PSYCHOPATHOLOGY

SECOND SEMESTER

SANJEEV KUMAR YADAV

 PSYCHOPATHOLOGY

Unit Topics

I Psychopathology: Historical Perspectives on Psychopathology:

How Far Have We Come? Current Viewpoints on Psychopathology: What
Makes it a Disorder, and Who Treats It?Theoretical perspective:
Psychodynamic, Behavioral, Cognitive, Humanistic.
Classification systems: DSM-V and ICD-11.

II Causes of abnormal behavior: Biogenic: genetic defects,

hormonal and neurotransmitter imbalances, physical deprivation, brain
pathology. Psychosocial: parental deprivation, pathogenic family patterns,
early trauma, pathogenic interpersonal relations, severe stress.
Socio-cultural : War and violence, group prejudice and discrimination, poverty
and unemployment

III Anxiety Disorders- Etiology and symptoms of phobia, general

anxiety disorder, Agoraphobia
Obsessive Compulsive related disorder, Separation AnxietyDisorder,
Selective Mutism
Somatic Symptoms and Related DisordersTrauma &
Stress related disorder.
Dissociative disorders- Etiology and Symptoms

IV Bipolar and Related DisordersDepressive

Disorders
Schizophrenia Spectrum & other Psychotic Disorders
Personality Disorders

V Neuro-developmental Disorders
Substance Related and Addictive Disorders

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UNIT-1
Psychopathology: Theoretical perspective and Classification systems

Introduction-
Abnormal psychology also called psychopathology deals with understanding the nature, causes, and
treatment of mental disorders.
According to the DSM 5, a mental disorder is defined as a syndrome that is present in an individual
and that involves clinically significant disturbance in behaviour, emotional regulation, or cognitive
functioning. These disturbances are thought to reflect a dysfunction in biological, psychological or
developmental processes that are necessary for mental functioning. Thus, abnormality is associated
with significant decrease in social, occupational and other activities that are important for human
functioning.
Although many definitions of abnormality have been used over the years, none has won universal
acceptance. Still, most definitions have certain common features, often called the ‘four Ds’: deviance,
distress, dysfunction and danger.
Indicators of abnormality-
The more that someone has a difficulty in the following areas, the more likely that they have a mental
disorder.
1 Subjective distress If people suffer from psychological pain we can consider this as an indication
of abnormality. For example, people with depression clearly report being distressed. However there
can be instances where worry is common and normal, such as when you have to study for a test.
Therefore, although subjective distress may be an element of abnormality, in many cases it is neither a
sufficient condition nor a necessary condition for abnormality.
2 Maladaptiveness Maladaptive behaviour is often an indicator for abnormality. It interferes with
our ability to enjoy our occupations and relationships. A depressed person may withdraw from family
and friends.
3 Statistical Deviance If something is statistically rare and undesirable we are more likely to
consider it abnormal than something that is statistically common but undesirable. But this has to be
understood right, for example, severe intellectual disability is considered abnormal while being a
genius or being rude is not an abnormality.
4 Violations of the standards of society Breaking cultural rules, laws, norms and moral standards
may indicate signs of abnormality. Much depends on the degree of violation of the rule. Parking in the
wrong spot may be against the law but it is not abnormal while a mother killing her children is a sign
of abnormal behaviour.
5 Social discomfort When someone violates an unwritten social rule that causes discomfort to
someone else, it may be considered abnormal. If a stranger decides to sit next to you in an empty bus,
you will be uncomfortable. But again, much depends on circumstances.
6 Irrationality and unpredictability Irrational and unpredictable behaviour makes no sense and can
indicate possible abnormality.The most important factor is our evaluation of whether the person can
control their behaviour.
7 Dangerousness It is quite reasonable to think that a person who can pose as a danger to themselves
or other people has an abnormality .Psychologists are required to hospitalize such people and alert the
police. One must note that no single indicator is sufficient in and of itself to determine abnormality.
Historical Conceptions of Abnormal Behaviour
Throughout history the dominant social, economic and religious views have had a great influence on
how people perceived abnormal behaviour. In the ancient world superstitious explanations for mental
disorders were popular. In the fifteenth and sixteenth centuries it was widely believed that mental
disorders were attributed by demonic possessions. However, Hippocrates denied that Gods and
demons caused illnesses and insisted that mental disorders had natural causes and required proper
treatment. He also believed that dreams are important to understand the patients’ personality. He also
recognised the importance of environment for mental health and thus removed some patients from

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their families. The Greek and Roman were among the few to treat people with mental disorders with
appropriate care. They provided pleasant surroundings with constant activities like parties, dances and
massages. They also followed the principle of contrariiscontrarius (opposite by opposite). For
example, having their patient drink chilled wine while taking a warm bath. Chinese physician, Chung
Ching conducted treatments that were similar to Hippocrates. Other references to mental health
disorders were also made in the Indian texts of Charaka Samhitha and Sushruta Samhita. In Europe
during the Middle age and Renaissance period, there was a general movement away from
superstitions and toward reasoned scientific studies. Mental asylums were created in the 16th century,
however, it lead to the isolation and maltreatment of the patients. Some patients were displayed to the
public in return for money. Slowly by the eighteenth century efforts were made for the better care of
patients by providing them with better living conditions and humane treatment. In the 19th and 20th
century rapid growth of abnormal psychology was observed. This can be because of the growth of
technology and scientific advancements. Thus the treatment of individuals with mental illnesses was
advanced. Because of the works of several renowned psychologists like Pavlov and Freud, the gradual
acceptance of patients with mental illnesses as people who need care and attention, was possible.
Successful application of biomedical methods to disorders and the growth of scientific research into
the biological, psychological and sociocultural roots of abnormal behaviour were observed.
Biological Viewpoint
The biological viewpoint focuses on mental disorders as diseases whose primary symptoms are
cognitive, behavioural and emotional in nature. Disorders are thus viewed as abnormalities in the
nervous system, endocrine system. The four categories of the biological viewpoint include:
1 Genetic Vulnerabilities- Genes are very long molecules of DNA that we inherit from our parents.
Genes are present in fibrous structures called the chromosomes. There is substantial evidence that
most mental disorders show at least some genetic influence. Abnormalities in the structure of
chromosomes can be associated with major disorders. Anomalies in the sex chromosome may cause
abnormal sexual behaviours. Generally disorders are influenced by several genes, thus no single gene
anomaly can cause a mental disorder because of their small effects. Genes tend to indirectly influence
behaviour, they can get ‘turned on’ or ‘turned off’ in response to the environment.
2 Brain Dysfunction and Neural Plasticity- Subtle deficiencies of brain can cause brain disorders.
This has been discovered due to the advancement in technology and brain scans to study the function
and structure of the brain. The brain has an ability to change its organization and function in response
to pre and post natal experiences, stress, diet, disease and other environmental conditions. This ability
is called plasticity. The brain is immensely affected by the experiences of young infants and children.
The plastic nature of the brain can be beneficial or detrimental based on an individuals’ experiences.
3 Imbalances of Neurotransmitters and Hormones- Neurotransmitters are chemical substances that
are released by neurons in order to pass messages to other neurons. There are different kinds of
neurotransmitters; some can cause a neural impulse while others can inhibit an impulse.
● Norepinephrine plays an important role in emergency responses to dangerous and stressful
situations. ● Dopamine influences pleasure and cognitive processing and has been implicated in
schizophrenia.
● Serotonin is responsible for the way we think and process information thus it plays an important
role in emotional disorders like anxiety and depression
● GABA is an inhibitory neurotransmitter, thus it is used to reduce anxiety and other emotional states.

Hormones are chemicals that are secreted directly into the bloodstream by endocrine glands. They
cause the flight or fight response, physical growth and other physical expressions of mental states.
Malfunctioning in hormone release can cause various forms of psychopathology such as depression
and post-traumatic stress disorder.
4 Temperament- Temperament refers to a child’s reactivity and characteristic ways of selfregulation.
Temperament is believed to be biologically programmed. Temperament causes differences in
emotional and arousal responses to various situations. Early temperament is thought to be the basis of
our personality. Not surprisingly temperament may also cause the development for various
psychopathologies later in life. Children who are fearful and very anxious may become behaviourally
inhibited as they grow older.

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Psychosocial Viewpoint
In general there are many more psychological interpretations of abnormal behaviour than biological
perspectives. It reflects a wide range of opinions on how to understand human motives, desires,
thoughts and perceptions. The psychosocial perspective can be further subdivided into three different
perspectives:
1 The psychodynamic perspective- This perspective emphasizes the role of unconscious motives
and thoughts that govern behaviour of human beings. According to this perspective abnormal
behaviour is because of the hurtful memories, forbidden desires and repressed experiences in the
unconscious mind. The unconscious continues to express itself in dreams, fantasies and slips of
tongue. When such unconscious material is brought to the consciousness it can lead to irrational and
maladaptive behaviour. Sigmund Freud is considered the founder of the psychoanalytic school of
thought.
2 The behavioural perspective The behavioural perspective emerged as a reaction against the
unscientific methods of the psychodynamic approach. Behavioural scientists believed that the study of
subjective experiences cannot be tested by other investigators. They resorted to laboratory research
rather than clinical practice. Behaviorists focus on the effects of environmental conditions when
subjected to various stimuli. The central theme of this perspective is learning- the modification of
behaviour based on its consequences.
3 The Cognitive-Behavioural Perspective This approach focused on cognitive processes and their
impact on behaviour. It involved the study of information processing mechanisms like attention,
memory, thinking, planning and decision making. Thus, the cognitive behavioural perspective on
abnormal behaviour generally focuses on how thoughts and information processing can become
distorted and leads to maladaptive emotions and behaviour.
4 Humanistic Perspective- Yet another perspective emerging on the scene was humanistic
psychology that came as a response to the deterministic viewpoints of psychoanalysis and
behaviorism. According to psychoanalysis, it is the inner mental processes and conflicts whereas
according to behaviorism, it is the environment that determines the human (normal and abnormal)
behavior. Both schools ignored the role of free will in human behavior and took a mechanistic view of
human beings as if the humans were like machines running on the fuel (unconscious/reinforcement).
Humanistic psychology was a response to depersonalization, that was a resultant of rapid
industrialization and mechanization. People had begun to feel alienated from their jobs. In
psychological labs, research was conducted on animals or on human functions in isolation, away from
human beings (King, Woody, & Viney, 2013). According to humanistic psychologists, human
behavior is too complex to be investigated by the simplistic empirical research. They tried to restore
to psychology, distinctly human aspects, such as, people’s innate capacity for creativity and goodness,
and self-concept (mental portrait of ourselves, according to which we judge and interpret our behavior
and existence). Humanistic psychology took a positive view of human beings and emphasized on the
role of free will, meaning, creativity, values, love, hope, personal growth, and self-fulfillment.
According to a famous humanist, Carl Rogers, human beings have a free will (an innate capacity to
choose what is good for them through a valuing process) which guides our behavior and help us to
achieve a meaningful and fulfilling life. We can achieve self-actualization by developing our full
potential. Denial of our own experiences, feelings and values will hamper our personal growth and
mental well-being, and lead to psychopathology (Butcher et al., 2019). The Humanistic viewpoint
gained momentum in 1960s by questioning the dominant forces of psychoanalysis and behaviourism
grew so rapidly that it was hailed as the ‘Third Force in Psychology.’
Sociocultural Viewpoint
According to this viewpoint our life experiences and interaction with the society help us face
challenges resourcefully and may lead to resilience during stress in the future. Unfortunately some of
our experiences as a child may be unhelpful and may influence us later in life. Social factors are
influences in the environment that consists of unpredictable and uncontrollable negative events.
Different social factors that can have a detrimental effect on a child’s socioemotional development are
listed below. 1Early Deprivation and trauma- Children who do not receive adequate food, shelter,
love and attention may be left with deep and irreversible psychological scars. This kind of treatment is
usually observed in foster homes and other institutions for children. Sometimes deprivation can occur

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in families where the parents suffer from mental disorders themselves thus are unwilling to provide
care to the child.
2 Problems in parenting style Deviations in parenting can also have profound impacts on a child’s
ability to cope with life’s difficulties. This may cause the child to be vulnerable to various forms of
psychopathology. For example, children who are anxious, irritable and impulsive may cause the
parents to become anxious and irritable thus further worsening the condition of the child. Parenting
styles like authoritarian and neglectful parents may result in aggressive behaviour of children and
cause them to resort to drug and alcohol abuse.
3 Marital Discord and Divorce A disturbed family structure serves as a high risk factor to
psychopathology. Marital discord can affect the offspring’s marriage and may lead to negative
interaction styles. Divorce of parents and have traumatic effects on the child. It can lead to a feeling of
insecurity, disloyalty and delinquency.
4 Low socioeconomic status and unemployment The lower economic class have a higher incidence
of mental and physical disorders. For example antisocial disorder occurs in the lower socioeconomic
backgrounds thrice as often as it occurs in better economic conditions. People with mental disorders
are usually prejudiced and slide down the economic ladder because of the lack of opportunities.
Unemployment, financial hardships, self-devaluation and emotional distress is associated with
enhanced chance of psychopathology.
Other social factors that can cause abnormal behaviors include prejudice, discrimination and strained
relationship among peers. Cultural variables such as over and undercontrolled behaviour can also
contribute to mental disorders. Although many serious mental disorders are fairly universal, the form
some mental disorders take varies widely among different cultures.
MEANING AND PURPOSE OF CLASSIFICATION OF PSYCHOPATHOLOGY
Classification is the core of science. Therefore, classification systems are developed with which we
could define or classify behaviour. Abnormal psychology is based on the assumption that behaviour is
part of one category or disorder and not of another one.
In order to classify the psychological disorders we need a classification system. The term
classification refers to process to construct categories and to assign people to these categories on the
basis of their attributes. Classification in scientific context refers to taxonomy. It also refers to
nomenclature, which describes the names and labels that may make up a particular disorder such as
schizophrenia or depression. Classification is at the heart of every science. If we cannot label and
order objects or experiences or behaviours scientists could not communicate with one another and our
knowledge will not advance. Without labelling and organising patterns of abnormal behaviour,
researchers could not communicate their findings to one another, and progress toward understanding
and decision about these disorders would come to a halt. Certain psychological disorders respond
better to one therapy than another or to one drug than another. Classification also helps clinicians
predict behaviour. Finally, classification helps researchers identify populations with similar patterns
of abnormal behaviour. By classifying groups of people as depressed, for example, researchers might
be able to identify common factors that help explain the origins of depression. Classification of
psychopathology fulfils following five primary purposes:
1) Communication
2) Control
3) Comprehension
4) Distinction
5) Prognosis/prediction
Development of ICD
In 1893 1st international list of causes of death was published. This stimulated worldwide organised
effort for classification of diseases which resulted in the publication of International Statistical
Classification of Diseases and Related Health Problems-1 (ICD-1) by the World Health Organisation
in 1900. However, it was only ICD-6 which was published with a separate section on mental disorder
in 1949. ICD-8 was published in 1972 with a comprehensive glossary of mental disorders. ICD-9 was
published in 1977 with greater clinical modification. Vol. 1 and 2 of ICD-9 described diagnostic
codes, while vol. 3 explained procedure codes for the Mental and Behavioural Disorders.
ICD-10: In 1978, WHO entered into a long-term collaborative project with the Alcohol, Drug Abuse
and Mental Health Administration (ADAMHA) in the USA, aiming to facilitate further improvements

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in the classification and diagnosis of mental disorders, and alcohol and drug related problems. A
series of workshops brought together researchers and practitioners from a number of different
psychiatric traditions and cultures, reviewed knowledge in specified areas, and developed
recommendations for future research. A major international conference on classification and diagnosis
was held in Copenhagen, Denmark, in 1982 to review the recommendations that emerged from these
workshops and to outline a research agenda and guidelines for future work. Several major research
efforts were undertaken to implement the recommendations of the Copenhagen conference. All these
efforts resulted in the publication of ICD-10 in 1992 in which in chapter V (F) pertained to the
classification of mental disorders explaining their inclusion and exclusion terms.
The ICD 10 was launched in 1990. It includes various Mental and Behavioral Disorders in Chapter V
as given below:
● Organic, including symptomatic, mental disorders
● Mental and behavioral disorders due to psychoactive substance use
● Schizophrenia, schizotypal and delusional disorders
● Mood (affective) disorders
● Neurotic, stress-related and somatoform disorders
● Behavioral syndromes associated with physiological disturbances and physical factors
● Disorders of adult personality and behavior
● Mental retardation
● Disorders of psychological development
● Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
● Unspecified mental disorder
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)
The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric
Association, is the handbook used most often in diagnosing mental disorders in the United States and
other countries.
A Brief History of DSM Need of statistical information regarding mental disorders stimulated
revolution in the efforts of development of a classification system in the United States. The National
census of 1840 used a single category, “idiocy/insanity”. Seven categories of mental disorders were
mentioned in the 1880 census: mania, melancholia, monomania, paresis, dementia, dipsomania, and
epilepsy. The American Psychiatric Association (APA), then known as Committee on Statistics,
together with the National Commission on Mental Hygiene, developed a new guide for mental
hospitals called the “Statistical Manual for the Use of Institutions for the Insane” in 1917, which
included 22 diagnoses. Subsequently, this was revised several times by APA over the years.
Revisions of DSM -In view of needs arisen from World War II, a committee headed by psychiatrist
and brigadier general William C. Menninger with the help of US psychiatrists developed a new
classification scheme called Medical 203 in 1943.
DSM-I (1952): In 1949, the World Health Organisation published the sixth revision of the
International Statistical Classification of Diseases (ICD-10) which included a section on mental
disorders for the first time. Consequently, an APA Committee on Nomenclature and Statistics was
empowered to develop a classification system for use in the United States. In 1950 the APA
committee undertook a review and consultation to circulated the Diagnostic and Statistical Manual of
Mental Disorders-1 (DSM-I) which was approved in 1951 and published in 1952. The structure and
conceptual framework were the same as in Medical 203, and many passages of text identical. The
manual was 130 pages long and listed 106 mental disorders. DSM-I made 94% changes in
nomenclature from the prior system and seventy disorder terms used “Reaction,” e.g., schizophrenic
reaction. This included reaction to internal conflict. DSM-I is criticised on the basis that it was
psychoanalytic in its theoretical orientation. The term “Unconscious” was mentioned a few times in
describing psychoneurotic disorders in DSM-I.
DSM-II (1968): Despite APA’s involvement in the revision of the mental disorder section of the
ICD-8 in 1968), it also published a revision of the DSM in 1968, listed 182 disorders, and was 134
pages long. It was quite similar to the DSM-I. The term “reaction” was dropped but the term
“neurosis” was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic
psychiatry, although they also included biological perspectives and concepts from Kraepelin’s system
of classification. Symptoms were not specified in detail for specific disorders. Many of the disorders

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were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems,
rooted in a distinction between neurosis and psychosis (roughly, anxiety/ depression broadly in touch
with reality, or hallucinations/delusions appearing disconnected from reality). Sociological and
biological knowledge was also incorporated, in a model that did not emphasise a clear boundary
between normality and abnormality. After wide post publication criticism of DSM-II, the term
“Homosexuality” was replaced with “Ego-dystonic Homosexuality” in 1973.
DSM-III (1980): To make the DSM nomenclature consistent with the International Statistical
Classification of Diseases and Related Health Problems (ICD) the decision to create a new revision of
the DSM was made in 1974 with Robert Spitzer as chairman of the task force. This revision was
aimed at improving the uniformity and validity of psychiatric diagnosis, standardising diagnostic
practices across the world and to facilitate the pharmaceutical regulatory process to avoid criticisms
levelled on DSM-II. The criteria for many of the mental disorders were taken from the Research
Diagnostic Criteria and Feighner Criteria. New categories of disorder and their criteria were
established by consensus during meetings of the committee. The psychodynamic or physiologic view
was abandoned, in favour of a regulatory or legislative model. A new “multi-axial” system attempted
to yield a picture more amenable to a statistical population census, rather than just a simple diagnosis.
DSM conceptualised each of the mental disorders as a clinically significant behavioural or
psychological syndrome. Finally published in 1980, the DSM-III was 494 pages long and listed 265
diagnostic categories. It rapidly came into widespread international use. DSM-III was published with
93% changes in nomenclature from the earlier version of DSM with diagnostic criteria for each of the
disorders mentioned. There was a multi-axial classification with five axes. DSM-III provided a vast
increase in background information about each disorder, adding diagnostic features, associated
features, cultural and gender features; prevalence, course, familiar patterns, differential diagnosis,
decision trees and glossary. However, DSM-III was later criticized on the ground that 20-30 percent
of the population would have been diagnosed as having behavioural disorders without having any
serious mental problems.
DSM-III-R (1987): The DSM-III-R was published as a revision of DSM-III in 1987. Categories were
renamed, reorganised, and significant changes in criteria were made. Six categories were deleted,
while some new categories were added. Controversial diagnoses such as pre-menstrual dysphoric
disorder and Masochistic Personality Disorder were discarded. “Sexual orientation disturbance” was
also removed and was largely subsumed under “sexual disorder not otherwise specified” which can
include “persistent and marked distress about one’s sexual orientation.” DSM-III-R contained 292
diagnoses and was 567 pages long.
DSM-IV (1994): DSM-IV was published in 1994 listing 297 disorders in 886 pages. Process of
development of DSM-IV included extensive literature review of diagnoses, analyses to determine
required change in criteria and multicenter field trials relating diagnoses to clinical practice. A major
change from previous versions was the inclusion of a clinical significance criterion to almost half of
all the categories, which required symptoms cause “clinically significant distress or impairment in
social, occupational, or other important areas of functioning”.
DSM-IV (TR) (2000): A “Text Revision” of the DSM-IV, known as the DSM-IVTR, was published
in 2000. The diagnostic categories and the vast majority of the specific criteria for diagnosis were
unchanged.The text sections giving extra information on each diagnosis were updated, as were some
of the diagnostic codes in order to maintain consistency with the ICD.
DSM-V-The 5th edition of DSM was launched in 2013. It is an improvement over its previous edition
DSM-IV-TR.
DSM-5 Classification categorizes disorders into clusters based on shared physiological pathology,
genetics, disease risk, neuroscientific and clinical findings.
DSM-5 diagnostic chapters
● Neurodevelopmental disorders
● Schizophrenia spectrum and other psychotic disorders
● Bipolar and related disorders
● Depressive disorders
● Anxiety disorders
● Obsessive-compulsive and related disorders
● Trauma- and stressor-related disorders

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● Dissociative disorders
● Somatic symptom and related disorders
● Feeding and eating disorders
● Elimination disorders
● Sleep-wake disorders
● Sexual dysfunctions
● Gender dysphoria
● Disruptive, impulse-control, and conduct disorders
● Substance-related and addictive disorders
● Neurocognitive disorders
● Personality disorders
● Paraphilic disorders
● Other mental disorders

DSM I to DSM 5

DSM I to DSM Introduction Main Features

5 Year
DSM I 1952 Addressed issues in clinical practice, no research focus,
based on the psychodynamic theory
DSM I 1968 Included only minor modifications in DSM I, and like the
first edition, had low reliability and validity
DSM I 1980 Followed an atheoretical approach, clearly defined criteria
for disorders, introduced multiaxial system, having five
axials for diagnosis and assessment of disorders, improved
reliability and validity
DSM III R 1987 Revision of DSM III to introduce significantly greater
reliability
DSM IV 1994 Introduced new disorders and revised criteria for certain
disorders
DSM IV TR 2000 No new addition, but included updated information about
(Text Revision) prevalence, prognosis, and co-morbidity and other factors
related to disorders, followed the multiaxial classification
with some changes
DSM 5 2013 Included subtypes and specifiers in the diagnosis, cultural
and social context was emphasized

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Unit-2
Causes of abnormal behavior
When trying to understand the causes or etiology of abnormal behaviour there are really no clear cut
answers as we have for understanding physical illnesses. Various viewpoints or models of the causes
of abnormal behaviour have emerged because no single approach could satisfactorily explain all
abnormal behaviours. Each approach focuses on important aspects of behaviour, although they fall
short of explaining the entire behaviour. Behaviour, whether normal or abnormal, is determined by a
multitude of factors. These factors can be grouped under three categories, viz., biological,
psychological and socio cultural. These factors alone or in most cases jointly influence and give rise
to the behaviour, that is normal or abnormal. Biological model include causal factors from the fields
of genetics and neuroscience. Psychological model includes factors from psychodynamic, behavioural
and cognitive processes. Social influences contribute in a variety of ways to psychopathology.
BIOLOGICAL FACTORS-
The biological viewpoint focuses on mental disorders as diseases whose primary symptoms are
behavioural or cognitive although their causes are biological or physiological as against the physical
illnesses where the cause and symptoms are purely physical. According to this view, mental disorders
are seen as disorders of the central nervous system and thus are sometimes inherited or caused by
some medical factors like injuries or physical diseases. Psychological or environmental factors are not
considered to cause these disorders. We will discuss ‘four’ of the most important categories of
biological factors that seem to be responsible for maladaptive behaviour. These are given below:
• Neurotransmitter and Hormonal imbalances in the brain,
• Genetics,
• Brain structure, Etiology of Psychopathology
• Physical deprivation or disruption.
1 Neurotransmitter and Hormonal Imbalances in the Brain
The 100 billion neurons in the central nervous system (CNS) communicate by chemical messengers
called neurotransmitters. When these neurotransmitters become imbalanced they give rise to many
psychological problems. Biological approaches to treatment focus mainly on medications that rectify
neurotransmitter imbalances. Neurotransmitters (e.g., serotonin, dopamine, nor epinephrine, GABA)
are released into the synaptic cleft* . They regulate level of mood, anxiety, and cognitive functioning.
2 Hormonal Imbalance –
Hormones are chemicals messengers secreted by the endocrine glands (e.g., pituitary). They play a
role in the functioning of the nervous system and in the regulation of behaviour (e.g., during
adolescence, changes in the hypothalamicpituitary-adrenal axis are involved in the increase in
cortisol, a stress-related hormone). Malfunction of this system has been said to be responsible for
various forms of psychopathology. Hormonal influences are also responsible for the differences in
behaviour between men and women.
3 Genetics-
Genes play an important role in determining risks for both psychotic and non psychotic disorders. For
example, the lifetime risk of schizophrenia is 1%, but for the offspring of an affected person it
becomes 10% and in bipolar disorder is 20%. For many years, twin studies served as the most direct
way of determining whether or not a disorder has a genetic basis. In the classic twin study design, the
similarity of monozygotic (‘identical’) twins and disygotic (‘fraternal’) twins are compared. Because
monozygotic twins share all of their genes and disygotic twins share only half their genes, greater
similarity among monozygotic twins than among disygotic twins implies a genetic component.
4 Brain Structure-
Knowledge about brain structure has increased with the advances in computed tomography (CT)
scanning and magnetic resonance imaging (MRI). This has lead to many notable observations. For
instance, neuroimaging in some patients with schizophrenia shows dilated cerebral ventricles and
reduced frontal lobe density. This evidence indicates that schizophrenia may be neurodevelopmental
in origin. Exposure to adverse conditions which can affect brain development (in utero or in early life)
may lead to changes in the frontal lobes that increase the risk of schizophrenia. Neuroimaging also
helps us to distinguish between different types of dementia. Also, some older people experiencing
severe depression for the first time might have underlying cerebro-vascular disease.

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5 Physical Deprivation or Disruption-

The most basic human requirements are those of food, water, oxygen, sleep and elimination of wastes.
Insufficient rest, inadequate diet or working too hard when ill, can all interfere with a person’s ability
to cope and might predispose him or her to a variety of problems. Experimental studies of volunteers
who have gone without sleep for 72 to 98 hours show psychological problems like disorientation for
time and place and feelings of depersonalisation. Prolonged food deprivation also affects
psychological health. Severe malnutrition in children not only impairs physical development and
lowers resistance to disease but it also stunts brain growth, results in lowered intelligence and
increases risk for disorders like attention-deficit disorder. Healthy mental development depends on a
child’s receiving adequate stimulation from the environment. In addition to the psychological
problems which can result by too little stimulation, the physical development of the brain is also
affected by an unstimulating environment.
PSYCHOSOCIAL VIEWPOINT
In general there are many more psychological interpretations of abnormal behaviour than biological
perspectives. It reflects a wide range of opinions on how to understand human motives, desires,
thoughts and perceptions. The psychosocial perspective can be further subdivided into three different
perspectives:
1 The psychodynamic perspective- This perspective emphasizes the role of unconscious motives
and thoughts that govern behaviour of human beings. According to this perspective abnormal
behaviour is because of the hurtful memories, forbidden desires and repressed experiences in the
unconscious mind. The unconscious continues to express itself in dreams, fantasies and slips of
tongue. When such unconscious material is brought to the consciousness it can lead to irrational and
maladaptive behaviour. Sigmund Freud is considered the founder of the psychoanalytic school of
thought.
2 The behavioural perspective- The behavioural perspective emerged as a reaction against the
unscientific methods of the psychodynamic approach. Behavioural scientists believed that the study of
subjective experiences cannot be tested by other investigators. They resorted to laboratory research
rather than clinical practice. Behaviorists focus on the effects of environmental conditions when
subjected to various stimuli. The central theme of this perspective is learning- the modification of
behaviour based on its consequences.
3 The Cognitive-Behavioural Perspective- This approach focused on cognitive processes and their
impact on behaviour. It involved the study of information processing mechanisms like attention,
memory, thinking, planning and decision making. Thus, the cognitive behavioural perspective on
abnormal behaviour generally focuses on how thoughts and information processing can become
distorted and leads to maladaptive emotions and behaviour.
SOCIOCULTURAL VIEWPOINT
According to this viewpoint our life experiences and interaction with the society help us face
challenges resourcefully and may lead to resilience during stress in the future. Unfortunately some of
our experiences as a child may be unhelpful and may influence us later in life. Social factors are
influences in the environment that consists of unpredictable and uncontrollable negative events.
Different social factors that can have a detrimental effect on a child‘s socioemotional development are
listed below.
1 Early Deprivation and trauma- Children who do not receive adequate food, shelter, love and
attention may be left with deep and irreversible psychological scars. This kind of treatment is usually
observed in foster homes and other institutions for children. Sometimes deprivation can occur in
families where the parents suffer from mental disorders themselves thus are unwilling to provide care
to the child.
2 Problems in parenting style- Deviations in parenting can also have profound impacts on a child‘s
ability to cope with life‘s difficulties. This may cause the child to be vulnerable to various forms of
psychopathology. For example, children who are anxious, irritable and impulsive may cause the
parents to become anxious and irritable thus further worsening the condition of the child. Parenting
styles like authoritarian and neglectful parents may result in aggressive behaviour of children and
cause them to resort to drug and alcohol abuse.
3 Low socioeconomic status and unemployment -The lower economic class have a higher incidence
of mental and physical disorders. For example antisocial disorder occurs in the lower socioeconomic

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backgrounds thrice as often as it occurs in better economic conditions. People with mental disorders
are usually prejudiced and slide down the economic ladder because of the lack of opportunities.
Unemployment, financial hardships, self-devaluation and emotional distress is associated with
enhanced chance of psychopathology.

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Unit-3
Anxiety Disorders
Category of Anxiety Disorders According to a standard manual for mental health clinicians the
Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition text revised of DSM IV TR)
categorises anxiety disorders under the following headings:
i) Generalised Anxiety Disorders: This consists of more prolonged ,vague, unexplained but intense
fears that do not seem to be attached to any particular object. It resembles normal fears but no actual
danger is present in most of the cases. A person who has experienced six month or more persistent
and excessive worry is diagnosed with generalised anxiety disorder. The symptoms of this disorder
are of four types, which may be experienced individually or in combination. They are:
• Motor Tension
• Apprehensive feelings about the future
• Automatic reactivity
• Hyper vigilance
ii) Panic Disorder: Panic Disorders may come about with no warning signs. The indicators are
mostly similar to generalised anxiety disorders except that they are magnified and usually have a
sudden onset. Panic attacks also have shortness of breath, increased heart rate, dizziness and a feeling
of helplessness. The victims fear that they will die, or go crazy or do something uncontrolled and they
report a variety of unusual psycho sensory symptoms. These attacks mainly ranges in length from a
few seconds to many hours and even days. They also differ in severity and in the degree of
incapacitation.
Symptoms of Panic Attacks
1) Dizziness, unsteadiness or faintness
2) Trembling, shaking or sweating
3) Heart palpitations or high heart rate
4) Chest pain or discomfort
5) Numbness or tingling
6) Fear of death or losing control
This disorder also affect women more than men and younger age groups more than the elderly.
Compared to other anxiety disorders panic attacks appear to be more distressing and sometimes
severe panic states are followed by periods of psychotic disorganisation in which there is a reduced
capacity to test reality.
iii) Obsessive Compulsive Disorder: According to DSMIV(TR) either obsessions or compulsions
need to be present. But most people who have obsessive compulsive disorder demonstrate both. This
illness is very much what it sounds like. This disorder mainly conveys the driven quality of the
thoughts and rituals seen in people with this condition. Obsessions are recurring thoughts, impulses or
images that the person tries to eliminate or resist but either cannot or has extreme difficulty in doing
so. The Person does not have the control on their obsessions which leads to increase anxiety and to
the method generally used to try to control the obsessions. People usually involve in doubt, hesitation,
fear of contamination or fear of ones own aggression. Compulsions are thought or action that provide
relief are generally used to suppress the obsession. The compulsions are not connected realistically
with the obsessions they are excessive in their nature. The exact incidence of obsessive compulsive
disorder is hard to determine. The victims tend to be secretive about their pre occupations and
frequently are able to work effectively in spite of their problems.
Symptoms of Obsessive Compulsive disorder:
1) Obsessivness to check the door locks
2) Obsessive of sexual thoughts
3) Obsession of counting
4) Washing the hands continuously.
5) Lots of doubt
6) Brushing the teeth continuously under compulsion
Thus obsessive compulsive disorder causes marked distress and takes considerable time to overcome
the problem.
iv) Phobias: Phobia is a term derived from the Greek word “Phobos”. It is an intense irrational and

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persistent fear of certain situations, activities, things etc. People with this disorder know exactly for
what they are afraid of, except for their fears of specific objects, phobic situations, individuals etc.
Physically there does not seem to be anything wrong with them, but their fears are out of proportion
with reality seem to be inexplicable and are beyond their voluntary control. Phobics do not need the
actual presence of the feared object or situation to experience intense tension and discomfort. It tends
to grow progressively broader. Phobias may begin with a generalised anxiety attack but that anxiety in
course of time gets crystallised around a particular object or situation. One study on phobic patients
showed that their fears fell into five categories, viz., (i) separation, (ii) animals, (iii) bodily mutilation,
(iv) social situation and (v) nature. Phobias like other forms of maladaptive behaviour do not come in
isolation. They are usually intertwined with a host of other problems. In consequence it is difficult to
estimate their frequency accurately. Mild phobias are common, though phobias which are serious
enough to be clinically diagnosed and recommended for treatment etc., occur infrequently.
It has been experienced by the psychologists that phobias were obtained more commonly among
women in all age groups, and these were found to be the second most common illness among men
older than 25 years of age.
Classification of Phobias Phobias are many and are classified according to the feared object. For
instance a person having phobia for heights will be considered as having phobia called “Acora
phobia” that is fear of heights. Then we have fear of opens spaces, closed spaces and so on and these
are presented below:
i) Agora phobia: Fear of open places
ii) Claustro phobia: Fear of closed spaces
iii) Xeno phobia: Fear of strangers
iv) Ochlo phobia: Fear of crowd
v) Hemo phobia: Fear of blood
vi) Somni phobia: Fear of sleep
vii) Phasmo phobia: Fear of ghosts
viii) Myso phobia: Fear of dirt
ix) Algophobia: Fear of pain
x) Andro phobia: Fear of men
xi) Aqua phobia: Fear of water
xii) Hydro phobia (commonly used terms); Fear of water
xiii) Arachno phobia: Fear of spiders
xiv) Social phobia: Fear and embarrassment in dealing with others.
Symptoms of Phobia
There are typical characteristic symptoms of phobias and these include the following:
• Intense and disabling fear, panic and anxiety
• Fear becomes too much excessive and unreasonable
• Avoiding certain places and situation for fear
• Avoidance becomes prominent and affects the normal life
• Obsessive thinking
• Fleeing from the situation
• Persistent worry
• Shaking and palpitation
Thus phobias have been seen more prevalent than generalised anxiety disorder and have no specific
known cause for happening.
v) Post Traumatic Stress Disorder: This is a disorder that develops after a person experiences a
traumatic or terrifying event. For example physical or sexual assault, unexpected death of loved ones,
natural disasters causing heavy damage and death and destruction, etc. Longtime after the event had
occurred the person mentally remains occupied along with the same feelings Anxiety Disorder of
anxiety that the original event had produced.
According to DSMIV (TR) (Diagnostic Statistical Manual) the symptoms like persistent re
experiencing of event, avoidance or emotional numbing remain for more than one month .It causes
significant impairment in social, occupational or in other areas of functioning. Mainly in the
occurrence of post traumatic disorder the physical and psychological trauma comes in combination
and affect the life of the individual. It has been said by the Psychologist atkinetal (2000) that

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posttraumatic stress disorder is cause by physical or psychological trauma caused by human such as
by rape, war or terror attack. Sometimes possible sources also come from childhood, assault, drug-
addiction, illness, medical complications or employment in occupations exposed to war or disaster.
Sometimes heredity brain functioning also affects the human being life.
Symptoms of Post Traumatic Stress Disorder
i) Anger and irritability
ii) Flashbacks
iii) Feelings of intense distress
iv) Depression and hopelessness
v) Feeling jumpy and easily startled
vi) Rapid breathing nausea and muscle tension
vii) Suicidal thoughts viii) Feelings of alienated
ix) Chest pain
Thus post traumatic stress disorder is gradual and ongoing process. Individual need to be confident
and strong to overcome from this disorder otherwise it leads to worsening the situation.

vi) Acute Stress Disorder: It is a psychological condition arising in response to a terrifying or

traumatic event. Disorder is similar to posttraumatic stress disorder but experienced immediately after
the traumatic event. The onset of a stress response is associated with specific physiological actions in
the sympathetic nervous system. Both directly and indirectly through the release of epinephrine from
the medulla of the adrenal glands.
Symptoms of Acute Stress Disorder
i) Numbing
ii) Detachment
iii) Derealisation
iv) Depersonalisation
v) Dissaociative amnesia
vi) Flashbacks
vii) Avoidance of any stimulation
The acute stress disorder and posttraumatic stress disorder are more or less is some if this disorder
persists longer than one month the diagnosis is changed to posttraumatic stress disorder.

vii) Separation anxiety disorder: Separation anxiety is a normal stage of development for infants
and toddlers. Young children often experience a period of separation anxiety, but most children
outgrow separation anxiety by about 3 years of age.In some children, separation anxiety is a sign of a
more serious condition known as separation anxiety disorder, starting as early as preschool age.If
your child's separation anxiety seems intense or prolonged — especially if it interferes with school or
other daily activities or includes panic attacks or other problems — he or she may have separation
anxiety disorder. Most frequently this relates to the child's anxiety about his or her parents, but it could
relate to another close caregiver.Less often, separation anxiety disorder can also occur in teenagers
and adults, causing significant problems leaving home or going to work. But treatment can help.

Causes

The causative factors include the following:

• Genetics
• Substance Abuse
• Stressful Life
• Mental or physical abuse
• Changes in living situation
• Illness
• Death of a loved one
• Faulty relationship
• Brain chemistry
• Changing of jobs or school

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• Migration
• Traumatic experience
• Fixation with objects, situations
• Witnessing bad experience
• Embarrassment
• Torture
• Natural disaster
Thus with the high prevalence of these anxiety disorders the necessary thing is need to be quite
cautious regarding the said disorders and public awareness. The 16 Mild Mental Disorders social
stigma associated with it may decrease and encourage those who suffer from it to seek professional
help.

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Unit-4
Bipolar and Related Disorders
Depressive Disorders
Schizophrenia Spectrum & other Psychotic Disorders
Personality Disorders

BIPOLAR DISORDERS:-
Although recurrent cycles of mania and depression were recognised as early as sixth century, but it
was Kraepelin in 1899 who first introduced the term manic-depressive insanity and to clarify the
clinical picture. Kraepelin described the disorder as a series of attack of deletion and depression, with
periods of relative normality in between, and a general favorable prognosis. Bipolar disorder has
traditionally been thought to be much less common than depression.
Earlier it was opined that depressive disorders were four to five times more frequent than bipolar
disorder. But recent studies disagree with this view and believe that depressive and bipolar disorder
are really very similar (Bowden, 1993). The reason is that depression has traditionally been
considered to be more common, and accordingly many individuals suffering from bipolar disorder are
wrongly classified as suffering from unipolar disorder because a manic or hypomanic episode has not
yet occurred. Sometimes, a person with severe episodes of mania or depression has psychotic
symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the
person’s extreme mood. For example, psychotic symptoms for a person having a manic episode may
include believing he or she is famous, has a lot of money, or has special powers. In the same way, a
person having a depressive episode may believe he or she is ruined and penniless, or has committed a
crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly
diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and
delusions.

Bipolar disorder is a serious, chronic mental illness characterized by unusual changes in mood,
energy, and activity levels. Early diagnosis and appropriate treatment of bipolar disorder are
important because the illness carries a high risk of suicide and can severely impair academic and work
performance, social and family relationships, and quality of life.
Classification of Bipolar Disorder
In DSM-IV-TR and ICD-10 bipolar disorder is conceptualised as a spectrum of disorders occurring on
a continuum. The DSM-IV-TR lists three specific subtypes and one for non-specified:
1 Bipolar I Disorder
2 Bipolar I Disorder
3 Cyclothymia
4 Bipolar Disorder NOS (Not Otherwise Specified)
1 Bipolar I-
Disorder Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven
days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually,
the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania
or depression must be a major change from the person’s normal behaviour. A person with bipolar
disorder experiences episodes of mania and, usually, major depressive episodes as well. Avery small
number of people may experience one or more periods of mania without ever experiencing depression
(Goodwin and Jamison, 1990).
2. Bipolar II Disorder- Bipolar II Disorder is defined by a pattern of depressive episodes shifting
back and forth with hypomanic episodes, but no full-blown manic or mixed episodes. Hypomanic
episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or
occupational impairment, and are without psychosis), and this can make bipolar II more difficult to
diagnose, since the hypomanic episodes may simply appear as a period of successful high
productivity and is reported less frequently than a distressing, crippling depression. Thus bipolar II
disorder differs from Bipolar I in that – rather than experiencing one or more florid, dramatic manic
episodes – the manic behaviour is present to a lesser degree. People who experience a hypomanic

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episode may not see it as pathological, although those around them may be concerned about the
erratic behaviour they see.
3 Cyclothymia- Cyclothymia, or Cyclothymic Disorder, is a mild form of bipolar disorder. People
who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for
at least two years. However, the symptoms do not meet the diagnostic requirements for any other type
of bipolar disorder. Symptoms of cyclothymic disorder are depressed mood for most of the day, for
more days than not, for one year, including the presence of two of the following symptoms: poor
appetite or overeating; insomnia/hypersomnia; low energy/fatigue; poor concentration; feelings of
hopelessness. Symptoms are less severe than those of a major depressive episode but are more
persistent. A history of hypomanic episodes with periods of depression that do not meet criteria for
major depressive episodes There is a lowgrade cycling of mood which appears to the observer as a
personality trait, and interferes with functioning.
4 Bipolar Disorder NOS (Not Otherwise Specified)- Bipolar Disorder Not Otherwise Specified
(BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria
for either bipolar I or II. The symptoms may not last long enough, or the person may have too few
symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s
normal range of behaviour. This is a catchall category, diagnosed when the disorder does not fall
within a specific subtype. Bipolar disorders NOS can still significantly impair and adversely affect the
quality of life of the patient.
MAJOR DEPRESSION-
It also known as recurrent depressive disorder, clinical depression, major depression, or unipolar
disorder. This mental disorder is characterised by an all low mood accompanied by low self esteem,
and by loss of interest or pleasure in normally enjoyable activities. The term “depression” is
ambiguous. Major depressive disorder is a disabling condition which adversely affects a person’s
family, work or school life, sleeping and eating habits, and general health. The understanding of the
nature and causes of depression has evolved over the centuries, though this understanding is
incomplete and has left many aspects of depression as the subject of discussion and research.
Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors.
Certain types of long-term drug use can both cause and worsen depressive symptoms. Psychological
treatments are based on theories of personality, interpersonal communication, and learning.
According to the Diagnosticians there are several subtypes of depressive disorder and these are given
below
Atypical Depression
It is characterised by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain,
excessive sleep or somnolence (hypersomnia), a sensation of heaviness in limbs known as leaden
paralysis, and significant social impairment as a consequence of hypersensitivity to perceived
interpersonal rejection.
Melancholic Depression
Melancholic depression is have loss of pleasure (anhedonia) in most or all activities, a failure of
reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or
loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation,
excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.
Psychotic Major Depression (PMD)
PMD or simply psychotic depression is the term for a major depressive episode, particularly of
melancholic nature, where the patient experiences psychotic symptoms such as delusions or, less
commonly, hallucinations. These are most commonly mood-congruent (content coincident with
depressive themes).
Catatonic Depression (CD)
CD is a rare and severe form of major depression involving disturbances of motor behaviour and
other symptoms. Here the person is mute and almost stuporose, and either immobile or exhibits
purposeless or even bizarre movements. Catatonic symptoms can also occur in schizophrenia, a manic
episode, or be due to neuroleptic malignant syndrome.
Postpartum Depression (PPD)
PPD refers to the intense, sustained and sometimes disabling depression experienced by women after
giving birth. Postpartum depression, which has incidence rate of 10–15%, typically sets in within

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three months of labour, and lasts for long. However, postpartum depression is different because it can
cause significant hardship and impaired functioning at home, work, or school as well as possibly
difficulty in relationships with family members, spouses, friends, or even problems bonding with the
newborn.
Seasonal Affective Disorder (SAD)
SAD also known as “winter depression” or “winter blues”, is a specifier. Some people have a
seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring.
The diagnosis is made if at least two episodes have occurred in colder months with none at other
times over a two-year period or longer.SAD is also more prevalent in people who are younger and
typically affects more females than males.
Symptoms of Depression
• Exhibits a very low mood
• Inability to experience pleasure
• inappropriate guilt or regret, helplessness
• Hopelessness, and self-hatred
• withdrawal from social situations and activities
• Reduced sex drive
• Thoughts of death or suicide
• Hyposomania or insomnia
• Thoughts and feelings of worthlessness
• Inappropriate guilt or regret
• Helplessness, hopelessness
• self-hatred
• Agitated or lethargic.
SCHIZOPHRENIA AND OTHER Psychotic Disorders PSYCHOTIC DISORDERS
Schizophrenia also sometimes called as split personality disorder. It is a chronic, severe, debilitating
mental illness which affects about two percent of the population. It is one of the psychotic mental
disorders and is characterised by behavioural and social abnormalities. The individual with this
disorder also develop disorganised speech, disorganised rigid or lax behaviour, significantly
decreased appropriate behaviours or feelings as well as development of delusions. Delusions are false
beliefs which for example believe someone is out to kill him while actually there is no such person
who has any intention to kill the person. It is thus a false belief. The person however believed in it as
such a reality that he is unable to distinguish between what is real and unreal. Thus based on the
delusions his behaviour becomes highly bizarre. Sometimes such persons may attack another without
reason based on his delusions. Most cases of schizophrenia appear in the late teens or early adulthood.
This is a disease of the brain and one of the most disabling and emotionally devastating illness and for
a long time has not been properly diagnosed and quite often misjudged and misunderstood. Persons
with this illness are stigmatized and are generally avoided by everyone. In severe condition they are
sent to hospitals for mental diseases. Like cancer and diabetes, schizophrenia has a biological basis. It
is relatively a common disease affecting one to two percent of the population.
TYPES OF SCHIZOPHRENIA
The nature of symptoms taken into account while determining the disease of schizophrenia varies
greatly with the progression of the disease. There are 5 types of schizophrenia, the subtypes are
defined in accordance with the most prominent characteristics. The same person maybe analysed with
different types of schizophrenia as the illness proceeds. The types of schizophrenia are:
1 Paranoid Schizophrenia The paranoid type of schizophrenia is marked by thoughts of conspiracy
or persecution and in some cases also auditory hallucinations. The patients however are more capable
of working and are better at relationships than those having the other types of schizophrenia. The life
is much more normal, especially if they can manage the disease. Though the reason is unknown, it
could probably be leading from the fact that those suffering from this schizophrenic type begin to
show their symptoms during the later part of life, and have thus already managed to grasp better
functioning before the illness could settle. The patients may be hesitant in discussing their illness, and
need not categorically look unusual or odd. Their delusions and hallucinations circle around particular
themes which do not change frequently. In schizophrenia paranoid type the overall behaviour and
temperament depends on the nature of their thoughts. For instance, somebody who imagines to be

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unjustly persecuted could become hostile easily or short tempered. These indications are generally
understood by professionals when extra stress triggers the symptoms. It is precisely in such situations
that the patient might realise the requirement for help. They may take such steps that might attract
attention.
Signs and Symptoms
• Delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy.
• Hallucinatory voices that threaten the patient or give commands, or auditory hallucinations without
verbal form, such as whistling, humming, or laughing.
• Hallucinations of smell or taste, or of sexual or other bodily sensations.
• Visual hallucinations may occur but are rarely predominant.
• Incoherent speech
• Marked loosening of associations
• Flat or grossly inappropriate affect
2 Disorganised Schizophrenia (Hebephrenic) As evident from its very name, this type of
schizophrenia is marked by disorganised thought patterns, with less of delusion and hallucination
difficulties. The ability to normal functioning of regular living might get seriously impaired, and
might include trouble in performing routine activities such as brushing, bathing, etc. This is one of
those sub types of schizophrenia where emotional impairment may be observed. For instance, the
patient’s emotions may fluctuate greatly, or might be unjustified in a given circumstance, with
unordinary responses of emotions (flat or blunted effect). The patient is unusually giddy or jocular,
like one who chuckles at a solemn occasion like funeral. The communication ability might get
impaired, with a practically incomprehensible speech, owing to disorganised thought patterns. It is
important to look out for speech which is marked with difficulties in forming of sentences with
correct word ordering than difficulties arising form articulation or enunciation.
Symptoms
• Delusions of persecution
• Delusion of reference, exalted birth, special mission, bodily change, or jealousy;
• Hallucinatory voices that threaten the patient or give commands, or auditory hallucinations without
verbal form, such as whistling, humming, or laughing;
• Hallucinations of smell or taste, or of sexual or other bodily sensations; visual hallucinations may
occur but are rarely predominant.
3 Catatonic Schizophrenia- Catatonic disorders are a group of symptoms characterised by
disturbances in motor (muscular movement) behaviour that may have either a psychological or a
physiological basis. The best known of these symptoms is immobility, which is a rigid positioning of
the body held for a considerable length of time. Patients diagnosed with a catatonic disorder may
maintain their body position for hours, days, weeks or even months at a time. Alternately, catatonic
symptoms may look like agitated, purposeless movements that are seemingly unrelated to the person’s
environment. The condition itself is called catatonia . A less extreme symptom of catatonic disorder is
slowed-down motor activity. Often, the body position or posture of a catatonic person is unusual or
inappropriate; in addition, he or she may hold a position if placed in it by someone else.
Symptoms These symptoms include:
• Catalepsy, or motionlessness maintained over a long period of time.
• Catatonic excitement, marked by agitation and seemingly pointless movement.
• Catatonic stupor, with markedly slowed motor activity, often to the point of immobility and seeming
unawareness of the environment.
• Catatonic rigidity, in which the person assumes a rigid position and holds it against all efforts to
move him or her.
• Catatonic posturing, in which the person assumes a bizarre or inappropriate posture and maintains it
over a long period of time.
• Waxy flexibility, in which the limb or other body part of a catatonic person can be moved into
another position that is then maintained. The body part feels to an observer as if it were made of wax.
• Akinesia, or absence of physical movement.
4 Undifferentiated Schizophrenia- Patients with undifferentiated schizophrenia do not experience
the Paranoia associated with paranoid schizophrenia. The catatonic state seen in patients with
catatonic schizophrenia, or the disorganised thought and expression observed in patients with

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disorganised schizophrenia are not obtained here. However, they do experience psychosis and a
variety of other symptoms associated with schizophrenia, including behavioural changes which may
be noticeable to family and friends. This mental disorder is challenging to diagnose, and it can take
weeks or months to confirm a diagnosis of schizophrenia. During this process, other causes for the
symptoms are ruled out, and the patient is observed to collect information about changes in the
patient’s personality, modes of expression, and mood. Family members and friends may also be
interviewed and asked for information with a goal of painting a more complete picture of what is
going on inside the patient’s mind. In this schizophrenia type, the patient’s symptoms may fluctuate,
or might stay excessively stable, causing a doubt in placing it under any other sub type. The best
schizophrenia type’s definition for this type of schizophrenia is ‘mixed clinical condition’.
Symptoms
This disorder does not have any specific symptoms and mostly similar to main symptoms of
Schizophrenia, which are as follows:
• Delusions
• Hallucinations
• Disorganised speech
• Grossly disorganised or catatonic behaviour
• Negative symptoms
5 Residual Type Schizophrenia- The symptoms are less severe as compared to the undifferentiated
schizophrenia or the disorganised schizophrenia. They do manifest idiosyncratic behaviours,
delusions or hallucinations and they appear less prominent as they were in the worst days of illness.
Just like varying types of schizophrenia, the ramifications are highly varying too. Different
impairments affect different people in different degrees. While some need custodial care, others may
have a fairly normal career and family life. Though generally patients do not stand at either of the two
extreme points, they generally have to opt for waning and waxing treatments marked with
hospitalisation visits, requiring outside support etc. On the other hand, a weaker prognosis is marked
by sinister and gradual onsets, starting from adolescence or childhood. They cause abnormalities in
the brain structure which can be revealed by imaging studies often causing permanent damages after
severe incidents.
Symptoms
• Social withdrawal
• Depersonalisation (intense anxiety and a feeling of being unreal)
• Loss of appetite
• Loss of hygiene
• Delusions Hallucinations (distorted perception that is for example, hearing things when there is none
talking, seeing thing swhen there is none present) The sense of being controlled by outside force
Personality disorders
A person characteristics ways of responding are referred to his or her personality. Personality styles
can be maladaptive if an individual is unable to modify the behaviour when the environment changes.
This inability to change is referred to as disorder. Personality disorder is a longstanding, maladaptive
and inflexible ways of relating to the enviiornment. These disorders sometimes may be noticed in
childhood or latest by early adolescence. These disorders cause problems for the persons who suffer
from it and also to people who are significant in the individual’s life. People with psychological
personality disorders have traits that cause them to feel and behave in socially distressing ways.
Depending on the specific disorder, these personalities are generally described in negative terms such
as hostile, detached, needy, antisocial or obsessive (Dobbert 2007).
Classification of Personality Disorders- Personality disorders are classified by DSM IV (TR) into
three clusters of disorders. There are currently 10 conditions that are considered personality disorders,
some of which have very little in common. Mental health professionals group those personality
disorders that share characteristics into one of three clusters

Cluster A Personality Disorders

These are considered to be marked by odd, eccentric behaviour. Paranoid, Schizoid and Schizotypal
Personality Disorders are in this category

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i) Paranoid Personality Disorder (PPD) PPD is a type of psychological personality disorder

characterised by an extreme level of distrust and suspiciousness of others. Paranoid personalities are
generally difficult to get along with, and their combative and distrustful nature often elicits hostility in
others. The negative social interactions that result from their behaviour reinforces their original
pessimistic expectations. Persons with PPD are unlikely to form many close relationships and are
typically perceived as cold and distant. They are quick to challenge the loyalty of friends and loved
ones and tend to carry long grudges (Dobbert 2007)
ii) Schizoid Personality Disorder Individuals with schizoid personality are characteristically
detached from social relationships and show a restricted range of expressed emotions. Their social
skills, as would be expected, are weak, and they do not typically express a need for attention or
approval. They may be perceived by others as somber and of, and often are referred to as “loners.”
iii) Schizotypal Personality Disorder Schizotypal personalities are characterised by odd forms of
thought, perception and beliefs. They may have bizarre mannerisms, an eccentric appearance, and
speech that is excessively elabourate and difficult to follow. However, these cognitive distortions and
eccentricities are only considered to be a disorder when the behaviours become persistent and very
disabling or distressing. In social interactions, schizotypals may react inappropriately, or not react at
all, or talk to themselves. They may believe that they have extra sensory powers or that they are
connected to unrelated events in some important way. However, they tend to avoid intimacy and
typically have few close friends. Although schizotypals may marry and hold down jobs, they are
prone to feel nervous around strangers (Dobbert 2007).

Cluster B Personality Disorders

These are evidenced by dramatic, erratic behaviours and include Histrionic, Narcissistic, Antisocial
and Borderline Personality Disorders. There are four Cluster B personality disorders: antisocial,
borderline, narcissistic, and histrionic. The DSM-IV views these as a subset of personality disorders
that are characterised by dramatic, emotional or erratic behaviour.

i) Antisocial Personality Disorder (APD) According to DSM-IV, antisocial personality disorder is a

“pervasive pattern of disregard for, and violation of, the rights of others that begins in early childhood
or early adolescence and continues into adulthood.” People with antisocial personality disorder have
been described as lacking empathy and may often be deceitful or break the law.They never feel bad or
regret their wrong actions. Despite being punished or jailed in certain cases, they continue to indulge
in wrong and deviant activities. Antisocial personality disorder is also associated with impulsive
behaviour, aggression (such as repeated physical assaults), disregard for their own or other’s safety,
irresponsible behaviour, and lack of remorse.
ii) Borderline Personality Disorder (BPD) BPD is associated with specific problems in
interpersonal relationships, selfimage, emotions, behaviours, and thinking. People with BPD tend to
have intense relationships characterised by a lot of conflict, arguments and break-ups. They also have
difficulties related to the stability of their identity or sense of self. They report many “ups and downs”
in how they feel about themselves. Individuals with BPD may say that they feel as if they are on an
emotional roller coaster, with very quick shifts in mood (for example, going from feeling OK to
feeling extremely down or blue within a few minutes). BPD is associated with a tendency to engage in
risky behaviours, such as going Personality Disorders on shopping sprees, drinking excessive amounts
of alcohol or abusing drugs, engaging in promiscuous sex, binge eating, or self-harming.
iii) Narcissistic Personality Disorder The next disorder in group B is the Narcissistic personality
disorder, which is characterised by an inflated sense of self-importance. People with narcissistic
personality disorder often believe that they are “special,” require excessive attention, take advantage
of others, lack empathy, and are described by others as arrogant.
iv) Histrionic Personality Disorder The next disorder in this group B is the histrionic personality
disorder. The central features of histrionic personality disorder are intense expressions of emotion and
excessive attention seeking behaviour. People with histrionic personality disorder often seek out
attention and are uncomfortable when others are receiving attention. They may often engage in
seductive or sexually promiscuous behaviour, or use their physical appearance to draw attention to

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themselves. They also may demonstrate rapidly shifting emotions and express emotion in a very
dramatic fashion.

Cluster C Personality Disorders

These are distinguished by anxious, fearful behaviour commonly seen in Obsessive-Compulsive,
Avoidant and Dependent Personality Disorders.

i) Obsessive-Compulsive Personality Disorder People suffering from OCPD, also called Anankastic
Personality Disorder, are so focused on order and perfection that their lack of flexibility interferes
their ability to get things done, and to enjoy life in general. Little is accomplished because, whatever
the task, for the obsessive-compulsive, it is never good enough. These individuals become involved
and overwhelmed in detail and are often unable to see the big picture.
ii) Avoidant Personality Disorder (AvPD) Those with AvPD experience an intense level of social
anxiety. Extremely selfconscious, they tend to avoid social situations and gravitate to jobs that involve
little interpersonal contact. Avoidants often feel inadequate or inferior to others and are hypersensitive
to rejection. Unlike individuals with schizoid personality disorder, those with AvPD do crave social
relationships but feel that social acceptance is unattainable (Dobbert 2007).
iii) Dependent Personality Disorder (DPD) DPD is a psychological personality disorder in which
the individuals are dependent on others to an extreme extent. They want to be taken care of, cling to
those they depend on, and often rely on others to make decisions for them. They have a strong fear of
rejection and may become suicidal when faced with a disintegrating relationship. Those with DPD
require excessive reassurance and advice, and are commonly over-sensitive to criticism or
disapproval.
General Symptoms of Personality Disorders
These are given below:
• Frequent mood swings
• Stormy relationships
• Social isolation
• Angry outbursts
• Suspicion and mistrust of others
• Difficulty making friends
• A need for instant gratification
• Poor impulse control

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Unit-5
Neuro-developmental Disorders
Substance Related and Addictive Disorders

Neuro-developmental Disorders-

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is a widely
used diagnostic tool for mental health professionals. It categorizes neurodevelopmental
disorders as a group of conditions characterized by impairments in the growth and
development of the central nervous system. Here are the neurodevelopmental disorders
listed in the DSM-5:

1. Autism Spectrum Disorder (ASD): This disorder is characterized by persistent deficits in

social communication and social interaction across multiple contexts, as well as restricted,
repetitive patterns of behavior, interests, or activities. Symptoms must be present in the early
developmental period, but may not become fully manifest until social demands exceed
limited capacities.
2. Intellectual Disability (Intellectual Developmental Disorder): Intellectual disability is
characterized by deficits in intellectual functioning (such as reasoning, problem-solving,
planning, abstract thinking, judgment, academic learning, and learning from experience) and
adaptive functioning (conceptual, social, and practical adaptive skills). The onset must occur
during the developmental period.
3. Global Developmental Delay: This diagnosis is used when a child fails to meet expected
developmental milestones in several areas of intellectual functioning and adaptive behavior.
It's often used when there is uncertainty about the specific developmental disorder,
particularly in young children.
4. Communication Disorders: This category includes disorders that affect a person's ability to
comprehend or produce language. It includes language disorder, speech sound disorder,
childhood-onset fluency disorder (stuttering), and social (pragmatic) communication disorder.
5. Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is characterized by a persistent
pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development. Symptoms must be present before the age of 12 and must occur in more than
one setting.
6. Specific Learning Disorder: This disorder involves difficulties in learning and using academic
skills. It includes impairments in reading (dyslexia), written expression, and mathematics.
7. Motor Disorders: This category includes developmental coordination disorder, which
involves difficulties with motor coordination that significantly interfere with academic
achievement or activities of daily living.
8. Tic Disorders: Tic disorders include Tourette's disorder, persistent (chronic) motor or vocal tic
disorder, and provisional tic disorder. They are characterized by sudden, rapid, recurrent,
nonrhythmic motor movements or vocalizations.

These disorders often have an onset during the developmental period and can significantly
impair functioning in various areas of life. Diagnosis typically involves a comprehensive
evaluation by a qualified mental health professional using the criteria outlined in the DSM-5.

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Substance Related and Addictive Disorders-

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) classifies Substance-
Related and Addictive Disorders as a group of conditions characterized by the problematic pattern of
substance use leading to clinically significant impairment or distress. Here are the Substance-Related
and Addictive Disorders listed in the DSM-5:

1. Substance Use Disorder (SUD): This overarching diagnosis encompasses a cluster of

cognitive, behavioral, and physiological symptoms indicating that an individual continues
using a substance despite significant substance-related problems. The specific substance may
include alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics,
anxiolytics, stimulants, tobacco, or other unknown substances.
2. Alcohol Use Disorder (AUD): This disorder involves problematic alcohol use leading to
clinically significant impairment or distress. Symptoms include a strong desire to drink,
difficulties in controlling alcohol intake, tolerance, withdrawal symptoms, and continued use
despite negative consequences.
3. Caffeine Use Disorder: This diagnosis is given when an individual develops a pattern of
problematic caffeine use leading to clinically significant impairment or distress.
4. Cannabis Use Disorder: Cannabis Use Disorder involves problematic cannabis use leading to
clinically significant impairment or distress. Symptoms are similar to those of other substance
use disorders and include cravings, tolerance, withdrawal, and continued use despite negative
consequences.
5. Stimulant Use Disorder: This disorder involves problematic use of stimulant substances such
as amphetamines, methamphetamine, cocaine, or other stimulants, leading to clinically
significant impairment or distress.
6. Opioid Use Disorder: Opioid Use Disorder involves problematic opioid use leading to
clinically significant impairment or distress. Opioids include prescription medications like
oxycodone and hydrocodone, as well as illegal drugs like heroin.
7. Sedative, Hypnotic, or Anxiolytic Use Disorder: This disorder involves problematic use of
sedatives, hypnotics, or anxiolytics leading to clinically significant impairment or distress.
8. Tobacco Use Disorder: Tobacco Use Disorder involves problematic tobacco use leading to
clinically significant impairment or distress. Symptoms include a strong desire to use tobacco,
difficulty quitting or cutting down, withdrawal symptoms, and continued use despite negative
consequences.
9. Other Substance-Related Disorders: This category includes disorders related to substances
not covered by the specific diagnoses listed above, such as hallucinogens, inhalants, and other
substances causing clinically significant impairment or distress.

These disorders can range in severity and may require different treatment approaches,
including psychotherapy, medication, and support groups, depending on the specific
substance and individual needs. Diagnosis typically involves a comprehensive evaluation by a
qualified mental health professional using the criteria outlined in the DSM-5.

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