ALAGAPPA UNIVERSITY

[Accredited with ‘A+’ Grade by NAAC (CGPA:3.64) in the Third Cycle

and Graded as Category–I University by MHRD-UGC]
(A State University Established by the Government of Tamil Nadu)
KARAIKUDI – 630 003

Directorate of Distance Education

M.Sc. (Psychology)
IV - Semester
363 41

ABNORMAL PSYCHOLOGY
Mrs. Leema Thomas, Visiting Psychologist, Alagappa University Health Care Centre, Alagappa Puram,
Karaikudi - 630003
 CONTENTS
UNIT 1 INTRODUCTION AND THEORITICAL PERSPECTIVES
OF ABNORMAL BEHAVIOUR 1-11
1.1 Introduction
1.2 Objectives
1.3 Definition of Abnormality
1.4 Classification System
1.5 Causes and Risk Factors
1.5.1 Biological Factors
1.5.2 Psychological Factors
1.5.3 Socio Cultural Factors
1.6 Let’s Sum Up
1.7 Unit End Exercise
1.8 Answers for Check Your Progress
1.9 Suggested Readings

UNIT 2 NORMALITY & ABNORMALITY 12-22

2.1 Introduction
2.2 Objectives
2.3 Concept of Normality
2.4 Mental health
2.5 Jahoda’s Positive Mental Health
2.6 Gordon Allport Mature Personality
2.7 Defining Abnormality
2.8 Let’s Sum Up
2.9 Unit End Exercise
2.10 Answers for Check Your Progress
2.11 Suggested Readings

UNIT 3 WAYS OF THINKING ABOUT ABNORMAL BEHAVIOUR 23-35

3.1 Introduction
3.2 Objectives
3.3 Conception of Abnormal Behavior
3.4 Multidimensional Models
3.4.1 Biological Model
3.4.2 Psychological Model
3.4.3 Socio Cultural Model
3.4.4 Bio-psychosocial Model
3.5 Clinical Assessment
3.6 Goals of Assessment
 3.7 Properties of Assessment Instruments
3.8 Assessment Instruments
3.8.1 Clinical Interviews
3.8.2 Psychological Testing.
3.8.3 Behavioral Assessments
3.9 Classification of Abnormal Behavior
3.10 Lets Sum Up
3.11 Unit End Exercise
3.12 Answers for Check Your Progress
3.13 Suggested Readings

UNIT 4 DISORDERS OF CHILDHOOD & ADOLESCENCE 36-46

4.1 Introduction
4.2 Objectives
4.3 Intellectual Disability
4.3.1 Diagnostic Criteria
4.3.2 Causes
4.3.3 Treatment
4.4 Autism Spectrum Disorder
4.4.1 Diagnostic Criteria
4.4.2 Features of Autism
4.4.3 Causes
4.4.4 Treatment
4.5 Lets Sum Up
4.6 Unit End Exercise
4.7 Answers for Check Your Progress
4.8 Suggested Readings

UNIT 5 ANXIETY RELATED DISORDER 47-60

5.1 Introduction
5.2 Objectives
5.3 Anxiety
5.3.1 Symptoms
5.3.2 Causes
5.3.3 Panic Disorder
5.3.4 Generalized Anxiety Disorder
5.3.5 Social Phobia
5.3.6 Specific Phobia
5.3.7 Obsessive Compulsive Disorder
5.3.8 Post Traumatic Stress Disorder
5.4 Somatoform Disorder
5.4.1 Common Factors
5.4.2 Somatization Disorder
5.4.3 Undifferntiated Somatoform Disorder
 5.4.4 Conversion Disorder
5.4.5 Pain Disorder
5.4.6 Hypochondriasis
5.4.7 Body Dysmorphic Disorder
5.5 Mood Disorder
5.5.1 Major Depressive Disorder
5.5.2 Dysthemia
5.5.3 Bipolar Disorder
5.5.4 Cyclothymic Disorder
5.6 Let’s Sum Up
5.7 Unit End Exercise
5.8 Answers for Check Your Progress
5.9 Suggested Readings
UNIT 6 PSYCHOSIS: PERSONALITY AND DEVELOPMENTAL
DISORDER 61-71
6.1 Introduction
6.2 Objectives
6.3 Personality disorder
6.3.1 Symptoms
6.3.2 Cluster A personality Disorder
6.3.3 Cluster B personality Disorder
6.3.4 Cluster C personality Disorder
6.4 Cognitive Disorder
6.4.1 Symptoms
6.4.2 Types of cognitive disorder
6.5 Developmental disorder
6.5.1 Symptoms
6.5.2 Types of Developmental Disorder
6.6 Let’s Sum Up
6.7 Unit End Exercise
6.8 Answers for Check Your Progress
6.9 Suggested Readings

UNIT 7 THE CONSUMER DECISION MAKING PROCESS 72-87

7.1 Introduction
7.2 Objective
7.3 Decision Making
7.3.1 Steps of Decision Making
7.3.2 Decision Environment
7.3.3 Types of Decision
7.3.4 Decision Making Model
7.4 Communication Process
7.4.1 Non Verbal Communication
7.4.2 Communication Barriers
 7.5 Leadership
7.5.1 Types of Leadership
7.5.2 Importance of Leadership
7.6 Let’s Sum Up
7.7 Unit end Exercise
7.8 Answer for Check Your Progress
7.9 Suggested Reading

UNIT 8 MOOD DISORDER, SCHIZOPHRENIA AND OTHER PSYCHOTIC

DISORDER 88-106
8.1 Introduction
8.2 Objectives
8.3 Mood Disorder
8.3.1 Depressive Disorder
8.3.2 Causes
8.3.3 Treatment
8.4 Bipolar Disorder
8.4.1 Causes
8.4.2 Treatment
8.5 Cyclothymic Disorder
8.6 Schizophrenia
8.6.1 Symptoms
8.6.2 Causes
8.6.3 Treatment
8.7 Other Schizophrenic Spectrum Disorder
8.7.1 Brief Psychotic Disorder
8.7.2 Schizo Affective Disorder
8.7.3 Shared Psychotic Disorder
8.8 Let’s Sum Up
8.9 Unit End Exercise
8.10 Answers for Check Your Progress
8.11 Suggested Readings

UNIT 9 DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR 107-138

9.1 Introduction
9.2 Objectives
9.3 Eating Disorder
9.3.1 Anorexia Nervosa
9.3.2 Bulimia Nervosa
9.4 Sleeping Disorder
9.4.1 Primary Insomnia
9.4.2 Hypersomnia
 9.4.3 Narcolepsy
9.4.4 Treatment
9.5 Personality Disorder
9.5.1 Cluster A Personality Disorder
9.5.2 Cluster B Personality Disorder
9.5.3 Cluster C Personality Disorder
9.5.4 Causes
9.5.5 Treatment
9.6 Impulse Control Disorder
9.6.1 Kleptomania
9.6.2 Intermittent Explosive Disorder
9.6.3 Pyromania
9.7 Sexual and Gender Identity Disorder
9.7.1 Disorder of Desire
9.7.2 Disorder of Excitement
9.7.3 Disorder of Orgasm
9.7.4 Disorder of Pain
9.8 Gender Identity Disorder
9.9 Let’s Sum Ip
9.10 Unit End Exercise
9.11 Answers for Check Your Progress
9.12 Suggested Readings
UNIT 10 CLASSIFICATION OF MENTAL DISORDER AND
ORGANIC MENTAL DISORDERS 139-151
10.1 Introduction
10.2 Objectives
10.3 History of Classifications
10.4 Dementia
10.4.1 Symptoms
10.4.2 Causes
10.5 Specific Disorders Associated with Dementia
10.5.1 Alzheimer
10.5.2 Huntington’s Disease
10.5.3 Parkinson Disease
10.5.4 Causes
10.6 Delirium
10.6.1 Symptoms
10.6.2 Causes
10.7 Amnestic Disorder
10.8 Treatment
10.8.1 Medication
10.8.2 Environment & Behavioral Management
10.8.3 Support for Caregivers
 10.9 Let’s Sum Up
10.10 Unit End Exercise
10.11 Answers for Check Your Progress
10.12 Suggested Readings

UNIT 11 STRESS RELATED AND SOMATOFORM DISORDERS 152-168

11.1 Introduction
11.2 Objectives
11.3 Definition of Stress
11.4 Psycho Physiological Response
11.5 Panic Disorder
11.5.1 Biological Factor
11.5.2 Cognitive Factor
11.5.3 Treatment
11.6 Phobic Disorder
11.6.1 Biological Factor
11.6.2 Cognitive Factor
11.6.3 Treatment
11.7 Generalized Anxiety Disorder
11.7.1 Cognitive Factor
11.7.2 Treatment
11.8 Obsession Compulsive Disorder
11.8.1 Causes
11.8.2 Treatment
11.9 Somatic Disorder
11.9.1 Body Dysmorphic Disorder
11.9.2 Somatic Disorder
11.9.3 Hypochondrias
11.9.4 Convention Disorder
11.10 Let’s Sum Up
11.11 Unit End Exercise
11.12 Answers for Check Your Progress
11.13 Suggested Readings

UNIT 12 ADDITIVE DISORDERS 169-181

12.1 Introduction
12.2 Objectives
12.3 Substance used Disorder
12.4 Alcohol
12.5 Nicotine
12.6 Amphetamine and Cocaine
12.7 Opiates
 12.8 Cannabis
12.9 Hallucinogens Related Drugs
12.10 Causes of Drug Abuse
12.10.1 Social Factors
12.10. Biological Factors
12.10.3 Psychological Factors
12.11 Treatment
12.11.1 Detoxification
12.11.2 Medications during Remission
12.11.3 Alcoholic Anonymous
12.11.4 Cognitive Behavior Therapy
12.11.5 Coping Skill Training
12.12 Let’s Sum Up
12.13 Unit End Exercise
12.14 Answers for Check Your Progress
12.15 Suggested Readings

UNIT 13 CAUSES AND RISK FACTORS FOR ABNORMAL

BEHAVIOUR 182-197
13.1 Introduction
13.2 Objectives
13.3 Causes and Risk Factor for Abnormal Behavior
13.4 Diathesis-Stress Model
13.5 Biological Causal Factor
13.5.1 Imbalance of Neurotransmitter
13.5.2 Hormonal Imbalance
13.5.3 Genetic Vulnerabilities
13.5.4 Temperament
13.5.5 Brain Dysfunction and Neural Plasticity
13.6 Psychological Causal Factors
13.6.1 Early Deprivation or Trauma
13.6.2 Inadequate Parenting Style
13.6.3 Marital Discord
13.6.4 Maladaptive Peer Relationship
13.7 Socio cultural Factor
13.7.1 Low Socio Economic Status and Unemployment
13.7.2 Prejudice, Gender Discrimination
13.7.3 Social Change and Uncertainty
13.8 Let’s Sum Up
13.9 Unit End Exercise
13.10 Answers for Check Your Progress
13.11 Suggested Readings

UNIT 14 ADJUSTMENT DISORDER 198-206

14.1 Introduction
14.2 Objectives
14.3 Meaning of Stress
 14.4 General Adaptation Syndrome
14.5 Adjustment Disorder
14.5.1 Acute Stress Disorder
14.5.2 Post traumatic Stress Disorder
14.6 Causes
14.7 Treatment
14.8 Let’s Sum Up
14.9 Unit End Exercise
14.10 Answers for Check Your Progress
14.11 Suggested Readings
UNIT -1
INTRODUCTION AND THEORITICAL PERSPECTAIVES OF
ABNORMAL BEHAVIOUR
Structure
1.1 Introduction
1.2 Objectives
1.3 Definition of abnormality
1.4 Classification system
1.5 Causes and risk factors
1.5.1 Biological factors
1.5.2 Psychological factors
1.5.3 Socio cultural factors
1.6 Let’s Sum Up
1.7 Unit End Exercise
1.8 Answers for check your progress
1.9 Suggested Readings

1.1 INTRODUCTION
You may witnessed a man with shabby and ugly look with lot of
garages in his hand, talking and laughing to himself and roam around the
place. You may wonder why he behaving like this? What happened to
him? Is he normal? Then you come to the conclusion that he is
abnormal. In this lesson, we explore the lives of people with troubling
psychological symptoms to understand how they think, what they feel,
and how they behave. We investigate what is known about the causes of
these symptoms and the appropriate treatments for them. The
psychology branch which deals with mental disorder is called as
Abnormal Psychology. Abnormal psychology has implications for all of
1
us. Everyone has feelings, thoughts, and behaviors, and occasionally
these become troublesome for us or for someone we know.
1.2 Objectives
After completion this unit, you will be able to understand the following
concept
 Definition of abnormality
 Classification of mental disorder
 Causes for abnormal behavior

1.3 DEFINING ABNORMALITY

Abnormal psychology is the scientific study of troublesome
feelings, thoughts, and behaviors associated with mental disorders. This
area of science is designed to evaluate, understand, predict, and prevent
mental disorders and help those who are in distress.
There is still no universal agreement about what is meant by
abnormality or disorder. This is not to say we do not have definitions;
we do. However, a truly satisfactory definition will probably why does
the definition of a mental disorder present so many challenges? A major
problem is that there is no one behavior that makes someone abnormal.
However, there no single indicator is sufficient to define or determine
abnormality. Nonetheless, the more that someone has difficulties in the
following

1. Suffering: If people suffer or experience psychological pain we are

inclined to consider this as indicative of abnormality. Depressed people
clearly suffer, as do people with anxiety disorders.

2. Maladaptiveness: Maladaptive behavior is often an indicator of

abnormality. The person with depression may withdraw from friends
and family and may be unable to work for weeks or months.
Maladaptive behavior interferes with our wellbeing and with our ability
to enjoy our work and our relationships. However, not all disorders
involve maladaptive behavior
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3. Statistical Deviancy: The word abnormal literally means “away from
the normal.” But simply considering statistically rare behavior to be
abnormal does not provide us with a solution to our problem
of defining abnormality. Genius is statistically rare, as is perfect pitch.
However, we do not consider people with such uncommon talents to be
abnormal in any way. Also, just because something is statistically
common

4. Violation of the Standards of Society: All cultures have rules. Some

of these are formalized as laws. Others form the norms and moral
standards that we are taught to follow. Although many social rules are
arbitrary to some extent, when people fail to follow the conventional
social and moral rules of their cultural group we may consider their
behavior abnormal. For example, wearing bikhini is considered
abnormal in India but it is very common in Europe.

5. Social Discomfort: When someone violates a social rule, those

around him or her may experience a sense of discomfort or unease. how
do you feel when someone you met only 4 minutes ago begins to chat
about her suicide attempt? Unless you are a therapist you would
probably consider this an example
of abnormal behavior.

6. Irrationality and Unpredictability: we expect people to behave in

certain ways. Although a little unconventionality may add some spice to
life, there is a point at which we are likely to consider a given
unorthodox behavior abnormal. If a person sitting next to you suddenly
began to scream and yell obscenities at nothing, you would probably
regard that behavior as abnormal.

One final point bears repeating. Decisions about abnormal behavior

always involve social judgments and are based on the values and
expectations of society at large. This means that culture plays a role in
determining what is and is not abnormal
3
The DSM-5 Definition of Mental Disorder
Behavioral or psychological syndrome (or pattern) that is present
in an individual and that reflects some kind of underlying
psychobiological dysfunction. Importantly, this behavioral syndrome
should result in clinically significant distress, disability, or impairment
in key areas of functioning. Predictable responses to common stressors
or losses (such as death of a loved one) are excluded. It is also important
that this dysfunctional pattern of behavior not stem from social deviance
or conflicts that the person has with society as a whole.

Why Do We Need to Classify Mental Disorders?

At the most fundamental level, classification systems provide us
with a nomenclature (a naming system) and enable us to structure
information in a more helpful manner. Organizing information within a
classification system also allows us to study the different disorders that
we classify and therefore to learn more not only about what causes them
but also how they might best be treated. For this reason, APA and ICD
are used in psychology.

1.4 Classification systems

A classification system for abnormal behaviors aims to provide
distinct categories and indicators for atypical behaviors, thought
processes, and emotional disturbances. Psychiatric classification systems
are like a catalog: a detailed description accompanies each mental
disorder. Thus, the pattern of behavior associated with each diagnosis is
distinctly different. For example, the symptoms associated
Today, there are two major psychiatric classification systems in use: the
International Classification of Disease (ICD-10) system, published by
the World Health Organization, and the Diagnostic and Statistical
Manual of Mental Disorders (DSM), published by the American
Psychiatric Association. The ICD-10 system is widely used in Europe
and many other countries, whereas the DSM system is the standard guide
for the United States.

4
The Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
is a widely used classification system for psychiatric disorders. The
DSM lists all officially designated mental disorders and the
characteristics or symptoms needed to confirm a diagnosis. Diagnostic
criteria include physical, behavioral, and emotional characteristics
associated with a disorder. For all disorders, the symptoms must cause
significant distress or impairment in social, occupational, or other
important areas of functioning. The DSM is widely used in the United
States, another important classification system is the International
Classification of Disease (ICD). This system covers all health
conditions, including mental disorders. The World Health Organization
oversees the system.
All of the DSMs are based on the classification system Emil
Kraepelin developed around 1850. Kraepelin believed that mental
disorders were like physical disorders, each with a specific set of
symptoms. To add to the complexity, the number of identified
psychological disorders has increased dramatically over time DSM,
DSM-I, 1952: 106 mental disorders
DSM-II, 1968: 182 mental disorders
DSM-III, 1980: 265 mental disorders
DSM-III-R: 292 mental disorders
DSM-IV, 1994: 297 mental disorders
DSM-5, published in May 2013, did not significantly increase the
number of diagnostic categories, although some new disorders were
added.
Check your progress
1. What is Abnormal Psychology?
2. What is DSM?

1.5 Causes and Risk Factors for Abnormal Behavior

Central to the field of abnormal psychology are questions about
what causes people to experience mental distress and to behave
maladaptive. If we knew the causes for given disorders, we might be
able to prevent conditions that lead to them and perhaps reverse those
5
that maintain them. We could also classify and diagnose disorders better
if we clearly understood their causes rather than relying on clusters of
symptoms. Although understanding the causes of abnormal behavior is
clearly a desirable goal, it is enormously difficult to achieve because
human behavior is so complex.
Necessary, Sufficient, and Contributory Causes
Regardless of one’s theoretical perspective, several terms can be
used to specify the role a factor plays in the etiology, or causal pattern,
of abnormal behavior. A necessary cause (e.g., cause X) is a condition
that must exist for a disorder (e.g., disorder Y) to occur. For example,
general paresis (Y)—a degenerative brain disorder—cannot develop
unless a person has previously contracted syphilis (X)
A sufficient cause (e.g., cause X) of a disorder is a condition that
guarantees the occurrence of a disorder (e.g., disorder Y). For example,
one current theory hypothesizes that hopelessness (X) is a sufficient
cause of depression (Y).

A contributory cause (e.g., cause X) is one that increases the probability

of a disorder (e.g., disorder Y) developing but is neither necessary nor
sufficient for the disorder to occur. Or, more generally, if X occurs, then
the probability of occurring Y increases. For example, parental rejection
could increase the probability that a child will later have difficulty in
handling close personal relationships or could increase the probability
that being rejected in a relationship in adulthood will precipitate
depression.
Necessary Cause If Disorder Y occurs, then Cause X must have
preceded it.

Sufficient Cause If Cause X occurs, then Disorder Y will also occur.

Contributory Cause If X occurs, then the probability of Disorder Y

increases.

6
 A reinforcing contributory cause is a condition that tends to
maintain maladaptive behavior that is already occurring. An example is
the extra attention, sympathy, and relief from unwanted responsibility
that may come when a person is ill; these pleasant experiences may
unintentionally discourage recovery

1.5.1 BIOLOGICAL FACTORS

We will focus here on four categories of biological factors that
seem particularly relevant to the development of maladaptive behavior:
(1) neurotransmitter and hormonal abnormalities in the brain or other
parts of the central nervous system, (2) genetic vulnerabilities, (3)
temperament, and (4) brain dysfunction and neural plasticity. Each of
these categories encompasses a number of conditions that influence the
quality and functioning of our bodies and our behavior.

Imbalances of Neurotransmitters and Hormones

The imbalances in neurotransmitters in the brain can result in
abnormal behavior. There may be excessive production and release of
the neurotransmitter substance into the synapses, causing a functional
excess in levels of that neurotransmitter Hormones are chemical
messengers secreted by a set of endocrine glands in our bodies. Each of
the endocrine glands produces and releases its own set of hormones.

Genetic Vulnerabilities
Genes are the carriers of genetic information that we inherit from
our parents and other ancestors, and each gene exists in two or more
alternate forms called alleles. Although neither behavior nor mental
disorders are ever determined exclusively by genes, there is substantial
evidence that most mental disorders show at least some genetic
influence ranging from small to large genes can affect behavior only
indirectly. Gene “expression” is normally not a simple outcome of the
information encoded in DNA but is, rather, the end product of an
intricate process that may be influenced by the internal (e.g.,
intrauterine) and external environment.
7
Temperament
Temperament refers to a child’s reactivity and characteristic ways
of self-regulation. Our early temperament is thought to be the basis
from which our personality develops the temperament of an infant or
young child has profound effects on a variety of important
developmental processes (Fox et al., 2010; Rothbart et al., 2000). For
example, a child with a fearful temperament learns to fear social
situations.
Brain Dysfunction and Neural Plasticity
Brain lesions with observable defects in brain tissue are rarely a
primary cause of psychiatric disorders. neural plasticity—flexibility of
the brain in making changes in organization and function in response to
pre- and postnatal experiences, stress, diet, disease, drugs, maturation,
and so forth. Existing neural circuits can be modified, or new neural
circuits can be generated (e.g., Fox et al., 2010; Kolb et al., 2003). The
effects can be either beneficial or detrimental to the individual,
depending on the circumstances.
Check your progress
3. What is temperament?
4. What is neural plasticity?

1.5.2 PSYCHOLOGICAL CAUSAL FACTORS

Psychological factors make people vulnerable to disorder or that may
precipitate the disorder. Psychological factors are those developmental
influences—often unpredictable and uncontrollable negative events—
that may handicap a person psychologically, making him or her less
resourceful in coping with events. Four categories of psychological
causal factors that can each have important detrimental effects on a
child’s socio emotional development: (1) early deprivation or trauma,
(2) inadequate parenting styles, (3) marital discord and divorce, and (4)
maladaptive peer.

Early Deprivation or Trauma

Children who do not have the resources that are typically supplied
by parents or parental surrogates may be left with deep and sometimes
8
irreversible psychological scars. The resources range from food and
shelter to love and attention. Deprivation of such resources can occur in
several forms. The most severe manifestations of deprivation are usually
seen among abandoned or orphaned child relationships the consequences
of parental deprivation from several psychological viewpoints. Such
deprivation might result in fixation at the oral stage of psychosexual
development (Freud); it might interfere with the development of basic
trust (Erikson); it might retard the attainment of needed skills because of
a lack of available reinforcements (Skinner); or it might result in the
child’s acquiring dysfunctional schemas and self-schemas in which
relationships are represented as unstable, untrustworthy, and without
affection (Beck).
Neglect and abuse in the home
Parents can neglect a child in various ways—by physical neglect,
denial of love and affection, lack of interest in the child’s activities and
achievements, or failure to spend time with the child or to supervise his
or her activities Outright parental abuse (physical or sexual or both) of
children has been associated with many negative effects on their
emotional, intellectual, and physical development.
Separation
Children who undergo a number of such separations may develop an
insecure attachment. In addition, there can be longer-term effects of
early separation from one or both parents. For example, such separations
can cause an increased vulnerability to stressors in adulthood.

Inadequate Parenting Styles

Inadequate parenting styles can have profound effects on a child’s
subsequent ability to cope with life’s challenges and thus create
vulnerability to various forms of psychopathology.

Parental psychopathology
It has been found that parents who have various forms of
psychopathology (including schizophrenia, depression, antisocial
personality disorder, and alcohol abuse or dependence) tend to have one

9
or more children who are at heightened risk for a wide range of
developmental difficulties.

MARITAL DISCORD
Marital discord is likely to be frustrating, hurtful, and generally
damaging in its effects on both adults and their children. Divorce can
have traumatic effects on children, too. Feelings of insecurity and
rejection may be aggravated by conflicting loyalties and sometimes, by
the spoiling the children may receive while staying with one of the
parents. Not surprisingly, some children do develop serious maladaptive
responses.

1.5.3 SOCIOCULTURAL CAUSAL FACTORS CLOSE-U

There are many sources of pathogenic social influences. Some of
these stem from socioeconomic factors. Others stem from socio-cultural
factors regarding role expectations and from the destructive forces of
prejudice and discrimination.
Low Socioeconomic Status and Unemployment
The higher incidence of mental and physical disorders reported in
lower socio economic class. The strength of this inverse correlation
varies with different types of mental disorder, however. For example,
antisocial personality disorder is strongly related to socioeconomic
status (SES).
Prejudice and Discrimination in Race, Gender, and Ethnicity
Discrimination may serve as a stressor that threatens self-esteem, which
in turn increases psychological distress (e.g., Cassidy et al., 2004). A
recent study of Arab and Muslim Americans two years after the
bombing of the World Trade Center in New York found increased
psychological distress, lower levels of happiness, and increased health
problems in those who had experienced personal or familial prejudice,
discrimination, or violence since the World Trade Center disaster.
1.6 Let’s Sum Up
Abnormal psychology is the study of the symptoms and causes of
behavioral and mental disorders; the objectives are to describe, explain,
predict, and modify distressing emotions and behaviors. Four criteria are
10
used to determine and define abnormality: distress, deviance,
dysfunction, and dangerous. Cultural context and sociopolitical factors
can influence definitions of abnormality. Criteria used to define
normality or abnormality must be considered in light of community
standards, changes over time, cultural values, and sociopolitical
experience. Over the course of a year, approximately 25 percent of
adults in the United States experience a mental disorder.
1.7 Unit End Exercise
1. How do we differentiate between normal and abnormal behaviors?
2. What societal factors affect definitions of abnormality?
3. What were early explanations regarding the causes of mental
disorders?
4. What are some contemporary trends in abnormal psychology?
1.8Answers for check your progress
1. Abnormal psychology is the scientific study of troublesome feelings,
thoughts, and behaviors associated with mental disorders.
2. DSM means Diagnostic statistical manual for mental disorder
3. Temperament refers to a child’s reactivity and characteristic ways of
self-regulation.
4. Neural plasticity—flexibility of the brain in making changes in
organization and function in response to pre- and postnatal experiences,
stress, diet, disease, drugs, maturation, and so forth.
1.9 Suggested Readings
1. Davidson and Neal (1996). Abnormal psychology. Revised 6th
Edition, John Wiley sons
2. World Health Organization. (2008). ICD-10: International statistical
classification of diseases and related health problem (10th Rev. ed. ).
New York: Author.
3. American psychiatric Association.(2000). Diagnostic and statistical
manual of mental disorders (4thed., text revision). Washington, DC:
Author

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 Unit 2
NORMALITY & ABNORMALITY
Structure
2.1 Introduction
2.2 Objectives
2.3 Concept of normality
2.4 Mental health
2.5 Jahoda’s positive mental health
2.6 Gordon Allport mature personality
2.7 Defining abnormality
2.8 Let’s sum up
2.9 Unit End Exercise
2.10 Answers for check your progress
2.11 Suggested Readings
2.1 Introduction

Sometimes it’s fairly easy to identify behavior as abnormal, as

when someone is still deeply troubled by events that happened 40 years
ago or is feeling so hopeless that he or she cannot get out of bed. But
sometimes identifying behavior as abnormal is not clear-cut. Put simply,
abnormal means “away from normal,” but that is a circular definition.
By this standard, normal becomes the statistical average and any
deviation becomes “abnormal.” For example, if the average weight for a
woman living in India is 60 kgs, then women who weigh less than 40
kgs or more than 90 kgs deviate significantly from the average. Their
weight would be considered abnormally low or high. For abnormal
psychology, defining abnormal behavior as merely being away from
normal assumes that deviations on both sides of average are negative
and in need of alteration or intervention. This assumption is often
incorrect. Specifically, we must first ask whether simply being different
is abnormal.

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2.2 Objectives
After studying this unit you will be able to understand the following
concept
 Normality
 Abnormality
 Jahoda’s Positive mental health
 Allport mature personality

2.3 CONCEPT OF NORMALITY

The concept of normal is not an uncontroversial topic in

psychiatry. When one gives a patient diagnosis, one is describing
abnormal psychology or psychopathology and it implies that there is the
concept of normal. Hawker (2008), states that normal means standard,
usual, ordinary, conventional, expected, typical, common, regular,
unremarkable, of sound mind and compos mentis. Professor Nicholas
Dent, (Honderich, 1995), describes normative as the, “average or usual
level of attainment or performance for an individual or a group, or …
(as) a standard rule, principle used to judge or direct human conduct as
something to be complied with”.

Normal here is unimpaired mental functioning. The problem with

average mental functioning is that the very high IQ is something that
most people would regard as very desirable, is not average or normal.
Normal is therefore not always a desirable state.

Sigmund Freud and the Normal/Abnormal:

Freud (1901), points out that, “normal forgetting takes place by

way of condensation”. There’s no evidence for this. Later in 1905,
Freud states that, “a periodic oscillation between a normal and an
inverted sexual object has also sometimes been observed. Those cases
are of particular interest in which the libido changes over to an inverted
sexual object after a distressing experience with a normal one”. Later in
1907, Freud pointed out that, “The fact is that we must put sexual
13
repression as an internal factor alongside such external factors as
limitation of freedom, inaccessibility of a normal sexual object, the
dangers of the normal sexual act, etc., which bring about perversions in
persons who might perhaps otherwise have remained normal”, and that,
“inversions [can] found in people who exhibit no other serious
deviations from the norm”.

In discussing normal, the major difficulty comes between

normality and people with mild abnormalities. Moderate and severe
abnormalities are real enough. It’s on the borderline between normal
and mild where the major difficulties occur and still occur in psychiatry.
This boundary is and is likely to remain blurred. Psychiatry has
seriously lowered the diagnostic threshold, and this is where so many of
its current problems have come from. Another definition of a person
whose normal mentally would be a person who doesn’t need to see a
psychiatrist but that begs the question and is not suffering abnormal
levels of psychological pain, or causing pain to his family or society.
Check your Progress

1. What is Normality?

2.4 MENTAL HEALTH

Mental health can affect daily living, relationships and physical

health. Looking after mental health can preserve a person’s ability to
enjoy life. Doing this involves reaching a balance between life activities,
responsibilities, and efforts to achieve psychological resilience.
Conditions such as stress, depression, and anxiety can all affect mental
health and disrupt a person’s routine. Although the term mental health is
in common use, many conditions that doctors recognize as psychological
disorders have physical roots.

14
 According to the World Health Organization (WHO):

“Mental health is a state of well-being in which an individual realizes his

or her own abilities, can cope with the normal stresses of life, can work
productively, and is able to make a contribution to his or her
community.”

The WHO stress that mental health is “more than just the absence
of mental disorders or disabilities.” Peak mental health is about not only
avoiding active conditions but also looking after ongoing wellness and
happiness. They also emphasize that preserving and restoring mental
health is crucial on an individual basis, as well as throughout different
communities and societies the world over. In 2017, an estimated 11.2
million adults in India, or about 4.5% of adults, had a severe
psychological condition, according to the National Institute of Mental
Health (NIMH).

Check your Progress

2. What is mental health?

2.5 JAHODA’S POSITIVE MENTAL HEALTH

Marie jahoda published a book on 1985. This book is used for the
study & a great source for defining characteristics of mental health.
Jahoda wants her discussion to lead first to description of various type of
human behaviors called mentally healthy. When discussing criteria of
healthy Jahoda starts by dismissing three common suggestions of
sufficient & necessary criteria of positive mental health.(1)the absence
of disease (2)statistical normality (3)well being.

Jahoda argues that we can’t define the mental health as the absence
of mental disease. She gives three reasons for this.

15
 First, it is not possible to find physiological causes for mental
disease. Second: there are cultural differences as to what to be
considered mental disease. However there are people who have tried to
give universal criteria for mental disease.

In psychoanalytic theory, disease is seen as the expression of

conflicts in unconscious and it is debatable. Jahoda concludes defining
the positive mental health as the absence of mental disease is for this
reason difficult. The Third reason Jahoda finds that there is no
continuing between health and disease. One indicator of this is that we
sometimes talk about diseased person as having health. Jahoda
concludes the opposite view that the absence of disease might after all,
be necessary requirement for health.

The First reason Jahoda suggested about the positive attitude

towards the self as individual feels happy with themselves

The Second reason Jahoda suggested about the autonomy states

about having the independence & self- reliance, that is not depending on
others.

The Third reason Jahoda suggested about the environmental

mastery. A person can adopt to any new situation & feels free is all
position of life.

The fourth reason Jahoda suggested about the resistance to stress.

In any stressed situation the person can handle the situation completely.

The Fifth reason Jahoda suggested about the accurate perception of

reality. The situation is how the individual sees the world around them

The sixth reason Jahoda suggested about the self- actualization.

The situation you feels that you have become the best you can be in a
state of contentment. Jahoda stated that the individual should experience

16
all these optimum mental health and if someone not fulfilled, the person
will experience difficulties.

2.6 GORDON ALLPORT’S; THE MATURE PERSON

Allport believed healthy individuals function on a rational and

conscious level, aware and in control of the forces that guide them.
Allport only studied mature, healthy adults and had little to say about
neurotics, hence, his system is truly health oriented. In fact he believed
the healthy person’s life could be grim with pain and sorrow. To this
end, Allport (1955) wrote: “Salvation comes only to him who
ceaselessly bestirs himself in the pursuit of objectives that in the end are
not fully attained.

Allport’s theory of motivation of the healthy personality also includes

the principle of mastery and competence which proposes that mature.
The woman whose goal was to raise children must find new goals and
redirect energy once the children reach adulthood.

CRITERIA FOR MATURE PERSONALITY

The following seven criteria of maturity represent Allport’s

characteristics of healthy personality.

Extension of the Sense of Self

Allport believed that the person needed to extend the self into
activities with a feeling of genuine personal involvement and
participation. This sense of authentic participation applies to work,
family, leisure and all aspects of living .i.e. an individual is fully
involved with various activities, people, or ideas, the more
psychologically healthy he or she will be.

17
Warm Relating of Self to Others

Allport reported two kinds of warmth in relation to other people: the

capacity for intimacy and the capacity for compassion. The healthy
person can display intimacy (love) for a parent child, spouse, or close
friend. The second kind of warmth, relates to an understanding of the
basic human condition and a sense of kinship with all people. Empathy
for others results from an “imaginative extension” of one’s own feelings
to humanity.

Emotional Security

This characteristic of healthy personality includes (1) self-acceptance(2)

frustration tolerance and (3)emotional control.

(1)Self-acceptance is the most important and involves accepting all

aspects of one’s being, including weaknesses and failings, without being
resigned to them.

(2)Frustration-tolerance relates to tolerating stress and the thwarting of

wants and desires, Frustration is not crippling as it may be for neurotics.

(3)Emotional control pertains to an individual’s control of personal

emotions so they do not disrupt social functioning. The control is not
repression, but a redirecting of the emotions into more constructive
channels.

Realistic Perception

Healthy persons regard their world objectively and they accept reality
for what it is.

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Skills and Assignments

Work and responsibility provide meaning and a sense of continuity to

life. Allport believed in the importance of work and the necessity of
losing oneself in this activity. He did not think it possible to find mature,
healthy persons who have not directed their skills toward their work.

Self-objectification

The individual who possesses a high level of self-objectification -

meaning self-insight - achieves a higher level of self-understanding.
Allport suggested that those with greater selfinsight are more intelligent
than those who possess less selfinsight.

A Unifying Philosophy of Life

Values are vital to the development of a unifying philosophy of life. The

neurotic’s values are thought to not be strong enough to unify all aspects
of life.

Check your Progress

3. What is Self acceptance?

4. What is emotional control?

2.7 A DEFINITION OF ABNORMAL BEHAVIOR

We define abnormal behavior as behavior that is inconsistent

with the individual’s developmental, cultural, and societal norms;
creates emotional distress; or interferes with daily functioning.

19
Factors Influencing the Expression of Abnormal Behaviors
Contextual factors play an important role when considering if and when
abnormal behaviors may develop. Some factors include personal
characteristics such as sex and race or ethnicity. For example, women
are more likely to suffer from anxiety disorders and mood disorders and
men are more likely to suffer from alcohol and drug abuse.
Socioeconomic status (SES), defined by family income and educational
achievement, is another important factor that affects the prevalence of
psychological disorders in the general population. Genetic
vulnerabilities plays a crucial role in abnormal behavior.

2.8 Let’s Sum Up

Being different, or behaving differently, does not necessarily mean that
someone is suffering from a psychological disorder. Determining the
presence of abnormal behavior requires evaluation of the behavior in
terms of its developmental, cultural, and societal contexts. The current
diagnostic system uses a categorical approach to classification of
abnormal behavior. However, psychological symptoms rarely fall into
one neat category. Furthermore, it is often difficult to determine the
boundary between normal feelings such as sadness and psychological
disorders such as depression. In these instances, a dimensional approach
may be more useful. Today biological, psychological, socio cultural, and
bio psychosocial explanations dominate the explanations for the
development of abnormal behavior. Each of the etiological theories has
strengths and weaknesses, and each alone is inadequate to fully explain
the presence of abnormal behavior. Determining abnormal behavior is
complex, and it is likely that a combination of factors is responsible for
any specific psychological disorder. There are many competing theories,
and as science progresses, new theories will be developed and others
will be discarded.

20
2.9 Unit End Exercise
1. Describe Jahoda’s positive mental health.
2. Explain Allport mature personality
3. What is abnormal Behavior?
4. Describe the factors that affect the prevalence of abnormal behavior?

2.10 Answers for check your progress

1. Normality means un-impairment mental functioning.

2. “Mental health is a state of well-being in which an individual realizes

his or her own abilities, can cope with the normal stresses of life, can
work productively, and is able to make a contribution to his or her
community.”

3. Self-acceptance is the most important and involves accepting all

aspects of one’s being, including weaknesses and failings, without being
resigned to them.

4. Emotional control is not repression, but a redirecting of the emotions

into more constructive channels.

2.11 Suggested Readings

1. Carson,r.c.,Butcher,J.N and Mineka, S.(2004). Abnormal psychology.

13th Edition.
New Delhi: Pearson education.
2. Barlow,D.H. and Durand, M.V.(2000). Abnormal psychology. 2nd
Edition. New Delhi:
3. Sue,D.,Sue,,D and Sue.S.(1990). Understanding Abnormal behavior.
3rd Edition, Houghton Miffin Co.
4. Davidson and Neal (1996). Abnormal psychology. Revised 6th
Edition, John Wiley sons

21
5. World Health Organization. (2008). ICD-10: International statistical
classification of diseases and related health problem (10th Rev. ed. ).
New York: Author.
6. American psychiatric Association.(2000). Diagnostic and statistical
manual of mental disorders (4thed., text revision). Washington, DC:
Author.
7. Barlow H. David and Durnad V. Mark(1999) – Abnormal
psychology; India, Brooks/Cole Publishing Company

22
UNIT 3
WAYS OF THINKING ABOUT ABNORMAL BEHAVIOUR
Structure
3.1 Introduction
3.2 Objectives
3.3 Conception of abnormal behavior
3.4 Multidimensional models
3.4.1 Biological model
3.4.2 Psychological model
3.4.3 Socio cultural model
3.4.4 Bio-psychosocial model
3.5 Clinical assessment
3.6 Goals of assessment
3.7 Properties of assessment instruments
3.8 Assessment instruments
3.8.1 Clinical interviews
3.8.2 Psychological Testing.
3.8.3 Behavioral assessments
3.9 Classification of abnormal behavior
3.10 Lets sum up
3.11 Unit End Exercise
3.12 Answers for check your progress
3.13 Suggested Readings
3.1 INTRODUCTION
Abnormal behavior is sometimes difficult to define. It is not just
behavior that is different because certain differences can sometimes be
positive for the individual and perhaps for society. Behavior that is
deviant may be different but not necessarily abnormal. New trends often
start as deviant but then become accepted by mainstream society.
Dangerous behavior may be abnormal, but many individuals who have

23
psychological disorders do not engage in dangerous behavior.
Dangerous behavior is not necessary or sufficient to meet the definition
of abnormal behavior. Two primary considerations for determining
whether a behavior is abnormal is whether it creates dysfunction
(interferes with daily activities) and /or emotional distress.
3.2 Objectives
After studying this unit, you should be able to understand the following
concept
 Concept of abnormal behavior
 Multi models of abnormal behavior
 Clinical assessment and
 Classification

3.3 CONCEPTION OF ABNORMAL BEHAVIOUR

Historically, spirit possession was among the first proposed causes
of abnormal behavior. However, as early as the classical Greek and
Roman periods, biological and environmental explanations were given
for some of the major psychiatric disorders (depression, schizophrenia).
Such theories fell out of favor in Western Europe shortly afterward
although they continued to flourish in the Middle East. It was not until
the Renaissance period that theories based on biology and environmental
factors re-emerged in Europe

Today, biological, psychological, sociocultural, and biopsychosocial

explanations dominate the explanations for the development of abnormal
behavior. Each of the etiological theories has strengths and weaknesses,
and each alone is inadequate to fully explain the presence of abnormal
behavior. Determining abnormal behavior is complex, and it is likely
that a combination of factors is responsible for any specific
psychological disorder. There are many competing theories, and as
science progresses, new theories will be developed and others will be
discarded.

24
3.4 MULTIDIMENSIONAL MODELS OF ABNORMAL
BEHAVIOUR
In this chapter, we introduce some of the different models that try
to explain abnormal behavior. You might wonder why so many different
models exist. The answer is that abnormal behavior is very complex, and
no one model appears capable of providing a comprehensive
explanation. Using a scientific approach, researchers develop, examine,
and discard models as new facts emerge. Next we examine some of the
currently accepted models of abnormal behavior.

3.4.1 BIOLOGICAL MODELS

The biological model assumes that abnormal behavior results from

biological processes of the body, particularly the brain. Technology
breakthroughs such as computerized axial tomography (CAT) scans and
magnetic resonance imaging (MRI) allow direct examination of brain
structure and activity. With this direct observation, we now have a much
greater understanding of the role of the brain in abnormal behavior.
Imaging tests such as the CAT scan and MRI examine the morphology
(structure) of the brain and are used to determine whether parts of the
brain are structurally different in those with and without psychological
disorders. Post-traumatic stress disorder (PTSD, an anxiety disorder
some abnormal behaviors may be related to structural abnormalities, that
occurs after a traumatic event), changes in the brain appears. Studies of
brain functioning appear to be a more promising avenue of research.
Advanced neuro imaging techniques such as positron emission
tomography (PET) and functional magnetic resonance imaging allow for
mapping various areas of the brain and identifying brain areas that might
be associated with various disorders.

GENETIC VULNERABILITIES
The field of behavioral genetics emerged with works by Sir
Francis Galton (1822–1911) and his 1869 publication, Hereditary

25
Genius. Since that time, behavioral genetics has explored the role of
both genes and environment in the transmission of behavioral traits

Viral Infection theory

Specifically, during the prenatal period or shortly after birth, viral
infections might cause brain abnormalities that later lead to behavioral
abnormalities. However, we cannot yet say that this is a definitive cause,
for the results of one study sometimes directly contradict those of
another.

3.4.2 PSYCHOLOGICAL MODELS

The biological model seeks the causes of abnormal behavior in the
workings of the brain or body. In contrast, psychological approaches
emphasize how environmental factors including parents and culture may
influence the development and maintenance of abnormal behavior.

Modern Psychoanalytic Models:

Modern psychoanalysts propose that mental representations
(views) of the self and others guide our interactions and may lead to
psychological symptoms. Finally, they believe that personality
development involves not only learning to regulate sexual and
aggressive feelings but also having mature interpersonal relationships
with others.

Behavioral Models
Learning theory stresses the importance of external events in the
onset of abnormal behaviors. According to learning theory, behavior is
the product of an individual’s learning history. Abnormal behavior is
therefore the result of maladaptive learning experiences. Behavioral
theories do not ignore biological factors; instead, they acknowledge that
biology interacts with the environment to influence behavior. Strict
behaviorists focus on observable and measurable behavior and do not
examine inner psychic causes.

26
Behavior therapists focus therapy on the elimination of abnormal
behaviors and on the acquisition of new behaviors and skills. Treatment
targets the patient’s current symptoms

The Cognitive Model

The cognitive model proposes that abnormal behavior is are sult of
distorted cognitive (mental) processes, not internal forces or external
events. To change abnormal behaviors, cognitive therapy is directed at
modifying the distorted thought processes do not affect our emotions
and behavior; rather, the way we perceive or think about those events
does. Imagine that you fail the first test in your abnormal psychology
class. If you think to yourself, “Well, that was a hard test, but now I
know what the instructor wants and I’ll do better the next time,” you are
likely to feel okay

The Humanistic Model

Based on phenomenology, a school of thought that holds that one’s
subjective perception of the world is more important than the actual
world, humanists believe that people are basically good and are
motivated to self-actualize (develop their full potential). Abnormal
behaviors occur when there is a failure in the process of self-
actualization, usually as a result of people’s failure to recognize their
weaknesses and establish processes and strategies to fulfill their
potential for positive growth.

3.4.3 SOCIOCULTURAL MODELS

All of the models of abnormal behavior discussed so far begin with
the assumption that abnormality lies within the individual. Instead,
socio-cultural models propose that abnormal behavior must be
understood within the context of social and cultural forces, such as
gender roles, social class, and interpersonal resources. From this
perspective, abnormal behavior does not simply result from biological or
psychological factors but also reflects the social and cultural
environment in which a person lives.

27
3.4.4 THE BIOPSYCHOSOCIAL MODEL
Currently, most mental health clinicians subscribe to a bio
psychosocial perspective, which acknowledges that many different
factors probably contribute to the development of abnormal behavior
and that different factors may be important for different people. The
presence of a biological or psychological predisposition to a disease or
disorder is called a diathesis. Rather, the predisposition is assumed to lie
dormant (as if it does not exist) until stressful environmental factors
create significant distress for the individual. People react differently to
stressful events. The combination of a biological predisposition and the
presence of environmental stress create psychological disorders. Modern
scientists now recognize that (a) abnormal behavior is complex, (b)
abnormal behavior cannot be understood using a single theoretical
explanation, and (c) understanding abnormal behavior will advance only
if we embrace and integrate the various conceptual models.
Check your progress
1. What is cat?
2. According to learning theory, what is abnormal behavior?

3.5 Clinical Assessment

The clinical assessment of any psychological problem involves a
series of steps designed to gather information (or data) about a person
and his or her environment in order to make decisions about the nature,
status, and treatment of psychological problems. Typically, clinical
assessment begins with a set of referral questions developed in response
to a request for help. Usually, the request comes from the patient or
someone closely connected to that person, such as a family member,
teacher, or other health care professional.

28
3.6 GOALS OF ASSESSMENT
As part of the assessment process, the psychologist decides which
procedures and instruments to administer. The patient’s age, medical
condition, and description of his or her symptoms strongly influence the
tools selected for assessment, but the psychologist’s theoretical
perspective also affects the scope of the assessment.
Once an assessment has been completed and all data have been
collected, the psychologist integrates the findings the process of
assessment sometimes has a therapeutic effect. Assessment can be useful
even before a referral is provided through the process of screening.
Screenings can help identify people who have problems but who may
not be aware of them or may be reluctant to mention them and/or those
who may need further evaluation.

3.7 PROPERTIES OF ASSESSMENT INSTRUMENTS

The potential value of an assessment instrument rests in part on its
various psychometric properties, which affect how confident we can be
in the testing results.
Standadization
Standard ways of evaluating scores can involve normative or self-
referent comparisons (or both).

Normative comparisons require comparing a person’s score with the

scores of a sample of people who are representative of the entire
population (with regard to characteristics such as age, sex, ethnicity,
education, and geographic region) or with the scores of a subgroup who
are similar to the patient being assessed.

Self-referent comparisons are those that equate responses on various

instruments with the patient’s own prior performance, and they are used
most often to examine the course of symptoms over time

29
Reliability The reliability of an instrument is its consistency, or how
well the measure produces the same result each time it is give Reliability
is assessed in many ways.

Validity A measure must not only be reliable but also valid. Validity
refers to the degree to which a test measures what it was intended to
assess. The instrument’s validity tells us how well we are assessing
these complicated dimensions

DEVELOPMENTAL AND CULTURAL CONSIDERATIONS

The assessment process itself may also vary depending on the
patient’s age. For example, different people may be involved in the
assessment process if the patient is a child, an adult, or an elderly person
with dementia. The assessment process should also consider cultural
factors.

ETHICS AND RESPONSIBILITY

Psychologists must only use instruments that have good reliability
and validity and are appropriate for the purpose of the examination. For
example, it would be unethical for a psychologist to give a test if (a) he
or she had not been trained to give the test, (b) the test had poor
reliability and validity, or (c) the test people need to be aware of
confidentiality limits before the assessment begins. Testing data should
remain confidential and be stored in a secure location, even assessments
that occur via the Internet.

3.8 ASSESSMENT INSTRUMENTS

Psychologists can select from a wide range of assessment
instruments when planning an evaluation. Choosing the best set of
instruments depends on the goals of the assessment, the properties of the
instruments, and the nature of the patient’s difficulties. Some
instruments ask patients to evaluate their own. symptoms (self-report
measures); others require a clinician to rate the symptoms (clinician
rated measures). Some instruments assess subjective responses (what
the patient perceives) and others objective responses (what can be
30
observed). Some measures are structured (each patient receives the same
set of questions), and others are unstructured (the questions vary across
patients)

3.8.1 CLINICAL INTERVIEWS

Clinical interviews consist of a conversation between an
interviewer and a patient, the purpose of which is to gather information
and make judgments related to the assessment goals. They also can be
conducted in either an unstructured or structured fashion. In an
unstructured interview, the clinician decides what questions to ask and
how to ask them. Typically, the initial interview is unstructured. In a
structured interview, the clinician asks each patient the same standard
set of questions, usually with the goal of establishing a diagnosis.

3.8.2 PSYCHOLOGICAL TESTS

Personality test is a psychological test that measures personality
characteristics. If the psychologist believes that personality
characteristics are causes for psychological disorder. The best-known
personality test is the Minnesota Multiphasic Personality Inventory
Intelligence Tests Although their results are often misinterpreted,
intelligence tests are some of the most frequently used tests among
psychologists. Created to predict success in school, these tests were
designed to produce an intelligence quotient, or IQ , score. Stanford-
Binet Intelligence Scale and the Weschler Adult Intelligence Scale,
another widely used intelligence test.
Projective Tests Projective testing emerged from psychoanalytic
theory. Two widely used projective tests are the Rorschach Inkblot Test
and the Thematic Apperception Test.
Tests for Specific Symptoms In addition to tests of general
psychological functioning, we also need assessment tools that provide
reliable and valid measures of specific types of symptoms, such as
depression and anxiety. Depressive symptoms, for example, are
commonly assessed by the Beck Depression Inventory–II

31
3.8.3 BEHAVIORAL ASSESSMENT
This approach relies on applying the principles of learning to
understand behavior, and its ultimate goal is a functional analysis
(Haynes et al., 2006). When conducting a functional analysis (also
known as behavioral analysis or functional assessment), the clinician
attempts to identify causal (or functional) links between problem
behaviors and contextual variables (e.g., environmental and internal
variables that affect the problem behavior). To identify antecedents and
consequences of behavior, a behavioral assessment often starts with a
behavioral interview. The interviewer asks very specific questions to
discover the full sequence of events and behaviors surrounding the
patient’s primary problems. self-monitoring, a process in which a
patient observes and records his or her own behavior as it happens self-
monitoring requires patients to record their symptoms when they occur,
allowing real-time information about the frequency, duration, and nature
of the symptoms. Self-monitoring can also create a record of how often
problem behaviors are occurring before treatment begins and how
symptoms change over time. Self-monitoring can also create a record of
how often problem behaviors are occurring before treatment begins and
how symptoms change over time.

PSYCHOPHYSIOLOGICAL ASSESSMENT
Psycho-physiological assessment measures brain structure, brain
function, and nervous system activity. This type of assessment measures
physiological changes in the nervous system that reflect emotional or
psychological events. Different types of measurements assess a range of
biochemical alterations in the brain or physiological changes in other
parts of the body. One of the oldest, most common and least invasive
types of psycho-physiological measurements is electroencephalography
(EEG).
Check your progress
1. What is screening?
2. What is reliability?

32
3.9 The Classification of Abnormal Behavior
The goal of having a classification system for abnormal behaviors is to
provide distinct categories, indicators, and nomenclature for different
patterns of behavior, thought processes, and emotional disturbances.
Thus the pattern of behavior classified as paranoid schizophrenia should
be clearly different from the pattern named borderline personality.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

The end of the nineteenth century, Emil Kraepelin devised the first
effective classification scheme for mental disorders. Kraepelin held the
organic view of psychopathology, and his system had a distinctly
biogenic slant. Classification was based on the patient’s symptoms, as in
medicine. It was hoped that disorders (similar groups of symptoms)
would have a common etiology (cause or origin), would require similar
treatments, would respond to those treatments similarly, and would
progress similarly if left untreated. Many of these same expectations
were held for the Diagnostic and Statistical Manual of Mental
Disorders, based on the Kraepelinian system and published by the
American Psychiatric Association in 1952. Each subsequent version of
DSM was developed to have greater reliability and validity. In addition,
DSM tried to incorporate new research findings. Although Kraepelin’s
concepts still formed the basis for some of its categories, successive
versions of DSM contained substantial revisions. For example, to
improve reliability, DSM specified the exact criteria that clinicians
should use in making a diagnosis. The American Psychiatric Association
published the latest version, DSM-V, in 2013.

3.10 Let’s sum it up

The biological, psychodynamic, cognitive-behavioral, and
humanistic approaches to understanding the causes of abnormal
behavior are alternative paradigms, and not just alternative theories.
Biological approaches emphasize causes “within the skin.”
Psychodynamic theory highlights unconscious processes.
Cognitive-behavioral viewpoints focus on observable, learned behavior.
The humanistic paradigm argues that behavior is a product of free will.
33
Biological factors in abnormal behavior begin with the neuron, or nerve
cell. Communication between neurons occurs when the axon terminals
release chemical substances called neurotransmitters into the synapse
between nerve cells. Disrupted communication among neurons,
particularly disruptions in the functioning of various neurotransmitters,
is involved in several types of abnormal behavior, although you should
be cautioned against mind–body dualism. Psychophysiology involves
changes in the functioning of the body that result from psychological
experiences.
Psycho-physiological arousal is caused by the endocrine system
and the nervous system. Endocrine glands release hormones into the
bloodstream that regulate some aspects of normal development as well
as some responses to stress. The autonomic nervous system is the part of
the central nervous system that is responsible for psycho-physiological
reactions. Psychology has not developed a list of its core components.
Some promise toward this goal is offered by evolutionary psychology,
the application of the principles of evolution to our understanding of the
animal and human minds. Two basic psychological motivations seen in
humans and other animals are the formation of attachments and
competition for dominance.
3.11 Unit End Exercise
1. Describe the biological model of abnormal behavior.

2. Describe the interview method in clinical assessment.

3. Write about DSM and its various editions.

3.12 Answers for check your progress

1. CAT means computerized axial tomography.
2. According to learning theory, behavior is the product of an
individual’s learning history. Abnormal behavior is therefore the
result of maladaptive learning experiences.
3. Screenings can help identify people who have problems but who
may not be aware of them or may be reluctant to mention them
and/or those who may need further evaluation.
4. The reliability of an instrument is its consistency, or how well the
measure produces the same result each time it is give Reliability is
assessed in many ways.
34
3.13 Suggested Readings
1. Carson, r.c., Butcher, J.N and Mineka, S.(2004). Abnormal
psychology. 13th Edition.
New Delhi: Pearson education.
2. Barlow, D.H. and Durand, M.V. (2000). Abnormal psychology. 2nd
Edition. New Delhi:
3. Sue,D., Sue,, D and Sue. S. (1990). Understanding Abnormal
behavior. 3rd Edition, Houghton Miffin Co.
4. Davidson and Neal (1996). Abnormal psychology. Revised 6th
Edition, John Wiley sons

35
UNIT -4 DISORDERS OF CHILDHOOD & ADOLESCENCE

Structure
4.1 Introduction
4.2 Objectives
4.3Intellectual Disability
4.3.1 Diagnostic criteria
4.3.2 Causes
4.3.3 Treatment
4.4 Autism Spectrum Disorder
4.4.1 Diagnostic Criteria
4.4.2 Features of Autism
4.4.3 Causes
4.4.4 Treatment

4.1 INTRODUCATION
Psychological disorders of childhood and adolescence often have a
special poignancy, perhaps none more than autism. These disorders
affect children at ages when they have little capacity to cope. Some of
these problems, such as autism and intellectual disability (formerly
called mental retardation), prevent children from fulfilling their
developmental potentials. Some psychological problems in children and
adolescents mirror those found in adults—problems such as mood
disorders and anxiety disorders. In some cases, the problems are unique
to childhood, such as separation anxiety; in others, such as ADHD,
or attention-deficit/hyperactivity disorder, the problem manifests itself
differently in childhood than in adulthood.

4.2 Objectives
After completing this unit, you should be able to understand the
following concept
o Intellectual disability and its causes and treatment
o Autism Spectrum Disorder and its causes and treatment

36
4.3 Intellectual Disability
About 1% of the general population is affected by intellectual
disability or ID (also called intellectual developmental disorder or IDD).
The primary feature of ID is a general deficit in intellectual
development. Formerly called mental retardation, intellectual disability
is the diagnostic term applying to individuals who have significant and
broad-ranging limitations or deficits in intellectual functioning and
adaptive behaviors
(e.g., lack of basic conceptual, social, and practical skills of daily living).
Children with
ID tend to have deficits in reasoning and problem-solving ability,
abstract thinking skills, judgment, and school performance. Intellectual
disability is diagnosed on the basis of a low IQ score and impaired
adaptive functioning occurring before the age of 18 that results in
significant impairments in meeting expected standards of independent
functioning and social responsibility.
These impairments may involve difficulty performing common
tasks of daily life expected of someone of the same age in a given
cultural setting in three domains: (1) conceptual (skills relating to use of
language, reading, writing, math, reasoning, memory, and problem
solving), (2) social (skills relating to awareness of other people’s
experiences, ability to communicate effectively with others, and ability
to form friendships, among others), and (3) practical (ability to meet
personal care needs, fulfill job responsibilities, manage money, and
organize school and work tasks, among others). Although earlier
versions of the DSM required an IQ score of less than 70 (100 is the
average score) for a diagnosis of mental retardation, DSM-5 does not set
any particular IQ score for the diagnosis of ID. The level of severity
depends upon the child’s adaptive functioning, or ability to meet the
expectable demands children face at school and in the home. Most
children with ID (about 85%) fall into the mild range. These children are
generally capable of meeting basic academic demands, such as learning
to read simple passages. As adults, they are generally capable of
independent functioning, although they may require some guidance

37
4.4 Diagnostic criteria for intellectual disability Retardation
A. Significantly sub average intellectual functioning: an IQ of
approximately 70 or below on an individually administered IQ test (for
infants, a clinical judgment of significantly sub average intellectual
functioning).
B. Concurrent deficits or impairments in present adaptive functioning
(i.e., the person’s effectiveness in meeting the standards expected for his
or her age by his or her cultural group) in at least two of the following
areas: communication, self care, home living, social/interpersonal skills,
use of community resources, self-direction, functional academic skills,
work, leisure, health, and safety.
C. The onset is before age 18 years.

Classification of Persons with Mental Retardation

Based on the 1983 AAMR definition, the operational classification
for persons with mental
retardation is as follows:
Level of Retardation IQ Range
Mild 89 - 70
Moderate 70 - 31
Severe 30 -20
Profound 19 - 0
Educational Classification
In the special education centres in India, the classroom classification in
operation is as shown
below:
I. Pre-Primary (A) level - Chronological ages 3 – 6 years
- Mental ages Upto 5 years
II. Pre-Primary (B) level - Chronological ages Over 6 years
- Mental ages Around 4½ years
III. Primary level - Chronological ages 7 – 10 years
- Mental ages 5 – 7 years
IV. Secondary level - Chronological ages 10 – 13 years
- Mental ages 7 – 9 years

38
V. Pre-Vocational level - Chronological ages 14 – 16 years
- Mental ages 8 + years
4.5 Causes
There are literally hundreds of known causes of intellectual
disability, including the following:

Environmental: For example, deprivation, abuse, and neglect

Prenatal: For instance, exposure to disease or drugs while still in the
womb
Peri-natal: Such as difficulties during labor and delivery
Postnatal: For example, infections and head injury

Biological Dimensions
Most research on the causes of intellectual disability focuses on
biological influences.

Genetic Influence: Almost 300 genes have been identified as having

the potential to contribute to intellectual disability, and it is expected that
there are many more A portion of the people with more severe
intellectual disability have identifiable single-gene disorders, involving a
dominant gene (expresses itself when paired with a normal gene), a
recessive gene (expresses itself only when paired with another copy of
itself), or an X-linked gene (present on the X or sex chromosome).
Someone who carries a dominant gene that results in intellectual
disability is less likely to have children and thus less likely to pass the
gene to offspring.

Chromosomal Influences
Down syndrome and fragile X syndrome is the great examples for
chromosome influences. Down syndrome, the most common
chromosomal form of intellectual disability, was first identified by the
British physician Langdon Down in 1866. The disorder is caused by
the presence of an extra 21st chromosome and is therefore sometimes
referred to as trisomy 2.1People with Down syndrome have
characteristic facial features, including folds in the corners of their
39
upwardly slanting eyes, a fl at nose, and a small mouth with a flat roof
that makes the tongue protrude somewhat.

Fragile X syndrome is a second common chromosomally related cause

of intellectual disability. This disorder is caused by an abnormality on
the X chromosome, a mutation that makes the tip of the chromosome
look as though it were hanging from a thread, giving it the appearance of
fragility. Fragile X primarily affects males because they do not have a
second X chromosome with a normal gene to balance out the mutation.
Men with the disorder display moderate to severe levels of intellectual
disability and have higher rates of hyperactivity, short attention spans,
gaze avoidance, and perseverative speech (repeating the same words
again and again)

Psychological and Social Dimensions

Sometimes referred to as cultural– familial intellectual
disability, people with these characteristics are thought to have
cognitive impairments that result from a combination of psychosocial
and biological influences, although the specific c mechanisms that lead
to this type of intellectual disability are not yet understood. The cultural
influences that may contribute to this condition include abuse, neglect,
and social deprivation.

Treatment
Biological treatment of intellectual disability is currently not a
viable option. Generally, the treatment of individuals with intellectual
disability parallels that of people with pervasive developmental
disorders, attempting to teach them the skills they need to become more
productive and independent. For people with more severe disabilities,
the general goals are the same; however, the level of assistance they
need is often more extensive Individuals with intellectual disability can
acquire skills through the many behavioral innovations. Communication
training is important for people with intellectual disability. Making their
needs and wants known is essential for personal satisfaction and for
40
participation in most social activities. Concern is often expressed by
parents, teachers, and employers that some people with intellectual
disability can be physically or verbally aggressive or may hurt
themselves. In addition to ensuring that people with intellectual
disability are taught specific skills, caretakers focus on the important
task of supporting them in their community.
Check Your Progress
1. What is Intellectual Disability?
2. What is Down syndrome?

Autism Spectrum Disorder

Autism is one of the most severe behavioral disorders of
childhood. It is a chronic, lifelong condition. The word autism derives
from the Greek autos, meaning “self.” The term was first used in 1906
by the Swiss psychiatrist Eugen Bleuler to refer to a peculiar style of
thinking among people with schizophrenia. Autistic thinking is the
tendency to view oneself as the center of the universe, to believe that
external events somehow refer to oneself. In 1943, another psychiatrist,
Leo Kanner, applied the diagnosis “early infantile autism” to a group of
disturbed children who seemed unable to relate to others, as if they lived
in their own private worlds. Unlike children with intellectual disability,
these children seemed to shut out any input from the outside world,
creating a kind of “autistic aloneness” (Kanner, 1943).
The DSM-5 places autism (previously called autistic disorder) in a
broader diagnostic category called autism spectrum disorder, or ASD,
that includes a range of autism related disorders that vary in severity.
DSM-5 identifies ASD on the basis of a common set of behaviors
representing persistent deficits in communication and social interactions
and restricted or fixated interests and repetitive behaviors. Clinicians
need to rate the severity of ASD as severe, moderate, or mild.

Diagnostic criteria for autism spectrum disorder

A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by the following,
currently or by history.
41
1. Deficits in social-emotional reciprocity, ranging, for example, from
abnormal social approach and failure of normal back-and-forth
conversation; to reduced sharing of interests, emotions, or affect; to
failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal and
nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack
of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships,
ranging, for example, from difficulties adjusting behavior to suit various
social contexts; to difficulties in sharing imaginative play or in making
friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history.
1. Stereotyped or repetitive motor movements, use of objects, or speech
(e.g., simple motor stereotypes, lining up toys or flipping objects,
echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized
patterns of verbal or nonverbal behavior (e.g., extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting
rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or
focus (e.g., strong attachment to or preoccupation with unusual objects,
excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g., apparent indifference to
pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights
or movement).
C. Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning,
42
E. These disturbances are not better explained by intellectual disability
(intellectual developmental disorder) or global developmental delay.
Intellectual disability and autism spectrum disorder frequently co-occur;
to make comorbid diagnoses of autism spectrum disorder and
intellectual disability, social communication should be below that
expected for general developmental level.

Features of Autism
Three major characteristics of autism are expressed in DSM-IV-TR:
impairment in social interactions; impairment in communication; and
restricted behavior, interests, and activities (American Psychiatric
Association, 2000).

Impairment in Social Interactions. One of the defining characteristics

of people with autistic disorder is that they do not develop the types of
social relationships expected for their age

Impairment in Communication. People with autism nearly always

have severe problems with communicating. About one third never
acquire speech. In those with some speech, much of their
communication is unusual. Some repeat the speech of others. Some
people with autism who can speak are unable or unwilling to carry on
conversations with others.

Restricted Behavior, Interests, and Activities. The more striking

characteristics of autism include restricted patterns of behavior, interests,
and activities. people with autism spend countless hours in stereotyped
and ritualistic behaviors, making such stereotyped movements as
spinning around in circles, waving their hands in front of their eyes with
their heads cocked to one side, or biting their hands

Causes:
Biological Dimensions
Genetic Infl uences.

43
 It is now clear that autism has a genetic component the genes
responsible for the brain chemical oxytocin. Because oxytocinis shown
to have a role in how we bond with others and in our social memory.

Neurobiological Influences.
The amygdala—the area of the brain that, involved in emotions
such as anxiety and fear. Earlier research showed that young children
with autism actually have a larger amygdala. The theory being proposed
is thatthe amygdala in children with autism is enlarged early in life—
causing excessive anxiety and fear (perhaps contributing to their social
withdrawal). With continued stress, the release of the stress hormone
cortisol damages the amygdala, causing the relative absence of these
neurons in adulthood. The damaged amygdala may account for the
different way people with autism respond to social situations. An
additional neurobiological influence we mentioned in the section on
genetics involves the neuropeptide oxytocin. Remember that this isan
important social neurochemical that influences bonding and is found to
increase trust and reduce fear. Some research on children with autism
found lower levels of oxytocin in their blood

Treatment
There is no completely effective treatment exists. Attempts to
eliminate the social problems experienced by these individuals have not
been successful to date.

Biological Treatments
A variety of pharmacological treatments are used to decrease
agitation, and the major tranquilizers and serotonin-specific reuptake
inhibitors seem helpful.

Integrating Treatments
The treatment of choice for people with autism disorder—
combines various approaches to the many facets of this disorder. For
children, most therapy consists of school education with special
44
psychological supports for problems with communication and
socialization. Behavioral approaches have been most clearly
documented as benefiting children in this area. Pharmacological
treatments can help some of them temporarily. Parents also need support
because of the great demands and stressors involved in living with and
caring for such children.
Check your Progress
1. What is Autism?

Let’s Sum Up
Mental retardation is defined as sub average intellectual
functioning, as measured by an IQ score below 70 and deficits in
adaptive behavioral functioning. There are four levels of mental
retardation, ranging from mild to profound. A number of biological
factors are implicated in mental retardation, including metabolic
disorders (PKU, Tay-Sachs disease); chromosomal disorders (Down
syndrome, fragile X, trisomy 13, and trisomy 18); prenatal exposure to
rubella, herpes, syphilis, or drugs (especially alcohol, as in fetal alcohol
syndrome); premature delivery; and head trauma (such as that arising
from being shaken as an infant). There is some evidence that intensive
and comprehensive educational interventions, administered very early in
a child’s life, can help decrease the level of mental retardation.
Autism is characterized by significant interpersonal,
communication, and behavioral deficits. Many children with autism
score in the mental retardation range on IQ tests. Outcomes of autism
vary widely, although the majority of people with autism must receive
continual care, even as adults. The best predictors of a good outcome in
autism are an IQ above 50 and language development before age 6.
Possible biological causes of autism include a genetic predisposition to
cognitive impairment, central nervous system damage, prenatal
complications, and neurotransmitter imbalances. Drugs reduce some
symptoms in autism but do not eliminate the core of the disorder.
Behavior therapy is used to reduce inappropriate and self-injurious
behaviors and encourage pro social behaviors.
45
Unit End Exercise
1. Describe the effects of child abuse.
2. Describe key features of autism spectrum disorder and ways of
understanding and treating it.
3. Describe the key features and causes of intellectual disability.

Answers for Check your Progress

1. Intellectual disability is the diagnostic term applying to individuals
who have significant and broad-ranging limitations or deficits in
intellectual functioning and adaptive behaviors (e.g., lack of basic
conceptual, social, and practical skills of daily living).
2. The disorder is caused by the presence of an extra 21st
chromosome and is therefore sometimes referred to as trisomy 21
3. DSM-5 identifies ASD on the basis of a common set of behaviors
representing persistent deficits in communication and social
interactions and restricted or fixated interests and repetitive
behaviors.

Suggested Readings:
1. Butcher, J.N. (2014). Abnormal Psychology. New Delhi: Pearson
Education.
2. Butcher, J.N., Hooley, J. M., Mineka, S &Dwivedi, C.B. (2017).
Abnormal Psychology 16th ed. Noida: Pearson.
3. Sarason, G.I. & Sarason, R.V. (2007). Abnormal Psychology: The
Problem of Maladaptive Behaviour (II Edition). Pearson Education, Inc.
and Dorling Kindersley Publication Inc.

46
UNIT 5
ANXIETY RELATED DISORDER
Structure
5.1 Introduction
5.2 Objectives
5.3 Anxiety
5.3.1 Symptoms
5.3.2 Causes
5.3.3 Panic Disorder
5.3.4 Generalized Anxiety Disorder
5.3.5 Social Phobia
5.3.6 Specific Phobia
5.3.7 Obsessive Compulsive Disorder
5.3.8 Post traumatic stress disorder
5.4 Somatoform Disorder
5.4.1 Common factors
5.4.2 Somatization disorder
5.4.3 Undifferntiated somatoform disorder
5.4.4 Conversion disorder
5.4.5 Pain disorder
5.4.6 Hypochondriasis
5.4.7 Body dysmorphic disorder
5.5 Mood disorder
5.5.1 Major depressive disorder
5.5.2 Dysthemia
5.5.3 Bipolar disorder
5.5.4 Cyclothymic disorder
5.6 Let’s sum up
5.7 Unit End exercise
5.8 Answers for check your progress
5.9 Suggested Readings

47
5.1 INTRODUCTION
Anxiety is complex and mysterious, as Sigmund Freud realized
many years ago. The various forms of anxiety disorders—including
phobias, obsessions, compulsions, and extreme worry—represent the
most common type of abnormal behavior. Anxiety disorders lead to
significant social and occupational impairment and reduced quality of
life. Anxiety disorders share several important similarities with mood
disorders. From a descriptive point of view, both categories are defined
in terms of negative emotional accompany anxiety and depression
5.2 Objectives
On completion of this unit, you will be able to understand the following
concepts
 Anxiety Disorder
 Somatoform disorder
 Mood disorder
5.3 Anxiety
Anxious mood is often defined in contrast to the specific emotion
of fear, which is more easily understood. Fear is experienced in the face
of real, immediate danger responses. Feelings such as guilt, worry, and
anger frequently anxiety involves a more general or diffuse emotional
reaction—beyond simple fear—that is out of proportion to threats from
the environment (Barlow, 2004). Rather than being directed toward the
person’s present circumstances, anxiety is associated with the
anticipation of future problems. Anxiety can be adaptive at low levels,
because it serves as a signal that the person must prepare for an
upcoming event. A pervasively anxious mood is often associated with
pessimistic thoughts and feelings. Factors can be used to define anxious
apprehension, which consists of (1) high levels of diffuse negative
emotion, (2) a sense of uncontrollability, and (3) a shift in attention to a
primary self-focus or a state of self preoccupation

5.3.1 SYMPTOMS OF ANXIETY DISORDERS

Excessive Worry: Worrying is a cognitive activity that is associated
with anxiety. Worry can be defined as a relatively uncontrollable

48
sequence of negative, emotional thoughts that are concerned with
possible future threats or danger.
Panic Attacks
A panic attack is a sudden, overwhelming experience of terror or
fright, People undergoing a panic attack also report a number of
cognitive symptoms. They may feel as though they are about to die, lose
control, or go crazy.
Phobias:
Phobias are persistent, irrational, narrowly defined fears that are
associated with a specific object or situation. Avoidance is an important
component of the definition of phobias.
Obsessions and Compulsions
Obsessions are repetitive, unwanted, intrusive cognitive events that
may take the form of thoughts or images or urges. They introduce
suddenly into consciousness and lead to an increase in subjective
anxiety. Compulsions are repetitive behaviors or mental acts that are
used to reduce anxiety. Examples include checking many times to be
sure that a door is locked
5.3.2 Causes for anxiety related disorder
Adaptive and Maladaptive Fears
Intense fear is triggered at an inappropriate time or place, these
response systems can become more harmful than helpful. Social threats
are more likely to provoke responses such as shyness and
embarrassment that may increase acceptance by other people by making
the individual seem less threatening.

Stressful Life Events

Common sense suggests that people who experience high stress
levels are likely to develop negative emotional reactions. Stressful life
events can influence the onset of anxiety disorders as well as depression.
Patients with anxiety disorders are more likely than other people to
report having experienced a negative event

49
Childhood Adversity:
Maternal prenatal stress, maternal partner changes, parental
indifference (being neglected by parents), and physical abuse (being
physically beaten or threatened with violence). Children who are
exposed to higher levels of adversity are more likely to develop anxiety
disorders later in their lives.

Attachment and Separation Anxiety

The anxiety is an innate response to separation, or the threat of
separation, from the caretaker. Those infants who are insecurely attached
to their parents are presumably more likely to develop anxiety disorders

Psychological Factors

COGNITIVE FACTOR
Cognitive events also play an important role as mediators between
experience and response. Perceptions, memory, and attention all
influence the ways that we react to events in our environments. It is now
widely accepted that these cognitive factors play a crucial role in the
development and maintenance of various types of anxiety disorders

Perception of Control:
There is an important relationship between anxiety and the
perception of control. People who believe that they are able to control
events in their environment are less likely to show symptoms of anxiety
than are people who believe that they are helpless

Thought Suppression:
The struggle to control our thoughts often leads to a process known
as thought suppression, an active attempt to stop thinking about
something. Obsessive–compulsive disorder may be related, in part, to
the maladaptive consequences of attempts to suppress unwanted or

50
threatening thoughts that the person has learned to see as being
dangerous or forbidden.
Learning process
Many researchers suggested that fear is a learned one. During
childhood we learned to fear to specific objects that develops the anxiety
towards that particular object in later life. We learned so many fears
from our immediate environment, that plays role in later life.
Biological Factors
Genetic Factors
Genetic factors that would be unique to individuals also play an
important role in the etiology of all anxiety disorders. Genetic factors
that would be shared by all members of a family do not seem to play an
important role for many people.

Neurobiology
The specific brain pathways that are responsible for detecting and
organizing a response to danger. The amygdale plays a central role in
these circuits, which represent the biological underpinnings of the
evolved fear module.
Anxiety disorder:

5.3.3 PANIC DISORDER AND AGORAPHOBIA

Panic attacks are the defining feature of two anxiety disorders:
panic disorder without agoraphobia and panic disorder with
agoraphobia. In panic disorder with agoraphobia, panic attacks are also a
central feature. Agoraphobia (literally meaning “fear of the
marketplace”) is a fear of being in public places or situations where
escape might be difficult or help unavailable if a panic attack occurs.
People who have agoraphobia avoid public places, such as
supermarkets; shopping malls; restaurants. Someone who has panic
disorder without agoraphobia does not avoid situations (driving,

51
shopping, getting on a bus) because of the fear that a panic attack might
occur

5.3.4 GENERALIZED ANXIETY DISORDER

The key feature of generalized anxiety disorder (GAD) is
excessive worry occurring more days than not and lasting at least 6
months. People with GAD worry about future events, past
transgressions, financial matters, and their own health and that of loved
one

5.3.5 SOCIAL PHOBIA

Social Phobia is a severe fear of social or performance situations
(APA, 2000a). Social situations that create distress include speaking,
eating, drinking, or writing in the presence of others; engaging in social
interactions such as parties or meetings; and simply initiating or
maintaining conversations. When in these situations, people with social
phobia fear that others will detect their anxiety through their speech or
behavior

5.3.6 SPECIFIC PHOBIA

Specific Phobias are severe and persistent fears of circumscribed
events, objects, or situations that lead to significant disruption in daily
functioning

5.3.7 OBSESSIVE-COMPULSIVE DISORDER

OCD is a condition involving obsessions (intrusive thoughts),
often combined with compulsions (repetitive behaviors) that can be
extensive, time consuming, and distressful

5.3.8 POST-TRAUMATIC STRESS DISORDER

Post-traumatic stress disorder (PTSD) begins with a traumatic
event such as military combat, assault, rape, or observation of the
serious injury or violent death of another person. Later when confronting

52
events or situations that symbolize or resemble part of the trauma, such
as a dark alley similar to the one where an assault

5.4 Somatoform Disorders

Somatoform disorders are defined as conditions in which physical
symptoms or concerns about an illness cannot be explained by a medical
or psychological disorder (e.g., depression or anxiety). People who
suffer from somatoform disorders experience real physical symptoms,
but their physical pain cannot be fully explained by an established
medical condition. The somatoform disorders are a confusing diagnostic
category because the individual disorders do not share an underlying
emotion or a common etiology occurred, the person may suffer an
intense psychological and physiological reaction. Specifically, what the
disorders share is the lack of a recognizable medical cause for their
physical distress. The six different somatoform disorders are
somatization disorder, undifferentiated somatoform disorder, conversion
disorder, pain disorder, hypochondriasis, and body dysmorphic disorder

5.4.1 COMMON FACTORS IN SOMATOFORM DISORDERS:

All somatoform disorders share certain features. Approximately 33
to 40% of people with a somatoform disorder also have coexisting
anxiety and/or depressive disorders It is often a challenge to determine
whether physical complaints represent a physical disorder, a
psychological disorder such as depression, or the separate category of
somatoform disorder.

FUNCTIONAL IMPAIRMENT
Somatoform disorders produce significant functional impairment
Hypochondriasis and pain disorder increase the likelihood of physical
disability, occupational impairment, and overutilization of health
services (Aigner et al., 2003; Gureje et al.). People with BDD report
severe social impairment; they are very often single, avoid dating, and
are socially isolated Although many physical complaints lack an organic
basis, they still have an enormous impact on our medical system.
53
Doctor-shopping is just one example of how somatoform disorders
increase medical utilization and costs.

CAUSES
Biological factors would seem to play a role, particularly when
distorted perceptual processes, such as those found in BDD, are
apparent. One small study found that female patients with somatization
disorder or undifferentiated somatoform disorder (n 5 10) had larger
caudate nuclei volumes compared with healthy people.

Psychosocial Factors
Psychodynamic explanations for somatoform disorders propose
that these disorders result from intra psychic conflict, personality, and
defense mechanisms. Behavioral principles of modeling and
reinforcement may also contribute to the development of illness
behavior. Other environmental factors also are associated with physical
symptoms, distress, and somatoform disorders. Among adults, stress was
temporally associated with 72% of somatoform disorders. In contrast, a
history of sexual abuse was present in 28% of the cases (Singh & Lee,
1997). Among children (Kozlowska et al., 2007), family separation/loss
was associated with the onset of the disorder in 34% of the cases. Family
conflict/ violence was associated in 20% of the cases, and sexual assault
correlated in only 4%. The relationship between somatoform disorders
and childhood sexual abuse is controversial (Alper et al., 1993; Coryell
& Norten, 1981; Morrison, 1989; see the feature “Examining Other
cognitive theories propose that somatoform disorders develop from
inaccurate beliefs about the (a) prevalence and contagiousness of
illnesses, (b) meani of bodily symptoms, and (c) course and treatment of
illnesses (Salkovskis, 1989).
Check Your Progress
1.What is GAD?
2. What is OCD?

54
5.4.2 SOMATIZATION DISORDER
Somatization disorder, the condition is defined as the presence of
many symptoms that suggest a medical problem but have no recognized
organic basis the one most important symptom is pain, including back
pain, joint pain arm or leg pain , headache, and abdominal pain Much
less common but more dramatic are the pseudo seizures, which are
sudden changes in behavior that mimic epileptic seizures but have no
organic basis.

5.4.3 UNDIFFERENTIATED SOMATOFORM DISORDER

The symptoms are not explained by the presence of a medical
condition and are not the result of injury, substance use, or medication
side effect. When such physical complaints are present for at least 6
months and cause distress or functional impairment, the person may be
suffering from undifferentiated somatoform disorder

5.4.4 CONVERSION DISORDER

A different somatoform disorder, conversion disorder, consists
solely of pseudo neurological complaints such as motor or sensory
dysfunction. Symptoms of conversion disorder can be quite dramatic,
such as sudden paralysis or blindness. They are not intentionally
produced and cannot be fully explained by the presence of any medical
condition Symptoms of conversion disorder fall into three groups. The
most common group includes motor symptoms or deficits, such as
impaired coordination or balance, paralysis or weakness, difficulty
swallowing, or a “lump in the throat,” aphonia (loss of speech), or
urinary retention Sensory deficits, a less common symptom group,
include loss of touch or pain sensations, double vision or blindness,
deafness, and hallucination Also rare is the third symptom group, which
consists of behaviors such as seizures and convulsions.

5.4.5 PAIN DISORDER

Pain, which is a common human experience, is frustrating to both
patients and health or mental health professionals. Pain can contribute to

55
the onset of psychological disorders or intensify conditions that are
already present

5.4.5 HYPOCHONDRIASIS
Fears or concerns about having an illness persist despite medical
reassurance, the problem may be hypochondriasis. People with
hypochondriasis do not necessarily suffer from physical symptoms.
Rather, they have a dysfunctional mind-set that leads to worry about
health, illness, and physical symptoms

5.4.6 BODY DYSMORPHIC DISORDER

Body dysmorphic disorder (BDD) is an overwhelming concern that
some part of the body is ugly or misshapen. Usually, if the concern is
even minimally based in reality, it is an extreme exaggeration of a very
minor flaw (e.g., avery small acne scar is described as a “huge crater on
my face”).

5.5 Mood disorders

Mood disorders experience disturbances in mood that are
unusually severe or prolonged and impair their ability to function in
meeting their normal responsibilities. Some people become severely
depressed even when things appear to be going well or when they
encounter mildly upsetting events that others take in stride. Still others
experience extreme mood swings. They ride an emotional roller coaster
with dizzying heights and abysmal depths when the world around them
remains largely on an even keel.

Types of Mood Disorders

The two major forms of mood disorders are depressive disorders
and bipolar disorders (mood swing disorders). There are two major types
of depressive disorders, major depressive disorder and persistent
depressive disorder, and two major types of bipolar disorders, bipolar
disorder and cyclothymic disorder (also called cyclothymia).

56
5.5.1 Major Depressive Disorder
The diagnosis of major depressive disorder (also called major
depression) is based on the occurrence of at least one major depressive
episode (MDE) in the absence of a history of mania or hypomania. A
major depressive episode involves a clinically significant change in
functioning involving a range of depressive symptoms, including
depressed mood (feeling sad, hopeless, or “down in the dumps”) and/or
loss of interest or pleasure in all or virtually all activities for a period of
at least two weeks (APA, 2013) Major depression is not simply a state of
sadness or the blues. People with major depressive disorder (MDD) may
have poor appetite, lose or gain substantial amounts of weight, have
trouble sleeping or sleep too much, and become physically agitated or—
at the other extreme—show a marked slowing down in their motor
(movement) activity.

5.5.2 Persistent Depressive Disorder (Dysthymia)

Major depressive disorder is severe and marked by a relatively
abrupt change from one’s preexisting state and followed by remission
after a period of a few weeks or months. But some forms of depression
become chronic conditions that can last for years.
The diagnosis of persistent depressive disorder is used to classify cases
of chronic lasting for at least two years. Persons with persistent
depressive disorder may have either chronic major depressive disorder
or a chronic but milder form of depression called dysthymia. Dysthymia
typically begins in childhood or adolescence and tends to follow a
chronic course through adulthood. The word dysthymia derives from
Greek roots dys-, meaning “bad” or “hard,” and thymos, meaning “spirit.

5.5.3 Bipolar Disorder

Bipolar disorder is characterized by extreme swings of mood and
changes in energy and activity levels. Mood swings typically shift
between the heights of elation to the depths of depression. The first
episode may be either manic or depressive. Manic episodes typically last
a few weeks or perhaps a month or two and are generally much shorter
and end more abruptly than major depressive episodes. Some people
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with bipolar disorder experience mixed states characterized by episodes
of both mania and depression (APA, 2013). During these mixed states,
the person’s mood may rapidly shift between mania and depression
(Swann et al., 2013).

5.5.4 Cyclothymic Disorder

Cyclothymia is derived from the Greek kyklos, which means “circle,”
and thymos, meaning “spirit.” The notion of a circular-moving spirit is
an apt description, because this disorder represents a chronic cyclical
pattern of mood disturbance characterized by mild mood swings lasting
at least two years (one year for children and adolescents). Cyclothymic
disorder (also called cyclothymia) usually begins in late adolescence or
early adulthood and persists for years. Few, if any, periods of normal
mood last for more than a month or two. However, the periods of
elevated or depressed mood are not severe enough to warrant a diagnosis
of bipolar disorder. Although cyclothymic disorder may be the most
common of the bipolar disorders, with reported prevalence rates ranging
from about 0.4% to 1.0%, it tends to be under diagnosed in clinical
practice (APA, 2013).
Check your Progress
3. What is hypochondriasis?
4. What is mood disorders?
5. What is dysthemia?

5.6 Let’s Sum up

Anxiety consists of three components. The physiological
components include sympathetic nervous system activation.
The cognitive or subjective component consists of negative thoughts,
impulses, or images and a subjective feeling of anxious distress. The
behavioral component is defined by escape from or avoidance of objects,
situations, or events that create anxious distress. Anxiety is a common
experience, and certain fears are common at various ages. However, to
be considered an anxiety disorder, the fear or anxiety must cause
significant distress and/or create functional impairment by interfering
with common life activities. Anxiety disorders develop in many different
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ways. Results of studies in molecular genetics, neurochemistry, and
neuro-anatomy are now allowing researchers and clinicians to make
advances in basic neuroscience and are providing unique insights into
brain functioning.
Somatoform disorders are defined by the presence of physical
symptoms or concerns about an illness that cannot be explained by an
established medical or psychological disorder. Biological, psychological,
and environmental factors may play a role in the onset of somatoform
disorders. Dissociative disorders involve disruption in the integrated
functions of consciousness, memory, identity, or perception, as in
depersonalization, derealization, amnesia, or confusion or alteration of
identity. Dissociative disorders are a controversial category of
psychological dysfunction.
Mood disorders are disturbances in mood that are unusually
prolonged or severe and serious enough to impair daily functioning.
Mood disorders are divided into two major types: (1) unipolar disorders
(major depressive disorder, persistent depressive disorder, and
premenstrual dysphoric disorder, all of which are characterized by a
downward mood disturbance); and (2) bipolar disorders (bipolar
disorder and cyclothymic disorder), which are characterized by mood
swings.
5.7 Unit End Exercise
1. Describe the physical, behavioral, and cognitive features of anxiety
disorders.
2. Describe the key features and specific types of phobic disorders
and explain how phobias develop.
3. Describe the key features of obsessive–compulsive disorder.
4. Describe the key features of somatic disorders.
5. Describe the key features of bipolar disorder and cyclothymic
disorder.
6. Describe the key features of persistent depressive disorder.

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5.8 Answers for check your Progress

1. The key feature of generalized anxiety disorder (GAD) is

excessive worry occurring more days than not and lasting at least 6
months
2. OCD is a condition involving obsessions (intrusive thoughts),
often combined with compulsions (repetitive behaviors) that can be
extensive, time consuming, and distressful.
3. People with hypochondriasis do not necessarily suffer from
physical symptoms. Rather, they have a dysfunctional mind-set that
leads to worry about health, illness, and physical symptoms.
4. Mood disorders experience disturbances in mood that are
unusually severe or prolonged and impair their ability to function in
meeting their normal responsibilities.
5. Persons with persistent depressive disorder may have either
chronic major depressive disorder or a chronic but milder form of
depression called dysthymia.
5.9 Suggested Readings
1. Butcher, J.N. (2014). Abnormal Psychology. New Delhi: Pearson
Education.
2. Butcher, J.N., Hooley, J. M., Mineka, S &Dwivedi, C.B. (2017).
Abnormal Psychology 16th ed. Noida: Pearson.

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UNIT- 6
PSYCHOSIS: PERSONALITY AND DEVELOPMENTAL
DISORDER 
 
Structure
6.1 Introduction
6.2 Objectives
6.3 Personality disorder
6.3.1 Symptoms
6.3.2 Cluster A personality Disorder
6.3.3 Cluster B personality Disorder
6.3.4 Cluster C personality Disorder
6.4 Cognitive Disorder
6.4.1 Symptoms
6.4.2 Types of cognitive disorder
6.5 Developmental disorder
6.5.1 Symptoms
6.5.2 Types of Developmental Disorder
6.6 Let’s sum up
6.7 Unit End Exercise
6.8 Answers for Check Your Progress
6.9 Suggested Readings
INTRODUCTION
In this unit we are discussing about various abnormal behaviors
such as personality disorder, cognitive disorders and developmental
disorder. Personality traits are influenced by various factors such as
genetic, parenting style, environment etc. The personality disorder
changes the entire lifestyle of the person. The impact of personality
disorder is long lasting one. Second one is cognitive disorder, generally

61
it is known as old age problem. When the age increases the severity of
the diseases also increased. There is no proven medicine for this disease.
The last one is Developmental disorder. It affects during the
developmental phase of the child. It creates lot of worries to the parents
and teachers. Managing these children is a challenging one. 
Objectives
By the end of this unit, you will be able to understand the following
abnormal behavior
 Personality disorder
 Cognitive disorder
 Developmental disorder
PERSONALITY DISORDER
Personality disorders are considered separately from other forms of
psychopathology in DSM-IV-TR. Most clinical disorders are listed on
Axis I, whereas the personality disorders are listed on Axis II. All of the
personality disorders are based on exaggerated personality traits that are
frequently disturbing or annoying to other people The pattern must be
evident in two or more of the following domains: cognition (such as
ways of thinking about the self and other people), emotional responses,
interpersonal functioning, or impulse control. This pattern of
maladaptive experience and behavior must also be 1.Inflexible and
pervasive across a broad range of personal and social situations. 2. The
source of clinically significant distress or impairment in social,
occupational, or other important areas of functioning. 3. Stable and of
long duration, with an onset that can be traced back at least to
adolescence or early adulthood. The concept of social dysfunction plays
an important role in the definition of personality disorders. It provides a
large part of the justification for defining these problems as mental
disorders.

Symptoms
The specific symptoms that are used to define personality disorders
represent maladaptive variations in several of the building blocks of
62
personality. These include motives, cognitive perspectives regarding the
self and others, temperament, and personality traits.

Social Motivation
The concept of a motive refers to a person’s desires and goals.
Motives (either conscious or unconscious) describe the way that the
person would like things to be, and they help to explain why people
behave in a particular fashion. For example, a man might have neglected
to return a telephone call because he wanted to be alone (rather than
because he forgot that someone had called). Two of the most important
motives in understanding human personality are affiliation—the desire
for close relationships with other people—and power—the desire for
impact, prestige, or dominance. Individual differences with regard to
these motives have an important influence on a person’s health and
adjustment. Many of the symptoms of personality disorders can be
described in terms of maladaptive variations with regard to needs for
affiliation and power

Cognitive Perspectives Regarding Self and Others

Our social world also depends on mental processes that determine
knowledge of ourselves and other people. Distortions of these
mechanisms are associated with personality disorders are described in
terms of maladaptive variations with regard to needs for affiliation and
power. When we misperceive the intentions and motives and abilities of
other people, our relationships can be severely disturbed.
Paranoid beliefs are one example
Temperament and Personality Traits
If motivation helps to explain why people behave in certain ways,
temperament and personality traits describe how they behave.
Temperament refers to a person’s most basic, characteristic styles of
relating to the world, especially those styles that are evident during the
first year of life Problems may arise in association with extreme
variations in either direction (high or low). Dramatically elevated levels
of anger–hostility, impulsiveness, and excitement seeking are

63
particularly important, as are extremely low levels of trust, compliance,
and tender mindedness.

Context and Personality

Two important qualifications must be made about the development
and persistence of individual differences in temperament and
personality. First, these differences may not be evident in all situations.
Some important personality features may be expressed only under
certain challenging circumstances that require or facilitate a particular
response.
Personality disorders are divided into three groups. They are cluster A,
cluster B cluster C
Cluster A Personality Disorders
Cluster A includes three disorders: paranoid, schizoid, and
schizotypal forms of personality disorder. The behavior of people who
fit the subtypes in this cluster is typically odd, eccentric, or asocial.
Paranoid personality disorder is characterized by the pervasive
tendency to be inappropriately suspicious of other motives and
behaviors.
Schizoid personality disorder is defined in terms of a pervasive pattern
of indifference to other people, coupled with a diminished range of
emotional experience and expression. These people are loners; they
prefer social isolation to interactions with friends or family.
Schizotypal personality disorder Centers around peculiar patterns of
behavior rather than on the emotional restriction and social withdrawal
that are associated with schizoid personality disorder. Many of these
peculiar behaviors take the form of perceptual and cognitive disturbance.

Cluster B Personality Disorder

Cluster B includes antisocial, borderline, histrionic, and narcissistic
personality disorders. These disorders are characterized by dramatic,
emotional, or erratic behavior.

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Antisocial personality disorder is defined in terms of a persistent
pattern of irresponsible and antisocial behavior that begins during
childhood or adolescence and continues into the adult years.

Borderline personality disorder is a diffuse category whose essential

feature is a pervasive pattern of instability in mood and interpersonal
relationships. People with this disorder find it very difficult to be alone.

Histrionic personality disorder is characterized by a pervasive pattern

of excessive emotionality and attention seeking behavior. People with
this disorder thrive on being the center of attention.

Cluster C Personality disorder

Cluster C includes avoidant, dependent, and obsessive–compulsive
personality disorders. The common element in all three disorders is
presumably anxiety or fearfulness.
Avoidant personality disorder is characterized by a pervasive pattern
of social discomfort, fear of negative evaluation, and timidity. People
with this disorder tend to be socially isolated when outside their own
family circle because they are afraid of criticism.
Dependent personality disorder is a pervasive pattern of submissive
and clinging behavior. People with this disorder are afraid of separating
from other people on whom they are dependent for advice and
reassurance.
Obsessive–compulsive personality disorder (OCPD) is defined by a
pervasive pattern of orderliness, perfectionism, and mental and
interpersonal control, at the expense of flexibility, openness, and
efficiency. People with this disorder set ambitious standards for their
own performance that frequently are so high as to be unattainable.
Check Your Progress
1. What is cluster A personality disorder?
2. Name the personality disorders in cluster C

65
COGNITIVE DISORDER
Introduction:
Dementia and delirium are the most frequent disorders found
among elderly psychiatric patients. It is a clinical syndrome that involves
progressive impairment of many cognitive abilities. Cognitive
processes, including perception and attention, are related to many types
of mental disorders Cognitive disorders are often associated with
specific identifiable changes in brain tissue. Because of the close link
between cognitive disorders and brain disease, patients with these
problems are often diagnosed and treated by neurologists, physicians
who deal primarily with diseases of the brain and the nervous system.
Multidisciplinary clinical teams study and provide care for people with
dementia and amnestic disorders. Neuropsychologists have particular
expertise in the assessment of specific types of cognitive impairments.
This is true for clinical assessments as well as for more detailed
laboratory studies for research purposes.
Dementia, delirium, and amnestic disorders are listed as Cognitive
Disorders in DSM-IV-TR.
Dementia is a gradual worsening loss of memory and related
cognitive functions, including the use of language, as well as reasoning
and decision making. It is a clinical syndrome that involves progressive
impairment of many cognitive abilities
Delirium is a confusion state that develops over a short period of
time and is often associated with agitation and hyperactivity. The most
important symptoms of delirium are disorganized thinking and a reduced
ability to maintain and shift attention (Gupta et al., 2008).
Delirium and dementia are produced by very different processes.
Dementia is a chronic, deteriorating condition that reflects the
gradual loss of neurons in the brain. Delirium is caused by medical
problems, such as infection, or of the side effects of medication.
Amnestic disorders experience memory impairments that are
more limited than those seen in dementia or delirium. The person loses
the ability to learn new information or becomes unable to recall
previously learned information, but other higher level cognitive
abilities—including the use of language are unaffected.
66
Check Your Progress
3. What is Dementia?
4. What is Delirium?

DEVELOPMENTAL DISORDER
Introduction
Childhood is considered particularly important because the brain
changes significantly for several years after birth; this is also when
critical developments occur in social, emotional, cognitive, and other
important competency areas. These changes mostly follow a pattern:
The child develops one skill before acquiring the next. Although this
pattern of change is only one aspect of development, it is an important
concept at this point because it implies that any disruption in the
development of early skills will, by the very nature of this sequential
process, disrupt the development of later skills.

Attention Deficit/Hyperactivity Disorder

Do you know people who flit from activity to activity, who start
many tasks but seldom finish one, who have trouble concentrating, and
who don’t seem to pay attention when others speak? These people may
have attention deficit/ hyperactivity disorder (ADHD), one of the
most common reasons children are referred for mental health services in
the United States (Durand, 2011; Greenhill & Hechtman, 2009). The
primary characteristics of such people include a pattern of inattention,
such as not paying attention to school- or work-related tasks, or of
hyperactivity and impulsivity. These deficits can significantly disturb
academic efforts and social relationships.
DSM IV-TR differentiates three types of symptoms. The first
includes problems of inattention. People may appear not to listen to
others; they may lose necessary school assignments, books, or tools; and
they may not pay enough attention to details, making careless mistakes.
The second type of symptom includes hyperactivity, which includes
67
fidgeting, having trouble sitting for any length of time, and always being
on the go. The third general symptom is impulsivity, which includes
blurting out answers before questions have been completed and having
trouble waiting.
Learning disorder
Parents often invest a great deal of time, resources, and emotional
energy to ensure their children’s academic success, it can be extremely
upsetting when a child with no obvious intellectual deficits does not
achieve as expected. In this section, we describe learning disorders in
reading, mathematics, and written expression—all characterized by
performance that is substantially below what would be expected given
the person’s age, intelligence quotient (IQ) score, and education.
Similarly, DSM-IV-TR defines a mathematics disorder as achievement
below expected performance in mathematics and defines a disorder of
written expression as achievement below expected performance in
writing. In each of these disorders, the difficulties are sufficient to
interfere with the students’ academic achievement and to disrupt daily
activities. People with pervasive developmental disorders experience
problems with language, socialization, and cognition (Durand, 2011).
The word pervasive means that these problems are not relatively minor
but significantly affect individuals throughout their lives. Included under
the heading of pervasive developmental disorders are autistic disorder
(or autism), Asperger’s disorder, Rett’s disorder, childhood is integrative
disorder, and pervasive developmental disorder not otherwise specified.
We focus on two of the more prevalent pervasive developmental
disorders—autistic disorder and Asperger’s disorder;
Autistic Disorder
Autistic disorder (autism) is a childhood disorder characterized
by significant impairment in social interactions and communication and
by restricted patterns of behavior, interest, and activities (Durand, 2011).
Individuals with this disorder have a puzzling array of symptoms. Three
major characteristics of autism are expressed in DSM-IV-TR:
impairment in social interactions; impairment in communication; and
restricted behavior, interests, and activities (American Psychiatric
Association, 2000).
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 Asperger’s Disorder
Asperger’s disorder involves a significant impairment in the ability
to engage in meaningful social interaction, along with restricted and
repetitive stereotyped behaviors but without the severe delays in
language or other cognitive skills characteristic of people with autism
(American Psychiatric Association, 2000). First described by Hans
Asperger in 1944, it was Lorna Wing in the early 1980s who
recommended that Asperger’s disorder be reconsidered as a separate
disorder from autism, with an emphasis on the unusual and limited
interests (such as train schedules) displayed by these individuals
(Volkmar et al., 2009).
Intellectual disability
ID (previously referred to as mental retardation) is a disorder evident in
childhood as significantly below-average intellectual and adaptive
functioning (Toth & King, 2010). People with intellectual disability
experience difficulties with day-to-day activities to an extent that reflects
both the severity of their cognitive deficits and the type and amount of
assistance they receive. We already studied detailed in previous unit.
Check Your Progress
5. What is Asperger’s Syndrome?
6. What is Autism?

Let’s Sum Up
DSM-IV-TR includes 10 personality disorders that are divided into
three clusters: Cluster A (odd or eccentric) includes paranoid, schizoid,
and schizotypal personality disorders; Cluster B (dramatic, emotional, or
erratic) includes antisocial, borderline, histrionic, and narcissistic
personality disorders; and Cluster C (anxious or fearful) includes
avoidant, dependent, and obsessive compulsive personality disorders.
Schizophrenia is characterized by a broad spectrum of cognitive and
emotional dysfunctions that include delusions and hallucinations,
disorganized speech and behavior, and inappropriate emotions.
The symptoms of schizophrenia can be divided into positive,
negative, and disorganized. Positive symptoms are active manifestations
of abnormal behavior, or an excess or distortion of normal behavior, and
69
include delusions and hallucinations. Negative symptoms involve
deficits in normal behavior on such dimensions as affect, speech, and
motivation. Disorganized symptoms include rambling speech, erratic
behavior, and inappropriate affect. A number of causative factors have
been implicated for schizophrenia, including genetic influences,
neurotransmitter imbalances, structural damage to the brain caused by a
prenatal viral infection or birth injury, and psychological stressors.
Delirium is a temporary state of confusion and disorientation that can be
caused by brain trauma, intoxication by drugs or poisons, surgery, and a
variety of other stressful conditions, especially among older adults.
Dementia is a progressive and degenerative condition marked by gradual
deterioration of a range of cognitive abilities including memory,
language, and planning, organizing, sequencing, and abstracting
information. Alzheimer’s disease is the leading cause of dementia,
affecting approximately 4 million Americans; there is currently no
known cause or cure. Amnestic disorders involve a dysfunction in the
ability to recall recent and past events. The most common is Wernicke-
Korsakoff syndrome, a memory disorder usually associated with chronic
alcohol abuse.
Developmental psychopathology is the study of how disorders
arise and change with time. These changes usually follow a pattern, with
the child mastering one skill before acquiring the next. This aspect of
development is important because it implies that any disruption in the
acquisition of early skills will, by the very nature of the developmental
process, also disrupt the development of later skills.
Unit End Exercise
1. Explain pervasive developmental disorders
2. What is cognitive disorders? Explain.
3. What is Antisocial personality disorder? Explain with examples.
4. Describe Intellectual disability
Answers for check your progress
1. Cluster A includes three disorders: paranoid, schizoid, and
schizotypal forms of personality disorder. The behavior of people
who fit the subtypes in this cluster is typically odd, eccentric, or
asocial.
70
 2.Cluster C includes avoidant, dependent, and obsessive–
compulsive personality disorders
3. Dementia is a chronic, deteriorating condition that reflects the
gradual loss of neurons in the brain.
4. Delirium is caused by medical problems, such as infection, or of
the side effects of medication.
5. Asperger’s disorder involves a significant impairment in the
ability to engage in meaningful social interaction, along with
restricted and repetitive stereotyped behaviors but without the
severe delays in language or other cognitive skills characteristic of
people with autism.
6. Autistic disorder (autism) is a childhood disorder characterized
by significant impairment in social interactions and
communication and by restricted patterns of behavior, interest, and
activities .
Suggested Readings
1. Carson, r.c., Butcher, J.N and Mineka, S.(2004). Abnormal
psychology. 13th Edition.
New Delhi: Pearson education.
2. Barlow, D.H. and Durand, M.V. (2000). Abnormal psychology. 2nd
Edition. New Delhi:
3. Sue, D., Sue,, D and Sue. S. (1990). Understanding Abnormal
behavior. 3rd Edition, Houghton Miffin Co.
4. Davidson and Neal (1996). Abnormal psychology. Revised 6th
Edition, John Wiley sons

71
UNIT 7
THE CONSUMER DECISION MAKING PROCESS
Structure
7.1 Introduction
7.2 Objective
7.3 Decision making
7.3.1 Steps of decision making
7.3.2 Decision environment
7.3.3 Types of decision
7.3.4 Decision making model
7.4 Communication process
7.4.1 Non verbal communication
7.4.2 Communication barriers
7.5 Leadership
7.5.1 Types of leadership
7.5.2 Importance of leadership
7.6 Let’s sum up
7.7 Unit end exercise
7.8 Answer for check your progress
7.9 Suggested Reading

7.1 Introduction
Decision making is essential phenomena in human life. In daily
activities we have to make decisions for simple to complex activities.
The success and failure of any endeavor depends upon the decision we
make. Communication and leadership are the two factors which helps
the individual to make decision wisely.

72
7.2 Objectives
On completion of this unit, you will be able to understand the following
concepts
 Decision making
 Communication
 Leadership

7.3 Decision Making Process

Decisions are responses to problems— differences between what is
and what could or should be. These problems can vary in importance
from figuring out which job you should accept after graduation to
deciding which brand of toothpaste to buy.

7.3.1 7 SIX STEPS OF DECISION MAKING

1 Recognize and define the problem: Perceiving a discrepancy
between what is and what could or should be is called problem
recognition and provides the foundation for all individual decision
making. Defining the problem correctly is critical to successful
individual decision making. However, because problem recognition is a
perceptual process, managers do not always accurately assess the
problems at hand.
There are several reasons they make this mistake: (a) They define the
problem by available solutions, (b) they focus on aspects of problems
they know they can solve and ignore larger, more difficult, issues, or (c)
they diagnose problems in terms of the most obvious symptoms..
2. Identify and weight criteria: The rational decision maker identifies
criteria necessary to make a decision. Given that most decisions require
accomplishing more than one objective, the criteria must also be
weighted to determine the relevant value of each identified criterion.
3. Search for information: If a perceived discrepancy is important, then
the decision maker will implement a third stage of the decision-making
process: determining why the problem occurred. This involves gathering
information about the problem or discrepancy and possible ways to
solve it. At the end of this process, the decision maker should have a

73
clear understanding of the problem and should have collected sufficient
information to begin the fourth phase of the decision-making process.
4. Generate alternatives: In this phase of individual decision making,
the decision maker develops or identifies potential courses of action.
This phase requires transforming the information that was previously
gathered into a set of alternatives. Identifying these alternatives is a
difficult task that requires considerable creativity and mental flexibility
5. Compute the optimal decision: When a sufficient number of
alternatives have been identified, it's time to evaluate them and make a
choice. Either the decision maker can compare each alternative to every
other alternative, or the decision maker can weigh each alternative in the
con-text of the desired goal.
6. Implement and assess the decision: When a choice has been made,
the decision maker must implement the decision. The process of making
a choice is important, but decisions are worthless unless implemented.

7.3.2 DECISION ENVIRONMENTS

Problem-solving decisions are typically made under three different
conditions or environments: certainty, risk, and uncertainty. Certain
environments exist when information is sufficient to predict the results
of each alternative in advance of implementation. When a person invests
money in a savings account, for example, absolute certainty exists about
the interest that will be earned on that money in a given period of time.
Certainty is an ideal condition for managerial problem solving and
decision making. The challenge is simply to locate the alternative
offering the best or ideal solution.
Risk environments exist when decision makers lack complete certainty
regarding the outcomes of various courses of action, but they are aware
of the probabilities associated with their occurrence. A probability, in
turn, is the degree of likelihood of an event’s occurrence. Probabilities
can be assigned through objective statistical procedures or through
personal intuition. Uncertain environments exist when managers have
so little information on hand that they cannot even assign probabilities to
various alternatives and their possible outcomes. This is the most
difficult of the three decision environments. Uncertainty forces decision
74
makers to rely heavily on individual and group creativity to succeed in
problem solving. It requires unique, novel, and often totally innovative
alternatives to existing patterns of behavior. Responses to uncertainty
are often heavily influenced by intuition, educated guesses, and hunches.

7.3.3 TYPES OF DECISIONS

The many routine and non routine problems in the modern
workplace call for different types of decisions. Routine problems arise
on a regular basis and can be addressed through standard responses,
called programmed decisions. These decisions simply implement
solutions that have already been determined by past experience as
appropriate for the problem at hand. Examples of programmed decisions
are reordering inventory automatically when stock falls below a
predetermined level. Non routine problems are unique and new, having
never been encountered before. Because standard responses are not
available, these circumstances call for creative problem solving.
These non programmed decisions are specifically crafted or
tailored to the situation at hand. Higher level managers generally spend a
greater proportion of their decision-making time on non routine
problems. An example is a senior marketing manager who has to
respond to the introduction of a new product by a foreign competitor.
Although past experience may help deal with this competitive threat.
Associative choices are decisions that can be loosely linked to
nagging continual problems but that were not specifically developed to
solve the problem. Given the chaotic nature of the setting, the necessity
to take action as opposed to waiting, and the ability of employees to
make nearly any “decision” work, a stream of associative choices may
be used to improve the setting, even though the problems are not solved.

7.3.4 Decision Making Models

The field of organizational behavior historically emphasizes two
alternative approaches to decision making—classical and behavioral
theory.
Classical decision theory models view the manager as acting in a world
of complete certainty. Behavioral decision theory models accept the
75
notion of bounded rationality and suggest that people act only in terms
of what they perceive about a given situation.
CLASSICAL AND BEHAVIORAL DECISION THEORY
Ideally, the manager faces a clearly defined problem, knows all
possible action alternatives and their consequences, and then chooses the
alternative that offers the best, or “optimum,” solution to the problem.
This optimizing style is an ideal way to make decisions. This classical
approach is normative and prescriptive, and is often used as a model for
how managers should make decisions. Behavioral scientists are cautious
about applying classical decision theory to many decision situations.
They recognize that the human mind is a wonderful creation, capable of
infinite achievements.
Human decision makers also operate with bounded rationality.
Bounded rationality is a short-hand term suggesting that, while
individuals are reasoned and logical, humans have their limits.
Individuals interpret and make sense of things within the context of their
personal situation. They engage in decision making “within the box” of
a simplified view of a more complex reality. This makes it difficult to
realize the ideal of classical decision making.
Behavioral decision theory models accept the notion of bounded
rationality and suggest that people act only in terms of what they
perceive about a given situation. Because these perceptions are
frequently imperfect, most organizational decision making does not take
place in a world of complete certainty. Rather, the behavioral decision
maker is viewed as acting most often under uncertain conditions and
with limited information. Organizational decision makers face problems
that are often ambiguous, and they have only partial knowledge of the
available action alternatives and their consequences.

THE GARBAGE CAN MODEL

A third view of decision making stems from the so-called garbage
can model. In this view, the main components of the choice process—
problems, solutions, participants, and choice situations—are all mixed
up together in the “garbage can” of the organization. In many
organizations where the setting is stable and the technology is well
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known and fixed, tradition, strategy, and the administrative structure
help order the contents of the garbage can. Specific problems can be
matched to specific solutions, an orderly process can be maintained, and
the behavior view of decision making may be appropriate.
But when the setting is dynamic, the technology is changing, demands
are conflicting or the goals are unclear, things can get mixed up. More
action than thinking can take place. Solutions emerge as “potential
capabilities”—capabilities independent of problems or opportunities.
Solutions often emerge not to solve specific problems but as lessons
learned from the experience of other organizations.
Choice making and implementation may be done by quite different
individuals. Often, the job of subordinates is to make the decisions of
senior manager work. They must interpret the intentions of their bosses
as well as solve local problems. Implementation becomes an opportunity
to instill many changes related to the choice of more senior executives.
So what is chosen gets implemented along with many other changes.
Check your Progress
1. What is certain environment?
2. What is programmed decision?

7.4 THE COMMUNICATION PROCESS

It is useful to think of communication as a process of sending and
receiving, messages with attached meanings. They include a source,
who encodes an intended meaning into a message, and a receiver, who
decodes the message into a perceived meaning. The receiver may or may
not give feedback to the source. Though this process may appear to be
very elementary, it is not quite as simple as it looks. The information
source is a person or group trying to communicate with someone else.
The source seeks to communicate, in part, to change the attitudes,
knowledge, or behavior of the receiver.
This involves encoding— the process of translating an idea or
thought into a message consisting of verbal, written, or nonverbal
symbols (such as gestures), or some combination of them. Such
messages are transmitted through various communication channels,
such as face-to-face meetings, electronic mail and other forms, written
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letters or memorandums, and telephone communications or voice-mail,
among others. The choice of channel can have an important impact on
the communication process. Some people are better at using certain
channels over others, and some messages are better handled by specific
channels.
The communication process is not completed just because a
message is sent. The receiver is the individual or group of individuals to
whom a message is directed. In order for meaning to be assigned to any
received message, its contents must be interpreted through decoding.
This process of translation is complicated by many factors, including the
knowledge and experience of the receiver and his or her relationship
with the sender. A message may also be interpreted with the added
influence of other points of view, such as those offered by friends,
coworkers, or organizational superiors. Ultimately, the decoding may
result in the receiver interpreting a message in a way that is different
from that originally intended by the source.

Essentials of Interpersonal Communication

Organizations today are information rich. They are also
increasingly “high-tech.” But, we always need to remember that people
still drive the system. And if people are to work together well and
commit their mutual talents and energies to create high performance
organizations, they must excel at interpersonal communication.
EFFECTIVE AND EFFICIENT COMMUNICATION
When people communicate with one another, at least two
important things are at issue. One is the accuracy of the
communication—an issue of effectiveness; the other is its cost—an issue
of efficiency.
Effective communication occurs when the intended meaning of
the source and the perceived meaning of the receiver are virtually the
same. Although this should be the goal in any communication, it is not
always achieved. Even now, we worry about whether or not you are
interpreting these written words exactly as we intend. Our confidence
would be higher if we were face to face in class together and you could
ask clarifying questions. Opportunities to offer feedback and ask
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questions are important ways of increasing the effectiveness of
communication.
Efficient communication occurs at minimum cost in terms of
resources expended. Time, for example, is an important resource.
As efficient as these forms of communication may be, they are not
always effective. A change in policy posted by efficient E-mail may
save time for the sender, but it may not achieve the desired
interpretations and responses. Similarly, an effective communication
may not be efficient. For a business manager to visit each employee and
explain a new change in procedures may guarantee that everyone
understands the change, but it may also be prohibitively expensive in
terms of the required time expenditure.

7.4.1 NONVERBAL COMMUNICATION

We all know that people communicate in ways other than the
spoken or written word. Indeed, nonverbal communication that takes
place through facial expressions, body position, eye contact, and other
physical gestures is important both to understand and master. It is
basically the act of speaking without using words. The nonverbal side to
communication can often hold the key to what someone is really
thinking or meaning. It can also affect the impressions we make on
others. Interviewers, for example, tend to respond more favorably to job
candidates whose nonverbal cues, such as eye contact and erect posture,
are positive than to those displaying negative nonverbal cues, such as
looking down or slouching. The art of impression management during
interviews and in other situations requires careful attention to both
verbal and nonverbal aspects of communication, including one’s dress,
timeliness, and demeanor. Nonverbal communication can also take place
through the physical arrangement of space, such as that found in various
office layouts. Proxemics, the study of the way space is utilized, is
important to communication.
ACTIVE LISTENING
The ability to listen well is a distinct asset to anyone whose job
involves a large proportion of time spent “communicating” with other
people. After all, there are always two sides to the communication
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process: (1) sending a message, or “telling,” and (2) receiving a
message, or “listening.” There is legitimate concern that too many
people emphasize the telling and neglect the listening. Everyone in the
new workplace should develop good skills in active listening—the
ability to help the source of a message say what he or she really means.
The concept comes from the work of counselors and therapists, who are
trained to help people to express themselves to others and talk about
things that are important to them.

7.4.2 COMMUNICATION BARRIERS

It is important to understand six sources of noise that are common
to most interpersonal exchanges: physical distractions, semantic
problems, mixed messages, cultural differences, absence of feedback,
and status effects.
PHYSICAL DISTRACTIONS
Any number of physical distractions can interfere with the
effectiveness of a communication attempt. Physical interruptions such
as telephone, drop-in visitors, and the like, should be prevented.
SEMANTIC PROBLEMS
Semantic barriers to communication involve a poor choice or use
of words and mixed messages. Carefully read the following instructions,
“We solicit any recommendations that you wish to make, and you may
be assured that any such recommendations will be given our careful
consideration.” One has to wonder why these messages weren’t stated
more simply as: “Send us your recommendations. They will be carefully
considered,” In this regard, the popular KISS principle of
communication is always worth remembering: “Keep it short and
simple.”
MIXED MESSAGES
Mixed messages occur when a person’s words communicate one
thing while actions or “body language” communicate another. They are
important to spot since nonverbal can add important insight into what is
really being said in face-to-face communication. For instance, someone
may voice a cautious “Yes” during a business meeting at the same time

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that her facial expression shows stress and she begins to lean back in her
chair.
CULTURAL DIFFERENCES
People must always exercise caution when they are involved in
cross-cultural communication—whether between persons of different
geographical or ethnic groupings within one country, or between persons
of different national cultures. The difficulties with cross-cultural
communication are perhaps most obvious in respect to language
differences. Gestures may also be used quite differently in the various
cultures of the world. For example, crossed legs in the United Kingdom
are quite acceptable, but are rude in Saudi Arabia if the sole of the foot
is directed toward someone.
ABSENCE OF FEEDBACK
One-way communication flows from sender to receiver only, as in
the case of a written memo or a voice-mail message. There is no direct
and immediate feedback from the recipient. Two-way communication,
by contrast, goes from sender to receiver and back again. It is
characterized by the normal interactive conversations in our daily
experiences. Research indicates that two-way communication is more
accurate and effective than is one-way communication. One-way
messages are easy for the sender but often frustrating for the receiver,
who may be left unsure of just what the sender means or wants done.
STATUS EFFECTS
Status differences in organizations create potential communication
barriers between persons of higher and lower ranks. On the one hand,
given the authority of their positions, managers may be inclined to do a
lot of “telling” but not much “listening.” On the other hand, we know
that communication is frequently biased when flowing upward in
organizational hierarchies. Subordinates may filter information and tell
their superiors only what they think the boss wants to hear. The higher
level decision maker may end up taking the wrong actions because of
biased and inaccurate information supplied from below. This is
sometimes called the MUM effect in reference to tendencies to
sometimes keep “mum” from a desire to be polite and a reluctance to
transmit bad news.
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Check your Progress
3. What is encoding?
4. What is nonverbal communication?
5. What is proxemics?

7.5 LEADERSHIP
Yukl and Van Fleet (1992) define leadership as ‘‘a process that
includes influencing the task objectives and strategies of an
organization, influencing people in the organization to implement the
strategies and achieve the objectives, influencing the group maintenance
and identification, and influencing the culture of the organization.
Vroom and Jago (2007) have recently defined leadership more
succinctly as ‘‘a process of motivating people to work together
collaboratively to accomplish great things’. There are several things to
note about these definitions. First, leadership involves the influencing of
others’ behaviors. Second, leadership is viewed as a process and not as
an outcome. It is possible, based on this definition, for a leader to engage
in unsuccessful influence attempts. Third, these definitions imply that
leadership requires a variety of skills. Influencing task objectives and
strategy may require strong analytical and conceptual skills; influencing
people to implement those strategies and objectives requires
interpersonal and persuasive skills.
Trait Leadership Perspectives
For over a century scholars have attempted to identify the key
characteristics that separate leaders from non leaders. Much of this work
stressed traits. Trait perspectives assume that traits play a central role
in differentiating between leaders and non leaders in that leaders must
have the “right stuff.” The great person-trait approach reflects the
attempt to use traits to separate leaders from non leaders. This list of
possible traits identified only became longer as researchers focused on
the leadership traits linked to successful leadership and organizational
performance. Key traits of leaders include ambition, motivation,
honesty, self-confidence, and a high need for achievement. Leaders must
be able to deal with the large amount of information they receive on a
regular basis. They do not need to be brilliant, but usually exhibit above-
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average intelligence. In addition, leaders have a good understanding of
their social setting and possess extensive knowledge concerning their
industry, firm, and job.
Behavioral Leadership Perspectives
The behavioral perspective assumes that leadership is central to
performance and other outcomes. However, instead of underlying traits,
behaviors are considered. Two classic research programs—at the
University of Michigan and at the Ohio State University— provide
useful insights into leadership behaviors.
Michigan Studies In the late 1940s, researchers at the University of
Michigan sought to identify the leadership pattern that results in
effective performance. From interviews of high- and low-performing
groups in different organizations, the researchers derived two basic
forms of leader behaviors: employee-centered and production-centered.
Employee-centered supervisors are those who place strong emphasis on
their subordinates’ welfare. In contrast, production-centered supervisors
are more concerned with getting the work done. In general, employee
centered supervisors were found to have more productive workgroups
than did the production-centered supervisors.
Ohio State Studies At about the same time as the Michigan studies, an
important leadership research program began at the Ohio State
University. A questionnaire was administered in both industrial and
military settings to measure subordinates’ perceptions of their superiors’
leadership behavior. The researchers identified two dimensions similar
to those found in the Michigan studies: consideration and initiating
structure. A highly considerate leader was found to be sensitive to
people’s feelings and, much like the employee-centered leader, tries to
make things pleasant for his or her followers. In contrast, a leader high
in initiating structure was found to be more concerned with defining task
requirements and other aspects of the work agenda; he or she might be
seen as similar to a production-centered supervisor. These dimensions
are related to what people sometimes refer to as socio-emotional and
task leadership, respectively.

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7.5.1 TYPES OF LEADERS
Leadership appears in two forms: (1) formal leadership, which is exerted
by persons appointed or elected to positions of formal authority in
organizations, and (2) informal leadership, which is exerted by persons
who become influential because they have special skills that meet the
needs of others.
Directive leadership has to do with spelling out the subordinates’ tasks;
it is much like the initiating structure mentioned earlier.
Supportive leadership focuses on subordinate needs and well-being
and on promoting a friendly work climate; it is similar to consideration.
Achievement oriented leadership emphasizes setting challenging
goals, stressing excellence in performance, and showing confidence in
the group members’ ability to achieve high standards of performance.
Participative leadership focuses on consulting with subordinates, and
seeking and taking their suggestions into account before making
decisions.
7.5.2 The importance of Leaders
Leaders are often needed to provide strategic direction and vision
to groups and, in many cases, to entire organizations (Bass,
1998). Work-group members are often too busy with routine task
completion, and with meeting deadlines, to think about where the group
is headed in the future. In many groups, strategic planning and visioning
activities are shared among group members, but the leader is typically
the focal point of such efforts. In a sense, then, leaders help
organizations to channel productive behavior in directions that are
beneficial and that meet relevant strategic objectives. Another important
function of leaders, particularly those in small groups, is to engage in
motivation and coaching behaviors. Even highly experienced employees
occasionally need encouragement and, in some cases, help in solving
difficult work related problems. A third important function of leaders in
organizations is enforcement and interpretation of organizational
policies. For most employees, leaders serve as ‘‘linking pins’’ to people
in higher levels of the organization (Likert, 1967). Because of this
concept, leaders are often required to interpret and enforce
organizational policies. Finally, leaders are important because they are
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typically responsible for obtaining resources for groups. Leaders
essentially represent the interests of their work groups within the broader
organizational environment. Because of this, groups often rely heavily
on the persuasive skills of leaders to obtain resources for task
completion. Without a leader, the members of a group may all be trying
to obtain resources and, at times, may get in each other’s way.

7.6 Let’s Sum Up

Because human beings make thousands of decisions every day, the
process of decision making appears to be deceptively simple. On closer
examination, however, it becomes clear that when done well, decision
making is often difficult and time-consuming. Although we would like
to perceive our decision making processes as rational, we are unable to
meet the cognitive and information demands necessary to always reach
optimal solutions. Although the demands of rationality exceed the
capabilities of human decision makers, we must still strive to make
rational decisions. Decision makers use four means to adapt to their
limitations: They conduct local rather than comprehensive alternative
searches; they evaluate alternatives sequentially rather than
simultaneously; they satisfied rather than optimize; and they use
judgmental heuristics to reduce the demands of information processing.
Communication is the process by which information is transmitted
and understood between two or more people. Communication supports
work coordination, organizational learning, decision making, and
employee wellbeing.
The communication process involves forming, encoding, and
transmitting the intended message to a receiver, who then decodes the
message and provides feedback to the sender. Effective communication
occurs when the sender’s thoughts are transmitted to and understood by
the intended receiver. To improve this process, both sender and receiver
should have common codebooks, share common mental models, be
familiar with the message topic, and be proficient with the
communication channel. The two main types of communication
channels are verbal and nonverbal.

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 Several barriers create noise in the communication process. People
misinterpret messages because of perceptual biases. Some information is
filtered out as it gets passed up the hierarchy. Jargon and ambiguous
language are barriers when the sender and receiver have different
interpretations of the words and symbols used. People also screen out or
misinterpret messages due to information overload. These problems are
often amplified in cross-cultural settings because of language barriers
and differences in meanings of nonverbal cues.
Leadership is defined as the ability to influence, motivate, and
enable others to contribute toward the effectiveness and success of the
organizations of which they are members. Leaders use influence to
motivate followers and arrange the work environment so that they do the
job more effectively. Leaders exist throughout the organization, not just
in the executive suite. The competency perspective tries to identify the
characteristics of effective leaders. Recent writing suggests that leaders
have specific personality characteristics, positive self-concept, drive,
integrity, leadership, motivation, knowledge of the business, cognitive
and practical intelligence, and emotional intelligence. The behavioral
perspective of leadership identifies two clusters of leader behavior,
people-oriented and task-oriented. People oriented behaviors include
showing mutual trust and respect for subordinates, demonstrating a
genuine concern for their needs, and having a desire to look out for their
welfare. Task-oriented behaviors include assigning employees to
specific tasks, clarifying their work duties and procedures, ensuring they
follow company rules, and pushing them to reach their performance
capacity.
7.7 Unit End Exercise
1. Explain the decision making model
2. Describe the communication process.
3. Explain the communication barriers.
4. Define leadership and its various types.
5. Explain the characteristics of leaders.

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7.8 Answers for check your progress
1. Certain environments exist when information is sufficient to
predict the results of each alternative in advance of
implementation.
2. Routine problems arise on a regular basis and can be addressed
through standard responses, called programmed decisions.
3. Encoding is the process of translating an idea or thought into a
message consisting of verbal, written, or nonverbal symbols (such
as gestures), or some combination of them.
4. Nonverbal communication that takes place through facial
expressions, body position, eye contact, and other physical
gestures is important both to understand and master the concept.
5. Proxemics, the study of the way space is utilized, is important to
communication.
7.9 Suggested Readings
1. Robert C. Carson &James N. Butcher. (2007). Abnormal Psychology.
Pearson Education Inc. New Delhi.
2. Barlow and Durand. (2006). Abnormal Psychology. New York.
Pearson India Ltd.
3. Sarason and Sarason. (2010). Abnormal Psychology: The Problem of
Maladaptive Behaviour (11th Edition). New Delhi. Prentice Hall of
India Pvt. Ltd.

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UNIT 8
MOOD DISORDER, SCHIZOPHRENIA AND OTHER
PSYCHOTIC DISORDER
Structure
8.1 Introduction
8.2 Objectives
8.3 Mood disorder
8.3.1 Depressive disorder
8.3.2 Causes
8.3.3 Treatment
8.4 Bipolar disorder
8.4.1 Causes
8.4.2 Treatment
8.5 Cyclothymic disorder
8.6 Schizophrenia
8.6.1 Symptoms
8.6.2 Causes
8.6.3 Treatment
8.7 Other schizophrenic spectrum disorder
8.7.1 Brief Psychotic disorder
8.7.2 Schizo affective disorder
8.7.3 Shared psychotic disorder
8.8 Let’s Sum up
8.9 Unit End Exercise
8.10 Answers for check your progress
8.11 Suggested Readings

8.1 INTRODUCTION
Emotion is the important factor in human life. Our behavior mainly
depends upon the emotion. We act according to our emotional state.
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The problem in emotion causes various abnormal behaviors such as
mood disorder, psychotic disorders. These disorders affect individual
personal life as well as the community. It creates serious problem to the
caregivers.
8.2 Objectives
On completion of this unit, You will be able to understand the following
concept
 Depressive disorder
 Bipolar disorder
 Delusional disorder and
 Schizophrenia
8.3 MOOD DISORDER
Mood refers to our emotional state or our prevailing frame of
mind. Our mood can significantly affect our perceptions of the world,
sense of well-being, and interactions with others. Persistent changes in
mood, Two groups of mental disorders involve significant mood
changes—depressive and bipolar disorders.
8.3.1 Depressive Disorders
Depressive disorders, a group of related disorders characterized by
depressive symptoms, include major depressive disorder, persistent
depressive disorder (dysthymia), and premenstrual dysphoric disorder

Diagnosis and Classification of Depressive Disorders

Major depressive disorder (MDD)
According to DSM-5, a major depressive episode involves a
consistent pattern of (a) depressed mood, feelings of sadness, or
emptiness and/or (b) loss of interest or pleasure in previously enjoyed
activities. The individual must also experience at least four additional
changes in functioning involving: significant alteration in weight or
appetite; atypical sleep patterns; restlessness or sluggishness; low
energy; feelings of guilt or worthlessness; difficulty concentrating or
making decisions; or preoccupation with death or suicide (APA, 2013)
Many people experience anxious distress during a depressive episode.

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Suicide is a significant concern for anyone with MDD. People who feel
hopeless or behave impulsively may act on suicidal thoughts, especially
if they are under the influence of drugs or alcohol

Persistent Depressive Disorder (Dysthymia)

Persistent depressive disorder (dysthymia) involves chronic
depressive symptoms that are present most of the day for more days than
not during a 2-year period (with no more than 2 months symptom-free).
According to the DSM-5, dysthymia involves the ongoing presence of at
least two of the following symptoms: feelings of hopelessness, low self-
esteem, poor appetite or overeating, low energy or fatigue, difficulty
concentrating or making decisions, or sleeping too little or too much
(APA, 2013)

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a controversial
diagnostic category serious symptoms of depression, irritability, and
tension that appear the week before menstruation and disappear soon
after menstruation begins

Prevalence of Depressive Disorders

Depression is one of the most common psychiatric disorders and
the second leading cause of disability worldwide, affecting
approximately 298 million people each year For many people,
depression is a chronic disorder. If depressive symptoms do not
completely resolve with treatment, the chances of a relapse or chronic
depression are greatly increased. The most common lingering symptoms
of depression include poor concentration, lack of decisiveness, low
energy, and sleep difficulties

8.3.2 Etiology of Depressive Disorders

Biological Dimension
Biological explanations regarding depressive disorders generally
focus on neurotransmitters and stress-related hormones, genetic

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influences, structural or functional brain irregularities, circadian rhythm
disruption, or interactions among these factors.

Neurotransmitters:
Low levels of certain neurotransmitters, including serotonin,
norepinephrine, and dopamine, are associated with depression. When
our biochemical systems are functioning normally, neurotransmitters
regulate our emotions and basic physiological processes involving
appetite, sleep, energy, and libido; however, biochemical irregularities
can produce the physiological symptoms associated with depression.

The Role of Heredity:

Depression tends to run in families, and the same types of
depressive disorders are often found among members of the same
family. Studies comparing the prevalence of depressive disorders among
the biological and adoptive families of individuals with depression
indicate that the incidence is significantly higher among biological
relatives compared to adoptive family members.

Cortisol, Stress, and Depression

Dysregulation and over activity of the hypothalamic- pituitary-
adrenal (HPA) axis and overproduction of stress-related hormones such
as cortisol appear to play an important role in the development of
depression. An overactive stress response system and excessive cortisol
production may also cause depressive symptoms by depleting certain
neurotransmitters, particularly serotonin. Additionally, stress can affect
the production of enzymes that are necessary for our brains to use
serotonin effectively

Functional and Anatomical Brain Changes with Depression

Neuroimaging studies document decreased brain activity and other brain
changes in people with depression (Stahl & Wise, 2008). For example,
researchers have found that individuals experiencing depression have
increased connectivity in the brain regions referred to as the default
mode network, regions that are associated with a wakeful resting state.
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Psychological Dimension
Behavioral Explanations
Behavioral explanations suggest that depression occurs when
people receive insufficient social reinforcement. Losses such as
unemployment, divorce, or the death of a friend or family member can
reduce available reinforcement (e.g., love, affection, companionship)
and produce depression. Consistent with this perspective, behaviorists
believe that it is possible to reduce depressive symptoms by becoming
more socially active,

Cognitive Explanations
Cognitive psychologists contend that depression is caused by the
way people think and that negative thoughts and errors in thinking result
in pessimism, damaging self-views, and feelings of helplessness. In
other words, depression may result from our internal responses to what
is happening around us. Depression is a disturbance in thinking rather
than a disturbance in mood, according to some theories

Social Dimension
Stressful interpersonal events can exert a powerful influence on
our mood and increase the risk of depression. Severe acute stress (e.g.,
serious illness or death of a loved one) often precedes the onset of major
depression and is much more likely to cause a first depressive episode
than is chronic stress. Individuals who fail to develop secure attachments
and trusting relationships with caregivers early in life have increased
vulnerability to depression when confronted with stressful life events
Distressing social interactions are also linked with depression. For
example, social rejection increases risk of depression,

Cultural Influences on Depression

A person’s cultural background may influence descriptions of
depressive symptoms, decisions about treatment, doctor–patient
interactions, and the likelihood of outcomes such as suicide. In some
cultures, depression is expressed in the form of somatic or bodily
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complaints, rather than as sadness. For example, depression is often
experienced as “nerves” and headaches in Latino and Mediterranean
cultures; weakness, tiredness, or “imbalance” in Chinese and other Asian
cultures; problems of the “heart” in Middle Eastern cultures.

8.3.3 Treatments for Depressive Disorders

Medication
Antidepressant medications increase the availability of certain
neurotransmitters in the brain.
Brain Stimulation Therapies
Electroconvulsive therapy, vagus nerve stimulation, and
transcranial magnetic stimulation are sometimes used to treat severe or
chronic treatment-resistant depression,

Psychological and Behavioral Treatments for Depressive Disorders

Three approaches behavioral activation, interpersonal therapy, and
cognitive-behavior therapy.

Behavioral Activation Therapy

Behavioral activation therapy, based on principles of operant
conditioning, focuses on helping those who are depressed to increase
their participation in enjoyable activities and social interactions. The
goal is to have clients improve their mood by actively engaging in life.
This emphasis is very important because individuals with depression
often lack the motivation to participate in social activities. Behavioral
activation therapy is based on the idea that depression results from
diminished reinforcement behavioral therapy have received extensive
research support for treating depression,

Interpersonal Psychotherapy
Interpersonal psychotherapy is an evidence based treatment
focused on current interpersonal problems. Because this approach
presumes that depression occurs within an interpersonal context, therapy

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focuses on relationship issues. Clients learn to evaluate their role in
interpersonal and make positive changes in their relationships.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) focuses on altering the
negative thought patterns and distorted thinking associated with
depression. Cognitive therapists teach clients to identify thoughts that
precede upsetting emotions. Check Your Progress
1. What is depressive disorder?
2. What is dysthemia?

8.4 Bipolar Disorder

Introduction
Bipolar disorder is a group of disorders that involve episodes of
hypomania and mania that may alternate with episodes of depression.
Although depressive symptoms occur in bipolar disorders, depressive
disorders and bipolar disorders are very different conditions. First,
bipolar disorders have a very strong genetic component. In fact, there is
strong evidence of physiological overlap (i.e., shared biological
etiology) between bipolar disorders and schizophrenia. Second, people
with bipolar disorders respond to medications that have little effect with
depressive disorders. Third, the peak age of onset is somewhat earlier for
bipolar disorders (teens and early twenties) than for depressive disorders
(late twenties). And finally, bipolar disorders occur much less frequently
than depressive disorders

Features and Conditions Associated with Bipolar Disorder

Bipolar disorder is associated with various features and comorbid
conditions. Mixed features is important to note because when
hypomanic /manic symptoms occur with depressive symptoms, the risk
of impulsive behaviors such as suicidal actions or substance abuse
increases; those who have this pattern often require more intensive
treatment.

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Rapid cycling, a pattern where there are four or more mood episodes
per year, occurs in some individuals with bipolar disorder; this pattern is
especially common among those who develop bipolar symptoms at an
early age Those with bipolar disorder often have comorbid (concurrent)
anxiety disorders (especially panic attacks), attention
deficit/hyperactivity disorder, and substance-use. Bipolar disorder is also
associated with increased rates of physical illnesses such as
hypertension, cardiovascular disease, and diabetes, as well as increased
rates of death from suicide Bipolar disorder is also associated with
increased rates of physical illnesses such as hypertension, cardiovascular
disease, and diabetes, as well as increased rates of death from suicide.

8.4.1 Etiology of Bipolar Disorders

Biological Dimension
Genetic factors contribute to bipolar disorder, a well-established
finding from twin, adoption, and family studies. Various neurological
abnormalities are associated with bipolar symptoms. For example,
irregularities in the way the brain processes and responds to stimuli
associated with reward are associated with both manic and depressive
symptoms individuals with hypersensitive neurological systems appear
to have a vulnerability to bipolar disorder that is triggered by events that
activate or deactivate brain systems involved in regulating energy and
motivation. It is likely that multiple biochemical pathways contribute to
the symptoms associated with bipolar disorder.

Other Etiological Factors Associated with Bipolar Disorders

Psychological and social factors may also influence the
development and progression of bipolar disorders. For example, a major
stressful event sometimes occurs just prior to the onset of bipolar
symptoms. Inadequate social support and strained social relationships
are sometimes evident prior to the onset of both manic and depressive
symptoms. Rumination is common among individuals with bipolar
disorder who experience depression; researchers theorize that rumination
results from deficits in both executive functioning and emotional

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regulation. Biological factors appear to play a much more prominent role
in the development of bipolar disorders compared to other factors.

8.4.2 Treatment for Bipolar Disorders

Biomedical Treatments for Bipolar Disorders
Treatment for bipolar disorders can be complicated. Medications
vary depending on a person’s present and past symptom. Mood-
stabilizing medications such as lithium are the foundation of treatment
for bipolar disorder. Although anticonvulsant and antipsychotic
medications with mood-stabilizing properties are also used, lithium is
considered the most effective mood-stabilizing medication for those who
respond to its effects

Psychosocial Treatments for Bipolar Disorders

Psychosocial therapies such as family-focused therapy,
interpersonal therapy, and cognitive-behavioral therapy play a key role
in helping those with bipolar disorder. Educating families about bipolar
disorder and teaching communication and problem-solving skills to all
family members is effective in reducing the risk of relapse and
hospitalization. Therapists teach clients to avoid stress and overly
ambitious goal setting, practice emotional regulation techniques, identify
signs of an impending mood episode, and understand the dangers of
substance abuse. Mindfulness interventions have proven successful in
helping those with bipolar disorder regulate their moods, especially
when mindfulness practices are used at the onset of a mood episode.

8.5 Cyclothymic Disorder

Cyclothymic disorder involves impairment in functioning resulting
from milder hypomanic symptoms that are consistently interspersed with
milder depressed moods for at least 2 years. For this diagnosis, the
depressive moods must not reach the level of a major depressive episode
and the energized symptoms must not meet the criteria for a hypomanic
or manic episode. Additionally, the person must experience mood
symptoms at least half of the time and never be symptom-free for more
than 2 months. Cyclothymic disorder is similar to persistent depressive
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disorder (dysthymia) because the mood symptoms are chronic; however,
with cyclothymic disorder there are also periods of hypomanic behavior.
Check your Progress
3. What is Bipolar disorder?

8.6 Schizophrenia spectrum Disorder

Introduction
Individuals with schizophrenia and some of the related disorders
we discuss in this chapter lose contact with reality, see or hear things
that are not actually present (hallucinations), or develop false beliefs
about themselves or others (delusions). Schizophrenia is a serious
chronic mental illness on the severe end of the schizophrenia spectrum.
The disorders on the schizophrenia spectrum all involve specific
symptoms: psychosis (an impaired sense of reality that frequently
involves hallucinations and delusions); impaired cognitive processes
(including disorganized speech); unusual or disorganized motor
behavior; and a constellation of uncommon behaviors that affect social
interactions. schizophrenia spectrum disorders vary in severity, duration
of symptoms, causes, and outcome. Schizophrenia is one of the most
serious disorders on the spectrum. A diagnosis of schizophrenia in a
member of the family affects all members of the unit.

8.6.1 Symptoms of Schizophrenia spectrum

The symptoms associated with schizophrenia spectrum disorders
fall into four categories: positive symptoms, psychomotor abnormalities,
cognitive symptoms, and negative symptoms.

Positive symptoms associated with schizophrenia spectrum disorders

involve delusions, hallucinations, disordered thinking, incoherent
communication, and bizarre behavior. These symptoms can range in
severity, and persist or fluctuate. Many people with positive symptoms
do not understand that their symptoms are the result of mental illness.
Delusions (false personal beliefs), persecutory Delusions (beliefs that
others are plotting against them, talking about them, or out to harm),

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hallucination (misperception of a nonexistent) are predominant features
of schizophrenia spectrum.

Cognitive Symptoms
Disordered thinking, communication, and speech are common
characteristics of schizophrenia. Individuals experiencing these
symptoms may have difficulty focusing on one topic, speak in an
unintelligible manner, or reply tangentially to questions.
Loosening of associations, also referred to as cognitive slippage, is
another characteristic of disorganized thinking. This involves a continual
shifting from topic to topic without any apparent logical or meaningful
connection between thoughts. Cognitive symptoms of schizophrenia also
include problems with attention and memory and difficulty making
decisions.
Abnormal Psychomotor Behavior
catatonia, a condition involving extremes in activity level (either
unusually high or unusually low), peculiar body movements or postures,
strange gestures and grimaces, or a combination of these silly activities.
They may talk and shout constantly, moving or running until they drop
from exhaustion. They may appear to be active and display loud,
inappropriate laughter. They sleep little and are continually on the go.
People experiencing withdrawn catatonia are extremely unresponsive,
as was the young man in the case study. They show prolonged periods of
stupor and mutism, despite an awareness of all that is going on around
them.
Negative Symptoms
Negative symptoms of schizophrenia are associated with an
inability or decreased ability to initiate actions or speech, express
emotions, or feel pleasure. Such symptoms include:
Avolition—an inability to initiate or persist in goal-directed behavior;
Alogia—a lack of meaningful speech;
Asociality—minimal interest in social relationships;
Anhedonia—reduced ability to experience pleasure from positive
events; and

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Diminished emotional expression—reduced display of emotion
involving facial expressions, voice intonation, or gestures in situations in
which emotional reactions are expected.

8.6.2 Etiology of Schizophrenia

Biological Dimension
Genetics and heredity play an important role in the development of
schizophrenia. Researchers have found that closer blood relatives of
individuals diagnosed with schizophrenia run a greater risk of
developing the disorder

Neurostructures
Individuals with schizophrenia have decreased volume in the
cortex and other areas of the brain, as well as ventricular enlargement.
Ventricular enlargement may be an early indication of an increased
susceptibility to schizophrenia ineffective communication between
different brain regions may lead to the cognitive symptoms (e.g.,
disorganized speech and impairment in memory, decision making, and
problem solving), negative symptoms (e.g., lack of drive or initiative),
and positive symptoms (e.g., delusions and hallucinations) that are found
in schizophrenia.

Biochemical Influences
Abnormalities in certain neurotransmitters (chemicals that allow brain
cells to communicate with one another) including dopamine, serotonin,
GABA, and glutamate have also been linked to schizophrenia.
According to the dopamine hypothesis, schizophrenia may result from
excess dopamine activity in certain areas of the brain.

Psychological Dimension
Individuals who develop schizophrenia have certain cognitive
attributes, dysfunctional beliefs, and interpersonal functioning that may
predispose them to the development of psychotic symptoms.
Communication problems and the lack of insight that frequently occurs
with schizophrenia may result, in part, from deficits in the theory of
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mind—the ability to recognize that others have emotions, beliefs, and
desires that may be different from one’s own. Early cognitive deficits
are also associated with schizophrenia. Numerous studies have
documented an association between early developmental delay and
schizophrenia. Certain personal cognitive processes involving
misattributions or negative attitudes can lead to or maintain psychotic
symptoms such as delusions.

Social Dimension
The role of social relationships in the development of
schizophrenia has been extensively s Maltreatment during childhood or
other significant social stressors may alter neurodevelopment in a
manner that increases susceptibility to schizophrenia. Certain social
events appear to influence the appearance of psychotic symptoms.
Expressed emotion (EE), a negative communication pattern found
among some relatives of individuals with schizophrenia, has been
associated with higher relapse rates in individuals diagnosed with
schizophrenia. EE is determined by a variety of factors, including
critical comments made by relatives; statements of dislike or resentment
directed toward the individual with schizophrenia by family members.

Socio cultural Dimension

Cultural Issues with Schizophrenia
Culture may affect how people view or interpret symptoms of
schizophrenia. In Japan, for example, schizophrenia is highly
stigmatized. The condition was previously called seishin-bunretsu-byou,
which roughly translates to “a split in mind or spirit,” a term that implies
it is an irreversible condition.

8.6.3 Treatment of Schizophrenia

Through the years, schizophrenia has been treated by a variety of
means, including performing a prefrontal lobotomy—a surgical
procedure in which the frontal lobes are disconnected from the
remainder of the brain. Today schizophrenia is often treated with
antipsychotic medication, along with some type of psychosocial therapy
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Antipsychotic Medications
First, antipsychotic medication can reduce intensity of symptoms;
second, dosage levels should be carefully monitored; and third, side
effects can occur as a result of medication and may affect a person’s
willingness to take prescribed medications.
Many consider the 1955 introduction of Thorazine, the first
antipsychotic drug, to be the beginning of a new era in treating
schizophrenia. For the first time, a medication was available that
sufficiently relaxed even those most severely affected by schizophrenia
Psychosocial Therapy
Inpatient Approaches
Both milieu therapy and behavioral therapy can be beneficial for
individuals with schizophrenia receiving inpatient treatment. In milieu
therapy, the hospital environment operates as a community within which
those with schizophrenia exercise a wide range of responsibilities and
help make decisions. Psychosocial skills training focuses on increasing
appropriate self-care behaviors, conversational skills, and job skills.
Undesirable behaviors such as “crazy talk” or social isolation are
decreased through reinforcement and modeling techniques

Cognitive-Behavioral Therapy
Major advances have been made in the use of cognitive and
behavioral strategies in treating the symptoms of schizophrenia; this is
particularly important for those who do not respond to medication.
Therapists teach coping skills that allow clients to manage their positive
and negative symptoms, as well as the cognitive challenges associated
with schizophrenia Cognitive-behavioral treatment to address concerns
such as these often includes the following steps
1. Engagement
2. Assessment.
3. Identification of negative
4. Normalization
5. Collaborative analysis of symptoms.
6. Development of alternative explanations.

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8.7 Other Schizophrenia Spectrum Disorders
Delusional disorder
Delusional disorder is characterized by persistent delusions that are
not accompanied by other unusual or odd behaviors—other than those
related to the delusional theme. According to DSM-5, the delusions must
persist for at least 1 month (APA, 2013).
Delusional disorder is distinct from the other psychotic disorders
due to the absence of additional disturbances in thoughts or perceptions,
beyond occasional hallucinations that may be associated with the
delusion People with delusional disorder generally behave normally
when they are not discussing or reacting to their delusional ideas.
Common themes involved in delusional disorders include the following

 Erotomania—the belief that someone is in love with the

individual; this delusion typically has a romantic rather than sexual
focus.
 Grandiosity—the conviction that one has great, unrecognized
talent, special abilities, or a relationship with an important person
or deity.
 Jealousy—the conviction that one’s spouse or partner is being
unfaithful.
 Persecution—the belief that one is being conspired or plotted
against.
 Somatic complaints—convictions of having body odor, being
malformed, or being infested by insects or parasites.
Check your Progress
4. What is catatonia?
5. What is Erotomania?

8.7.1 Brief Psychotic Disorder

A DSM-5 diagnosis of brief psychotic disorder requires the
presence of one or more psychotic symptoms, including at least one
symptom involving delusions, hallucinations, or disorganized speech,
that continue for at least 1 day but last less than 1 month. The symptoms

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sometimes occur during pregnancy or within 4 weeks of childbirth
(APA, 2013). A psychological trauma can also produce the short-term
psychotic episodes seen in brief psychotic disorder. For example, among
soldiers engaged in combat in Croatia, 20 percent reported
hallucinations and delusions. A significant stressor often precedes the
onset. Eve experienced a number of stressors before her psychotic
episode. She had just lost her best friend to an accident, was struggling
with academic demands t of symptoms, although in some cases the
precipitating event is not apparent.
8.7.2 Schizoaffective disorder
Schizoaffective disorder is diagnosed when someone demonstrates
psychotic symptoms that meet the diagnostic criteria for schizophrenia
combined with symptoms of a major depressive or manic episode that
continue for the majority of the time the schizophrenic symptoms are
present. Additionally, according to DSM-5, the psychotic features must
sometimes continue for at least 2 weeks after symptoms of the manic or
depressed episode have subsided. Thus, schizoaffective disorder has
features of both schizophrenia and a depressive or bipolar disorder
Schizoaffective disorder is relatively rare, occurring in only 0.32 percent
of the population, and is more prevalent in women. Younger individuals
with this disorder tend to have the bipolar subtype whereas older people
are more likely to have the depressive subtype. As with schizophrenia,
the age of onset is later for women than men. In a twin study,
schizoaffective disorder and schizophrenia showed substantial familial
overlap. Similar biochemical and brain structure abnormalities have
been found in individuals with schizoaffective disorder and
schizophrenia

8.7.3 Shared Psychotic Disorder

In a rare form of delusional disorder (shared psychotic delusion), a
person who has a close relationship with an individual with delusional or
psychotic beliefs comes to accept those beliefs. Shared delusions
(sometimes referred to as folie à deux) are more prevalent among those
who are socially isolated. The pattern generally involves a family
member or partner acquiring the delusional belief from the dominant
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individual. A decreased ability to obtain corrective feedback, combined
with preexisting personality traits of suspiciousness, may increase a
person’s susceptibility to developing delusional beliefs. For example,
hearing impairment in early adolescence is associated with an increased
risk of developing delusions. There is a significant genetic relationship
between delusional disorder and schizophrenia.

8.7.4 Culture Bound Syndrome

The diagnostic manual attempts to sensitize clinicians to cultural
issues by including a glossary of culture-bound syndromes. These are
patterns of erratic or unusual thinking and behavior that have been
identified in diverse societies around the world and do not fit easily into
the other diagnostic categories that are listed in the main body of DSM-
IV-TR. They are called “culture-bound” because they are considered to
be unique to particular societies, particularly in non-Western or
developing countries. Their appearance is easily recognized and
understood to be a form of abnormal behavior by members of certain
cultures, but they do not conform to typical patterns of mental disorders
seen in the United States or Europe. Culture bound syndromes have also
been called idioms of distress. In other words, they represent a manner
of expressing negative emotion that is unique to a particular culture and
cannot be easily translated or understood in terms of its individual parts.

8.8 Let’s sum up

Mood disorders are among the most common psychological
disorders, and the risk of developing them is increasing worldwide,
particularly in younger people. Two fundamental experiences can
contribute either singly or in combination to all specific mood disorders:
a major depressive episode and mania. A less severe episode of mania
that does not cause impairment in social or occupational functioning is
known as a hypomanic episode. An episode of mania coupled with
anxiety or depression is known as a dysphoric manic or mixed episode.
An individual who suffers from episodes of depression only is said to
have a unipolar disorder. An individual who alternates between
depression and mania has a bipolar disorder. Cyclothymic disorder is a
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milder but more chronic version of bipolar disorder. The causes of mood
disorders lie in a complex interaction of biological, psychological, and
social factors. From a biological perspective, researchers are particularly
interested in the stress hypothesis and the role of neurohormones.
Psychological theories of depression focus on learned helplessness, the
depressive cognitive schemas, and interpersonal Schizophrenia is
characterized by a broad spectrum of cognitive and emotional
dysfunctions that include delusions and hallucinations, disorganized
speech and behavior, and inappropriate emotions. The symptoms of
schizophrenia can be divided into positive, negative, and disorganized.
Positive symptoms are active manifestations of abnormal behavior, or an
excess or distortion of normal behavior, and include delusions and
hallucinations. Negative symptoms involve deficits in normal behavior
on such dimensions as affect, speech, and motivation. Disorganized
symptoms include rambling speech, erratic behavior, and inappropriate
affect. A number of causative factors have been implicated for
schizophrenia, including genetic influences, neurotransmitter
imbalances, structural damage to the brain caused by a prenatal viral
infection or birth injury, and psychological stressors.

8.9 Unit End Exercise

1. Define the term mood disorder and describe the key features of
major depressive disorder.
2. Describe the key features of bipolar disorder and cyclothymic
disorder.
3. Define the term schizophrenia. Evaluate methods used to treat
schizophrenia.
4. Describe the general features of other disorders in the
schizophrenia spectrum.
8.10 Answers for Check your Progress

1. Depressive disorders, a group of related disorders characterized by

depressive symptoms, include major depressive disorder, persistent
depressive disorder (dysthymia), and premenstrual dysphoric
disorder
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 2. Persistent depressive disorder (dysthymia) involves chronic
depressive symptoms that are present most of the day for more
days than not during a 2-year period (with no more than 2 months
symptom-free).
3. Bipolar disorder is a group of disorders that involve episodes of
hypomania and mania that may alternate with episodes of
depression.
4. catatonia, a condition involving extremes in activity level (either
unusually high or unusually low), peculiar body movements or
postures, strange gestures and grimaces, or a combination of these
silly activities.
5. Erotomania means the belief that someone is in love with the
individual; this delusion typically has a romantic rather than sexual
focus.
8.11 Suggested Readings
1. Robert C. Carson &James N. Butcher. (2007). Abnormal Psychology.
Pearson Education Inc. New Delhi.
2. Barlow and Durand. (2006). Abnormal Psychology. New York.
Pearson India Ltd.
3. Sarason and Sarason. (2010). Abnormal Psychology: The Problem of
Maladaptive Behaviour (11th Edition). New Delhi. Prentice Hall of
India Pvt. Ltd.

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UNIT 9
DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR
Structure
9.1 Introduction
9.2 Objectives
9.3 Eating Disorder
9.3.1 Anorexia Nervosa
9.3.2 Bulimia Nervosa
9.4 Sleeping disorder
9.4.1 Primary Insomnia
9.4.2 Hypersomnia
9.4.3 Narcolepsy
9.4.4 Treatment
9.5 Personality Disorder
9.5.1 Cluster A Personality Disorder
9.5.2 Cluster B Personality Disorder
9.5.3 Cluster C Personality Disorder
9.5.4 Causes
9.5.5 Treatment
9.6 Impulse control Disorder
9.6.1 Kleptomania
9.6.2 Intermittent Explosive Disorder
9.6.3 Pyromania
9.7 Sexual and Gender Identity Disorder
9.7.1 Disorder of Desire
9.7.2 Disorder of Excitement
9.7.3 Disorder of Orgasm
9.7.4 Disorder of pain
9.8 Gender identity disorder

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 9.9 Lets sum up
9.10 Unit End Exercise
9.11 Answers for Check your progress
9.12 Suggested Readings

INTRODUCTION
Adulthood is the crucial stage of human life. Each individual
develops his/ her own personality types based on various factors such as
childhood experience, Genetic factors, social factors, mental abilities.
Sometimes the deprivation on one of these factors causes disorder in
personality and leads to maladaptive behavior. The personality and
behavior change in adult life is vast one. In this chapter, we are
discussing various disorders that impact on adult personality and
behavior.
Objectives
By the end of this unit, You will be able to understand
 Eating disorders
 Sleep Disorders
 Personality disorder
 Impulse control disorder
 Sexual and gender identity disorder
EATING DISORDER
Eating disorders are severe disturbances in eating behavior. Some
experts suggest that dieting disorder is a more accurate term, because
dread of weight gain and obsession with weight loss often are central
features of eating disorders. DSM-IV-TR lists two major types of eating
disorders: anorexia nervosa and bulimia nervosa. Both anorexia and
bulimia are about 10 times more common among females than males,
and they develop most commonly among women in their teens and early
twenties. The increased incidence among young people reflects both the
intense focus on young women’s physical appearance and the difficulties

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many adolescent girls have in adjusting to the rapid changes in body
shape and weight that begin with puberty.

Anorexia nervosa
The most obvious characteristic of anorexia nervosa is extreme
emaciation, or more technically, the refusal to maintain a minimally
normal body weight. The term anorexia literally means “loss of
appetite,” but this is a misnomer. People with anorexia nervosa are
hungry, yet they starve themselves.

Symptoms of Anorexia
Refusal to Maintain a Normal Weight
The most obvious and most dangerous symptom of anorexia is a
refusal to maintain a minimally normal body weight. Anorexia nervosa
often begins with a diet to lose just a few pounds. The diet goes awry,
however, and losing weight eventually becomes the key focus. Weight
falls well below the normal range and often plummets to dangerously
low levels.

Disturbance in Evaluating Weight or Shape

A second defining symptom of anorexia nervosa can involve one
of several related symptoms about weight and shape. Other people with
the disorder suffer from a disturbance in the way body weight or shape
is experienced. Sometimes this may include a distorted body image, an
inaccurate perception of body size and shape.

Fear of Gaining Weight

An intense fear of becoming fat is a third defining characteristic of
anorexia. The fear of gaining weight presents particular problems for
treatment.

Cessation of Menstruation
Amenorrhea, the absence of at least three consecutive menstrual
cycles, is the final DSM-IV-TR symptom of anorexia nervosa (in

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females). The presence of amenorrhea has led to speculation about the
role of sexuality and sexual maturation in causing anorexia nervosa.

Medical Complications
Anorexia nervosa can cause a number of medical complications.
People with anorexia commonly complain about constipation,
abdominal pain, intolerance to cold, and lethargy. Some of these
complaints stem from the effects of semi starvation on blood pressure
and body temperature.

Comorbid Psychological Disorders

Anorexia nervosa is associated with other psychological problems,
including obsessive–compulsive disorder and obsessive– compulsive
personality disorder. People with anorexia nervosa are obsessed with
food and diet, and they often follow compulsive eating rituals.

Struggle for Control

Some people with anorexia act impulsively, but clinical accounts
and some research suggest that more are conforming and controlling.

Symptoms of Bulimia
Inappropriate Compensatory Behavior
Almost all people with bulimia nervosa engage in purging,
designed to eliminate consumed food from the body. The most common
form of purging is self-induced vomiting; as many as 90 percent of
people with bulimia nervosa engage in this behavior (APA, 2000).

Binge eating
Binge eating is defined as eating an amount of food that is clearly
larger than most people would eat under similar circumstances in a fixed
period of time, for example, less than two hours. There have been some
attempts to define a binge more objectively, such as eating more than
1,000 calories,

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Excessive Emphasis on Weight and Shape
People with bulimia nervosa place excessive emphasis on body
shape and weight in evaluating themselves, a symptom shared with
anorexia nervosa. Their self esteem and much of their daily routine,
centers around weight and diet.

Comorbid Psychological Disorders

Depression is common among individuals with bulimia nervosa,
especially those who self-induce vomiting (APA, 2000). Other disorders
that may co-occur with bulimia nervosa include anxiety disorders,
personality disorders (particularly borderline personality disorder), and
substance abuse, particularly excessive use of alcohol and or stimulants.
Although each of these psychological difficulties presents special
challenges in treating bulimia, the co morbidity with depression is most
common and most significant.

Medical Complications
A number of medical complications can result from bulimia
nervosa. Repeated vomiting can erode dental enamel, particularly on the
front teeth, and in severe cases teeth can become chipped and ragged
looking. Repeated vomiting can also produce a gag reflex that is
triggered too easily and perhaps unintentionally.

Causes of eating disorder

Social Factors
Standards of beauty and the premium placed on young women’s
appearance contribute to causing eating disorders.

Troubled Family Relationships

Troubled family relationships may also increase vulnerability to
the culture of thinness. Young people with bulimia nervosa report
considerable conflict and rejection in their families, difficulties that also
may contribute to their depression.

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Psychological Factors
A Struggle for Perfection and Control
Perfectionism is another part of the endless pursuit of control.
Perfectionists set unrealistically high standards, are self-critical, and
demand a nearly flawless performance from themselves. Young people
with eating disorders may also try to control their own emotions
excessively. They may lack interoceptive awareness—recognition of
internal cues, including hunger and various emotional states.
Depression, Low Self-Esteem, and Dysphoria
Depression is often comorbid with eating disorders, particularly
bulimia nervosa. Depressive symptoms, and not necessarily clinical
depression, also may play a role in eating disorders. Low self-esteem is a
particular concern. In particular, women with eating disorders may be
preoccupied with their social self, how they present themselves in
public.

Negative Body Image

A negative body image, a highly critical evaluation of one’s weight
and shape.
Dietary Restraint
Some symptoms of eating disorders may be effects of dietary
restraint, that is, direct consequences of overly restrictive eating
contribute to the development of eating disorder.

Biological Factors
Physiologically, weight is maintained around weight set points,
fixed weights or small ranges of weight. Weight regulation around set
points results from the interplay between behavior (e.g., exercise,
eating), peripheral physiological activity (e.g., digestion, metabolism),
and central physiological activity. Genetic factors also contribute to
eating disorders. An early twin study of bulimia nervosa found a
concordance rate of 23 percent for MZ twins and 9 percent for DZ twins.
Several neurophysiologic measures also are correlated with eating
disorders, including elevations in endogenous opioids, low levels of
serotonin, and diminished neuroendocrine functioning
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Treatment of Anorexia Nervosa
The treatment of anorexia nervosa usually focuses on two goals.
The first is to help the patient gain at least a minimal amount of weight.
If weight loss is severe, the patient may be treated in an inpatient setting.
Hospitalized patients may receive forced or intravenous feeding, The
second goal in treating anorexia nervosa is to address the broader eating
difficulties. The most carefully studied family therapy is the
Maudsley method (named after Maudsley Hospital in London where the
treatment was developed). In the Maudsley method, parents take
complete control over the anorexic child’s eating, planning meals,
preparing food, and monitoring eating.

Treatment of Bulimia nervosa

Cognitive Behavior Therapy
First, the therapist uses education and behavioral strategies to
normalize eating patterns. The goal is to end the cycle where extreme
dietary restraint leads to binge eating and, in turn, to purging. Second,
the therapist addresses the client’s broader, dysfunctional beliefs about
self, appearance, and dieting. Techniques include a variation of Beck’s
cognitive therapy to address perfectionism or depression. Individual
problems such as poor impulse control or troubled relationships also
may be addressed at this stage. Third, the therapist attempts to
consolidate gains and prepare the client for expected relapses in the
future.

Interpersonal Psychotherapy
Interpersonal psychotherapy also can be an effective treatment for
bulimia nervosa. This is surprising because interpersonal therapy does
not address eating disorders directly but instead focuses on difficulties in
close relationships. First, the interpersonal treatments explicitly excluded
direct discussions of eating, diet, and related topics. Second, the
investigators had lower expectations for interpersonal therapy, and the
allegiance effect often influences treatment outcome.

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Antidepressant Medications
All classes of antidepressant medications are somewhat effective in
treating bulimia nervosa; however, medication alone is not the treatment
of choice. Binge eating and compensatory behavior improve only among
a minority of people treated with antidepressants, and relapse is common
when medication is stopped.
Check Your Progress
1. What is Anorexia nervosa?
2. What is Bulimia nervosa?

9.4 SLEEP DISORDER

INTRODCTION
We spend about one third of our lives asleep. That means most of
us sleep nearly 3,000 hours per year. For many of us, sleep is energizing,
both mentally and physically. Unfortunately, most people do not get
enough sleep, and 28% of people in the United States report feeling
excessively sleepy during the day. Most of us know what it’s like to
have a bad night’s sleep. The next day we’re a little groggy, and as the
day wears on we may become irritable. Research tells us that even minor
sleep deprivation over only 24 hours impedes our ability to think clearly
Lack of sleep also affects you physically. People who do not get enough
sleep are more susceptible to illnesses such as the common cold, perhaps
because immune system functioning is reduced with the loss of even a
few hours of sleep.

An Overview of Sleep Disorders

The study of sleep has long influenced concepts of abnormal
psychology the relationship between sleep disturbances and mental
health is more complex. Sleep problems may cause the difficulties
people experience in everyday life, or they may result from some
disturbance common to a psychological disorder.
The region of the brain is also involved with our dream sleep,
which is called rapid eye movement (REM) sleep. Mutual
neurobiological connection suggests that anxiety and sleep may be
interrelated in important ways, although the exact nature of the
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relationship is still unknown. Similarly, REM sleep seems related Sleep
disorders are divided into two major categories: dyssomnias and
parasomnias. Dysssomnias involve difficulties in getting enough sleep,
problems with sleeping when you want to and complaints about the
quality of sleep, such as not feeling refreshed even though you have
slept the whole night. Parasomnias are characterized by abnormal
behavioral or physiological events that occur during sleep, such as
nightmares and sleepwalking.

9.4.1 Primary Insomnia

Insomnia is one of the most common sleep disorders. Despite the
common use of the term insomnia to mean “not sleeping,” it actually
applies to a number of complaints. People are considered to have
insomnia if they have trouble falling asleep at night (difficulty initiating
sleep), if they wake up frequently or too early and can’t go back to sleep
(difficulty maintaining sleep), or even if they sleep a reasonable number
of hours but are still not rested the next day (non restorative sleep).

Causes
Insomnia accompanies many medical and psychological disorders,
including pain and physical discomfort, physical inactivity during the
day, and respiratory problems. Sometimes insomnia is related to
problems with the biological clock and its control of temperature. Some
people who can’t fall asleep at night may have a delayed temperature
rhythm: Their body temperature doesn’t drop and they don’t become
drowsy until later at n Among the other factors that can interfere with
sleeping are drug use and a variety of environmental influences such as
changes in light, noise, or temperature.. Finally, various psychological
stresses can also disrupt your sleep. For example, one study looked at
how medical and dental school students were affected by a particularly
stressful event Biological vulnerability may, in turn, interact with sleep
stress, which includes a number of events that can negatively affect
sleep. For example, poor bedtime habits (such as having too much
alcohol or caffeine) can interfere with falling asleep. Note that biological
vulnerability and sleep stress influence each other.
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9.4.2 Primary Hypersomnia
Insomnia involves not getting enough sleep (the prefix in means
“lacking” or “without”), and hypersomnia is a problem of sleeping too
much (hyper means “in great amount” or “abnormal excess”). Many
people who sleep all night find themselves also falling asleep several
times in next day. Several factors that can cause excessive sleepiness
would not be considered hypersomnia. People with hypersomnia sleep
through the night and appear rested upon awakening but still complain
of being excessively tired throughout the day. Another sleep problem
that can cause a similar excessive sleepiness is a breathing-related sleep
disorder called sleep apnea. People with this problem have difficulty
breathing at night. They often snore loudly, pause between breaths, and
wake in the morning with a dry mouth and headache.

9.4.3 Narcolepsy
Narcolepsy is a different form of the sleeping problem. In addition
to daytime sleepiness, people with narcolepsy experience cataplexy, a
sudden loss of muscle tone. Cataplexy occurs while the person is awake
and can range from slight weakness in the facial muscles to complete
physical collapse. Cataplexy lasts from several seconds to several
minutes; it is usually preceded by strong emotion such as anger or
happiness. Imagine that while cheering for your favorite team, you
suddenly fall asleep; while arguing with a friend, you collapse to the
floor in a sound sleep. Cataplexy appears to result from a sudden onset
of REM sleep. Instead of falling asleep normally and going through the
four non-rapid eye movement (NREM) stages that typically precede
REM sleep, people with narcolepsy periodically progress right to this
dream-sleep stage almost directly from the state of being awake.

9.4.4 Treatment for Sleep Disorder

Medical Treatments
People who complain of insomnia to a medical professional are
likely prescribed one of several benzodiazepine or related medications,
which include short-acting drugs and long-acting drugs such as. Short-
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acting drugs (those that cause only brief drowsiness) are preferred
because the long-acting drugs sometimes do not stop working by
morning and people report more daytime sleepiness

Environmental Treatments
One general principle for treating circadian rhythm disorders is
that phase delays (moving bedtime later) are easier than phase advances
(moving bedtime earlier). In other words, it is easier to stay up several
hours later than usual than to force yourself to go to sleep several hours
earlier. Scheduling shift changes in a clockwise direction (going from
day to evening schedule) seems to help workers adjust better. Another
strategy to help people with sleep problems involves using bright light to
trick the brain into readjusting the biological clock.

Psychological Treatments
Different treatments help people with different kinds of sleep
problems. For example, relaxation treatments reduce the physical
tension that seems to prevent some people from falling asleep at night.
Some people report that their anxiety about work, relationships, or other
situations prevents them from sleeping or wakes them up in the middle
of the night. To address this problem, cognitive treatments are used.
Research shows that some psychological treatments for insomnia may be
more effective than others. For adult sleep problems, stimulus control
may be recommended. People are instructed to use the bedroom only for
sleeping and for sex and not for work or other anxiety-provoking
activities (for example, watching the news on television).

Parasomnias
Parasomnias are not problems with sleep itself but abnormal events
that occur either during sleep or during that twilight time between
sleeping and waking. Some events associated with parasomnia are not
unusual if they happen while you are awake (e.g., walking to the kitchen
to look into the refrigerator) but can be distressing if they take place
while you are sleeping.

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 Parasomnias are of two types: those that occur during REM sleep,
and those that occur during NREM sleep. Nightmares occur during REM
or dream sleep. Sleep terrors, which most commonly afflict children,
usually begin with a piercing scream. The child is extremely upset, often
sweating, and frequently has a rapid heartbeat. On the surface, sleep
terrors appear to resemble nightmares— the child cries and appears
frightened—but they occur during NREM sleep. Sleepwalking (also
called somnambulism) occurs during NREM sleep. This means that
when people walk in their sleep, they are probably not acting out a
dream. This parasomnia typically occurs during the first few hours while
a person is in the deep stages of sleep.
Check Your Progress
3. What is somnambulism?
4. What is Narcolepsy?

9.5 PERSONALITY DISORDER

Introduction
The DSM-IV-TR definition notes that these personality
characteristics are “inflexible and maladaptive and cause significant
functional impairment or subjective distress.” personality disorders are
chronic; they do not come and go but originate in childhood and
continue throughout adulthood. Because they affect personality, these
chronic problems pervade every aspect of a person’s life. For example, if
a woman is overly suspicious (a sign of a possible paranoid personality
disorder), this trait will affect almost everything she does, including her
employment (she may have to change jobs often if she believes
coworkers conspire against her), her relationships (she may not be able
to sustain a lasting relationship if she can’t trust anyone), and even
where she lives (she may have to move often if she suspects her landlord
is out to get her). However, individuals with personality disorders may
not feel any subjective distress; indeed, it may be others who acutely feel
distress because of the actions of the person with the disorder.

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Personality Disorder Clusters
DSM-IV-TR divides the personality disorders into three groups, or
clusters (see Table 11.1) (American Psychiatric Association, 2000). The
cluster division is based on resemblance. Cluster A is called the odd or
eccentric cluster; it includes paranoid, schizoid, and schizotypal
personality disorders. Cluster B is the dramatic, emotional, or erratic
cluster; it consists of antisocial, borderline, histrionic, and narcissistic
personality disorders. Cluster C is the anxious or fearful cluster; it
includes avoidant, dependent, and obsessive-compulsive personality
disorders.

9.5.1 Cluster A Personality Disorder

Three personality disorders—paranoid, schizoid, and schizotypal—share
common features that resemble some of the psychotic symptoms seen in
schizophrenia.
Paranoid Personality Disorder
People with paranoid personality disorder are excessively
mistrustful and suspicious of others, without any justification. They
assume other people are out to harm or trick them; therefore, they tend
not to confide in others. Suspicion and mistrust can show themselves in
a number of ways. People with paranoid personality disorder may be
argumentative, may complain, or may be quiet. This style of interaction
is communicated, sometimes nonverbally, to others, often resulting in
discomfort among those who come in contact with them because of this
volatility.
Causes
Evidence for biological contributions to paranoid personality
disorder is limited. Some research suggests the disorder may be slightly
more common among the relatives of people who have schizophrenia,
although the association does not seem to be strong. As you will see
later with the other odd or eccentric personality disorders in Cluster A,
there seems to be some relationship with schizophrenia, although its
exact nature is not yet clear. Cultural factors have also been implicated
in paranoid personality disorder. Certain groups of people, such as
prisoners, refugees, people with hearing impairments, and older adults,
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are thought to be particularly susceptible because of their unique
experiences
Treatment
Therapists try to provide an atmosphere conducive to developing a
sense of trust. They often use cognitive therapy to counter the person’s
mistaken assumptions about others, focusing on changing the person’s
beliefs that all people are malevolent and most people cannot be trusted

Schizoid personality disorder

People with this personality disorder show a pattern of detachment
from social relationships and a limited range of emotions in
interpersonal situations. They seem aloof, cold, and indifferent to other
people.

Causes and Treatment

Childhood shyness is reported as a precursor to later adult schizoid
personality disorder. It may be that this personality the development of
this disorder. Abuse and neglect in childhood are also reported among
individuals with this disorder trait is inherited and serves as an important
determinant in early problems with interpersonal relationships to
produce the social deficits that define schizoid personality disorder.
Therapists often begin treatment by pointing out the value in social
relationships. The person with the disorder may even need to be taught
the emotions felt by others to learn empathy. Because their social skills
were never established or have atrophied through lack of use, people
with schizoid personality disorder often receive social skills training.

Schizotypal Personality Disorder

People with schizotypal personality disorder are typically socially
isolated, like those with schizoid personality disorder.
In addition, they also behave in ways that would seem unusual to many
of us, and they tend to be suspicious and have odd beliefs. Schizotypal
personality disorder is considered by some to be on a continuum.

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Causes
Schizotypal personality disorder is viewed by some to be one
phenotype of a schizophrenia genotype. Recall that a phenotype is one
way a person’s genetics is expressed. A genotype is the gene or genes
that make up a particular disorder. However, depending on a variety of
other influences, the way you turn out—your phenotype—may vary
from other people with a similar genetic makeup. Many characteristics
of schizotypal personality disorder, including ideas of reference,
illusions, and paranoid thinking, are similar but milder forms of
behaviors observed among people with schizophrenia. Genetic research
also seems to support a relationship. Some research suggests that
schizotypal symptoms are strongly associated with childhood
maltreatment among men and this childhood maltreatment seems to
result in posttraumatic stress disorder (PTSD) symptoms among women.
Cognitive assessment of people with this disorder points to mild to
moderate decrements in their ability to perform on tests involving
memory and learning,

9.5.2 Cluster B Personality Disorder

Personality Disorders Characterized by Dramatic, Emotional, or
Erratic Behavior
This cluster of personality disorders includes the antisocial,
borderline, histrionic, and narcissistic types. People with these disorders
exhibit behavior patterns that are excessive, unpredictable, or self
centered; they also have difficulty forming and maintaining relationships
and show antisocial behavior.
Antisocial Personality Disorder
People with antisocial personality disorder are antisocial in the
sense that they often violate the rights of others, disregard social norms
and conventions, and, in some cases, break the law. They show a lack of
concern or callous indifference about violating the rights of others and
using other people for their own gain. Clinicians once used terms such as
psychopath and sociopath to refer to people who today are classified as
having antisocial personalities—people whose behavior is amoral,
asocial, and impulsive, and who lack remorse and shame. Antisocial
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personality disorder occurs more commonly in men than in women.
Over time, antisocial and criminal behavior associated with the disorder
tends to decline with age and may disappear by the time the person
reaches the age of 40.
Socio-cultural Factors and Antisocial Personality Disorder
Antisocial personality disorder cuts across all racial and ethnic groups.
The disorder is most common, however, among people in lower
socioeconomic groups. One explanation is that people with antisocial
personality disorder drift downward occupationally, perhaps because
their antisocial behavior makes it difficult for them to hold steady jobs
or to progress upward.

Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by features
such as a deep sense of emptiness, an unstable self-image, a history of
turbulent and unstable relationships, dramatic mood changes,
impulsivity, difficulty regulating negative emotions, self-injurious
behavior, and recurrent suicidal behaviors.
People with borderline personality disorder tend to be uncertain
about their personal identities—their values, goals, careers, perhaps even
their sexual orientations. This instability in self-image or personal
identity leaves them with nagging feelings of emptiness and boredom.
They cannot tolerate being alone and make desperate attempts to avoid
feelings of abandonment. Borderline personality disorder is usually
diagnosed in early adulthood, although signs of the disorder are often
seen in adolescence

Histrionic Personality Disorder

Histrionic personality disorder is characterized by excessive
emotionality and an overwhelming need to be the center of attention.
The term is derived from the Latin histrio, which means “actor.” People
with histrionic personality disorder tend to be dramatic and emotional,
but their emotions seem shallow, exaggerated, and volatile. The disorder
was formerly called hysterical personality. People with histrionic
personalities may become unusually upset by news of a sad event and
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exude exaggerated delight at a pleasant occurrence. They may faint at
the sight of blood or blush at a slight faux pas. They tend to demand that
others meet their needs for attention and play the victim when others fall
short. They also tend to be self-centered and intolerant of delays of
gratification: People with histrionic personalities may be attracted to
professions like modeling or acting, where they can hog the spotlight.

Narcissistic Personality Disorder

People with narcissistic personality disorder have an inflated or
grandiose sense of themselves and an extreme need for admiration. They
brag about their accomplishments and expect others to shower them with
praise. They expect others to notice their special qualities, even when
their accomplishments are ordinary, and they enjoy basking in the light
of adulation. They are self-absorbed and lack empathy for others.
Although more than half of the people diagnosed with narcissistic
personality disorder are men, we cannot say whether there is an
underlying gender difference in prevalence rates in the general
population.
A certain degree of narcissism may represent a healthful
adjustment to insecurity, a shield from criticism and failure, or a motive
for achievement. People with narcissistic personalities tend to be
preoccupied with fantasies of success and power, ideal love, or
recognition for brilliance or beauty. Like people with histrionic
personalities, they may gravitate toward careers in modeling, acting, or
politics. Interpersonal relationships are invariably strained by the
demands that people with narcissistic personality impose on others and
by their lack of empathy with, and concern for, other people.

9.5.3 Cluster C Personality Disorder

Personality Disorders Characterized by Anxious or Fearful
Behavior
This cluster of personality disorders includes the avoidant,
dependent, and obsessive– compulsive types. Although the features of
these disorders differ, they share a component of fear or anxiety.

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Avoidant Personality Disorder
People with avoidant personality disorder are so terrified of
rejection and criticism that they are generally unwilling to enter into
relationships without ardent reassurances of acceptance. As a result, they
may have few close relationships outside their immediate families. They
also tend to avoid group occupational or recreational activities for fear of
rejection. They prefer to lunch alone at their desks. Unlike people with
schizoid qualities, with whom they share the feature of social
withdrawal, individuals with avoidant personalities have interest in, and
feelings of warmth toward, other people. However, fear of rejection
prevents them from striving to meet their needs for affection and
acceptance. In social situations, they tend to hug the walls and avoid
conversing with others. They fear public embarrassment, the thought
that others might see them blush, cry, or act nervously.

Dependent Personality Disorder

Dependent personality disorder describes people who have an
excessive need to be taken care of by others. This leads them to be
overly submissive and clinging in their relationships and extremely
fearful of separation. People with this disorder find it very difficult to do
things on their own. They seek advice in making even the smallest
decision. Dependent personality disorder is linked to other psychological
disorders, including mood disorders and social phobia, as well as to
physical problems such as hypertension, cardiovascular disorder, and
gastrointestinal disorders like ulcers and colitis.
Obsessive–Compulsive Personality Disorder
The defining features of obsessive–compulsive personality
disorder include excessive orderliness, perfectionism, rigidity, difficulty
coping with ambiguity, difficulty expressing feelings, and
meticulousness in work habits. Estimates of the prevalence of the
disorder vary from 2.1% to 7.9% of the population (APA, 2013). The
disorder is about twice as common in men as in women. Unlike
obsessive–compulsive anxiety disorder, people with obsessive–
compulsive personality disorder do not necessarily experience outright
obsessions or compulsions. If they do, both diagnoses may be deemed
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appropriate. People with obsessive–compulsive personality disorder are
so preoccupied with the need for perfection that they cannot complete
work on time.

9.5.4 Causes for Personality Disorder

Biological Perspectives
Genetic Factors Evidence points to genetic factors playing a role in the
development of several types of personality disorders, including
antisocial, narcissistic, paranoid, and borderline types. Parents and
siblings of people with personality disorders, such as antisocial,
schizotypal, and borderline types, are more likely to be diagnosed with
these disorders themselves than are members of the general population.
Investigators also report finding genetic indicators in a particular
chromosome linking to features of borderline personality disorder.
Although we have evidence of genetic contributions to personality traits
associated with personality disorders, it is important to recognize that
environmental factors also play an important contributing role. For
example, exposure to environmental influences, such as being raised in a
dysfunctional or troubled family, may predispose individuals to develop
personality disorders, such as antisocial or borderline personality
disorders.
Brain Abnormalities: Brain imaging links borderline personality
disorder and antisocial personality disorder to dysfunctions in parts of
the brain involved in regulating emotions and restraining impulsive
behaviors, especially aggressive behaviors. Areas of the brain most
directly implicated are the prefrontal cortex (located in the front or
anterior part of the frontal lobes) and deeper brain structures in the
limbic system. The prefrontal cortex is involved in controlling impulsive
behavior, weighing consequences of actions, and solving problems.

Socio-cultural Perspectives
Social conditions may contribute to the development of personality
disorders. Because antisocial personality disorder is reported most
frequently among people from lower socioeconomic classes, the kinds of
stressors encountered by disadvantaged families may contribute to
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antisocial behavior patterns. Many inner-city neighborhoods are beset
with social problems such as alcohol and drug abuse, teenage pregnancy,
and disorganized and disintegrating families. These stressors are
associated with an increased likelihood of child abuse and neglect,
which may in turn contribute to lower self-esteem and breed feelings of
anger and resentment in children. Children reared in poverty are also
more likely to be exposed to deviant role models, such as neighborhood
drug dealers. Maladjustment in school may lead to alienation and
frustration with the larger society, leading to antisocial behavior.
Addressing
9.5.5 Treatment
Psychodynamic Approaches
Psychodynamic approaches are often used to help people
diagnosed with personality disorders become aware of the roots of their
self-defeating behavior patterns and learn more adaptive ways of relating
to others. However, people with personality disorders, especially those
with borderline and narcissistic personality disorders, often present
particular challenges to the therapist. For example, people with
borderline personality disorder tend to have turbulent relationships with
therapists, sometimes idealizing them, sometimes denouncing them as
uncaring.
Promising results are reported using structured forms of psycho
dynamically oriented therapies in treating personality disorders. These
therapies raise clients’ awareness of how their behaviors cause problems
in their close relationships. The therapist takes a more direct,
confrontational approach that addresses the client’s defenses than would
be the case in traditional psychoanalysis.
Cognitive-Behavioral Approaches
Cognitive behavior therapists focus on changing clients’
maladaptive behaviors and dysfunctional thought patterns rather than
their personality structures. They may use behavioral techniques such as
modeling and reinforcement to help clients develop more adaptive
behaviors. For example, when clients are taught behaviors that are likely
to be reinforced by other people, the new behaviors may well be
maintained.
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Biological Approaches
Drug therapy does not directly treat personality disorders.
However, antidepressant and anti-anxiety drugs are sometimes used to
treat depression and anxiety in people with personality disorders.
Neurotransmitter activity is also implicated in aggressive behavior of the
type seen in individuals with borderline personality disorder. The
neurotransmitter serotonin helps put the brakes on impulsive behaviors,
including acts of impulsive aggression.

9.6 IMPULSE CONTROL DISORDERS

People with borderline personalities often have difficulty
controlling their impulses. But problems with impulse control are not
limited to people with personality disorders. The DSM includes a
category of mental disorders called impulse-control disorders that are
characterized by difficulties in controlling or restraining impulsive
behavior. Impulse-control disorders in DSM-5 are grouped in a broader
category of disruptive, impulse-control, and conduct disorders. Other
impulse control problems such as compulsive Internet use and
compulsive shopping are presently under consideration for inclusion in
later versions of the diagnostic manual. Our focus here is on three types
of impulse control disorders: kleptomania, intermittent explosive
disorder, and pyromania.
9.6.1 Kleptomania
Kleptomania, which derives from the Greek kleptes, meaning thief,
and mania, meaning “madness” or “frenzy,” is characterized by repeated
acts of compulsive stealing. The stolen objects are typically of little
value or use to the person. The person may give them away, return them
secretly, discard them, or just keep them hidden at home. In most cases,
people with kleptomania can easily afford the items they steal. Even
wealthy people have been known to be compulsive shoplifters.

9.6.2 Intermittent Explosive Disorder

People have been concerned about the human capacity for rage and
the violent behavior it often provokes for time immemorial. Rage is not
a criterion used to diagnose mental or psychological disorders in the
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DSM. But rage is often a feature of intermittent explosive disorder, or
IED, a type of impulse-control disorder characterized by repeated
episodes of impulsive, uncontrollable aggression in which people strike
out at others or destroy property. The core feature of IED is impulsive
aggression, the tendency to lose control of aggressive impulses. People
with IED have episodes of violent rage in which they suddenly lose
control and hit or try to hit other people or smash objects. Recent
research on IED has largely focused on its biological underpinnings, and
particularly on the possible role of the neurotransmitter serotonin.

9.6.3 Pyromania
Pyromania, from the Latin roots pyr, meaning “fire” and the Greek
word mania, meaning “madness” or “frenzy,” is characterized by
repeated acts of compulsive fire setting in response to irresistible urges.
Only a small percentage of arsonists are diagnosed with pyromania. The
most common motives for fire setting appear to be anger and revenge,
Pyromania is considered a rare disorder, which may help explain why it
remains so poorly understood. People with pyromania feel a sense of
release or psychological relief when setting fires and perhaps feelings of
empowerment as the result of prompting firefighters to rush to the scene
of the blaze, along with the heavy firefighting equipment they bring. The
fire setter may also experience pleasurable excitement by watching or
even participating in the firefighting effort.
Check Your Progress
5. What is dependent personality disorder?
6. What is kleptomania?

9.7 SEXUAL AND GENDER IDENTITY DISORDER

Sexual Dysfunctions
Sexual dysfunctions, disorders in which people cannot respond
normally in key areas of sexual functioning, Sexual dysfunctions are
typically very distressing, and they often lead to sexual frustration, guilt,
loss of self-esteem, and interpersonal problems. Often these
dysfunctions are interrelated; many patients with one dysfunction
experience another as well. The human sexual response can be described
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as a cycle with four phases: desire, excitement, orgasm, and resolution.
Sexual dysfunctions affect one or more of the first three phases.
Resolution consists simply of the relaxation and reduction in arousal that
follow orgasm.

9.7.1 Disorders of Desire

The desire phase of the sexual response cycle consists of an urge to
have sex, sexual fantasies, and sexual attraction to others. Two
dysfunctions—hypoactive sexual desire disorder and sexual aversion
disorder—affect the desire phase. People with hypoactive sexual desire
disorder lack interest in sex and, in turn, display little sexual activity.
Nevertheless, when these individuals do have sex, their physical
responses may be normal and they may enjoy the experience.
People with sexual aversion disorder find sex distinctly unpleasant or
repulsive. Sexual advances may sicken, disgust, or frighten them. Some
people are repelled by a particular aspect of sex,

Causes
A person’s sex drive is determined by a combination of biological,
psychological, and socio-cultural factors, and any of them may reduce
sexual desire.
Biological Causes
A number of hormones interact to help produce sexual desire and
behavior, and abnormalities in their activity can lower the sex drive. In
both men and women, a high level of the hormone prolactin, a low level
of the male sex hormone testosterone, and either a high or low level of
the female sex hormone estrogen can lead to low sex drive. Clinical
practice and research have further indicated that sex drive can be
lowered by certain pain medications, psychotropic drugs, and illegal
drugs

Psychological Causes
A general increase in anxiety, depression, or anger may reduce
sexual desire in both men and women. Frequently, as cognitive theorists
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have noted, people with hypoactive sexual desire and sexual aversion
have particular attitudes, fears, or memories that contribute to their
dysfunction, such as a belief that sex is immoral or dangerous.

Socio-cultural Causes
The attitudes, fears, and psychological disorders that contribute to
hypoactive sexual desire and sexual aversion occur within a social
context, and thus certain socio-cultural factors have also been linked to
these dysfunctions. Many sufferers are feeling situational pressures—
divorce, a death in the family, job stress, infertility difficulties, having a
baby. Others may be having problems in their relationships.

9.7.2 Disorders of Excitement

The excitement phase of the sexual response cycle is marked by
changes in the pelvic region, general physical arousal, and increases in
heart rate, muscle tension, blood pressure, and rate of breathing. In men,
blood pools in the pelvis and leads to erection of the penis; in women,
this phase produces swelling of the clitoris and labia, as well as
lubrication of the vagina.
Female Sexual Arousal Disorder
Women with a female sexual arousal disorder are persistently
unable to attain or maintain proper lubrication or genital swelling during
sexual activity. Understandably, many of them also experience an
orgasmic disorder or other sexual dysfunction.
Male Erectile Disorder
Men with male erectile disorder persistently fail to attain or
maintain an adequate erection during sexual activity. This problem
occurs in as much as 10 percent of the general male population.
Biological Causes
The same hormonal imbalances that can cause hypoactive sexual
desire can also produce erectile disorder. Medical procedures, including
ultrasound recordings and blood tests, have been developed for
diagnosing biological causes of erectile disorder. Measuring nocturnal
penile tumescence (NPT), or erections during sleep, is particularly useful
in assessing whether physical factors are responsible.
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Psychological Causes
Any of the psychological causes of hypoactive sexual desire can
also interfere with arousal and lead to erectile disorder. The cognitive-
behavioral theory developed by William Masters and Virginia. The
explanation emphasizes performance anxiety and the spectator role.
Once a man begins to experience erectile problems, for whatever reason,
he becomes fearful about failing to have an erection and worries during
each sexual encounter.
Socio-cultural Causes
Each of the socio-cultural factors that contribute to hypoactive
sexual desire has also been tied to erectile disorder. Men who have lost
their jobs and are under financial stress are suffering with this.

9.7.3 Disorders of Orgasm

During the orgasm phase of the sexual response cycle, an
individual’s sexual pleasure peaks and sexual tension is released as the
muscles in the pelvic region contract, or draw together, rhythmically.
The man’s semen is ejaculated, and the outer third of the woman’s
vaginal wall contracts. Dysfunctions of this phase of the sexual response
cycle are rapid, or premature, ejaculation; male orgasmic disorder; and
female orgasmic disorder.

Rapid, or Premature, Ejaculation

A man suffering from rapid, or premature, ejaculation persistently
reaches orgasm and ejaculates with very little sexual stimulation before,
on, or shortly after penetration and before he wishes to. Psychological,
particularly behavioral, explanations of rapid ejaculation have received
more research support than other kinds of explanations. Rapid
ejaculation often occurs when a young man has his first sexual
encounter. With continued sexual experience, most men acquire greater
control over their sexual responses.
Three biological theories have emerged from the limited
investigations done so far. One theory states that some men are born
with a genetic predisposition to develop this dysfunction. Indeed, one
study found that 91 percent of a small sample of men suffering from
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rapid ejaculation had first-degree relatives who also displayed the
dysfunction. A second theory, based on animal studies, argues that the
brains of men with rapid ejaculation contain certain serotonin receptors
that are overactive and others that are underactive. A third explanation
holds that men with this dysfunction experience greater sensitivity or
nerve conduction in the area of their penis, a notion that has received
inconsistent research support thus far.
Male Orgasmic Disorder
A man with male orgasmic disorder is repeatedly unable to reach
orgasm or is very delayed in reaching orgasm after normal sexual
excitement. The disorder occurs in 8 percent of the male population A
low testosterone level, certain neurological diseases, and some head or
spinal cord injuries can interfere with ejaculation. The drugs which
affect the sympathetic nervous system (such as alcohol, some
medications for high blood pressure, and certain psychotropic
medications) can also affect ejaculation. For example, certain serotonin-
enhancing antidepressant drugs appear to interfere with ejaculation in at
least 30 percent of men who take them. A leading psychological cause of
male orgasmic disorder appears to be performance anxiety and the
spectator role, the cognitive-behavioral factors also involved in male
erectile disorder

Female Orgasmic Disorder

Women with female orgasmic disorder rarely reach orgasm or
generally experience a very delayed one. As many as 24 percent of
women apparently have this problem to some degree.
Biological Causes
A variety of physiological conditions can affect a woman’s arousal
and orgasm. Diabetes can damage the nervous system in ways that
interfere with arousal, lubrication of the vagina, and orgasm. Lack of
orgasm has sometimes been linked to multiple sclerosis and other
neurological diseases,
Psychological Causes
The psychological causes of hypoactive sexual desire and sexual
aversion, including depression, may also lead to the female arousal and
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orgasmic disorders. In addition, as both psychodynamic and cognitive
theorists might predict, memories of childhood traumas and relationships
have sometimes been associated with these disorders.
9.7.4 Disorders of Sexual Pain
Two sexual dysfunctions do not fit neatly into a specific phase of
the sexual response cycle. These are the sexual pain disorders,
vaginismus and dyspareunia, each marked by enormous physical
discomfort when sexual activity is attempted.
Vaginismus
In vaginismus, involuntary contractions of the muscles around the
outer third of the vagina prevent entry of the penis. Severe cases can
prevent a couple from ever having intercourse. Some women experience
painful intercourse because of an infection of the vagina or urinary tract,
a gynecological disease such as herpes simplex, or the physical effects
of menopause. In such cases vaginismus can be overcome only if the
women receive medical treatment for these conditions
Dyspareunia
A person with dyspareunia (from Latin words meaning “painful
mating”) experiences severe pain in the genitals during sexual activity.
Dyspareunia in women usually has a physical cause. Among the most
common is an injury (for example, to the vagina or pelvic ligaments)
during childbirth. Similarly, the scar left by an episiotomy (a cut often
made to enlarge the vaginal entrance and ease delivery) can cause pain.
Paraphilias
Paraphilias are disorders in which individuals repeatedly have
intense sexual urges or fantasies or display sexual behaviors that involve
nonhuman objects, children, non consenting adults, or the experience of
suffering or humiliation. Many people with a paraphilia can become
aroused only when a paraphilic stimulus is present, fantasized about, or
acted out.
Fetishism
Key features of fetishism are recurrent intense sexual urges,
sexually arousing fantasies, or behaviors that involve the use of a
nonliving object, often to the exclusion of all other stimuli. Usually the
disorder, which is far more common in men than in women, begins in
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adolescence. Almost anything can be a fetish; women’s underwear,
shoes, and boots are particularly common (APA, 2000).
Transvestic Fetishism
Transvestic fetishism, also known as transvestism or cross-
dressing, is a recurrent need or desire to dress in clothes of the opposite
sex in order to achieve sexual arousal.
Exhibitionism
A person with exhibitionism has recurrent urges to expose his
genitals to another person, almost always a member of the opposite sex,
or has sexually arousing fantasies of doing so. He may also carry out
those urges but rarely attempts to initiate sexual activity with the person
to whom he exposes himself (APA, 2000).
Voyeurism
A person who engages in voyeurism has recurrent and intense
urges to secretly observe unsuspecting people as they undress or to spy
on couples having intercourse.
Frotteurism
A person who develops frotteurism has repeated and intense sexual
urges to touch and rub against a non consenting person or has sexually
arousing fantasies of doing so. The person may also act on the urges.
Frottage (from French frotter, “to rub”) is usually committed in a crowd.
Pedophilia
A person with pedophilia gains sexual gratification by watching,
touching, or engaging in sexual acts with prepubescent children, usually
13 years old or younger. Some people with this disorder are satisfied by
child pornography or seemingly innocent material such as children’s
underwear ads; odd place, such as a subway or a busy sidewalk.
Sexual Sadism
A person with sexual sadism, usually male, is intensely sexually
aroused by the thought or act of inflicting suffering on others by
dominating, restraining, blindfolding, cutting, strangling, mutilating, or
even killing the victim.

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9.8 GENDER IDENTITY DISORDER
DSM-IV-TR categorizes these individuals as having gender
identity disorder, a disorder in which people persistently feel that a vast
mistake has been made, they have been born to the wrong sex, and
gender changes would be desirable.
The DSM-IV-TR categorization of gender identity disorder is
controversial. Many people believe that transgender experiences reflect
alternative— not pathological—ways of experiencing one’s gender
identity. People with gender identity disorder would like to get rid of
their primary and secondary sex characteristics—many of them find
their own genitals repugnant—and acquire the characteristics of the
other sex (APA, 2000).
Types of Gender Dysphoria Clients
Richard Carroll (2007), a leading theorist on gender dysphoria, has
described the three patterns of gender identity disorder for which
individuals most commonly seek treatment: (1) female-to-male gender
dysphoria, (2) male-to-female gender dysphoria: androphilic type, and
(3) male-to-female gender dysphoria: autogynephilic type.
Female-to-Male Gender Dysphoria
People with a female-to-male gender dysphoria pattern are born
female but appear or behave in a stereotypically masculine manner from
early on—often as young as 3 years of age or younger.
Male-to-Female Gender Dysphoria:
Androphilic Type People with an androphilic type of
male-to-female gender dysphoria are born male but appear or behave in
a stereotypically female manner from birth. As children, they are viewed
as effeminate, pretty, and gentle; avoid rough games; and hate to dress in
boys’ clothing.
9.9 LET’S SUM IT UP
Anorexia nervosa is characterized by self-starvation and failure to
maintain normal body weight, intense fears of becoming over weight,
and distorted body image. Bulimia nervosa involves preoccupation with
weight control and body shape, repeated binges, and regular purging to
keep weight down. Binge-eating disorder (BED) involves a recurrent
pattern of binge eating that is not accompanied by compensatory
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behaviors such as purging. People with BED tend to be older than those
with anorexia or bulimia and are more likely to be obese. Eating
disorders typically begin in adolescence and affect more females than
males. Anorexia nervosa and bulimia nervosa are linked to
preoccupations with weight control and maladaptive ways of trying to
keep weight down. Many other factors are implicated in their
development, including social pressures on young women to adhere to
unrealistic standards of thinness, issues of control, underlying
psychological problems, and conflict within the family, especially over
issues of autonomy.
Insomnia disorder is often associated with worry and anxiety,
especially performance anxiety associated with overconcern about not
getting enough sleep. Hypersomnolence disorder involves excessive
daytime sleepiness, whereas narcolepsy involves the occurrence of
abrupt sleep attacks during waking hours. Narcolepsy may involve
genetic factors and loss of brain cells in the hypothalamus involved in
producing a chemical that regulates wakefulness. Breathing-related sleep
disorders involve recurrent episodes of momentary cessation of
breathing during sleep and are often associated with daytime sleepiness.
Obstructive sleep apnea hypopnea syndrome, the most common type of
breathing-related sleep disorder, is typically caused by respiratory
problems.
Personality disorders are maladaptive or rigid behavior patterns or
personality traits associated with states of personal distress that impair
the person’s ability to function in social or occupational roles.
People with personality disorders do not generally recognize the need to
change themselves. The three major clusters of personality disorders are
categorized on the basis of the following characteristics: (1) odd or
eccentric behavior, (2) dramatic, emotional, or erratic behavior, and (3)
anxious or fearful behavior. Impulse-control disorders are psychological
disorders characterized by a pattern of repeated failure to resist impulses
to perform acts that lead to harmful consequences to self or others.
People affected by these disorders experience a rising level of tension or
arousal just before the act, then a sense of relief or release when the act
is committed
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 A sexual dysfunction is a persistent or recurrent pattern involving
lack of sexual desire, problems in becoming sexually aroused, and/or
problems in reaching orgasm. Sexual dysfunctions can be classified in
three general categories: (1) disorders involving low sexual desire or
impaired arousal (female sexual interest/arousal disorder, male
hypoactive sexual desire disorder, erectile disorder); (2) disorders
involving impaired orgasmic response (female orgasmic disorder,
delayed ejaculation, and premature or early ejaculation); and (3)
disorders involving sexual pain (genito-pelvic pain/penetration
disorder)..
9.10 Unit End Exercise
1. Describe causal factors involved in anorexia nervosa and bulimia
nervosa. Identify factors linked to obesity
2. Evaluate problems associated with the classification of personality
disorders.
3. Evaluate methods used to treat personality disorders.
4. Define the concept of impulse-control disorders and describe the
features of several major types.
9.11 Answers for Check your Progress
1. The most obvious characteristic of anorexia nervosa is extreme
emaciation, or more technically, the refusal to maintain a
minimally normal body weight.
2. Almost all people with bulimia nervosa engage in purging,
designed to eliminate consumed food from the body.
3. Somnabulism means sleep Walking.
4. Narcolepsy is a different form of the sleeping problem. In addition
to daytime sleepiness, people with narcolepsy experience
cataplexy, a sudden loss of muscle tone.
5. Dependent personality disorder describes people who have an
excessive need to be taken care of by others. This leads them to be
overly submissive and clinging in their relationships and extremely
fearful of separation.
6. Kleptomania is characterized by repeated acts of compulsive
stealing.

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9.12 Suggested Readings
1. Carson, r.c., Butcher, J.N and Mineka, S.(2004). Abnormal
psychology. 13th Edition.
New Delhi: Pearson education.
2. Barlow, D.H. and Durand, M.V. (2000). Abnormal psychology. 2nd
Edition. New Delhi:
3. Sue, D., Sue,,D and Sue. S. (1990). Understanding Abnormal
behavior. 3rd Edition, Houghton Miffin Co.

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UNIT10
CLASSIFICATION OF MENTAL DISORDER AND
ORGANIC MENTAL DISORDERS
Structure
10.1 Introduction
10.2 Objectives
10.3 History of classifications
10.4Dementia
10.4.1 Symptoms
10.4.2 Causes
10.5 Specific disorders associated with Dementia
10.5.1 Alzheimer
10.5.2 Huntington’s Disease
10.5.3 Parkinson Disease
10.5.4 Causes
10.6 Delirium
10.6.1 Symptoms
10.6.2 Causes
10.7 Amnestic Disorder
10.8 Treatment
10.8.1 Medication
10.8.2 Environment & Behavioral Management
10.8.3 Support for caregivers
10.9 Let us sum up
10.10 Unit End Exercise
10.11 Answers for Check your Progress
10.12 Suggested Readings

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10.1 Introduction
The use of a common language to describe observed clinical
phenomena is critical to both clinical practice and research. These
common terms for symptoms and categories allow the new clinician to
develop a relatively accurate picture of the patient. Using diagnostic
labels to describe sets of symptoms helps clinicians and researchers
communicate about their patients. Deciding which diagnosis best fits a
patient’s pattern of symptoms also helps the clinician develop an
appropriate treatment plan. The way clinicians refer to mental disorders
has changed over the years as our understanding of these disorders
continues to evolve.
10.2 Objectives
On completion of this unit, you will be able to understand
Classifications - DSM & ICD
Cognitive Disorders such as Dementia, Delirium, Amnestic
disorder and their causes and treatment.

10.3 HISTORY OF CLASSIFICATION OF ABNORMAL

BEHAVIORS
In 1952 the American Psychiatric Association (APA) adopted a
classification system— the Diagnostic and Statistical Manual of
Mental Disorders (DSM-I) (APA, 1952)—from an earlier system
developed in 1918 to provide the Bureau of the Census with uniform
statistics about psychiatric hospitals. The 1952 DSM manual contained
106 categories of mental disorders. From that point forward, the DSM
has expanded. Published in 1968, the DSM-II (APA, 1968) listed 182
disorders in 134 pages and reflected the dominant psychodynamic
perspective of the time. Symptoms were described as reflections of
broad underlying conflicts or maladaptive reactions to life problems
rather than in observable behavioral terms (Wilson, 1993). In
1974, the task force working to revise the DSM emphasized the
importance of establishing more specific diagnostic criteria. The
intention was to facilitate mental health research and to establish
classifications that would reflect current scientific knowledge.

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 In the DSM-III (APA, 1980), categorization was based on
description rather than assumptions about the causes of the disorder, and
a more biomedical approach replaced the psychodynamic perspective
(Wilson, 1993). The DSM-III, published in 1980, was more than three
times the size of the earlier DSM and described twice as many
diagnostic categories (265). The controversial expansion included many
new diagnostic categories. For example, the former category of anxiety
neurosis was divided into several different and distinct categories
including generalized anxiety disorder, panic disorder, and social
phobia. All subsequent revisions have maintained the structure of the
DSM-III and have attempted to refine or improve this version rather than
to overhaul the diagnostic system entirely. The next version, the DSM-
III-R (APA, 1987) included not only revisions but also renaming,
reorganization, and replacement of several disorders, which yielded 292
diagnoses.
In 1994, DSM-IV listed 297 disorders. This revision emerged from
the work of a steering committee, consisting of work groups of experts
who (a) conducted an extensive literature review of the diagnoses, (b)
obtained data from researchers to determine which criteria to change,
and (c) conducted multicenter clinical trials (Schaffer, 1996).
DSM-IV-TR (APA, 2000), a “text” revision, was published in 2000 with
most diagnostic criteria unaltered. This revision primarily provided
updated information on each diagnosis and was more consistent with
International Classification of Diseases-10 published by the
World Health Organization (discussed later in this chapter). As we
continue to learn more about psychopathology, the DSM continues to
evolve.
The next version, the DSM-V, released in May 2013. Although
many valid criticisms have arisen as a reaction to the DSM system, at its
most useful, it provides a framework and common language for
clinicians and researchers. The DSM system helps clinicians examine
presenting problems and associated features and to identify appropriate
assessments and treatments. Moreover, accurate classification of mental
disorders is a critical element of rigorous research.

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 An alternative to the DSM classification system is the
International Classification of Diseases and Related Health Problems
(ICD). Published by the World Health Organization (WHO; 1992), the
ICD uses a code-based classification system for physical diseases and a
broad array of psychological symptoms and syndromes. The ICD system
for diagnosing mental disorders was developed in Europe at
approximately the same time that the original DSM was being developed
in the United States, shortly after World War II. The first set of mental
disorders was included in the ICD in 1948. The APA and WHO have
worked to coordinate the DSM and the relevant sections of ICD,
although some differences remain. Like the DSM system, the ICD is
regularly revised; it is currently in its tenth edition (ICD-10 in 1992).
The ICD has become the international standard diagnostic classification
system for epidemiology and many health management purposes.
Beyond its use in classifying diseases and other health problems, the
ICD is used for morbidity and mortality statistics for the WHO and for
third party payers and insurance companies (WHO, 2007).
The diagnosis and classification of psychological disorders are
important for creating a common language for clinicians and researchers
to facilitate communication about patients and psychological symptoms
and syndromes. Diagnoses also help clinicians to develop appropriate
treatment plans. The DSM system of classification is most often used in
this country. An alternative classification system, the International
Classification of Diseases (ICD), is used in Europe. _ Developmental,
demographic, and cultural variables affect the nature and experience of
abnormal behavior. These variables must be considered when evaluating
the utility of diagnostic classification systems.
Check your Progress
1. What is the expansion for DSM &ICD?
2. Name the current version of DSM

10.4 Dementia
Dementia is a gradual worsening loss of memory and related
cognitive functions, including the use of language, as well as reasoning
and decision making. It is a clinical syndrome that involves progressive
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impairment of many cognitive abilities. Dementia is a chronic,
deteriorating condition that reflects the gradual loss of neurons in the
brain. In dementia, memory and other cognitive functions are the most
obvious manifestations of the problem. They are its defining features. As
dementia progresses, the person’s attention span, concentration,
judgment, planning, and decision making become severely disturbed.

10.4.1 Symptoms
Cognitive Symptoms
Dementia appears in people whose intellectual abilities have
previously been unimpaired. The earliest signs of dementia are often
quite vague. They include difficulty remembering recent events and the
names of people and familiar objects. These are all problems that are
associated with normal aging, but they differ from that process in order
of magnitude. The distinguishing features of dementia include cognitive
problems in a number of areas, ranging from impaired memory and
learning to deficits in language and abstract thinking. By the final stages
of dementia, intellectual and motor functions may disappear almost
completely.
Memory and Learning
The diagnostic hallmark of dementia is memory loss. Retrograde
amnesia refers to the loss of memory for events prior to the onset of an
illness or the experience of a traumatic event.
Anterograde amnesia refers to the inability to learn or remember
new material after a particular point in time.

Verbal Communication
Language functions can also be affected in dementia. Aphasia is a
term that describes various types of loss or impairment in language that
are caused by brain damage. Language disturbance in dementia is
sometimes relatively subtle, but it can include many different kinds of
problems. In addition to problems in understanding and forming
meaningful sentences, the demented person may also have difficulty
performing purposeful movements in response to verbal commands, a
problem known as apraxia.
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Perception
Some patients with dementia have problems identifying stimuli in
their environments. The technical term for this phenomenon is agnosia,
which means “perception without meaning.” The person’s sensory
functions are unimpaired, but he or she is unable to recognize the source
of stimulation. Agnosia can be associated with visual, auditory, or
tactile sensations.
Abstract Thinking
Another manifestation of cognitive impairment in dementia is loss of the
ability to think in abstract ways. The person may be bound to concrete
interpretations of things that other people say.
Judgment and Social Behavior
Related to deficits in abstract reasoning is the failure of social
judgment and problem-solving skills. The disruption of short-term
memory, perceptual skills, and higher-level cognitive abilities obviously
causes disruptions of judgment.
Motor Behaviors
Demented persons may become agitated, pacing restlessly or
wandering away from familiar surroundings. In the later stages of the
disorder, patients may develop problems in the control of the muscles by
the central nervous system. Some specific types of dementia are
associated with involuntary movements, or dyskinesia— tics, tremors,
and jerky
10.4.2 Causes:
Neurotransmitters
In patients suffering from dementia, the process of chemical
transmission of messages within the brain is probably disrupted,
Parkinson’s disease are directly related to dopamine deficiencies.
Other types of dementia have also been linked to problems with specific
neurotransmitters. Huntington’s disease may be associated with
deficiencies in gamma-aminobutyric acid (GABA).

Viral Infections
Some forms of primary dementia are known to be the products of
“slow” viruses—infections that develop over a much more extended
144
period of time than do most viral infections. Creutzfeldt-Jakob disease is
one example.
Immune System Dysfunction
The immune system is the body’s first line of defense against
infection. It employs antibodies to break down foreign materials, such as
bacteria and viruses, that enter the body. The regulation of this system
allows it to distinguish between foreign bodies that should be destroyed
and normal body tissues that should be preserved.
The production of these antibodies may be dysfunctional in some forms
of dementia, such as Alzheimer’s disease. In other words, the destruction
of brain tissue may be caused by a breakdown in the system that
regulates the immune system. The presence of beta-amyloid at the core
of amyloid plaques is one important clue to the possible involvement of
immune system dysfunction.
Environmental Factors Epidemiological investigations have
discovered several interesting patterns that suggest that some types of
dementia, especially Alzheimer’s disease, may be related to
environmental factors. One example is head injury, which can cause a
sudden increase of amyloid plaque

10.5 Specific Disorders Associated with Dementia

10.5.1 Dementia of the Alzheimer’s Type The speed of onset serves as
the main feature to distinguish Alzheimer’s disease from the other types
of dementia listed in DSM-IV-TR. In this disorder, the cognitive
impairment appears gradually, and the person’s cognitive deterioration is
progressive. If the person meets these criteria, the diagnosis is then made
on the basis of excluding other conditions, Brain imaging procedures
offer exciting new tools for the measurement of brain lesions associated
with dementia. Scientists have developed a technique to detect amyloid
plaques using positron emission tomography (PET imaging) in the living
brain. This procedure may eventually replace the need to wait for
autopsy to verify a diagnosis of Alzheimer’s disease.

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10.5.2 Huntington’s Disease
Unusual involuntary muscle movements known as chorea (from
the Greek word meaning “dance”) represent the most distinctive feature
of Huntington’s disease. These movements are relatively subtle at first,
with the person appearing to be merely restless or fidgety. As the
disorder progresses, sustained muscle contractions become difficult.
Movements of the face, trunk, and limbs eventually become
uncontrolled, leaving the person to writhe and grimace. A large
proportion of Huntington’s patients also exhibit a variety of personality
changes and symptoms of mental disorders, primarily depression and
anxiety. The movement disorder and the cognitive deficits are produced
by progressive neuronal degeneration in the basal ganglia.

10.5.3 Parkinson’s Disease

A disorder of the motor system, known as Parkinson’s disease, is
caused by a degeneration of a specific area of the brain stem known as
the substantia nigra and loss of the neurotransmitter dopamine, which is
produced by cells in this area. Typical symptoms include tremors,
rigidity, postural abnormalities, and reduction in voluntary movements.
Unlike people with Huntington’s disease, most patients with Parkinson’s
disease do not become demented. Follow-up studies suggest that
approximately 20 percent of elderly patients with Parkinson’s disease
will develop symptoms of dementia. Their risk is approximately double
the risk of dementia found among people of similar age who do not have
Parkinson’s disease.

Check your Progress

1. What is dementia?
2. What is Huntington disease?

10.6 Delirium
Delirium is a confusion state that develops over a short period of
time and is often associated with agitation and hyperactivity. The most
146
important symptoms of delirium are disorganized thinking and a reduced
ability to maintain and shift attention.
Delirium and dementia are produced by very different processes.

10.6.1 Symptoms
The primary symptom of delirium is clouding of consciousness in
association with a reduced ability to maintain and shift attention.
The disturbance in consciousness might also be described as a reduction
in the clarity of a person’s awareness of his or her surroundings.
Memory deficits may occur in association with impaired consciousness
and may be the direct result of attention problems. The person’s thinking
appears disorganized, and he or she may speak in a rambling, incoherent
fashion. Fleeting perceptual disturbances, including visual
hallucinations, are also common in delirious patients. The symptoms of
delirium follow a rapid onset—from a few hours to several days—and
typically fluctuate throughout the day. The person may alternate
between extreme confusion and periods in which he or she is more
rational and clearheaded. Symptoms are usually worse at night.

10.6.2 Causes
The underlying mechanisms responsible for the onset of delirium
undoubtedly involve neuropathology and neurochemistry. The incidence
of delirium increases among elderly people, presumably because the
physiological effects of aging make elderly people more vulnerable to
medication side effects and cognitive complications of medical illnesses.
Delirium can be caused by many different kinds of medication,
including the following:
• Psychiatric drugs (especially antidepressants, antipsychotics,
and benzodiazepines)
• Drugs used to treat heart conditions
• Painkillers
• Stimulants (including caffeine)

147
 Delirium also develops in conjunction with a number of metabolic
diseases, including pulmonary and cardiovascular disorders (which can
interfere with the supply of oxygen to the brain), as well as endocrine
diseases (especially thyroid disease and diabetes mellitus). Various kinds
of infections can lead to the onset of delirium. Perhaps the most common
among elderly people is urinary tract infection, which can result from
the use of an indwelling urinary catheter (sometimes necessary with
incontinent nursing home patients).

10.7 Amnestic Disorder

Some cognitive disorders involve more circumscribed forms of
memory impairment than those seen in dementia. In amnestic disorders,
a person exhibits a severe impairment of memory while other higher
level cognitive abilities are un-affected. The memory disturbance
interferes with social and occupational functioning and represents a
significant decline from a previous level of adjustment. Subtypes of
amnestic disorder are diagnosed on the basis of evidence, acquired from
the patient’s history, from a physical examination, or from laboratory
tests, regarding medical conditions or substance use that is considered to
be related to the onset of the memory impairment.
One widely accepted theory regarding this condition holds that
lack of vitamin B1 (thiamine) leads to atrophy of the medial thalamus, a
sub cortical structure of the brain, and mammillary bodies (MB).
Support for one aspect of this theory comes from studies that used
magnetic resonance imaging to compare brain structures in alcoholic
patients with amnesia, alcoholic patients without amnesia, and normal
controls. Deficits in MB volume occur in both types of alcoholics, and
greater volume deficits are found in alcoholic patients with amnesia.
Other data suggest, however, that these problems cannot be traced
exclusively to thiamine deficiency.
Check your progress
3. What is delirium?
4. What is Amnestic Disorder?
5. Which is the primary symptoms of delirium?

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10.8 Treatment and Management
10.8.1 Medication
Some drugs are designed to relieve cognitive symptoms of
dementia by boosting the action of acetylcholine (ACh), a
neurotransmitter that is involved in memory and whose level is reduced
in patients with Alzheimer’s disease. Unfortunately it usually works for
only six to nine months and is not able to reverse the relentless
progression of the disease.

10.8.2 Environmental and Behavioral Management

Patients with dementia experience fewer emotional problems and
are less likely to become agitated if they follow a structured and
predictable daily schedule. Activities such as eating meals, exercising,
and going to bed are easier and less anxiety-provoking if they occur at
regular times. The use of signs and notes may be helpful reminders for
patients who are in the earlier stages of the disorder. As the patient’s
cognitive impairment becomes more severe, even simple activities, such
as getting dressed or eating a meal, must be broken down into smaller
and more manageable steps. Directions have to be adjusted so that they
are appropriate to the patient’s level of functioning. Patients with
apraxia, for example, may not be able to perform tasks in response to
verbal instructions. Caregivers need to adjust their expectations and
assume increased responsibilities as their patients’ intellectual abilities
deteriorate.
10.8.3 Support for Caregivers
A final area of concern is the provision of support to people who
serve as caregivers for demented patients. In India, spouses and other
family members provide primary care for more than 80 percent of
people who have dementia of the Alzheimer’s type (Ballard, 2007).
Their burdens are often overwhelming, both physically and emotionally.

149
10.9 Let’s sum up
Dementia, delirium, and amnestic disorders are listed as Cognitive
Disorders in DSM-IV-TR. Disruptions of memory and other cognitive
functions are the most obvious symptoms of these disorders. Dementia is
defined as a gradually worsening loss of memory and related cognitive
functions, including the use of language as well as reasoning and
decision making. Aphasia and apraxia are among the most obvious
problems in verbal communication. Perceptual difficulties, such as
agnosia, are also common. In amnestic disorder, the memory
impairment is more circumscribed. The person may experience severe
anterograde amnesia, but other higher-level cognitive abilities remain
unimpaired. Delirium is a confusion state that develops over a short
period of time and is often associated with agitation and hyperactivity.
The causes of dementia include many different factors.
Some types of dementia are produced by viral infections and
dysfunction of the immune system. Environmental toxins also may
contribute to the onset of cognitive impairment. Behavioral and
environmental management are important aspects of any treatment
program for demented patients. They allow patients to reside in the least
restrictive and safest possible settings. Respite programs provide much-
needed support to caregivers, usually spouses and other family

10.10 Unit End Exercise

1. In what ways is delirium different from dementia?
2. Is memory impairment the only indication that a person is
developing dementia?
3. Why is depression in an elderly person sometimes confused with
dementia?
4. What are the most difficult problems faced by people caring for a
person with dementia?

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10.11 Answers for check Your Progress

1. Dementia is a gradual worsening loss of memory and related

cognitive functions, including the use of language, as well as
reasoning and decision making.
2. Unusual involuntary muscle movements known as Huntington’s
disease.
3. Delirium is a confusion state that develops over a short period of
time and is often associated with agitation and hyperactivity.
4. In amnestic disorders, a person exhibits a severe impairment of
memory while other higher level cognitive abilities are un-
affected.
5. The primary symptom of delirium is clouding of consciousness in
association with a reduced ability to maintain and shift attention.

10.12 Suggested Readings

1. Robert C. Carson &James N. Butcher. (2007). Abnormal Psychology.
Pearson Education Inc. New Delhi.
2. Barlow and Durand. (2006). Abnormal Psychology. New York.
Pearson India Ltd.
3. Sarason and Sarason. (2010). Abnormal Psychology: The Problem of
Maladaptive Behaviour (11th Edition). New Delhi. Prentice Hall of
India Pvt. Ltd.

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UNIT 11
STRESS RELATED AND SOMATOFORM DISORDERS
Structure
11.1 Introduction
11.2 Objectives
11.3 Definition of stress
11.4 Psycho physiological response
11.5 Panic disorder
11.5.1Biological factor
11.5.2 Cognitive factor
11.5.3 Treatment
11.6 Phobic Disorder
11.6.1 Biological factor
11.6.2 Cognitive factor
11.6.3 Treatment
11.7 Generalized Anxiety disorder
11.7.1 Cognitive factor
11.7.2 Treatment
11.8 Obsession compulsive disorder
11.8.1 Causes
11.8.2 Treatment
11.9Somatic Disorder
11.9.1 Body dysmorphic disorder
11.9.2 Somatic disorder
11.9.3 Hypochondrias
11.9.4 Convention disorder
11.10 Lets sum up
11.11 Unit End Exercise
11.12 Answers for check your progress
11.13 Suggested Readings

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11.1 INTRODUCTION
Scientists define stress as any challenging event that requires
physiological, cognitive, or behavioral adaptation. Stress may involve
minor, daily hassles, like taking an exam, or major events, such as going
through a divorce. The most common daily stressors involve
interpersonal arguments and tensions. Scientists once thought that stress
contributed to only a few physical diseases. Ulcers, migraine headaches,
hypertension (high blood pressure), asthma, and a few other illnesses
were thought to be psychosomatic disorders. The holistic view of health
and disease has brought about major changes in medicine. Psychologists
who specialize in behavioral medicine often are called health
psychologists.
11.2 Objectives
By the end of this unit you will be able to understand
 Concept of stress
 Stress related disorders
 Causes of stress related disorder and
 Treatment

11.3 Defining Stress

We define stress as a challenging event that requires physiological,
cognitive, or behavioral adaptation.

11.4 Psycho physiological Responses to Stress

Physiologically, the fight-or-flight response activates the
sympathetic nervous system: Your heart and respiration rates increase,
your blood pressure rises, your pupils dilate, your blood sugar levels
elevate, and your blood flow is redirected in preparation for muscular
activity. These physiological reactions heighten attention, provide
energy for quick action, and prepare the body for injury.

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11.5 Panic Disorder
Panic disorder is characterized by repeated, unexpected panic
attacks. Panic attacks are intense anxiety reactions that are accompanied
by physical symptoms such as a pounding heart; rapid respiration,
shortness of breath, or difficulty breathing; heavy perspiration; and
weakness or dizziness. There is a stronger bodily component to panic
attacks than to other forms of anxiety. The attacks are accompanied by
feelings of sheer terror and a sense of imminent danger or impending
doom and by an urge to escape the situation.

11.5.1 Biological Factors

Evidence indicates that genetic factors contribute to proneness or
vulnerability to panic disorder. Genes may create a predisposition or
likelihood, but not a certainty that panic disorder or other psychological
disorders will develop. The biological underpinnings of panic attacks
may involve an unusually sensitive internal alarm system involving parts
of the brain, especially the limbic system and frontal lobes that normally
become involved in responding to cues of threat or danger. Let’s also
consider the role of neurotransmitters, especially gamma-aminobutyric
acid (GABA). GABA is an inhibitory neurotransmitter, which means
that it tones down excess activity in the central nervous system and helps
quell the body’s response to stress.

11.5.2 Cognitive Factors

The role of cognitive factors may play in determining
oversensitivity of panic-prone people to biological challenges, such as
manipulation of carbon dioxide levels in the blood. These challenges
produce intense physical sensations that panic-prone people may
misinterpret as signs of an impending heart attack or loss of control.
Perhaps these misinterpretations—not any underlying biological
sensitivities per se—are responsible for inducing the spiraling of anxiety
that can quickly lead to a panic attack. The fact that panic attacks often

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seem to come out of the blue seems to support the belief that the attacks
are biologically triggered
11.5.3 Treatment Approaches
The most widely used forms of treatment for panic disorder are
drug therapy and cognitive behavioral therapy. Drugs commonly used to
treat depression, called antidepressant drugs, also have anti-anxiety and
anti-panic effects. Cognitive-behavioral therapists use a variety of
techniques in treating panic disorder, including coping skills
development for handling panic attacks, breathing retraining and
relaxation training to reduce states of heightened bodily arousal, and
exposure to situations linked to panic attacks and bodily cues associated
with panicky symptoms. The therapist may help clients think differently
about changes in bodily cues, such as sensations of dizziness or heart
palpitations.

11.6 Phobic Disorders

The word phobia derives from the Greek phobos, meaning “fear.”
The concepts of fear and anxiety are closely related. Fear is anxiety
experienced in response to a particular threat. A phobia is a fear of an
object or situation that is disproportionate to the threat it poses. A
curious thing about phobias is that they usually involve fears of the
ordinary events in life, such as taking an elevator or driving on a
highway, not the extraordinary. Phobias can become disabling when
they interfere with daily tasks such as taking buses, planes, or trains;
driving; shopping; or even leaving the house.
Specific Phobias A specific phobia is a persistent, excessive fear of a
specific object or situation that is out of proportion to the actual danger
these objects or situations pose.
There are many types of specific phobias, including the following (APA,
2013):
• Fear of animals, such as fear of spiders, insects, and dogs

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• Fear of natural environments, such as fear of heights (acrophobia),
storms, or water
• Fear of blood-injection injury, such as fear of needles or invasive
medical procedures
• Fear of specific situations, such as fear of enclosed spaces
(claustrophobia), elevators,
The phobic person experiences high levels of fear and
physiological arousal when encountering the phobic object, which
prompts strong urges to avoid or escape the situation or to avoid the
feared stimulus,

Psychodynamic Perspectives
A phobic reaction is a projection of the person’s own threatening
impulses onto the phobic object. For instance, a fear of knives or other
sharp instruments may represent the projection of one’s own destructive
impulses onto the phobic object. The phobia serves a useful function.

11.6.1 Biological Perspectives

Genetic factors can predispose individuals to develop anxiety
disorders such as panic disorder and phobic disorder.
For one thing, we’ve learned that people with variations of particular
genes are more prone to develop fear responses and to have greater
difficulty overcoming them. For example, people with a variation of a
particular gene who are exposed to fearful stimuli show greater
activation of a brain structure called the amygdala, an almond-shaped
structure in the brain’s limbic system. The amygdala produces fear
responses to triggering stimuli without conscious thought. It works as a
kind of “emotional computer” whenever we encounter a threat or
danger.

11.6.2 Cognitive Perspectives

Research highlights the importance of cognitive factors in
determining proneness to phobias, including factors such as
oversensitivity to threatening cues, over predictions of dangerousness,
and self-defeating thoughts and irrational beliefs
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 1. Oversensitivity to threatening cues. People with phobias tend to
perceive danger in situations most people consider safe, such as
riding on elevators or d riving over bridges. Similarly, people with
social anxiety tend to be overly sensitive to social cues of rejection
or negative evaluation from others (Schmidt et al., 2009).
2. Over prediction of danger. Phobic individuals tend to over predict
how much fear or anxiety they will experience in the fearful
situation. The person with a snake phobia, for example, may
expect to tremble when he or she encounters a snake in a cage.
3. Self-defeating thoughts and irrational beliefs. Self-defeating
thoughts can heighten and perpetuate anxiety and phobic disorders.
When faced with fear-evoking stimuli, the person may think, “I’ve
got to get out of here,” or “My heart is going to leap out of my
chest.”
11.6.3 Treatment Approaches
The major contemporary treatment approaches to specific phobias,
as for other anxiety disorders, derive from the learning, cognitive, and
biological perspectives.
Learning-Based Approaches
A substantial body of research demonstrates the effectiveness of
learning-based approaches in treating a range of anxiety disorders. At
the core of these approaches is the effort to help individuals cope more
effectively with anxiety-provoking objects and situations. Examples of
learning-based approaches include systematic desensitization, gradual
exposure, and flooding
Systematic desensitization is based on the assumption that
phobias are learned or conditioned responses that can be unlearned by
substituting an incompatible response to anxiety in situations that
usually elicit anxiety. Muscle relaxation is generally used as the
incompatible response. Systematic desensitization creates a set of
conditions that can lead to extinction of fear responses. The technique
fosters extinction by providing opportunities for repeated exposure to
phobic stimuli in imagination without aversive consequences.
Gradual exposure uses a stepwise approach in which phobic
individuals gradually confront the objects or situations they fear.
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Repeated exposure to a phobic stimulus in the absence of any aversive
event (“nothing bad happening”) can lead to extinction, or gradual
weakening, of the phobic response, even to the point that it is eliminated
Flooding is a form of exposure therapy in which subjects are
exposed to high levels of fear-inducing stimuli either in imagination or
in real-life situations. Why? The belief is that anxiety represents a
conditioned response to a phobic stimulus and should dissipate if the
individual remains in the phobic situation for a long enough period of
time without harmful consequences.

Cognitive Therapy
Cognitive therapists seek to identify and correct dysfunctional or
distorted beliefs. For example, people with social anxiety might think no
one at a party will want to talk with them and that they will wind up
lonely and isolated for the rest of their lives. One example of a cognitive
technique is cognitive restructuring, a method in which therapists help
clients pinpoint self-defeating thoughts and generate rational alternatives
they can use to cope with anxiety-provoking situations.

Drug Therapy
Evidence also supports the use of antidepressant drugs, in treating
social anxiety. A combination of psychotherapy and drug therapy in the
form of antidepressant medication may be more effective in some cases
than either treatment approach alone.
Check your progress
1. What is phobia and acrophobia?
2. What is flooding?

11.7 Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by excessive
anxiety and worry that is not limited to any one object, situation, or
activity. Normally, anxiety can be an adaptive response, a kind of built-
in bodily warning system to signal when something is threatening and
requires immediate attention. But for people with generalized anxiety

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disorder, anxiety becomes excessive, becomes difficult to control, and is
accompanied by physical symptoms.
From a learning perspective, generalized anxiety is precisely that:
generalization of anxiety across many situations. People concerned
about broad life themes, such as finances, health, and family matters, are
likely to experience apprehension or worry in a variety of settings.
Anxiety would thus become connected with almost any environment or
situation.
11.7.1 The cognitive perspective
GAD emphasizes the role of exaggerated or distorted thoughts and
beliefs, especially beliefs that underlie worry. People with GAD tend to
worry just about everything. They also tend to be overly attentive to
threatening cues in the environment, perceiving danger and calamitous
consequences at every turn. Consequently, they feel continually on edge,
as their nervous systems respond to the perception of threat or danger
with activation of the sympathetic nervous system, leading to increased
states of bodily arousal and the accompanying feelings of anxiety, and
symptoms such as restlessness, jumpiness, and muscle tension. The
central feature of GAD is excessive worry. People with GAD tend to be
chronic worriers—even lifelong worriers. They may worry about many
things, including their health, their finances, the well-being of their
children, and their social relationships. The emotional distress associated
with GAD interferes significantly with the person’s daily life. GAD
frequently occurs together with other disorders, including depression or
other anxiety disorders such as agoraphobia and obsessive–compulsive
disorder.
The cognitive and biological perspectives converge in evidence
showing irregularities in the functioning of the amygdala in GAD
patients and in its connections to the brain’s thinking center, the
prefrontal.
11.7.2 Treatment Approaches
The major forms of treatment of generalized anxiety disorder are
psychiatric drugs and cognitive- behavioral therapy. Antidepressant
drugs can help relieve anxiety symptoms. Bear in mind, however, that
although psychiatric drugs may help relieve anxiety, they do not cure the
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underlying problem. Once the drugs are discontinued, the symptoms
often return. Cognitive-behavioral therapists use a combination of
techniques in treating GAD, including training in relaxation skills;
learning to substitute calming, adaptive thoughts for intrusive,
worrisome thoughts; and learning skills of de-catastrophizing

11.8 Obsessive–Compulsive Disorder

People with obsessive–compulsive disorder (OCD) are troubled by
recurrent obsessions or compulsions, or both obsessions and
compulsions, that are time-consuming, such as lasting more than an hour
a day, or causing significant distress or interference with a person’s
normal routines or occupational or social functioning.
An obsession is a recurrent, persistent, and unwanted thought,
urge, or mental image that seems beyond the person’s ability to control.
Obsessions can be potent and persistent enough to interfere with daily
life and can engender significant distress and anxiety.
A compulsion is a repetitive behavior (e.g., hand washing or
checking door locks) or mental act (e.g., praying, repeating certain
words, or counting) that the person feels compelled or driven to perform
(APA, 2013). Compulsions typically occur in response to obsession
thoughts and are frequent and forceful enough to interfere with daily life
or cause significant distress. Compulsions often accompany obsessions
and may at least partially relieve the anxiety created by obsession
thinking.

11.8.1 Theoretical Perspectives

Within the psychodynamic tradition, obsessions represent leakage
of unconscious urges or impulses into consciousness, and compulsions
are acts that help keep these impulses repressed. Obsessive thoughts
about contamination by dirt or germs may represent the threatened
emergence of unconscious infantile wishes to soil one self and play with
feces.
Vulnerability to OCD is in part determined by genetic factor. Just
what genes are involved in OCD remains under study, but research
evidence points to a possible role for a gene that works to tone down the
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actions of a particular neurotransmitter, glutamate, at least in some cases
of the disorder Another possibility is that the actions of particular genes
affect chemical balances in the brain that lead to over arousal of a
network of neurons called a worry circuit, a neural network that signals
danger in response to perceived threats. In OCD, the brain may be
continually sending messages through this “worry circuit” or neural
circuit that something is wrong and requires immediate attention,
leading to obsession, worrisome thoughts and repetitive, compulsive
behaviors.
Other parts of the brain, including the basal ganglia, may also be
involved in OCD. The basal ganglia are involved in controlling body
movements, so it is conceivable that a dysfunction in this region might
help explain the ritualistic behaviors seen in OCD patients.

Psychological models
OCD emphasize cognitive and learning-based factors. They can’t
seem to break the mental loop in which the same intrusive, negative
thoughts keep reverberating in their minds. They also tend to exaggerate
the risk that unfortunate events will occur. Because they expect terrible
things to happen, people with OCD engage rituals.
Another cognitive factor linked to the development of OCD is
perfectionism, or belief that one must perform flawlessly. People who
hold perfectionist beliefs exaggerate the consequences of turning in less-
than perfect work and may feel compelled to redo their efforts until
every detail is flawless.

11.8.2 Treatment Approaches

Behavior therapists have achieved impressive results in treating
obsessive–compulsive disorder with the technique of exposure with
response prevention (ERP). The exposure component involves exposure
to situations that evoke obsessive thoughts. For many people, such
situations are hard to avoid. Through exposure with response prevention,
people with OCD learn to tolerate the anxiety triggered by their
obsessive thoughts while they are prevented from performing their
compulsive rituals. With repeated exposure trials, the anxiety eventually
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subsides, and the person feels less compelled to perform the
accompanying rituals SSRI anti-depressants also have therapeutic
benefits in treating OCD.
Check your Progress
3. What is obsession?
4. What is compulsion?
5. What is ERP?

11.9 Body Dysmorphic Disorder

People with body dysmorphic disorder (BDD) are preoccupied
with an imagined or exaggerated physical defect in their appearance,
such as skin blemishes, wrinkling or swelling of the face, body moles or
spots, or facial swelling, causing them to feel they are ugly or even
disfigured. They fear others will judge them negatively on the basis of
their perceived defect or flaw. They may spend hours examining
themselves in the mirror and go to extreme measures to correct the
perceived defect, even undergoing invasive or unpleasant medical
procedures, including unnecessary plastic surgery.
BDD is classified within the obsessive–compulsive spectrum
because people with the disorder often become obsessed with their
perceived defect and often feel compelled to check themselves in the
mirror or engage in compulsive behaviors aimed at fixing, covering, or
modifying the perceived defect.
Exposure therapy with response prevention is often used in
treating body dysmorphic disorder. Exposure can take the form of
intentionally revealing the perceived defect in public, rather than
concealing it with makeup or clothing. Response prevention may
involve efforts to avoid mirror checking (e.g., by covering mirrors at
home) and excessive grooming. ERP is generally combined with
cognitive restructuring, in which therapists help clients challenge their
distorted beliefs about their physical appearance and evaluate them in
light of evidence.

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11.9.1 Somatic Disorders
The word somatic derives from the Greek soma, meaning “body.”
People with somatic disorders (formerly called somatoform disorders)
may have physical (“somatic”) symptoms without an identifiable
physical cause or have excessive concerns about the nature or meaning
of their symptoms. The symptoms significantly interfere with the
people’s lives and often lead them to go “doctor shopping” in the hope
of finding a medical practitioner who can explain and treat their
ailments. The concept of somatic symptom and related disorders
presumes that psychological processes affect physical functioning. For
example, some people complain of problems in breathing or swallowing,
or a “lump in the throat.” Such problems can reflect over activity of the
sympathetic branch of the autonomic nervous system, which might
result from anxiety.

1.9.3 Somatic Symptom Disorder

Most people have physical symptoms somewhere along life’s
course. It is normal to feel concerned about one’s physical symptoms
and to seek medical attention. However, people with somatic symptom
disorder (SSD) not only have troubling physical symptoms, but they are
excessively concerned about their symptoms to the extent that it affects
their thoughts, feelings, and behaviors in daily life. Thus, the diagnosis
emphasizes the psychological features of physical symptoms, not
whether the underlying cause or causes of the symptoms can be
medically explained.

11.9.3Hypochondrias, which applied to people with physical

complaints who believed they are suffer with a serious, undetected
illness, such as cancer or heart disease, despite medical reassurance to
the contrary. For example, a person suffering from headaches may fear
that they are a sign of a brain tumor and believe doctors are wrong when
they say these fears are groundless. At the core of hypochondrias is
health anxiety, a preoccupation that one’s physical symptoms are signs
of something terribly wrong with one’s health.

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 Hypochondrias is believed to affect about 1% to 5% of the general
population and about 5% of patients seeking medical care. People with
hypochondrias do not consciously fake their symptoms. They feel real
physical discomfort, often involving their digestive system or an
assortment of aches and pains throughout the body. They may be overly
sensitive to benign changes in physical sensations, such as slight
changes in heartbeat and minor aches and pains.
Anxiety about physical symptoms can produce its own physical
sensations, however— for example, heavy sweating and dizziness, even
fainting. Thus, a vicious cycle may ensue. Patients may become
resentful when their doctors tell them that their own fears may be
causing their physical symptoms.

11.9.4 Conversion Disorder

Conversion disorder (called functional neurological symptom
disorder in DSM-5) is characterized by symptoms or deficits that affect
the ability to control voluntary movements (inability to walk or move an
arm, for example) or that impair sensory functions, such as an inability
to see, hear, or feel tactile stimulation (touch, pressure, warmth, or pain).
In some cases, however, what appears to be conversion disorder actually
turns out to be intentional fabrication or faking of symptoms for some
external gain (malingering). Unfortunately, clinicians lack the ability to
reliably determine that someone is faking.
The physical symptoms in conversion disorder usually come on
suddenly in stressful situations. A soldier’s hand may become
“paralyzed” during intense combat, for example. The fact that
conversion symptoms first appear in the context of, or are aggravated by,
conflicts or stressors suggests a psychological connection. Some classic
symptom patterns take the form of paralysis, epilepsy, problems in
coordination, blindness and tunnel vision, loss of the sense of hearing or
of smell, or loss of feeling in a limb (anesthesia). The bodily symptoms
found in conversion disorders often do not match the medical conditions.

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Psychodynamic Theory
According to psychodynamic theory, hysterical symptoms are
functional: They allow the person to achieve primary gains and
secondary gains. The primary gain of the symptoms is to allow the
individual to keep internal conflicts repressed. The person is aware of
the physical symptom but not of the conflict it represents. Secondary
gains from the symptoms are those that allow the individual to avoid
burdensome responsibilities and to gain the support—rather than
condemnation—of those around them. For example, soldiers sometimes
experience sudden “paralysis” of their hands, which prevents them from
firing their guns in battle. From the learning perspective, people with
somatic symptom and related disorders may also carry the benefits, or
reinforcing properties, of the “sick role.” People with conversion
disorders, for instance, may be relieved of chores and responsibilities
such as going to work or performing household tasks. Being sick also
usually earns sympathy and support.

Cognitive Theory
From a cognitive perspective, we can think about hypochondrias in
some cases as a type of self-handicapping strategy, a way of blaming
poor performance on failing health. In other cases, diverting attention to
physical complaints may serve as a means of avoiding thinking about
other life problems. Another cognitive explanation focuses on the role of
distorted thinking. People with hypochondrias have a tendency to
exaggerate the significance of minor physical complaints

Treatment of Somatic Disorders

Psychoanalysis seeks to uncover and bring into conscious
awareness unconscious conflicts that originated in childhood. Once the
conflict is aired and worked through, the symptom is no longer needed
and should disappear.
The behavioral approach to treatment focuses on removing sources
of secondary reinforcement (or secondary gain) that may become
connected with physical complaints. Family members and others, for
example, often perceive individuals with these disorders as sickly and
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incapable of carrying out normal responsibilities. This reinforces
dependent and complaining behaviors. The behavior therapist may teach
family members to reward attempts to assume responsibility and to
ignore nagging and complaining.
The cognitive technique of restructuring distorted thinking helps
clients identify and replace exaggerated illness-related beliefs with
rational alternatives. The behavioral technique of exposure with
response prevention, can help patients with somatic symptom disorder
and illness anxiety disorder break the pattern of running to doctors for
reassurance whenever they experience some worrisome, health-related
concerns. These individuals can also benefit from breaking problem
habits, such as repeatedly checking the Internet for illness-related
information and reading newspaper obituaries.

11.10 Let’s sum up

Stress takes its toll on our physical and psychological well-being. In the
DSM-IV-TR, Axis IV is used to note any psychosocial stressors that may
contribute to or result from an Axis I disorder. When we are stressed, the
autonomic nervous system responds in a variety of ways. One
consequence of stress is increased production of cortisol. High levels of
this stress hormone may be beneficial in the short term but problematic
over the longer term.
The DSM-IV-TR classifies people’s psychological problems in response
to stressful situations under two general categories: adjustment disorders
and posttraumatic stress disorder (which is a form of anxiety disorder).
Several relatively common stressors (prolonged unemployment, loss of a
loved one through death, and marital separation or divorce) may produce
a great deal of stress and psychological maladjustment, resulting in
adjustment disorder. More intense psychological disorders in response to
trauma or excessively stressful situations (such as military combat, being
held hostage, or torture) may be categorized as posttraumatic stress
disorder.
PTSD can involve a variety of symptoms including intrusive thoughts
and repetitive nightmares about the event, intense anxiety, avoidance of
stimuli associated with the trauma, and increased arousal manifested as
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chronic tension, irritability, insomnia, impaired concentration and
memory, and depression. Although it is very common to experience
psychological symptoms after a traumatic event, these often fade with
time. Most people exposed to traumatic events do not develop PTSD.
The prevalence of PTSD in the general population is 6.8 percent. If
symptoms begin 6 months or more after the traumatic event, the
diagnosis is delayed posttraumatic stress disorder. Medications are
sometimes used in the treatment of PTSD. Psychological treatments
include prolonged exposure therapy and cognitive therapy. A new
approach that appears promising is the use of virtual reality exposure
therapy.
11.11 Unit end Exercise
1. Describe the biological changes that occur when we are under stress.
2. What is cortisol? Is cortisol beneficial or harmful? What is the main
difference between acute stress disorder and PTSD?
3. What risk factors are associated with experiencing trauma?
4. What risk factors are implicated in the development of PTSD?

11.12 Answers for check your Progress

1. A phobia is a fear of an object or situation that is disproportionate to
the threat it poses, fear of heights.
2. Flooding is a form of exposure therapy in which subjects are exposed
to high levels of fear-inducing stimuli either in imagination or in real-life
situations.
3. An obsession is a recurrent, persistent, and unwanted thought, urge,
or mental image that seems beyond the person’s ability to control.
4. A compulsion is a repetitive behavior (e.g., hand washing or checking
door locks) or mental act (e.g., praying, repeating certain words, or
counting) that the person feels compelled or driven to perform.
5. The exposure component involves exposure to situations that evoke
obsessive thoughts. For many people, such situations are hard to avoid.
Through exposure with response prevention, people with OCD learn to
tolerate the anxiety triggered by their obsessive thoughts while they are
prevented from performing their compulsive rituals.

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11.13 Suggested Readings
1. Robert C. Carson &James N. Butcher. (2007). Abnormal Psychology.
Pearson Education Inc. New Delhi.
2. Barlow and Durand. (2006). Abnormal Psychology. New York.
Pearson India Ltd.
3. Sarason and Sarason. (2010). Abnormal Psychology: The Problem of
Maladaptive Behaviour (11th Edition). New Delhi. Prentice Hall of
India Pvt. Ltd.

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Unit 12
ADDITIVE DISORDERS
Structure
12.1 Introduction
12.2 Objectives
12.3 Substance used disorder
12.4 Alcohol
12.5 Nicotine
12.6 Amphetamine and Cocaine
12.7 Opiates
12.8 Cannabis
12.9 Hallucinogens related Drugs
12.10 Causes of drug abuse
12.10.1 Social factors
12.10.2 Biological factors
12.10.3 Psychological factors
12.11 Treatment
12.11.1 Detoxification
12.11.2 Medications during Remission
12.11.3 Alcoholic Anonymous
12.11.4 Cognitive behavior therapy
12.11.5 Coping skill training
12.12 Let’s sum up
12.13 Unit End Exercise
12.14 Answers for check your progress
12.15 Suggested Readings

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12.1 INTRODUCTION
The costs of substance abuse are astronomical. According to the
World Health Organization, alcohol use was responsible for 5 percent of
the total burden of disease and disability worldwide in 2004. Cirrhosis of
the liver, which is frequently the result of chronic alcoholism, is a
leading cause of death in India. In addition, alcohol plays a prominent
role in many suicides, homicides, and motor vehicle accidents.

12.2 Objectives
On completion of this unit you will be able to understand
 Types of substance related disorder
 Different groups of drugs
 Causes of substance abuse
 Treatment

12.3 Substance used disorder

DSM-IV-TR uses two terms to describe substance use disorders,
and these terms reflect different levels of severity. Substance
dependence, the more severe of the two forms, refers to a pattern of
repeated self-administration that often results in tolerance, the need for
increased amounts of the drug to achieve intoxication; withdrawal,
unpleasant physical and psychological effects that the person
experiences when he or she tries to stop taking the drug; and compulsive
drug-taking behavior. Substance abuse describes a more broadly
conceived, less severe pattern of drug use that is defined in terms of
interference with the person’s ability to fulfill major role obligations at
work or at home, the recurrent use of a drug in dangerous situations, and
repeated legal difficulties associated with drug use.
Addiction is another term that is often used to describe problems
such as alcoholism. It is essentially synonymous with substance
dependence, although it does not appear in DSM-IV-TR. A drug of
abuse, sometimes called a psychoactive substance, is a chemical
substance that alters a person’s mood, level of perception, or brain
functioning.
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 Despite these differences, the various forms of substance abuse
share many common elements. All forms of abuse represent an inherent
conflict between immediate pleasure and longer-term harmful
consequences. The psychological and biochemical effects on the user are
often similar, as are the negative consequences for both social and
occupational.

12.4 Alcohol
Alcohol affects virtually every organ and system in the body.
After alcohol has been ingested, it is absorbed through membranes in the
stomach, small intestine, and colon. The rate at which it is absorbed is
influenced by many variables, including the concentration of alcohol in
the beverage (for example, distilled spirits are absorbed more rapidly
than beer or wine), the volume and rate of consumption, and the
presence of food in the digestive system. After it is absorbed, alcohol is
distributed to all the body’s organ systems. Almost all the alcohol that a
person consumes is eventually broken down or metabolized in the liver.

Short-Term Effects
Blood alcohol levels are measured in terms of the amount of
alcohol per unit of blood. According to DSM-IV-TR, the symptoms of
alcohol intoxication include slurred speech, lack of coordination, an
unsteady gait, nystagmus (involuntary to-and-fro movement of the
eyeballs induced when the person looks upward or to the side), impaired
attention or memory, and stupor or coma.
Long-Term Consequences
The prolonged use and abuse of alcohol can have a devastating
impact on many diseases. Many people who abuse alcohol experience
blackouts. In some cases, abusers may continue to function without
passing out, but they will be unable to remember their behavior. The
disruption of relationships with family and friends can be especially
painful. On a biological level, prolonged exposure to high levels of
alcohol can disrupt the functions of several important organ systems,
especially the liver, pancreas, gastrointestinal system, cardiovascular
system, and endocrine system. The symptoms of alcoholism include
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many secondary health problems, such as cirrhosis of the liver, heart
problems (in part, the result of being overweight), and various forms of
cancer, as well as severe and persistent forms of dementia and memory
impairment or amnestic disorders.

12.5 Nicotine
Nicotine is the active ingredient in tobacco, which is its only
natural source. Nicotine is almost never taken in its pure form because it
can be toxic. Very high doses have extremely unpleasant effects.
Controlled doses are easier to achieve by smoking or chewing tobacco,
which provides a diluted concentration of nicotine. Another way of
ingesting nicotine is to inhale snuff (powdered tobacco) into the nostrils.
When tobacco smoke is inhaled, nicotine is absorbed into the blood
through the mucous membranes of the lungs.
Short-Term Effects
The effects of nicotine on the peripheral nervous system include
increases in heart rate and blood pressure. In the central nervous system,
nicotine has pervasive effects on a number of neurotransmitter systems.
It stimulates the release of norepinephrine from several sites, producing
CNS arousal. Nicotine also causes the release of dopamine and
norepinephrine in the mesolimbic dopamine pathway, Nicotine has a
complex influence on subjective mood states. Many people say that they
smoke because it makes them feel more relaxed.
Long-Term Consequences
Nicotine is one of the most harmful and deadly addicting drugs.
Considerable evidence points to the development of both tolerance and
withdrawal symptoms among people who regularly smoke or chew
tobacco. Physiological symptoms of withdrawal from nicotine include
drowsiness, lightheadedness, headache, muscle tremors, and nausea.
People who smoke tobacco increase their risk of developing many fatal
diseases, including heart disease, lung disease (bronchitis and
emphysema), and various types of cancer. Eighty percent of all deaths
caused by lung cancer can be attributed to smoking tobacco.

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12.6 Amphetamine and Cocaine
Members of the class of drugs known as psychomotor stimulants
produce their effects by simulating the actions of certain
neurotransmitters, specifically epinephrine, norepinephrine, dopamine,
and serotonin. Cocaine is a naturally occurring stimulant drug that is
extracted from the leaf of a small tree that grows at high elevations, as
in the Andes Mountains. The amphetamines (such as Dexedrine and
methamphetamine) are produced synthetically. The stimulants can be
taken orally, injected, or inhaled. It is easier to maintain a constant blood
level when the drugs are taken orally. They are absorbed more slowly
through the digestive system, and their effects are less potent. More
dramatic effects are achieved by injecting the drug or sniffing it.
Short-Term Effects
Cocaine and amphetamines are called stimulants because they
activate the sympathetic nervous system. They increase heart rate and
blood pressure and dilate the blood vessels and the air passages of the
lungs. Stimulants also suppress the appetite and prevent sleep. These
effects have been among the reasons for the popularity and frequent
abuse of stimulants. Acute overdoses of stimulant drugs can result in
irregular heartbeat,
Long-Term Consequences
High doses of amphetamines and cocaine can lead to the onset of
psychosis. The risk of a psychotic reaction seems to increase with
repeated exposure to the drug. The symptoms of amphetamine psychosis
include auditory and visual hallucinations, as well as delusions of
persecution and grandeur. As with other forms of addiction, the most
devastating effects of stimulant drugs frequently center the disruption of
occupational and social roles.
12.7 Opiates
The opiates (sometimes called opioids) are drugs that have properties
similar to those of opium. The natural source of opium is a poppy with a
white flower. The main active ingredients in opium are morphine and
codeine, both of which are widely used in medicine, particularly to
relieve pain. The opiates can be taken orally, injected, or inhaled.
Opium is sometimes eaten or smoked.
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Short-Term Effects
The opiates can induce a state of dreamlike euphoria, which may
be accompanied by increased sensitivity in hearing and vision. People
who inject morphine or heroin also experience a rush—a brief, intense
feeling of pleasure that is sometimes described as being an orgasm in the
entire body. The opiates can induce nausea and vomiting among novice
users, constrict the pupils of the eye, and disrupt the coordination of the
digestive system. Continued use of opiates decreases the level of sex
hormones in women and men, resulting in reduced sex drive and
impaired fertility.
Long-Term Consequences
The effects of opiates on occupational performance and health
depend in large part on the amount of drugs that the person takes. People
who are addicted to opiates become preoccupied with finding and using
the drug, in order to experience the rush and to avoid withdrawal
symptoms. Tolerance develops rather quickly, and the person’s daily
dose increases regularly until it eventually levels off and remains steady.
12.8 Cannabis
Marijuana and hashish are derived from the hemp plant, Cannabis
sativa. The most common active ingredient in cannabis is a compound
called delta-9-tetrahydro-cannabinol (THC). Because every part of the
plant contains THC, cannabis can be prepared for consumption in
several ways. Marijuana refers to the dried leaves and flowers, which
can be smoked in a cigarette or pipe. It can also be baked in brownies
and ingested orally. Hashish refers to the dried resin from the top of the
female cannabis plant. It can be smoked or eaten after being baked in
cookies or brownies.
Oral administration of cannabis material leads to incomplete
absorption. Therefore, the dose must be two or three times larger to
achieve the same subjective effect as when it is smoked. Most of the
drug is metabolized in the liver.

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Short-Term Effects
The subjective effects of marijuana are almost always pleasant.
“Getting high” on marijuana Cannabis intoxication is often accompanied
by temporal disintegration, a condition in which people have trouble in
retaining and organizing information, even over relatively short periods
of time refers to a pervasive sense of well-being and happiness.
Long-Term Consequences
Withdrawal symptoms are unlikely to develop among occasional
smokers of marijuana. People who have been exposed to continuous,
high doses of THC may experience withdrawal symptoms, such as
irritability, restlessness, and insomnia. Prolonged heavy use of marijuana
may lead to certain types of performance deficits on neuropsychological
tests, especially those involving sustained attention, learning, and
decision making
12.9 Hallucinogens and Related Drugs
Drugs that are called hallucinogens cause people to experience
hallucinations. Although many other types of drugs can lead to
hallucinations at toxic levels, hallucinogens cause hallucinations at
relatively low doses. There are many different types of hallucinogens,
and they have very different neuro physiological effects.
Short-Term Effects
The effects of hallucinogenic drugs are difficult to study
empirically because they are based primarily in subjective experience.
They typically induce vivid, and occasionally spectacular, visual images.
During the early phase of this drug experience, the images often take the
form of colorful geometric patterns. The later phase is more likely to be
filled with meaningful images of people, animals, and places. The
images may change rapidly, and they sometimes follow an explosive
pattern of movement. Although these hallucinatory experiences are
usually pleasant, they are occasionally frightening.

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Long-Term Consequences
The perceptual effects of hallucinogenic drugs almost always wear
off after several hours. There are cases, however, in which these drugs
have induced persistent psychotic behavior. Most experts interpret these
examples as an indication that the drug experience can trigger the onset
of psychosis in people who were already vulnerable to that type of
disorder.
Check your progress
1. Name the psychomotor stimulant drugs
2. What is Hallucinogens drugs?
12.10 Causes
12.10.1 Social Factors
People who don’t drink obviously won’t develop alcoholism, and
culture can influence that decision. Some cultures prohibit or actively
discourage alcohol consumption. Many Muslims, for example, believe
that drinking alcohol is sinful. Other religions encourage the use of small
amounts of alcohol in religious ceremonies—such as Jewish people
drinking wine at Passover seder. Several studies have examined social
factors that predict substance use among adolescents. Initial
experimentation with drugs is most likely to occur among those
individuals who are rebellious and extroverted and whose parents and
peers model or encourage use. The relative influence of parents and
friends varies according to the gender and age of the adolescent as well
as the drug in question. Parents can influence their children’s drinking
behaviors in many ways. They can serve as models for using drugs to
cope with stressful circumstances. They may also help promote attitudes
and expectations regarding the benefits of drug consumption,

12.10.2 Biological Factors

Genetics of Alcoholism
The strategy followed in an adoption study allows the investigator
to separate relatively clearly the influence of genetic and environmental
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factors. Participants in this type of study are individuals who meet two
criteria: (1) They had a biological parent who was alcoholic, and (2) they
were adopted from their biological parents at an early age and raised by
adoptive parents. Investigators then locate these individuals when they
have become adults and determine the frequency of alcoholism as a
function of both biological and environmental background.
Neuroanatomy and Neurochemistry
All of the addicting drugs produce changes in the chemical
processes by which messages are transmitted in the brain, including
systems that involve catecholamines (for example, dopamine,
norepinephrine, and serotonin), as well as the neuropeptides.

Dopamine and Reward Pathways

Scientists who study the biological basis of addiction have devoted
a considerable amount of their attention to understanding the rewarding
or reinforcing properties of drugs. People may become dependent on
psychoactive drugs because they stimulate areas of the brain that are
known as “reward pathways”. One primary circuit in this pathway is the
medial forebrain bundle. The effects of alcohol on reward pathways in
the brain are more complex and less clearly understood than the effects
of many other drugs.

12.10.3 Psychological Factors

Expectations About Drug Effects
Placebo effects demonstrate that expectations are an important
factor in any study of drug effects. This is certainly true in the case of
alcohol. Expectations account for many effects that are sometimes
assumed to be products of the drug itself. These expectations may
constitute one of the primary reasons for continued and increasingly
heavy consumption of alcoholic beverages. In fact, expectancy patterns
can help predict drinking behaviors.

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Integrated Systems
Alcoholism and other forms of addiction clearly result from an
interaction among several types of systems. Various social,
psychological, and biological factors influence the person’s behavior at
each stage in the cycle, from initial use of the drug through the eventual
onset of tolerance and withdrawal. Furthermore, it appears that different
influences are important at different stages of use. The process seems to
progress in the following way. Initial experimentation with drugs is
influenced by the environment—the person’s family, peers, school, and
neighborhood. Other people also influence the person’s attitudes and
expectations about the effects of drugs. Access to drugs, in addition to
the patterns in which they are originally consumed, is determined, in
part, by cultural factors.

12.11 Treatment
The treatment of alcoholism and other types of substance use
disorders is an especially difficult task. Many people with substance use
disorders do not acknowledge their difficulties, and only a relatively
small number seek professional help. When they do enter treatment, it is
typically with reluctance or on the insistence of friends, family
members, or legal authorities.

12.11.1 Detoxification
Alcoholism and related forms of drug abuse are chronic conditions.
Treatment is typically accomplished in a sequence of stages, beginning
with a brief period of detoxification—the removal of a drug on which a
person has become dependent—for three to six weeks. This process is
often extremely difficult, as the person experiences marked symptoms of
withdrawal and gradually adjusts to the absence of the drug.

12.11.2 Medications During Remission

Following the process of detoxification, treatment efforts are
aimed at helping the person maintain a state of remission. The best
outcomes are associated with stable, long-term abstinence from
drinking. Several forms of medication are used to help the person
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achieve this goal. Disulfiram (Antabuse) is a drug that can block the
chemical breakdown of alcohol. It was introduced as a treatment for
alcoholism in Europe in 1948 and is still used fairly extensively. If a
person who is taking disulfiram consumes even a small amount of
alcohol, he or she will become violently ill. The symptoms include
nausea, vomiting, profuse sweating, and increased heart rate and
respiration rate.

12.11.3 Self-Help Groups: Alcoholics Anonymous

One of the most widely accepted forms of treatment for alcoholism
is Alcoholics Anonymous (AA). Organized in 1935, this self-help
program is maintained by alcohol abusers for the sole purpose of helping
other people who abuse alcohol become and remain sober.

12.11.4 Cognitive Behavior Therapy

Psychological approaches to substance use disorders have often
focused on cognitive and behavioral responses that trigger episodes of
drug abuse. In the case of alcoholism, heavy drinking has been viewed
as a learned, maladaptive response that some people use to cope with
difficult problems or to reduce anxiety.
Cognitive behavior therapy teaches people to identify and respond more
appropriately to circumstances that regularly precipitate drug abuse.

12.11.5 Coping Skills Training

One element of cognitive behavior therapy involves training in the
use of social skills, which might be used to resist pressures to drink
heavily, includes problem-solving procedures, which can help the person
both to identify situations that lead to heavy drinking and to formulate
alternative courses of action.

12.12 Let’s sum up

The DSM-5 classifies substance related disorders in two major
diagnostic categories, substance-induced disorders (repeated episodes of
drug intoxication or development of a withdrawal syndrome), and
substance use disorders (maladaptive use of a substance leading to
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 distress or impaired functioning). Physiological dependence involves
changes in the body as the result of regular use of a substance, such as
the development of tolerance and a withdrawal syndrome. Psychological
dependence involves habitual use of a substance to meet a psychological
need, either with or without physiological dependence.
Depressants are drugs that depress or slow down nervous system
activity. They include alcohol, sedatives and minor tranquilizers, and
opioids. Their effects include intoxication, impaired coordination,
slurred speech, and impaired intellectual functioning. Chronic alcohol
abuse is associated with health risks including Korsakoff’s syndrome,
cirrhosis of the liver, fetal alcohol syndrome, and other physical health
problems epilepsy, among other uses. Like alcohol, they can impair
driving ability and also can be dangerous in overdose situations,
especially when use of barbiturates is combined with alcohol.
Opioids such as morphine and heroin are derived from the opium
poppy. Others are synthesized. Opioids are used medically for relief of
pain and are strongly addictive and can result in lethal overdoses.
Stimulants increase activity in the central nervous system.
Amphetamines and cocaine are stimulants that increase the availability
of neurotransmitters in the brain, leading to heightened states of arousal
and pleasurable feelings. High doses can produce psychotic reactions
that mimic features of paranoid schizophrenia. Habitual cocaine use can
lead to a variety of health problems, and an overdose can cause sudden
death. Repeated use of nicotine, a mild stimulant found in tobacco, leads
to physiological dependence.
Hallucinogens are drugs that distort sensory perceptions and can
induce hallucinations. They include LSD, psilocybin, and mescaline.
Other drugs with similar effects are cannabis (marijuana) and
phencyclidine, a deliriant that can induce a state of mental confusion or
delirium. Although hallucinogens may not lead to physiological
dependence, psychological dependence may occur. Concerns are also
raised about the potential for brain damage affecting learning and
memory ability in heavier users of marijuana. Biological approaches to
substance use disorders include detoxification; the use of drugs such as
disulfiram, methadone, naltrexone, and antidepressants; and nicotine
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replacement therapyResidential treatment approaches include hospitals
and therapeutic residences. Nonprofessional support groups, such as
Alcoholics Anonymous, promote abstinence within a supportive group
setting.

12.13 Unit end Exercise

1. Write about the consequences of Alcoholism.
2. What is Detoxification?
3. How do self help groups helps the Alcoholic people?
4. Describe the social factors that influence the substance use?

12.14 Answers for check your progress

1. Amphetamine and Cocaine
2. Drugs that are called hallucinogens cause people to experience
hallucinations.

12.15 Suggested Readings

1. Robert C. Carson &James N. Butcher. (2007). Abnormal Psychology.
Pearson Education Inc. New Delhi.
2. Barlow and Durand. (2006). Abnormal Psychology. New York.
Pearson India Ltd.

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UNIT 13
CAUSES AND RISK FACTORS FOR
ABNORMAL BEHAVIOUR
Structure
13.1 Introduction
13.2 Objectives
13.3 Causes and Risk factor for abnormal behavior
13.4 Diathesis- Stress model
13.5 Biological causal factor
13.5.1 Imbalance of neurotransmitter
13.5.2 Hormonal imbalance
13.5.3 Genetic vulnerabilities
13.5.4 Temperament
13.5.5 Brain dysfunction and Neural plasticity
13.6 Psychological causal factors
13.6.1 Early deprivation or Trauma
13.6.2 Inadequate parenting style
13.6.3 Marital Discord
13.6.4 Maladaptive peer relationship
13.7 Socio cultural factor
13.7.1 Low Socio economic status and unemployment
13.7.2 Prejudice, Gender Discrimination
13.7.3 Social change and uncertainty
13.8 Let’s Sum up
13.9 Unit End Exercise
13.10 Answers for check your progress
13.11 Suggested Readings

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13.1 INTRODUCTION
From early times, those who observed disordered behavior
grappled with the question of its cause. Hippocrates, for example, had a
type of disease model and suggested that an imbalance in the four bodily
humors produced abnormal behavior, with each humor connected with
certain kinds of behavior. To other observers, the cause was possession
by demons or evil spirit. Later, bodily dysfunction was suggested as a
cause. Each attempt at identifying a cause brought with it a theory, or
model, of abnormal behavior. Today we are still puzzling over the
causes of abnormal behavior, and speculation about causes continues to
give rise to new models of abnormality. Since about 1900, several
important schools of thought have developed elaborate models to
explain the origins of abnormal behavior and to suggest how it might be
treated.
13.2 Objectives
By the end of this unit you will be able to understand the causes for
various mental disorders.
 Biological causes
 Psychological causes
 Socio cultural causes
13.3 Causes and Risk Factors for Abnormal Behavior
Central to the field of abnormal psychology are questions about
what causes people to experience mental distress and to behave in a
maladaptive manner. If we knew the causes for given disorders, we
might be able to prevent conditions that lead to them and perhaps
reverse those that maintain them. It is difficult to understand the
abnormal behavior because human behavior is so complex. Even the
simplest human behavior, such as speaking or writing a single word, is
the product of thousands of prior events—the connections among which
are not always clear. As a result, many investigators now prefer to speak
of risk factors (variables correlated with an abnormal outcome) rather
than of causes

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13.4 Diathesis-Stress Models
A predisposition toward developing a disorder is termed a
diathesis. It can derive from biological, psychological, or socio cultural
causal factors. Many mental disorders are believed to develop when
some kind of stressor operates on a person who has a diathesis or
vulnerability for that disorder. Hence we will discuss what are
commonly known as diathesis-stress models of abnormal behavior. To
translate these terms into the types of causal factors described earlier, the
diathesis is a relatively distal necessary or contributory cause, but it is
generally not sufficient to cause the disorder. Instead, generally must be
a more proximal undesirable event or situation (the stressor), which may
also be contributory or necessary but is generally not sufficient by itself
to cause the disorder except in someone with the diathesis.
In additive model, individuals who have a high level of a diathesis
may need only a small amount of stress before a disorder develops, but
those who have a very low level of a diathesis may need to experience a
large amount of stress for a disorder to develop. In other words, the
diathesis and the stress sum together, and when one is high the other can
be low, and vice versa; thus, a person with no diathesis or a very low
level of diathesis could still develop a disorder when faced with truly
severe stress. In what is called an interactive model, some amount of
diathesis must be present before stress will have any effect. Thus, in the
interactive model, someone with no diathesis will never develop the
disorder, no matter how much stress he or she experiences, whereas
someone with the diathesis will show increasing likelihood of
developing the disorder with increasing levels of stress.
More complex models are also possible because diatheses often
exist on a continuum, ranging from zero to high levels, or exceeding his
or her personal resources. Since the late 1980s, attention has been
focused on the concept of protective factors, which are influences that
modify a person’s response to environmental stressors, making it less
likely that the person will experience the adverse consequences of the
stressors. Protective factors operate only to help resist against the effects
of a risk factor rather than to provide any benefits to people without risk
factors.
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 Protective factors are not necessarily positive experiences.
Indeed, sometimes exposure to stressful experiences that are dealt with
successfully can promote a sense of self-confidence or self-esteem and
thereby serve as a protective factor; thus some stressors paradoxically
promote coping. Protective factors most often, but not always, lead to
resilience— the ability to adapt successfully to even very difficult
circumstances. This discussion should make it very clear that diathesis.
Stress models need to be considered in a broad framework of multi
causal developmental models. Specifically, in the course of development
a child may acquire a variety of cumulative risk factors that may interact
in determining his or her risk for psychopathology. It is also important to
note, however, to understand what is abnormal, one must always have a
good understanding of normal human development at biological,
psychological, and socio cultural levels of analysis. This has been the
focus of the rapidly growing field of developmental psychopathology,
which focuses on determining what is abnormal at any point in
development by comparing and contrasting it with the normal and
expected changes that occur in the course of development.
Check your progress
1. What is a necessary cause? A sufficient cause? A contributory
cause?
2. What is a diathesis-stress model of abnormal behavior?

13.5 The Biological Viewpoint and Biological Causal Factors

Mental disorders are thus viewed as disorders of the central
nervous system, the autonomic nervous system, and/or the endocrine
system that are either inherited or caused by some pathological process.
At one time, people who adopted this viewpoint hoped to find simple
biological explanations. Today, however, most clinical psychologists
and psychiatrists recognize that such explanations are rarely simple, and
many also acknowledge that psychological and socio cultural causal
factors play important roles as well. The disorders first recognized as
having biological or organic components were those associated with

185
gross destruction of brain tissue. These disorders are neurological
diseases—that is, they result from the disruption of brain functioning by
physical or biochemical means and often involve psychological or
behavioral aberrations. For example, damage to certain areas in the brain
can cause memory loss, and damage to the left hemisphere that occurs
during a stroke can cause depression. However, most mental disorders
are not caused by only neurological damage.
We will focus here on four categories of biological factors that
seem particularly relevant to the development of maladaptive behavior:
(1) neurotransmitter and hormonal abnormalities in the brain or other
parts of the central nervous system, (2) genetic vulnerabilities, (3)
temperament, and (4) brain dysfunction and neural plasticity.
13.5.1 IMBALANCES OF NEUROTRANSMITTER SYSTEMS
The belief that imbalances in neurotransmitters in the brain can
result in abnormal behavior is one of the basic tenets of the biological
perspective today Sometimes psychological stress can bring on
neurotransmitter imbalances. These imbalances can be created in a
variety of ways.
There may be excessive production and release of the
neurotransmitter substance into the synapses, causing a functional
excess in levels of that neurotransmitter.
 There may be dysfunctions in the normal processes by which
neurotransmitters, once released into the synapse, are deactivated.
 Finally, there may be problems with the receptors in the
postsynaptic neuron, which may be either abnormally sensitive or
abnormally insensitive.
Although over a hundred neurotransmitters have been discovered
to date, five different kinds of neurotransmitters have been most
extensively studied in relationship to psychopathology:
(1) norepinephrine, (2) dopamine, (3) serotonin,
(4) glutamate, and (5) gamma aminobutyric acid (known as
GABA.
Norepinephrine has been implicated as playing an important role in
the emergency reactions our bodies show when we are exposed to an

186
acutely stressful or dangerous situation, as well as in attention,
orientation, and basic motives. The functions of dopamine include
pleasure and cognitive processing, and it has been implicated in
schizophrenia. Serotonin has been found to have important effects on the
way we think and process information from our environment as well as
on behaviors and moods. GABA, which is strongly implicated in
reducing anxiety as well as other emotional states characterized by high
levels of arousal
13.5.2 HORMONAL IMBALANCES
Some forms of psychopathology have also been linked to hormonal
imbalances. Hormones are chemical messengers secreted by a set of
endocrine glands in our bodies. Each of the endocrine glands produces
and releases its own set of hormones directly into our bloodstream. One
particularly important set of interactions occurs in the hypothalamic-
pituitary-adrenal axis (HPA axis). Activation of this axis involves:
1. Messages in the form of corticotrophin-releasing hormone (CRH)
travel from the hypothalamus to the pituitary.
2. In response to CRH, the pituitary releases adrenocorticotrophic
hormone (ACTH), which stimulates the cortical part of the adrenal
gland (located on top of the kidney) to produce epinephrine
(adrenaline) and the stress hormone cortisol, which are released
into general circulation. Cortisol mobilizes the body to deal with
stress.
3. Cortisol in turn provides negative feedback to the hypothalamus
and pituitary to decrease their release of CRH and ACTH, which in
turn reduces the release of adrenaline and cortisol. This negative
feedback system operates much as a thermostat does to regulate
temperature.

13.5.3 Genetic Vulnerabilities

The biochemical processes described above are themselves
affected by genes, which consist of very long molecules of
DNA (deoxyribonucleic acid) and are present at various locations on
chromosomes. Chromosomes are the chain-like structures within a cell

187
nucleus that contain the genes. Genes are the carriers of genetic
information Research in developmental genetics has shown that
abnormalities in the structure or number of the chromosomes can be
associated with major defects or disorders. For example,
Down syndrome is a type of mental retardation in which there is a
trisomy (a set of three chromosomes instead of two) in chromosome 21.
Here the extra chromosome is the primary cause of the disorder. More
typically, however, personality traits and mental disorders are not
affected by chromosomal abnormalities. Instead they are more often
influenced either by abnormalities in some of the genes on the
chromosomes or by naturally occurring variations of genes known as
polymorphisms. Although you will often hear about discoveries that “the
gene” for a particular disorder has been discovered, vulnerabilities to
mental disorders are almost always polygenic, which means they are
influenced by multiple genes
13.5.4 Temperament
Temperament refers to a child’s reactivity and characteristic ways
of self-regulation. When we say that babies differ in temperament, we
mean that they show differences in their characteristic emotional and
arousal responses to various stimuli and in their tendency to approach,
withdraw, or attend to various situations. Our early temperament is
thought to be the basis from which our personality develops. Starting at
about 2 to 3 months of age, approximately five dimensions of
temperament can be identified: fearfulness, irritability and frustration,
positive affect, activity level, and attention persistence and effortful
control, although some of these emerge later than others. These seem to
be related to the three important dimensions of adult personality: (1)
neuroticism or negative emotionality, (2) extraversion or positive
emotionality, and (3) constraint temperament may also set the stage for
the development of various forms of psychopathology later in life. For
example, children who are fearful and hyper vigilant in many novel or
unfamiliar situations have been labeled behaviorally inhibited.
This trait has a significant heritable component and, when it is stable, is
a risk factor for the development of anxiety disorders later in childhood.

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13.5.5 Brain Dysfunction and Neural Plasticity
As noted earlier, specific brain lesions with observable defects in
brain tissue are rarely a primary cause of psychiatric disorders.
However, advances in understanding how more subtle deficiencies of
brain structure or function are implicated in many mental disorders have
been increasing at a rapid pace in the past few decades. There is
considerable neural plasticity—flexibility of the brain in making
changes in organization and function in response to pre- and postnatal
experiences, stress, diet, disease, drugs, maturation, and so forth.
Existing neural circuits can be modified, or new neural circuits can be
generated. The effects can be either beneficial or detrimental to the
individual, depending on the circumstances.. This research on neural and
behavioral plasticity, in combination with the work described earlier on
genotype– environment correlations, makes it clear why developmental
psychopathologists have been devoting increasing attention to a
developmental systems approach.
This approach acknowledges not only that genetic activity
influences neural activity, which in turn influences behavior, which in
turn influences the environment, but also that these influences are
bidirectional. Various aspects of our environment (physical, social, and
cultural) also influence our behavior, which in turn affects our
neural.activity, and this in turn can even influence genetic activity.

Check your Progress

3. what is hormone?
4. what is neural plasticity?
13.6 Psychological Causal Factors
We begin life with few built-in patterns and a great capacity to
learn from experience. What we do learn from our experiences may help
us face challenges resourcefully and may lead to resilience in the face of
future stressors. Unfortunately, some of our experiences may be much
less helpful in our later lives, and we may be deeply influenced by
factors in early childhood over which we have no control. Exposure to
multiple uncontrollable and unpredictable frightening events is likely to
leave a person vulnerable to anxiety and negative affect, a central
189
problem in a number of mental disorders such as anxiety and depression.
In this section we will examine the types of psychological factors that
make people vulnerable to disorder or that may precipitate disorder. We
will focus on four categories of psychological causal factors that can
each have important detrimental effects on a child’s socio emotional
development: (1) early deprivation or trauma, (2) inadequate parenting
styles, (3) marital discord and divorce, and (4) maladaptive peer
relationships
13.6.1 Early Deprivation or Trauma
Children who do not have the resources that are typically supplied
by parents or parental surrogates may be left with deep and sometimes
irreversible psychological scars. Deprivation of such resources can occur
in several forms. The most severe manifestations of deprivation are
usually seen among abandoned or orphaned children, who may be either
institutionalized or placed in a succession of unwholesome and
inadequate foster homes. However, it can also occur in intact families
where, for one reason or another, parents are unable (for instance,
because of mental disorder) or unwilling to provide close and frequent
human attention and nurturing. We can interpret the consequences of
parental deprivation from several psychological viewpoints. Such
deprivation might result in fixation at the oral stage of psychosexual
development (Freud); it might interfere with the development of basic
trust (Erikson); it might retard the attainment of needed skills because of
a lack of available reinforcements (Skinner); or it might result in the
child’s acquiring dysfunctional schemas and self-schemas in which
relationships are represented as unstable, untrustworthy, and without
affection (Beck).
13.6.2 INSTITUTIONALIZATION
In some cases children are raised in an institution where, compared
with an ordinary home, there is likely to be less warmth and physical
contact; less intellectual, emotional, and social stimulation; and a lack of
encouragement and help in positive learning. Many children
institutionalized in infancy and early childhood show severe emotional,
behavioral, and learning problems and are at risk for disturbed
attachment relationships and psychopathology.
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13.6.3 NEGLECT AND ABUSE IN THE HOME
Most infants subjected to parental deprivation are not separated
from their parents but, rather, suffer from maltreatment at home.
Outright parental abuse (physical or sexual or both) of children has been
associated with many negative effects on their emotional, intellectual,
and physical development, although some studies have suggested that, at
least among infants, gross neglect may be worse than having an abusive
relationship. Abused children often have a tendency to be overly
aggressive (both verbally and physically), Abused and maltreated infants
and toddlers are also quite likely to develop atypical patterns of
attachment—most often a disorganized and disoriented style of
attachment.
13.6.4 Inadequate Parenting Styles
Even in the absence of severe deprivation, neglect, or trauma,
many kinds of deviations in parenting can have profound effects on a
child’s subsequent ability to cope with life’s challenges and thus can
create a child’s vulnerability to various forms of psychopathology. a
parent–child relationship is always bidirectional: As in any continuing
relationship, the behavior of each person affects the behavior of the
other. Some children are easier to love than others; some parents are
more sensitive than others to an infant’s needs
PARENTAL PSYCHOPATHOLOGY
In general, it has been found that parents who have various forms
of psychopathology (including schizophrenia, depression, antisocial
personality disorder, and alcohol abuse or dependence) tend to have one
or more children who are at heightened risk for a wide range of
developmental difficulties.
PARENTING STYLES: WARMTH AND CONTROL
Researchers have been interested in how parenting styles—
including their disciplinary styles—affect children’s behavior over the
course of development. A parenting style reflects an attitude and values
that are expressed toward a child across a wide range of settings. Four
types of parenting styles have been identified that seem to be related to
different developmental outcomes for the children: (1) authoritative, (2)
authoritarian, (3) permissive/indulgent, and (4) neglectful/uninvolved.
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These styles vary in the degree of parental warmth (amount of support,
encouragement, and affection versus shame, rejection, and hostility) and
in the degree of parental control. Parental control includes both
behavioral control (rewards and punishments) and psychological control
(e.g., expression of approval vs disapproval, or guilt induction).
13.7 MARITAL DISCORD
Whatever the reasons for marital discord, when it is long-standing
it is likely to be frustrating, hurtful, and generally damaging in its effects
on both adults and their children. More severe cases of marital discord
may expose children to one or more of the stressors we have already
discussed: child abuse or neglect, the effects of living with a parent with
a serious mental disorder, authoritarian or neglectful/ uninvolved
parenting, and spouse abuse. But even less severe cases of marital
discord also have negative effects on many children. For example, one
study showed that children of parents with high levels of overt conflict
showed a greater disposition to behave aggressively toward both their
peers and their parents.
Effects of Divorce on Children
Divorce can have traumatic effects on children, too. Feelings of
insecurity and rejection may be aggravated by conflicting loyalties and,
sometimes, by the spoiling the children may receive while staying with
one of the parents. Not surprisingly, some children do develop serious
maladaptive responses. Temperamentally difficult children are likely to
have a more difficult time adjusting. Delinquency and a wide range of
other psychological problems such as anxiety and depression are much
more frequent among children and adolescents from divorced.
Maladaptive Peer Relationships
Important peer relationships usually begin in the preschool years.
Children at this stage are hardly masters of the fine points of human
relationships or diplomacy. The child’s own immediate satisfaction
tends to be the primary goal of any interaction, and there is only an
uncertain recognition that cooperation and collaboration may bring even
greater benefits. A substantial minority of children seem somehow ill
equipped for the rigors and competition of the school years, often
because of temperamental factors in the child or dysfunctional family
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situations. A significant number of them withdraw from their peers and
become loners. A significant number of others (especially males) adopt
physically intimidating and aggressive lifestyles, often becoming
schoolyard or neighborhood bullies. Being either a loner or a bully does
not bode well for good mental health outcomes. In recent years a new
form of particularly insidious bullying has emerged as an enormous
problem in many countries. Cyber bullying, as it is called, includes
sending offensive, harassing, or intimidating messages over the Internet,
spreading ugly rumors on certain Internet sites, and spreading someone’s
very personal information. Some estimate that as many as one-third of
teenagers who use the Internet engage in cyber bullying. The
psychological consequences of cyber bullying on the victims can be very
serious— including anxiety, school phobia, lower self-esteem, suicidal
ideation, and occasional cases of suicide.
Check your Progress
5. How does parenting style affects child’s mental health?
6. What is cyber bullying?

13.8 Socio cultural Causal Factors

Each socio cultural group fosters its own cultural patterns by
systematically teaching its offspring, all its members tend to be
somewhat alike. Children reared among headhunters tend to become
headhunters; children reared in societies that do not sanction violence
usually learn to settle their differences in nonviolent ways. The more
uniform and thorough the education of the younger members of a group,
the more alike they will become. There are many sources of pathogenic
social influences. Some of these stem from socioeconomic factors.
Others stem from socio cultural factors regarding role expectations and
from the destructive forces of prejudice and discrimination.
Low Socioeconomic Status and Unemployment
In our society the lower the socioeconomic class has the higher the
incidence of mental and physical disorders. The strength of this inverse
correlation varies with different types of mental disorder. Thus lower

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socioeconomic groups may show increased prevalence of mental and
physical disorders due at least partly to increased stress on the people at
risk. Other studies have examined the effects of unemployment on adults
and children. Since the 1970s, there have been a number of severe
economic recessions experienced worldwide, and significant rates of
unemployment have accompanied each. Studies have repeatedly found
unemployment— with its financial hardships, self-devaluation, and
emotional distress—to be associated with emotional distress and
enhanced vulnerability to psychopathology. Recent evidence suggests
that it is the financial difficulties often resulting from unemployment
that lead to the elevated levels of distress and mental disorders.
Prejudice and Discrimination in Race, Gender, and Ethnicity
Vast numbers of people in our society have been subjected to
demoralizing stereotypes as well as to both overt and covert
discrimination in areas such as employment, community, religion, and
status. Prejudice against minority groups may also explain why these
groups sometimes show increased prevalence of certain mental disorders
such as depression. One possible reason for this is that perceived
discrimination may serve as a stressor that threatens self-esteem, which
in turn increases psychological distress.
Social Change and Uncertainty
The rate and pervasiveness of change today are different from
anything our ancestors ever experienced. All aspects of our lives are
affected—our education, our jobs, our families, our health, our leisure
pursuits, our finances, and our beliefs and values. Constantly trying to
keep up with the numerous adjustments demanded by these changes is a
source of considerable stress. Simultaneously, we confront inevitable
crises as the earth’s consumable natural resources dwindle, as our
environment becomes increasingly noxious with pollutants, and as
global warming occurs. No longer people are confident that the future
will be better than the past or that technology will solve all our
problems. On the contrary, our attempts to cope with existing problems
seem increasingly to create new problems that are as bad or worse. The
resulting despair, demoralization, and sense of helplessness are well-

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established predisposing conditions for abnormal reactions to stressful
events.
13.9 Let’s Sum Up
In considering the causes of abnormal behavior, it is important to
distinguish among necessary, sufficient, and contributory causal factors,
as well as between relatively distal causal factors and those that are more
proximal.
This chapter discusses biological, psychological, and socio cultural
viewpoints, each of which tends to emphasize the importance of causal
factors of a characteristic type. Ultimately we strive for an integrative
bio psychosocial viewpoint.
In examining biologically based vulnerabilities, we must consider
abnormalities in neuro chemical and hormonal systems, genetic
vulnerabilities, temperament, and brain dysfunction and neural
plasticity.
Sources of psychologically determined vulnerability include early social
deprivation or severe emotional trauma, inadequate parenting styles,
marital discord and divorce, and maladaptive peer relationships.
The socio cultural viewpoint is concerned with the contribution of socio
cultural variables to mental disorder. Although many serious mental
disorders are fairly universal, the form that some disorders take and their
prevalence vary widely among different cultures.
Low socioeconomic status and unemployment; being subjected to
prejudice and discrimination in race, gender, and ethnicity; experiencing
social change and uncertainty; and urban violence and homelessness are
all associated with greater risk for various disorders.

13.10 Unit End Exercise

1. Define the terms protective factors and resilience. Give examples of
each.
2. Explain how neurotransmitter and hormonal abnormalities might
produce abnormal behavior.
3. What is temperament, and why is it important for the origins of
abnormal behavior?

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4. What is the typical range of effects that divorce and marital discord
can have on children? What about effects on adults?
5. What are two different types of popular children and two different
types of rejected children?
6. What effects do low SES and unemployment have on adults and
children?
13.11 Answers for check your progress
1. A necessary cause is a condition that must exist for a disorder to
occur.

2. A predisposition toward developing a disorder is termed a diathesis. It

can derive from biological, psychological, or socio cultural causal
factors. Many mental disorders are believed to, develop when some
kind of stressor operates on a person who has a diathesis or vulnerability
for that disorder.

3. Hormones are chemical messengers secreted by a set of endocrine

glands in our bodies.

4 Neural plasticity means flexibility of the brain in making changes in

organization and function in response to pre- and postnatal experiences,
stress, diet, disease, drugs, maturation, and so forth.

5. Parenting style affects child’s behavior and cognitive structure in

early childhood which laid the foundation to the personality
development in adulthood.

6. Cyber bullying, as it is called, includes sending offensive, harassing,

or intimidating messages over the Internet, spreading ugly rumors on
certain Internet sites, and spreading someone’s very personal
information.

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13.12 Suggested Readings
1. Butcher, J.N. (2014). Abnormal Psychology. New Delhi: Pearson
Education.
2. Butcher, J.N., Hooley, J. M., Mineka, S &Dwivedi, C.B. (2017).
Abnormal Psychology 16th ed. Noida: Pearson.
Sarason, G.I. &Sarason, R.V. (2007). Abnormal Psychology: The
Problem of Maladaptive Behaviour (II Edition). Pearson Education, Inc.
and Dorling Kindersley Publication Inc.

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UNIT 14
ADJUSTMENT DISORDER
Structure
14.1 Introduction
14.2 Objectives
14.3 Meaning of stress
14.4 General Adaptation Syndrome
14.5 Adjustment Disorder
14.5.1Acute stress disorder
14.5.2Post traumatic stress disorder
14.6 Causes
14.7 Treatment
14.8 Let’s sum up
14.9 Unit End Exercise
14.10 Answers for check your progress
14.11 Suggested Readings
14.1 INTRODUCTION
Nowadays it is very common to hear that, I am stressed. The word
stress is used by the child as well as the old age people. You may
wonder what they are saying about, what causes this stress. Our life
events like unemployment, separation of loved ones, natural disasters,
or brutal accidents triggers the stress level in our body. The coping skills
varies depend upon the individuals. This maladaptive coping style
creates stress.

14.2 Objectives
After studying this unit, you will be able to understand the following
concepts
 Stress and stressors
 Reaction to stressful events
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  Characteristics of adjustment disorder
 Types of adjustment disorders such as Acute stress disorder and
 Post traumatic stress disorder.
14.3 Meaning of Stress
The term stress refers to pressure or force placed on a body. In the
physical world, tons of rock that crash to the ground in a landslide, for
example, cause stress on impact, forming indentations or craters when
they land. In psychology, we use the term stress to refer to pressures or
demands placed on organisms to adapt or adjust. A stressor is a source
of stress. Stressors (or stresses) include psychological factors, such as
examinations in school and problems in social relationships, and life
changes, such as the death of a loved one, divorce, or a job termination.
Stress is implicated in a wide range of physical and psychological
problems. We begin our study of the effects of stress by discussing
relationships between stress and health. We then examine stress-related
psychological disorders that involve maladaptive reactions to stress.
14.4 The General Adaptation Syndrome
Stress researcher Hans Selye (1976) coined the term general
adaptation syndrome (GAS) to describe a common biological response
pattern to prolonged or excessive stress. Selye pointed out that our
bodies respond similarly to many kinds of unpleasant stressors, whether
the source of stress is an invasion of microscopic disease organisms, a
divorce, or the aftermath of a flood.
The GAS consists of three stages: the alarm reaction, the resistance
stage, and the exhaustion stage. Perception of an immediate stressor
(e.g., a car that swerves in front of you on the highway) triggers the
alarm reaction. The alarm reaction mobilizes the body to prepare for
challenge or stress.
In 1929, Harvard University physiologist Walter Cannon termed
this response pattern the fight-or-flight reaction. During the alarm
reaction, the adrenal glands, controlled by the pituitary gland in the
brain, pump out cortical steroids and stress hormones that help mobilize

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the body’s defenses. The fight-or-flight reaction most probably helped
our early ancestors cope with the many perils they faced. The reaction
may have been provoked by the sight of a predator or by a rustling
sound in the undergrowth. The fight-or-flight reaction most probably
helped our early ancestors cope with the many perils they faced. The
reaction may have been provoked by the sight of a predator or by a
rustling sound in the undergrowth. (e.g., release of stress hormones)
remain at high levels, but not quite as high as during the alarm reaction.
During the resistance stage, the body tries to renew spent energy
and repair damage. But when stressors continue or new ones appear, we
may progress to the final stage of the GAS: the exhaustion stage.
Although there are individual differences in capacity to resist stress, all
of us will eventually exhaust our bodily resources. The exhaustion stage
is characterized by dominance of the parasympathetic branch of the
ANS.
Check your Progress
1. What is stress?
2. Describe the stages of General Adaptive syndrome

14.5 ADJUSTMENT DISORDER

An adjustment disorder is a maladaptive reaction to a distressing
life event or stressor that develops within 3 months of the onset of the
stressor. The stressful event may be either a traumatic experience, such
as a natural disaster or a motor vehicle accident with serious injury, or a
non traumatic life event, such as the breakup of a romantic relationship
or starting college.
According to the DSM, the maladaptive reaction is characterized
by significant impairment in social, occupational, or other important area
of functioning, such as academic work, or by marked emotional distress
exceeding what would normally be expected in coping with the stressor.
Prevalence estimates of the rates of the disorder in the population vary
widely. However, the disorder is common among people seeking
outpatient mental health care, with estimates indicating that between 5%
and 20% of people receiving outpatient mental health services present
with a diagnosis of adjustment disorder.
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 Characteristics of Adjustment Disorder
Our emotional reaction exceeds an expected response, or our ability to
function is impaired (e.g., avoidance of social interactions, difficulty
getting out of bed, or falling behind in schoolwork), then a diagnosis of
adjustment disorder may be indicated. Thus, if you are having trouble
concentrating on your schoolwork following the breakup of a romantic
relationship and your grades are slipping, you may have an adjustment
disorder. There are several specific types of adjustment disorders that
vary in terms of the type of maladaptive reaction.
For the diagnosis of an adjustment disorder to apply, the stress
related reaction must not be sufficient to meet the diagnostic criteria for
other or posttraumatic stress disorder), or anxiety or mood disorders or
mood disorder. The maladaptive reaction may be resolved if the stressor
is removed or the individual learns to cope with it. If the adjustment
disorder lasts for more than six months after the stressor (or its
consequences) has been removed, the diagnosis may be changed.
Although the DSM system distinguishes adjustment disorder from other
clinical syndromes, it may be difficult to identify distinguishing features
of adjustment disorders that are distinct from other disorders, such as
depression, such as traumatic stress disorders (acute stress disorder).
Traumatic Stress Disorders
In adjustment disorders, people may have difficulty adjusting to stressful
life events such as business or marital problems, termination of a
romantic relationship, or death of a loved one. But with traumatic stress
disorders, the focus shifts to how people cope with disasters and other
traumatic experiences. Exposure to trauma can tax anyone’s ability to
adjust. For some people, traumatic experiences lead to the development
of traumatic stress disorders, which are characterized by maladaptive
patterns of behavior in response to trauma that involve marked personal
distress or significant impairment of functioning.
Here we focus on the two major types of traumatic stress disorders,
acute stress disorder and posttraumatic stress disorder.

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14.5.1 Acute Stress Disorder
In acute stress disorder, the person shows a maladaptive pattern of
behavior for a period of three days to one month following exposure to a
traumatic event. The traumatic event may involve exposure to either
actual or threatened death, a serious accident, or a sexual violation. The
person with acute stress disorder may have been directly exposed to the
trauma, witnessed other people experiencing the trauma, or learned
about a violent or accidental traumatic event experienced by a close
friend or family member. People with acute stress disorder may feel they
are “in a daze” or that the world seems like a dreamlike or unreal place.
The symptoms or features of acute stress disorder vary and may include
disturbing, intrusive memories or dreams about the trauma;
re experiencing the trauma in the form of flashbacks; feelings of
unreality or detachment (“dissociation”) from one’s surroundings or
from oneself; avoidance of external reminders of the trauma (such as
places or people associated with the trauma); problems sleeping; and
development of irritable or aggressive behavior or an exaggerated startle
response to sudden noises.

14.5.2 Posttraumatic Stress Disorder

Posttraumatic stress disorder is a prolonged maladaptive reaction
that lasts longer than one month after the traumatic experience. PTSD
presents with a similar symptom profile as acute stress disorder, but may
persist for months, years, or even decades, and may not develop until
many months or even years after the traumatic event. Many people with
acute stress disorder, but certainly not all, go on to develop PTSD.
Researchers find both types of traumatic stress disorders in soldiers
exposed to combat and among rape survivors, victims of serious motor
vehicle and other accidents, and people who have witnessed the
destruction of their homes and communities by natural disasters, such as
floods, earthquakes, or tornadoes, or technological disasters, such as
railroad or airplane crashes.
1. What is Adjustment Disorder?
2. What is Acute stress disorder?
3. What is PTSD?
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14.6 Causes
Some vulnerability factors relate to the traumatic event itself, such
as the degree of exposure to the trauma, whereas others relate to the
person or the social environment. The more direct the exposure to the
trauma, the greater the person’s likelihood of developing PTSD. Another
factor relating to the likelihood of developing PTSD is gender. Although
men more often have traumatic experiences, women are more likely to
develop PTSD, about twice as likely. However, women’s greater
vulnerability to PTSD may have more to do with their greater incidence
of sexual victimization and with their younger ages at the time of trauma
than with gender itself. Other vulnerability factors relate to personal and
biological factors. Genetic factors involved in regulating the body’s
response to stress appear to play a part in determining a person’s
susceptibility to PTSD in the wake of trauma.
Recently, investigators reported that the amygdala, a small
structure in the brain’s limbic system that triggers the body’s fear
response, was smaller in a group of combat veterans with PTSD than in
combat veterans without PTSD. Other factors linked to increased
vulnerability to PTSD include a history of childhood sexual abuse, lack
of social support, and limited coping skills. Personality factors such as
lower levels of self-efficacy and higher levels of hostility are also linked
to increased risk of PTSD. People who experience unusual symptoms
during or immediately after the trauma, such as feeling that things are
not real or feeling as though one were watching oneself in a movie as the
events unfold, stand a greater risk of developing PTSD.

14.7 Treatment Approaches

Cognitive-behavioral therapy has produced impressive results in the
treatment of PTSD. The basic treatment component is repeated exposure
to cues and emotions associated with the trauma. In cognitive-behavioral
therapy, the person gradually re experiences the anxiety associated with
the traumatic event in a safe setting, thereby allowing extinction to take
its course. The PTSD patient may be encouraged to repeatedly talk about
the traumatic experience, re experience the emotional aspects of the
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trauma in imagination, view related slides or films, or visit the scene of
the traumatic event. Training in stress management skills, such as self-
relaxation, can also improve the client’s ability to cope with troubling
symptoms of PTSD, such as heightened arousal and the desire to run
away from trauma-related stimuli. Training in anger management skills
may also be helpful, especially for combat veterans with PTSD.
Treatment with antidepressant drugs, such as sertraline (Zoloft) or
paroxetine (Paxil), may help reduce the anxiety components of PTSD.

14.8 Let’s Sum Up

Exposure to stress, especially traumatic stress like that experienced by
many thousands of people stress can have profound effects on our
physical and emotional health. Psychologists who study
interrelationships between psychological factors, including stress, and
physical health are called health Psychologists. The term stress refers to
pressure or force placed on a body. The general adaptation syndrome,
(1) the alarm reaction, in which the body mobilizes its resources to
confront a stressor; (2) the resistance stage, in which bodily arousal
remains high but the body attempts to adapt to continued stressful
demands; and (3) the exhaustion stage, in which bodily resources b
These factors include effective coping styles, self-efficacy expectancies,
psychological hardiness, optimism, and social support. Adjustment
disorders are maladaptive reactions to identified stressors.
Adjustment disorders are characterized by emotional reactions that
are greater than normally expected given the circumstances The two
types of traumatic stress disorders are acute stress disorder and
posttraumatic stress disorder. Both involve maladaptive reactions to
traumatic stressors. Acute stress disorder occurs in the days and weeks
following exposure to the traumatic event. Posttraumatic stress disorder

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persists for months, years, or even decades after the traumatic
experience and may not begin until months or years after the event.
14.9 Unit End Exercise
1. Explain Adjustment Disorders and its types.
2. What is PTSD? Explain causes for PTSD?
3. Write about the various treatment approaches for adjustment
disorders.
14.10 Answers for Check your Progress
1. The term stress refers to pressures or demands placed on organisms to
adapt or adjust.

2. The general adaptation syndrome, which is characterized by three

stages: (1) the alarm reaction, in which the body mobilizes its resources
to confront a stressor; (2) the resistance stage, in which bodily arousal
remains high but the body attempts to adapt to continued stressful
demands; and (3) the exhaustion stage, in which bodily resources
become dangerously depleted in the face of persistent and intense stress,
and stress-related disorders, or diseases of adaptation, may develop.

3. Adjustment disorders are maladaptive reactions to identified stressors.

Adjustment disorders are characterized by emotional reactions that are
greater than normally expected given the circumstances or by evidence
of significant impairment in functioning.

4. Acute stress disorder occurs in the days and weeks following

exposure to the traumatic event.

5. Posttraumatic stress disorder is a prolonged maladaptive reaction that

lasts longer than one month after the traumatic experience. PTSD

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presents with a similar symptom profile as acute stress disorder, but may
persist for months, years, or even decades,

14.11 Suggested Readings

1. Butcher, J.N. (2014). Abnormal Psychology. New Delhi: Pearson
Education.
2. Butcher, J.N., Hooley, J. M., Mineka, S &Dwivedi, C.B. (2017).
Abnormal Psychology 16th ed. Noida: Pearson.
3. Sarason, G.I. &Sarason, R.V. (2007). Abnormal Psychology: The
Problem of Maladaptive Behaviour (II Edition). Pearson Education, Inc.
and Dorling Kindersley Publication Inc.

206