise compulsively Develop unusual habits such as refusing to eat in front of others,
the anorexic may lose large amounts of weight and even starve herself/himself to death.

2. In bulimia nervosa, (binge –purge cycle)

the individual may eat excessive amounts of food, then purge her/ his body of food by
using medicines such as laxatives or diuretics or by vomiting.
The person often feels disgusted and ashamed when s/he binges and is relieved of
tension and negative emotions after purging.

3. In binge eating,
there are frequent episodes of out-of-control eating
tends to eat at a higher speed than normal and continues to eat till s/he feels
uncomfortably full
large amounts of food are eaten even when the individual isn’t hungry

Neurodevelopmental Disorders
i). Manifested in the early stages of development.
ii). Symptoms appear before the child enters school or during early stages of
schooling.
iii). These disorders hinder personal social academic and occupational functioning
iv). They are manifested as deficits or excesses in a particular behavior or delays in
achieving a particular age appropriate behavior.

I. Attention Deficit hyperactivity disorder (ADHD)

i. The two main features of ADHD are inattention and hyperactivity impulsivity.
ii. Children who are inattentive find it difficult to:
• sustain mental effort during work or play.
• They have a hard time keeping their minds on any one thing or in following
instructions.
• do not listen,
• cannot concentrate,
• do not follow instructions,
• Are disorganized,
• easily distracted,
• Forgetful,
• do not finish assignments,
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• quick to lose interest in boring activities.

iii. Children who are impulsive:

• seem unable to control their immediate reactions or to think before they
act.
• find it difficult to wait or take turns,
• have difficulty resisting immediate temptations or delaying gratification.
• Minor mishaps such as knocking things over
• more serious accidents and injuries can also occur.

iv. Children with Hyperactivity:-

• are in constant motion. Sitting still through a lesson is impossible for
them.
• may fidget, squirm, climb and run around the room aimlessly.
• Parents and teachers describe them as ‘driven by a motor’, always on the
go, and talk nonstop.
Boys are four times more likely to be given this diagnosis than girls.

II. Autism Spectrum Disorder

Children with autistic disorder have marked difficulties in:

• Social interaction: Children with autism experience profound difficulties in relating to other
people. They are unable to start social behavior and seem unresponsive to other people’s feelings.
They are unable to share experiences or emotions with others.

• Communication: They show serious abnormalities in communication and language that

continue over time. Many autistic children never develop speech and those who do, have
repetitive and deviant speech patterns.

• A restricted range of interests and strong desire for routine: Children with autism often show
narrow patterns of interests and repetitive behaviors such as lining up objects or stereotyped
body movements such as rocking. These motor movements may be self-stimulatory such as hand
flapping or self-injurious such as banging their head against the wall.

About 70 per cent of children with autism are also mentally retarded.

III. Specific Learning disorder

i). The individual experiences difficulty in perceiving or processing information
efficiently and accurately
ii). These become visible during early school years
iii). The individual faces issues in basic skills of reading, writing and/or mathematics.
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iv). Child tends to perform below average for her/his age.
v). Some may be able to reach acceptable performance levels with additional inputs and
efforts.
vi). This disorder impairs functioning and performance in activities/ occupations
dependent on these related skills.

IV. Intellectual Disability

The American Association on Mental Deficiency (AAMD) views mental retardation as
“significantly sub-average general intellectual functioning existing concurrently with deficits
in adaptive behaviour and manifested during the developmental period”. (Do Table 4.2,
Pg.85)

Disruptive , Impulse control and conduct disorders

1) Oppositional Defiant Disorder (ODD)

Children with Oppositional Defiant Disorder (ODD) display age-inappropriate amounts of:
i). stubbornness,
ii). are irritable,
iii). rebellious,
iv). disobedient,
v). Behave in a hostile manner.
vi). Do not see themselves as angry, stubborn
vii). often justify their behavior as reaction to the demands

Unlike ADHD, the rates of ODD in boys and girls are not very different.

2) Conduct Disorder and Antisocial Behavior

i. refer to age inappropriate actions and attitudes that violate family expectations,
societal norms, and the personal or property rights of others.
ii. The behaviors typical of conduct disorder include
• aggressive actions that cause or threaten harm to people or animals,
• non-aggressive conduct that causes property damage,
• major deceitfulness or theft,
• Serious rule violations.
iii. Children show many different types of aggressive behavior, such as:
• verbal aggression (i.e. name-calling, swearing),
• physical aggression (i.e. hitting, fighting),
• hostile aggression (i.e. directed at inflicting injury to others),
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• proactive aggression (i.e. dominating and bullying others without
provocation).

Substance Related And Addictive Disorders

(Do Box 4.2, 4.3 From N.C.E.R.T.)
Are disorders relating to maladaptive behaviors, resulting from regular and consistent use
of the substance involved.
Psychoactive substances: are substances which have the ability to change a person’s mood,
thinking and consciousness.
Addictive behaviour is one of the most severe problems being faced today. It refers to an
excessive intake of high calorie food or the abuse of substances such as alcohol or cocaine.

Substance use disorders Substance Dependence (Tolerance, Withdrawal)

Substance Abuse
Substance Dependence: strong craving for the substance to which person is addicted to. The
person shows tolerance withdrawal symptoms and takes drug over and over again.
Tolerance means that person needs more amount of a substance to feel its effect.
Withdrawal refers to physical symptoms that occur when a person stops or reduces the use
of the substance.

Substance Abuse: refers to the frequent and significant, extreme consequences which occur
because of use of substance. People who regularly consume drugs cause harm to their family,
friends and perform poorly at work.

Alcohol abuse and dependence

i). Alcohol abusers drink it in large amounts regularly.
ii). They depend on it to help them deal with difficult situations.
iii). This interferes with their ability to think and work.
iv). It interferes with social behavior.
v). Over time, abuse results in dependence. Their bodies develop tolerance for alcohol.
They also experience unpleasant physical symptoms when they reduce the quantity
or stop the consumption.
• The chemical in alcohol (called ethyl alcohol) slows down the functioning of the
central nervous system.
• It slows down those areas of brain that control judgement and inhibition. Thus,
people feel more confident and happy. They become more talkative and friendly.
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• As alcohol is absorbed it affects other areas of brain. People are unable to think
logically and can’t reason well. They are unable to speak clearly. May become
emotional and aggressive.
• Can’t walk well. Are clumsy in performing simple activities.

Effects of alcohol:
i). destroys families,
ii). road accidents,
iii). damage to physical health which could further lead to death,
iv). damage to babies in mother’s womb,
v). blurred vision,
vi). problem in hearing,
vii). difficulty in problem solving,
viii). distorts ability to make judgments.
ix). Children of alcohol abusers have higher rates of psychological problems like,
depression, anxiety, phobias.

Heroine abuse and dependence

i). Consuming heroine interferes with social and occupational activities.
ii). Most abusers develop dependence and tolerance for it. Their lives revolve around
obtaining and consuming the drug. They experience withdrawal symptoms when
they stop taking it.
iii). An overdose of this drug slows down the respiratory centres in the brain, which
disturb breathing and lead to death, in many cases.

Cocaine abuse and dependence

i). Regular use of cocaine may lead to a pattern where the person remains under the
influence of the drug throughout the day. This will cause him/her to function poorly
in social relationships and at work.
ii). It can cause problems in short term memory and attention.
iii). Dependence may develop (more amount of drug is needed to get desired effect).
iv). Stopping use of drug results in withdrawal symptoms like-sleep problems,
depression, tiredness, anxiety, irritability.
v). It has dangerous effects on the psychological functioning and physical well being of
the person.

Somatic Symptom And Related Disorders:

1. In these disorders, there are physical symptoms in the absence of a physical
disease.
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2. That is, the individual has psychological difficulties and complains of physical
symptoms, which have no biological cause.

Somatic symptom disorder

i. Involves multiple and recurrent /chronic bodily complaints such as headaches,
tiredness, fainting spells, vomiting, allergies, which may or may not be related to
any serious medical condition.
ii. Patients are excessively pre-occupied with their symptoms
iii. Worry about their health continuously
iv. Visit doctors frequently
v. Thus, experience significant distress and disturbance in daily life

Illness Anxiety disorder

• An individual holds a persistent belief that s/he is unwell despite Medical
reassurance (despite a doctor comforting them about their good health)
• Worry about developing a serious illness
• Are always anxious about their health
• Have excessive ,persistent concerns about –
• Undiagnosed disease
• Negative diagnostic result
• Easily alarmed when they hear about other people being unwell

Both illness anxiety and somatic symptom disorder are concerned with
medical illnesses
The difference lies in the way the concern is expressed-
i). In illness anxiety theexpression is the anxiety about health
ii). In somatic symptom disorder the expression is in terms of physical
complaints

Conversion Disorders:
i. Symptoms include –reported loss of part or all of some basic body function.
ii. Common symptoms are- Paralysis, blindness, deafness , difficulty in walking
iii. These symptoms mostly occur after a stressful experience and may be sudden.
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