CHAPTER 4: PSYCHOLOGICAL DISORDERS

CONCEPT OF ABNORMALITY

Most definitions of abnormality have certain common features, often called the ‘four Ds’:
deviance, distress, dysfunction and danger. That is, psychological disorders are deviant
(different, extreme, unusual, even bizarre), distressing (unpleasant and upsetting to the person
and to others), dysfunctional (interfering with the person’s ability to carry out daily activities
in a constructive way), and possibly dangerous (to the person or to others).

The stigma attached to mental illness means that people are hesitant to consult a doctor or
psychologist because they are ashamed of their problems. Actually, psychological disorder
which indicates a failure in adaptation should be viewed as any other illness.

BIOLOGICAL FACTORS UNDERLYING ABNORMAL BEHAVIOUR

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 may
interfere with normal development and functioning of the human body.

Biological researchers have found that psychological disorders are often related to problems in
the transmission of messages from one neuron to another.

A tiny space called synapse separates one neuron from the next, and the message must move
across that space. When an electrical impulse reaches a neuron’s ending, the nerve ending is
stimulated to release a chemical, called a neuro-transmitter. 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, and
depression to low activity of serotonin.

Genetic factors have been linked to bipolar and related disorders, schizophrenia, intellectual
disability and other psychological disorders. Researchers have not, however, been able to
identify the specific genes that are the culprits. It appears that in most cases, no single gene is
responsible for a particular behaviour or a psychological disorder. Infact, many genes combine
to help bring about our various behaviours and emotional reactions, both functional and
dysfunctional.
MAJOR 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 losing control or even dying.

3) Specific Phobia

Irrational fears related to specific objects, interactions with others, and unfamiliar situations

4) Separation Anxiety Disorder

Extreme distress when expecting or going through separation from home or other significant
people to whom the individual is immensely attached to.

5) Post-Traumatic Stress Disorder (PTSD)

Recurrent dreams, flashbacks, impaired concentration, and emotional numbing followed by a

traumatic event or stressful event like a natural disaster, serious accident etc. Adjustment
Disorders and Acute Stress Disorder are also included under this category.

6) Other Disorders

Selective Mutism, Substance/MedicationInduced Anxiety Disorder, Anxiety Disorder Due to

Another Medical condition, etc.
OBSESSIVE COMPULSIVE DISORDER

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.

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 in
this category include hoarding disorder, trichotillomania (hair-pulling disorder), excoriation
(skin-picking) disorder etc.

SOMATIC SYMPTOM AND RELATED DISORDER

 Somatic Symptom Disorder : The person experiences body-related symptoms in the

absence of any medical condition (or even if medical condition is present, it is not as
serious as the symptoms presented).
 Illness Anxiety Disorder : The person experiences worry about the possibility of
developing a serious medical condition.
 Conversion : The person suffers from a loss or impairment of motor or sensory
function (e.g., paralysis, blindness, etc.) that has no physical cause but may be a
response to stress and psychological problems

DISSOCIATIVE DISORDERS

 Dissociative amnesia : The person is unable to recall important, personal information

often related to a stressful and traumatic report. The extent of forgetting is beyond
normal.
 Depersonalisation/Derealisation Disorder : The person experiences a change in the
person's sense of reality and perception of self.
  Dissociative identity (multiple personality) Disorder : The person exhibits two or
more separate and contrasting personalities, generally associated with a history of
abuse.

DEPRESSIVE DISORDERS

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 is defined as a period of depressed mood and/or loss of interest or
pleasure in most activities, together with other symptoms which may include change in body
weight, constant sleep problems, tiredness, inability to think clearly, agitation, greatly slowed
behaviour, and thoughts of death and suicide. Other symptoms include excessive guilt or
feelings of worthlessness.

Factors Predisposing towards Depression :

Genetic make-up, or heredity is an important risk factor for major depression and other
depressive disorders. 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. Similarly 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. Other risk factors are experiencing negative
life events and lack of social support.

BIPOLAR AND RELATED DISORDERS

Bipolar I disorder involves both mania and depression, which are alternately present and
sometimes interrupted by periods of normal mood. Manic episodes rarely appear by
themselves; they usually alternate with depression.

Bipolar mood disorders were earlier referred to as manic-depressive disorders. Some

examples of types of bipolar and related disorders include Bipolar I Disorder, Bipolar II
disorder and Cyclothymic Disorder.
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. positive symptoms
(i.e. excesses of thought, emotion, and behaviour), negative symptoms (i.e. deficits of thought,
emotion, and behaviour), and psychomotor symptoms.

Positive 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.

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.

 Delusions of persecution are the most common in schizophrenia. People with this
delusion believe that they are being plotted against, spied on, slandered threatened,
attacked or deliberately victimised.
 People with schizophrenia may also experience delusions of reference in which they
attach special and personal meaning to the actions of others or to objects and events.
 In delusions of grandeur, people believe themselves to be specially empowered
persons.
 In delusions of control, they believe that their feelings, thoughts and actions are
controlled by others
Hallucinations

People with schizophrenia may have hallucinations, i.e. perceptions that occur in the absence
of external stimuli.

 Auditory hallucinations are most common in schizophrenia. Patients hear sounds or

voices that speak words, phrases and sentences directly to the patient (second-person
hallucination) or talk to one another referring to the patient as s/he (third-person
hallucination).
 These include 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).

Negative Symptoms

Negative symptoms are ‘pathological deficits’ and include poverty of speech, blunted and
flat affect, loss of volition, and social withdrawal.

People with schizophrenia show alogia or poverty of speech, i.e. a reduction in speech and
speech content.

 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.
 Also 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. 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.

People in a catatonic stupor remain motionless and silent for long stretches of time. Some
show catatonic rigidity, i.e. maintaining a rigid, upright posture for hours. Others exhibit
catatonic posturing, i.e. assuming awkward, bizarre positions for long periods of time.

ATTENTION DEFICIT/HYPERACTIVITY DISORDER

The two main features of ADHD are inattention and hyperactivityimpulsivity. 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.

Children who are impulsive seem unable to control their immediate reactions or to think before
they act. They find it difficult to wait or take turns, have difficulty resisting immediate
temptations or delaying gratification. Minor mishaps such as knocking things over are common
whereas more serious accidents and injuries can also occur.

Hyperactivity also takes many forms. Children with ADHD are in constant motion. Sitting
still through a lesson is impossible for them. The child may fidget, squirm, climb and run
around the room aimlessly. Parents and teachers describe them as ‘driven by a motor’, always
on the go, and talk incessantly.
AUTISM SPECTRUM DISORDER

Autism Spectrum Disorder is characterised by widespread impairments in social interaction

and communication skills, and stereotyped patterns of behaviours, interests and activities.
Children with autism spectrum disorder have marked difficulties in social interaction and
communication across different contexts, a restricted range of interests, and strong desire for
routine. About 70 per cent of children with autism spectrum disorder have intellectual
disabilities.

Children with autism spectrum disorder 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 of them never
develop speech and those who do, have repetitive and deviant speech patterns. Such children
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 with autism spectrum disorder tend to experience difficulties in starting,
maintaining and even understanding relationships.

FEEDING AND EATING DISORDERS

Another group of disorders which are of special interest to young people are 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 person with
anorexia may lose large amounts of weight and even starve herself/himself to death.
  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. The individual
tends to eat at a higher speed than normal and continues eating till s/he feels
uncomfortably full. In fact, large amount of food may be eaten even when the individual
is not feeling hungry

SUBSTANCE RELATED AND ADDICTIVE DISORDERS

Disorders relating to maladaptive behaviours resulting from regular and consistent use of the
substance involved are included under substance related and addictive disorders. These
disorders include problems associated with the use and abuse of alcohol, cocaine, tobacco and
opiods among others, which alter the way people think, feel and behave.

In Substance Dependence, there is an intense craving for the substance to which the person is
addicted and hence person shows tolerance, withdrawal symptoms and compulsive drug taking.

In Substance Abuse, there are recurrent and significant adverse consequences related to the
use of substance.

Alcohol

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. Their bodies then 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.
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.

Heroine

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

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. Dependence may develop, so that cocaine
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.

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