Chapter 4

Psychological Disorders

Concepts of Abnormality and Psychological Disorders

The Four D’s* (hehehehaw)
1. Although many definitions of abnormality have been used over the years,
none has won universal acceptance.
2. Still, most definitions have certain common features, often called the ‘four
Ds’: deviance, distress, dysfunction and danger.
3. 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).
- Possibly dangerous (to the person or to others).
1. This definition is a useful starting point from which we can explore
psychological abnormality.
2. Since the word ‘abnormal’ literally means “away from the normal”, it implies
deviation from some clearly defined norms or standards.
3. In psychology, we have no ‘ideal model’ or even ‘normal model’ of human
behaviour to use as a base for comparison.
4. Various approaches have been used in distinguishing between normal and
abnormal behaviours.
5. From these approaches, there emerge two basic and conflicting views.

‘Deviation from Social Norms’ Perspective*

1. The first approach views abnormal behaviour as a deviation from social
norms.
2. Many psychologists have stated that ‘abnormal’ is simply a label that is
given to a behaviour which is deviant from social expectations.
3. Abnormal behaviour, thoughts and emotions are those that differ markedly
from a society’s ideas of proper functioning.
 4. Each society has norms, which are stated or unstated rules for proper
conduct.
5. Behaviours, thoughts and emotions that break societal norms are called
abnormal.
6. A society’s values may change over time, causing its views of what is
psychologically abnormal to change as well.
7. A society’s norms grow from its particular culture — its history, values,
institutions, habits, skills, technology, and arts.
8. Thus, a society whose culture values competition and assertiveness may
accept aggressive behaviour, whereas one that emphasises cooperation
and family values (such as in India) may consider aggressive behaviour as
unacceptable or even abnormal.
9. A society’s values may change over time, causing its views of what is
psychologically abnormal to change as well.
10. Serious questions have been raised about this definition.
11. It is based on the assumption that socially accepted behaviour is not
abnormal, and that normality is nothing more than conformity to social
norms.

‘Maladaptive Behaviour' Perspective*

1. The second approach views abnormal behaviour as maladaptive.
2. Many psychologists believe that the best criterion for determining the
normality of behaviour is not whether society accepts it but whether it
fosters the well-being of the individual and eventually of the group to which
s/he belongs.
3. Well-being is not simply maintenance and survival but also includes
growth and fulfilment, i.e. the actualisation of potential, which you must
have studied in Maslow’s need hierarchy theory.
4. 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.
5. 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 Attached to Psychological Disorders and Mental Health Professionals*
1. If you talk to people around you, you will see that they have vague ideas
about psychological disorders that are characterised by superstition,
ignorance and fear.
2. Again it is commonly believed that psychological disorder is something to
be ashamed of.
3. The stigma attached to mental illness means that people are hesitant to
consult a doctor or psychologist because they are ashamed of their
problems.
4. Actually, psychological disorder which indicates a failure in adaptation
should be viewed as any other illness.

Historical Background
The Ancient Theory*
1. One ancient theory that is still encountered today holds that abnormal
behaviour can be explained by the operation of supernatural and magical
forces such as evil spirits (bhoot-pret), or the devil (shaitan).
2. Exorcism, i.e. removing the evil that resides in the individual through
countermagic and prayer, is still commonly used.
3. 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.
4. Through the shaman, an afflicted person can learn which spirits are
responsible for her/his problems and what needs to be done to appease
them.

The Biological/Organic Approach*

1. A recurring theme in the history of abnormal psychology is the belief that
individuals behave strangely because their bodies and their brains are not
working properly.
2. This is the biological or organic approach.
3. In the modern era, there is evidence that body and brain processes have
been linked to many types of maladaptive behaviour.
 4. For certain types of disorders, correcting these defective biological
processes results in improved functioning.

The Psychological Approach*

1. Another approach is the psychological approach.
2. According to this point of view, psychological problems are caused by
inadequacies in the way an individual thinks, feels, or perceives the world.
3. All three of these perspectives — supernatural, biological or organic, and
psychological — have recurred throughout the history of Western
civilization.

The Ancient Western World and Abnormal Psychology*

1. 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 and viewed disturbed behaviour as
arising out of conflicts between emotion and reason.
2. Galen elaborated on the role of the four humours in personal character
and temperament.
3. According to him, the material world was made up of four elements, viz.
earth, air, fire, and water which combined to form four essential body fluids,
viz. blood, black bile, yellow bile, and phlegm.
4. Each of these fluids was seen to be responsible for a different
temperament.
5. Imbalances among the humours were believed to cause various disorders.
6. This is similar to the Indian notion of the three doshas of vata, pitta and
kapha which were mentioned in the Atharva Veda and Ayurvedic texts.

Demonology and Superstition in the Middle Ages*

1. In the Middle Ages, demonology and superstition gained renewed
importance in the explanation of abnormal behaviour.
2. Demonology is related to a belief that people with mental problems were
evil and there are numerous instances of ‘witch-hunts’ during this period.
 3. During the early Middle Ages, the Christian spirit of charity prevailed and
St. Augustine wrote extensively about feelings, mental anguish and
conflict.
4. This laid the groundwork for modern psychodynamic theories of abnormal
behaviour.

The Renaissance Period*

1. The Renaissance Period was marked by increased humanism and curiosity
about behaviour.
2. Johann Weyer emphasised psychological conflict and disturbed
interpersonal relationships as causes of psychological disorders.
3. He also insisted that ‘witches’ were mentally disturbed and required
medical, not theological, treatment.

The Age of Reason and Enlightenment*

1. The seventeenth and eighteenth centuries were known as the Age of
Reason and Enlightenment, as the scientific method replaced faith and
dogma as ways of understanding abnormal behaviour.
2. The growth of a scientific attitude towards psychological disorders in the
eighteenth century contributed to the Reform Movement and to increased
compassion for people who suffered from these disorders.
3. Reforms of asylums were initiated in both Europe and America.
4. One aspect of the reform movement was the new inclination for
deinstitutionalisation which placed emphasis on providing community
care for recovered mentally ill individuals.

The Current Period*

1. In recent years, there has been a convergence of these approaches, which
has resulted in an interactional, or bio-psycho-social approach.
2. From 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 Disorders
Why Do We Need Classification of Psychological Disorders?*
1. In order to understand psychological disorders, we need to begin by
classifying them.
2. 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.
3. Classifications are useful because they enable users like psychologists,
psychiatrists and social workers to communicate with each other about the
disorder and help in understanding the causes of psychological disorders
and the processes involved in their development and maintenance.

DSM-5 by the American Psychiatric Association*

1. The American Psychiatric Association (APA) has published an official
manual describing and classifying various kinds of psychological
disorders.
2. The current version of it, the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition (DSM-5), presents discrete clinical criteria which
indicate the presence or absence of disorders.

ICD-10 by WHO*
1. The classification scheme officially used in India and elsewhere is the
tenth revision of the International Classification of Diseases (ICD-10),
which is known as the ICD-10 Classification of Behavioural and Mental
Disorders.
2. It was prepared by the World Health Organisation (WHO).
3. 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

1. In order to understand something as complex as abnormal behaviour,
psychologists use different approaches.
 2. Each approach in use today emphasises a different aspect of human
behaviour, and explains and treats abnormality in line with that aspect.
3. These approaches also emphasise the role of different factors such as
biological, psychological and interpersonal, and socio-cultural factors.

Biological Model*
1. Biological factors influence all aspects of our behaviour.
2. 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.
3. These factors may be potential causes of abnormal behaviour.
4. According to this model, abnormal behaviour has a biochemical or
physiological basis.
5. Biological researchers have found that psychological disorders are often
related to problems in the transmission of messages from one neuron to
another.
6. A tiny space called synapse separates one neuron from the next, and the
message must move across that space.
7. When an electrical impulse reaches a neuron’s ending, the nerve ending is
stimulated to release a chemical, called a neuro-transmitter.
8. Studies indicate that abnormal activity by certain neuro-transmitters can
lead to specific psychological disorders.
9. 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 Model*
1. Genetic factors have been linked to bipolar and related disorders,
schizophrenia, intellectual disability and other psychological disorders.
2. Researchers have not, however, been able to identify the specific genes
that are the culprits.
3. It appears that in most cases, no single gene is responsible for a particular
behaviour or a psychological disorder.
 4. Many genes combine to help bring about our various behaviours and
emotional reactions, both functional and dysfunctional.
5. Although there is sound evidence to believe that genetic/ biochemical
factors are involved in mental disorders as diverse as schizophrenia,
depression, anxiety, etc. but biology alone cannot account for most mental
disorders.

Psychological Models*
1. There are several psychological models which provide a psychological
explanation of mental disorders.
2. These models maintain that psychological and interpersonal factors have a
significant role to play in abnormal behaviour.
3. 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.

Psychodynamic Model*
1. The psychodynamic model is the oldest and most famous of the modern
psychological models.
2. Psychodynamic theorists believe that behaviour, whether normal or
abnormal, is determined by psychological forces within the person of
which he is not consciously aware.
3. These internal forces are considered dynamic, i.e. they interact with one
another and their interaction gives shape to behaviour, thoughts and
emotions.
4. Abnormal symptoms are viewed as the result of conflicts between these
forces.
5. This model was first formulated by Freud who believed that three central
forces shape personality — instinctual needs, drives and impulses (id),
rational thinking (ego), and moral standards (superego).
 6. 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*
1. The behavioural model states that both normal and abnormal behaviours
are learned and psychological disorders are the result of learning
maladaptive ways of behaving.
2. The model concentrates on behaviours that are learned through
conditioning and proposes that what has been learned can be unlearned.
3. 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).
4. These three types of conditioning account for behaviour, whether adaptive
or maladaptive.

Cognitive Model*
1. The cognitive model states that abnormal functioning can result from
cognitive problems.
2. People may hold assumptions and attitudes about themselves that are
irrational and inaccurate.
3. 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*
1. Humanistic-existential model which focuses on broader aspects of human
existence.
2. 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.
3. Existentialists believe that from birth we have total freedom to give
meaning to our existence or to avoid that responsibility.
 4. Those who shirk from this responsibility would live empty, inauthentic, and
dysfunctional lives.

Socio-cultural Model*
1. 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.
2. According to the socio-cultural model, abnormal behaviour is best
understood in light of the social and cultural forces that influence an
individual.
3. 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.
4. It has been found that certain family systems are likely to produce
abnormal functioning in individual members.
5. Some families have an enmeshed structure in which the members are
over-involved in each other’s activities, thoughts, and feelings.
6. Children from this kind of family may have difficulty in becoming
independent in life.
7. The broader social networks in which people operate include their social
and professional relationships.
8. 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.
9. Socio-cultural theorists also believe that abnormal functioning is
influenced by the societal labels and roles assigned to troubled people.
10. When people break the norms of their society, they are called deviant and
‘mentally ill’.
11. Such labels tend to stick so that the person may be viewed as ‘crazy’ and
encouraged to act sick.
 12. The person gradually learns to accept and play the sick role, and functions
in a disturbed manner.

Diathesis-stress model*
1. One of the most widely accepted explanations of abnormal behaviour has
been provided by the diathesis-stress model.
2. This model states that psychological disorders develop when a diathesis
(biological predisposition to the disorder) is set off by a stressful situation.
3. This model has three components.
4. The first is the diathesis or the presence of some biological aberration
which may be inherited.
5. The second component is that the diathesis may carry a vulnerability to
develop a psychological disorder.
6. This means that the person is ‘at risk’ or ‘predisposed’ to develop the
disorder.
7. The third component is the presence of pathogenic stressors, i.e. factors/
stressors that may lead to psychopathology.
8. If such “at risk” persons are exposed to these stressors, their
predisposition may actually evolve into a disorder.
9. This model has been applied to several disorders including anxiety,
depression, and schizophrenia.

Major Psychological Disorders

Anxiety Disorders
1. High levels of anxiety that are distressing and interfere with effective
functioning indicate the presence of an anxiety disorder — the most
common category of psychological disorders.
2. The term anxiety is usually defined as a diffuse, vague, very unpleasant
feeling of fear and apprehension.
3. The anxious individual also shows combinations of the following
symptoms: rapid heart rate, shortness of breath, diarrhoea, loss of
appetite, fainting, dizziness, sweating, sleeplessness, frequent urination
and tremors.
Generalised anxiety disorder*
1. It consists of prolonged, vague, unexplained and intense fears that are not
attached to any particular object.
2. The symptoms include worry and apprehensive feelings about the future;
hypervigilance, which involves constantly scanning the environment for
dangers.
3. It is marked by motor tension, as a result of which the person is unable to
relax, is restless, and visibly shaky and tense.

Panic disorder*
1. It consists of recurrent anxiety attacks in which the person experiences
intense terror.
2. A panic attack denotes an abrupt surge of intense anxiety rising to a peak
when thoughts of a particular stimulus are present.
3. Such thoughts occur in an unpredictable manner.
4. The clinical features include shortness of breath, dizziness, trembling,
palpitations, choking, nausea, chest pain or discomfort, fear of going crazy,
losing control or dying.

Phobias*
1. They are characterised by irrational fears of specific objects, people, or
situations.
2. Phobias often develop gradually or begin with a generalised anxiety
disorder.
3. Phobias can be grouped into three main types, i.e. specific phobias, social
phobias, and agoraphobia.

Specific Phobias*
1. Specific phobias are the most commonly occurring type of phobia.
2. This group includes irrational fears such as intense fear of a certain type of
animal, or of being in an enclosed space

Social Phobias*
 1. Intense and incapacitating fear and embarrassment when dealing with
others characterises social anxiety disorder (social phobia).

Agoraphobia*
1. Agoraphobia is the term used when people develop a fear of entering
unfamiliar situations.
2. Many people with agoraphobia are afraid of leaving their home.
3. So their ability to carry out normal life activities is severely limited.

Separation anxiety disorder (SAD)*

1. Individuals with separation anxiety disorder are fearful and anxious about
separation from attachment figures to an extent that is developmentally not
appropriate.
2. 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.
3. To avoid separation, children with SAD may fuss, scream, throw severe
tantrums, or make suicidal gestures.

Obsessive-Compulsive and Related Disorders

1. 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*
1. Obsessive behaviour is the inability to stop thinking about a particular
idea or topic.
2. The person involved, often finds these thoughts to be unpleasant and
shameful.

Compulsive Behaviour*
 1. Compulsive behaviour is the need to perform certain behaviours over and
over again.
2. Many compulsions deal with counting, ordering, checking, touching and
washing.
3. Other disorders in this category include hoarding disorder, trichotillomania
(hair-pulling disorder), excoriation (skin-picking) disorder etc.

Trauma- and Stressor-Related Disorders

1. Very often people who have been caught in a natural disaster (such as
tsunami) or have been victims of bomb blasts by terrorists, or been in a
serious accident or in a war-related situation, experience post-traumatic
stress disorder (PTSD).
2. PTSD symptoms vary widely but may include recurrent dreams,
flashbacks, impaired concentration, and emotional numbing.
3. Adjustment Disorders and Acute Stress Disorder are also included under
this category.

Somatic Symptom and Related Disorders

1. These are conditions in which there are physical symptoms in the absence
of a physical disease.
2. In these disorders, the individual has psychological difficulties and
complains of physical symptoms, for which there is no biological cause.
3. These include conversion disorders, somatic symptom disorder, and
illness anxiety disorder among others.

Somatic Symptom Disorder*

1. Somatic symptom disorder involves a person having persistent
body-related symptoms which may or may not be related to any serious
medical condition.
2. 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.
3. As a result, they experience significant distress and disturbances in their
daily life.
Illness anxiety disorder*
1. Illness anxiety disorder involves persistent preoccupation about
developing a serious illness and constantly worrying about this possibility.
2. This is accompanied by anxiety about one’s health.
3. Individuals with illness anxiety disorder are overly concerned about
undiagnosed disease, negative diagnostic results, do not respond to
assurance by doctors, and are easily alarmed about illness such as on
hearing about someone else's ill-health or some such news.

Difference Between Somatic Symptom Disorder and Illness Anxiety Disorder*

1. In general, both somatic symptom disorder and illness anxiety disorder are
concerned with medical illnesses.
2. But, the difference lies in the way this concern is expressed.
3. 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*
1. The symptoms of conversion disorders are the reported loss of part or all
of some basic body functions.
2. Paralysis, blindness, deafness and difficulty in walking are generally
among the symptoms reported.
3. These symptoms often occur after a stressful experience and may be quite
sudden.

Dissociative Disorders
1. Dissociation can be viewed as severance of the connections between
ideas and emotions.
2. Dissociation involves feelings of unreality, estrangement,
depersonalisation, and sometimes a loss or shift of identity.
 3. Sudden temporary alterations of consciousness that blot out painful
experiences are a defining characteristic of dissociative disorders.

Dissociative Amnesia*
1. Dissociative amnesia is characterised by extensive but selective memory
loss that has no known organic cause (e.g., head injury).
2. Some people cannot remember anything about their past.
3. Others can no longer recall specific events, people, places, or objects,
while their memory for other events remains intact.
4. A part of dissociative amnesia is dissociative fugue.
5. Essential features of this could be an unexpected travel away from home
and workplace, the assumption of a new identity, and the inability to recall
the previous identity.
6. The fugue usually ends when the person suddenly ‘wakes up’ with no
memory of the events that occurred during the fugue.
7. This disorder is often associated with overwhelming stress.

Dissociative Identity Disorder*

1. Dissociative identity disorder, often referred to as multiple personality
disorder, is the most dramatic of the dissociative disorders.
2. It is often associated with traumatic experiences in childhood.
3. In this disorder, the person assumes alternate personalities that may or
may not be aware of each other.

Depersonalisation/Derealisation Disorder*
1. Depersonalisation/Derealisation disorder involves a dreamlike state in
which the person has a sense of being separated both from self and from
reality.
2. In depersonalisation, there is a change of self-perception, and the person’s
sense of reality is temporarily lost or changed.

Depressive Disorders
1. One of the most widely prevalent and recognised of all mental disorders is
depression.
 2. Depression covers a variety of negative moods and behavioural changes.
3. Depression can refer to a symptom or a disorder.
4. 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*

1. 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.
2. Other symptoms include excessive guilt or feelings of worthlessness.

Factors Predisposing towards Depression

1. Genetic make-up, or heredity is an important risk factor for major
depression and other depressive disorders.
2. Age is also a risk factor.
3. For instance, women are particularly at risk during young adulthood, while
for men the risk is highest in early middle age.
4. Similarly gender also plays a great role in this differential risk addition.
Women in comparison to men are more likely to report a depressive
disorder.
5. Other risk factors are experiencing negative life events and lack of social
support.

Bipolar and Related Disorders

1. Bipolar I disorder involves both mania and depression, which are
alternately present and sometimes interrupted by periods of normal mood.
2. Manic episodes rarely appear by themselves; they usually alternate with
depression.
3. Bipolar mood disorders were earlier referred to as manic-depressive
disorders.
 4. Some examples of types of bipolar and related disorders include Bipolar I
Disorder, Bipolar II disorder and Cyclothymic Disorder.

Suicide and Suicide Prevention*

1. Every suicide is a misfortune.
2. Suicide takes place throughout the lifespan.
3. Suicide is a result of complex interface of biological, genetic,
psychological, sociological, cultural and environmental factors.
4. Some other risk factors are having mental disorders (especially depression
and alcohol use disorders), going through natural disasters, experiencing
violence, abuse or loss and isolation at any stage of life. Previous suicidal
attempt is the strongest risk factor.

Problems Faced by an Individual Displaying Suicidal Behaviour*

1. Often, suicidal behavior indicates difficulties in problem-solving, stress
management, and emotional expression.
2. Suicidal thoughts lead to suicidal action only when acting on these
thoughts seems to be the only way out of a person’s difficulties.
3. These thoughts are heightened under acute emotional and other distress.
4. The ramifications of suicide on social circle and communities tend to be
devastating and long-lasting.

Suicide Prevention*
1. The stigma surrounding suicide continues despite recent advances in
research in this field.
2. Due to this, many people who are contemplating or even attempting suicide
do not seek help thus, preventing timely help from reaching them.
3. Therefore improving identification, referral, and management of behaviour
are crucial for preventing suicide.
4. Therefore we need to identify vulnerability; comprehend the circumstances
leading to such behaviour and accordingly plan interventions.

Measures Suggested by WHO to Prevent Suicides*

● Suicides are preventable.
 ● There is a need for a comprehensive multi-sectoral approach where the
government, media and civil society all play important roles as
stakeholders.
● Some measures suggested by WHO include:
- limiting access to the means of suicide;
- reporting of suicide by media in a responsible way;
- bringing in alcohol-related policies;
- early identification, treatment and care of people at risk;
- training health workers in assessing and managing for suicide;
- care for people who attempted suicide and providing community
support.

Identifying Students in Distress

Any unexpected or striking change affecting the adolescent’s performance,
attendance or behaviour should be taken seriously, such as:
1. lack of interest in common activities
2. declining grades
3. decreasing effort
4. misbehaviour in the classroom
5. mysterious or repeated absence
6. smoking or drinking, or drug misuse

Strengthening Students’ Self-Esteem

1. Having a positive self-esteem is important in the face of distress and helps
in coping adequately.
2. In order to foster positive self-esteem in children the following approaches
can be useful:
1. accentuating positive life experiences to develop positive identity.
This increases confidence in self.
2. providing opportunities for development of physical, social and
vocational skills.
3. establishing a trustful communication.
4. goals for the students should be specific, measurable, achievable,
relevant, to be completed within a relevant time frame.
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia*
1. 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.
2. It is a debilitating disorder.
3. The social and psychological costs of schizophrenia are tremendous, both
to patients as well as to their families and society.

Symptoms of Schizophrenia
1. 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*
1. Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’ to a
person’s behaviour.
2. Delusions, disorganised thinking and speech, heightened perception and
hallucinations, and inappropriate affect are the ones most often found in
schizophrenia.

Delusions and Types of Delusions*

1. A delusion is a false belief that is firmly held on inadequate grounds.
2. It is not affected by rational argument, and has no basis in reality.
3. Delusions of persecution are the most common in schizophrenia.
4. People with this delusion believe that they are being plotted against, spied
on, slandered, threatened, attacked or deliberately victimised.
 5. 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.
6. In delusions of grandeur, people believe themselves to be specially
empowered persons and in delusions of control, they believe that their
feelings, thoughts and actions are controlled by others.
7. People with schizophrenia may not be able to think logically and may
speak in peculiar ways.

Formal Thought Disorders*

1. These formal thought disorders can make communication extremely
difficult.
2. These include rapidly shifting from one topic to another so that the normal
structure of thinking is muddled and becomes illogical (loosening of
associations, derailment), inventing new words or phrases (neologisms),
and persistent and inappropriate repetition of the same thoughts
(perseveration).

Hallucinations and Types of Hallucinations*

1. People with schizophrenia may have hallucinations, i.e. perceptions that
occur in the absence of external stimuli.
2. Auditory hallucinations are most common in schizophrenia.
3. 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 he (third-person hallucination).
4. Hallucinations can also involve the other senses.
5. 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).

Inappropriate Affect*
 1. People with schizophrenia also show inappropriate affect, i.e. emotions
that are unsuited to the situation.

Negative Symptoms*
1. Negative symptoms are ‘pathological deficits’ and include poverty of
speech, blunted and flat affect, loss of volition, and social withdrawal.
2. People with schizophrenia show alogia or poverty of speech, i.e. a
reduction in speech and speech content.
3. Many people with schizophrenia show less anger, sadness, joy, and other
feelings than most people do.
4. Thus they have blunted affect.
5. Some show no emotions at all, a condition known as flat affect.
6. Also patients with schizophrenia experience avolition, or apathy and an
inability to start or complete a course of action.
7. People with this disorder may withdraw socially and become totally
focused on their own ideas and fantasies.

Psychomotor Symptoms*
1. People with schizophrenia also show psychomotor symptoms.
2. They move less spontaneously or make odd grimaces and gestures.
3. These symptoms may take extreme forms known as catatonia.
4. People in a catatonic stupor remain motionless and silent for long
stretches of time.
5. Some show catatonic rigidity, i.e. maintaining a rigid, upright posture for
hours.
6. Others exhibit catatonic posturing, i.e. assuming awkward, bizarre
positions for long periods of time.

Neurodevelopmental Disorders
1. A common feature of the neurodevelopmental disorders is that they
manifest in the early stage of development.
2. Often the symptoms appear before the child enters school or during the
early stage of schooling.
 3. These disorders result in hampering personal, social, academic and
occupational functioning.
4. These get characterised as deficits or excesses in a particular behaviour or
delays in achieving a particular age-appropriate behaviour.

Attention-Deficit/Hyperactivity Disorder*
1. The two main features of ADHD are inattention and
hyperactivity-impulsivity.
2. Children who are inattentive find it difficult to sustain mental effort during
work or play.
3. They have a hard time keeping their minds on any one thing or in following
instructions.
4. 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.
5. Children who are impulsive seem unable to control their immediate
reactions or to think before they act.
6. They find it difficult to wait or take turns, have difficulty resisting immediate
temptations or delaying gratification.
7. Minor mishaps such as knocking things over are common whereas more
serious accidents and injuries can also occur.
8. Hyperactivity also takes many forms.
9. Children with ADHD are in constant motion.
10. Sitting still through a lesson is impossible for them.
11. The child may fidget, squirm, climb and run around the room aimlessly.
12. Parents and teachers describe them as ‘driven by a motor’, always on the
go, and talk incessantly.

Autism Spectrum Disorder*

1. Autism Spectrum Disorder is characterised by widespread impairments in
social interaction and communication skills, and stereotyped patterns of
behaviours, interests and activities.
 2. 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.
3. About 70 percent of children with autism spectrum disorder have
intellectual disabilities.
4. Children with autism spectrum disorder experience profound difficulties in
relating to other people.
5. They are unable to initiate social behaviour and seem unresponsive to
other people’s feelings.
6. They are unable to share experiences or emotions with others.
7. They also show serious abnormalities in communication and language that
persist over time.
8. Many of them never develop speech and those who do, have repetitive and
deviant speech patterns.
9. Such children often show narrow patterns of interests and repetitive
behaviours such as lining up objects or stereotyped body movements such
as rocking.
10. These motor movements may be self-stimulatory such as hand flapping or
self-injurious such as banging their head against the wall.
11. 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.

Intellectual Disability*
1. 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*

1. In case of specific learning disorder, the individual experiences difficulty
in perceiving or processing information efficiently and accurately.
 2. These get manifested during early school years and the individual
encounters problems in basic skills in reading, writing and/or mathematics.
3. The affected child tends to perform below average for her/his age.
4. However, individuals may be able to reach acceptable performance levels
with additional inputs and efforts.
5. Specific learning disorder is likely to impair functioning and performance in
activities/ occupations dependent on the related skills.

Disruptive, Impulse-Control and Conduct Disorders

Oppositional Defiant Disorder (ODD)*
1. Children with Oppositional Defiant Disorder (ODD) display
age-inappropriate amounts of stubbornness, are irritable, defiant,
disobedient, and behave in a hostile manner.
2. Individuals with ODD do not see themselves as angry, oppositional, or
defiant and often justify their behaviour as reaction to
circumstances/demands.
3. Thus, the symptoms of the disorder become entangled with the
problematic interactions with others.
4. The terms conduct disorder and antisocial behaviour refer to
age-inappropriate actions and attitudes that violate family expectations,
societal norms, and the personal or property rights of others.
5. The behaviours typical of conduct disorder include aggressive actions that
cause or threaten harm to people or animals, non-aggressive conduct that
causes property damage, major deceitfulness or theft, and serious rule
violations.
6. 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

1. Another group of disorders which are of special interest to young people
are eating disorders.
 2. These include anorexia nervosa, bulimia nervosa, and binge eating.

Anorexia Nervosa*
1. In anorexia nervosa, the individual has a distorted body image that leads
him to see himself as overweight.
2. 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 himself to death.

Bulimia Nervosa*
1. 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.
2. The person often feels disgusted and ashamed when he binges and is
relieved of tension and negative emotions after purging.

Binge Eating*
1. In binge eating, there are frequent episodes of out-of-control eating.
2. The individual tends to eat at a higher speed than normal and continues
eating till s/he feels uncomfortably full.
3. In fact, a large amount of food may be eaten even when the individual is
not feeling hungry.

Substance-Related and Addictive Disorders

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

Alcohol
 1. People who abuse alcohol drink large amounts regularly and rely on it to
help them face difficult situations.
2. Eventually the drinking interferes with their social behaviour and ability to
think and work.
3. Their bodies then build up a tolerance for alcohol and they need to drink
even greater amounts to feel its effects.
4. They also experience withdrawal responses when they stop drinking.
5. Alcoholism destroys millions of families, social relationships and careers.
6. Intoxicated drivers are responsible for many road accidents.
7. It also has serious effects on the children of persons with this disorder.
8. These children have higher rates of psychological problems, particularly
anxiety, depression, phobias and substance-related disorders.
9. Excessive drinking can seriously damage physical health.

Heroin
1. Heroin intake significantly interferes with social and occupational
functioning.
2. 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.
3. 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
1. 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.
2. It may also cause problems in short-term memory and attention.
3. 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.
4. Cocaine poses serious dangers.
5. It has dangerous effects on psychological functioning and physical
well-being.