PSYCHOLOGICAL DISORDERS

Chapter 4

• Abnormal Psychology is the area within psychology that is focused on maladaptive behaviour – its causes, consequences, and treatment.

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• The ‘four Ds’:
• Deviance (different, extreme, unusual, even bizarre)
• Distress (unpleasant and upsetting to the person and to others)
• Dysfunction (interfering with the person’s ability to carry out daily activities in a constructive way)
• Danger (to the person or to others)

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Abnormal- Away from Normal….

TWO APPROACHES OF ABNORMALITY

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1. Deviation From Social Norms
• Norms - which are stated or unstated rules for proper conduct.
• Culture — its history, values, institutions, habits, skills, technology, and arts.
• Dynamic process.

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• Maladaptive
• Well-being - is not simply maintenance and survival but also includes growth and fulfilment, i.e. the actualisation of potential.

Historical Background

• Supernatural and magical forces
• Exorcism, i.e. removing the evil that resides in the individual through countermagic and prayer.
• 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.
• Biological or Organic Approach
• Brain not working properly
• Psychological Approach
• inadequacies in the way an individual thinks, feels, or perceives the world.

Historical Background

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.

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FACTORS UNDERLYING ABNORMAL�BEHAVIOUR

BIOLOGICAL FACTORS

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• Faulty genes, endocrine imbalances, malnutrition, injuries and other conditions may interfere with normal development and functioning of the human body.

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• Problems in the transmission of messages from one neuron to another.
• Anxiety disorders have been linked to low activity of the neurotransmitter gamma aminobutyric acid
• (GABA), schizophrenia to excess activity of dopamine, and depression to low activity of serotonin.

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• Genetic factors have been linked to mood disorders, schizophrenia, mental retardation and other psychological disorders.
• However, its not specific genes but a combination of many genes that bring about various behavior and emotional reactions, both functional and dysfunctional.

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FACTORS UNDERLYING ABNORMAL�BEHAVIOUR

SOCIOCULTURAL MODEL

• Socio-cultural factors such as war and violence, group prejudice and discrimination, economic and employment problems, and rapid social change, put stress on most of us and can also lead to psychological problems in some individuals.
• 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.
• Enmeshment vs Disengagement in family systems
• Labeling- living upto the roles (sick role)

DIATHESIS-STRESS MODEL

• Psychological disorders develop when a diathesis (biological predisposition to the disorder) is set off by a stressful situation.
1. The diathesis or the presence of some biological aberration which may be inherited.
2. The person is ‘at risk’ or ‘predisposed’ to develop the disorder.
3. The presence of pathogenic stressors, i.e. factors/stressors that may lead to psychopathology.

MAJOR PSYCHOLOGICAL DISORDERS

• Anxiety Disorders
• Somatoform Disorders
• Dissociative Disorders
• Mood Disorders
• Schizophrenic Disorders
• Behavioural and Developmental Disorders
• Substance-use Disorders

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ANXIETY DISORDERS

1. GENERALISED ANXIETY DISORDER : prolonged, vague, unexplained and intense fears that have no object, accompanied by hypervigilance and motor tension

2. 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 loosing control or even dying.

3. PHOBIAS : irrational fears related to specific objects, interactions with others, and unfamiliar situations.

SOME PHOBIAS

ANXIETY DISORDERS

4. OBSESSIVE-COMPULSIVE DISORDER : being preoccupied with certain thoughts that are viewed by the person to be embarrassing or shameful, and being unable to check the impulse to repeatedly carry out certain acts like checking, washing, counting, etc.

5. POST-TRAUMATIC STRESS DISORDER (PTSD) : recurrent dreams, flashbacks, impaired concentration, and emotional numbing followed by a traumatic or stressful event like a natural disaster, serious accident, etc.

SOMATOFORM 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.
• Somatoform disorders include :
1. Pain Disorders
2. Somatisation Disorders
3. Conversion Disorders
4. Hypochondriasis

SOMATOFORM DISORDERS

SOMATOFORM DISORDERS

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.
• Four types:
1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder
4. Depersonalisation

DISSOCIATIVE DISORDERS

DISSOCIATIVE DISORDERS

Let’s Compare & Review

MOOD DISORDERS

• Mood disorders are characterised by disturbances in mood or prolonged emotional state.
• The most common mood disorder is depression, which covers a variety of negative moods and behavioural changes.
• Depression can refer to a symptom or a disorder.
• In day-to-day life, 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 Mood disorders are:
1. Major Depressive Disorder
2. Mania
3. Bipolar Disorder

MAJOR DEPRESSIVE DISORDER

• Defined as a period of depressed mood and/or loss of interest or pleasure in most activities.
• symptoms which may include:
• Change in body weight
• Constant Sleep Problems
• Tiredness
• Inability To Think Clearly
• Agitation
• Greatly Slowed Behavior
• Thoughts Of Death And Suicide
• Clinical diagnosis- Helplessness, Hopelessness & Worthlessness

Factors Predisposing towards Depression

• Genetic make-up / heredity (predisposition)
• Age (young adulthood in females, middle age in males)
• Gender (females report more)
• Experiencing Negative Life Events
• Lack Of Social Support

MANIA & BIPOLAR MOOD DISORDER

• People suffering from mania become:
• Euphoric (‘high’)
• Extremely active
• Excessively talkative
• Easily distractible.
• Manic episodes rarely appear by themselves, they usually alternate with depression.
• Such a mood disorder, in which both mania and depression are alternately present, is sometimes interrupted by periods of normal mood and is known as Bipolar Mood Disorder.
• Earlier referred to as Manic-depressive Disorders.

MOOD DISORDERS & SUICIDE

• Highest risk in Bipolar Disorder
• Age – Teenagers and young adults are as much at high risk for suicide, as those who are over 70 years.
• Gender- men have higher rate of contemplated suicide than women.
• Ethnicity / Race / cultural attitudes toward suicide - In Japan, for instance, suicide is the culturally appropriate way to deal with feeling of shame and disgrace. (Honour Killing- HARAKIRI)

PREVENTING SUICIDE

Suicide can be prevented by being alert to:

• 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

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• Persistent Boredom
• Difficulty In Concentration
• Complaints About Physical Symptoms,
• Loss Of Interest In Pleasurable Activities.
• Seeking timely help from a professional counsellor/psychologist

SCHIZOPHRENIC 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.

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• The social and psychological costs of schizophrenia are tremendous, both to patients as well as to their families and society.

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Symptoms of Schizophrenia

1. Positive symptoms (i.e. excesses of thought, emotion, and behaviour)

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• Negative symptoms (i.e. deficits of thought, emotion, and behaviour)

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• Psychomotor symptoms

Positive Symptoms of Schizophrenia

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Negative Symptoms of Schizophrenia

Psychomotor Symptoms

They move less spontaneously or make odd grimaces and gestures.

These symptoms may take extreme forms known as catatonia.

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CATATONIC STUPOR remain motionless and silent for long stretches of time.

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CATATONIC RIGIDITY- maintaining a rigid, upright posture for hours.

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CATATONIC POSTURING - assuming awkward, bizarre positions for long periods

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.

• 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.

BEHAVIOURAL AND DEVELOPMENTAL DISORDERS

According to Achenbach:

EXTERNALISING DISORDERS (Undercontrolled problems) include behaviours that are disruptive and often aggressive and aversive to others in the child’s environment.

• Attention-deficit Hyperactivity Disorder (ADHD)
• Oppositional Defiant Disorder (ODD)
• Conduct Disorder

INTERNALISING DISORDERS (Overcontrolled problems) are those conditions where the child experiences depression, anxiety, and discomfort that may not be evident to others.

• Separation Anxiety Disorder (SAD) and
• Depression

Attention-Deficit Hyperactivity Disorder (ADHD)

Oppositional Defiant Disorder (ODD) &�Conduct Disorder (CD)

Oppositional Defiant Disorder- Display age-inappropriate amounts of stubbornness, are irritable, defiant, disobedient, and behave in a hostile manner.

• Unlike ADHD, the rates of ODD in boys and girls are not very different.
• Conduct Disorder and Antisocial Behaviour - Age inappropriate actions and attitudes that violate family expectations, societal norms, and the personal or property rights of others.
• Types of Aggression:
• Verbal aggression (name-calling, swearing)
• Physical aggression (hitting, fighting),
• Hostile aggression (directed at inflicting injury to others), and
• Proactive aggression (dominating and bullying others without provocation).

Separation Anxiety Disorder (SAD) and�Depression

• Internalising disorder unique to children.
• Excessive anxiety or even panic experienced by children at being separated from their parents.
• Have difficulty being in a room by themselves,
• Going to school alone
• Fearful of entering new situations
• Cling to and shadow their parents’ every move.
• To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or make suicidal gestures.

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PERVASIVE DEVELOPMENTAL DISORDERS

• Characterised by severe and widespread impairments in social interaction and communication skills, and stereotyped patterns of behaviours, interests and activities.
• AUTISM
• 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.
• 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.

EATING DISORDERS

• ANOREXIA NERVOSA - 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.
• BULIMIA NERVOSA - 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 - frequent episodes of out-of-control eating.

Substance Abuse 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 called SUBSTANCE ABUSE DISORDERS.
• 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.

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Substance Abuse Disorders

• 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.

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• 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.

Substance Abuse Disorders

The End