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CHAPTER NO. 4 Psychological Disorders DEFINITION OF ABNORMALITY Since the word ‘abnormal’ literally means “away from the normal”, it implies deviation from some clearly defined norms or standards. In psychology, we have no ‘ideal model’ or even ‘normal model’ of human behaviour to use as a base for comparison. COMMON FEATURES/CHARACTERISTICS OF THE ABNORMALITY It is often called the ‘four Ds’:
- Deviance - Deviant (different, extreme, unusual, even bizarre)
- Distress - Distressing (unpleasant and upsetting to the person and to others)
- Dysfunction - Dysfunctional (interfering with the person’s ability to carry out daily activities in a constructive way)
- Danger - Dangerous (to the person or to others). APPROACHES DIFFERENTIATING NORMAL AND ABNORMAL BEHAVIOUR Various approaches have been used in distinguishing between normal and abnormal behaviours. From these approaches, there emerge 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. Abnormal behaviour, thoughts and emotions are those that differ markedly from a society’s ideas of proper functioning. Each society has norms, which are stated or unstated rules for proper conduct. Behaviours, thoughts and emotions that break societal norms are called abnormal. Thus, a society whose culture values competition and assertiveness may accept aggressive behaviour, whereas one that emphasises cooperation and family values (such as in India) may consider aggressive behaviour as unacceptable or even abnormal. Assumption that socially accepted behaviour is not abnormal, and that normality is nothing more than conformity to social norms. 2. The second approach views abnormal behaviour as maladaptive. Well-being is not simply maintenance and survival but also includes growth and fulfilment, i.e. the actualisation 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. It also suggests that vulnerability in the individual, inability to cope, or exceptional stress in the environment have led to problems in life. Psychological disorders that are characterised by superstition, ignorance and fear. It is commonly believed that psychological disorder is something to be ashamed of. The stigma attached to mental illness means that people are hesitant to consult a doctor or psychologist because they are ashamed of their problems. Actually, psychological disorder which indicates a failure in adaptation to be viewed as illness. HISTORICAL BACKGROUND/HISTORY OF PSYCHOLOGICAL DISORDERS
- Ancient Theory Abnormal behaviour 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 countermagic and prayer, is still commonly used. 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. 2. Biological Or Organic Approach Belief that the 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 civiliza. 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. All three of these perspectives — supernatural, biological or organic, and psychological — have recurred throughout the history of Western civilization. 4. Organismic Approach Physicians of ancient Greece such as Hippocrates, Socrates, and in particular Plato in ancient western civilization. behaviour as arising out of conflicts between emotion and reason.
CLASSIFICATION OF PSYCHOLOGICAL DISORDERS
A classification of such disorders consists of a list of categories of specific psychological disorders grouped into various classes on the basis of some shared characteristics. 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. TWO OFFICIAL MANUALS OF DISORDERS APA - American Psychiatric Association (APA) has published an official manual describing and classifying various kinds of psychological disorders. DSM - 5 - Diagnostic and Statistical Manual of Mental Disorders, 5th^ Edition presents discrete clinical criteria which indicate the presence or absence of disorders. ICD - 10 - The classification scheme officially used in India and elsewhere is the tenth revision of the International Classification of Diseases. Classification of Behavioural and Mental Disorders. It was prepared by the World Health Organisation (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/CAUSES/REASONS/MODELS OF ABNORMAL BEHAVIOUR
1. Biological 2. Psychological Psychodynamic Behavioural Cognitive Humanistic 3. Socio-cultural factors 4. Diathesis Stress Model 1. BIOLOGICAL FACTORS - Faulty genes, endocrine imbalances, malnutrition, injuries and other conditions like neurotransmitters and genetic factors may interfere with normal development and functioning of the human body. These factors may be potential causes of abnormal behaviour. According to this model, abnormal behaviour has a biochemical or physiological basis. a.Neurotransmitters - Biological researchers have found that psychological disorders are often related to problems in the transmission of messages from one neuron to another. An electrical 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 aminobutyric acid (GABA), Depression to low activity of serotonin. Schizophrenia to excess activity of dopamine b. Genetic Genetic factors have been linked to bipolar and related disorders, schizophrenia, intellectual disability and other psychological disorders. Researchers have not, however, been able to identify the specific genes that are the culprits. No single gene is responsible for a particular behaviour or a psychological disorder. Infact, many genes combine to help bring about our various behaviours and emotional reactions, both functional and dysfunctional.
2. PSYCHOLOGICAL FACTORS These factors include 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, etc.), Maladaptive family structures (inadequate or disturbed family), and severe stress. The various psychological models are Psychodynamic, Behavioral, Cognitive, Humanistic- Existential models. The psychodynamic model is the oldest and most famous of the modern psychological models. **Psychological Models:
- Psychodynamic Model (Sigmund Freud):** Abnormal symptoms are viewed as the result of conflicts between these forces (Id, Ego, Superego) 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.
- 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.
- The third component is the presence of pathogenic stressors, i.e. factors/ stressors that may lead to psychopathology. If such “at risk” persons, are exposed to these stressors, their predisposition may actually evolve into a disorder. This model has been applied to several disorders including anxiety, depression, and schizophrenia. **MAJOR PSYCHOLOGICAL DISORDERS
- ANXIETY DISORDERS DEFINITION OF ANXIETY** The term anxiety is usually defined as a diffuse, vague, very unpleasant feeling of fear and apprehension. SYMPTOMS OF ANXIETY The anxious individual also shows combinations of the following symptoms: rapid heart rate, shortness of breath, diarrhoea, loss of appetite, fainting, dizziness, sweating, sleeplessness, frequent urination and tremors. TYPES OF ANXIETY DISORDERS i. Generalised Anxiety Disorder: prolonged, vague, unexplained and intense fears that have no object, accompanied by hyper vigilance and motor tension. ii. Panic Disorder: frequent anxiety attacks characterised by feelings of intense terror and dread; unpredictable ‘panic attacks’ along with physiological symptoms like breathlessness, palpitations, trembling, dizziness, and a sense of losing control or even dying. iii. 3. Phobia: Irrational fears related to specific objects, people, or situations. Phobias often develop gradually or begin with a generalised anxiety disorder. Phobias can be grouped into three main types, i.e. specific phobias, social phobias, and agoraphobia. Specific phobias are the most commonly occurring type of phobia. This group includes irrational fears such as intense fear of a certain type of animal, or of being in an enclosed space. (Social Phobia) Social Anxiety Phobia - Intense and incapacitating fear and embarrassment when dealing with others. Agoraphobia – Irrational fear of entering unfamiliar situations’. People with this are afraid of leaving their home. iv. Separation Anxiety Disorder: Extreme distress when expecting or going through separation from home or other significant people to whom the individual is immensely attached to. 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 parents’ every move. To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or make suicidal gestures. v. Other disorders included under this category are Selective Mutism, Substance/Medication Induced Anxiety Disorder, and Anxiety Disorder Due to Another Medical condition, etc.
- Obsessive – Compulsive and Related Disorders Obsessive compulsive disorder is unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series of acts that affect their ability to carry out normal activities. i. Obsessive behaviour is the inability to stop thinking about a particular idea or topic. The person involved, often finds these thoughts to be unpleasant and shameful. ii. Compulsive behaviour is the need to perform certain behaviours over and over again. Many compulsions deal with counting, ordering, checking, touching and washing. iii. Other disorders in this category include hoarding disorder, trichotillomania (hair- pulling disorder), excoriation (skin-picking) disorder etc. 3.Trauma- and Stressor-Related Disorders Very often people who have been caught in a natural disaster (such as tsunami). PTSD – Post Traumatic Stress Disorders - Victims of bomb blasts by terrorists, or been in a serious accident or in a war-related situation. PTSD symptoms vary widely but may include recurrent dreams, flashbacks, impaired concentration, and emotional numbing. Adjustment Disorders and Acute Stress Disorder are also included under this category. Somatic Symptom and Related Disorders – These are conditions in which 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. These include conversion disorders, somatic symptom disorder, and illness anxiety disorder among others****. 1. Somatic symptom disorder - a person having persistent body-related symptoms which may or may not be related to any serious medical condition. 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 involves persistent preoccupation about developing a serious illness and constantly worrying about this possibility. This is accompanied by anxiety about one’s health. Individuals with illness anxiety disorder are overly concerned about undiagnosed disease, negative diagnostic results, do not respond to assurance by doctors, and are
DEPRESSSIVE DISORDERS
Depression can refer to a symptom or a disorder. 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 is defined as a period of depressed mood and/or loss of interest or pleasure in most activities, together with other symptoms which may include change in body weight, constant sleep problems, tiredness, inability to think clearly, agitation, greatly slowed behaviour, and thoughts of death and suicide. Other symptoms include excessive guilt or feelings of worthlessness. Factors Predisposing towards Depression:
1. Genetic make-up - A great role in this differential risk addition. For example, women in comparison to men are **more likely to report a depressive disorder.
- Heredity** is an important risk factor for major depression and other depressive disorders. 3. Age is also a risk factor. For instance, women are particularly at risk during young adulthood, while for men the risk is highest in early middle age. Other risk factors are experiencing negative life events and lack of social support. Bipolar and Related Disorders Bipolar mood disorders were earlier referred to as manic-depressive disorders. Bipolar I disorder involves both mania and depression, which are alternately present and sometimes interrupted by periods of normal mood. Manic episodes rarely appear by themselves; they usually alternate with depression. Some examples of types of bipolar and related disorders include Bipolar I Disorder, Bipolar II disorder and Cyclothymic Disorder. SUICIDE Every suicide is a misfortune. Suicide takes place throughout the lifespan. CAUSES OF SUICIDE Suicide is a result of complex interface of biological, genetic, psychological, sociological, cultural and environmental factors. Some other risk factors are having mental disorders ( especially depression and alcohol use disorders), going through natural disasters, experiencing violence, abuse or loss and isolation at any stage of life. Previous suicidal attempt is the strongest risk factor.
INDICATIONS OF SUICIDAL BEHAVIOUR
Difficulties in problem-solving, Stress management, and Emotional Expression. Suicidal thoughts lead to suicidal action only when acting on these thoughts seems to be the only way out of a person’s difficulties. These thoughts are heightened under acute emotional and other distress. PREVENTIVE MEASURES OF SUICIDE Limiting access to the means of suicide
- Training health workers in assessing and managing for suicide;
- Care for people who attempted suicide and providing community support.
- 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 it and provide community support. IDENTIFYING STUDENTS IN DISTRESS: Any unexpected or striking change affecting the adolescent’s performance, attendance or behaviour should be taken seriously, such as:
- lack of interest in common activities
- declining grades
- decreasing effort
- misbehavior in the classroom
- mysterious or repeated absence
- smoking or drinking, or drug misuse STRENGTHENING STUDENTS’ SELF-ESTEEM:
- Having a positive self-esteem is important in face of distress and helps in coping adequately.
- 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.
b. FORMAL THOUGHT DISORDRES o People with schizophrenia may not be able to think logically and may speak in peculiar ways. o These formal thought disorders can make communication extremely difficult. These include o Loosening of associations, derailment - rapidly shifting from one topic to another so that the normal structure of thinking is muddled and becomes illogical o Neologisms- inventing new words or phrases and o Perseveration - persistent and inappropriate repetition of the same thoughts c. HALLUCINATIONS
- What Is Hallucination?
- Hallucination - Perceptions that occur in the absence of external stimuli. TYPES OF HALLUCINATIONS
- Auditory hallucinations are most common in schizophrenia. S econd-person hallucination - Patients hear sounds or 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 Hallucinations can also involve the other senses.
- Tactile hallucinations (forms of tingling, burning),
- Somatic hallucinations (something happening inside the body such as a snake crawling inside one’s stomach),
- Visual hallucinations (vague perceptions of colour or distinct visions of people or objects),
- Gustatory hallucinations (food or drink taste strange)
- Olfactory hallucinations (smell of poison or smoke) People with schizophrenia also show inappropriate affect, i.e. emotions that are unsuited to the situation. 2. Negative symptoms These are ‘pathological deficits’ and include poverty of speech, blunted and flat affect, loss of volition, and social withdrawal.
- Alogia – It is poverty of speech, i.e. a reduction in speech and speech content.
- Blunted Effect - show less anger, sadness, joy, and other feelings than most people do.
- Flat affect - No emotions at all.
- Avolition - or Apathy - An inability to start or complete a course of action. People with this disorder may withdraw socially and become totally focused on their own ideas and fantasies.
3. Psychomotor symptoms. - They move less spontaneously or make odd grimaces and gestures. These symptoms may take extreme forms known as catatonia. - Catatonic Stupor - remain motionless and silent for long stretches of time. - Catatonic Rigidity - maintaining a rigid, upright posture for hours. - Catatonic posturing - assuming awkward, bizarre positions for long periods of time. NEURODEVELOPMENTAL DISORDERS
- A common feature it is that
- They manifest in the early stage of development.
- Often the symptoms appear before the child enters school or during the early stage of schooling.
- These disorders result in hampering personal, social, academic and occupational functioning.
- These get characterised as deficits or excesses in a particular behaviour or delays in achieving a particular age-appropriate behaviour.
- Attention-Deficit/Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorder.
- Intellectual Disability, and Specific Learning Disorder. These disorders, if not attended, can lead to more serious and chronic disorders as the child moves into adulthood. 1. ATTENTION – DEFICIT/HYEPRACTIVITY DISORDER - ADHD
- The two main features of ADHD are inattention and hyperactivity impulsivity. Children who are inattentive find it difficult to sustain mental effort during work or play.
- They have a hard time keeping their minds on any one thing or in following instructions.
- Common complaints are that the child does not listen, cannot concentrate, does not follow instructions, is disorganised, easily distracted, and forgetful, does not finish assignments, and is quick to lose interest in boring activities.
- Children who are impulsive seem unable to control their immediate reactions or to think before they act.
- They find it difficult to wait or take turns, have difficulty resisting immediate temptations or delaying gratification.
- Minor mishaps such as knocking things over are common whereas more serious accidents and injuries can also occur.
- Hyperactivity also takes many forms.
- Children with ADHD are in constant motion.
- Sitting still through a lesson is impossible for them.
- The child may fidget, squirm, climb and run around the room aimlessly. Parents and teachers describe them as ‘driven by a motor’, always on the go, and talk incessantly.
However, individuals may be able to reach acceptable performance levels with additional inputs and efforts. Specific learning disorder is likely to impair functioning and performance in activities / occupations dependent on the related skills. DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS The disorders included under this category are Oppositional Defiant Disorder. Conduct Disorder and others.
- Children with Oppositional Defiant Disorder (ODD) display age- inappropriate amounts of stubbornness, are irritable, defiant, disobedient, and behave in a hostile manner. Individuals with ODD do not see themselves as angry, oppositional, or defiant and often justify their behaviour as reaction to circumstances/demands. Thus, the symptoms of the disorder become entangled with the problematic interactions with others. 2. 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. 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. Children show many different types of aggressive behaviour of Conduct Disorder 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). FEEDING AND EATING DISORDERS Another group of disorders which are of special interest to young people are eating disorders. Anorexia nervosa Bulimia nervosa Binge eating.
CHAP.NO 4 DISORDERS Anorexia nervosa The individual has a distorted body image that leads her/ him to see herself/himself as overweight. 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. 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. The person often feels disgusted and ashamed when s/he binges and is relieved of tension and negative emotions after purging. Binge Eating In binge eating, there are frequent episodes of out-of-control eating. The individual tends to eat at a higher speed than normal and continues eating till s/he feels uncomfortably full. In fact, large amount of food may be eaten even when the individual is not feeling hungry. Substance-Related and Addictive Disorders Addictive behaviour, whether it involves excessive intake of high calorie food resulting in extreme obesity or involving the abuse of substances such as alcohol or cocaine, is one of the most severe problems being faced by society today. Disorders relating to maladaptive behaviours resulting from regular and Consistent use of the substance involved are included under Substance related and addictive disorders These disorders include problems associated with the use and abuse of alcohol, cocaine, tobacco and opiods among others, which alter the way people think, feel and behave. While there are many disorders listed under this category, few frequently used substances are discussed below: Alcohol People who abuse alcohol drink large amounts regularly and rely on it to help them face difficult situations. TOLERANCE Their bodies then build up a tolerance for alcohol and they need to drink even greater amounts to feel its effects. WITHDRAWAL - They also experience withdrawal responses when they stop drinking. Alcoholism destroys millions of families, social relationships and careers. Intoxicated drivers are responsible for many road accidents. It also has serious effects on the children of persons with this disorder. These children have higher rates of psychological problems, particularly anxiety, depression, phobias and substance-related disorders. Excessive drinking can seriously damage physical health.
WORDS THAT MATTER
- Abnormal Psychology: Serenities study of abnormal behaviour. By using scientific Techniques, Psychology attempts to describe, explain and predict abnormal behaviour. - Anti-Social Behaviour: refers to any behaviour that is considered harmful or disruptive within a group or society. Aspects of behaviour such as aggression or deserimination would fall into this category. - Anorexia nervosa: Disorder involving severe loss of body weight, accompanied by an intense fear of gaining weight or becoming ‘fat’. - Anxiety: A state of psychic distress characterized by fear, apprehension, and physiological arousal. - Anxiety Disorders: Disorders in which anxiety is a central symptom. The disorder is characterized by feelings of vulnerability, apprehension, or fear. - Autism: Pervasive developmental disorder beginning in infancy and involving a wide range of abnormalities, including deficits in language, perceptual, and motor development, defective reality testing, and social withdrawal. - Delusions: Irrational beliefs that are held despite overwhelming evidence to the contrary. - De-institutionalisation: Movement whose purpose is to remove from care-giving institution such as large mental hospitals all those patients who do not present a clear danger to others or to themselves and to provide treatment sheltered living conditions for them in the community. - Depersonalization Disorder: Dissociative disorder in which there is a loss of the sense of self. - Diathesis-stress Model: A view that the interaction of factors such as biological predisposition combined with life stress may cause a specific disorder. - Dissociation: A split in consciousness whereby certain thoughts, feelings, and behaviour operate independently from others. - Exorcism: Religiously inspired treatment procedure designed to drive out evil spirits or forces from a ‘possessed’ person. - Eating disorders: A term which refers to a serious disruption of the eating habits or the appetite. The main types of eating disorders are Anorexia Nervosa, Bulimia Nervosa and Binge eating. - Genetics: A branch of Biology referring or relating to genes. Inherited genes are basic unit of inheritance. - Hallucination: A false perception which has a compulsive sense of the reality of objects although relevant and adequate stimuli for such perception is lacking. It is an abnormal phenomenon. - Hypochondriasis: A psychological disorder in which the individual is dominated by preoccupation with bodily processes and fear of presumed diseases despite reassurance from doctor that no physical illness exists. - Hyperactivity: Condition characterised by overactive, poorly controlled behaviour and lack of concentration. - Main symptom of ADHD: Severe and frequent problems of either or both attention to tasks or hyperactive and impulsive behaviour. - Mental retardation: Subnormal intellectual functioning associated with impairment in adaptive behaviour and identified at an early age. - Mood Disorder: Disorder affecting one’s emotional state, including depression and bipolar
disorder.
- Neurotransmitter: Chemicals that carry message across the synapse to the dendrite (and sometimes the cell body) of a receiver neurone. - Norms: A generalised expectation shared by most members of a group or culture that underlies views of what is appropriate within that group. In terms of Psychological testing norms are standards of test performance that permit the comparison of one person’s score on the test to the scores of others who have taken the same test. This is the criteria to compare or typical score of an average group. - Obsessive-compulsive Disorder: A disorder characterised by obsession or compulsions. - Phobia: A strong, persistent. And irrational fear of some specific object or situation that presents little or no actual danger to a person. - Post-traumatic Stress Disorder: Patterns of symptoms involving anxiety reactions, tension, nightmares, and depression following a disaster such as an earthquake or a flood. - Schizophrenia: A group of psychotic reactions characterised by the breakdown of integrated personality functioning, withdrawal from reality, emotion blunting and distortion, and disturbances in thought and behaviour. - Somatoform disorder: Condition involving physical complaints or disabilities occurring in the absence of any identifiable organic cause. - Substance Abuse: The use of any drug or chemical to modify mood or behaviour that results in impairment. - Syndrome: Group or pattern of symptoms that occur together in a disorder and represent the typical picture of the disorder
