Chapter 4 psychological disorders-final-30.05.2021

CBSE Class-XII:Psychology: Chapter-IV : Psychological Disorders

1. Chapter 4 : Psychological Disorders Mrs . Navarathina D evakumar , M.Phil ( Psy ) CBSE Class XII

2. Psychological Disorders are patterns of thoughts, feeling and actions that are deviant, distressful and dysfunctional

3. Classification of Psychological Disorders Anxiety Disorders Obsessive- Compulsive And Related Disorders Trauma And Stressor- Related Disorders Somatic Symptom And Related Disorders Dissociative Disorders Depressive Disorders Bipolar And Related Disorders Schizophrenia Spectrum And Other Psychotic Disorders Neurodevelopmental Disorders Disruptive, Impulse -Control And Conduct Disorders Feeding a nd eating Disorders Substance- Related And Addictive Disorders

4. 1. Anxiety D isorders Anxiety is defined as a diffuse , v ague , very unpleasant feeling of fear and apprehension. Symptoms : R apid heart rate S hortness of breath D iarrhoea and loss of appetite F ainting and dizziness S leeplessness S weating and tremors F requent urination Anxiety disorders are the most commonest psychological disorders

5. Types Of Anxiety Disorders Anxiety Disorders

6. Generalised Anxiety Disorders It consists of a prolonged , vague, unexplained and intense f ears that a r e not attached to any object Symptoms Worry and apprehensive feelings about the future Hypervigilance which involves constantly scanning the environment for danger It is marked by motor tension as a result of which the person is unable to relax Restless , tense and visibly shaky

7. Panic Disorder Panic attack denotes an abrupt surge of intense anxiety rising to a peak when thoughts of a particular stimuli are present . Such thoughts occur in an unpredictable manner It consists of recurrent anxiety attacks in which a person experiences intense terror Symptoms Shortness of breath Dizziness and trembling Palpitations Nauseated Chest pain or discomfort Fear of going crazy Losing control or dying PANIC ATTACK

8. P h ob i a s Irrational fears related to specific objects, people or situations Phobias often develop gradually or begin with a generalised anxiety disorder Specific Phobia Social Phobia Agoraphobia

9. Types o f Phobia

10. Separation Anxiety Disorder Individuals with this disorder are fearful and anxious about separation from attachment figures to an extent that is developmentally not appropriate Symptoms in children Difficulty being in a room by themselves Going to school alone Fearful of entering new situations Cling to and shadow their parents every move To avoid separation children with SAD may fuss, scream, throw severe tantrums or make suicidal gestures

11. 2. Obsessive Compulsive & Related Disorders People affected by OCD 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 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 The need to perform certain behaviours over and over again Many compulsions deal with counting, ordering, checking , touching and washing Other disorders int his category include Hoa rding disorder, T richotillomania- H air pulling disorder Excoriation – S kin picking disorder

12. 3. Trauma & Stressor Related Disorders Post Traumatic Disorder People who have been caught in a natural disaster ( such as tsunami, earthquakes) or have been victims of bomb blasts by terrorists or war related situations or met with a serious accident experience post-traumatic stress disorder. Symptoms Recurrent dreams Flashbacks Impaired concentration and emotional numbing Adjustment disorders and acute stress disorders are included in this category

13. 4. Somatic Symptom & Related Disorders These are conditions in which there are physical symptoms in the absence of a physical disease Individuals have psychological difficulties and complaints of physical symptoms with no biological cause Types of Somatic Symptoms Disorder

14. The person experiences body related symptoms which may or may not be related to any serious medical condition People with this disorder are O verly preoccupied with their symptoms Continually worry about the health and make frequent doctor visits As a result they experience significant distress and disturbances in their daily life Expression is in terms of physical illness Somatic Symptom Disorder

15. It involves persistent preoccupation about developing a serious illness and constantly worrying about this possibility Expression is in terms of anxiety which is in the main concern Overly concerned about the undiagnosed disease, negative diagnostic results, do not respond to assurance by doctors and easily alarmed about illness such as hearing about someone else's ill health or such news Illness Anxiety Disorder

16. Conversion Disorders The person suffers from a loss or impairment of motor or sensory function ( paralysis , blindness etc) that has no physical cause but may be a response to stress and psychological problems Paralysis Blindness Deafness & Difficulty in walking are generally reported among the symptoms

17. Dissociative Disorders Dissociation : I t can be viewed as severance of the connections between ideas and emotions Symptoms : feelings of unreality, estrangement, depersonalisation and sometimes a loss of shift of identity Dissociative disorders : Sudden temporary alternations in consciousness that blot out painful experiences are a defining characteristic of dissociative disorders

18. It is characterised by extensive but selective memory loss that has no organic cause ( 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 remain intact. A part of dissociative amnesia is dissociative fugue Essential feature 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 The fugue usually ends when the person suddenly wakes up with no memory of the events that occurred during the fugue. Types of Dissociative Disorders Dissociative Amnesia Dissociative Fugue Unexpected travel away home and assuming a new identity

19. It is referred to as multiple personality and the most dramatic of the dissociative disorders In this disorder , the person assumes alternate personalities that may or may not be aware of each other. It is often associated with traumatic experience of the childhood It involves a dreamlike state in which the person has a sense of being separated both from self and from the reality In depersonalisation ,there is a change of self perception and the persons sense of reality is temporarily lost or changed Dissociative Identity Disorder Depersonalisation/ Derealisation Disorder Person assumes alternate personalities Types of Dissociative Disorders

20. 6. Depressive Disorders Major D epression D isorder Major depressive disorder is defined as a period of depression mood or loss of interest or pleasure in most activities together with other symptoms like Change in body weight Constant sleep problems Tiredness Inability to think clearly Agitation Greatly slower behaviour Thoughts of death and suicide Excessive guilt or feelings of worthlessness

21. Factors Predisposing Towards Depression Genetic make up or heredity is an important risk factor for major depression Age: women are particularly at risk during young adulthood while men are at highest risk in early middle age Gender: women in comparison to men are more likely to report a depressive disorder Negative life events and lack of social support GENDER HEREDITY NEGATIVE LIFE EVENTS

22. 7. Bipolar a nd Related Disorders Bipolar 1 disorder involves both mania and depression, which alternatively present and sometimes interrupted by periods of normal mood . Bipolar disorders were earlier referred as manic- depressive disorders . Depression Mania Depression Mania Depressed Mood Euphoric Mood Loss of Energy & Fatigue Hyper Activity Poverty of Speech Excessively Talkative Negative Self Concept Inflated Self Esteem Highly Pessimistic Highly Optimistic

23. S u i c i d e Suicide refers to act of intentionally killing oneself. Suicide occurs as a result of complex interface of biological, g enetic , psychological, sociological, cultural and environmental facto rs Suicide warning signs Exhibits drastic changes in behavior Withdraws from friends or social activities Loses interest in school, work or hobbies Trouble with eating or sleeping Preoccupied with death and dying Gives away prized possessions Increased intake of alcohol or drugs Previous suicidal attempt is an important risk factor

24. Suicide Prevention Suicides are preventable. improving identification, referral and management of behaviours are crucial. We need to identify vulnerability, comprehend the circumstances leading to such behaviour and accordingly plan interventions Measures suggested by WHO : Li miting access to the means of suicide R eporting of suicide in media in a responsible way B ringing in alcohol related policies Ea rly identification, treatment and carer of risk T raining health workers in assessing and managing for suicide C are for people who attempted suicide and providing community support

25. 8. Schizophrenia Spectrum and o ther 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 process, strange perceptions , unusual emotional states and motor abnormalities. The symptoms of schizophrenia can be grouped into 3 categories Positive symptom s - excesses of thought emotion and behavior . Delusion, disorganized thinking and speech, heightened perception, hallucinations and inappropriate affect Negative symptoms- deficits of thought, emotion and behavior . Poverty of speech, blunted and flat affect , loss of volition and social withdrawal. Psychomotor symptoms Positive symptoms Negative symptoms Psychomotor symptoms

26. A. Positive Symptoms o f Schizophrenia Delusion: 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 the reality Types Of Delusion Delusion of P ersecution : People with this delusion believe that they are being plotted against, spied on, slandered, threatened, attacked or deliberately victimized. Delusion of R eference : In these delusions people attach special and personal meaning to actions of others or to the objects and events Delusion of G randeur : people believe themselves to be specially empowered beings Delusion of Control : people believe that their feelings , thoughts and actions are controlled by others Delusion of Grandeur Delusion of Persecution

27. Schizophrenia Formal thought disorders include Rapidly shifting from one topic to another so that the normal structure of thinking is muddled and become illogical ( loosening of association and derailment ) Neologism -inventing new words or phrases Perseveration- persistent and inappropriate repetition of the same thoughts Inappropriate repetition of same thoughts

28. Types o f Hallucination HALLUCINATION : Perception that occur in the absence of external stimuli TYPES OF HALLUCINATION: Auditory H allucination: M ost common in schizophrenia. Patients hear sounds or voices that speak words, phrases and sentences directly to the patient ( second –person hallucination) Talk to one another referring to the patient ( third – person hallucination ) Tactile Hallucinations: Forms of tingling , burning S omatic H allucination : S omething happening inside the body such as snake crawling inside ones stomach V isual H allucination : V ague perceptions of colour or distinct visions of people or objects G ustatory H allucination : F ood or drink tastes strange O lfactory H allucination : S mell of poison or smoke

29. Types of Hallucination VISUAL HALLUCINATION AUDITORY HALLUCINATION TACTILE HALLUCINATION OLFACTORY HALLUCINATION

30. Negative Symptoms o f Schizophrenia Negative Symptoms Are Pathological Deficits w hich includes p overty o f speech , Blunted a nd f lat affect, Loss o f v olition a nd S ocial w ithdrawal Alogia : P overty of speech that is reduction in speech and speech content Blunted A ffect : S ome show less anger, sadness, joy and other feelings than most people do Flat A ffect : A condition in which they show no emotions Avolition : A pathy and an inability to start or complete a course of action Social withdrawal : P eople with this disorder socially withdraw and become totally focussed on their own ideas and fantasies

31. Psychomotor Symptoms o f Schizophrenia Catatonic R igidity CATATONIA : They move less spontaneously or make odd grimaces and gestures. These symptoms may take extreme forms called catatonia. CATATONIC STUPOR : people remain motionless and silent for long stretches of time CATATONIC RIGIDITY : maintaining a rigid, upright postures for hours CATATONIC POSTURING : assuming awkward, bizarre position for hours Catatonic posturing

32. 9.Neurodevelopmental Disorders A common feature of the neurodevelopmental disorders is that they manifest in the early stage of development Often 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 Types :

33. Attention Deficit Hyperactive Disorder The main features of ADHD are inattention, hyperactivity and impulsive Inattention: Children who are inattentive find it difficult to sustain mental effort during a w ork or play.. They have a hard time keeping their minds on any one thing or following instructions Symptoms Child does not listen and cannot concentrate Disorganised Easily distracted and forgetful Does not finish assignments Quick to lose interest in boring activities

34. Attention Deficit Hyperactive Disorder (ADHD) HYPERACTIVITY Children with ADHD are in constant motion . Parents and teachers describe them as " driven by a motor “ T alk s incessantly The child may fidget, squirm , climb and run around the room aimlessly Sitting still through a lesson is impossible for them IMPULSIVE Children who are impulsive seem unable to control their immediate reactions or think before they act . Common complaints are They find difficult to wait or take turns Difficulty resisting immediate temptations or delaying gratification Minor mishaps, knocking things over and sometimes serious accidents or injuries can occur

35. Autism Spectrum Disorder It is characterised by widespread impairments in social interaction and communication skills and stereotyped patterns of behaviour , interests and activities Symptoms Have marked difficulties in social interaction and communication across different contexts Restricted range of interests Strong desire for routine 70percent of children have intellectual disability Experience profound difficulties in relating to others Unable to initiate social behaviour and seem unresponsive to other peoples feelings Have difficulty in sharing experiences or emotions with others

36. Autism Spectrum Disorder They show serious abnormalities in communication and language that persist over time S o m e o f t he m d o n o t d e v el o p s p ee c h a n d h a v e r e p e t i t i v e a n d d e v i a n t speech patterns Autism children show narrow patterns of interests and repetitive behaviours such as lining up of objects or stereotyped body movements such as rocking Motor movements may be self stimulatory such as hand flapping or self injurious such as head banging against the wall. Due to difficulties in verbal and nonverbal communication they tend to have difficulties in starting, maintaining and even understanding relationships . Hand F lapping Lining up of objects

37. Intellectual Disability Refers to below average intellectual functioning ( IQ of 70 or below ) and deficits or impairments in adaptive behaviour in the areas of communication, self café, home living, social/ interpersonal skills, functional academic skills, work etc. which are manifested before the age of 18 years

38. Characteristics of Individuals with Different Levels of Intellectual Disability Areas of functioning Mild ( IQ = 55 to 70 ) Moderate ( IQ= 35-50 to approximately 50-55) Severe ( IQ= 20-25 approximately 35-50) Profound IQ below 20-25 Self- help Skills Feeds and dresses self and cares for own toilet needs Requires training but can learn self- help skills No skills, but some can care for personal needs on limited basis Speech and Communication Receptive and expressive language is adequate, understands communication Receptive and expressive language is adequate but has speech problems Receptive language is limited; expressive language is poor Academics Optimal learning environment: third to sixth grade Few academic skills: first or second grade maximum No academic skills Social Skills Has friends , can learn to adjust quickly Capable of making friends has difficulty in social situations Not capable of social interactions Vocational Adjustment Can hold job –unskilled work Can work in sheltered work environment under supervision Generally no employment Adult Living Usually marries, has children . No marriage, dependent No marriage completely dependent

39. Specific Learning Disorder Individuals experience difficulty in perceiving or processing information efficiently and accurately It gets manifested during early school years and the individual encounters problems in basic skills in reading, writing or mathematics The affected child tends to perform below average for his/ her age However with additional inputs and efforts the individuals will be able to reach acceptable performance levels Specific learning disorder is likely to impair functioning and performance in activities / occupations dependant on related skills

40. 10. Disruptive, Impulse- Control a nd Conduct Disorder The disorders included under the category are O ppositional defiant disorder C onduct disorder Oppositional D efiant D isorder : Children with ODD display age inappropriate a mounts of stubbornness, irritable , defiant, disobedient and behave in a hostile manner Individuals with ODD will not see themselves as angry, oppositional or defiant and often justify their behaviour as reactions to circumstances or demands The symptoms of the disorder become entangled with the problematic interactions with others Oppositional Defiant Disorder

41. 2) Conduct disorders and antisocial behaviour refer to age inappropriate actions and attitudes that violate family expectation societal norms and the personal or property rights of others Symptoms of C onduct D isorder : 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 D ifferent types of aggressive behaviour shown by Children: Verbal aggression- name calling, swearing Physical aggression- hitting, fighting Hostile aggression- directed at inflicting injury to others Proactive aggression- dominating and bullying others without provocation 10. Disruptive, Impulse- Control a nd Conduct Disorder

42. 11. Feeding And Eating Disorders Disorders included in this category are Anorexia nervosa Bulimia nervosa Binge eating Anorexia N ervosa : The individual has a distorted body image that leads him/her to see herself as overweight Symptoms : Refusing to eat Exercising compulsively Developing unusual habits such as refusing to eat in front of others Starve to death Person with anorexia may loose large amounts of weight ANOREXIA NERVOSA

43. Bulimia N ervosa : T h e i n d i v i d u a l m a y e a t e xce ss i v e a m o un t s o f foo d, t he n p u r ge t h e food by using medicines such as laxatives or diuretics or by vomiting The person often feels disgusted and ashamed when he/she binges and is relieved of tension and negative emotions after purging Bing e E ating : In this condition there are frequent episodes of out of control eating The individual tends to eat at a higher speed than normal and continuous eating till she feels uncomfortably full Large amounts of food may be eaten even when the individual is not h ungry 11. Feeding And Eating Disorders

44. 12. Substance- Related a nd Addictive Disorders Disorders related to maladaptive behaviours resulting from regular and consistent use of the substance involved are included under substance related and addictive disorders These disorders include problems associated with the use and abuse of alcohol, cocaine, tobacco and opioids among others , which alter the way people think, feel and behave Commonly abused substances ( DSM- 5 ) Alcohol Stimulants : Cocaine, D extroamphetimines Caffeine : C offee, Tea, Analgesics, Chocolate, Cocoa Cannabis : M arijuana Hallucinogens : LSD Opioid : M orphine, Heroin Tobacco : C igarettes, B idi

45. A l co h o l People who abuse alcohol drink large amounts regularly and rely on it to help them face difficult situations. Eventually , drinking interferes with their social behaviour and ability to think & work Tolerance : T heir bodies build up a tolerance for alcohol and they need to drink even greater amounts to feel its effects Withdrawal : they also experience withdrawal symptoms when they stop drinking alcoholism affects families, social relationships and careers and intoxicated drivers are responsible for road accidents Children of persons with this disorder suffer from psychological disorders such as anxiety, depression, phobias, and substance abuse disorders Excessive drinking results in serious damage to physical health

46. Effects of Alcohol Ethyl alcohol in alcoholic beverages is absorbed into the blood and carried into the central nervous system where it depresses those areas of brain that controls judgement and inhibition. People become more talkative, friendly and they feel more confident and happy. People who consume alcohol suffer from memory falters, difficulty in making sound judgements, speech becomes less careful and less clear, emotional , loud and aggressive. Motor difficulties increase- people become unsteady when they walk and clumsy in performing simple activities, vision become blurred and have trouble in hearing, they have difficulty in driving and solving simple problems.

47. H e r o i n 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 centers in the brain almost paralysing breathing and in many cases death

48. Coc a i n e Regular use of cocaine may lead to a pattern of abuse in which the person may be intoxicated through out the day and function poorly in social relationships and at work. Problems in Short term memory and attention will be present Dependence may develop so that the cocaine dominates the persons life , more of the drug is needed to get the desired effects and stopping it results in feelings of depression, fatigue , sleep problems , irritabilit y and anxiety. Cocaine poses serious effects on psychological functioning and physical well being

49. “Mental Illness is not a CHOICE But RECOVERY is”