CHAPTER 4

PSYCHOLOGICAL DISORDERS

Definition of abnormality has the following four common features (the ‘four Ds’)
• Deviance: psychological disorders are deviant - different, extreme, unusual, even bizarre
• Distress: unpleasant and upsetting to the person and to others
• Dysfunction: interfering with the person’s ability to carry out daily activities in a constructive way
• Danger: possibly dangerous to the person or to others

Approaches towards abnormal behaviour

Deviation from social norms

• Many psychologists have stated that ‘abnormal’ is simply a label that is given to a behaviour which is
deviant from social expectations.
• Abnormal behaviour, thoughts and emotions are those that differ markedly from a society’s ideas of
proper functioning.
• Each society has norms, which are stated or unstated rules for proper conduct. Behaviours, thoughts
and emotions that break societal norms are called abnormal.
For example, 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.

Maladaptive behaviour
• The second approach views abnormal behaviour as maladaptive.
• 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.
• Well-being is not simply maintenance and survival but also includes growth and fulfilment, i.e. the
actualisation of potential.
• 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.
• 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.

Historical Background of Abnormal Behaviour

1. Ancient view
Abnormal behaviour can be explained by the operation of supernatural and magical forces such as evil
spirits (bhoot-pret), or the devil (shaitan).
Exorcism, i.e. removing the evil that resides in the individual through countermagic and prayer, is still
commonly used. In many societies, the shaman, or medicine man (ojha) is a person who is believed to
have contact with supernatural forces and is the medium through which spirits communicate with human
beings.

2. Biological or organic approach

Individuals behave strangely because their bodies and their brains are not working properly. This is the
biological or organic approach. In the modern era, there is evidence that body and brain processes have
been linked to many types of maladaptive behaviour. For certain types of disorders, correcting these
defective biological processes results in improved functioning.

3. Psychological approach
According to this point of view, psychological problems are caused by inadequacies in the way an
individual thinks, feels and perceives the world.

(All three of these perspectives — supernatural, biological or organic, and psychological — have recurred
throughout the history of Western civilisation).
 4. Organismic approach: Proposed by Hippocrates, Socrates and Plato. View disturbed behaviour as
arising out of conflicts between emotion and reason.
Galen elaborated on the role of the four humours in personal character and temperament. 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. Imbalances among the
humours were believed to cause various disorders.

5. Middle Ages: Demonology and superstition gained renewed importance in the explanation of abnormal
behaviour.
Demonology related to a belief that people with mental problems were evil and there are numerous
instances of ‘witch-hunts’ during this period.

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

7. Age of Reason and Enlightenment (seventeenth and eighteenth centuries):

The growth of a scientific attitude towards psychological disorders contributed to the Reform
Movement. Compassion for people who suffered from these disorders increased. Reforms of asylums
were initiated in both Europe and America. There was a new inclination for deinstitutionalisation
which placed emphasis on providing community care for recovered mentally ill individuals.

8. Interactional approach
In recent years, there has been a convergence of these approaches, which has resulted in an
interactional, or biopsycho-social approach. 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

In order to understand psychological disorders, we need to begin by classifying them.

Why classification is important?

• Classifications are useful because they enable users like psychologists, psychiatrists and social workers
to communicate with each other about the disorder
• Help in understanding the causes of psychological disorders and the processes involved in their
development and maintenance.

How do we classify??
Two systems of classification are available:
• Diagnostic and Statistical Manual of Mental Disorders, V Edition (DSM-V), published by American
Psychiatric Association describes and classifies various kind of psychological disorders. It presents
discrete clinical criteria which indicate presence or absence of disorder.

• The classification scheme officially used in India International Classification of Diseases (ICD-10),
which is known as the ICD-10 Classification of Behavioural and Mental Disorders. It was prepared by
the World Health Organisation (WHO).For each disorder, description of the main clinical features or
symptoms or other associated features including diagnostic guidelines is provided in the scheme.

Factors Underlying Abnormal Behaviour

1. Biological factors:
• Biological factors such as faulty genes, endocrine imbalances, malnutrition, injuries and other
conditions may become potential causes of abnormal behaviour.
• According to this model, abnormal behaviour has a biochemical or physiological basis.
• Biological researchers have found that psychological disorders are often related to problems in
the transmission of messages from one neuron to another.
 • Studies indicate that abnormal activity by certain neurotransmitters can lead to specific
psychological disorders.
 Anxiety disorders have been linked to low activity of the neurotransmitter gamma
aminobutyric acid (GABA).
 Schizophrenia to excess activity of dopamine,
 Depression to low activity of serotonin

2. Genetic factors have been linked to mood disorders, schizophrenia, mental retardation and other
psychological disorders. No single gene is responsible for a particular behaviour or a psychological
disorder.

3. Psychological models: provide a psychological explanation of mental disorders.

According to these models psychological and interpersonal factors have a significant role to play in
abnormal behaviour. 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

The psychological models include the psychodynamic, behavioural, cognitive, and humanistic-existential
models.

a. Psychodynamic model
 Psychodynamic theorists believe that behaviour, whether normal or abnormal, is determined
by the internal forces present in the unconscious.
 These internal forces (id, ego and superego as mentioned by Freud) are dynamic, i.e. they
interact with one another and their interaction gives shape to behaviour, thoughts and
emotions.
 Abnormal symptoms are viewed as the result of conflicts between these forces. Freud stated
that abnormal behaviour is a symbolic expression of unconscious mental conflicts that can
be generally traced to early childhood or infancy.

b. Behavioural model:
 This model states that both normal and abnormal behaviours are learned and
psychological disorders are the result of learning maladaptive ways of behaving.
 The model concentrates on behaviours that are learned through conditioning and
proposes that what has been learned can be unlearned.
 Learning can take place by classical conditioning, operant conditioning and social learning
(observing others’ behaviour). These three types of conditioning account for behaviour,
whether adaptive or maladaptive.

c. Cognitive model:
 This model states that abnormal behaviours can result from cognitive problems.
 People may hold assumptions and attitudes about themselves that are irrational and
inaccurate.
 Repeatedly thinking in illogical ways and making overgeneralisations, (i.e., drawing
broad, negative conclusions on the basis of a single insignificant event) may lead to
cognitive problems

d. Humanistic-existential model:
Humanists believe that human beings are born with a natural tendency to be friendly, cooperative
and constructive. They are driven to self-actualise, i.e. to fulfil this potential for goodness and
growth.
Existentialists believe that from birth we have total freedom to give meaning to our existence or
to avoid that responsibility.
Those who shirk from this responsibility would live empty, inauthentic, and dysfunctional lives.
 4. Socio-cultural model:
Abnormal behaviour can be understood by focussing on social and cultural forces that influence an
individual.
Factors such as family structure and communication, social networks, societal conditions, and societal
labels and roles influence behaviour.
Family structure: Some families have an enmeshed structure in which the members are over involved in
each other’s activities, thoughts, and feelings. Children from this kind of family may have difficulty in
becoming independent in life.
Social network: 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.
Societal labels and roles: When people break the norms of their society, they are called deviant and
‘mentally ill’. Such labels tend to stick so that the person may be viewed as ‘crazy’and encouraged to act
sick. The person gradually learns to accept and play the sick role, and functions in a disturbed manner.

5. Diathesis-stress model.
• This model states that psychological disorders develop when a diathesis (biological predisposition
to the disorder) is triggered off by a stressful situation.
• This model has three components.
 The first is the diathesis or the presence of some biological aberration which may be
inherited.
 The second component is that the diathesis may carry a vulnerability to develop a
psychological disorder. This means that the person is ‘at risk’ or ‘predisposed’ to develop
the disorder.
 The third component is the presence of pathogenic stressors, i.e. factors/stressors that
may lead to psychopathology.
• If such “at risk” persons are exposed to these stressors, their predisposition may actually evolve
into a disorder.
• This model has been applied to several disorders including anxiety, depression, and
schizophrenia.
•
SOME PSYCHOLOGICAL DISORDERS

1. Anxiety Disorders

Anxiety is usually defined as a diffuse, vague, very unpleasant feeling of fear and apprehension.

1. Generalised anxiety disorder- consists of prolonged, vague, unexplained and intense fears that are not
attached to any particular object. The symptoms include:
 worry and apprehensive feelings about the future;
 hypervigilance: which involves constantly scanning the environment for dangers.
 motor tension -which makes the person unable to relax, restless, visibly shaky and tense

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

3. Phobias: irrational fears related to specific objects, people, or situations.

Phobias can be grouped into three main types, i.e. specific phobias, social phobias, and agoraphobia.
 Specific phobias: most commonly occurring type of phobia. Includes irrational fears such as
intense fear of a certain type of animal, or of being in an enclosed space
 Social phobias: Intense and incapacitating fear and embarrassment when dealing with others
characterises social anxiety disorders or social phobias.
  Agoraphobia: fear of entering unfamiliar situations

4 Separation Anxiety Disorder (SAD)
An internalising disorder unique to children. Its most prominent symptom is excessive anxiety or even
panic experienced by children at being separated from their parents.
Children with SAD may show behaviours such as:
• difficulty being in a room by themselves, or going to school alone,
• fearful of entering new situations,
• cling to and shadow their parents’ every move
To avoid separation, they may fuss, scream, throw severe tantrums, or make suicidal gestures.

5. Other disorders included in the category are Selective Mutism, substance/ Medication induced
anxiety Disorder, anxiety disorder due to another medical condition etc.

2. Obsessive-Compulsive and related disorders

OCD is inability to control preoccupation with specific ideas or repeatedly carrying out a particular act or
series of acts. The ability to carry out normal activities is affected.
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, trichotillomanis(hair pulling disorder) and excortation(skin picking disorder )etc

3. Trauma and Stressor related disorders

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). PTSD symptoms generally include: recurrent dreams, flashbacks,
impaired concentration, and emotional numbing. Adjustment disorders and acute stress disorders are also
included in this category.

4. Somatic symptoms and related disorders

• These are conditions in which there are physical symptoms in the absence of a physical disease.
• In somatoform disorders, the individual has psychological difficulties and complains of physical
symptoms, for which there is no biological cause.
• Types of Somatoform disorders
 Somatic Symptom Disorder
 conversion disorders, and
 Illness anxiety Disorders

1) Somatic Symptom disorders: Refer Book

2) Conversion disorders: Patient will report loss of part or all of some basic body functions.
o Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms
reported.
o These symptoms often occur after a stressful experience and may be quite sudden.

3) Illness anxiety disorder:

• Illness anxiety disorder involves persistent preoccupation about developing a serious illness and
constantly worrying about the possibility.
 • This is accompanied by anxiety about one’s health. Individuals with this 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.
• In general, both somatic symptom disorder and illness anxiety disorder are concerned with medical
illness. But the difference lies in the way this concerned is expressed. In the case of somatic
symptom disorder, this expression is in terms of physical complaints while in case of illness anxiety
disorder, as the name suggests, it is the anxiety which is the main concern.

5. Dissociative Disorders

• Dissociation can be viewed as severance of the connections between ideas and emotions.
• Dissociation involves feelings of unreality, estrangement, depersonalisation, and sometimes a loss or shift
of identity.
• Sudden temporary alterations of consciousness that blot out painful experiences are a defining
characteristic of dissociative disorders.
• Three types: dissociative amnesia, dissociative identity disorder, and depersonalisation/ Derealization
Disorder

1. Dissociative amnesia:
Characterised by extensive but selective memory loss that has no known organic cause (e.g., head injury).
Some people cannot remember anything about their past.
Others can no longer recall specific events, people, places, or objects, while their memory for other events
remains intact.
This disorder is often associated with an overwhelming stress.
A part of Dissociative amnesia is fugue.

 Which is an unexpected travel away from home and workplace

 the assumption of a new identity
 the inability to recall the previous identity
The fugue usually ends when the person suddenly ‘wakes up’ with no memory of the events that occurred
during the fugue. This disorder is often associated with overwhelming stress.

2. Dissociative identity disorder

Often referred as multiple personality disorder
It is often associated with traumatic experiences in childhood.
In this disorder, the person assumes alternate personalities that may or may not be aware of each other.

3. Depersonalisation involves a dream like state in which the person has a sense of being separated both
from self and from reality.
There is a change of self-perception.
The person’s sense of reality is temporarily lost or changed.

6. Depressive Disorders

Depressive disorders are characterised by disturbances in mood or prolonged emotional state.

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
 excessive guilt or feelings of worthlessness

Factors Predisposing towards Depression:

 Genetic make-up, or heredity
 Age: Women are particularly at risk during young adulthood, while for men the risk is highest in early
middle age.
 Gender: Women in comparison to men are more likely to report a depressive disorder.
 Experiencing negative life events
 Lack of social support

7. Bipolar and related disordesr:

Bipolar I disorder involves both mania and depression which are alternately present, sometimes interrupted by
periods of normal mood. Bipolar I disorders were referred as manic-depressive disorders earlier.

Some examples of bipolar and related disorder include bipolar I disorder. Bipolar II disorder and
cyclothymic disorder.

Among the mood disorders, the lifetime risk of a suicide attempt is highest in case of bipolar mood disorders.

Risk factors that predict the likelihood of suicide

 Age: Teenagers and young adults are as much at high risk for suicide, as those who are over 70 years.
 Gender: Men have a higher rate of contemplated suicide than women.
 Ethnicity/ race or cultural attitudes toward suicide: In Japan, for instance, suicide is the culturally
appropriate way to deal with feeling of shame and disgrace recent occurrence of serious life events.
 Negative expectations, hopelessness, setting unrealistically high standards, and being over -critical

Suicide can be prevented by being alert to some of the symptoms which include:
• changes in eating and sleeping habits
• withdrawal from friends, family and regular activities
• violent actions, rebellious behaviour, running away
• drug and alcohol abuse
• marked personality change
• persistent boredom
• difficulty in concentration
• complaints about physical symptoms
• loss of interest in pleasurable activities

Suicides are preventable. There is a need for comprehensive multi-sectoral approach where the government,
media and civil society all play important role as stakeholders. Some measures suggested by WHO include:

• Limiting access to media 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 suicide;
• Care of 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:

• Lack of interest in common activities

• Declining grades
• Decreasing effort
• Misbehaviour in the classroom
• Mysterious or repeated absence
• Smoking or drinking, or drug misuse

Strengthening students’ self-esteem: Having a positive self-esteem is important in face of distress and
helps in coping adequately. In order to foster positive self-esteem in children the following approaches can
be useful:

• Accentuating positive life experiences to develop positive identity. This increases confidence in self.
• Providing opportunities for development of physical, social and vocational skills.
• Establishing a trustful communication.
• Goals for the students should be specific, achievable, measurable, relevant, to be completed within a
relevant time frame.

8. Schizophrenic Disorders

• Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and
occupational functioning deteriorate as a result of disturbed thought processes, strange perceptions,
unusual emotional states, and motor abnormalities.
• 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
Can be grouped into three categories:
 positive symptoms (i.e. excesses of thought, emotion, and behaviour): delusions, disorganised thinking
and speech, heightened perception and hallucinations, and inappropriate affect
 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.

1. Delusions. A delusion is a false belief that is firmly held on inadequate grounds.

It is not affected by rational argument, and has no basis in reality.
Types of delusions:
 Delusions of persecution: People with this delusion believe that they are being plotted against,
spied on, slandered, threatened, attacked or deliberately victimised.
 Delusions of reference: patients attach special and personal meaning to the actions of others or to
objects and events.
 Delusions of grandeur: people believe themselves to be specially empowered persons
 Delusions of control: patients believe that their feelings, thoughts and actions are controlled by
others

2. Formal thought disorders: People with schizophrenia may not be able to think logically and may speak
in peculiar ways.
Communication becomes extremely difficult. This may include
  rapidly shifting from one topic to another
 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)

3. Hallucinations: Perceptions that occur in the absence of external stimuli. Types includes:
 Auditory hallucinations: 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).
 Tactile hallucinations: forms of tingling, burning
 Somatic hallucinations: something happening inside the body such as a snake crawling inside
one’s stomach
 Visual hallucinations: vague perceptions of colour or distinct visions of people or objects
 Gustatory hallucinations: food or drink taste strange and
 Olfactory hallucinations: smell of poison or smoke

4. Inappropriate affect: displaying emotions that are unsuited to the situation.

Negative symptoms
Negative symptoms are ‘pathological deficits’ to a person’s behaviour.
Includes poverty of speech, blunted and flat affect, loss of volition, and social withdrawal.

1. Alogia: poverty of speech, i.e. a reduction in speech and speech content.

2. Blunted affect: Many people with schizophrenia show less anger, sadness, joy, and other feelings than
most people do.
3. Flat affect: showing no emotions at all
4. Avolition: apathy and an inability to start or complete a course of action.
5. Social withdrawal: People with this disorder may withdraw socially and become totally focused on their
own ideas and fantasies.

Psychomotor symptoms: People with schizophrenia move less spontaneously or make odd grimaces and
gestures. These symptoms may take extreme forms known as catatonia. Three forms of catatonia:
Catatonic stupor: people remain motionless and silent for long stretches of time.
Catatonic rigidity: maintaining a rigid, upright posture for hours.
Catatonic posturing: assuming awkward, bizarre positions for long periods

9. Neuro Developmental Disorders

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

Several neuro developmental disorders are:

Attention-deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, Intellectual disability and specific
learning disorders.

1) Attention-deficit Hyperactivity Disorder (ADHD)

The two main features of ADHD are:

i. inattention: inattentive children find it difficult to sustain mental effort during work or play, have
difficulty in keeping their minds on any one thing, cannot concentrate, does not follow
 instructions, is disorganised, easily distracted, forgetful, does not finish assignments, and is quick
to lose interest in boring activities.
ii. hyperactivity-impulsivity: impulsive children seem unable to control their immediate reactions
, cannot think before they act, find it difficult to wait or take turns, have difficulty resisting
immediate temptations or delaying gratification
Hyperactivity: 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.

2) Autism Spectrum Disorder

These disorders are characterised by severe and widespread impairments in social interaction and
communication skills, and stereotyped patterns of behaviours, interests and activities. Autistic disorder or
autism is one of the most common of these disorders.

Children with autistic disorder have

• marked difficulties in social interaction and communication,
 Children with autism experience profound difficulties in relating to other people.
 They are unable to initiate social behaviour and seem unresponsive to other people’s feelings.
 They are unable to share experiences or emotions with others.
 They also show serious abnormalities in communication and language that persist over time.
 Many autistic children never develop speech and those who do, have repetitive and deviant speech
patterns.
• a restricted range of interests, and strong desire for routine
Children with autism often show narrow patterns of interests and repetitive behaviours such as lining up
objects or stereotyped body movements such as rocking. These motor movements may be self-
stimulatory such as hand flapping or self-injurious such as banging their head against the wall.

About 70 per cent of children with autism are also mentally retarded.

3) Intellectual Disability

Intellectual Disability refers to below average intellectual functioning (with an IQ of approximately 70 or

below), and deficits or impairments in adaptive behaviour (i.e. in the areas of communication, self-care, home
living, social/interpersonal skills, functional academic skills, work, etc.) which are manifested before the age of
18.
(Please refer to table 4.2 on page 85 of the textbook for characteristics of individuals with different levels of ID)

4) Specific Learning Disorder

• the individual experiences difficulty in perceiving or processing information efficiently and

accurately.
• These get manifested during early school years and the individual encounters problems in basic
skills in reading, writing and/or mathematics. The affected child tends to perform below average for
her/his age.
• However, individuals may be able to reach acceptable performance levels with additional inputs and
efforts. Specific learning disorder is likely to impair functioning and performance in
activities/occupations dependent in the related skills.

10. Feeding and Eating Disorders

1. Anorexia nervosa, the individual has a distorted body image that leads her/him to see herself/himself
as overweight. Typical behaviours include: Often refusing to eat, exercising compulsively and developing
unusual habits such as refusing to eat in front of others
 The anorexic may lose large amounts of weight and even starve herself/himself to death.

2. 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.

3. Binge eating: frequent episodes of out-of-control eating.

11. Substance-Related and Addictive Disorders

Addictive behaviours involves excessive intake of high calorie food resulting in extreme obesity or involving the
abuse of substances such as alcohol and cocaine.
Disorders relating to maladaptive behaviours resulting from regular and consistent use of the substance involved
are called substance use disorders.
These disorders include problems associated with using and abusing such drugs as alcohol, cocaine and heroin,
which alter the way people think, feel and behave.
There are two sub-groups of substance-use disorders, i.e. those related to substance dependence and those related
to substance abuse.

Substance Dependence
In substance dependence, there is intense craving for the substance to which the person is addicted, and the
person shows tolerance, withdrawal symptoms and compulsive drug-taking.
Tolerance means that the person has to use more and more of a substance to get the same effect. Withdrawal
refers to physical symptoms that occur when a person stops or cuts down on the use of a psychoactive substance.

Substance Abuse
In substance abuse, there are recurrent and significant adverse consequences related to the use of substances.
Damage is caused to the family and social relationships, poor performance at work is seen, and physical hazards
can be created. Common forms of substance abuse

Alcohol abuse and dependence

Harmful Effects of alcohol

i. Alcohol is absorbed into the blood and carried into the central nervous system (brain and spinal cord)
where it depresses or slows down functioning.
ii. Alcohol depresses those areas in the brain that control judgment and inhibition; people become more
talkative and friendly, and they feel more confident and happy.
iii. As alcohol is absorbed, it affects other areas of the brain. For example, drinkers are unable to make sound
judgments, speech becomes less careful and less clear, and memory falters; many people become
emotional, loud and aggressive.
iv. Motor difficulties increase. For example, people become unsteady when they walk and clumsy in
performing simple activities; vision becomes blurred and they have trouble in hearing; they have
difficulty in driving or in solving simple problems.
v. Alcoholism destroys millions of families, social relationships and careers.
vi. 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.
vii. Excessive drinking can seriously damage physical health.

Heroin abuse and dependence

Danger of heroin abuse is an overdose, which slows down the respiratory centres in the brain, almost paralysing
breathing, and in many cases causing death.

Cocaine abuse and dependence

• Regular use of cocaine may lead to a pattern of abuse in which the person may be intoxicated throughout
the day.
• Function poorly in social relationships and at work.
• Cause problems in short-term memory and attention.
• Dependence may develop, so that cocaine dominates the person’s life.
• Withdrawal symptoms include feelings of depression, fatigue, sleep problems, irritability and anxiety.