CHAPTER 4

PSYCHOLOGIA
L DISORDERS
CLASS XII

Meenakshi Medhi
PGT Psychology
* When the behaviours cannot be modified according to the
situation it is called maladaptive.

* Abnormal Psychology study the maladaptive behaviour- its

causes, consequences and treatment
FOUR D’S TO DEFINE ABNORMALITY

* Deviance: extreme , unusual , bizzare.

* Distress: unpleasant and upsetting to the person and to the others.

* Dysfunctional: interfering with persons ability to carry out daily activities in

a constructive way.

* Dangerous: to the person or to others.

APPROACHES USED TO DEFINE NORMAL
AND ABNORMAL BEHAVIOUR

* First approach view Abnormal Behaviors as deviation from social norms.

* Second approach view abnormal behaviour as maladaptive. This approach

views behaviours as fostering the well being of the person and eventually to
the group to which she belong. Well being not only involves maintainance
and survival but also includes growth and fulfillment.
STIGMA

The stigma attached to the mental illness means that people are hasitant
to consult a doctor or psychologist because they are ashamed of their
problem.
HISTORICAL BACKGROUND

1. Supernatural and magical forces: evil spirit (bhoot- pret), devil (saitan)

* Exorcism: removing the evil that resides in the individual through counter
magic and prayer

* In many societies the shaman or the medicine man Ojha is the person who is
believed to have contact with the supernatural forced and is the medium
through which spirits communicate to the human being
2. Biological and organic Approach :

* It believed that body and brain are not working properly.

* For certain type of disorders, correcting these defective biological process

results in improved functioning
3. Psychological Approach

* Psychological problem are caused by inadequacies in the way an individual

think, feels, or perceive the world
4. ORGANISMIC APPROACHED

 Developed by philosopher-physician of Ancient Greece such as Hippocrates,

Socrates and Plato.

 Viewed disturbed behaviour as arising out of conflicts between emotions and

reasons.

 Galen elaborated on Four Humours .i,e, material world is made up of four

elements: earth, air, fire, water which combine to form four essential body
fluid I,e, blood, black bile, yellow bile and phlegm.
* Each of these fluids were seen to be responsible for a different
temperament.

* Imbalance in the humours cause various disorders.

* This is similar to three doshas of vata, pitta, kapha mentioned in Atharva

Veda an Ayurvedic Text.
5. The Middle Age:
Demonology and Superstition gained Importance.

6. The Renaissance Period:

* Increased Humanism and curiosity about behaviour

* Johann wayer emphasized psychological conflicts and disturbed

interpersonal relationships are cause of psychological disorders.
7. AGE OF REASON AND ENLIGHTENMENT:

* Seventeenth and eighteenth century

* Scientific method replaced faith and dogma
* Reform Movement as an increase compassion towards people with mental
disorders.
* Deinstitutionalisation which placed emphasis on providing community care
for recovery of mentally ill individuals.
8. Interactional or Bio-psycho-social approach:
Three factors play important role in influencing the expression and outcome of
psychological disorders
CLASSIFICATION OF PSYCHOLOGICAL DISORDERS

* The American Psychiatric Association (APA) has published a manual describing

and classifying various kinds of psychological disorders.

* The Diagnostic and Statistical Manual of Mental Disorders V Edition (DSM

V) evaluate the patient on five axes or dimensions.

* The classification scheme used in India and elsewhere is International

Classification of Diseases ( ICD 11) which is known as ICD 11 Classification
of Behavioural and Mental Disorders. It was prepared by World Health
Organisation.
FACTORS UNDERLYING 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.

*When an electrical impulse reaches a neuron’s ending the nerve ending is

stimulated to release a chemical called neurotransmitter.
*Abnormal activity of these neurotransmitter lead to Psychological disorders.
For example:
Anxiety disorder – gamma aminobutyric acid (GABA)
Schizophrenia- Excess activity of Dopamine
Depression – low activity of serotonin.
2. Genetic factor:
* Linked to Mood disorder, schizophrenia, mental retardation .
3. PSYCHOLOGICAL MODEL:

• Psychological and interpersonal factors have a significant role to play in abnormal

behaviour.

• For example:

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
 PSYCHODYNAMIC MODEL:

* 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.

 BEHAVIOURAL MODEL:

* Both normal and abnormal behaviours are learned and psychological

disorders are result of learning maladaptive behaviours.

* Behaviours are learned through conditioning and what is learned can be

unlearned.
COGNITIVE MODEL:

* People may hold assumptions and attitude about themselves which are
irrational and inaccurate.

*people may also repeatedly think in illogical ways and make

overgeneralizations i.e., they may draw negative conclusions on the basis of
single insignificant events
 HUMANISTIC- EXISTENTIAL MODEL:

*Believe that from birth we have total freedom to give meaning to our
existence or to avoid that responsibility.

* Those who shrink from responsibility would live empty, inauthentic and
dysfunctional lives
4. SOCIO – CULTURAL MODEL:

* Family members are over involve in each others activity---- difficulty in

becoming independent in life.

*Isolated and lack of social support---- depressed

* Societal role and label assigned to people----- such labels stick to that
person
5. 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.
ANXIETY DISORDER
 Symptoms:
 The term anxiety is defined as Rapid heart rate,
diffuse, vague, very unpleasant
shortness of breath,
feeling of fear and apprehension.
dizziness,
loss of appetite,
fainting,
sweating,
sleeplessness,
frequent,
urination and tremors.
TYPES OF ANXIETY DISORDER

Generalized Anxiety Disorder

Panic Disorder
Phobias
SAD
GENERALIZED ANXIETY DISORDER:

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.
PANIC DISORDER

Recurrent anxiety attacks in which the person experience intense terror

 Symptoms: 7.Chest pain

1.Shortness of breadth 8.Fear of going crazy
2.Dizziness 9. losing control or dying
3.Trembling
4.Palpitation
5.Choking
6.Nausea
 PHOBIAS
Irrational fear related to specific object , people or situations.

 Types of Phobia:
Specific Phobia
Social Phobia
Agoraphobia – Unfamiliar situation
SEPARATION ANXIETY DISORDER (SAD):

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 DISORDER
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.
TRAUMA AND STRESS RELATED DISORDER.
POST TRAUMATIC STRESS DISORDER (PTSD)

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

 Adjustment Disorders and Acute Stress Disorder are also

included under this category.
SOMATIC SYMPTOMS AND RELATED DISORDER

 Somatic symptom disorder

 Illness anxiety disorder
 Conversion disorders

Physical symptoms in the absence of physical disease.

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.
ILLNESS ANXIETY DISORDER

It involves persistent preoccupation about

developing a serious illness and constantly
worrying about this possibility
CONVERSION DISORDER

* Report loss of part or all of some basic body functions.

Paralysis
Blindness
Deafness
Difficulty in walking
* Occurs after a stressfull situation or sudden
DISSOCIATIVE DISORDER
*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

3. Depersonalisation
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.
DISSOCIATIVE IDENTITY DISORDER

* 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.
DEPERSONALIZATION

Dreamlike state in which the person has a sense of being

separated both from self and from reality.
DEPRESSIVE DISORDERS

Disturbance in mood or prolonged emotional state.

TYPES:
Depression
Major depressive disorder
DEPRESSION
* Depression covers variety of negative mood and behavioural changes
* 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

MAJOR DEPRESSIVE DISORDER
Period of depressed mood or lose of interest  Excessive guilt feeling
or pleasure in most activities together  Feeling of worthlessness
with other symptoms such as:

 Change in body weight

 Constant sleep problem
 Tiredness
 Inability to think clearly
 Agitation
 Greatly slowed behaviour
 Though of death and suicide
BIPOLAR RELATED DISORDERS
 Bipolar I disorder: 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
 Misbehavior 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
SCHIZOPHRENIC DISORDER
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 OF SCHIZOPHRENIA
 Positive symptoms: these are ‘ pathological Excess’ or ‘ bizarre addition’
to the persons behaviour . Excess of thought , emotions and behaviour

 Negative symptoms: Deficit of thought , emotions and behaviour

 Psychomotor symptoms
POSITIVE SYMPTOMS
1. Delusions: False belief that is firmly held on inadequate grounds.

Types

 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 DISORDERS:

* 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
fantacies.
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 DISORDER

 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. ATTENTION – DEFICIT HYPERACTIVE DISORDER (ADHD):

Two main features are inattentive and Hyperactivity-impulsivity.

Common complaints for inattentive :  Does not finish assignment

 Cannot concentrate  Quick to lose interest in boring
 does not listen activities
 Does not follow instructions

 Disorganized

 easily distractible

 Forgetful
Common complaints for impulsivity :
Children with impulsivity seems unable to control their immediate reactions or to think before they act.
They find it difficult to wait for their turn.
Have difficulty resisting immediate temptation or delaying gratification.

Common complaints for Hyperactivity :

 Constant motion
 fidget
 Squirm
 Climb
 Run around in the room aimlessly
2. AUTISM SPECTRUM DISORDER (ASD):

 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
3. INTELLECTUAL DISABILITY:

 Intellectual disability refers to below average

intellectual functioning with an IQ of
approximately 70 or below.

4. 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
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.

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

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
1. 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

( note: Affect of alcohol in our body.

table 4.2 is important)
The end