CHAPTER 4: PSYCHOLOGICAL DISORDERS

The word ‘abnormal’ literally means “away from the normal”, it implies
deviation from some clearly defined norms or standards.

Abnormal behaviour is characterised by ‘four Ds’: deviance, distress,

dysfunction and danger.

Psychological disorders are:

• 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

APPROACHES USED IN DISTINGUISHING NORMAL AND ABNORMAL

BEHAVIOUR

The first approach views 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 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 behaviour,
whereas one that emphasises cooperation and family values (such as in India)
may consider aggressive behaviour as unacceptable or even abnormal.

The second approach views abnormal behaviour 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 the group to which s/he belongs.

Well-being is not simply maintenance and survival but also includes growth
and fulfilment, i.e. the actualisation 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. For
example, a student in the class prefers to remain silent even when s/he has
questions in her/his mind.

Maladaptive behaviour implies that a problem exists, vulnerability in the

individual, inability to cope or exceptional stress in the environment has led
to problems in life.
Due to the stigma attached to mental illness people are hesitant to consult a
doctor/psychologist because they are ashamed of their problems and as a
result they fail to adapt to their environment.

HISTORICAL APPROACH

❖ ANCIENT PERIOD

• Supernatural approach - One ancient theory that is still encountered

today holds 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 is used for removing the evil that resides in the individual
through countermagic and prayer.

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.

• Organismic approach – Philosopher physicians of ancient Greece such

as Hippocrates, Socrates, and in particular Plato developed the
organismic approach and viewed disturbed behaviour as arising out
of conflicts between emotion and reason.

Galen elaborated on the role of the four humours in personal character

and temperament. 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.

• Biological/Organic approach – According to this approach,

individuals behave strangely because their bodies and their brains are
not working properly. For certain types of disorders, correcting these
defective biological processes results in improved functioning.

• Psychological approach - According to this point of view, psychological

problems are caused by inadequacies in the way an individual thinks,
feels, or perceives the world.

❖ MIDDLE AGES

In the Middle Ages, demonology and superstition gained renewed

importance in the explanation of abnormal behaviour. Demonology
related to a belief that people with mental problems were evil and there
are numerous instances of ‘witch-hunts’ during this period.

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 behaviour.

❖ RENAISSANCE PERIOD

The Renaissance Period was marked by increased humanism and

curiosity about behaviour.

Johann Weyer emphasised psychological conflict and disturbed

interpersonal relationships as causes of psychological disorders. He
also insisted that ‘witches’ were mentally disturbed and required
medical, not theological, treatment.

❖ AGE OF REASON AND ENLIGHTENMENT

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 behaviour.

The growth of a scientific attitude contributed to the Reform

Movement and 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 deinstitutionalisation which

placed emphasis on providing community care for recovered mentally
ill individuals.

In recent years, there has been a convergence of these approaches,

which has resulted in an interactional, or biopsychosocial approach.
From this perspective, all three factors, i.e. biological, psychological and
social play important roles in influencing the expression and outcome
of psychological disorders.

CLASSIFICATION OF DISORDERS

A classification of 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 and help in understanding the causes of psychological disorders and
the processes involved in their development and maintenance.

Diagnostic Statistical Manual International Classification of

(DSM – 5) Diseases (ICD – 10)
Published by American Psychiatric Prepared by World Health
Association (APA) Organization (WHO)
Official manual for describing and Classification scheme officially used
and classifying various kinds of in India and elsewhere for
psychological disorders. classification of behavioural and
mental disorders.
Currently, the 5th edition is in use. Currently, the 10th revision is in use.
It presents discrete clinical criteria For each disorder, a description of
which indicate the presence or the main clinical features or
absence of disorders. symptoms, and of other associated
features including diagnostic
guidelines is provided.
FACTORS UNDERLYING ABNORMAL BEHAVIOUR

Some of the approaches/factors which are currently being used to explain

abnormal behaviour:

❖ Biological factors - A wide range of biological factors such as faulty

genes, endocrine imbalances, malnutrition, injuries and other
conditions may lead to abnormal behaviour.

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 aminobutyric acid (GABA), schizophrenia to
excess activity of dopamine, and depression to low activity of serotonin.
❖ Genetic factors have been linked to mood disorders, schizophrenia,
mental retardation and other psychological disorders.
No single gene is responsible for a particular behaviour or a
psychological disorder. Infact, many genes combine to help bring about
various behaviours and emotional reactions, both functional and
dysfunctional.

❖ Psychological factors – Psychological models maintain that

psychological and interpersonal factors have a significant role to play
in abnormal behaviour.
These factors include:
• Maternal deprivation (separation from the mother, or lack of
warmth and stimulation during early years of life)
• Faulty parent-child relationships (rejection, overprotection, over
permissiveness, faulty discipline, etc.)
• Maladaptive family structures (inadequate or disturbed family)
• Severe stress

The psychological models include the psychodynamic, behavioural,

cognitive, and humanistic-existential models.
1. 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.

This model was first formulated by Freud who believed that three
central forces shape personality — id (instinctual needs, drives and
impulses), ego (rational thinking), and superego (moral standards).
Freud stated that abnormal behaviour is a result of unconscious mental
conflicts that can be generally traced to early childhood or infancy.

2. Behavioural model – This model states that both normal and abnormal
behaviours are learned and psychological disorders are the result of
learning maladaptive ways of behaving. It also proposes that what has
been learned can be unlearned.

Learning can take place by classical conditioning (temporal

association in which two events repeatedly occur close together in time),
operant conditioning (behaviour is followed by a reward) and social
learning (learning by imitating others behaviour).

3. Cognitive model – This model states that abnormal functioning can

result from cognitive problems. People may hold assumptions and
attitudes about themselves that are irrational and inaccurate. People
may also repeatedly think in illogical ways and make
overgeneralisations, that is, they may draw broad, negative conclusions
on the basis of a single insignificant event.

4. Humanistic-existential model 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.

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 factors – 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.
• Socio-cultural model - Abnormal behaviour is best understood in light
of the social and cultural forces that influence an individual.
As behaviour is shaped by societal forces, factors such as family
structure and communication, social networks, societal conditions, and
societal labels and roles become more important.

Some families have an enmeshed structure in which the members are

overinvolved in each other’s activities, thoughts, and feelings. Children
from this kind of family may have difficulty in becoming independent in
life.

Studies have shown that people who are isolated and lack social
support are likely to become more depressed and remain depressed
longer than those who have good friendships.

Abnormal functioning is influenced by the societal labels and roles

assigned to troubled people. When people break the norms of their
society, they are called deviant and ‘mentally ill’. Such labels tend to
stick to the person and the person gradually learns to accept and play
the sick role, and functions in a disturbed manner.

• Diathesis-stress model. This model states that psychological disorders

develop when a diathesis (biological predisposition to the disorder) is set
off by a stressful situation.

This model has three components:

The first is the diathesis or the presence of some biological aberration

which may be inherited.

The second component is that the diathesis may carry a vulnerability

to develop a psychological disorder. This means that the person is ‘at
risk’ or ‘predisposed’ to develop the disorder.
The third component is the presence of pathogenic stressors. If such “at
risk” persons are exposed to these stressors, their predisposition may
actually evolve into a disorder.

This model has been applied to several disorders including anxiety,

depression, and schizophrenia.
MAJOR PSYCHOLOGICAL DISORDERS

❖ ANXIETY DISORDERS

The term anxiety is usually defined as a diffuse, vague, very

unpleasant feeling of fear and apprehension.

The anxious individual also shows combinations of the following

symptoms:

• Rapid heart rate

• Shortness of breath
• Diarrhoea
• Loss of appetite
• Fainting
• Dizziness
• Sweating
• Sleeplessness
• Frequent urination
• Tremors

Anxiety disorders are of many types:

1. Generalised Anxiety Disorder (GAD)

2. Panic Disorder
3. Phobias (Specific phobias, Social phobia (social anxiety disorder) and
Agoraphobia)
4. Separation Anxiety Disorder (SAD)

Generalised Anxiety Disorder

Generalised anxiety disorder 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

Panic disorder consists of recurrent panic attacks in which the person

experiences intense terror.

A panic attack denotes an abrupt surge of intense anxiety rising to a peak

when thoughts of a particular stimuli are present.

Clinical features include:

• Shortness of breath
• Dizziness
• Trembling
• Palpitations
• Choking
• Nausea
• Chest pain or discomfort
• Fear of going crazy
• Losing control or dying

Phobia

People who have phobias have irrational fears related to specific objects,
people or situations.

Phobias can be grouped into three main types:

• Specific phobia includes irrational fear such as intense fear of certain

type of animal or being in an enclosed space.
• Social phobia/Social anxiety disorder involves intense and
incapacitating fear and embarrassment when dealing with others.
• Agoraphobia is the term used when people develop a fear of entering
unfamiliar situations.

Separation Anxiety Disorder (SAD)

Individuals with separation anxiety disorder are fearful and anxious about
separation from attachment figures that is developmentally not
appropriate.

Children with SAD may have difficulty being in a room by themselves, going
to school alone, fearful of entering new situations and cling to their parents.
To avoid separation, these children may fuss, scream, throw severe tantrums
or make suicidal gestures.

Other disorders included under the category of Anxiety Disorders are:

Selective Mutism
Substance/Medication Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition

❖ OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

People affected by obsessive compulsive disorder are unable to control

their preoccupation with specific ideas or are unable to prevent
themselves from repeatedly carrying out a particular act or series of
acts that affect their ability to carry out normal activities.

Obsessive behaviour is the inability to stop thinking about a particular

idea or topic. The person involved, often finds these thoughts to be
unpleasant and shameful.

Compulsive behaviour is the need to perform certain behaviours over

and over again. Many compulsions deal with counting, ordering,
checking, touching and washing.

Other disorders in this category include:

Hoarding disorder
Trichotillomania (hair-pulling disorder)
Excoriation (skin-picking) disorder

❖ TRAUMA AND STRESSOR-RELATED DISORDERS

Very often people who have been caught in a natural disaster (such as
tsunami), bomb blasts by terrorists, or been in a serious accident or in
a war-related situation, experience post-traumatic stress disorder
(PTSD).

PTSD symptoms vary widely but may include:

• Recurrent dreams
• Flashbacks
• Impaired concentration
• Emotional numbing

Other disorders included in this category are:

Adjustment Disorders
Acute Stress Disorder
❖ SOMATIC SYMPTOM AND RELATED DISORDERS

In these disorders, the individual has psychological difficulties and

complains of physical symptoms, for which there is no biological cause
i.e. there are physical symptoms in the absence of physical disease.

These disorders include:

1. Somatic symptom disorder

2. Illness Anxiety disorder
3. Conversion disorders

Somatic symptom disorder

Somatic symptom disorder involves a person having persistent body-related

symptoms which may or may not be related to any serious medical condition.

People with this disorder tend to be:

• Overly preoccupied with their symptoms

• Continually worry about their health
• Make frequent visits to the doctor

As a result, they experience significant distress and disturbances in their daily

life.

Illness anxiety disorder

Illness anxiety disorder involves persistent preoccupation about developing

a serious illness and constantly worrying about this possibility.

It is accompanied by:

• Anxiety about one’s health

• Overly concerned about undiagnosed disease/negative diagnostic
results
• Do not respond to assurance by doctors
• Easily alarmed about illness such as on hearing about someone else’s
ill-health
Both somatic symptom disorder and illness anxiety disorder are concerned
with medical illness. However, in the case of somatic symptom disorder,
the expression is in terms of physical complaints while in the case if illness
anxiety disorder, it is the anxiety which is the main concern.

Conversion disorder

The symptoms of conversion disorders are the reported loss of part or all of
some basic body functions. It may include symptoms like:

• Paralysis
• Blindness
• Deafness
• Difficulty in walking

These symptoms often occur after a stressful experience and may be quite
sudden.

❖ DISSOCIATIVE DISORDERS

• Dissociation is severance of the connections between ideas and

emotions.
• Dissociation involves feelings of unreality, estrangement,
depersonalisation, and sometimes a loss or shift of identity.
• Sudden temporary alterations of consciousness that blot out painful
experiences are a defining characteristic of dissociative disorders.

Conditions included in this are:

1. Dissociative Amnesia
2. Dissociative Identity Disorder
3. Depersonalisation/Derealisation Disorder

Dissociative amnesia

• Dissociative amnesia is characterised by extensive but selective

memory loss that has no known organic cause (e.g., head injury).
• Some people cannot remember anything about their past. Others can
no longer recall specific events, people, places, or objects, while their
memory for other events remains intact.
• A part of dissociative amnesia is dissociative fugue. Essential feature
of this could be an unexpected travel away from home and
workplace, the assumption of a new identity, and the inability to
recall the previous identity. The fugue usually ends when the person
suddenly ‘wakes up’ with no memory of the events that occurred during
the fugue.

This disorder is often associated with an overwhelming stress.

Dissociative identity disorder

• Often referred to as multiple personality, is the most dramatic of the

dissociative disorders.
• It is often associated with traumatic experiences in childhood.
• In this disorder, the person assumes alternate personalities that may
or may not be aware of each other.

Depersonalisation/Derealisation disorder

• This disorder involves a dreamlike state in which the person has a

sense of being separated both from self and from reality.
• In depersonalisation, there is a change of self-perception, and the
person’s sense of reality is temporarily lost or changed.
❖ DEPRESSIVE DISORDERS

Depression can refer to a symptom or a disorder.

In day-to-day life, we often use the term depression to refer to normal

feelings after a significant loss, such as the break-up of a relationship,
or the failure to attain a significant goal.

Major depressive disorder is defined as a period of depressed mood

and/or loss of interest or pleasure in most activities, together with other
symptoms which may include:

• Change in body weight

• Constant sleep problems
• Tiredness
• Inability to think clearly
• Agitation
• Greatly slowed behaviour
• Thoughts of death and suicide
• Excessive guilt or feelings of worthlessness

Factors Predisposing towards Depression:

• Genetic make-up, or heredity is an important risk factor for major

depression and other depressive disorders.
• Age is also a risk factor. For instance, women are particularly at risk
during young adulthood, while for men the risk is highest in early
middle age.
• Gender also plays a great role in this differential risk addition. For
example, women in comparison to men are more likely to report a
depressive disorder.
• Other risk factors are experiencing negative life events and lack of social
support.

❖ BIPOLAR AND RELATED DISORDERS

• Bipolar mood disorders were earlier referred to as manic-depressive

disorders.
• Bipolar I disorder involves both mania and depression, which are
alternately present and sometimes interrupted by periods of normal
mood. Manic episodes rarely appear by themselves; they usually
alternate with depression.
• Some examples of types of bipolar and related disorders include Bipolar
I Disorder, Bipolar II disorder and Cyclothymic Disorder.

Suicide takes place throughout the lifespan. Suicide is a result of complex

interface of biological, genetic, psychological, sociological, cultural and
environmental factors.

Some risk factors are:

• Having mental disorders (especially depression and alcohol use

disorders)
• Going through natural disasters
• Experiencing violence, abuse or loss and isolation at any stage of life
• Previous suicidal attempt is the strongest risk factor

Suicidal behaviour indicates difficulties in:

• Problem solving
• Stress management
• Emotional expression

Suicidal thoughts lead to suicidal action. These thoughts are heightened

under acute emotional and other distress.

The ramifications of suicide on social circle and communities tend to be

devastating and long-lasting. Due to the stigma surrounding suicide, many
people who are contemplating or even attempting suicide do not seek help
thus, preventing timely help from reaching them.

Thus, in order to prevent suicide, it is important to improve:

• Identification (Identify vulnerability and comprehend circumstances
that lead to such behaviour)
• Referral
• Management of behaviour (Plan interventions)

There is a need for comprehensive multi-sectoral approach where the

government, media and civil society all play important role as stakeholders.

Some measures suggested by WHO include:

• Limiting access to the means of suicide;

• Reporting of suicide by media in a responsible way;
• Bringing in alcohol-related policies;
• Early identification, treatment and care of people at risk;
• Training health workers in assessing and managing for suicide;
• Care for people who attempted suicide and providing community
support.

Identifying students in distress:

Any unexpected or striking change affecting the adolescent’s performance,

attendance or behaviour should be taken seriously, such as:

• Lack of interest in common activities

• Declining grades
• Decreasing effort
• Misbehaviour in the classroom
• Mysterious or repeated absence
• Smoking or drinking, or drug misuse

Strengthening students’ self-esteem:

In order to foster positive self-esteem in children the following approaches can

be useful:

• Accentuating positive life experiences to develop positive identity. This

increases confidence in self.
• Providing opportunities for development of physical, social and
vocational skills.
• Establishing a trustful communication.
• Goals for the students should be specific, measurable, achievable,
relevant, to be completed within a relevant time frame. (SMART)

❖ SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC

DISORDERS

Schizophrenia is the descriptive term for a group of psychotic

disorders in which personal, social and occupational functioning
deteriorate as a result of disturbed thought processes, strange
perceptions, unusual emotional states, and motor abnormalities.

Symptoms of Schizophrenia

The symptoms of schizophrenia can be grouped into three categories:

• Positive symptoms (i.e. excesses of thought, emotion, and behaviour)
• Negative symptoms (i.e. deficits of thought, emotion, and behaviour)
• Psychomotor symptoms

Positive Symptoms

Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to a

person’s behaviour.

The ones most often found in schizophrenia are:

• Delusions
• Disorganised thinking and speech
• Heightened perception and hallucinations
• Inappropriate affect

Delusions - A delusion is a false belief that is firmly held on inadequate

grounds. It is not affected by rational argument, and has no basis in reality.

• Delusions of persecution - People with this delusion believe that they

are being plotted against, spied on, slandered, threatened, attacked or
deliberately victimised.
• Delusions of reference in which they attach special and personal
meaning to the actions of others or to objects and events.
• Delusions of grandeur - People believe themselves to be specially
empowered persons.
• Delusions of control - They believe that their feelings, thoughts and
actions are controlled by others.

Disorganised thinking and speech- People with schizophrenia may not be

able to think logically and may speak in peculiar ways. These formal thought
disorders can make communication extremely difficult. These include:

• Rapidly shifting from one topic to another so that the normal structure
of thinking is muddled and becomes illogical (loosening of associations,
derailment)
• Inventing new words or phrases (neologisms)
• Persistent and inappropriate repetition of the same thoughts
(perseveration)
Hallucinations - People with schizophrenia may have hallucinations, i.e.
perceptions that occur in the absence of external stimuli.

• Auditory hallucinations - Patients hear sounds or voices that speak

words, phrases and sentences directly to the patient (second-person
hallucination) or talk to one another referring to the patient as s/he
(third-person hallucination).
• Tactile hallucinations - Forms of tingling, burning
• Somatic hallucinations - Something happening inside the body such as
a snake crawling inside one’s stomach
• Visual hallucinations - Vague perceptions of colour or distinct visions
of people or objects
• Gustatory hallucinations - Food or drink taste strange
• Olfactory hallucinations - Smell of poison or smoke

Inappropriate Affect - People with schizophrenia also show inappropriate

affect, i.e. emotions that are unsuited to the situation.

Negative Symptoms

Negative symptoms are ‘pathological deficits’ and include poverty of speech,

blunted and flat affect, loss of volition, and social withdrawal.

• Alogia or poverty of speech - A reduction in speech and speech

content.
• Blunted Affect - Many people with schizophrenia show less anger,
sadness, joy, and other feelings than most people do.
• Flat Affect - Some show no emotions at all, a condition known as flat
affect.
• Avolition or apathy - An inability to start or complete a course of
action.

People with this disorder may withdraw socially and become totally focused
on their own ideas and fantasies.

Psychomotor Symptoms

People with schizophrenia also show psychomotor symptoms. They move less
spontaneously or make odd grimaces and gestures.

These symptoms may take extreme forms known as catatonia.

• Catatonic stupor - Remain motionless and silent for long stretches of
time.
• Catatonic rigidity - Maintaining a rigid, upright posture for hours.
• Catatonic posturing - Assuming awkward, bizarre positions for long
periods of time.

❖ NEURODEVELOPMENTAL DISORDERS

Often the symptoms appear before the child enters school or during the
early stage of schooling. These disorders result in hampering personal,
social, academic and occupational functioning.
These get characterised as:
• Deficits or excesses in a particular behaviour or
• Delays in achieving a particular age-appropriate behaviour

There are several disorders under this category like:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder
• Intellectual Disability
• Specific Learning Disorder

Attention-Deficit/Hyperactivity Disorder

The two main features of ADHD are inattention and hyperactivity-

impulsivity.
• Children who are inattentive find it difficult to sustain mental effort
during work or play. They have a hard time keeping their minds on any
one thing or in following instructions. Common complaints are that the
child does not listen, cannot concentrate, does not follow
instructions, is disorganised, easily distracted, forgetful, does not
finish assignments, and is quick to lose interest in boring
activities.
• Children who are impulsive seem unable to control their immediate
reactions or to think before they act. They find it difficult to wait or
take turns, have difficulty resisting immediate temptations or
delaying gratification. Minor mishaps such as knocking things over
are common whereas more serious accidents and injuries can also
occur.
• Hyperactivity also takes many forms. Children with ADHD are in
constant motion. Sitting still through a lesson is impossible for them.
The child may fidget, squirm, climb and run around the room
aimlessly. Parents and teachers describe them as ‘driven by a motor’,
always on the go, and talk incessantly.

Autism Spectrum Disorder

• Children with autism spectrum disorder experience profound

difficulties in relating to other people. They are unable to initiate
social behaviour and seem unresponsive to other people’s feelings. They
are unable to share experiences or emotions with others.
• They also show serious abnormalities in communication and
language that persist over time. Many of them never develop speech
and those who do, have repetitive and deviant speech patterns.
• Such children often show narrow patterns of interests and repetitive
behaviours such as lining up objects or stereotyped body movements
such as rocking. These motor movements may be self-stimulatory
such as hand flapping or self-injurious such as banging their head
against the wall.

Intellectual disability

• Intellectual disability refers to below average intellectual functioning

(with an IQ of approximately 70 or below)
• Deficits or impairments in adaptive behaviour (i.e. in the areas of
communication, self-care, home living, social/interpersonal skills,
functional academic skills, work, etc.)
• Manifested before the age of 18 years

Write the definition from Chapter 1 and refer to the table on the next page for
the types of MR.
❖ DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS

The disorders included under this category are:

• Oppositional Defiant Disorder
• Conduct Disorder

Oppositional Defiant Disorder

Children with Oppositional Defiant Disorder (ODD) display:

• Age-inappropriate amounts of stubbornness and are

• Irritable
• Defiant
• Disobedient
• Behave in a hostile manner

Individuals with ODD do not see themselves as angry, oppositional, or defiant

and often justify their behaviour as reaction to circumstances/demands.

Conduct Disorder

• The terms conduct disorder and antisocial behaviour refer to age-

inappropriate actions and attitudes that violate family expectations,
societal norms, and the personal or property rights of others.
• The behaviours typical of conduct disorder include aggressive actions
that cause or threaten harm to people or animals, nonaggressive
conduct that causes property damage, major deceitfulness or theft, and
serious rule violations.

Children show many different types of aggressive behaviour:

• Verbal aggression (i.e. name-calling, swearing)

• Physical aggression (i.e. hitting, fighting)
• Hostile aggression (i.e. directed at inflicting injury to others)
• Proactive aggression (i.e. dominating and bullying others without
provocation).
FEEDING AND EATING DISORDERS

These include anorexia nervosa, bulimia nervosa, and binge eating.

• Anorexia nervosa - The individual has a distorted body image that

leads her/ him to see herself/himself as overweight. Often refusing to
eat, exercising compulsively and developing unusual habits such as
refusing to eat in front of others, the person with anorexia may lose
large amounts of weight and even starve herself/himself to death.

• Bulimia nervosa - The individual may eat excessive amounts of food,

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

• Binge eating - There are frequent episodes of out-of-control eating.

The individual tends to eat at a higher speed than normal and continues
eating till s/he feels uncomfortably full. In fact, large amount of food
may be eaten even when the individual is not feeling hungry.

❖ SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

Addictive behaviour involves excessive intake of high calorie food

resulting in extreme obesity or involving the abuse of substances such
as alcohol or cocaine.

Disorders relating to maladaptive behaviours resulting from regular

and consistent use of the substance involved are included under
substance related and addictive disorders.

These disorders include problems associated with the use and abuse of
alcohol, cocaine, tobacco and opiods among others, which alter the
way people think, feel and behave.

Few frequently used substances are:

Alcohol
• People who abuse alcohol drink large amounts regularly and rely
on it to help them face difficult situations.
• Eventually the drinking interferes with their social behaviour
and ability to think and work.
• Their bodies then build up a tolerance for alcohol and they need
to drink even greater amounts to feel its effects.
• They also experience withdrawal responses when they stop
drinking.
• Alcoholism destroys millions of families, social relationships
and careers. It also has serious effects on the children of persons
with this disorder. These children have higher rates of
psychological problems, particularly anxiety, depression,
phobias and substance-related disorders.
• Intoxicated drivers are responsible for many road accidents.
• Excessive drinking can seriously damage physical health.

Heroin

• Heroin intake significantly interferes with social and occupational

functioning.
• Most abusers further develop a dependence on heroin, revolving their
lives around the substance, building up a tolerance for it, and
experiencing a withdrawal reaction when they stop taking it.
• The most direct danger of heroin abuse is an overdose, which slows
down the respiratory centres in the brain, almost paralysing
breathing, and in many cases causing death.

Cocaine

• Regular use of cocaine may lead to a pattern of abuse in which the

person may be intoxicated throughout the day and function poorly in
social relationships and at work.
• It may also cause problems in short-term memory and attention.
• Dependence may develop, so that cocaine dominates the person’s life,
more of the drug is needed to get the desired effects, and stopping it
results in feelings of depression, fatigue, sleep problems, irritability
and anxiety.
• It has dangerous effects on psychological functioning and physical
well-being.