Psychology: Class 12 — Chapter 4: Psychological Disorders

Two basic and conflicting views exist to distinguish between normal and abnormal behaviour:

1. Deviation from Social Norms: This approach views abnormal behaviour as a deviation from societal expectations and rules of proper conduct. Norms are heavily influenced by a society's specific culture, history, values, and institutions.
2. Maladaptive Behaviour: This approach focuses on whether the behaviour fosters the well-being of the individual and the group. Well-being includes survival, growth, and self-actualisation. Behaviour is considered abnormal if it is maladaptive, meaning it interferes with optimal functioning and adaptation to life challenges.

Ancient beliefs attributed abnormal behaviour to evil spirits, devils, or supernatural forces. Treatments included exorcism (removing evil spirits through countermagic and prayer) performed by a shaman or medicine man (ojha).

This view suggests that abnormal behaviour arises because the body and brain are not functioning properly.

• In ancient Greece, philosopher-physicians like Hippocrates, Socrates, and Plato developed the organismic approach, viewing disturbed behaviour as a conflict between emotion and reason.
• Galen elaborated on the role of the four humours (blood, black bile, yellow bile, and phlegm). Imbalances among these fluids were believed to cause disorders. This is similar to the Indian concept of the three doshas (vata, pitta, and kapha) in Ayurvedic texts.

This perspective attributes psychological problems to inadequacies in how an individual thinks, feels, or perceives the world.

• Middle Ages: Demonology and superstition resurfaced, leading to witch-hunts. However, St. Augustine wrote about mental anguish, laying the groundwork for modern psychodynamic theories.
• Renaissance Period: Johann Weyer emphasised psychological conflict and disturbed interpersonal relationships, arguing that "witches" were mentally disturbed and needed medical treatment.
• Age of Reason and Enlightenment: The scientific method replaced dogma. The 18th century saw the rise of the Reform Movement, leading to the humanisation of asylums and eventually deinstitutionalisation (providing community-based care).

Today, there is a convergence of these views into the interactional or bio-psycho-social approach, which integrates biological, psychological, and social factors.

Biological factors include faulty genes, endocrine imbalances, malnutrition, and physical injuries. A key focus is on neurotransmitters (chemical messengers in the brain):

• Anxiety disorders are linked to low activity of gamma aminobutyric acid (GABA).
• Schizophrenia is linked to excess activity of dopamine.
• Depression is linked to low activity of serotonin.

• Psychodynamic Model: Formulated by Freud, it suggests behaviour is determined by unconscious psychological forces (id, ego, and superego). Abnormal symptoms result from conflicts between these forces.
• Behavioural Model: States that both normal and abnormal behaviours are learned through conditioning (classical conditioning, operant conditioning, and social learning).
• Cognitive Model: Asserts that abnormal functioning results from cognitive problems, such as irrational assumptions, illogical thinking, and overgeneralisations.
• Humanistic-Existential Model: Focuses on broader aspects of human existence, emphasizing natural tendencies toward self-actualisation, personal freedom, and the responsibility to give meaning to life.

Abnormal behaviour is understood in the context of social and cultural forces, such as family structure (e.g., enmeshed families), social networks, societal conditions, and labels/roles assigned to individuals.

This model integrates multiple factors, stating that psychological disorders develop when a diathesis (biological predisposition or vulnerability) is triggered by a stressful situation or pathogenic stressor.

Anxiety is a diffuse, vague, and highly unpleasant feeling of fear and apprehension. Major types include:

• Generalized Anxiety Disorder: Prolonged, vague, unexplained, and intense fears not attached to any specific object, accompanied by hypervigilance and motor tension.
• Panic Disorder: Recurrent, unpredictable anxiety attacks of intense terror, accompanied by physical symptoms like breathlessness, palpitations, and dizziness.
• Phobias: Irrational fears of specific objects, people, or situations. Divided into:
  • Specific Phobias: Fear of specific animals, heights, enclosed spaces, etc.
  • Social Anxiety Disorder (Social Phobia): Intense fear and embarrassment when dealing with others.
  • Agoraphobia: Fear of entering unfamiliar situations or leaving home.
• Separation Anxiety Disorder (SAD): Extreme, developmentally inappropriate distress when separated from attachment figures.

Characterised by an inability to control preoccupations and repetitive actions:

• Obsessive Behaviour: Inability to stop thinking about a particular idea or topic.
• Compulsive Behaviour: The need to perform repetitive, ritualistic actions (e.g., washing, counting, checking) to reduce anxiety.
• Other disorders in this category include hoarding, trichotillomania (hair-pulling), and excoriation (skin-picking).

• Post-Traumatic Stress Disorder (PTSD): Triggered by experiencing or witnessing extremely traumatic events (e.g., natural disasters, war, terrorist attacks). Symptoms include flashbacks, recurrent dreams, impaired concentration, and emotional numbing.

Conditions involving physical symptoms in the absence of any organic or biological cause:

• Somatic Symptom Disorder: Persistent, distressing body-related symptoms accompanied by excessive worry and frequent medical visits.
• Illness Anxiety Disorder: Persistent preoccupation with developing a serious medical illness, despite reassurance.
• Conversion Disorders: Reported loss of basic body functions (e.g., paralysis, blindness, deafness) typically occurring suddenly after a stressful experience.

Characterised by a sudden, temporary alteration or severance of connections between ideas, memory, and identity:

• Dissociative Amnesia: Extensive but selective memory loss with no organic cause. May involve dissociative fugue (unexpected travel away from home, assumption of a new identity, and inability to recall the past).
• Dissociative Identity Disorder: Often called multiple personality; the individual assumes two or more distinct, alternating personalities.
• Depersonalisation/Derealisation Disorder: Involves a dreamlike state where the person feels separated from their self and reality.

Depression covers a variety of negative moods and behavioural changes:

• Major Depressive Disorder: Defined by a period of depressed mood, loss of interest in activities, changes in body weight, sleep problems, fatigue, feelings of worthlessness, and thoughts of death or suicide.
• Predisposing Factors: Genetic make-up, age (young adulthood for women, middle age for men), gender (women are more likely to report depression), and lack of social support.

Characterised by alternating periods of mania (extreme euphoria, high energy) and depression. Types include Bipolar I, Bipolar II, and Cyclothymic Disorder.

Suicide is a complex outcome of biological, genetic, psychological, and socio-cultural factors. Key WHO-recommended prevention measures include:

• Limiting access to the means of suicide.
• Responsible media reporting of suicide.
• Early identification, treatment, and care of people at risk.
• Providing community support and training health workers.

Schizophrenia is a debilitating disorder involving deteriorated personal, social, and occupational functioning. Symptoms are grouped into three categories:

1. Positive Symptoms (Pathological Excesses):
   • Delusions: False beliefs firmly held on inadequate grounds (e.g., delusions of persecution, reference, grandeur, and control).
   • Formal Thought Disorders: Illogical, muddled thinking and speech (e.g., loosening of associations, neologisms, perseveration).
   • Hallucinations: Perceptions in the absence of external stimuli (most commonly auditory, but also tactile, somatic, visual, gustatory, and olfactory).
   • Inappropriate Affect: Emotions unsuited to the situation.
2. Negative Symptoms (Pathological Deficits):
   • Alogia: Poverty of speech or reduction in speech content.
   • Blunted or Flat Affect: Showing little to no emotion.
   • Avolition: Apathy and inability to start or complete a course of action.
3. Psychomotor Symptoms:
   • Catatonia: Extreme movement abnormalities, including catatonic stupor (motionless and silent), catatonic rigidity (rigid posture), and catatonic posturing (awkward, bizarre positions).

Disorders that manifest early in development, often before or during early school years:

• ADHD (Attention-Deficit/Hyperactivity Disorder): Characterised by inattention (difficulty sustaining mental effort) and hyperactivity-impulsivity (constant motion, inability to delay gratification).
• Autism Spectrum Disorder: Characterised by widespread impairments in social interaction, communication difficulties, and repetitive, stereotyped patterns of behaviour and interests.
• Specific Learning Disorder: Difficulty in perceiving or processing information efficiently, leading to problems in reading, writing, or mathematics.
• Intellectual Disability: Below-average intellectual functioning (IQ of 70 or below) and deficits in adaptive behaviour manifested before age 18.

• Oppositional Defiant Disorder (ODD): Age-inappropriate stubbornness, irritability, defiance, and hostile behaviour.
• Conduct Disorder: Age-inappropriate actions that violate family expectations, societal norms, and personal rights of others (e.g., aggression, property damage, theft). Aggression types include verbal, physical, hostile, and proactive.

• Anorexia Nervosa: Distorted body image leading to self-starvation, extreme weight loss, and compulsive exercise.
• Bulimia Nervosa: Cycles of binge eating followed by purging behaviours (vomiting, laxatives).
• Binge Eating: Frequent episodes of out-of-control eating without purging, leading to distress.

Maladaptive behaviours resulting from regular and consistent use of substances:

• Alcohol: Depresses the central nervous system. Leads to tolerance (needing larger amounts to feel effects) and withdrawal symptoms.
• Heroin: Highly addictive opioid; interferes with social/occupational functioning and carries a high risk of fatal overdose.
• Cocaine: Powerful stimulant; regular use leads to cognitive impairment, memory issues, and severe psychological dependence.