Chapter 4 -

Psychological
Disorders
Abnormal, Maladaptive – Psy. Dysfunction/Psychopathology

4 COMMON FEATURES
1. Deviance – Unusual, different
2. Distress – Unpleasant, upsetting, discomfort to sig. others?
3. Dysfunction – Interfere with daily functioning
4. Danger – to the person or surroundings (suicidal? self harm?)

2 approaches to define abnormal and normal behaviour

a. Deviation from social norms
- Societal norms
- Culture – eg: homosexuality
b. Abnormal behaviour is maladaptive
- Well being

Stigma
El Colacho, Spain- Baby jumping to cleanse them
Historical Background
1. Supernatural and Magical forces
- Exorcism
- Shaman or medicine man (Ojha) – communicate with spirits which are responsible for
his/her problems

2. Biological or Organic approach : Bodies + Brains not working properly – linked to

maladaptive functioning

3. Psychological approach : Inadequacies in the way an individual think, feels, or perceive the
world

All 3 approaches in Western world

4. Organismic approaches – Ancient Greek philosophers and physicians : Hippocrates,
Socrates, Plato – behaviour arose from conflicts between emotions and reason

Galen – 4 humors – in personal character = temperament

- Earth, Air, Fire, Water body fluids
- Body fluids – blood, black bile, yellow bile, phlegm – each body fluids is responsible for
temperament. Imbalances – cause various disorders
- Similar to Indian – 3 doshas – Vata, Pitta, Kapha

5. Middle Ages – Demonology + superstition

Spirit possession – belief influenced by teachings of RC church

6. Renaissance period – Increased humanism + curiosity about behaviour

Johann Weyer – psy. conflict + disturbed interpersonal relationships which leads to psy.
disorders.
7. Age of Reason and Enlightenment – 17th – 18th century
Scientific methods>>>
Reform movement – increased compassion for people with disorders. Reform
asylums – in America and Europe
Deinstitutionalisation – provide community care for recovered mentally ill
individuals.

8. Interactional/Biopsychosocial approach :
Biological + Psychological + Social influence

Why classification of disorders?

Advantages – enable psychologists, psychiatrists to communicate about the
disorders, the cause of disorders, provide nomenclature
Disadvantages – stigma, labelling

Person A is diagnosed with depression

Factors underlying the abnormal behaviour

1. Biological factors: Faulty genes , endocrine imbalance, malnutrition, injuries etc

may interfere with normal development and functioning of human development.
Biological research found that psychological disorders are often related to
problems in the transmission of messages from one neuron to another.
- Neurotransmitter - Abnormal activity of these neurotransmitter lead to
psychological disorders.
- Anxiety disorder – gamma aminobutyric acid (GABA)
Schizophrenia- Excess activity of Dopamine
Depression – low activity of serotonin.

2. Genetic factors: No single gene is responsible for particular psychological disorders

Linked to Mood disorder, Schizophrenia, ID
3. Psychological factors: Psychological + interpersonal factors have a significant role to play in abnormal behaviour.

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)
Maladaptive family structure (inadequate or disturbed family)
Severe stress

3a. Psychodynamic model (Hiding problems): OLDEST + FAMOUS

Freud – Whether normal or abnormal is determine by the psychological factors within the person, of which he /she is not
consciously aware.
Internal factors interact with one another and their interactions give shape to behaviour, thought and emotions. Abnormal forces are
result of conflict between these forces. ID, EGO and SUPEREGO – repressed thoughts, unacceptable thoughts, urges. It is traced
back to early childhood and infancy.
3b. Behavioural model (Learning problems): Ab. Or not behaviour are LEARNED.
Through conditioning and learned which can be unlearned.
Learning can take place by classical c, operant c, social learning

3c. Cognitive model (Thinking problems): Attitude about oneself – Irrational and
inaccurate
Overgeneralizing, illogical ways, catastrophizing, personalization

3d. Humanistic model – Existential model – Humans – driven to self – actualize.

Existentialists – From birth we have freedom to give meaning to our existence or to
avoid. Living empty, inauthentic, dysfunctional functional lives

4. Sociocultural model : SOCIAL + CULTURAL forces

Societal labels + roles
Family structure
Lack of social support
Bullying Psychopaths
Diathesis – Stress model

Psychological disorders are developed when diathesis( biological predisposition to the disorder) is set off by a stressful situation.

*Three components:
1. Diathesis or the presence of some biological aberration which is inherited.
2. Diathesis may carry a vulnerability to develop a psychological disorder.
3. Presence of pathogenic stressors i.e., factors that may lead to psychopathology.

Eg : Broken home – Diathesis

Financial loss – Stress
Divorce – Diathesis stress
Anxiety Disorder

The term anxiety is defined as diffuse, vague, very unpleasant feeling of fear and apprehension.

Symptoms: Rapid heart rate, shortness of breath, dizziness, loss of appetite, fainting, sweating, sleeplessness, frequent urination and tremors

Types of anxiety disorders:

- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Specific Phobias
- Separation Anxiety Disorder (SAD)
Generalized Anxiety Disorder (GAD) : Prolonged, vague, unexplained and intense fears that are not attached to any particular object
Symptoms:
1.Worry
2. Apprehension feeling about the future,
3. Hyper vigilance
4. Constant scanning the environment for danger
5. Motor tension as a result of which the person is unable to relax, is restless and visibly shaky and tense.

Mr. G was a successful, married, 28-year-old teacher who presented for a psychiatric evaluation to treat
mounting symptoms of worry and anxiety. Mr. G noted that for the preceding year, he had become more
and more worried about his job performance. For example, although he had always been a respected
and popular lecturer, he found himself worrying about his ability to engage students and convey the
material effectively. Similarly, although he had always been financially secure, he increasingly worried
that he was going to lose his wealth due to unexpected expenses. Mr. G noted frequent somatic
symptoms that accompanied his worries. For example, he often felt tense and irritable while he worked
and spent time with his family, and he had difficulty distracting himself from worries about the
upcoming challenges for the next day. He reported feeling increasingly restless, especially at night,
when his worries kept him from falling asleep.
Panic Disorder : Recurrent anxiety attacks in which the person experience intense terror

Symptoms:
1.Shortness of breadth
2.Dizziness
3.Trembling
4.Palpitation
5.Choking
6.Nausea
7.Chest pain
8.Fear of going crazy
9.Losing control or dying
Mrs. K was a 35-year-old woman who initially presented for treatment at the medical
emergency department at a large university-based medical center. She reported that while
sitting at her desk at her job, she had suddenly experienced difficulty breathing, dizziness,
tachycardia, shakiness, and a feeling of terror that she was going to die of a heart attack. A
colleague drove her to the emergency department, where she received a full medical
evaluation, including electrocardiography and routine blood work, which revealed no sign of
cardiovascular, pulmonary, or other illness. She was subsequently referred for psychiatric
evaluation, where she revealed that she had experienced two additional episodes over the
past month, once when driving home from work and once when eating breakfast. However,
she had not presented for medical treatment because the symptoms had resolved relatively
quickly each time, and she worried that if she went to the hospital without ongoing
symptoms, “people would think I’m crazy.” Mrs. K reluctantly took the phone number of a
local psychiatrist but did not call until she experienced the fourth episode of a similar nature.
Phobias : Irrational fear related to specific object , people or situations.

Types of phobias:
- Specific Phobia
- Social Phobia (Social Anxiety Disorder)
- Agoraphobia – Unfamiliar situation
SEPARATION ANXIETY DISORDER (SAD)
Individuals with separation anxiety disorder are fearful and anxious about separation from attachment figures to an
extent that is developmentally not appropriate.
Children with SAD may have difficulty being in a room by themselves, going to school alone, are fearful of
entering new situations, and cling to and shadow their parent’ every move.

Obsessive – Compulsive related disorders

Unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series that affect
their ability to carry out normal activities.
Obsessive behaviour is the inability to stop thinking about particular idea or topic. Often find these thoughts to be unpleasant and shameful.
Compulsive behaviour is the need to perform certain behaviours over and over again. Example - counting, checking, touching, washing.
Ms. K was referred for psychiatric evaluation by her general practitioner. In the
interview, Ms. K described a long history of checking rituals that had caused her
to lose several jobs and had damaged numerous relationships. She reported, for
example, that she often had the thought that she had not locked the door to the
car. It was difficult for her to leave her car until she had repeatedly checked that it
was secure. She had broken several car door handles with the vigor of her
checking and had been up to an hour late to work because she spent too much
time checking her car door. Similarly, she had recurrent thoughts that she had left
the door to her apartment unlocked. She returned several times to check her
door before she left for work. She reported that checking doors decreased her
anxiety about security. Ms. K reported that she had occasionally tried to leave
her car or apartment without checking the door (e.g., when she was already late
for work). However, she found that she became so worried that someone would
steal her car or break into her apartment that she had difficulty going anywhere.
Ms. K reported that her obsessions about security had become so extreme over
the past 3 months that she had lost her job due to recurrent tardiness. She
recognized the irrational nature of her obsessive concerns but could not bring
herself to ignore them.
Trauma and related disorders

PTSD (Post traumatic stress disorder):

Symptoms:
1. Recurrent dreams
2. Flashback
3. Impaired concentration
4. Emotional numbing

Mrs. M sought treatment for symptoms that she developed in the wake of an assault that had occurred
about 6 weeks before her psychiatric evaluation. While leaving work late one evening, Mrs. M was
attacked in a parking lot next to the hospital in which she worked. She was raped and badly beaten but
was able to escape and call for help. On referral, Mrs. M reported frequent intrusive thoughts about the
assault, including nightmares about the event and recurrent intrusive visions of her assailant. She now
took the bus to work to avoid the scene of the attack and changed her work hours to avoid leaving the
building after dark. Also, she reported that she had difficulty interacting with men, particularly those who
resembled her attacker, and that she consequently avoided such interactions whenever possible. Mrs. M
described increased irritability, difficulty staying asleep at night, poor concentration, and an increased
focus on her environment, particularly after dark.

Adjustment Disorder and Acute Stress Disorder – under trauma related disorders
Somatic Symptom Disorder

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

- Somatic Symptom Disorder

- Illness Anxiety Disorder
- Conversion Disorder

Somatic Symptom Disorder: People with this disorder tend to be overly preoccupied with their symptoms and
they continually worry about their health and make frequent visits to doctors. Involves a person having
persistent body-related symptoms which may or may not be related to any serious medical condition.

IIIness Anxiety Disorder: It involves persistent preoccupation about developing a serious illness and
constantly worrying about this possibility. Don’t have significant physical symptoms.

In the case of somatic symptom disorder, this expression is in terms of physical complaints while in
case of illness anxiety disorder, as the name suggests, 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. Paralysis, blindness, deafness and difficulty in walking are generally among the
symptoms reported.
Mr. J is a 28-year-old single man who works in a factory. He was brought to an emergency department by his father, complaining
that he had lost his vision while sitting in the back seat on the way home from a family gathering. He had been playing volleyball
at the gathering but had sustained no significant injury except for the volleyball hitting him in the head a few times. He was
initially reluctant to play volleyball because of his mediocre athleticism and was a last-minute addition to the team . He recalls
having some problems with seeing during the game, but his vision did not become ablated until he was in the car on the way
home. By the time he got to the emergency department, his vision was improving, although he still complained of blurriness and
mild diplopia. The physician could attenuate the double vision by having the patient focus on different items at different distances.
On examination, Mr. J was fully cooperative, somewhat uncertain about why this would have occurred, and rather nonchalant.
Pupillary, oculomotor, and general sensorimotor examinations were routine. After being cleared medically, the physician referred
the patient to a mental health center for further evaluation. At the mental health center, the patient recounts the same story as he
did in the emergency department. His father continued to accompany him. He said his vision improved when his father stopped
the car, and they talked about the day’s events. He spoke with his father about how he had felt embarrassed and somewhat
conflicted about playing volleyball but felt pressure to play. Further history from the patient and his father revealed that this young
man had been shy as an adolescent, particularly around athletic participation. He had never had another episode of visual loss.
He did recount feeling anxious and sometimes not feeling well in his body during athletic activities. Discussion with the patient at
the mental health center focused on the potential role of psychological and social factors in acute vision loss. The patient was
somewhat perplexed by this but was also amenable to discussion. He stated that he recognized that he began seeing and
feeling better when his father pulled off to the side of the road and discussed things with him. Doctors stated that they did not
know the cause of the vision loss and that it would likely not return. The patient and his father were satisfied with the medical and
psychiatric evaluation and agreed to return for care if there were any further symptoms. The patient was appointed a follow-up
time at the outpatient psychiatric clinic .
Dissociative Disorders

- Dissociation involves feeling of unreality, estrangement, depersonalization and sometimes a loss or shift of identity.
- Sudden temporary alterations of consciousness that blot out painful experiences are defined characteristics of dissociation

TYPES:
1. Dissociative amnesia:
- Dissociative fugue

2. Dissociative identity disorder (DID)/Multiple Personality Disorder

3. Depersonalisation/Derealization
Dissociative Amnesia:
- Excessive but selective memory loss that has no organic cause (head injury).
- Some people cannot remember anything about the past
- Some no longer recall specific events, people, places etc while their memory for others remain intact
- Associated with overwhelming stress
- Dissociative Fugue:
* Unexpected travel away from home and workplace.
* Assumption of a new identity.
* Inability to recall their previous identity.

A 45-year-old, divorced, left-handed, male bus dispatcher was seen in psychiatric consultation on a medical unit. He had
been admitted with an episode of chest discomfort, light-headedness, and left-arm weakness. He had a history of
hypertension and had a medical admission in the past year for ischemic chest pain, although he had not suffered a
myocardial infarction. Psychiatric consultation was called, because the patient complained of memory loss for the previous 12
years, behaving and responding to the environment as if it were 12 years previously (e.g., he did not recognize his 8-year-old
son, insisted that he was unmarried, and denied recollection of current events, such as the name of the current president).
Physical and laboratory findings were unchanged from the patient’s usual baseline. Brain computed tomography (CT) scan
was normal. On mental status examination, the patient displayed intact intellectual function but insisted that the date was 12
years earlier, denying recall of his entire subsequent personal history and of current events for the past 12 years. He was
perplexed by the contradiction between his memory and current circumstances. The patient described a family history of
brutal beatings and physical discipline. He was a decorated combat veteran, although he described amnestic episodes for
some of his combat experiences. In the military, he had been a champion golden glove boxer noted for his powerful left hand.
He was educated about his disorder and given the suggestion that his memory could return as he could tolerate it, perhaps
overnight during sleep or perhaps over a longer time. If this strategy was unsuccessful, hypnosis or an amobarbital interview
was proposed.
Dissociative Identity Disorder (DID): Referred to as multiple personality disorder.
*Associated with traumatic experience in childhood.
*Assumes alternate personalities that may or may not be aware of each other.

Ms. A, a 33-year-old married woman employed as a librarian in a school for disturbed children, presented to
psychiatric attention after discovering her 5-year-old daughter “playing doctor” with several neighborhood
children. Although this event was of little consequence, the patient began to become fearful that her
daughter would be molested. The patient was seen by her internist and was treated with antianxiety agents
and antidepressants, but with little improvement. She sought psychiatric consultation from several clinicians
but repeated, appropriate trials of antidepressants, antianxiety agents, and supportive psychotherapy
resulted in limited improvement. After the death of her father from complications of an alcohol use disorder,
the patient became more symptomatic. He was estranged from the family since the patient was
approximately 12 years of age, owing to his drinking and associated antisocial behavior.
Psychiatric hospitalization was precipitated by the patient’s arrest for disorderly conduct in a nearby city. She
was found in a hotel, in revealing clothing, engaged in an altercation with a man. She denied knowledge of
how she had come to the hotel, although the man insisted that she had come there under a different name
for a voluntary sexual encounter. On psychiatric examination, the patient described dense amnesia for the
first 12 years of her life, with the feeling that her “life started at 12 years old.”
She reported that, for as long as she could remember, she had an imaginary companion, an elderly black
woman, who advised her and kept her company. She reported hearing other voices in her head: several
women and children, as well as her father’s voice repeatedly speaking to her in a derogatory way. She
reported that since age 12, she had episodes of amnesia: for work, for her marriage, for the birth of her
children, and her sex life with her husband. She reported perplexing changes in skills; for example, people
told her that she played the piano well but had no conscious awareness that she could do so. Her husband
reported that she had always been “forgetful” of conversations and family activities.

He also noted that, at times, she would speak like a child; at times, she would adopt a southern accent; and,
at other times, she would be angry and provocative. She frequently had little recall of these episodes. When
questioned about her early life, the patient appeared to enter a trance and stated, “I just don’t want to be
locked in the closet” in a childlike voice. Inquiry about this produced rapid shifts in a state between alter
identities who differed in manifested age, facial expression, voice tone, and knowledge of the patient’s
history. One spoke in an angry, expletive-filled manner and appeared irritable and preoccupied with
sexuality. She discussed the episode with the man in the hotel and stated that it was she who had arranged
it. Gradually, the alters described a history of family chaos, brutality, and neglect during the first 12 years of
the patient’s life, until her mother, who also struggled with alcohol use disorder, achieved sobriety and fled
her husband, taking her children with her. The patient, in the alter identities, described episodes of physical
abuse, sexual abuse, and emotional torment by the father, her siblings, and her mother. After an assessment
of family members, the patient’s mother also met diagnostic criteria for dissociative identity disorder, as did
her older sister, who also had been molested. A brother met diagnostic criteria for PTSD, major depression,
and alcohol use disorder
Depersonalization/Derealization: Persistent or recurrent feeling of detachment or estrangement from
one’s self. The individual may report feeling where an automation or watching himself or herself in a
movie.
- Feelings of unreality or of being detached from one’s environment.
- Dreamlike state in which the person has a sense of being separated both from self and from reality.

Depressive Disorders

Depression covers a variety of negative moods and behavioural changes. 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: Major depressive disorder is defined as a period of

- depressed mood and/or loss of interest or pleasure in most activities
- 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
- Age ( women-young adulthood, men-middle age)
- Gender ( women report more)
- Experiencing negative life event
- Lack of social support

Bipolar related disorders : It involves both mania and depression. Bipolar mood disorders were earlier
referred to as manic-depressive disorders.
Some examples of types of bipolar and related disorders include Bipolar II disorder and
Cyclothymic Disorder.
Suicide is a result of complex interface of biological, genetic, psychological, sociological, cultural
and environmental factors.

Some measures suggested by WHO TO PREVENT SUICIDE includes :

- 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.

How can we identify students in distress?

- Lack of interest in common activities
- Declining grades
- Decreasing effort
- Misbehaviour in the classroom
- Mysterious or repeated absence
- Smoking or drinking, or drug misuse

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
Schizophrenia and other psychotic disorders:Schizophrenia is a descriptive term for a group of psychotic disorders in
which personal, social and occupational functioning deteriorates as a result of disturbed thought processes, strange perception, unusual
emotional states and motor abnormalities.

Symptoms:
 Positive symptoms: these are ‘ pathological excess’ or ‘ bizarre addition’ to the persons behaviour . Excess of thought , emotions and
behaviour. Hallucinations, Delusions, Positive formal thought disorder

 Negative symptoms: Deficit of thought , emotions and behaviour. Alogia, Flat affect, absence of motivation, asociality, apathy

 Psychomotor symptoms: They move less spontaneously or make odd grimaces and
gestures. Catanoia, catanoia stupor, catanoia rigidity, catanoia posturing
POSITIVE SYMPTOMS

1. Delusions: False belief that is firmly held on inadequate grounds.

Types of delusions:

Delusion of persecution : believe that they are being plotted against, spied on, slandered, threatened , attacked, or deliberately victimized.

Delusions of reference : attach special and personal meaning to the actions of others or to objects and events.

Delusions of Grandeur: believe themselves to be specially empowered persons .

Delusions of control: believe that their feelings , thoughts and actions are controlled by others
2.Formal Thought Disorder: People with schizophrenia may not think logically and may speak in peculiar way. This can make
communication extremely difficult.
These includes :
- Rapidly shifting of one topic to another so that normal structure of thinking is muddled and become illogical ( loosening of association, derailment)
- Inventing new words or phrases (neologisms)
- Persistent and inappropriate repetition of the same thoughts (perseveration)

3. Hallucination : Perception that occurs in the absence of external stimuli

Types of Hallucination:
- Auditory hallucination:
*Second person hallucination: person hears sounds , voices that speak words , phrases and sentences directly to the patient
*Third person hallucination: talk to one another referring to the patient as s/he
- Tactile hallucination : forms of tingling , burning
- Somatic hallucination: something happening inside the body such as snake crawling inside one’s stomach
- Visual hallucination: vague perception of colours or distinct vision of people or object
- Gustatory hallucination : food or drink taste strange
- Olfactory hallucination : smell of poison or smoke
4. Inappropriate affect: Emotions that are unsuited to the situation.

NEGATIVE SYMPTOMS

‘Pathological deficits’ are included in poverty of speech, blunted and flash affect, loss of volition, and social withdrawal.
Types :-
- Alogia or poverty of speech: reduction in speech and speech content
- Blunted affect: less anger, sadness, joy and other feelings than most people do.
- Flat affect: no emotion at all.
- Avolition: inability to start or complete a course of action

People with this disorder withdraw socially and becomes totally focused on their own ideas and fantasies.
PSYCHOMOTOR SYMPTOMS

Catatonia: move less spontaneously or make odd grimaces and gestures

Catatonic stupor: remain motionless and silent for strong stretches of time
Catatonic rigidity: maintaining rigid posture for hours.
Catatonic posturing: assuming awkward, bizarre positions for long periods of time
SUB TYPES OF SCHIZOPHRENIA

- Paranoid type: preoccupied with delusion or auditory hallucination, no disorganized speech or behaviour or inappropriate
affect.
- Disorganized type: disorganized speech and behaviour, inappropiate or flat affect , no catatonic symptoms.
- Catatonic type: extreme motor immobility, excessive motor inactivity, extreme negativism or mutism.
- Undifferentiated type: does not fit any of the subtypes but meets symptoms criterion.
- Residual type: has experienced at least one episode of schizophrenia , no positive symptoms but show negative symptoms
NEURODEVELOPMENTAL DISORDERS: They manifest in the early stage of
development.
Deficits or excesses in a particular behaviour or delays in achieving a particular age-
appropriate behaviour.

1. ADHD:
Two main features are Inattentive and Hyperactivity-impulsivity.

Common complaints for inattentive :

- Cannot concentrate
- Does not listen
- Does not follow instructions
- Disorganized
- Easily distractible
- Forgetful
- Does not finish assignment
- Quick to lose interest in boring activities
2. Autism Spectrum Disorder:
It is characterised by :
• Widespread impairments in social interaction
communication skills,
• Stereotyped patterns of behaviours,
• Restricted range of interests, and
• Strong desire for routine.

About 70 percent of children with autism spectrum

disorder have intellectual disabilities
4. INTELLECTUAL DISABILITY: Intellectual disability refers to below average intellectual
functioning with an IQ of approximately 70 or below.

5. SPECIFIC LEARNING DISORDER: These get manifested during early school years and the
individual encounters problems in basic skills in reading, writing and/or mathematics.
Disruptive, Impulse-Control and Conduct Disorders

1. Oppositional Defiant Disorder (ODD):

- Display Inappropriate amount of stubbornness
- Irritable
- Defiant
- Disobedient
- Behave in a hostile manner

2. Conduct Disorder and Antisocial Behaviour:

Age inappropriate actions and attitudes that violate family expectations, societal norms, and personal or property right of others.

• The behaviors includes:

- Aggressive action that cause harm to others
- Non aggressive conduct that cause property damage
- Major deceitfulness or theft
- Serious rule violation
Children may show different type of aggressive behaviour in conduct disorder:

Verbal Aggression: Name – calling, swearing

Physical aggression: Hitting , fighting
Hostile aggression: Directed at inflicting injury to others
Proactive aggression: Dominating and bullying others without provocation.
FEEDING AND EATING DISORDERS

1. Anorexia nervosa : has distorted body image that leads her/him to see herself/ himself overweight.
 Often refusing to eat.
 Exercising excessively.
 Lose large amount of weight and even starve herself/himself to death.

2. Bulimia Nervosa: 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 . feels disgusted and ashamed when s/he binges and is relieves of tension and negative emotions after purging

3. Binge eating: frequent episodes of out-control eating.

SUBSTANCE RELATED AND ADDICTIVE DISORDERS

Disorder related to maladaptive behaviour resulting from regular and consistent use of the substance involve are substance abuse disorder.

Two subgroups:
- Substance dependence
- Substance abuse

Substance Abuse: there is a recurrent and significant adverse consequences related to the use
of substances. Damage their family and social relationships, perform poorly at work and create
physical hazards.

Tolerance
Withdrawal
Forms of substance abuse:

1. Alcohol: Abuse and Dependence

2. Heroin: Abuse and Dependence
3. Cocaine Abuse and Dependence

Effects of Alcohol:
- All alcohol beverages contain ethyl alcohol.
- This chemical is absorbed into the blood and carried into the central nervous system
(brain and spinal cord) where it depresses or slows down functioning.
- Ethyl alcohol depresses those areas in the brain that control judgment and
inhibition; people become more talkative and friendly, and they feel more confident and
happy.
- As alcohol is absorbed, it affects other areas of the brain. For example, drinkers are
unable to make sound judgments, speech becomes less careful and less clear, and
memory falters; many people become emotional, loud and aggressive.
- Motor difficulties increase. For example, people become unsteady when they walk and
clumsy in performing simple activities; vision becomes blurred and they have trouble in
hearing; they have difficulty in driving or in solving simple problems.