TYBA Abnormal Psychology
TYBA Abnormal Psychology
TYBA Abnormal Psychology
Prof. VimalAmbre
Gonsalo Garsia College,
Vasai Dist, Thane
I
T.Y.B.A. Paper V
Abnormal Psychology
Objectives :
1
UNDERSTANDING ABNORMALITY:
DEFINITION, CLASSIFICATION
AND ASSESSMENT
Unit Structure
1.0 Objectives
1.1 Introduction
1.2 What is Abnormal Behaviour
1.2.1 Defining Abnormality
1.2.2 Challenges Involved in Characterising Abnormal
Behaviour
1.2.3 What causes Abnormality
1.3 The Diagnostic and Statistical Manual of Mental Disorders
1.3.1 How the DSM Developed
1.3.2 Controversial Issues Pertaining to the DSM
1.3.3 Definition of Mental Disorder
1.3.4 Assumptions of the DSM-IV-TR
1.4 Psychological Assessment
1.4.1 Clinical Interview
1.4.2 Mental Status Examination
1.5 Behavioural Assessment
1.6 Multicultural Assessment
1.7 Environmental Assessment
1.8 Physiological Assessment
1.9 Summary
1.10 Questions
1.11 Suggested Readings
1.0 OBJECTIVES :
1.1 INTRODUCTION :
Biological causes:
x In understanding what causes abnormality from the biological
perspective, mental health professionals focus on the processes
in a person’s body, such as genetic inheritance or physical
disturbances.
x Many disorders run in the family. For example, the chances of
the son or daughter developing schizophrenia are greater if
either of their parents is suffering from it as compared to
children of parents who do not have the disorder.
x Other factors such as medical conditions (thyroid), brain
damage (head trauma), exposure to certain environmental
stimuli (toxic substances, allergens), ingestion of certain
medicines, illicit drugs, etc., can cause disturbances in the
physical functioning that cause emotional or behavioural
disturbances.
Psychological causes:
x Traumatic life experiences that have an impact on the
individual’s personality constitute the psychological factors in
the development of abnormality. For example, an irrational fear
of the marketplace may be caused due to a childhood
experience of having been lost in the market.
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Sociocultural causes:
x The term sociocultural refers to the sources of social influence
in one’s life. The most immediate circle that has an impact on a
person comprises of the family members and friends - troubled
relationships can make one feel depressed. Similarly, a failed
lover may become suicidal.
x The next circle involves extended family, neighbours with whom
there is less interaction. Nonetheless their behaviours,
standards, attitudes and expectations do influence individuals.
x The society plays a decisive role in most people’s lives. Political
turmoil, even at the local level can leave one feeling anxious or
fearful. Discrimination on the basis of gender, caste, sexual
orientation, disability can have an impact on individuals. As
seen earlier, social and cultural norms determine what would be
called abnormal, to a large extent.
This is the most common method used to understand the client, his
presenting problem, history and future goals. The interview involves
asking questions in a face-to-face interaction. The clinician may
audiotape or videotape the details or note them down during or
after the interview. There are two kinds of clinical interviews:
Unstructured Interview:
x In this type of an interview, the client is asked open-ended
questions related to his or her presenting problem, the family
background and life history.
x The term ‘unstructured’ is used to indicate that the interviewer is
free to ask questions in any order and frames them in a manner
that he prefers. The client’s response to the previous question
and nonverbal cues such eye-contact, posture, tone of voice,
etc., guide the interviewer in this process.
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The mental status means what the client thinks, feels and how the
client thinks, speaks and behaves. The mental status examination
or the MSE is used to assess the client’s thoughts, feelings and
behaviour and identify symptoms. An example of a structured MSE
is the mini-mental status examination (MMSE) which is very useful
in assessing patients with cognitive disorders such as Alzheimer’s
disease. The MSE report is based on the client’s responses and the
clinician’s objective observations of the client’s appearance, speech
and behaviour. Following are the components of the MSE:
The intensity of affect, that is, its strength is also noted. The
affect is described as blunted affect when there is a severe
reduction in the intensity of externalised feeling tone and as flat
affect when signs of affective expression are absent or nearly
absent, the face is immobile and voice is monotonous. On the
other hand, exaggerated or heightened or overdramatic
affect is reported when the emotional expression is very strong.
The range of affect in terms of the variety of emotional
expressions noted is also taken into account.
Behavioural Observation:
x In this method, the clinician observes and records the frequency
of the behaviour in question, including any other relevant
situational variables. For example, a nurse may be asked to
observe the number of times a patient washes her hands and
also her reactions when she is prevented from doing that. Or a
trained observer may record the number of times a child leaves
his place or speaks out of turn.
x In observing the clients, the clinician first selects the problem
behaviour on the basis of an interview, direct observation or
using behavioural checklists or inventories. The problem
behaviour is then broken down into behavioural terms, that is, it
is defined. For example, temper tantrum would be defined in
terms of crying and shouting.
x Selecting vague target behaviours is inappropriate in
behavioural observation because it makes measurement
difficult. For example, violent behaviour cannot be measured
unless specified as breaking things around or whichever is the
behaviour exhibited.
x It is best to observe the target behaviour in the natural setting
and this kind of behavioural observation is known as in vivo
observation. In assessing a child with attention deficit
hyperactivity disorder, a clinician is likely to get an accurate
picture of the child’s problem behaviours if he is observed in the
classroom or at home rather than in the lab or clinic.
x While using this method the clinician has to be careful about the
client’s reactivity - the knowledge of being observed can
influence the target behaviours. In order to avoid these
problems, the client may be observed through a one-way mirror.
In some situations, others may be included and the client’s
interaction with them may be observed with focus on the target
behaviours.
Psychophysiological Assessment
Neuropsychological Assessment
x Neuropsychological assessment involves assessing brain
functioning from how an individual performs on certain
psychological tests.
x Two best known test batteries that are used for
neuropsychological evaluation are the Halstead-Reitan Battery
and the Luria-Nebraska Neuropsychological Battery.
x The Halstead-Reitan is used to differentiate between the brain
damaged individuals and the neurologically intact and
comprises of subtests such as category test, tactual
performance test, rhythm test, speech-sounds perception test,
time sense test, aphasia screening test, finger-oscillation test,
etc. This may often be combined with the MMPI-2 to get a
measure of the individual’s personality and the WAIS-III to
assess cognitive functioning.
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1.9 SUMMARY :
1.10 QUESTIONS :
2
THEORETICAL PERSPECTIVES
Unit Structure
2.0 Objectives
2.1 Introduction
2.2 The Purpose of Theoretical Perspectives in Abnormal
Psychology
2.3 Psychodynamic Perspective
2.4 Humanistic Perspective
2.5 Sociocultural Perspective
2.6 Behavioural and Cognitively Based Perspectives
2.7 Biological Perspective
2.8 Biopsychosocial Perspective on Theories and Treatment :
An Integrative Approach
2.9 Summary
2.10 Questions
2.11 Suggested Readings
2.0 OBJECTIVES :
2.1 INTRODUCTION :
Id: The id is the most primitive part of the unconscious mind and
contains sexual and aggressive instincts. It is based on the
‘pleasure principle’ and needs immediate satisfaction of its desires.
because her friend didn’t invite her to a party said that she
wasn’t interested in it in the first place.
1.) Oral stage: In this stage which lasts from birth to 18 months,
the mouth and the lips are the primary source of pleasure for the
infant. This stage is divided into the oral-passive or receptive
phase in which the child gains pleasure from nursing or eating,
and the oral-aggressive phase in which the child enjoys
chewing, spitting and tries to bite anything that is around. In
Freud’s view, regression or fixation at the oral passive phase
would result in an adult who depends excessively on oral
gratification such as overeating, cigarette smoking, etc. Those
who are regressed or fixated at the oral-aggressive phase tend
to be unfriendly and critical of others.
2.) Anal stage: In this stage the toddler (18 months to 3 years)
derives pleasure from holding on to and expelling feces.
Fixation at this stage may result in an anal retentive personality,
that is, an adult who is a control freak and obsessed about
hoarding things. On the other hand, fixation at this stage may
also result in an anal expulsive character, that is, an adult who
is sloppy, disorganised and uncontrolled.
Treatment
x According to Freud, the goal of psychoanalytical treatment is to
become consciously aware of the repressed material. This is
achieved through techniques like free association, in which the
client is encouraged to feel free and speak about anything that
comes to his mind, and dream analysis, in which the client
relates details of a dream and freely associates them while the
psychoanalyst gives meaning to the dreams on the basis of its
content and the associations.
x The essence of psychoanalysis is the systematic analysis of
transference and resistance. Transference is the process in
which, while interacting with the therapist, the client relives
conflictual relationships shared with one’s parents and transfers
them onto the therapist. Often clients resist or hold back in
therapy which blocks the process. Dealing with unconscious
fears and conflicts is painful and as a result the client might
forget (unconsciously block) important information, may not be
able to freely associate, postpone appointments or discontinue
therapy altogether.
x The therapist uses interpretation, a technique in which client’s
resistance is analysed and then he or she is helped to work
through the conflictual issues by resolving them in a healthy
manner as compared to what had occurred in the childhood.
x The post-Freudian therapists developed new theories of
personality and methods of treatment but the reliance on
Freudian concepts to explore the unconscious continued.
Person-Centered Theory
x The person-centered or client-centered theory has been
developed by Carl Rogers, who considered every human being
as unique. He believed that individuals naturally move towards
self-actualisation, that is, fulfillment of their potential for love,
creativity and meaning. The term ‘client-centered’ suggests the
idea that the focus is on the client and not on the therapist or
therapeutic techniques.
x The concepts of ‘self’ and ‘self-concept’, one’s subjective
perception of who one is and what one is like are central to
Rogers’s theory. He said there is the self – the person one
thinks he is and the ideal self - the person one wishes to be. For
example, I am an average student (self) but I would like to get a
distinction in my exams (ideal self).
x According to Rogers, a person is said to be fully functional or
well-adjusted when there is a match between the real and ideal
self and between one’s self-image and his experiences. The
term ‘fully’ implies that the individual is utilising his psychological
resources effectively. Thus, a psychological disorder results
from an inability to use one’s full potential that leads to an
inconsistency between how one perceives oneself and reality.
x Due to stress from parents and the society, individuals develop
rigid, distorted perspectives of self and lose touch with their
values and needs. Consider the case of Sohan, who believes he
is unpopular when in fact most of his classmates are fond of
him. This creates a mismatch between reality and Sohan’s
perception of it. Others may try to interact with him but his
ignorance would cause him to avoid them. According to Rogers,
this leads to emotional distress, unhealthy behaviours and in
extreme cases, psychosis.
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Self-Actualisation Theory
x Abraham Maslow, best known for his hierarchy of needs
suggested that the source of motivation is certain needs. He
proposed five types of needs - at the base of the hierarchy are
the basic biological needs for hunger, thirst, etc., followed by the
safety needs, the need for belongingness, esteem needs and at
the top of the hierarchy is the need for self-actualisation.
x Maslow defined self-actualisation as the inner directed drive in
human beings to reach their highest potential. He described
self-actualised people as those who are more concerned about
the welfare of others than themselves, they usually work for
some cause or task than for fame or money, they enjoy the
company of their friends but are not dependent on their
approval, they have an accurate view of life and are yet positive
about life etc.
x Maslow was of the opinion that there are very few self-
actualising individuals in this world and that many are partially
actualised who get to experience self-actualisation in what he
referred to as the ‘peak experience’ - intensely moving
experiences in which one is completely immersed and feels a
sense of unity with the world.
x He also said that behaviour is dominated and determined by
needs that are unfulfilled. When an individual attempts to satisfy
his needs he does it very systematically by beginning with the
most basic needs and then gradually working up the hierarchy.
x Both Maslow and Rogers were of the view that psychological
disorders are caused by a movement away from the ideal state
and had similar ideas about the conditions that hinder self-
actualisation.
Treatment
x Rogers firmly believed that the focus on therapy should be the
client and his needs. The clinician’s role is to help the client
realise that he is innately good and enhance his understanding
of himself.
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Social Discrimination
x Sociocultural theorists suggest that discrimination on the
grounds of gender, race, religion, social class, age, sexual
orientation, etc., can also cause psychological disorders.
x Due to stressors such as poverty, unemployment, lack of
education, nutrition, access to health care systems, etc., many
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Treatment
Family Therapy
x Family therapy focuses on helping the family members relate to
each other and communicate in healthy ways. The therapist
often spends time talking to every family member so as to build
rapport, especially with those who seem to resist therapy.
x To improve communication, the therapist may initiate a
conversation, observe the dynamics of their relationship and
then guide the two members as they proceed. Sometimes these
sessions are videotaped or held in rooms with one-way mirrors.
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Group Therapy
x In this method people having similar problems share their
experiences with each other. Irvin Yalom (1995) suggested that
this technique is effective for various reasons - it relieves the
individuals and gives them hope as they realise that their
problems are not exceptional; they receive useful information
and suggestions from others who share how they dealt with
their issues and the feeling of being of help to someone makes
them feel better about themselves.
x The evidence for the effectiveness of group therapy comes from
Alcoholics Anonymous, in which individuals with alcohol-related
problems and their families share their stories and the
techniques they successfully used to stay away from it.
x Group therapy also helps individuals with pedophilias, who have
sexually abused children, to drop their defenses by providing a
very supportive environment to share their concerns (Berlin,
1998).
x Studies have shown that group therapy is effective for
individuals with depression, especially when combined with
individual therapy or medication (Kasters et al., 2006).
Multicultural Approach
x The therapists need to be sensitive to the cultural background of
the clients. When dealing with clients from different
backgrounds, treatment should incorporate three components:
awareness, knowledge and skills.
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Milieu Therapy
x The term milieu implies the surrounding or the environment.
This form of therapy involves scientific structuring of the
environment by the staff - therapist, nurse or the paramedical
professional, and clients as a team, to enhance the client’s
functioning.
x It focuses on improving social interaction, the physical structure
of the setting and scheduling activities such as group therapy
session, occupational therapy, physiotherapy, etc.
x The goal of milieu therapy is to provide a supportive
environment that encourages socially desirable behaviour and
to keep as many links as possible to the client’s life, beyond the
family.
Classical Conditioning
For example: Sharda feels sad every time she sees the sari gifted
by her husband, who passed away recently. Here, sari is initially a
neutral stimulus because it doesn’t evoke any response by itself.
But after becoming associated with her husband (a naturally
evoking stimulus) seeing the sari (now, a conditioned stimulus)
evokes the emotion of sadness (conditioned response) .
x He also put forth the concept of self-efficacy, that is, the belief
that one can successfully execute behaviours necessary to
control desired outcome (‘I think I can’). Self-efficacy is found to
be related to motivation, self-esteem, interpersonal
relationships, health behaviours, addictions, etc. (Bandura et al.,
2004).
Dysfunctional Attitude
I need to at my best at all times.
Ļ
Experience
I happen to slip and fall.
Ļ
Automatic Thought
I am so dumb / People must be thinking I’m stupid.
Ļ
Negative Emotion
I feel useless and angry.
x Albert Ellis gave the A-B-C model which suggests that how one
feels is determined by the way one thinks about the events in
his life. A refers to the ‘activating event’, B to the ‘beliefs’ and C
is the ‘consequences’. According to him, irrational beliefs, that
is, unrealistic and exaggerated views about self and the world
are the cause of several psychological disorders. Conforming
rigidly to these irrational beliefs using ‘should/must/ought’
makes one feel miserable and results in emotional disturbances.
x David Barlow gave a model that explains the impact of a
combination of physiological, cognitive and behavioural factors
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Treatment
Conditioning Techniques
x Using principles of classical conditioning and operant
conditioning such as positive and negative reinforcement,
counterconditioning, aversive conditioning, extinction, etc
behaviour therapists help client change faulty behavioural
patterns and substitute them with healthy behaviours.
x Joseph Wolpe used counterconditioning to treat phobias or
irrational fears. For example, he taught cats who were
classically conditioned to experience anxiety in a room in which
they were administered shocks, to associate the room with
eating, which reduced their anxiety.
x Counterconditioning is effective when the new stimulus used is
able to evoke a response that is stronger and cannot exist at the
same time as the conditioned response. For example, to help
little Albert get rid of his fear of white rats, one needs to pair
white rats with a stimulus such as chocolates or his favourite
toy. Fear (evoked by the rats) and joy (evoked by the
chocolate/toy) being contradictory states cannot co-exist and
repeated pairing of this nature would gradually help to reduce
his fear.
x Another form of counterconditioning is systematic
desensitisation in which the therapist attempts to reduce the
client’s anxiety by combining relaxation techniques and
progressive or graded exposure to the phobic stimulus. For
example, to treat a client with dog phobia, the therapist may
gradually expose him to the concept of dog in a hierarchical
order. The first step would involve helping the client enter a
relaxed state following which the therapist would speak about
the feared stimulus (the dog), the next step would involve
watching pictures of a dog, next watching a live dog outside
from the window and so on till the client is comfortable with the
idea of being close to a dog without anxiety.
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Cognitive Therapies
x According to the cognitive and cognitive-behavioural therapies,
the way we think determines the way we feel. Based on this
principle is the technique of cognitive restructuring in which the
therapist helps the client change the way he thinks about
himself, others and the future. The therapist does this by
encouraging the client to identify maladaptive attitudes and
irrational beliefs, challenge them and replace them with ideas
that can be checked in real life.
x Panic control therapy (PCT) is a form of cognitive-behavioural
therapy that is used to treat panic disorder which is a type of
anxiety disorder in which the person experiences recurrent and
unexpected panic attacks. PCT combines cognitive
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x The chromosomes operate in pairs and each set has the same
genes on it but in different combinations called alleles. Alleles
refer to whether the combination of genes is dominant or
recessive. The hair colour, texture, eye colour, etc., are decided
by the combination of alleles inherited by the individual. A
dominant allele always shows its effect irrespective of what the
other allele in the pair is whereas a recessive allele expresses
its effect only if it paired with another allele of its own kind.
Treatment
2.9 SUMMARY :
2.10 QUESTIONS :
3
ANXIETY DISORDERS
Unit Structure
3.0 Objectives
3.1 Introduction
3.2 Anxiety Disorders
3.3 Panic Disorder and Phobias
3.4 Generalised Anxiety Disorder
3.5 Obsessive Compulsive Disorder
3.6 Post Traumatic Stress Disorder
3.7 The Bio psychosocial Perspective of Anxiety Disorder
3.8 Summary
3.9 Glossary
3.10 Questions
3.11 Suggested Reading
3.0 OBJECTIVES :
3.1 INTRODUCTION :
Phobias
Agoraphobia :-
Specific Phobias :-
Social Phobia
People with social phobia fear being judged on
embarrassing themselves in front of other people. Social phobia
creates severe disruption in a person’s daily life. People with a
social phobia may avoid eating or drinking in public, for fear they
will make noises when they eat, drop food, or otherwise embarrass,
themselves. They may avoid writing in public, including signing their
names, for fear that others see their hands tremble. Men with social
phobia will often avoid urinating in public bathrooms for fear of
embarrassing themselves. People with social phobia tend to fall
into three groups (Eng et al 2000) some people with social phobia
fear only public speaking. Others have moderate anxiety about a
variety of social situations finally, who have severe fear of many
social situations, from speaking in public to just having a
conversation with another person, are said to have a generalised
type of social phobia.
1. Psychodynamic Theories :-
Freud (1917) developed the first psychological theory of
generalised anxiety. He distinguished among three kinds of
anxiety : realistic, neurotic, and moral. Realistic anxiety occurs
when we face a real danger or threat, such as an oncoming
tornado. Neurotic anxiety occurs when we are repeatedly prevented
from expressing our id impulses, it causes anxiety. Moral anxiety
occurs when we have been punished for expressing our id
impulses, and we come to associate those impulses with
punishment, causing anxiety. Generalised anxiety occurs when our
defense mechanisms can no longer contain either the id impulses
or the neurotic or moral anxiety that arises from these impulses.
3. Cognitive Theories :-
Cognitive theories of GAD suggest that the cognitions of
people with GAD are focused on threat, at both the conscious and
non conscious levels. At the conscious level, people with GAD have
a number of maladaptive assumptions that set them up for anxiety,
such as “I must be loved or approved of by everyone,” “It’s always
best to expect the worst, “People with GAD believe that worrying
can prevent bad events from happening. These beliefs are often
superstitions, but people with GAD also believe that worrying
motivates them and facilitates their problem solving, yet people with
GAD seldom get around to problem solving. Indeed, they actively
avoid visual images of what they worry about, perhaps as a way of
avoiding the negative emotion associated with those images.
Obsessions
They are recurrent and persistent thoughts, impulses, or
images that are experienced as intrusive and inappropriate and that
cause anxiety or distress.
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Compulsions
They are repetitive behaviours (such as hand washing,
checking, etc.) or mental acts (such as praying, repeating words,
etc.) that the person feels driven to perform in response to an
obsession or according to rules that must be applied rigidly.
THEORIES OF OCD –
TREATEMTNS OF OCD –
Drug Therapy : The most effective drug therapies for OCD are the
antidepressant known as selective – serotonin reuptake inhibitors.
CAUSES OF PTSD
1. Psychological Causes –
a) Human beings live with many assumptions about
themselves and others, this keeps the person’s faith and
trust intact. But if these assumptions, one shattered because
of the trauma, may result in PTSD.
b) People already suffering from depression and anxiety are
more vulnerable to develop PTSD.
c) The onset of PTSD also depends on the person’s coping
styles and adjustments. People using self-destructive styles
such as taking alcohol, drugs, isolation are more vulnerable
to PTSD.
2. Biological Causes -
a) Lower level of the hormone cortisol can result in PTSD, as it
prolongs the activity of the sympathetic nervous system.
PTSD people show increased blood flow in the amygdala
area of the brain.
b) Twin and family studies shows that PTSD can be inherited, it
runs in the family.
TREATMENT OF PTSD
1. Cognitive Treatment
a) Behavioural therapy –
Systematic desensitisation helps the patient to identify the
stimulus and rank the fear ascendingly. Positive imagery
training helps the victims of rape to recover from PTSD.
b) Stress management methods helps to develop skills to
overcome stressful issues.
2. Biological therapy –
Selective Serotonin Reuptake Inhibitors (SSRI) and
Benzodiazepines are helpful in treating PTSD symptoms.
3.8 SUMMARY :
3.9 GLOSARY :
3.10 QUESTIONS :
4
SOMATOFORM DISORDERS,
PSYCHOLOGICAL FACTORS AFFECTING
MEDICAL CONDITIONS AND
DISSOCIATIVE DISORDERS - I
Unit Structure
4.0 Objectives
4.1 Introduction
4.2 Somatoform Disorders
4.3 Psychological Factors Affecting Medical Conditions
4.4 Summary
4.5 Questions
4.6 Reference
4.0 OBJECTIVES
4.1 INTRODUCTION
Briquet’s syndrome for more than 100 years and was called as
somatisation disorder for the first time only in 1980s in the DSM- III.
In this disorder there are repeated and multiple vague somatic
complaints for which there is no physiological cause. This is a very
rare disorder and occurs on a continuum.
4.4 SUMMARY
4.5 QUESTIONS
4.6 REFERENCES
5
SOMATOFORM DISORDERS,
PSYCHOLOGICAL FACTORS AFFECTING
MEDICAL CONDITIONS AND
DISSOCIATIVE DISORDERS - II
Unit Structure
5.0 Objectives
5.1 Introduction
5.2 Dissociative Disorders
5.3 Somatoform Disorders, Psychological Factors Affecting
Medical Conditions and Dissociative Disorders: The
Biopsychosocial Perspective
5.4 Summary
5.5 Questions
5.6 Reference
5.0 OBJECTIVES
5.1 INTRODUCTION
ii. Lack of Social Support: It has also been found that a lack
of social support during or after the abuse also seems
implicated. A recent study of 428 adolescent twins has
demonstrated that in 33% to 50% of the cases dissociative
disorder could be attributed to chaotic, nonsupportive family
environment.
flees for a long time, etc. This disorder is most common among
males.
A still another type of dissociative disorder found among the
native people of Aartic which is similar to “Amok” is called
“Pivloktoq” and the same disorder amongst the Navajo tribe is
called “Frenzy Witchcraft”.
which are often vague. Currently the most prevalent view is that
stress related factors and not repressed sexuality is central to
understanding somatoform disorders. Besides stress, learning
seems to play a strong role, especially in cases where individuals
have developed secondary gains from their symptoms.
5.4 SUMMARY
5.5 QUESTIONS
5.6 REFERENCE
6
SEXUAL DISORDERS
Unit Structure
6.0 Objectives
6.1 Introduction
6.2 Abnormal Sexual Behaviour
6.3 Paraphilias
6.4 Gender Identity Disorder
6.5 Sexual Dysfunctions
6.6 Sexual Disorders :The Bio psychosocial Perspective
6.7 Summary
6.8 Glossary
6.9 Questions
6.10 Suggested Readings
6.0 OBJECTIVES :
6.1 INTRODUCTION :
6.3 PARAPHILIAS :
1. Fetishism :-
a) An inanimate object.
b) A source of specific tactile stimulation such as rubber, etc.
c) Part of the body such as toe, buttocks, etc.
3. Frotteurism :-
Causes of Paraphilias
Biological Causes :-
a) Most of the paraphilics are male (over 90 percent). This may
be because paraphilic behaviour often involves hostile or
aggressive impulses, which may be more common in males
than in females.
b) Some studies have found links between endocrine
abnormalities and paraphilia.
c) Some studies suggest a relationship between testosterone
abnormalities and sexually aggressive paraphilias.
d) Alcohol and other drug abuse is common in paraphilias
because these substances, may disinhibit the paraphilic and so
he acts out his fantasy.
Psychological Causes :
Behavioural Causes :
Cognitive Causes :-
Treatment of Paraphilias
Biological Treatment
a) Drug Treatment
Certain drugs are sometimes used to treat paraphilias, the
most popular drug is an anti- androgen drug called, Medroxy
proqesterone acetate. This drug eliminates the person’s sexual
desire and fantasy by reducing his testoterone levels. But
fantasies and arousal soon returns as soon as the drug is
removed. This drug is useful for dangrous sexual offenders
who do not respond to alternative treatments.
Psychosocial Treatments :-
c) Cognitive Therapy :-
This therapy encourages the paraphilics to identify and
challenge thought and situations that arouses them sexually.
They are not asked to justify their behaviours.
Symptoms
2. Discomfort
Persistent discomfort with his/her sex and sense of in
appropriateness in the gender role of that sex.
3. Disinterest in Opposite Sex
He/she is not interested in sexual relation with opposite sex.
They experience distress or problem in sexual interaction with
the opposite sex, if forced.
4. Confusion
Adults with gender identity disorder is also referred as
transsexual or transgender individuals. They wear dress of
opposite sex. Some go for sex change operation, some of
them are asexual, some are hetrosexual and some are
homosexual.
5. Disturbed Mental State
To relieve themselves from the tension and confusion, some
go for alcohol and drugs. Because of rejection from others they
experience frustration, low self-esteem and distress.
Causes of GID
1. Biological Causes –
a) Biological theories have emphasised the effects of prenatal
hormones on brain development. The excessive exposure to
unusual levels of hormones affects the hypothalamus and
other important brain structures that controls sexual identity
and sexual orientation. But these theories are not well
investigated.
b) Few studies focus on a cluster of cells in the hypothalamus
called the “bed nucleus of stria terminalis”. It plays an
important role in sexual behaviour. The size of this cell cluster
plays an important role in GID. This cell cluster are found to be
half of the size in transsexual as compared to non-
transsexuals.
c) Another study suggested that prenatal hormones play an
important role in GID. In an experiment, girls were exposed to
elevated levels of testosterone in utero. Most of these girls
were born with some degree of masculisation of their genitalia
and have more masculine behaviour than other girls.
2. Psychological Causes-
a) Psychological theories focuses on the prenatal nurturing
dimension. How the parents share the child’s gender related
norms will decide the vulnerability of the child to develop GID
later as adult. Usually parents encourage their children to show
gender appropriate behaviour, for example, girls playing with
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Treatment of GID
2. Orgasm Disorders
a) Inhibited Orgasm
It is inability to achieve an orgasm despite adequate sexual
desire and arousal, commonly seen in women but rarely seen
in men. Five to ten percent of the females may experience
female orgasmic disorder in which they never or almost never
reach orgasm (Wincze & Carey, 1991).
122
b) Premature Ejaculation
A far more common disorder of orgasm experienced by males
is premature ejaculation, which refers to ejaculation occurring
well before the partner wishes it to.
1. Biological Causes
2. Psychological Causes
3. Socio Cultural Causes
1. Biological Causes
a) Disease
Diabetes has been linked to sexual dysfunction. Diabetes can
lower the sexual drive, arousal, pleasure and satisfaction,
especially in men. Cardiovascular disease, multiple sclerosis,
renal failure, vascular disease, spinal chord injury and injury to
automatic neurons system due to surgery or radiation have
also been linked to causes of sexual dysfunction. Males are
more prone to get affected.
b) Hormones
Low level of androgen hormones in men, especially.
Testosterone, and high/level of estrogen and prolactin
hormone have been linked to cause sexual dysfunction.
Menopausal women have low sexual desire and arousal
because of no estrogen secretion in the body. Ovarian cancer,
vaginal surgery and sexual self image problem can bring
sexual dysfunction among women.
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Prescribed Drugs
2. Psychological Causes
a) Psychological disorder
Depression in one such cause of sexual dysfunction. Besides
this, the individual suffering from anxiety disorder, panic
disorder, obsessive compulsive disorder, schizophrenia too
have reported no or little desire for having sex. They lack
feelings of sexual arousal and have problems in sexual
functioning.
b) Trauma
Death of loved one, job loss, diagnosis of a serious disease
unemployment in men, etc., leads to lower self esteem and
distorts the self concept. Trauma also leads to depression and
reduces desire for sex.
1. Biological Therapy
2. Sex Therapy
3. Couple Therapy
4. Individual Psychotherapy
5. Treatment approach towards homosexual and bisexual issue
1. Biological Therapy
Certain medical conditions like diabetese, etc., automatically
leads to sexual dysfunctioning. Regulating dosage of drugs
helps in regulating/curing sexual dysfunction.
3. Couple Therapy
Many times couples do not give enough attention to foreplay
and seduction prior to sexual intercourse. They just rush to
experience the sexual pleasure through the sexual act. This
can be problematic for couple later in life, when the biological
level of testosterone and estrogen starts diminishing it result in
inadequate arousal and displeasurable experience while
having sex.
4. Individual Psychotherapy
Cognitive behaviour therapy in conducted to reshape sexual
attitudes and script between couples (Rosen and Leiblum
1995). The reasoning behind sexual fears are confronted to
form fresh perspective and positive cognitions. Psychodynamic
therapies too are used to find clues from the past to the current
sexual problems.
6.7 SUMMARY :
6.8 GLOSSARY :
6.9 QUESTIONS :
7
MOOD DISORDER
Unit Structures :
7.0 Objectives
7.1 Introduction
7.2 General Characteristics of Mood Disorder
7.3 Depressive Disorders
7.3.1 Major Depressive Disorder
7.3.2 Types of Depression
7.3.3 Dysthymic Disorder
7.4 Disorders Involving Alterations of Mood
7.4.1 Cyclothymic Disorder
7.5 Theories of Mood Disorders
7.5.1 Biological Perspectives
7.5.2 Psychological Perspectives
7.5.3 Socio Cultural And Interpersonal Perspectives
7.6 Treatment of Mood Disorders.
7.7 Suicide.
7.8 Summary
7.9 Questions
7.10 References
7.0 OBJECTIVES
7.1 INTRODUCTION
The onset and the course of disorder:- The average age for
major depressive disorder is 30 years.(Hasin et al 2005) A study
performed Cross National Collaboration Group 1992, (Kessler at al
2003) showed that incidence of depression and consequent
suicide is steadily increasing over the years. The national
morbidity study has shown that increasing younger groups called
as cohorts have higher prevalence rates than older people.
Individuals aged 18-29 years are more likely to become depressed
at the earlier ages than the people in the age group 30-44 years. In
short, depression has started surfacing at an early age with greater
frequency.
1) Bipolar disorder :
Genetics:-
A) Biological Treatment :
B) Psychological Treatment –
Cognitive Behavioural approach and interpersonal
psychotherapy are the most commonly adopted approaches for
treatment of depression.
Behavioural Approach :
The major features of this approach in dealing with
depression are :
Interpersonal Psychotherapy :
7.7 SUICIDE
The study found that suicide rate for women in the age group
of 19-29 years in 148 per 1,00,000 and for men it is 58 per
1,00,000.
1) Causes of Suicide –
i) Biological perspective –
1) Treatment of psychopathology.
2) Reduction of cognitive distortion.
3) Work improvement of social skills.
4) Encouragement of problem solving.
5) Regulation of affect and family intervention.
7.8 SUMMARY :
7.9 QUESTIONS :
7.10 REFERENCES :
8
SCHIZOPHRENIA AND RELATED
DISORDERS – I
Unit Structure
8.0 Objectives
8.1 Introduction
8.2 Characteristics of Schizophrenia – positive, negative and
other Symptoms
8.3 Other Psychotic Disorders
8.4 Summary
8.5 Glossary
8.6 Questions
8.7 Suggested readings
8.0 OBJECTIVES :
8.1 INTRODUCTION :
(a) Delusions
A belief that would be seen by most of members of a society
as a misrepresentation of reality is called a disorder of thought,
content as a delusion. Because of its importance in schizophrenia
delusions has been called as basic characteristic of madness. If for
example, you belief that squirrels really are aliens sent to earth on a
reconnaissance mission, this belief would be considered a
delusion.
b) Hallucinations
The experience of sensory events without any input from
surrounding environment is called hallucination. Hallucination can
involve any of the senses, although hearing things that are not
there or auditory hallucination in the most common form
experienced by person with schizophrenia.
Types of Hallucinations :-
i) Auditory Hallucinations
ii) Visual Hallucinations
iii) Tactile Hallucinations
iv) Somatic Hallucinations
152
i) Auditory Hallucinations :-
In auditory hallucinations individuals hear heavy voices,
music, different type of noises, which are imaginary and not
existing. Women are more prone to it than men. The schizophrenic
answer the voice back even when in the middle of conversations
with a real person.
c) Disorganised speech :-
words that have some meaning only to them. Such words are
known as neologisms. They also associate the words on the basis
of its sounds rather than meaning. Such associations are known as
clangs. e.g., dog may be called “spog” and cat as “meaw”.
Sometimes the person may repeat the same word again and
again by stressing on particular word.
(b) Avolition :-
Derived from the prefix a meaning “Without” and volitions
which mean “am act of willing, choosing or deciding.” Avolition is an
inability to initiate and persist in many important activities. It is also
referred to as apathy, people with this symptom show little interest
in even the most basic day-to-day activities, including personal
hygiene. Avolition in an inability to be committed to a common goal
directed activity. Schizophrenic are unmotivated, disorganised and
careless in the task that they undertake.
(C) Alogia :-
It refers to the relative absence in either the amount or the
content of speech. The word derives from the combination of a
(without) and logos (word). A person suffering with alogia may
respond the question with very brief replies that have little content
and many appear disinterested in the conversation.
ii) Grandiose Delusion - False belief that one has great power,
knowledge, or talent or that one is a famous and powerful person.
8.4 SUMMARY
8.5 GLOSSARY
8.6 QUESTIONS
9
SCHIZOPHRENIA AND RELATED
DISORDERS- II
UNIT STRUCTURE
9.0 Objectives
9.1 Introduction
9.2 Theories of Schizophrenia
9.3 Treatments of Schizophrenia
9.4 The Bio psychosocial perspective
9.5 Summary
9.6 Glossary
9.7 Suggested Readings
9.0 OBJECTIVES
9.1 INTRODUCTION
1. Biological Theories
2. Psycho – social Theories
a) Family Studies –
Franz Kallmann (1938) in his research showed that severity
of the parent’s disorder influenced the likelihood of the child’s
having schizophrenia. All forms of schizophrenia (for example,
catatonic paranoid) were seen within the families. A person may
inherit a general predisposition for schizophrenia that may be same
or different from that of his parent.
b) Twin Studies –
Gottesman (1991) has reported that monozygotic twins have
higher possibility of suffering from schizophrenia as compared to
dizygotic twins. 46% of monozygotic twins have concordance rate
where as 14% was found for dizygotic twins.
c) Adoption Studies –
A study carried out by Leonard Heston (1966) on adoption,
found that 17% of the adopted children of parents with
schizophrenia developed the disorder in their adulthood. Kety
(1994) found that biological relative of adoptees were 10 times
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2) Neurotransmitters –
Various theories has studied the interlink between
schizophrenia and the neurotransmitter dopamine. Davis, Kahn,
Ko, and Davidson (1991) found that there is a strong relatation
between dopamine and schizophrenia. The dopamine system is too
active in person with this disorder. The drug phenothiazines or
neuroleoptics reduces the dopamine levels and calms down the
symptoms accordingly. High number of neuronal receptors for
dopamine in certain brain areas and high level of a by product of
dopamine named homovamilic (HVA) in the blood and
cerebrospinal fluld is reported to be the cause of schizophrenia.
Enlarged Ventricles
The ventricles are fluid-filled space in the brain. When the
ventricles are enlarged the blood tissues starts detoriating. It has
been seen that schizophrenics having enlarged ventricles also
show deterioration of the whole matter, i.e., prefrontal areas of the
brain and abnormal link between the pre-frontal cortex and the
amygdala and hippocampus. The patients having enlarged
ventricles show poor tendencies of social, emotional and other
behavioural issues even before the full ouset of schizophrenia.
3) Birth Complications -
Prenatal development and complications during birth also
influences the possibilities of schizophrenia due to neurological
damage and dysfunction. Delivery complications and oxygen
deprivation to the baby, during labour and delivery, can give rise to
neurological vulnerability, thus further leading to schizophrenic
tendencies. Study show that 39% of people with schizophrenia
reported to have a history of prenatal hypoxia. (deprivation of
oxygen at birth).
b) Communication Patterns
Bateson (1959) introduced the term “double bind” which
portrays a type of communication style that produces conflicting
messages, which in turn, causes schizophrenia to develop. If the
parent communicates messages that have two conflicting meanings
(for example, a mother responding coolly to her child’s embrace,
but saying “Don’t you love me anymore?” when the child withdraws.
Such children get sensitive to the contrasting remarks and distrust
their own feelings and perceptions of the world. It may result in
developing fake views of themselves, of others and of the
environment, which may contribute to schizophrenia.
c) Expressed Emotions
One area researchers have focused on a particular
emotional communication style of few families which is referred to
as “Expressed Emotions” (E E). This concept was given by George
W. Brow and his colleagues in London. The researchers studied a
sample of people discharged from the hospital after an episode of
schizophrenia. They found that former patients with less family
contact did better than the patients who spent long periods of time
with their families (Brown,1959). The cause was that the level of
criticism (expressing disapproval), hostility (expressing animosity),
and emotional overinvolvement (being intrusive) by the families was
high, patients tended to relapse (Brown Monck & Wing 1962). Jill
Hooley (1985) have found that ratings of high expressed emotion in
a family are a good predictor of relapse among people with
schizophrenia (almost 3.7 times more likely to relapse). An analysis
of 27 Studies reveals the fact that the relapse rate of schizophrenia
in “high expressed emotion” families were 70% as compared to
31% of relapse cases in patients from “low expressed emotion”
families.
d) Social Circumstances
According to Dohrenmed et al (1987), people suffering from
this disorder are more likely to be exposed to chronically stressful
circumstances. They may live in low income and low status
occupations neighborhood.
1. BIOLOGICAL TREATMENT :
DRUG THERAPY –
2. Family therapy -
Traditional Healers
9.5 SUMMARY
9.6 GLOSSARY
10
PERSONALITY DISORDERS – I
Unit Structure :
10.0 Objectives
10.1 Introduction
10.2 Nature of Personality Disorder
10.3 Antisocial Personality Disorder
10.4 Borderline Personality Disorder
10.5 Histrionic Personality Disorder
10.6 Narcissistic Personality Disorder
10.7 Summary
10.8 Questions
10.9 References
10.0 OBJECTIVES
10.1 INTRODUCTION
This disorder has been known since a long time but different
labels were used to refer to this disorder. This is relatively one of
the most studied and researched disorders. In this disorder the
rights of others are violated. Individuals with this disorder find
themselves in confrontation with the laws and norms of society.
This disorder was earlier called as Sociopath or Psychopath.
1. People with this disorder wreck havoc in society and for this
reason they have been the focus of great deal of research.
2. The life time prevalence of this disorder is 4.5 percent of the
adult males and 0.8 percent of the adult females (Robins and
Regier, 1991).
3. Hervey Cleckley (1941) in his work “The Mask of Sanity”, made
the first scientific attempt to list and categorise the behaviour of
“psychopathic” personality. Cleckley developed a set of criteria
for Psychopathy (which is today called as antisocial personality
disoreder). He identified more than a dozen criteria which
constitutes the core of antisocial personality disorder. Harvey
Cleckly identified 16 traits that he found was common in these
individuals. These are as follows:
i. Regulating emotions
ii. Developing interpersonal effectiveness
iii. Learning to tolerate emotional distress
iv. Developing self-management skills
10.7 SUMMARY
Personality disorder is a separate group of disorders. In
DSM IV these disorders are coded on a separate Axis II. They are
regarded as being different enough from the standard psychiatric
syndromes to warrant separate classification. Personality Disorders
are learned life-long consistent patterns of characteristic behavior
which impair an individual's occupational, interpersonal and social
functioning, and which lead to problematic behavior both for the
individual and for those around him. After defining personality
disorders, some important features of this group of disorders were
discussed in brief.
186
10.8 QUESTIONS
10.9 REFERENCES
11
PERSONALITY DISORDERS – II
Unit Structure:
11.0 Objectives
11.1 Introduction
11.2 Paranoid Personality Disorder
11.3 Schizoid Personality Disorder
11.4 Schizotypal Personality Disorder
11.5 Avoidant Personality Disorder
11.6 Dependent Personality Disorder
11.7 Obsessive-Compulsive Personality Disorder
11.8 Personality Disorder: The Biopsychosocial Perspective
11.9 Summary
11.10 Questions
11.11 References
11.0 OBJECTIVES
11.1 INTRODUCTION
disorder had parents who were more rejecting, more, more guilt
engendering and less affectionate than the control group.
According to psychodynamic writers individuals having this disorder
have a fear of attachment in relationships. Cognitive behavioural
approaches regard this disorder as hypersensitive to rejection due
to childhood experiences of extreme parental criticism. These
individuals have dysfunctional attitudes that they are unworthy of
other people’s regard. As a result of this attitude they view
themselves as unworthy and they expect that other people will not
like them and as a result they avoid getting close to other people.
11.9 SUMMARY
11.10 QUESTIONS
11.11 REFERENCES
12
DEVELOPMENT-RELATED,
AGING-RELATED AND COGNITIVE
DISORDERS - I
Unit Structure
12.0 Objectives
12.1 Introduction
12.2 Introductory Issues
12.3 Mental Retardation
12.4 Pervasive Developmental Disorders
12.5 Attention Deficit and Disruptive Behavior Disorders
12.6 Learning, Communication and Motor Skills Disorder
12.7 Summary
12.8 Questions
12.9 References
12.0 OBJECTIVES
12.1 INTRODUCTION
after that. According to DSM-IV there are three groups of criteria for
defining mental retardation:
3. The third most important criteria is the age of onset. That is low
IQ and deficits in adaptive behavior must occur before the age
of 18 years in order to call it mental retardation.
x Carelessness
x Forgetfulness in daily activities. Inattentive children
commonly loose their belongings.
x Easily distracted
x Cannot follow through on instructions
x Difficulty organsing tasks
x
Hyperactivity is characterized by fidgeting, restlessness,
running about inappropriately, difficulty in playing quietly and talking
excessively. Impulsivity is seen in individuals who blurt out
answers, cannot wait their turn, interrupt or intrude on others, etc.
age than average and progress more slowly than the average.
Others acquire this disorder as a result of medical illness or a
neurological problem resulting from a head trauma.
12.7 SUMMARY:
12.8 QUESTIONS:
12.9 REFERENCES:
13
DEVELOPMENT-RELATED,
AGING-RELATED AND COGNITIVE
DISORDERS – II
Unit Structure
13.0 Objectives
13.1 Introduction
13.2 Separation Anxiety Disorder
13.3 Other Disorders that Originate in Childhood
13.4 Development - Related Disorders: The Biopsychosocial
Perspective
13.5 The Nature of Cognitive Disorders
13.6 Delirium, Amnestic Disorders, Traumatic Brain Injury,
Dementia
13.7 Cognitive Disorders: The Biopsychosocial Perspective
13.8 Summary
13.9 Questions
13.10 References
13.0 OBJECTIVES
13.1 INTRODUCTION
They also found that along with strong heritability there are also
environmental factors that contribute to development of this
disorder. Some important environmental factors that result in
anxiety disorder include:
x Loss of threat
x Loss of father from the home
x Natural or man made disasters
Alois Alzheimer
At a scientific meeting in November 1906, German physician
Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-
year-old woman brought to see him in 1901 by her family. Auguste
had developed problems with memory, unfounded suspicions that
her husband was unfaithful, and difficulty speaking and
understanding what was said to her. Her symptoms rapidly grew
worse, and within a few years she was bedridden. She died in
1906, of overwhelming infections from bedsores and pneumonia.
deposits in small blood vessels, dead and dying brain cells, and
abnormal deposits in and around cells.
13.8 SUMMARY
13.9 QUESTIONS
13.10REFERENCES
14
Unit Structure
14.0 Objectives
14.1 Introduction
14.2 Anorexia Nervosa
14.3 Bulimia Nervosa
14.4 Theories and Treatment of Eating Disorders
14.5 Summary
14.6 Questions
14.7 Reference
14.0 OBJECTIVES
14.1 INTRODUCTION
There are four basic criteria for the diagnosis of anorexia nervosa
that are characteristic:
1. The refusal to maintain body weight at or above a minimally
normal weight for age and height (maintaining a body weight
less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even
though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis
on body weight in self-assessment, and weight loss that is
either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at
least three consecutive periods are missed (amenorrhea), or
menstrual periods occur only after a hormone is
administered.
induced vomiting to get rid of what they have eaten. They may do
this in any one of the following ways:
x Induced vomiting
x Administer an enema
x Take laxatives or diuretics
Criteria of
difference Anorexia Nervosa Bulimia Nervosa
between the two
primarily white, but the disorder has also been reported among
other ethnic groups.
Some experts also hold the view that these eating disorders
develop as a result of complex interaction among biological,
psychological and sociological factors. IN the case of anorexia
nervosa biological factors, dieting and psychosocial influences
come together and set the stage for development of this disorder.
Once the stage is set the individual becomes trapped in a cycle of
physiological changes that leads to disorder.
14.5 SUMMARY
14.6 QUESTIONS
14.7 REFERENCE
15
EATING DISORDERS AND IMPULSE
CONTROL DISORDERS – II
Unit Structure
15.0 Objectives
15.1 Introduction
15.2 Definition of Impulse Control Disorders
15.3 Kleptomania
15.4 Pathological Gambling
15.5 Pyromania
15.6 Sexual Impulsivity
15.7 Trichotillomania
15.8 Intermittent Explosive Disorder
15.9 Internet Addiction
15.10 Self-injurious Behaviour
15.11 Summary
15.12 Questions
15.13 Reference
15.0 OBJECTIVES
15.1 INTRODUCTION
15.3 KLEPTOMANIA
15.5 PYROMANIA
15.7 TRICHOTILLOMANIA
x People with this disorder are secretive about what they are
doing and tend to engage in hair pulling only when they are
alone. For some the interest goes beyond their hair and may
involve pulling the hair from another person, or even pets,
dolls and materials such as carpets and sweaters. People
with this disorder deny that they are pulling the hair.
x This disorder often coexists with other disorders including
depression, obsessive compulsive disorder, substance
abuse or an eating disorder.
15.11SUMMARY
15.12QUESTIONS
15.13 REFERENCE