CHAPTER 4

PYSCHOLOGICAL DISORDERS

Why Do We Need Classification of Psychological Disorders?

Given the basic comorbid nature of psychological disorders, it becomes even more
important to classify disorders to identify which disorders exist in an individual and
how to treat them. Beyond the basic need for prognosis, diagnosis, and treatment,
classification also plays an important role in research and academic communication
of psychological disorders. Knowing the significance of the classification of
psychological disorders, many academicians, as well as institutions, have tried to
classify disorders over a period of time. The two of these classification systems that
are most popular today are DSM classification by APA (the latest version of which is
DSM-V TR) and ICD classification by WHO (the latest version of which is ICD 10).
Before understanding some of the most common classifications that are necessary
for understanding psychological disorders, it is imperative to know various models
that have been used as a tool to understand psychological disorders. These are
discussed in the next section.

Models of Psychological Disorder

Models of psychological disorders are different understandings of abnormality and its
causes, symptoms, and treatment. Some of the most popular models are as follows:

 Biological model: This model characterizes psychological disorders as

originating from biological causes, usually issues with the brain, and
encourages pharmacological treatment for disorders.
 Psychodynamic model: This model originated from the psychodynamic
theory of Freud and views imbalance in internal psychological forces of id,
ego, and superego as a cause of psychological disorders. Further, it suggests
psychodynamic-therapeutic methods of dream analysis, free association,
transference, etc., as a means of treatment.
 Behavioral Model: This model considers maladaptive learned behavior as a
cause of disorders and suggests behavioral manipulations through behavioral
therapies to bring adaptive behavioral change.
 Cognitive Model: This model characterizes maladaptive cognition as a major
cause of the psychological disorder and therefore focuses on replacing and
modifying these maladaptive cognitions as a way of treatment.
 Humanistic Existential Model: The main concepts of this model are self-
actualization, individual responsibility, self-determination, and individual
choice, among others. It suggests abnormality as a result of maladaptiveness
in these concepts of humanism and existentialism and, therefore, focuses on
resolving them through focusing on the individual's ability to resolve them with
therapists' assistance.
 Socio-cultural model: This model emphasizes the role of cultural and social
underpinnings in causing a psychological disorder; thus, its treatment is also
oriented towards cultural and social dimensions.
 Eclectic approach: This approach is the most recent and accepted one and
considers all other approaches while creating a holistic understanding
treatment of psychological disorders.
While these models may result in the classification of psychological disorders of their
own, one of the most common and significant classifications that one should be
acquainted with before understanding any other complex classification is based on
symptoms and causes, i.e., psychosis and neurosis.

Concept of Abnormality and Psychological disorders:

The term ‘abnormal’ with its prefix ab (away from), generally signify the deviance or

variation from the normal.

Anything not normal must, therefore, be abnormal. But acquiring insight into what we

consider normal, expected behaviour is difficult enough, understanding human

behaviour beyond the normal range is quite challenging.

Normal and abnormal behaviour are subjective terms. These terms are qualitative

and matter of degree because drawing a sharp line between then is not possible.

The study of Psychopathology is a search for why people behave, think and feel in

unexpected, sometimes bizzare and typically self defeating ways.

Several characteristics are considered in evaluating whether a behaviour is

abnormal: violation of social norms, personal distress, disability or dysfunction,

dangerous behaviour (4Ds), unexpectedness and statistical infrequency. Each

characteristics tells some thing about what can be considered abnormal, but

conception change with time, making it impossible to offer a simple definition that

captures abnormality in its totality.

Classification of Psychological factors: Classification refers to a list of categories of

specific Psychological disorders grouped into various classes on the basis of some

shared characteristics.

Main Classification.

ICD-10: Developed by WHO. This is official classification in India.

The classification is based op symptoms under one broad heading i.e. Mental

disorders. DSMIV: Developed by APA. It is multi-axial. It is very comprehensive

because classification is based on biological Psychological social factors, cause and

prognosis of disorders.

Importance: These classification provide standard vocabulary standard vocabulary

through which professionals universally can converse.

It also helps in understanding the cause and diagnosis of mental disorders.

Recurring Theories to Study Abnormal Behaviour:

1. Ancient theory suggests some people possessed by supernatural and magical

forces such as evil spirits. Exorcism (removing the evil residing in the individual

through prayer) is still commonly used. Shaman or medicine man has contact with

supernatural forces, medium of communication between human and spirits.

2. Biological/Organic approach links defective biological processes to maladaptive

behaviour.

3. According to psychological approach problems caused by inadequacies in the way

an individual thinks, feels and perceives.

Historical Background:

(a) Ancient Greek philosophers (Hippocrates, Socrates, Plato) developed organismic

approach—viewed disturbed behaviour arising out of conflicts between emotion and

reason.

Galen—temperament affected by imbalance in four humours, similar to tridoshas.

(b) Middle ages, superstition and demonology—people with mental problems, were

associated to demons.

St. Augustine wrote about feelings, mental anguish and conflict—laid groundwork for

modem psychodynamic theories.

(c) Renaissance Period—increased humanism and curiosity about behaviour.

Johann Weyer—disturbed interpersonal relationships as cause of psychic disorders,

mentally disturbed required medical not theological treatment.

(d) Age of Reason and Enlightenment (17th /18th centuries)- growth of scientific

method replaced faith and dogma, contributed to Reform movement

Increased compassion for those suffering—reform of asylums, deinstitutionalization,

emphasized community care.

(e) Recent years—convergence of approaches, resulted in interactional biopsycho-

social approach.

Factors Underlying Abnormal Behaviour

I. Biological Factors (faulty genes, endocrine imbalances, malnutrition) affect normal

development and functioning—behaviour has a biochemical or physiological basis.

Abnormal activity by neuro-transmitters (transmission of messages between

neurons) leads to specific psychological disorders.

(i) Anxiety disorders (Low activity of gamma amino butyric acid (GABA).

(ii) Depression (Low activity of serotonin).

(iii) Schizophrenia (excess activity of dopamine).

Scientific evidence links genetic factors to depression, anxiety, mood disorders,

schizophrenia, mental retardation—unable to identify the specific genes, no single

gene responsible for a particular behaviour—cannot alone account for a mental

disorder.

II. Psychological and interpersonal factors affect abnormal behaviour.

• Maternal deprivation (separation from mother, lack of warmth in early years).

• Faulty parent-child relationships (rejection, overprotection, over-permissiveness,

faulty discipline)

• Maladaptive family structures (inadequate or disturbed family).

• Severe stress.

Psychological Models:

1. Psychodynamic Model (Freud):

(i) Behaviour determined by unconscious psychological forces—abnormal

symptoms, the result of conflicts between these internal, dynamic forces.

(ii) Three central forces shape personality—instinctual needs, drives and impulses
(Id), rational thinking (ego) and moral standards (super go).

(iii) Abnormal behaviour—a symbolic expression of unconscious mental conflicts

traced to early childhood or infancy.

2. Behavioural Model:

(i) Behaviours are learned through classic (temporal association between two

events), operant (behaviour followed by a reward), conditioning and social (imitating

other’s behaviour) learning.

(ii) Psychological disorders—the result of learning maladaptive ways of behaving.

3. Cognitive Model:

(i) Abnormal functioning results from cognitive problems:

— Irrational and inaccurate assumptions and attitudes.

— Thinking in illogical ways, making over-generalisations (broad, negative

conclusions on the basis of a single insignificant event).

4. Humanistic-Existential Model:

(i) Human beings born with a natural tendency to self-actualise, i.e., fulfil the

potential for growth.

(ii) Existentialists believe that individuals from birth have total freedom to give

meaning of existence—those who shirk from responsibility live empty, inauthentic,

dysfunctional lives.

WORDS THAT MATTER

• Abnormal Psychology: Serenities study of abnormal behaviour. By using

scientific Techniques, Psychology attempts to describe, explain and predict

abnormal behaviour.

• Anti-Social Behaviour: refers to any behaviour that is considered harmful or

disruptive within a group or society. Aspects of behaviour such as aggression or

deserimination would fall into this category.

• Anorexia nervosa: Disorder involving severe loss of body weight, accompanied by

an intense fear of gaining weight or becoming ‘fat’.

• Anxiety: A state of psychic distress characterized by fear, apprehension, and

physiological arousal.

• Anxiety Disorders: Disorders in which anxiety is a central symptom. The disorder

is characterized by feelings of vulnerability, apprehension, or fear.

• Autism: Pervasive developmental disorder beginning in infancy and involving a

wide range of abnormalities, including deficits in language, perceptual, and motor

development, defective reality testing, and social withdrawal.

• Delusions: Irrational beliefs that are held despite overwhelming evidence to the

contrary.

• De-institutionalisation: Movement whose purpose is to remove from care-giving

institution such as large mental hospitals all those patients who do not present a

clear danger to others or to themselves and to provide treatment sheltered living

conditions for them in the community.

• Depersonalization Disorder: Dissociative disorder in which there is a loss of the

sense of self.

• Diathesis-stress Model: A view that the interaction of factors such as biological

predisposition combined with life stress may cause a specific disorder.

• Dissociation: A split in consciousness whereby certain thoughts, feelings, and

behaviour operate independently from others.

• Exorcism: Religiously inspired treatment procedure designed to drive out evil

spirits or forces from a ‘possessed’ person.

• Eating disorders: A term which refers to a serious disruption of the eating habits
or the appetite. The main types of eating disorders are Anorexia Nervosa, Bulimia

Nervosa and Binge eating.

• Genetics: A branch of Biology referring or relating to genes. Inherited genes are

basic unit of inheritance.

• Hallucination: A false perception which has a compulsive sense of the reality of

objects although relevant and adequate stimuli for such perception is lacking. It is an

abnormal phenomenon.

• Hypochondriasis: A psychological disorder in which the individual is dominated by

preoccupation with bodily processes and fear of presumed diseases despite

reassurance from doctor that no physical illness exists.

• Hyperactivity: Condition characterised by overactive, poorly controlled behaviour

and lack of concentration.

• Main symptom of ADHD: Severe and frequent problems of either or both attention

to tasks or hyperactive and impulsive behaviour.

• Mental retardation: Subnormal intellectual functioning associated with impairment

in adaptive behaviour and identified at an early age.

• Mood Disorder: Disorder affecting one’s emotional state, including depression and

bipolar disorder.

• Neurotransmitter: Chemicals that carry message across the synapse to the

dendrite (and sometimes the cell body) of a receiver neurone.

• Norms: A generalised expectation shared by most members of a group or culture

that underlies views of what is appropriate within that group.

In terms of Psychological testing norms are standards of test performance that

permit the comparison of one person’s score on the test to the scores of others who

have taken the same test. This is the criteria to compare or typical score of an
average group.

• Obsessive-compulsive Disorder: A disorder characterised by obsession or

compulsions.

• Phobia: A strong, persistent. And irrational fear of some specific object or situation

that presents little or no actual danger to a person.

• Post-traumatic Stress Disorder: Patterns of symptoms involving anxiety

reactions, tension, nightmares, and depression following a disaster such as an

earthquake or a flood.

• Schizophrenia: A group of psychotic reactions characterised by the breakdown of

integrated personality functioning, withdrawal from reality, emotion blunting and

distortion, and disturbances in thought and behaviour.

• Somatoform disorder: Condition involving physical complaints or disabilities

occurring in the absence of any identifiable organic cause.

• Substance Abuse: The use of any drug or chemical to modify mood or behaviour

that results in impairment.

• Syndrome: Group or pattern of symptoms that occur together in a disorder and

represent the typical picture of the disorder