Psychological Disorders (Notes)

 

4. PSYCHOLOGICAL DISORDERS

 

FACTS THAT MATTER

 

CONCEPT OF ABNORMALITY:

·         There are many definitions of abnormality but none has got universal acceptance.

·         Most definitions have certain common features called 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

·         And possibly dangerous to the person or to others.

 

The word ‘abnormal’ literally means “away from the normal”

·         It implies deviation from some clearly defined norms or standards.

·         There are two basic and conflicting views :

 

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 social 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 as normal whereas

·         Society that gives importance to cooperation and family values (such as in India) may consider aggressive behaviour as unacceptable or even abnormal.

·         A society’s values may change over time, causing its views of what is psychologically abnormal to change as well.

·         Serious questions have been raised about this definition. It is based on the assumption that socially accepted behaviour is not abnormal, and that normality is nothing more than conformity to social norms.

 

The second approach views

·         Abnormal behaviour as maladaptive.

·         Many psychologists believe that the best criterion for determining the normality of behaviour is not whether society accepts it but whether it fosters the well-being of the individual and eventually of the group to which he/she belongs.

·         Well-Being is not simply maintenance and survival but also includes growth and fulfillment, i.e. the actualization 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.

·         Describing behaviour as maladaptive implies that a problem exists.

 

Psychological disorders:

·         Often characterised by superstition, ignorance and fear.

·         It is commonly believed that psychological disorder is something to be ashamed of.

·         The stigma (shame, disgrace or dishonor) attached to mental illness means that people are hesitant to consult a doctor or psychologist because they are ashamed of their problems.

 

Historical Background of Psychological Disorder:

The history of abnormal psychology has been viewed through different periods of history.

 

The Ancient Theory

·         It states that abnormal behavior can be explained by the operation of supernatural and magical forces such as evil spirits (bhoot-pret), or the devil (shaitan).

·         Exorcism, i.e. removing the evil that resides in the individual through counter magic and prayer, is still commonly used.

·         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.

 

The Biological or Organic Approach

·         A recurring (persistent) thing in the history of abnormal psychology is: The belief that individuals behave strangely because their bodies and their brains are not working properly.

·         In the modern era, there is evidence that body and brain processes have been linked to many types of maladaptive behaviour.

·         For certain types of disorders, correcting these defective biological processes results in improved functioning.

 

The Psychological Approach

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

·         All three of these perspectives — supernatural, biological or organic, and psychological have recurred throughout the history of Western civilization.

 

The Organismic Approach

·         Pertains to ancient western world

·         Approach was given by Hippocrates, Socrates in general and Plato in particular.

·         They 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 Earth, Air, Fire and Water which combined to form four essential body fluids, viz, blood, black bile, yellow bile, and phleam. 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.

 

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.

 

The Renaissance Period was marked by increased humanism and curiosity about behaviour. Johann Weyer emphasized

·         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.

 

The Age of Reason and Enlightenment

·         The seventeenth and eighteenth centuries were the age of Reason and Enlightenment.

·         During this age scientific method replaced faith and dogma as ways of understanding abnormal behaviour.

 

The Reform Movement

·         The growth of scientific attitude towards Psychological Disorders in the 18th Century contributed to the reform movement and to 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 the new inclination for deinstitutionalization 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 Bio-Psycho-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.

 

Classification of Psychological Disorders (PD)

·         To understand PD we have to do classification of PD.

·         Classification of disorders consists of a list of categories of specific psychological disorders groups into various classes on the basis of some shared characteristics.

 

Why Classification?

Classifications are useful because they enable psychologists, psychiatrists and social workers:

·         to communicate with each other about the disorder,

·         to help in understanding the causes of psychological disorders, and

·         To know the processes involved in their development and maintenance.

 

DSM

·         The American Psychiatric Association (APA) has published an official manual describing and classifying various kinds of psychological disorders.

·         The current version of it is “The Diagnostic and Statistical Manual of Mental Disorders, V Edition (DSM-V)”.

·         Evaluates the patient on five axes or dimensions rather than just one broad aspect of ‘mental disorder’.

·         These dimensions relate to biological, psychological, social and other aspects.

·         The classification scheme officially used in India is the 10th revision of International Classification of Diseases (ICD)-10 which is known as ICD-10 Classification of Behavioural and Mental Disorders.

·         It was prepared by the World Health Organization (WHO).

·         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

 

FACTORS UNDERLYING ABNORMAL BEHAVIOUR

·         Psychologists used different approaches.

·         Each approach in use today emphasizes a different aspect of human behaviour, and explains and treats abnormality in line with that aspect.

·         These approaches also emphasize the role of different factors such as biological, psychological and interpersonal, and socio-cultural factors.

 

I.          Biological Factors

·         Influence all aspects of our behaviour.

·         Biological factors such as faulty genes, endocrine imbalances, malnutrition, injuries and other conditions may interfere with normal development and functioning of the human body. These factors may be potential causes of abnormal behavior.

·         According to this biological model, abnormal behaviour has a biochemical or physiological basis.

·         Biological researchers have found that 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 amino butyric acid (GABA).

·         schizophrenia linked to excess activity of dopamine, and

·         Depression linked to low activity of serotonin.

 

II.         Genetic factors

·         Linked to mood disorders, schizophrenia, mental retardation and other psychological disorders.

·         Researchers have not been able to identify the specific genes that are the culprits.

·         It appears that no single gene is responsible for a particular behaviour or a psychological disorder.

·         In fact, many genes combine to help bring about our various behaviours and emotional reactions, both functional and dysfunctional.

·         Although there is sound evidence to believe that genetic biochemical factors are involved in mental disorders as diverse as schizophrenia, depression, anxiety, etc. and biology alone cannot account for most mental disorders.

 

1.         Psychological model

·         Provides a psychological explanation of mental disorder.

·         As per this model Psychological and interpersonal factors play an important role in abnormal behaviour. These factors include

Ø   maternal deprivation (separation from the mother, or lack of warmth and stimulation during early years of life),

Ø   Faulty parent-child relationships (rejection, overprotection, over- permissiveness, faulty discipline, etc.),

Ø   Maladaptive family structures (inadequate or disturbed family), and

Ø   Severe stress.

·         The psychological models include the psychodynamic, behavioural, cognitive, and humanistic-existential models.

The psychodynamic model is the oldest and most famous of the modern psychological models.

Psychodynamic theorists believe that

·         Psychological forces within the person of which he/she is not consciously aware, whether normal or abnormal, determine behaviour.

·         These internal forces are considered dynamic, i.e. they interact with one another and their interaction gives shape to behaviour, thoughts and emotions.

·         Abnormal symptoms are viewed as the result of conflicts between these forces.

·         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).

·         Freud stated that abnormal behaviour is a symbolic expression of unconscious mental conflicts that can be generally traced to early childhood or infancy.

 

2.         The 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.

·         The model concentrates on behaviours that are learned through conditioning and proposes that what has been learned can be unlearned.

·         Learning can take place by

Ø  Classical conditioning: temporal association in which two events repeatedly occur close together in time.

Ø  operant conditioning: behaviour is followed by a reward, and

Ø  Social learning: learning by imitating others’ behaviour.

·         These three types of conditioning account for behaviour, whether adaptive or maladaptive.

 

3.         The 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 overgeneralizations, that is, they may draw broad, negative conclusions on the basis of a single insignificant event.

 

The humanistic-existential model

·         Humanists believe that human beings are born with a natural tendency to be friendly, cooperative and constructive, and are driven to self-actualize, i.e. to fulfill this potential for goodness and growth.

·         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.

 

III.       Socio-cultural Factors (war, violence, group prejudice and discrimination, economic and employment problems) create stress and can lead to psychological problems.

 

(i) Family system likely to produce abnormal functioning in individual members, e.g., enmeshed structure in which members are over involved in each other’s activities—children have difficulty becoming independent.

 

(ii) Social networks in which people operate (social and professional relationships) — people isolated and lacking social support likely to become depressed.

 

(iii) Societal labels and roles assigned to troubled people influence abnormal functioning. For example, person, who breaks societal norms called ‘deviants’ and ‘mentally ill’—labels stick so that the person is encouraged to act sick, gradually accepts and plays the role and functions in a disturbed manner.

 

IV.        Diathesis-Stress Model:

Psychological disorders develop when a diathesis (biological predisposition to disorder) is triggered by a stressful situation; three components—

(i) Diathesism presence of a biological aberration which may be inherited.

Diathesis may carry a vulnerability to develop a psychological disorder— person is ‘at risk’ or ‘predisposed’ to develop the disorder.

(ii) Presence of pathogenic stressors, i.e., factors/stressors that may lead to psychopathology—if an ‘at risk person’ is exposed to these stressors, predisposition may evolve into a disorder, e.g., anxiety, depression, schizophrenia.

 

V.         Interactional approach, i.e., Biological, Psychological and social factors in combination cause mental disorders.

I. The term anxiety in usually defined as a diffused, vague, very unpleasant feeling of fear and apprehension.

 

Anxiety Disorder: High levels of anxiety that are distressing and interfere with effective functioning also get prolonged for long time indicate the presence of an anxiety disorder.

Anxiety is different from worry. In worry the cause in known but in anxiety the patient finds no apparent cause of the discomfort. General symptoms in anxiety disorders:

·         Rapid heart rate               

·         Shortness of breath

·         Diarrhoea                     

·         Loss of Appetite

·         Fainting                       

·         Dizziness

·         Sweating                     

·         Sleeplessness

·         Frequent urination            

·         Tremors

 

1.         Generalised Anxiety disorder: Consists prolonged, vague, unexplained and intense fears that are not attached to any particular object.

Symptoms:

·         Worry                

·         Apprehensive feelings                

·         Hyper vigilance

·         Restless              

·         Consistently scanning the environment

·         Shaky              

·         Tense                             

·         Motor tension

 

2.         Panic disorder: Main features:

1. Recurrent attacks of anxiety causing intense terror.

2. Unpredictable

3. Lasts only for 6-7 minutes.

Symptoms:

·         Shortness of breath   

·         Chest pain     

·         Dizziness       

·         Trembling

·         Palpitations          

·         Choking        

·         Nausea

·         Fear of going crazy    

·         Losing control or feeling of dying

 

3.         Phobias: Irrational fears

 

(a) Specific Phobia: This is most common.

·         Fear of certain type of animal

·         Enclosed space

 

(b) Social Phobia: Intense and incorporating fear and embarrassment when dealing with others.

·         eg. Fear of attending telephone calls.     

·         Attending a party.

 

(c) Agoraphobia: Refers to fear of unfamiliar people and unfamiliar places.

·         Such people have very limited normal social life.

·         In new place these people get themselves house arrest.

 

4.         Separation Anxiety Disorder (SAD): Individual with SAD are fearful and anxious about separation from attachment figures to an extent that is developmentally appropriate.

·         Children may have difficulty in a room alone.

·         Difficulty in going to school alone.

·         Fearful in entering new situations.

·         Tendency to cling and shadow their parents.

·         These children/Individual of suffer from insecurity of losing their parents.

·         To avoid separation children with SAD may fuss, scream, throw severe tantrums or make suicidal gestures.

 

II.         Obsessive-Compulsive and related Disorders:

·         People affected are unable to control their preoccupations with specific ideas or are unable to prevent themselves from repeatedly carrying out or series of acts that affect their ability to carry out normal activities.

(a) Obsessive Behaviour: It refers to the inability to stop thinking about a particular idea or topic.

·         These thoughts are usually unpleasant and shameful.

 

(b) Compulsive Behaviour: It refers to the need to perform certain behaviours repeatedly.

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

(c) Hoarding Disorders

(d) Trichotillomania (Hair pulling disorder)

(e) Excoriation (Skin picking) disorder.

 

III.       Trauma Stressor-Related Disorder:

 

1. PTSD: It refers to a distinct pattern of symptoms that develop as a result of some traumatic event such as natural disaster, victims of bomb explosion of terrorists, been in a serious accident or in a war related situations. Post-Traumatic Stress Disorder symptoms are:

·         Recurrent dreams

·         Flashbacks

·         Impaired concentration.

·         Emotional numbing

 

2. Adjustment Disorders

 

3. Acute Stress Disorder

 

IV.        Somatic Symptoms and Related disorders: It refers to the conditions in which there are physical symptoms in the absence of a physical disease.

Patient has psychological difficulties and complains of physical symptoms for which there in no biological cause.

 

1.         Somatic Symptoms Disorders: Patient having persistent body-related symptoms which may or may not be related to any serious medical conditions.

Symptoms:

·         Overly preoccupied with their symptoms

·         Continuous worry about their health.

·         Make frequent visit to doctors.

·         Ready for all sort of checkups.

·         Experience significant distress and disturbances in their daily life.

 This expression is in terms of Physical Complaints. Patient monitors minor symptoms like fatigue, indigestion, headache, low energy etc. and believes that he is ill.

 

2.         Illness Anxiety Disorders:

·         Involves persistent preoccupation about developing a serious illness and constantly worrying about this possibility.

·         Patient suffers from anxiety about ones health.

·         Patient becomes obsessed about undiagnosed disease and negative diagnostic results.

·         These people do not respond to assurance by doctors.

·         Easily alarmed about illness such as hearing about someone else’s ill health or some such news.

·         Patient develops anxiety regarding a serious illness and this is the main concern for them.

 

3.         Conversion Disorders: It refers to loss or impairment of motor or sensory functions without physical cause but may be in response to stress and psychological problems.

Symptoms:

·         Reported loss of part or all of some basic bodily functions.

·         Paralysis

·         Blindness

·         Deafness

·         Difficulty in walking

·         These symptoms often occur after a stressful experience

·         They may by quite sudden.

 

V.         Dissociative Disorder:

·         These disorders can be viewed as severance (lack of coordination) of the connections between ideas and emotions.

·         Sudden temporary alterations of consciousness that blot out painfull experiences are defining characteristic of dissociative disorders.

Main symptoms:

·         Feeling of unreality

·         Estrangement

·         Depersonalisation

·         Loss or shift of identify.

 

1.         Dissociative Amnesia:

This disorder is characterised by extensive but selective memory loss that has no known organic cause (eg. head injury). Patient/person may forget his whole past, part of the post or immediate past.

They can no longer recall specific events, people, places or objects.

·         A part of dissociative amnesia is dissociative fugue.

·         Main feature of dissociative fugue refers to an unexpected travel away from house or work place.

·         Patient/person in between may assume a new identity and shows 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.

 

2.         Dissociative Identity disorder:

·         Often referred to as multiple personality.

·         Most dramatic dissociative disorder.

·         It is mostly associated with traumatic experiences in childhood.

·         Patient/person assumes alternate personalisties that may or may not be aware for each other.

 

3.         Depersonalisation/Derealisation disorder:

·         Involves a dreamlike state.

·         The person has a sense of being separated both from self and from reality.

·         There is a change of self-perception.

·         Person’s sense of reality is temporarily lost or changed.

 

VI.        Depressive Disorders:

·         Most widely prevalent disorder.

·         Depression can refer to a symptom or a disorder

Major depression disorder: It is defined as a period of depressed mood and/or loss of interest or pleasure in most activities.

Symptoms:

·         Weight variation

·         Constant sleep problems

·         Tiredness

·         Inability to think clearly

·         Agitation

·         All activities cognitive or behavioural slowed down

·         Thoughts of death and suicide

·         Excessive guilt

·         Feeling or worthlessness

·         No interest in pleasurable activities

·         Finds no purpose in life

·         Tendency of blaming others

·         Low energy

·         Break up in relationship

 

Risk Factors Predisposing towards Depression:

1. Genetic make up or heredity:

2. Age: Women are particularly at risk during young adulthood.

Men: The risk in highest in early middle age.

3. Gender:  Women in comparison to men are more likely to report a depression disorder

4. Other Risk Factors:

·         Negative life events

·         Lack of social support.

 

Bipolar and Related disorders:

·         Bipolar involves both Mania and Depressions.

·         These are cyclic-alternately present with episodes for normal interval.

·         Manic disorder was rarely appear by themselves referred to as Manic Depression Disorders.

·         Bioplar disorder was earlier.

·         Types of Bipolar disorder includes Bipolar I disorder, Bipolar II disorder, and Cyclothymic disorder.

·         Depression and other related disorder may lead to suicide.

·         Suicide is a result of complex in interface of biological, genetic, psychological, cultural and environmental factors.

·         Suicidal behaviour is influenced by:

\[\Rightarrow \]Social factors.

\[\Rightarrow \]Psychological factors

\[\Rightarrow \]Cultural factors

\[\Rightarrow \]Mental disorders: depression, alcohol, abuse, disasters in life, violence in life, abuse or loss, isolation.

·         Suicides also happens impulsively during crisis.

·         Low coping capacity to deal with stressors:

·         Financial crisis

·         Breakup in relationship

·         Previous suicidal attempt.

·         Difficulty in problem solving

·         stress management

·         Emotional expression

·         Additional Factors:

·         Problems in interpersonal relationship

·         Family and negative peer pressure

·         Helplessness

·         Acceptance or rejection attitude of culture and community.

 

Prevention:

·         Improving identification-vulnerability

·         Referral

·         Management of behaviour

Suicides are preventable. It requires comprehensive multi-sectional approach where government, media, and civil society all play important role.

 

Measures to prevent suicide suggested by WHO:

·         Limiting access to the means of suicide.

·         Reporting of suicide by media in a responsible way.

·         Bringing in alcohol-related policy.

·         Early identification, treatment and care of people at risk.

·         Training health workers in the assessing and managing for suicide.

·         Care of people who attempted suicide and providing community support

·         Identifying students in distress: Any unexpected/sudden striking change affecting adolescent’s performance attendence or behaviour should be taken seriously such as

(a) Lack of interest in common activities.

(b) Declining grades

(c) Decreasing effort

(d) Misbehaviour in the classroom.

(d) Mysterious or repeated absence.

(e) Smoking or drinking or drug misuse.

·         Strengthening student’s self esteem:

Following approaches can be useful in enhancing self esteem.

(a) Accentuating positive life experiences to develop positive identity. This increases confidence in self.

(b) Providing opportunities for development of physical, social and vocational skills.

(c) Establishing a trustful communication.

(d) Goals for the students should be specific and realistic, measurable, achievable relevant, to be completed within a relevant time frame.

 

VII.      Schizophrenic Spectrum and other Psychotic Disorders:

Schizophrenic and the other psychotic disorders are some of the most impairing forms of psychopathology.

The spectrum of psychotic disorders includes schizophrenia, schizoaffective disorder delusional disorder, schizotypal disorder as well as psychosis associated with substance use or medical conditions.

The primary clinical features of these disorder, describe the known cognitive and these biological changes associated with schizophrenia, describe potential risk factors and/or causes for the development of schizophrenia.

These psychotic disorders in schizophrenic spectrum show symptoms like delusions, hallucinations, disorganised speech and behaviour, abnormal motor behaviour including catatonia, and negative symptoms like avolition, blunted affect, flat affect and alogia.

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational functioning deteriorate as a result of—

(i) Disturbed thought processes,

(ii) Strange perceptions,

(iii) Unusual emotional states,  

(iv) Motor abnormalities.

 

1. Positive Symptoms: excesses of thought, emotion and behaviour; ‘pathological excesses’ or ‘bizarre additions’ to a person’s behaviour.

 

1.	Symptoms	Defination	Types
A.	Delusions	A false belief firmly held on inadequate grounds. Unaffected by rational argument. Has no basis in reality.	(a) Persecution (most common) - belief of being plotted against, spied on, slandered, threatened, attacked, deliberately victimized (b) Grandeur: Belief that he/she has extraordinary/supernatural power. (c) Reference: Belief of patient that he/she can read other’s mind. They attach special meaning to the action of others to objects and events. (d) Control: Belief that their feelings, thoughts and actions are controlled by others.
B.	Formal Thought Disorders	Inability to think logical. Speak in peculiar ways. Makes communication very difficult.	Loosening of associations, derailment— rapidly shifting from one topic to another so that the normal structure of thinking is muddled and becomes illogical. Neologisms—inventing new words or phrases Perseveration—persistent and inappropriate repetition of the same thoughts.
C.	Hallucinations	Perceptions that occur in the absence of external stimuli	Visual—vague perceptions of colour or distinct visions for people or objects. Auditory (most common)- 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). Olfactory—smell of poison or smoke. Gustatory—food or drink taste strange. Tactile—forms of tingling, burning. Somatic—something happening inside the body such as a snake crawling inside one’s stomach.
D.	Inappropriate Effect	Emotions that are unsuited to the situation.

 

2. Negative Symptoms: deficits of thought, emotion and behaviour; ‘pathological deficits’.

 

	Symptoms	Definition
a.	Alogia (poverty of speech)	Reduction in speech content.
b.	Blunted Affect	Show less feelings than most people do.
c.	Flat Affect	Show no emotions at all.
d.	Avolition (loss of volition)	Apathy and an inability to start or complete a course of action.
e.	Social Withdrawal	Withdraw socially, become totally focused on own ideas and fantasies.

 

3. Psychomotor Symptoms:

	Symptoms	Definition
a.	Catatonic Stupor	Remain motionless and silent for long stretches of time.
b.	Catatonic Rigidity	Maintaining a rigid, upright posture for hours.
c.	Catatonic Posturing	Assuming awkward, bizarre positions for long periods.

 

VIII.     Neurodevelopmental disorder:

·         These disorders get manifested in early years of life. Symptoms may be observed during pre-school age or during the early stage of schooling.

·         These disorders are pervasive because they hamper personal, social, academic and occupational functioning.

·         These disorders get characterised as deficient or excesses in a particular behaviour.

·         Children may show delay in achieving a particular age appropriate behaviour such as walking, speaking etc.

 

 

1.         Attention Deficit Hyperactivity Disorder (ADHD)

The two main features of ADHD are

(a) Inattention

(b) Hyperactivity-impulsivity

Inattentive children show following symptoms:

·   Difficult to sustain mental effort for long time.

·   Difficulty in following instruction.

·   Common complaints are:

Does not listen

Cannot concentrate

Does not follow instructions

Disorganized

Forgetful

Does not finish assignment

Quickly lose interest in boring activities

 

Impulsivity:

·         unable to control their immediate reactions

·         Find difficult to wait

·         Difficulty in immediate temptations or delaying gratification.

·         Minor mishaps are common although serious injurious can also occur.

 

Hyperactivity:

·         Hyperactive children are constantly in motion.

·         Cannot sit at one place.

·         Fidgit

·         Sequirm

·         Climb and seen around the room aimlessly

·         Parents and teachers call them as Motor driven.

·         Always on the go.

·         Too talkative.

 

2.         Autism Spectrum Disorder:

(a) Characterised by widespread impairments in communicational skills.

·   Autistic children because of communication problem find difficulty in starting maintaining and understanding relationships.

·   Many of them never develop speech. Sometimes repetitive and deviant speech although their vocal cord is perfect.

(b) Marked difficulty in social interaction.

·   Profound difficulty in relation to other people.

·   Cannot imitate social behaviour and seem unresponsive to others feelings.

·   Unable to share emotions and experiences

·   Marked difficulty in communication—both active as well as passive.

(c) Stereotyped pattern of behaviour-This behaviour can be called as ritualistic and repetitive behaviour.

(d) They have restricted range of interest. Mostly interested in non-living things particularly moving objects.

(e) 70% Autistic children suffer from intellectual deficiency/disabilities.

(f) Stereotyped body movement as rocking hand flapping, jumping, clapping is common.

·   Self injuries such as banging the head against a wall in rhythmic way is common.

 

3.         Intellectual disability:

·   Refers to below average intellectual functioning.

·   IQ less than 70

·   Deficits or impairment in adaptive behaviour such as areas of communication, self care, home living, social-interpersonal skills functional academic skill, work etc.

·   This deficit gets manifested before the age of 18 years.

·   Intellectual disability can get manifested at 4 levels:

Mild (IQ 55-70)           

Moderate (IQ range 35-40-54)

Severe (IQ 20-25-35-40)    

Profound (IQ below 20-25)

At Mild level, the self help skills, speech and communication, academics, social skills vocational adjustment is slightly disturbed.

Academics 3rd - 6th grade possible.

At moderate level, these areas of functioning gets significantly impaired. Academics 1st -2nd grade is possible.

At severe and profound level, these areas are impaired. Language, self-help skills, social interaction is very limited. No academic skills.

 

4.         Specific learning disorders:

·   Individual experience difficulty in perceiving or processing information

·   Difficulty in learning basic skills such as reading, writing or mathematics.

·   Problem starts at early school years.

·   Performance of such children in below average although additional help may improve performance.

 

IX.        Disruptive, Impulse-control and Conduct disorder

 

 

1.         ODD

Symptoms:

Age inappropriate stubbornness

Irritability

Defiant

Disobedient

Hostile

·         Individual having ODD justify his behaviour due to circumstances/demands.

 

2.         Conduct disorder and Anti Social behaviour:

·   Age inappropriate actions and attitude

·   Violate family expectations

·   Violate societal norms.

·   No respect for other person and their right of property.

·   Major theft

These people manifest aggression and non-aggressive behaviour.

Aggressive behaviour include harm to people and animals.

Non aggressive cause damage to property, theft and serious rule violations.

 

 

X.         Feeding and Eating Disorders: (Special interest to youth)

In the current psychiatric nomenclature of the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) the feeding and eating disorders category includes three eating disorder syndromes - anorexia Nervosa, Bulinua Nervosa, and Binge eating disorder and three conditions that were modified and moved from the section on feeding and eating disorders of infancy or early childhood in DSM-IV-TR-Pica, rumination disorder, and Avoidant-Restrictive food intake disorder (ARFID).

·      Anorexia Nervosa: a distorted body image that leads him/her to see himself/herself as overweight—refuses to eat, exercises compulsively, develops unusual habits such as refusing to eat in front of others, may lose large amounts of weight and even starve himself/herself to death.

·      Bulimia Nervosa: may eat excessive amounts of food, then purge his/her body of food by using medicines such as laxatives or diuretics or by vomiting—feels disgusted and ashamed when he/she binges and is relieved of tension and negative emotions after purging.

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

·      They eat with higher speed than normal.

·      Continue eating till feels uncomfortably full.

·      Person consumes excessive account of food without feeling hungry.

 

XI.        Substances related and addictive disorders:

·      Consistent use of substance may lead to addictive disorders which causes maladaptive behaviour.

·      These disorders may include problems associated with:

·      Abuse of alcohol            

·      Abuse of Cocaine

·      Abuse of Tabacoo          

·      Abuse of Heroin.

 

Alcohol:

·      Drinking interferes with social behaviour and ability to think and work.

·      It may lead to tolerance i.e. a particular dose becomes uneffected to provide the desired effect and person wants more.

·      Alcoholic also experience withdrawal responses when they stop drinking.

When the alcoholic is deprived from the alcohol the body demands the substance and reacts in the form of severe physical and psychological symptoms like abdominal pain, itching, burning sensation, difficulty in concentration etc.

 

Harmful Effect:

·   Alcoholism destroys families, relationship and careers. It causes road accidents and crime. It has hazardous impact on children because they observe the maladaptive behaviour of their alcoholic parents.

Alcoholic parents have major fight, violence among each other and with their children. Such children become prove to develop anxiety, depression, phobias and substance related disorders.

·   Excessive drinking can seriously damage physical health.

 

Heroin:

·      Significantly interferes with social and occupational functioning.

·      It can lead to dependence on heroin. It means the person is using the drug so consistently that now he/she has become addict to it. The person now cannot live without it, cannot work without consuming it and if deprived, shows tolerance and withdrawal symptoms/reactions.

Person who is addict to the substance, his/her life revolves around the acquisition and usage of the drug only.

·      Overdose of heroin slows down the respiratory centres in the brain, almost paralysing, and in many cases causing death.

 

Cocaine:

·      Consistent use may lead to a pattern of abuse.

·      Such abuses may be intoxicated through out the day and function poorly in social relationship and work.

·      It causes problems is short term memory and attention.

·      It develops dependence and person shows tolerance and withdrawal reactions.

Due to withdraw reaction, abusers show feeling of depression, fatigue, sleep problems, irritability and anxiety.

·      Cocaine causes serious effects on psychological functioning and physical well being.

 

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 a sheltered living conditions for them in the community.

·         Depersonaliation 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 behavior 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 over active, 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.

·         Neurotransmitter: Chemicals that carry message across the synapse to the dendrite (and sometimes the cell body) of a receiver neuron.

·         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 characterized 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 characterized 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.