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What is abnormal behaviour?
4 Ds:
1. Deviance: Psychological disorders are deviant- different, extreme, unusual, even bizarre.
2. Distress: Behaviour which is unpleasant and upsetting to the person and to the others.
3. Dysfunction:Behaviour which is interferingwith the person’s ability to carry out daily activities in a constructive way.
4. Danger: Behaviour which is dangerous to the person or to others.
Abnormal literally means “away from normal”. It implies deviation from some clearly-defined
norms or standards.
There emerges two basic and conflicting views:
• The first approach views abnormal behaviour as deviation from social norms.
• The second approach views abnormal behaviour as maladaptive which states the best criterion for
determining the normality of behaviour is not whether society accepts it but whether it fosters
the well being of the individual and eventually of the group to which s/he belongs.
Well being is not simply maintenance and survival but also includes growth and fulfilment.
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How are psychological disorders diagnosed?
In order to diagnose psychological disorders, they are classified into categories.
The American Psychiatric Association (APA) has published an official manual describing and
classifying various kinds of psychological disorders.
The current version of it, the Diagnostic and Statistical Manual of Mental Disorders, V edition(DSM-V),
evaluates the patients on five axes or dimension rather than just one broad aspect of ‘mental disorder’.
These dimensions relate to biological, psychological, social and other aspects.
The classification scheme officially used in India and elsewhere in the tenth revision of the
International Classification of Diseases(ICD-10), which is known asthe ICD-10 Classification of
Behavioural andMental Disorders.
It was prepared by the World Health Organisation (WHO).
For each disorder, a description of the main clinical features or symptoms, and of other associated
Features including diagnostic guidelines is provided in this scheme.
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MODELS OF ABNORMAL BEHAVIOUR
1. Biological Model:
According to this model, abnormal behaviour has a biochemical or physiological basis. When an electrical impulse
reaches a neuron’s ending, the nerve ending is stimulated to release a chemical, called a neurotransmitter.
Studies indicate that abnormal activity by certain neurotransmitters can lead to specific psychological disorders.
• Anxiety disorders have been linked to low activity of the neurotransmitter gamma aminobutyric acid (GABA).
• Schizophrenia to excess activity of dopamine.
• Depression to low activity of serotonin.
2. Genetic Model:
specific genes that are culprits. It appears that inmost cases, no single gene is responsible
for a particular behaviour or a psychological disorder.
3. Psychological Model:. These models maintain that psychological and interpersonal
factors have a significant role to play in abnormal behaviour. These factors include:
• Maternal deprivation
• Faulty parent-child relationship
• Faulty discipline
• Maladaptive family structure
• Severe stress
The Psychological models include psychodynamic model, behavioural, cognitive and
humanistic -existential models.
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Psychodynamic theorists = by psychological forces within the person of which s/he is not consciously
aware.
Behavioural model=states that both normal and abnormal behaviours are learned and psychological
disorders are the result of learning maladaptive ways of behaving.
Cognitive model. states that abnormal functioning can result from cognitive problems. People may
hold assumptions and attitudes about themselves that are irrational and inaccurate.
Humanists believe that human beings are born with a natural tendency to be friendly, cooperative
and constructive, and are driven to self-actualise, i.e. to fulfil this potential for goodness and growth.
Existentialists believe that from birth we have total freedom to give meaning to our existence or to
avoid that responsibility. Those who shirk from this responsibility would live empty, inauthentic, and
dysfunctional lives.
Diathesis-Stress Model
This model states that psychological disorders develop when a
diathesis (biological predisposition to the disorder) is set off by a stressful situation.
This model has three components:
• The first is the diathesis or the presence of some biological aberration which may be inherited.
• The second component is that the diathesis may carry a vulnerability to develop a psychological disorder.
This means that the person is “at risk” or “predisoposed” to develop the disorder.
• The third component is the factors/stressors that may lead to psychopathology. If such “at risk” persons are
exposed to these stressors, their predisposition may actually evolve into a disorder.
This model has been applied to several disorders including anxiety, depression and schizophrenia.
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Historical Background
Ancient theory = abnormal behaviour can be explained by the operation of supernatural
and magical forces such as evil spirits (bhoot-pret), or the devil (shaitan).
Exorcism, i.e. removing the evil that resides in the individual through countermagic and
prayer, is still commonly used.
In many societies, the shaman, or medicine man (ojha) is a person who is believed to have
contact with supernatural forces and is the medium through which spirits communicate with
human beings.
Biological or organic approach.= Belief that individuals behave strangely because their bodies
and their brains are not working properly.
Psychological approach= psychological problems are caused by inadequacies in the
way an individual thinks, feels, or perceives the world.
Organismic approach = Philosopher physicians of ancient Greece such as Hippocrates,
Socrates, and in particular Plato viewed disturbed behaviour as arising out of conflicts
between emotion and reason.
Galen elaborated on the role of the four humours in personal character and temperament.
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Demonology and superstition gained renewed importance in the explanation of
abnormal behaviour. Demonology related to a belief that people with mental problems
were evil and there are numerous instances of ‘witch-hunts’ during this period.
During the early Middle Ages, the Christian spirit of charity prevailed and St. Augustine
wrote extensively about feelings, mental anguish and conflict. This laid the groundwork
for modern psychodynamic theories of abnormal behaviour.
The Renaissance Period was marked by increased humanism and curiosity about
behaviour. Johann Weyer emphasised psychological conflict and disturbed interpersonal
relationships as causes of psychological disorders.
He also insisted that ‘witches’ were mentally disturbed and required medical, not theological,
treatment.
17TH-18TH C= Age of Reason and Enlightenment
The growth of a scientific attitude towards psychological disorders in the eighteenth century
contributed to the Reform Movement and to increased compassion for people who suffered
from these disorders.
Reforms of asylums were initiated in both Europe and America. One aspect of the reform
movement was the new inclination for deinstitutionalisation which placed emphasis on
providing community care for recovered mentally ill individuals.
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In recent years, there has been a convergence of these approaches, which has resulted in
an interactional, or biopsycho-social approach. From this perspective, all three factors, i.e.
biological, psychological and social play important roles in influencing the expression
and outcome of psychological disorders.
MAJOR PSYCHOLOGICAL DISORDERS
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ANXIETY DISORDERS
Anxiety is usually defined as a diffuse, vague, very unpleasant feeling of fear
and apprehension.
Symptoms: rapid heart rate, shortness of breath, diarrhoea, loss of appetite,
fainting, dizziness, sweating, sleeplessness, frequent urination and tremors.
ANXIETY
DISORDERS
Generalized Separation
Panic
Anxiety Phobia Anxiety
Disorder
Disorder Disorder
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Generalised Anxiety Disorder
Consists of prolonged, vague, unexplained and intense fears that are not attached to
any particular object.
The symptoms include worry and apprehensive feelings about the future;
hypervigilance, which involves constantly scanning the environment for dangers.
It is marked by motor tension, as a result of which the person is unable to relax, is
restless, and visibly shaky and tense.
Panic disorder
Panic disorder, which consists of recurrent anxiety attacks in which the person experiences intense
terror.
A panic attack denotes an abrupt surge of intense anxiety rising to a peak when thoughts of a particular
stimuli are present.
Such thoughts occur in an unpredictable manner.
The clinical features include shortness of breath, dizziness, trembling, palpitations, choking, nausea,
chest pain or discomfort, fear of going crazy, losing control or dying.
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PHOBIAS
Irrational fears related to a person, object or situation.
Specific phobias Social Phobias Agoraphobia
includes irrational fears Intense & incapacitating When people develop a fear of
such as intense fear of fear & embarrassment entering into unfamiliar situations.
certain type of animal or when dealing with others They are also afraid of leaving their
being into enclosed in public. home, because of which they can’t
spaces. carry normal life activities.
Separation anxiety disorder (SAD)
Are fearful and anxious about separation from attachment figures to an extent that
is developmentally not appropriate.
Children with sad may have difficulty being in a room by themselves, going to
school alone, are fearful of entering new situations, and cling to and shadow their
parents’ every move.
To avoid separation, children with SAD may fuss, scream, throw severe tantrums, or
make suicidal gestures.
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Obsessive-Compulsive and Related Disorders
People with OCD are unable to control their preoccupations with specific ideas or are unable to prevent
themselves from repeatedly carrying out a particular act, which affect their ability to carry out normal
activities.
Obsessive Behaviour- inability to stop thinking about a particular idea or topic.
Compulsive Behaviour- is the need to perform certain behaviours over and over again. For eg.
Counting, touching, checking, washing etc.
Other disorders in this category
E.g. Hoarding Disorder, Trichotillomania (hair pulling disorder), Excoriation (skin picking).
Trauma- and Stressor-Related Disorders
Very often people who have been caught in a natural disaster (such as tsunami) or have been victims of
bomb blasts by terrorists, or been in a serious accident or in a war-related situation, experience post-
traumatic stress disorder (PTSD).
PTSD symptoms vary widely but may include recurrent dreams, flashbacks, impaired concentration, and
emotional numbing.
Adjustment Disorders and Acute Stress Disorder are also included under this category.
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Somatic Symptom and RelatedDisorder
Are conditions in which there are physical symptoms in the absence of a physical diseases.
The individual has psychological difficulties & complains of physical symptoms, for which there is
no biological cause.
Somatic Symptom Disorder: Illness anxiety disorder
Persistent body-related symptoms which may or Persistent preoccupation about developing
may not be related to any serious medical a serious illness and constantly worrying
condition. about this possibility.
People with this disorder tend to be overly This is accompanied by anxiety about one’s
preoccupied with their symptoms and they health. Individuals with illness anxiety
continually worry about their health and make disorder are overly concerned about
frequent visits to doctors. undiagnosed disease, negative diagnostic
results, do not respond to assurance by
As a result, they experience significant distress doctors, and are easily alarmed about
and disturbances in their daily life. illness such as on hearing about someone
else's ill-health or some such news.
In the case of somatic symptom disorder, this expression is in terms of physical complaints while in
case of illness anxiety disorder, as the name suggests, it is the anxiety which is the main concern.
Conversion Disorders are the reported loss of part or all of some basic body functions.
Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms reported.
These symptoms often occur after a stressful experience and may be quite sudden.
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Dissociative Disorders
Dissociation can be viewed as severance of the connections between ideas and emotions.
Dissociation involves feelings of unreality, estrangement, depersonalisation, and
sometimes a loss or shift of identity.
Sudden temporary alterations of consciousness that blot out painful experiences are a
defining characteristic of dissociative disorders.
Conditions included in this are Dissociative Amnesia, Dissociative Identity Disorder, and
Depersonalisation/Derealisation Disorder.
Dissociative amnesia : The person is unable to recall
important, personal information often related to a stressful and
traumatic report. The extent of forgetting is beyond normal.
Dissociative Fugue An unexpected travel away from home and workplace.
Assumption of a new identity Inability to recall previous identity Fugue usually ends
when the person suddenly wakes up with no memory of events that occurred during
fugue.
Dissociative identity (multiple personality) Disorder :
The person exhibits two or more separate and contrasting
personalities,generally associated with a history of abuse.
Depersonalisation/Derealisation Disorder :
The person experiences a change in the person's sense of reality
and perception of self.
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Depressive Disorders
Depression covers a variety of negative moods and behavioural changes.
Depression can refer to a symptom or a disorder. In day-to-day life, we often use
the term depression to refer to normal feelings after a significant loss, such as the
break-up of a relationship, or the failure to attain a significant goal.
Major depressive disorder is defined as
a period of
Factors Predisposing towards Depression :
• Depressed mood
• Loss of interest or pleasure in most • Age - For eg.Woman are at risk during young
activities, adulthood & men during middle age.
• Symptoms which may include change in • Heredity – is a major risk factor predisposing
body weight, people to mood disorders.
• Constant sleep problems • Gender- For. Eg woman in comparison to men are
• Tiredness likely to be more depressed.
• Inability to think clearly • Other factors- For eg. Negative life events and lack
• Agitation, greatly slowed behaviour of social support.
• Thoughts of death and suicide.
Other symptoms include excessive guilt or
feelings of worthlessness.
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Bipolar and Related Disorders
Bipolar I disorder involves both mania and depression, which are alternately present and
sometimes interrupted by periods of normal mood.
Manic episodes rarely appear by themselves; they usually alternate with depression.
Bipolar mood disorders were earlier referred to as manic-depressive disorders
Some examples of types of bipolar and related disorders include Bipolar I Disorder, Bipolar
II disorder and Cyclothymic Disorder.
SUICIDE
Suicidal behavior indicates difficulties in problem-solving, stress management, and emotional expression.
Suicidal thoughts lead to suicidal action only when acting on these thoughts seems to be the only way out
of a person’s difficulties.
These thoughts are heightened under acute emotional and other distress.
The ramifications of suicide on social circle and communities tend to be devastating and long-lasting.
The stigma surrounding suicide continues despite recent advances in research in this field.
Due to this, many people who are contemplating or even attempting suicide do not seek help thus,
preventing timely help from reaching them.
Therefore improving identification, referral, and management of behaviour are crucial for preventing
suicide.
Therefore we need to identify vulnerability; comprehend the circumstances leading to such behaviour and
accordingly plan interventions.
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Suicides are preventable.
Some measures suggested by WHO include:
• limiting access to the means of suicide;
• reporting of suicide by media in a responsible way;
• bringing in alcohol-related policies;
• early identification, treatment and care of people at risk;
• training health workers in assessing and managing for suicide;
• care for people who attempted suicide and providing community support.
Identifying students in distress : Strengthening students’ self-esteem :
Any unexpected or striking change Having a positive self-esteem is important
affecting the adolescent’s performance, in face of distress and helps in coping
attendance or behaviour should be adequately.
taken seriously,such as:
In order to foster positive selfesteem –
• lack of interest in common activities • accentuating positive life experiences to develop
• declining grades positive identity. This increases confidence in self.
• decreasing effort • providing opportunities for development of
• misbehavior in the classroom physical, social and vocational skills.
• mysterious or repeated absence • establishing a trustful communication.
• smoking or drinking, or drug misuse • goals for the students should be specific,
measurable, achievable,relevant, to be completed
within a relevant time frame.
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Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia is the descriptive term for a group of psychotic disorders in which
personal, social and occupational functioning deteriorate as a result of disturbed thought
processes, strange perceptions, unusual emotional states, and motor abnormalities.
Symptoms of Schizophrenia
Positive Symptoms Negative Symptoms Psychomotor Symptoms
(i.e. excesses of thought, (i.e. deficits of thought, emotion,
emotion, and behaviour) and behaviour),
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Positive symptoms
are ‘pathological excesses’ or ‘bizarre additions’ to a person’s behaviour.
A delusion is a false belief that is firmly held on inadequate grounds.
It is not affected by rational argument, and has no basis in reality.
Delusions of reference- in which they attach personal meaning to the actions,
objects and events
Delusions of grandeur-They believe themselves to be specially empowered.
Delusions of control- They believe their thoughts, feelings and actions are
controlled by others.
Formal Thought Disorders
not be able to think logically and may speak in peculiar ways.
Perseveration
Loosening of associations, Neologisms
derailment inventing new words persistent and
or phrases inappropriate repetition
These include rapidly shifting from of the same thoughts
one topic to another so that the
normal structure of thinking is
muddled and becomes illogical
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Hallucinations
perceptions that occur in the absence of external stimuli
Auditory hallucinations-
• Second-person hallucination = Patients hear sounds or voices that speak words, phrases
and sentences directly to the patient
• Third-person hallucination - Talk to one another referring to the patient as s/he .
Hallucinations can also involve the other senses.
• Tactile hallucinations -. forms of tingling, burning
• Somatic hallucinations- something happening inside the body such as a snake crawling
inside one’s stomach
• Visual hallucinations - vague perceptions of colour or distinct visions of people or objects
• Gustatory hallucinations -food or drink taste strange
• Olfactory hallucinations- smell of poison or smoke
Inappropriate Affect
emotions that are unsuited to the situation.
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Negative symptoms
are ‘pathological deficits’
Alogia or poverty of speech= a reduction in speech and speech content.
Blunted effect– Less expression of sadness, joy, anger and other feelings.
Flat effect- No emotions and feelings
Avolition= apathy and an inability to start or complete a course of action.
Social Withdrawal= withdraw socially and become totally focused on their own ideas and fantasies.
Psychomotor symptoms:
Less spontaneous, make odd grimaces and gestures.
Catatonic stupor: remain motionless and silent for long durations.
Catatonic rigidity: maintain a rigid upright posture for hours.
Catatonic posturing: assuming odd, awkward positions.
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Neurodevelopmental Disorders
A common feature of the neurodevelopmental disorders is that they manifest in the early
stage of development.
Often the symptoms appear before the child enters school or during the early stage of
schooling.
These disorders result in hampering personal, social, academic and occupational
functioning.
These get characterised as deficits or excesses in a particular behaviour or delays in
achieving a particular age-appropriate behaviour.
Attention-deficit Hyperactivity Disorder (ADHD)-
Inattentive- Find it difficult to sustain mental effort during work or play or in following instructions.
Cannot concentrate, is disorganized, easily distracted, forgetful, does not finish assignments, and is
quick to lose interest in boring activities.
Impulsive- unable to control their immediate reactions or to think before they act. They find it
difficult to wait or take turns, have difficulty resisting immediate temptations or delaying
gratification. Minor mishaps or more serious accidents and injuries can also occur.
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Hyperactivity – They are in constant motion.
Sitting still through a lesson is impossible for them.
The may fidget, squirm, climb and run around the room aimlessly.
Parents and teachers describe them as ‘driven by a motor’, always on the go, and talk
incessantly.
Boys are four times more likely to be given this diagnosis than girls.
Autism Spectrum Disorder is characterised by widespread impairments in social interaction
and communication skills, and stereotyped patterns of behaviours, interests and activities.
Children with autism spectrum disorder have marked difficulties in social interaction and
communication across different contexts, a restricted range of interests, and strong desire for
routine.
About 70 per cent of children with autism spectrum disorder have intellectual disabilities.
Unresponsive to other people’s feelings.
Repetitive and deviant speech patterns
Stereotyped body movements
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Intellectual Disability Disorder
Specific learning disorder the individual
experience difficulty in perceiving or
Below average intellectual functioning (with
processing information efficiently and
an IQ of approximately 70or below), and
accurately.
deficits or impairments in adaptive
behaviour(i.e.in the areas of communication,
These get manifested during early school
selfcare, home living, social/interpersonal
years and the individual encounters
skills, functional academic skills, work, etc.)
problems in basic skills in reading, writing
which are manifested before the age of 18
and/or mathematics.
years.
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Disruptive, Impulse-Control and Conduct Disorder
Conduct Disorder & Antisocial Behaviour
Oppositional Defiant Disorder
refer to age inappropriate actions and attitudes that
display age-inappropriate amounts of violate family expectations, societal norms, and the
stubbornness, are irritable, defiant, personal or property rights of others.
disobedient, and behave in a hostile
manner. The behaviours typical of conduct disorder include
aggressive actions that cause or threaten harm to
Unlike ADHD, the rates of ODD in boys people or animals, nonaggressive conduct that causes
and girls are not very different. property damage, major deceitfulness or theft, and
serious rule violations.
Types of aggressive behaviour
Verbal Agression (Name-calling,swearing),
Physical aggression (i.e. hitting, fighting),
Hostile aggression(i.e.directed at inflicting injury to
others) and bullying others without provocation).
Feeding and Eating Disorders
In anorexia nervosa, the In bulimia nervosa, the In binge eating, there are frequent
individual has a distorted body individual may eat excessive episodes of out-of-control eating.
image that leads her/ him to see amounts of food, then purge The individual tends to eat at a
herself/himself as overweight. her/his body of food by using higher speed than normal and
medicines such as laxatives or continues eating till s/he feels
Often refusing to eat, exercising diuretics or by vomiting. uncomfortably full.
compulsively and developing
unusual habits such as refusing to The person often feels disgusted In fact, large amount of food may
eat in front of others, the person and ashamed when s/he binges be eaten even when the individual
with anorexia may lose large and is relieved of tension and is not feeling hungry.
amounts of weight and even negative emotions after purging.
starve herself/himself to death.
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Substance-Related and Addictive Disorders
ALCOHOL
People who abuse alcohol drink large amounts and rely on it to help them face difficult situations.
Eventually, the drinking interferes with their social behaviour and ability to think and work.
Their bodies built up tolerance for alcohol and they need to drink large amounts to feel its effect.
They also feel withdrawal symptoms when they stop drinking.
Alcohol destroys millions of families, social relationships and careers.
It also has serious effects on the children of persons with this disorder. These children have higher rates of
psychological problems, particularly anxiety, depression, phobias and substance abuse related disorders.
Heroin intake significantly interferes with social and occupational functioning.
Most abusers further develop a dependence on heroin, revolving their lives around the
substance, building up a tolerance for it, and experiencing a withdrawal reaction when they
stop taking it.
The most direct danger of heroin abuse is an overdose, which slows down the respiratory
centers in the brain, almost paralyzing breathing and in many cases causing deaths
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Regular use of cocaine may lead to a pattern of abuse in which the person may be intoxicated throughout the day
and function poorly in social relationships and at work.
May also cause problems of short term memory and attention.
Dependence may develop,so that cocaine dominates the person’s life,more of the drug is needed to get the desired
effects, and stopping it results in feelings of depression, fatigue, sleep problems, irritability and anxiety.
Cocaine poses serious dangers. It has dangerous effects on psychological functioning and physical wellbeing.
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