CLASS 12TH
PSYCHOLOGY NCERT
CHAPTER -4
PSYCHOLOGICAL DISORDERS
By Neetu Dalal
Ph.D Research Scholar
UGC-Net Qualified
INDEX
INTRODUCTION
In this chapter, we will try to understand
1. what goes wrong when people develop psychological problems,
2. what are the causes and factors which lead to abnormal behavior
[Link] are the various signs and symptoms associated with different
types of psychological disorders?
Abnormal Psychology is the area within psychology that is focused on
maladaptive behaviour – its causes, consequences, and treatment.
Basic Concepts
Abnormal Psychology is the area within psychology that is
focused on maladaptive behaviour – its causes, consequences,
and treatment.
Behavior which cannot be modified according to the need of
the situations is Maladaptive.
The word ‘abnormal’ literally means “away from the normal”, it
implies deviation from some clearly defined norms or standards.
Abnormality has 4 D’s
• Deviance : Different, Extreme, Unusual, Bizarre
• Distressing : Unpleasant and Upsetting to the person and
others
• Dysfunctional : Interfering with person’s ability to carry
out daily activities in constructive way
• Dangerous :to the person and to others
APPROACHES TO ABNORMAL
BEHAVIOUR
Various approaches have been used in distinguishing between normal
and abnormal behaviours :
FIRST APPROACH: views abnormal behaviour as a deviation from
social norms.
Each society has norms, which are stated or unstated rules for proper conduct.
Behaviours, thoughts and emotions that break societal norms are called
abnormal.
SECOND APPROACH: views abnormal behaviour as Maladaptive.
Whether it fosters the well-being of the individual and eventually of the
group to which s/he belongs.
Historical Background
1. Supernatural Approach
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).
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. 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
Historical Background
2. Biological or Organic Approach - the belief that individuals
behave strangely because their bodies and their brains are not
working properly.
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.
Historical Background
3. Psychological Approach-
According to this point of view, psychological problems are
caused by inadequacies in the way an individual thinks, feels, or
perceives the world.
4. Organismic Approach
Hippocrates, Socrates, and in particular Plato who
developed this approach and viewed disturbed behaviour
as arising out of conflicts between emotion and reason.
Historical Background
In the Middle Ages,
Demonology and superstition gained renewed importance in the
explanation of abnormal behaviour.
The 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.
Historical Background
Seventeenth and Eighteenth Centuries -known as the Age
of Reason and Enlightenment, as the scientific method
replaced faith and dogma as ways of understanding
abnormal behaviour.
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.
Historical Background
Biopsycho-social 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.
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 Classification
The American Psychiatric Association (APA) has published
an official manual describing and classifying various kinds of
psychological disorders.
The current version of it, the Diagnostic and Statistical
Manual of Mental Disorders, 5 th Edition (DSM-5), presents
discrete clinical criteria which indicate the presence or
absence of disorders.
ICD-10 Classification
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.
It was prepared by the World Health Organisation (WHO).
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 Behavior
In order to understand abnormal behavior, psychologists use different
approaches.
Each approach in use today emphasises a different aspect of human
behaviour, and explains and treats abnormality in line with that
aspect.
These approaches also emphasise the role of different factors such as
biological, psychological and interpersonal, and socio-cultural factors.
Factors underlying Abnormal Behavior
1. BIOLOGICAL FACTORS
2. PSYCHOLOGICAL MODEL
Psychodynamic model
Behavioural model
Cognitive model
Humanistic-existential model
3. SOCIO-CULTURAL MODEL
4. DIATHESIS- STESS MODEL
1. BIOLOGICAL FACTORS/MODELS
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.
According to this model, abnormal behaviour has a
biochemical or physiological basis.
Studies indicate that abnormal activity by certain neuro-
transmitters can lead to specific psychological disorders.
1. BIOLOGICAL FACTORS/MODELS
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
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.
2. PSYCHOLOGICAL FACTORS
These models maintain that psychological and interpersonal
factors have a significant role to play in abnormal behavior.
These factors include maternal deprivation ,faulty parent-child
relationships, maladaptive family structures and severe stress.
The psychological models include the
A. Psychodynamic Models
B. Behavioral Models
C. Cognitive Models
D. Humanistic-Existential models.
A. Psychodynamic Models
The psychodynamic model is the oldest and most famous of the modern
psychological models.
Psychodynamic theorists believe that behavior is determined by
psychological forces within the person of which s/he is not consciously aware.
Abnormal symptoms are viewed as the result of conflicts between these
forces.
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).
Freud stated that abnormal behaviour is a symbolic expression of
unconscious mental conflicts that can be generally traced to early childhood
or infancy.
B. Behavioral Models
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 .These three types of conditioning account for
behaviour, whether adaptive or maladaptive.
C. Cognitive Models
Psychological factors are also emphasised by the cognitive model.
This model states that abnormal functioning can result from cognitive
problems.
People may hold assumptions and attitudes about themselves that are
irrational and inaccurate. People may also repeatedly think in illogical
ways and make overgeneralisations.
D. Humanistic-Existential models
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.
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.
3. SOCIO-CULTURAL MODEL
According to the socio-cultural model, abnormal behaviour is best
understood in light of the social and cultural forces that influence an
individual.
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. It has been found that certain family
systems are likely to produce abnormal functioning in individual members.
Socio-cultural theorists believe that abnormal functioning is influenced by
the societal labels and roles assigned to troubled people.
4. DIATHESIS- STESS MODEL
One of the most widely accepted explanations of abnormal behaviour has been
provided by the diathesis-stress model.
This model states that psychological disorders develop when a diathesis
(biological predisposition to the disorder) is set off by a stressful situation.
This model has three components.
1. Diathesis or the presence of some biological aberration which may be inherited.
2. Diathesis may carry a vulnerability to develop a psychological disorder. This
means that the person is ‘at risk’ or ‘predisposed’ to develop the disorder.
3. 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.
MAJOR PSYCHOLOGICAL DISORDERS
1. Anxiety Disorders
2. Obsessive-Compulsive and Related Disorders
3. Trauma- and Stressor-Related Disorders
4. Somatic Symptom and Related Disorders
5. Dissociative Disorders
6. Depressive Disorders
7. Bipolar and Related Disorders
8. Schizophrenia Spectrum and Other Psychotic Disorders
9. Neurodevelopmental Disorders
10. Disruptive, Impulse-Control and Conduct Disorders
11. Feeding and Eating Disorders
12. Substance- Related and Addictive Disorders
1. Anxiety Disorders
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.
The anxious individual shows combinations of the following symptoms:
rapid heart rate, shortness of breath, diarrhoea, loss of appetite, fainting,
dizziness, sweating, sleeplessness, frequent urination and tremors.
There are many types of anxiety disorders.
Obsessive-Compulsive and Related Disorders
People affected by obsessive compulsive disorder are unable to control
their preoccupation with specific ideas 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.
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 vary widely but may include recurrent dreams,
flashbacks, impaired concentration, and emotional numbing.
Adjustment Disorders and Acute Stress Disorder are also included under
this category.
Somatic Symptom and Related
Disorders
These are conditions in which there are physical symptoms in
the absence of a physical disease.
In these disorders, the individual has psychological
difficulties and complains of physical symptoms, for which
there is no biological cause.
These include conversion disorders, somatic symptom
disorder, and illness anxiety disorder among others.
Somatic symptom disorder - persistent body-related symptoms which
may or may not be related to any serious medical condition.
overly preoccupied with their symptoms and they continually worry about their
health and make frequent visits to doctors.
Experience significant distress and disturbances in their daily life.
Illness anxiety disorder - involves persistent preoccupation about
developing a serious illness and constantly worrying about this possibility.
This is accompanied by anxiety about one’s health.
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.
In general, both somatic symptom disorder and illness anxiety
disorder are concerned with medical illnesses.
But, the difference lies in the way this concern 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.
Conversion Disorder –
The symptoms of conversion disorders are the reported loss of
part or all of some basic body functions.
Paralysis, blindness, deafness and difficulty in walking are
generally among the symptoms reported.
These symptoms often occur after a stressful experience and
may be quite sudden.
Dissociative Disorders
Dissociation can be viewed as ending of the connections between
ideas and emotions.
Dissociation involves feelings of unreality, 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.
Conditions included in this are Dissociative Amnesia, Dissociative
Identity Disorder, and Depersonalisation/Derealisation Disorder.
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. 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.
Depressive Disorders
Depression is the most widely prevalent and recognised of all
mental disorders
Depression covers a variety of negative moods and behavioural
changes. Depression can refer to a symptom or a disorder.
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.
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.
Some 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
1. Positive symptoms - excesses of thought, emotion, and
behavior
2. Negative symptoms - deficits of thought, emotion, and
behavior
3. Psychomotor symptoms
1. 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.
A. 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.
a. 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.
b. 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.
c. In delusions of grandeur, people believe themselves to be specially empowered persons.
d. In delusions of control, they believe that their feelings, thoughts and actions are controlled
by others.
1. Positive symptoms
B. Disorganised thinking and speech
People with schizophrenia may not be able to think logically and may speak in
peculiar ways. These include rapidly shifting from one topic to another so that the
normal structure of thinking is muddled and becomes illogical, inventing new words
or phrases, and persistent and inappropriate repetition of the same thoughts.
C. Hallucinations
Hallucinations are 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
Hallucinations can also involve the other senses..
D. Inappropriate affect
People with schizophrenia also show inappropriate affect, i.e. emotions that are
unsuited to the situation
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.
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.
3. Psychomotor symptoms
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.
Neurodevelopmental Disorders
Neurodevelopmental disorders manifest in the early stage of development.
Usually the symptoms appear before the child enters school or during the
early stage of schooling.
These disorders result in hampering personal, social, academic and
occupational functioning.
These get characterized as deficits or excesses in a particular behaviour or
delays in achieving a particular age-appropriate behavior
Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder,
Intellectual Disability, and Specific Learning Disorder fall under
Neurodevelopmental Disorders
Attention-Deficit/Hyperactivity Disorder
(ADHD)
The two main features of ADHD are inattention and hyperactivity-impulsivity.
Inattention
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.
Hyperactivity-Impulsivity
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.
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
Characterized 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.
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.
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
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
In case of 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 on the related
skills.
Disruptive, Impulse-Control and Conduct
Disorders
The disorders included under this category are Oppositional Defiant Disorder,
Conduct Disorder and others.
Oppositional Defiant Disorder (ODD)
Children with ODD display age-inappropriate amounts of stubbornness, are
irritable, defiant, disobedient, and behave in a hostile manner. Individuals with
ODD do not see themselves as angry, oppositional, or defiant and often justify
their behaviour as reaction to circumstances/demands. Thus, the symptoms of the
disorder become entangled with the problematic interactions with others.
Conduct Disorder
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.
The behaviours typical of conduct disorder include aggressive actions that cause
or threaten harm to people or animals, nonaggressive conduct that causes property
damage, major deceitfulness or theft, and serious rule violations.
Feeding and 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.
Substance-Related and Addictive
Disorders
Addictive behaviour, is one of the most severe problems being faced by
society today.
Disorders 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
1. Alcohol
2. Heroin
3. Cocaine
Substance-Related and Addictive
Disorders
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
behavior 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.
Heroin- 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.
Substance-Related and Addictive
Disorders
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
Thank You