Chapter 4 Psychological Disorders

Introduction

Psychological disorders, also known as mental disorders, represent deviations from normal adaptive functioning that cause unhappiness, discomfort, anxiety, and unrealized potential. These conditions have intrigued cultures for millennia, often shrouded in superstition and fear. However, the study of abnormal psychology focuses on understanding the causes, consequences, and treatments of maladaptive behaviors.

While individuals may experience temporary distress in response to life's challenges, psychological disorders involve more extreme and persistent reactions that hinder a person's ability to adapt and function constructively. This chapter aims to explore what goes wrong in the development of psychological problems, the factors contributing to abnormal behavior, and the signs and symptoms associated with various psychological disorders.

Activity 4.1 encourages students to interview people about their understanding of mental illness, its causes, and potential treatments, fostering a discussion on common perceptions and labeling of abnormal behavior.

Concepts Of Abnormality And Psychological Disorders

Defining abnormality is complex, with no single universally accepted definition. However, most definitions incorporate the "four Ds": deviance (statistical rarity, differing from norms), distress (unpleasantness and suffering), dysfunction (interference with daily activities), and sometimes danger (to self or others).

Two main perspectives exist regarding abnormality:

• Deviation from Social Norms: This view defines abnormality as behavior that deviates from societal expectations and norms. What is considered abnormal varies across cultures and can change over time. However, this perspective is criticized for equating normality solely with conformity.
• Maladaptive Behavior: This perspective defines abnormality based on whether behavior fosters individual well-being and growth. Behavior that interferes with optimal functioning and self-fulfillment is considered maladaptive, even if it conforms to social norms.

Historically, explanations for psychological disorders have ranged from supernatural beliefs (evil spirits) to biological factors (brain dysfunction) and psychological factors (inadequate thinking, feeling, or perception). The current understanding often integrates these perspectives into a bio-psycho-social model.

Activity 4.2 prompts students to identify behaviors that are considered abnormal in general but might be normal in specific contexts, illustrating the influence of situation and social norms.

Historical Background

Throughout history, views on psychological disorders have evolved:

• Ancient Beliefs: Supernatural and magical forces (evil spirits) were often blamed, with treatments like exorcism.
• Biological/Organic Approach: Emphasized bodily and brain dysfunctions as causes. Hippocrates, Plato, and Galen in ancient Greece linked humors to temperaments and disorders.
• Psychological Approach: Focused on thoughts, feelings, and perceptions. Johann Weyer in the Renaissance highlighted psychological conflict and disturbed relationships.
• Middle Ages: Demonology and superstition resurged, though figures like St. Augustine emphasized psychological anguish.
• Renaissance and Enlightenment: A shift towards scientific methods and humanism led to reforms in treatment and a move towards deinstitutionalization and community care.
• Modern Era: The bio-psycho-social model integrates biological, psychological, and social factors as crucial influences on psychological disorders.

Classification Of Psychological Disorders

Classification systems for psychological disorders, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) by the American Psychiatric Association and the ICD-10 Classification of Behavioural and Mental Disorders by the World Health Organisation (WHO), provide standardized criteria for identifying and categorizing disorders. These classifications are essential for communication among professionals, understanding causes, and guiding treatment.

Activity 4.3 asks students to reflect on their own emotional experiences during stressful periods like examinations, comparing them to typical stress symptoms.

Factors Underlying Abnormal Behaviour

Understanding abnormal behavior involves considering various models that emphasize different causal factors:

• Biological Factors: Include genetic predispositions, biochemical imbalances, malnutrition, injuries, and problems with neurotransmitter transmission (e.g., low GABA in anxiety, excess dopamine in schizophrenia, low serotonin in depression). While biological factors are significant, they rarely act alone and often interact with other factors.
• Psychological Factors: Emphasize the role of experiences and mental processes. These include:
  • Psychodynamic Model: Abnormal behavior stems from unconscious conflicts, often originating in early childhood, involving the id, ego, and superego.
  • Behavioral Model: Focuses on learned maladaptive behaviors through conditioning (classical, operant, social learning).
  • Cognitive Model: Attributes abnormal functioning to irrational thoughts, beliefs, and cognitive distortions.
  • Humanistic-Existential Model: Highlights issues related to self-actualization, freedom, and finding meaning in life.
• Socio-cultural Factors: Consider the influence of societal pressures, family structures, social networks, and societal labels. Factors like war, discrimination, economic hardship, and labels like "mentally ill" can contribute to or exacerbate psychological problems.
• Diathesis-Stress Model: Proposes that disorders develop when a biological predisposition (diathesis) is triggered by stressful life events (stressors). This model acknowledges the interplay of vulnerability and environmental challenges.

Major Psychological Disorders

Psychological disorders encompass a wide range of conditions affecting thoughts, emotions, and behaviors. They are typically categorized based on symptom clusters and etiological factors.

Anxiety Disorders

Characterized by excessive and often irrational fear and apprehension. They include:

• Generalized Anxiety Disorder (GAD): Prolonged, vague, unexplained fear and worry about the future, accompanied by restlessness and physical tension.
• Panic Disorder: Recurrent, intense panic attacks with overwhelming terror and physical symptoms like rapid heart rate, shortness of breath, and dizziness, often occurring unpredictably.
• Phobias: Irrational fears of specific objects, situations, or social interactions. These are categorized into specific phobias (e.g., animals, enclosed spaces), social phobias (fear of social situations), and agoraphobia (fear of unfamiliar situations, often leading to avoidance of leaving home).
• Separation Anxiety Disorder (SAD): Developmentally inappropriate fear and anxiety about separation from attachment figures.

Table 4.1 summarizes major anxiety disorders and their symptoms. Activity 4.3 relates to the experience of examination anxiety.

Obsessive-Compulsive and Related Disorders

Characterized by persistent, unwanted ideas (obsessions) and/or repetitive, ritualistic behaviors (compulsions) that interfere with daily functioning. Examples include excessive handwashing, counting, or checking.

Trauma- and Stressor-Related Disorders

Develop in response to significant trauma or stress. Examples include Post-Traumatic Stress Disorder (PTSD), characterized by flashbacks, nightmares, and emotional numbing after a traumatic event, as well as Adjustment Disorders and Acute Stress Disorder.

Somatic Symptom and Related Disorders

Involve physical symptoms that have no apparent medical cause, often stemming from psychological distress. These include:

• Somatic Symptom Disorder: Persistent body-related complaints and excessive worry about health, leading to significant distress and life disruption.
• Illness Anxiety Disorder: Preoccupation with the possibility of developing a serious illness, often accompanied by health-related anxiety and resistance to medical reassurance.
• Conversion Disorders: Reported loss or impairment of bodily functions (e.g., paralysis, blindness) following a stressful event.

Box 4.1 highlights salient features of these disorders.

Dissociative Disorders

Involve a disruption in consciousness, memory, identity, emotion, perception, or behavior. Key features include feelings of unreality and detachment. Examples include:

• Dissociative Amnesia: Selective memory loss for personal information, often following stress or trauma. Dissociative fugue involves unexpected travel and assuming a new identity.
• Dissociative Identity Disorder (Multiple Personality): The presence of two or more distinct personality states that recurrently take control of behavior.
• Depersonalisation/Derealisation Disorder: A feeling of being detached from oneself or reality, experiencing a sense of unreality.

Box 4.1 also outlines key features of dissociative disorders.

Depressive Disorders

Characterized by persistent sadness, loss of interest or pleasure, and other mood and behavioral changes. Major Depressive Disorder involves depressed mood, changes in appetite and sleep, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and sometimes suicidal thoughts. Risk factors include genetics, age, gender, negative life events, and lack of social support.

Activity 4.4 encourages students to recall and compare personal experiences of sadness and depression.

Bipolar and Related Disorders

Characterized by extreme mood swings, including manic episodes (elevated mood, energy, and activity) and depressive episodes. Bipolar I Disorder involves both manic and depressive episodes, while Bipolar II Disorder involves hypomanic (less severe manic) and depressive episodes.

The chapter also touches upon the issue of suicide, its risk factors, and preventative measures suggested by the WHO. It emphasizes early identification and support for individuals in distress.

Activity 4.5 asks students to identify types of delusions portrayed by characters in media and relate them to diagnostic criteria.

Schizophrenia Spectrum and Other Psychotic Disorders

A group of severe disorders characterized by disturbances in thought processes, perception, emotional responsiveness, and social functioning. Key symptoms include:

• Positive Symptoms: Delusions (false beliefs), hallucinations (perceiving things without external stimuli, often auditory), disorganized thinking and speech (loosening of associations, neologisms), and inappropriate affect (unsuited emotions).
• Negative Symptoms: Deficits in behavior, such as alogia (poverty of speech), blunted or flat affect (reduced emotional expression), avolition (lack of motivation), and social withdrawal.
• Psychomotor Symptoms: Abnormalities in movement, including catatonia (marked decrease in reactivity to the environment).

Neurodevelopmental Disorders

These disorders manifest early in development and affect personal, social, academic, or occupational functioning. They are characterized by deficits or excesses in behavior or delays in achieving age-appropriate milestones. Examples include:

• Attention-Deficit/Hyperactivity Disorder (ADHD): Marked by inattention (difficulty concentrating, following instructions) and/or hyperactivity-impulsivity (excessive movement, difficulty controlling impulses).
• Autism Spectrum Disorder: Characterized by significant impairments in social interaction, communication skills, and restricted, repetitive patterns of behavior and interests.
• Intellectual Disability: Defined by below-average intellectual functioning (IQ approx. 70 or below) and deficits in adaptive behavior (communication, self-care, social skills) that manifest before age 18. Table 4.2 details characteristics of different levels of intellectual disability.
• Specific Learning Disorder: Difficulties in processing information efficiently, impacting reading, writing, or mathematics skills.

Disruptive, Impulse-Control and Conduct Disorders

These involve conduct problems and difficulties with self-control. Examples include Oppositional Defiant Disorder (ODD), characterized by defiant and hostile behavior towards authority, and Conduct Disorder, involving aggression towards people or animals, destruction of property, deceitfulness, or rule violations.

Feeding and Eating Disorders

Conditions related to disordered eating patterns and body image. Major types include:

• Anorexia Nervosa: Characterized by a distorted body image, intense fear of gaining weight, and severe restriction of food intake, often leading to starvation.
• Bulimia Nervosa: Involves recurrent episodes of binge eating followed by compensatory behaviors like purging (vomiting, laxative use).
• Binge Eating Disorder: Frequent episodes of eating large amounts of food rapidly, often feeling uncomfortably full, with associated guilt but without compensatory behaviors.

Substance - Related and Addictive Disorders

These disorders arise from the regular and consistent use of substances that alter mood, cognition, and behavior. They include problems related to alcohol, stimulants (cocaine), cannabis, opioids (heroin), hallucinogens, and tobacco, among others. Dependence involves tolerance and withdrawal symptoms. Abuse can lead to severe physical and psychological damage, social dysfunction, and overdose.

Box 4.2: Effects of Alcohol lists some of the physiological and psychological impacts of alcohol consumption. Box 4.3 provides a list of commonly abused substances.