Ch 4 Psychological Disorders

Explain abnormality.
Abnormality mainly has the following common features, often called the ‘four Ds’:
Deviance - 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 and
Dangerous - possibly dangerous (to the person or to others)

 Well-being is not simply maintenance and survival but also includes growth and fulfilment.

Trace a brief history of how our understanding of psychological disorders has evolved to its current status.
(Very imp)
The history of our understanding of psychological disorders can be explained under the following heads -
1. Supernatural and magical forces
a. It is still believed that abnormal behaviour occurs by the operation of supernatural and magical forces such as
evil spirits (bhoot-pret), or the devil (shaitan).
b. Exorcism, i.e. removing the evil that resides in the individual through counter magic and prayer, is still
commonly used.
c. 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.
d. Through the shaman, an afflicted person can learn which spirits are responsible for his problems and what
needs to be done to appease them.
2. Biological or organic approach
a. This approach believes that individuals behave strangely because their bodies and their brains are not
working properly.
b. In the modern era, there is evidence that body and brain processes have been linked to many types of
maladaptive behaviour.
c. For certain types of disorders, correcting these defective biological processes results in improved functioning.
3. Psychological approach
Psychological problems are caused by inadequacies in the way an individual thinks, feels, or perceives the world.
4. Organismic approach
a. In the ancient Western world, it was philosopher physicians of ancient Greece such as Hippocrates, Socrates,
and in particular Plato who developed this approach
b. They viewed disturbed behaviour as arising out of conflicts between emotion and reason.
c. Galen elaborated on the role of the four humours in personal character and temperament.
d. 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.
e. Each of these fluids was seen to be responsible for a different temperament. Imbalances among the humours
were believed to cause various disorders.
f. 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.
5. Middle Ages
a. Demonology and superstition gained renewed importance in the explanation of abnormal behaviour in the
Middle Ages.
b. It had the belief that people with mental problems were evil and there are numerous instances of ‘witch-
hunts’ during this period.
c. During the early Middle Ages, the Christian spirit of charity prevailed and St. Augustine wrote extensively
about feelings, mental anguish and conflict.
d. This laid the groundwork for modern psychodynamic theories of abnormal behaviour.
 6. Renaissance Period
a. This period was marked by increased humanism and curiosity about behaviour.
b. Johann Weyer emphasised psychological conflict and disturbed interpersonal relationships as causes of
psychological disorders.
c. He also insisted that ‘witches’ were mentally disturbed and required medical, not theological, treatment.
7. The seventeenth and eighteenth centuries
a. These periods were known as the Age of Reason and Enlightenment, as the scientific method replaced faith
and dogma as ways of understanding abnormal behaviour.
b. The growth of a scientific attitude towards psychological disorders in the eighteenth century contributed to
the Reform Movement and to increased compassion for people who suffered from these disorders.
c. Reforms of asylums were initiated in both Europe and America.
d. One aspect of the reform movement was the new inclination for deinstitutionalisation which placed
emphasis on providing community care for recovered mentally ill individuals.
8. Biopsycho-social approach
a. In recent years, there has been a convergence of these approaches, which has resulted in an interactional, or
biopsycho-social 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.

Explain the various psychological models used to understand mental disorders.

(a) Psychodynamic model
a. Believes that behaviour, whether normal or abnormal, is determined by psychological forces within the
person of which s/he is not consciously aware.
b. These internal forces are considered dynamic, i.e. they interact with one another and their interaction gives
shape to behaviour, thoughts and emotions.
c. Abnormal symptoms are viewed as the result of conflicts between psychological forces.
d. This model was first formulated by Freud who believed that three central forces shape personality —
instinctual needs, drives and impulses (id), rational thinking (ego), and moral standards (superego).
e. Freud stated that abnormal behaviour is a symbolic expression of unconscious mental conflicts that can be
generally traced to early childhood or infancy.
(b) Behavioural model
a. It states that both normal and abnormal behaviours are learned.
b. Psychological disorders are the result of learning maladaptive ways of behaving.
c. Concentrates on behaviours that are learned through conditioning and proposes that what has been learned
can be unlearned.
d. Learning can take place by
 classical conditioning (temporal association in which two events repeatedly occur close together in
time),
 operant conditioning (behaviour is followed by a reward),
 social learning (learning by imitating others’ behaviour).
(c) Cognitive Model
a. States that abnormal functioning can result from cognitive problems.
b. People may hold assumptions and attitudes about themselves that are irrational and inaccurate.
c. They 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.
(d) Humanistic-Existential Model
a. It focuses on broader aspects of human existence.
b. Humanists believe that human beings are born with a natural tendency to be friendly, cooperative and
constructive, and are driven to self-actualise, i.e. to fulfil this potential for goodness and growth.
 c. Believe that from birth we have total freedom to give meaning to our existence or to avoid that
responsibility.
d. Those who shirk from this responsibility would live empty, inauthentic, and dysfunctional lives.

The classification of psychological disorders is important. Justify the statement and explain the two classification
schemes.
1. A classification of psychological disorders consists of a list of categories of specific psychological disorders
grouped into various classes on the basis of some shared characteristics.
2. 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.
3. DSM-5 and ICD-10 are manuals which classify various kinds of psychological disorders.
4. The American Psychiatric Association (APA) has published an official manual describing and classifying
various kinds of psychological disorders. The current version of it, the Diagnostic and Statistical Manual of
Mental Disorders, 5th Edition (DSM-5), presents discrete clinical criteria which indicate the presence or
absence of disorders.
5. The classification scheme officially used in India and elsewhere is the tenth revision of the International
Classification of Diseases (ICD-10), which is known as the ICD-10 Classification of Behavioural and Mental
Disorders.
6. It was prepared by the World Health Organisation (WHO).
7. For each disorder, a description of the main clinical features or symptoms, and of other associated features
including diagnostic guidelines is provided in this scheme.

Deepa has been diagnosed with generalised anxiety disorder. Explain the development of this disorder with the
help of diathesis-stress model.
The diathesis-stress 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:
1. The first is the diathesis or the presence of some biological aberration which may be inherited.
2. 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.
3. The third component is the presence of pathogenic stressors, i.e. factors/ stressors that may lead to
psychopathology.
In Deepa’s case, the development of generalized anxiety disorder can be explained with the help of diathesis stress
model.
It could be possible that Deepa may be having genetic predisposition, i.e., she may be having a family history of
anxiety disorders.
Also, she may be having imbalance of neurotransmitters (e.g., serotonin, GABA).
Deepa may also be having personality traits of perfectionism, low self-esteem which may lead to heightened anxiety.
She may be facing stressful life events like illness of family members, marriage, job pressure etc. or environmental
factors: chronic stress or lack of social support.
All these factors can lead to the development of this disorder, according to the diathesis-stress model.

Explain generalised anxiety disorder.

Generalised anxiety disorder –
(i) It consists of prolonged, vague, unexplained and intense fears that are not attached to any particular object.
(ii) The symptoms include worry and apprehensive feelings about the future; hypervigilance, which involves
constantly scanning the environment for dangers.
(iii) It is marked by motor tension, as a result of which the person is unable to relax, is restless, and visibly shaky and
tense.

Explain Panic disorder.

Panic disorder
1. It consists of recurrent anxiety attacks in which the person experiences intense terror.
2. A panic attack denotes an abrupt surge of intense anxiety rising to a peak when thoughts of a particular
stimuli are present.
3. Such thoughts occur in an unpredictable manner.
4. The clinical features include shortness of breath, dizziness, trembling, palpitations, choking, nausea,
chest pain or discomfort, fear of going crazy, losing control or dying.

 People who have phobias have irrational fears related to specific objects, people, or situations.
 Agoraphobia - People develop a fear of entering unfamiliar situations.

 Separation Anxiety Disorder (SAD).

1. A type of anxiety disorder.
2. Individuals are fearful and anxious about separation from attachment figures to an extent that is
developmentally not appropriate.
3. Such children 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 parents’ every move.
4. To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or make suicidal gestures.

What are obsessions?

Obsessions are the inability to stop thinking about a particular idea or topic. The person involved, often finds these
thoughts to be unpleasant and shameful.
What are compulsions?
Compulsions are the need to perform certain behaviours over and over again. Many compulsions deal with counting,
ordering, checking, touching and washing.

 PTSD
1. People who have been caught in a natural disaster or have been victims of bomb blasts by terrorists etc.
experience post-traumatic stress disorder (PTSD).
2. PTSD symptoms vary widely but may include recurrent dreams, flashbacks, impaired concentration, and
emotional numbing.

 Somatic symptom disorder

1. Involves a person having persistent body-related symptoms which may or may not be related to any serious
medical condition.
2. 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.
3. As a result, they experience significant distress and disturbances in their daily life.
 Illness anxiety disorder.
1. This disorder involves persistent preoccupation about developing a serious illness and constantly worrying
about this possibility.
2. This is accompanied by anxiety about one’s health.
3. These are conditions in which there are physical symptoms in the absence of a physical disease.
4. In these disorders, the individual has psychological difficulties and complains of physical symptoms, for which
there is no biological cause.
 5. Such individuals are overly concerned about undiagnosed disease, negative diagnostic results, do not
respond to assurance by doctors, and are easily alarmed about illness such as on hearing about someone
else's ill-health or some such news.
 Conversion disorders
1. The symptoms of conversion disorders are the reported loss of part or all of some basic body functions.
2. Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms reported.
3. These symptoms often occur after a stressful experience and may be quite sudden.

Explain the various dissociative disorders.

Dissociative amnesia
1. This disorder is characterised by extensive but selective memory loss that has no known organic cause.
2. Some people cannot remember anything about their past.
3. Others can no longer recall specific events, people, places, or objects, while their memory for other
events remains intact.
4. Fugue is a kind of dissociative amnesia. (Important)
5. Essential feature of fugue could be an unexpected travel away from home and workplace, the
assumption of a new identity, and the inability to recall the previous identity.
6. The fugue usually ends when the person suddenly ‘wakes up’ with no memory of the events that
occurred during the fugue.
7. This disorder is often associated with an overwhelming stress.
Dissociative identity disorder
1. This disorder is often referred to as multiple personality.
2. It is the most dramatic of the dissociative disorders. It is often associated with traumatic
experiences in childhood.
3. In this disorder, the person assumes alternate personalities that may or may not be aware of
each other.
Depersonalisation/Derealisation
1. This disorder involves a dreamlike state in which the person has a sense of being separated both from
self and from reality.
2. In depersonalisation, there is a change of self-perception, and the person’s sense of reality is temporarily
lost or changed.

Positive symptoms in Schizophrenia (Very Imp)

1. Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to a person’s behaviour.
2. People may also have delusions.
3. A delusion is a false belief that is firmly held on inadequate grounds.
4. It is not affected by rational argument, and has no basis in reality.
The various types of delusions are -
5. Delusions of persecution- People with this delusion believe that they are being plotted against, spied on,
slandered, threatened, attacked or deliberately victimised.
6. Delusions of reference- People attach special and personal meaning to the actions of others or to objects
and events.
7. Delusions of grandeur- People believe themselves to be specially empowered persons
8. Delusion of control- They believe that their feelings, thoughts and actions are controlled by others.
9. People with schizophrenia may not be able to think logically and may speak in peculiar ways.
10. These formal thought disorders can make communication extremely difficult.
11. 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),
and persistent and inappropriate repetition of the same thoughts (perseveration).
 12. People with schizophrenia may have hallucinations, i.e. perceptions that occur in the absence of external
stimuli.
13. Auditory hallucinations are most common in schizophrenia. 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).
14. These can also experience tactile hallucinations (i.e. forms of tingling, burning), somatic hallucinations (i.e.
something happening inside the body such as a snake crawling inside one’s stomach), visual hallucinations
(i.e. vague perceptions of colour or distinct visions of people or objects), gustatory hallucinations (i.e. food
or drink taste strange), and olfactory hallucinations (i.e. smell of poison or smoke).
Negative symptoms in Schizophrenia
1. Negative symptoms are ‘pathological deficits’ and include poverty of speech, blunted and flat affect, loss of
volition, and social withdrawal.
2. People with schizophrenia show alogia or poverty of speech, i.e. a reduction in speech and speech content.
3. Many people with schizophrenia show less anger, sadness, joy, and other feelings than most people do. Thus,
they have blunted affect.
4. Some show no emotions at all, a condition known as flat affect.
5. Also, patients with schizophrenia experience avolition, or apathy and an inability to start or complete a
course of action.
Psychomotor symptoms in Schizophrenia
1. They move less spontaneously or make odd grimaces and gestures.
2. These symptoms may take extreme forms known as catatonia.
3. People in a catatonic stupor remain motionless and silent for long stretches of time.
4. Some show catatonic rigidity, i.e. maintaining a rigid, upright posture for hours.
5. Others exhibit catatonic posturing, i.e. assuming awkward, bizarre positions for long periods of time.

Common features of neurodevelopmental disorders

1. They manifest in the early stage of development.
2. Often the symptoms appear before the child enters school or during the early stage of schooling.
3. These disorders result in hampering personal, social, academic and occupational functioning.
4. These get characterised as deficits or excesses in a particular behaviour or delays in achieving a particular
age-appropriate behaviour.

Neurodevelopmental disorders (Cue: SAAI)

1. Specific learning disorder
2. ADHD
3. Autism spectrum disorder
4. Intellectual disability

I. Write short note on ADHD

1. ADHD is characterised by inattention and hyperactivity - impulsivity.
2. Children who are inattentive find it difficult to sustain mental effort during work or play.
3. They have a hard time keeping their minds on any one thing or in following instructions.
4. 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.
5. Children who are impulsive seem unable to control their immediate reactions or to think before they act.
6. They find it difficult to wait or take turns, have difficulty resisting immediate temptations or delaying
gratification.
 7. Minor mishaps such as knocking things over are common whereas more serious accidents and injuries
can also occur.
8. Children with ADHD are in constant motion. Sitting still through a lesson is impossible for them.
9. The child may fidget, squirm, climb and run around the room aimlessly.
10. Parents and teachers describe them as ‘driven by a motor’, always on the go, and talk incessantly.

Pia has just joined school. Her teachers observed her closely during her group interactions. They noticed that
she shows narrow patterns of interest and is preoccupied in flapping her hands. Pia also finds it challenging to
start and maintain conversation. What do you Pia’s symptoms indicate? List the other symptoms displayed by
children diagnosed with this problem.
1. Pia’s symptoms indicate that she is suffering from autism spectrum disorder.
2. This disorder is characterised by widespread impairments in social interaction and
communication skills, and stereotyped patterns of behaviours, interests and activities.
3. Children with autism spectrum disorder have marked difficulties in social interaction and
communication across different contexts, a restricted range of interests, and strong desire for
routine.
4. About 70 per cent of children with autism spectrum disorder have intellectual disabilities.
5. Children with autism spectrum disorder experience profound difficulties in relating to other
people.
6. They are unable to initiate social behaviour and seem unresponsive to other people’s feelings.
7. They are unable to share experiences or emotions with others.
8. They also show serious abnormalities in communication and language that persist over time.
9. Many of them never develop speech and those who do, have repetitive and deviant speech
patterns.
10. Such children often show narrow patterns of interests and repetitive behaviours such as lining up
objects or stereotyped body movements such as rocking.
11. These motor movements may be self-stimulatory such as hand flapping or self-injurious such as
banging their head against the wall.
12. Due to the nature of these difficulties in terms of verbal and non-verbal communication,
individuals with autism spectrum disorder tend to experience difficulties in starting, maintaining
and even understanding relationships.

Describe the symptoms of conduct disorder and antisocial behaviour.

1. 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.
2. 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.
3. Children show many different types of aggressive behaviour, such as -
verbal aggression i.e. name-calling, swearing,
physical aggression i.e. hitting, fighting,
hostile aggression i.e. directed at inflicting injury to others, and
proactive aggression i.e. dominating and bullying others without provocation.

Shahid is a thin boy but he sees himself as fat and overweight. He refuses to eat and starves himself for days.
These symptoms are typical of which disorder? Explain its other types.
Shahid is suffering from anorexia nervosa, a kind of feeding and eating disorder.
1. In this, the individual has a distorted body image that leads him to see himself as overweight.
2. 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.
The following are the other types of feeding and eating disorders –
1. In 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.
2. The person often feels disgusted and ashamed when s/he binges and is relieved of tension and negative
emotions after purging.
1. In binge eating, there are frequent episodes of out-of-control eating.
2. The individual tends to eat at a higher speed than normal and continues eating till s/he feels uncomfortably
full.
3. In fact, large amount of food may be eaten even when the individual is not feeling hungry.

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