PSYCHOLOGICAL DISORDERS

Psychological disorders
• Psychological disorders are persistently harmful
thoughts, feelings and actions.
• When behavior is deviant, distressful and
dysfunctional, psychologists label it a disorder.
• Most definitions have certain common features,
often called the ‘four Ds’:
– deviance,
– distress,
– dysfunction and
– danger
 4 D’s
• 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),
• Dangerous (to the person or to others).
 What is abnormal behaviour
• 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.
• In case of physical illnesses, the nature of our
biological system presupposes a level or a range of
normal functioning in reference to which abnormality
or conditions of illness can be identified.
 What is abnormal behaviour
• The normal body temperature of human beings is
around 970 F (or 370 C) and a gross deviation from
the same may be safely taken as a symptom of some
physical illness.
• Similarly, the human heart has a normal range of
beats per minute and any departure from this range
may indicate abnormal physical condition.
• Nevertheless, in respect to human behaviour and
psychological functioning, there is no universal or
objective standard of normality.
Approaches to abnormal behaviour
• Various approaches have been used in
distinguishing between normal and abnormal
behaviours.
• From these approaches, there emerge two
basic and conflicting views
• Deviation from social norms.
• Maladaptive behaviour.
 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
societal norms are called abnormal.
 Deviation from social norms
• Further, social values and practices change over a
period of time making ‘normality’ a changing
concept.
• For instance, earlier on homosexuality was
considered quite abnormal in most societies. But
today, several societies have now changed to accept
it as a normal sexual preference of some people in
the society.
• As such, normality and abnormality are only relative
concepts.
 Abnormal behaviour as maladaptive
• 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.
• Well-being is not simply maintenance
and survival but also includes growth and
fulfilment, i.e. the actualisation of
potential.
 Abnormal behaviour as maladaptive

• For example, a student in the class prefers to

remain silent even when he has questions in
his mind. Describing behaviour as maladaptive
implies that a problem exists.
• it also suggests that vulnerability in the
individual, inability to cope, or exceptional
stress in the environment have led to
problems in life.
 Stigma
• 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.
 Historical Roots

• In the ancient world,

psychopathology was thought to
be caused by demons and spirits
that had taken possession of the
person’s mind and body.
 Historical Background: Exorcism

• 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.
 Exorcism
• Through the shaman, an afflicted person can
learn which spirits are responsible for his
problems and what needs to be done to
appease them.
 The Biological or organic approach.
• Individuals behave strangely because their
bodies and their brains are not working properly.
This is the biological or organic approach.
• 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.
 Psychological approach
• According to this point of view,
psychological problems are caused
by inadequacies in the way an
individual thinks, feels, or perceives
the world.
 Organismic approach
• In the ancient Western world, it was
philosopher- physicians of ancient Greece such
as Hippocrates, Socrates, and in particular Plato
who developed the organismic approach
• They viewed disturbed behaviour as arising
out of conflicts between emotion and reason.
 Four humours
• Galen elaborated on the role of the four humours in
personal character and temperament.
• blood,
• black bile,
• yellow bile, and
• phlegm.
• Each of these fluids was seen to be responsible for a
different temperament.
• Imbalances among the humours were believed to cause
various disorders.
 Hippocrates
• In 400 B.C. the Greek physician Hippocrates took the
first step toward a scientific view of mental illness when
he said that abnormal behavior had physical causes.
• He taught his disciples to interpret the symptoms of
psychopathology as an imbalance among our body fluids
called “humors.”

Humors Origins Temperament

Blood Heart Sanguine (cheerful)

Choler (yellow bile) Liver Choleric (angry)

Melancholer (black bile) Spleen Melancholy (depressed)

Phlegm Brain Phlegmatic (sluggish)

 Middle Ages:Regression in Thought
• Then in the Middle Ages, superstition eclipsed the
Hippocratic model & 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.
• Under the influence of the Medieval Church,
physicians and reverted to the old ways of
explaining abnormal behavior.
Hippocrates
 Middle Ages:Regression in Thought cont.

• 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
• The Renaissance Period was marked by increased
humanism and curiosity about behaviour.
• Johann Weyer emphasised 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.
 
 Age of Reason and Enlightenment
• The 17th and 18th centuries were known as the Age
of Reason and Enlightenment,
• In this era the scientific method replaced faith and
dogma as ways of understanding abnormal behaviour.
• The growth of a scientific attitude towards
psychological disorders in the eighteenth century
contributed to the Reform Movement.
• It helped in increasing compassion for people who
suffered from these disorders.
Age of Reason and Enlightenment cont.

• Reforms of asylums were initiated in

both Europe and America.
• One aspect of the reform movement was
the new inclination for
deinstitutionalisation.
• it placed emphasis on providing
community care for recovered mentally
ill individuals.
 Interactional, or bio- psycho-social
approach.
• According to 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 disorder
• Any attempt at classifying psychological disorders
begins with the patient’s symptoms.
• However, same or similar symptoms may be
present in different psychological disorders.
• Therefore, the emphasis should not be on
individual symptoms but on syndromes.
• A syndrome is a cluster of symptoms that are
generally found together (in a psychological
disorder).
 Uses of classification
• Classifications are useful because they enable
users like psychologists, psychiatrists and social
workers to communicate with each other about
the disorder
• It helps in understanding the causes of
psychological disorders and the processes
involved in their development and
maintenance.
 
 Classification of psychological disorder

• Currently, two systems of classification are in vogue.

• International Classification of Diseases (ICD)
accepted by the World Health Organisation (WHO). It
covers both physical and mental disorders and is used
worldwide. Currently it is in its tenth revision (ICD-
10).
• Diagnostic and Statistical Manual of Mental
Disorders (DSM) devised by the American Psychiatric
Association (APA).
• Currently, its fifth version (DSM-V ) is being used.
 DSM V
• 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, V Edition (DSM-V),
presents discrete clinical criteria which indicate the
presence or absence of disorders.
• These dimensions relate to biological, psychological,
social and other aspects.
 
International Classification of Diseases (ICD-
10)
• The classification scheme officially used in India and
elsewhere is the International Classification of
Diseases (ICD-10), which is known as the ICD-10
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 UNDERLYING ABNORMAL 
BEHAVIOUR
 

• Biological factors
• Psychological models
 Biological factors
• Biological factors influence all aspects of our
behaviour. A wide range of biological factors such as
• faulty genes,
• endocrine imbalances
• malnutrition,
• injuries and other conditions
• It may interfere with normal development and
functioning of the human body. These factors may
be potential causes of abnormal behaviour.
 Biological factors: Neurotransmitter
• According to this model, abnormal behaviour has a
biochemical or physiological basis..
• Studies indicate that abnormal activity by certain neuro-
transmitters can lead to specific psychological disorders.
• Anxiety disorders have been linked to low activity of the
neurotransmitter gamma aminobutyric acid GABA),
• Schizophrenia to excess activity of dopamine,
• Depression to low activity of serotonin
 
Biological factors: Genetic factors
• Genetic factors have been linked to mood
disorders, schizophrenia, mental retardation
and other psychological disorders.
• Researchers have not, however, been able to
identify the specific genes that are the culprits.
• It appears that in most cases, no single gene is
responsible for a particular behaviour or a
psychological disorder.
Biological factors: Genetic factors
• Infact, 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.
 
 Psychological models
• There are several psychological models which
provide a psychological explanation of mental
disorders.
• These models maintain that psychological and
interpersonal factors have a significant role to
play in abnormal behaviour.
 Psychological models
• 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.
 Psychological models
The psychological models include:
• the psychodynamic,
• behavioural,
• cognitive
• humanistic-existential models.
• Social cultural model
 Psychodynamic model
• This model was first formulated by Freud.
• Psychodynamic theorists believe that
behaviour, whether normal or abnormal, is
determined by psychological forces within the
person of which he is not consciously aware.
• These internal forces are considered dynamic,
i.e. they interact with one another and their
interaction gives shape to behaviour, thoughts
and emotions.  
 
 
 
 Psychodynamic model
• Abnormal symptoms are viewed as the result of
conflicts between these forces.
• Freud who believed that three central forces
shape personality —id, ego, and superego.
• Freud stated that abnormal behaviour is a
symbolic expression of unconscious mental
conflicts that can be generally traced to early
childhood or infancy.
 
 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.
 Behavioural model
• 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), and
• Social learning (learning by imitating others’
behaviour).
• These three types of conditioning account for
behaviour, whether adaptive or maladaptive.
 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 overgeneralisations, that is, they may draw
broad, negative conclusions on the basis of a single
insignificant event.
 
 
 Humanistic-existential model
• The humanistic-existential model focuses on
broader aspects of human existence.
• 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.
 Humanistic-existential model
• 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.
 
 
 Socio- cultural model
• According to the socio- cultural model, abnormal
behaviour is best understood in light of the social and
cultural forces that influence an individual.
• As behaviour is shaped by societal forces, factors such
as family structure and communication, social
networks, societal conditions, and societal labels and
roles become more important.
• It has been found that certain family systems are
likely to produce abnormal functioning in individual
members
 Socio- cultural model
• Some families have an enmeshed structure in which the
members are overinvolved in each other’s activities, thoughts,
and feelings.
• Children from this kind of family may have difficulty in becoming
independent in life.
• The broader social networks in which people operate include
their social and professional relationships.
• Studies have shown that people who are isolated and lack social
support, i.e. strong and fulfilling interpersonal relationships in
their lives are likely to become more depressed and remain
depressed longer than those who have good friendships.
 Socio- cultural model
• Socio-cultural theorists also believe that abnormal
functioning is influenced by the societal labels and roles
assigned to troubled people.
• When people break the norms of their society, they are
called deviant and ‘mentally ill’.
• Such labels tend to stick so that the person may be viewed
as ‘crazy’ and encouraged to act sick. The person gradually
learns to accept and play the sick role, and functions in a
disturbed manner.
 
 
 diathesis-stress model
• This 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.
• The first is the diathesis or the presence of some
biological aberration which may be inherited.
 Diathesis-stress model
• 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
• Obsessive - compulsive and related disorders
• Trauma and stressor-related disorders
• Somatic symptom and related disorders
• Dissociative disorders
• Depressive disorders
• Bipolar and related disorders
• Schizophrenia spectrum and other psychotic disorders
• Neurodevelopment disorders
• Autism spectrum disorders
• Disruptive, impulse - control and conduct disorders
• Feeding and eating disorders
 Anxiety
• High levels of anxiety that are distressing and
interfere with effective functioning indicate
the presence of an anxiety disorder
• The term anxiety is usually defined as a
diffuse, vague, very unpleasant feeling of fear
and apprehension.
 Symptoms Of Anxiety
• rapid heart rate,
• shortness of breath,
• diarrhoea,
• loss of appetite,
• fainting, dizziness,
• sweating, sleeplessness,
• frequent urination and tremors.
 TYPES OF ANXIETY DISORDERS
• GAD
• PANIC ATTACKS
• PHOBIA
• SAD
 Anxiety disorders
• Anxiety disorders have two fundamental
emotions in common: anxiety and fear.
• Anxiety is a future-oriented emotion
characterized by marked negative affect,
bodily symptoms of tension, and chronic
apprehension.
 Fear

• Fear, on the other hand, is an immediate alarm

reaction to present danger characterized by
strong escape-action tendencies.
• We have also learned that one can experience
the emotion of fear when there is really
nothing to be afraid of. This experience has
been labeled panic. These emotions are the
building blocks of anxiety disorders
 Panic attack
• Panic attack is defined as a discrete period of intense fear or
discomfort accompanied by somatic and psychic symptoms.
The attack has a sudden onset and rapidly builds to a peak
(usually in 10 minutes or less). It is accompanied by a sense of
imminent danger or impending doom and an urge to escape.
• The attack usually lasts few minutes, but is generally followed
by a sense of depression, distress, uneasiness that may
persist for several hours.
• The anxiety that is characteristic of a panic attack can be
differentiated from generalised anxiety by its intermittent,
almost paroxysmal nature and its typically greater severity.
 Symptoms of Panic attack
(1) Palpitations, pounding heart
(2) Sweating
(3) Trembling or shaking
(4) Sensations of shortness of breath or smothering
(5) Feeling of choking
(6) Chest pain or discomfort
(7) Nausea or abdominal distress
(8) Feeling dizzy, unsteady, lightheaded, or faint
(9) Derealization (feelings of unreality) or depersonalization (being detached
from oneself )
(10) Fear of losing control or going crazy
(11) Fear of dying
(12) Paresthesias (numbness or tingling sensations
 Case study : Panic disorder

• Marilyn is a 33-year-old single woman who works at a

local telephone company and lives alone in her
apartment. She has panic disorder with agoraphobia and
her first panic attack occurred 3 years ago when driving
over a bridge on a very rainy day. She experienced
dizziness, pounding heart, trembling and difficulty
breathing. She was terrified her symptoms meant she
was about to pass out and lose control of her car. Since
that time she has experienced eight unexpected panic
attacks during which she feared she was about to pass
out and lose control of herself
 Case study : Panic disorder

She frequently experiences limited symptom attacks (e.g. feels

dizzy and fears she may pass out). As a result of her intense
fear of having another panic attack she avoids the following
situations: waiting in line, drinking alcohol, elevators, movie
theatres, driving over bridges, driving on the freeway, flying by
plane, and heights (e.g. she will not go out on her tenth floor
balcony). She is often late for work because of taking a route
that doesn’t require her to take the freeway. She also finds
herself avoiding more and more activities. She frequently feels
tearful and on guard. Sometimes she gets very angry at herself
as she does not understand why she has become so fearful
and avoidant.
 Case study 2 : Panic disorder

• Sharon is a 38-year-old single mother of two

teenage daughters who works as a fitness instructor
at a local gym. She experienced her first panic
attack during her teens when watching a horror
movie with friends at a local movie theatre. Since
that time she has experienced one to two full panic
attacks per year that come out of the blue in a
variety of situations (e.g. while waiting in line at the
bank, at a shopping mall, walking alone at the park).
 Case study 2 : Panic disorder

The panic attacks recurred out of the blue when she was
29 while eating a hot and spicy meal at a local
restaurant. Her panic attacks always include dizziness,
feeling of choking, dry mouth, unreality, feeling detached
from her body and feeling as if she may lose bowel
control. Her main fear is that she is dying due to a stroke,
although medical problems have been ruled out. Sharon
does not avoid anything to prevent the panic attacks and
there has not been a huge negative impact of the panic
attacks upon her work, family or social functioning.
 Clinical Commentary

• Both Marilyn and Sharon exhibit a number of physical symptoms

typical of panic attacks, although these examples show that not
everyone experiences similar symptoms. Panic attacks often come ‘out
of the blue’ and are unpredictable, which adds to their frightening
nature.
• In both examples the individual believes that the symptoms are signs
of impending physical illness or loss of control (catastrophic
misinterpretation).
• The pervasive fear of further attacks means that Marilyn has
developed avoidance responses in an attempt to minimize future
attacks. These avoidance responses interfere with her normal daily life
(causing further stress), and inadvertently help to maintain
dysfunctional catastrophic beliefs.
 Generalised Anxiety Disorder
• It consists of prolonged, vague, unexplained and
intense fears that are not attached to any particular
object.
• The symptoms include worry and apprehensive
feelings about the future; hyper-vigilance, which
involves constantly scanning the environment for
dangers.
• It is marked by motor tension, as a result of which
the person is unable to relax, is restless, and visibly
shaky and tense.
Generalized Anxiety Disorder (GAD
• Unfocused anxiety
• feels vaguely uneasy
• overreacts to mild stressors
• inability to relax, disturbed sleep
• rapid heart rate,
• fatigue, headaches, dizziness
• Hard to treat because there is no obvious
source of the anxiety
 Case study: Generalized Anxiety Disorder
(GAD)
• “Tom, a 37 year old electrician, complains of
dizziness, sweating palms, heart palpitations and
ringing in the ears. He feels edgy and sometimes
finds himself shaking. With reasonable success he
hides his symptoms from his family and co-
workers. Never the less, he has few social contacts
since the symptoms began two years ago. He
occasionally has to leave work. His family doctor
and a neurologist can find no physical problem.”
 Case study- GAD
• Amy, age 38, is a worrier. She is restless, irritable and
has difficulty concentrating. She worries that she
worries so much and isn’t always sure what it is that
she is worried about. She can’t let her husband or
children leave the house without making them call
her regularly to reassure her that they are ok. Her
husband is growing weary of her fretting. Her children
can’t understand what all the fuss is about. Their
impatience with her only makes her worry more.
 
 PHOBIA
• Persistent and irrational fear of an object or situation that
presents no realistic danger.
• Specific phobias are defined as an excessive,
unreasonable, persistent fear triggered by a specific object
or situation.
• Social phobia - fear of public scrutiny or Public speaking
• Agoraphobia - fear of being in public places. People
develop a fear of entering unfamiliar situations.
agoraphobics are afraid of leaving their home. So their
ability to carry out normal life activities is severely
limited.
 Phobia
• Specific phobias (SP) are defined as an excessive,
unreasonable, persistent fear triggered by a specific
object or situation.
• Anxiety experienced in response to a specific stimulus
Specific (simple) phobias
• Animals (snakes, spiders, rats)
• Situations (high places, enclosed spaces, doctor’s office)
• Things (blood, waters, clowns)
• Social phobia - fear of public scrutiny Public speaking
• Agoraphobia - fear of entering into unfamiliar situations.
 How do phobias develop?
• Psychoanalytic Accounts of phobia
• Classical Conditioning and Phobias
• Evolutionary Accounts of Phobias
• Behavioural Account of Phobia
Psychoanalytic Accounts of phobia
• Psychoanalytic theory as developed by Freud.
• He saw phobias as a defence against the anxiety
produced by repressed id impulses.
• This fear became associated with external events or
situations that had a symbolic relevance to that
repressed id impulse.
• According to Freud’s psychoanalytic theory, the
function of phobias was to avoid confrontation with
the real, underlying issues (in this case, a repressed
childhood conflict).
Psychoanalytic Accounts of phobia
• Phobia are a result of displacement. It is a way
for people to take strong feelings from
whatever originally aroused them and redirect
them into something else.
• Thus people who are unconsciously
threatened by unacceptable feelings ( fear of a
spouse or parent ) may redirect these towards
something else (e.g. a fear of elevators or
spider.
 Behaviourist view of Phobias
• Behaviourist believe that people who suffer
from anxiety disorders learned to associate
fear and anxiety with an apparently harmless
situation.
• It may be noted that fear has generalized
from some other, similar situation that really
was harmful.
 Behaviourist view of Phobias
• The person may have had a terrifying
experience in the past and been unable to
unlearn that terror.
• E.g. a young boy is savagely attacked by a
large dog. Because of this experience he is
now terribly afraid of all large dogs.
• Even other children who saw the attack or
heard about it may also come to fear dogs.
 Evolutionary Accounts of Phobias
• Evolutionary researchers to suggest that we may be
biologically prepared or pre-wired to acquire certain
phobias.
• For instance, clinical phobias tend to cluster around things
such as heights, water, spiders, snakes, blood and injury, all
of which can be considered to have a real life-threatening
significance that has been present for many thousands of
years.
• In contrast, we rarely develop clinical phobias of life-
threatening stimuli that have only appeared more recently
in our phylo-genetic past – such as guns and electricity
Evolutionary Accounts of Phobias
• Seligman (1972) suggests that there is a
relatively limited and predictable range of
phobic objects. E.g. people are more likely to
be injured in an automobile accidents than by
a snake or spider bite, yet snake and spider
phobias are far more common than car
phobias.
 Internalising disorders :
Separation Anxiety Disorder (SAD)

• Separation anxiety disorder is an internalising disorder

unique to children.
• Its most prominent symptom is excessive anxiety or even
panic experienced by children at being separated from
their parents.
• 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.
 Internalising disorders :
Separation Anxiety Disorder (SAD)
• The ways in which children express and experience
depression are related to their level of physical,
emotional, and cognitive development.
• An infant may show sadness by being passive and
unresponsive;
• a pre-schooler may appear withdrawn and inhibited;
• a school-age child may be argumentative and
combative; and
• a teenager may express feelings of guilt and
hopelessness.
 OCD
• People affected by obsessive-compulsive
disorder are 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.
Obssesive compulsive and Related disorders

• OCD is a disorder in which intruding* thoughts

that occur again and again are followed by some
repetitive, ritualistic behavior or mental acts.
• obsessions, such as a fear that germs are on one’s
hands compulsions, such as repeated hand
washing, counting, etc.).
• The compulsions are meant to lower the anxiety
caused by the thought (Soomro, 2001).
 Difference b/w Obsession & compulsion

• 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.
• Compulsive behaviour is the need to perform
certain behaviours over and over again. Many
compulsions deal with counting, ordering,
checking, touching and washing.
 Other disorders
• Hoarding disorder
• Trichotillomania(hair pulling disorder)
• Excoriation(skin - picking disorders)
• Kleptomania. Etc
 Trauma and stressor - Related disorders
Post-traumatic and stress disorder
(PTSD)

• This disorder resulting from exposure to a

major stressor (natural disaster, serious
accident, etc) with symptoms of anxiety,
dissociation, nightmares, poor sleep, reliving
the event, and concentration problems, lasting
for more than 1 month.
Somatic symptom and related Disorders
• These are conditions in which there are
physical symptoms in the absence of a
physical disease.
• In somatoform disorders, the individual has
psychological difficulties and complains of
physical symptoms, for which there is no
biological cause.
Types of somatic symptom and related Disorders

• Somatic symptom disorders,

• Illness anxiety disorder
• conversion disorders.
 Somatic symptom disorder
It involves 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. As a result, they experience significant
distress and Disturbances in their daily life.
 Illness Anxiety disorder
It 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, and are easily alarmed about someone else's ill -
health or some such news.
 Difference between somatic
symptom and illness anxiety
disorder
In general, both somatic symptom and illness
anxiety disorder are concerned with medical
illness but the difference lies in the way this
concern is expressed. In the case of somatic
symptom disorder, this expression is in terms of
physical complaints while in case of illness anxiety
disorder, as the name suggests, it is the anxiety
which is the main concern.
 conversion disorders
• The symptoms of conversion disorders are the
reported loss of part or all of some basic body
functions.
• Paralysis, blindness, deafness and difficulty in
walking are generally among the symptoms
reported.
• These symptoms often occur after a stressful
experience and may be quite sudden.
 Dissociative Disorders

 Dissociation can be viewed as severance of the

connections between ideas and emotions.
• Dissociation involves feelings of unreality,
estrangement, depersonalisation, and
sometimes a loss or shift of identity.
• Sudden temporary alterations of consciousness
that blot out painful experiences are a defining
characteristic of dissociative disorders.
 Dissociative Disorders

• three conditions are included in this group:

• dissociative amnesia
• dissociative identity disorder, and
• depersonalisation.
 Dissociative amnesia

• Dissociative amnesia is characterised by extensive but

selective memory loss that has no known organic cause
(e.g., head injury).
• Some people cannot remember anything about their past.
• Others can no longer recall specific events, people, places,
or objects, while their memory for other events remains
intact.
• This disorder is often associated with an overwhelming
stress.
 
 Dissociative fugue :
It is a part of dissociative amnesia
• an unexpected travel away from home and
workplace, the assumption of a new identity,
and the 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.
 Dissociative identity disorder
• It is referred as multiple personality disorder.
• It is often associated with traumatic
experiences in childhood.
• In this disorder, the person assumes alternate
personalities that may or may not be aware of
each other.
Depersonalisation/ Derealisation disorder

• Depersonalisation involves a dreamlike state

in which the person has a sense of being
separated both from self and from reality.
• In depersonalisation, there is a change of self-
perception, and the person’s sense of reality is
temporarily lost or changed.
 Depressive Disorders

depression covers a variety of negative moods

and behavioural changes.
• Depression can refer to a symptom or a
disorder.
• In day-to-day life, we often use the term
depression to refer to normal feelings after a
significant loss, such as the break-up of a
relationship, or the failure to attain a significant
goal.
 Major depressive disorder
• It is defined as a period of depressed mood and loss of interest
or pleasure in most activities along with other symptoms.
other symptoms are:
• change in body weight,
• constant sleep problems,
• tiredness,
• inability to think clearly,
• agitation, greatly slowed behaviour,
• and thoughts of death and suicide.
• excessive guilt or feelings of worthlessness.
Factors Predisposing towards Depression :

• Genetic make-up, or heredity

• 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.
• Gender also plays a great role in this differential risk
addition. For example, women in comparison to men are
more likely to report a depressive disorder.
• Negative life events and
• Lack of social support.
 
 Bipolar and related disorders
• Bipolar I disorder involves both mania and
Depressive, which are alternatively present
and sometimes interrupted by periods of
normal mood.
• Manic episodes rarely appear by themselves;
they usually alternate with depression.
• Bipolar mood disorders were earlier referred
to as manic-depressive disorders.
 Comparisons of Common Symptoms in
Manic and Depressive Episodes

Manic Episode Depressive Episode

• Emotional Elated, euphoric, • Gloomy, hopeless, socially
very sociable, impatient at withdrawn, irritable
any hindrance. • Characterized by slowness
• Cognitive Characterized by of thought processes,
racing thoughts, flight of obsessive worrying, inability
ideas, desire for action, and to make decisions, negative
impulsive behavior; self-image, self-blame and
talkative, self-confident; delusions of guilt and
experiencing delusions of disease
grandeur
 Comparisons of Common Symptoms in
Manic and Depressive Episodes
Manic Episode Depressive Episode

• Less active, tired,

• Motor Hyperactive, tireless,
experiencing difficulty in
requiring less sleep than
sleeping, showing
usual, showing increased
decreased sex drive and
sex drive and fluctuating
decreased appetite
appetite
Types of Bipolar and related disorders

• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic etc
 Suicide
• Suicide takes place throughout the life span
suicide is a result of complex interface of
biological, genetic, psychological, sociological,
cultural and environmental factors.
• Some other risk factors are having mental
disorders, going through natural disasters
experiencing violence, abuse or loss and
isolation at any stage of life. Previous suicidal
attempt is the strong risk factor.
 Suicide
• Suicidal behavior indicates 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
stress. The ramifications of suicide on social
circle and communities tend to be
devastating and long lasting.
 Suicide
• The stigma surrounding sucide continues despite
recent advances in research in this field. Due to this.
Many people who are contemplating or even
attempting suicide do not seek help thus,preventing
timely help from reaching them.
• Improving identification,referral,and management of
behavior are crucial for preventing suicide.
• Therefore we need to identify vulnerability,
comprehend the situation leading to such behavior
and accordingly plan interventions.
 Measures to prevent suicide
Sucides are preventable. There is a need for comprehensive
multi- sectoral approach where the govt., media and civil
society all play important role as stakeholders.
Some measures suggested by WHO-
• Limiting access to the means to sucide
• Reporting suicide by media in a possible way
• Bringing in alcohol - related policies
• Early identification, treatment and care of people at risk
• Training health workers in assessing and managing for
suicide
• Care for people who attempted suicide and providing
community support.
 Identifying students in distress
• changes in eating and sleeping habits
• withdrawal from friends, family and regular activities
• violent actions, rebellious behaviour, running away
• drug and alcohol abuse
• marked personality change
• persistent boredom
• difficulty in concentration
• complaints about physical symptoms, and
• loss of interest in pleasurable activities.
• Help from a professional counsellor/psychologist .
 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.
• Goals for the students should be specific, measurable,
achievable, relevant, to be completed within a relevant tim
frame.
 Schizophrenia spectrum and other psychotic disorders

• Schizophrenia is the descriptive term for a group of

psychotic disorders in which personal, social and
occupational functioning deteriorate as a result of
disturbed thought processes, strange perceptions,
unusual emotional states, and motor abnormalities.
• It is a debilitating disorder. The social and
psychological costs of schizophrenia are
tremendous, both to patients as well as to their
families and society.
 Symptoms of Schizophrenia

• The symptoms of schizophrenia can be grouped into three categories,

viz.
1. Positive symptoms (i.e. excesses of thought, emotion, and
behaviour),
2. Negative symptoms (i.e. deficits of thought, emotion, and behaviour),
3. psychomotor symptoms.
• Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to
a person’s behaviour.
• Delusions, disorganised thinking and speech, heightened perception
and hallucinations, and inappropriate affect are the ones most often
found in schizophrenia.
• Many people with schizophrenia develop delusions.
 Delusions
• A delusion is a false belief that is firmly held
on inadequate grounds. It is not affected by
rational argument, and has no basis in reality.
• Types of delusion:
• Delusions of persecution
• Delusions of reference
• delusions of control
• Delusions of grandeur
 Delusions of persecution
• People with this delusion believe that they
are being plotted against, spied on, slandered,
threatened, attacked or deliberately
victimised.
• One who believes that the intelligence
agencies/police are conspiring to trap her/him
in a spy scandal.
 
 Delusions of reference
• Delusions of reference in which they attach
special and personal meaning to the actions of
others or to objects and events.
• One who believes that the tsunami occurred to
prevent her/him from enjoying her/his
holidays.
 Delusions of control
• In delusions of control, they believe that their
feelings, thoughts and actions are controlled
by others.
• One who believes that her/his actions are
controlled by the satellite through a chip
implanted in her/his brain by some
extraterrestrial beings.
 Delusions of grandeur
• In delusions of grandeur, people believe
themselves to be specially empowered.
• One who believes that s/he is the incarnation
of God and can make things happen.
• A person who believes that s/he is going to be
the next President of India.
SCHIZOPHRENIA: formal thought disorders

• People with schizophrenia may not be able to think

logically and may speak in peculiar ways.
• These formal thought disorders can make
communication extremely difficult.
• These include rapidly shifting from one topic to another
so that the normal structure of thinking is jumbled and
becomes illogical.(loosening of association)
• It also includes invention of new words or phrases
(neologism), and inappropriate repetition of the same
thoughts (perseveration).
 Hallucinations
• Schizophrenics may have hallucinations, i.e.
perceptions that occur in the absence of external
stimuli.
• Types of Hallucinations
• Auditory hallucinations are most common in
schizophrenia.
• Patients hear sounds or voices that speak words,
phrases and sentences directly to the patient or talk to
one another ( second person hallucination)
•.
 Hallucinations
• 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).
 
 Schizophrenic :Negative symptoms
• People with schizophrenia also show inappropriate
affect, i.e. emotions that are unsuited to the
situation.
• Negative symptoms are ‘pathological deficits’ and
include poverty of speech, blunted and flat affect,
loss of avolition ( loss of motivation), and social
withdrawal.
• People with schizophrenia show alogia or poverty of
speech, i.e. a reduction in speech and speech
content
 Schizophrenic :Negative symptoms
• Many people with schizophrenia show less anger, sadness
joy, and other feelings than most people do. Thus they
have blunted affect.
• Some show no emotions at all, a condition known as flat
affect.
• Patients with schizophrenia experience avolition, or
apathy and 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.
Psychomotor symptom: Catatonic
• People with schizophrenia also show
Psychomotor symptoms.
• They move less spontaneously or make odd
grimaces and gestures.
• These symptoms may take extreme forms
known as catatonia.
Psychomotor symptoms:Catatonic
• catatonic stupor: People 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.
 Sub-types of Schizophrenia

According to DSM-IV-TR, the sub-types of

schizophrenia and their characteristics are :
• Paranoid type : Preoccupation with delusions
or auditory hallucinations; no  disorganised
speech or behaviour or inappropriate affect.
• Disorganised type : Disorganised speech and
behaviour; inappropriate or flat affect ; no
catatonic symptoms.
 Sub-types of Schizophrenia

•Catatonic type : Extreme motor immobility;

excessive motor inactivity; extreme negativism (i.e.
resistance to instructions) or mutism (i.e. refusing to
speak).
• Undifferentiated type : Does not fit any of the sub-
types but meets symptom criteria.
• Residual type : Has experienced at least one episode
of schizophrenia; no positive symptoms but shows
negative symptoms.
•  
•
 
 Neurodevelopmental disorders
• Neurodevelopment disorders 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 characterized as deficits in a particular
behavior or delays in achieving a particular age -
appropriate behavior.
 Neurodevelopment disorders

• Attention - deficit /hyperactivity

disorder (ADHD)
• Autism spectrum disorder
• Intellectual disability
• Specific learning 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, forgetful, does not finish
assignments, and is quick to lose interest in boring activities.
 ADHD
• 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.
 ADHD

• 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(turn around), climb and
run around the room aimlessly.
• Parents and teachers describe them as ‘driven by a
motor’, always on the go, and talk constantly.
• Boys are four times more likely to be given this
diagnosis than girls.
 Autism spectrum disorder
• These disorders are characterised by severe and
widespread impairments in social interaction and
communication skills, and stereotyped patterns of
behaviours, interests and activities.
• Autistic spectrum disorder is one of the most common
of these disorders.
• Children with autistic spectrum disorder have marked
difficulties in social interaction and communication, a
restricted range of interests, and strong desire for routine.
• About 70 per cent of children with autism are also
mentally retarded.
 Autism spectrum disorder
• Children with autism experience profound difficulties in relating to other
people. They are unable to initiate social behaviour and seem
unresponsive to other people’s feelings.
• They are unable to share experiences or emotions with others.
• They also show serious abnormalities in communication and language that
persist over time.
• Many autistic children never develop speech and those who do, have
repetitive and deviant speech patterns.
• Children with autism often show narrow patterns of interests and
repetitive behaviours such as lining up objects or stereotyped body
movements such as rocking.
• These motor movements may be self-stimulatory such as hand flapping or
self-injurious such as banging their head against the wall.
• Due to the nature of these difficulties in terms of verbal and non-verbal
communication, individuals and Autism spectrum disorder tend to
experience difficulties in starting, maintaining and even understanding
relationships.
 Intellectual disability
• Intellectual disability refers to below average
intellectual functioning (with an IQ of
approximately 70 or below),
• and deficits or impairments in adaptive
behaviour (i.e. in the areas of communication,
self-care, home living, social/interpersonal
skills, functional academic skills, work, etc.)
• which are manifested before the age of 18
years.  
 Specific learning disorder
• The individual experience difficult in perceiving or
processing information efficiently and accurately.
• These get manifested during early school years and
the individual encounters problems in basic skills in
reading, writing and /or mathematics.
• The affected child tends to perform below average
for her/his age. 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
 

• 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 behavior
as reaction to circumstances. Thus, the symptoms of
the disorder become entangled with the problematic
interactions with other.
• Unlike ADHD, the rates of ODD in boys and girls are not
very different.
 Conduct Disorder

• 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 :
a. aggressive actions that cause or threaten harm to
people or animals,
b. non-aggressive conduct that causes property
damage, major deceitfulness or theft, and serious
rule violations.
 Conduct Disorder

• 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) 
 Feeding and Eating disorders
• These include anorexia nervosa, bulimia nervosa, and
binge eating.
• In 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 anorexic may lose large amounts of weight and
even starve herself/himself to death.  
 Eating disorders
• 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.
• The person often feels disgusted and ashamed
when s/he binges and is relieved of tension and
negative emotions after purging.
• In binge eating, there are frequent episodes of
out-of-control eating.
 Substance - related and addictive disorders
 

• Disorders relating to maladaptive behaviours

resulting from regular and consistent use of
the substance iare included under substance
related and addictive disorders.
• These disorders include problems associated
with using and abusing such drugs as alcohol,
cocaine and heroin, which alter the way
people think, feel and behave
 Substance-use Disorders

• . There are two sub-groups of substance-use

disorders:
• substance dependence
• substance abuse.
 SUBSTANCE DEPENDENCE
• In substance dependence: there is intense craving for the
substance to which the person is addicted, and the person
shows tolerance, withdrawal symptoms and compulsive
drug-taking.
• Tolerance means that the person has to use more and
more of a substance to get the same effect.
• Withdrawal refers to physical symptoms that occur when
a person stops or cuts down on the use of a psychoactive
substance, i.e. a substance that has the ability to change
an individual’s consciousness, mood and thinking
processes.
 SUBSTANCE ABUSE

• In substance abuse, there are recurrent and significant

adverse consequences related to the use of substances.
• People who regularly ingest drugs damage their family
and social relationships, perform poorly at work, and
create physical hazards.
• common forms of substance abuse
• alcohol abuse and dependence,
• heroin abuse and dependence, and
• cocaine abuse and dependence.
 Alcohol Abuse and Dependence

• People who abuse alcohol drink large amounts regularly and

rely on it to help them face difficult situations.
• Eventually the drinking interferes with their social behaviour
and ability to think and work.
• For many people the pattern of alcohol abuse extends to
dependence.
• Their bodies build up a tolerance for alcohol and they need
to drink even greater amounts to feel its effects.
• They also experience withdrawal responses when they stop
drinking.
  
 Alcohol Abuse and Dependence

• 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.
 Heroin Abuse and Dependence
 

• Heroin intake significantly interferes with social and

occupational functioning.
• Most abusers further develop a dependence on
heroin, revolving their lives around the substance,
building up a tolerance for it, and experiencing a
withdrawal reaction when they stop taking it.
• The most direct danger of heroin abuse is an
overdose, which slows down the respiratory centres
in the brain, almost paralysing breathing, and in
many cases causing death.
 Cocaine Abuse and Dependence
 

• Regular use of cocaine may lead to a pattern of abuse in

which the person may be intoxicated throughout the day
and function poorly in social relationships and at work.
• It may also cause problems in short-term memory and
attention.
• cocaine dependence dominates the person’s life, more of
the drug is needed to get the desired effects, and stopping
it results in feelings of depression, fatigue, sleep problems,
irritability and anxiety.
• Cocaine poses serious dangers. It has dangerous effects on
psychological functioning and physical well-being.
 Effects of Alcohol : Some Facts
• All alcohol beverages contain ethyl alcohol.
• This chemical is absorbed into the blood and
carried into the central nervous system (brain
and spinal cord) where it depresses or slows
down functioning.
• Ethyl alcohol depresses those areas in the brain
that control judgment and inhibition; people
become more talkative and friendly, and they
feel more confident and happy.
 Effects of Alcohol : Some Facts
• As alcohol is absorbed, it affects other areas of the brain.
• For example, drinkers are unable to make sound
judgments, speech becomes less careful and less clear,
and memory falters; many people become emotional,
loud and aggressive.
• Motor difficulties increase. For example, people become
unsteady when they walk and clumsy in performing
simple activities; vision becomes blurred and they have
trouble in hearing; they have difficulty in driving or in
solving simple problems.