Introduction
Abnormality refers to deviation from ideal mental health. Psychological disorders are those mental disorders which result in certain behavioural pattern such as unhappiness, discomfort, anxiety, etc. They also lead to failure in adaptation to life challenges.
When the behaviour cannot be changed according to the needs of the situation, it becomes maladaptive. Abnormal psychology discusses about maladaptive behaviour, its causes, consequences and treatment.
Concept of Abnormality and Psychological Disorders
Many definitions of abnormality have used over the years, but none is accepted universally. However, these definitions have common features known as four D’s. This four D’s are:
(i) Deviant/deviance (different, extreme, unusual, even bizarre)
(ii) Distressing/distress (unpleasant and upsetting to the person and to others)
(iii) Dysfunctional/dysfunction (interfering with the person’s ability to carry out daily activities in a constructive way)
(iv) Dangerous/danger (to the person or to others)
The word ‘abnormal’ literally means ‘away from the normal’. It implies deviation from some clearly defined norms or standards. In psychology, we have no ‘ideal model’ or ‘normal model’ of human behaviour to use as a base for comparison. Various approaches have been used in distinguishing between normal and abnormal behaviours.
From these approaches , two basic and conflicting views emerged:
(i) The first approach refers abnormal behaviour as a deviation from social norms. Each society has norms, which are stated or unstated rules for proper conduct. Behaviours, thoughts and emotions that break societal norms are called abnormal.
A society’s norms grow from its particular culture. Culture includes history, values, institutions, habits, skills, technology and arts. A society which permits competition and assertiveness may accept aggressive behaviour.
But the society which emphasises cooperation and family values may consider aggressive behaviour as abnormal and unacceptable. A society’s values may change over time. It is based on the assumption that socially accepted behaviour is not abnormal, and that normality is nothing more than conformity to social norms.
(ii) The second approach views abnormal behaviour as maladaptive. Many psychologists think that the normality of behaviour does not depend on the fact whether society accepts it or not, but it depends on the well-being of the individual and group. Well-being is not only maintenance or survival, but it includes growth and fulfilment. According to this criterion, conforming behaviour can be seen as abnormal if it is maladaptive i.e. if it interferes with optimal functioning and growth. Maladaptive behaviour refers to the vulnerability or inability to cope with exceptional stress. This leads to problems in individual’s life. These are stigma attached to mental illness, i.e., people are hesitant to consult a doctor or psychologist, as they are ashamed of it. But psychological disorder should viewed as any other illness.
Historical Background of Abnormality
Ancient theory about abnormality holds that 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. It is believed that through shaman, an affected person can know which spirit is responsible for his problem and what needs to be done to appease the spirit.
Approaches of Abnormality
Biological or Organic Approach
The history of abnormal psychology believed that individuals behave strangely because their bodies and their brains are not working properly. This is the biological or organic approach. In the modern era, there is evidence that body and brain processes have been liked to many types of maladaptive behaviour. For certain types of disorders, correcting these defective biological processes results in improved functioning.
Psychological Approach
According to this point of view, psychological problems are caused by inadequacies in the way an individual thinks, feels or perceives the world. All three of these perspectives i.e. supernatural, biological or organic and psychological have recurred throughout the history of Western civilization.
Organismic Approach
In the ancient Western world, philosopher and temperament, physicians of ancient Greece such as Hippocrates, Socrates and Plato developed the orgasmic approach and viewed distributed behaviour as arising out of conflicts between emotion and reason.
Galen elaborated the role of the four humors in personal character and temperament. According to him, the material world was made up of four elements, viz earth, air, fire and water which combined to form four essential body builds, viz, blood, black bile, yellow bile, and phlegm. Each of these fluids was seen to be responsible for a different temperament. Imbalances among the humours were believed to cause various disorders.
This is similar to the Indian notion of three doshas i.e. vata, pitta and kapha which were mentioned in the Atharva Veda and Ayurvedic texts.
Demonology and Superstition
Demonology is related to a belief that people with mental problems were evil and there are numerous instances of ‘witch-hunts’ during the middle age. In this period, demonology and superstitions gained renewed importance in the explanation of abnormal behaviour.
During the early Middle Ages, the Christian spirit of charity was appreciated. St. Augustine wrote elaborately about feelings, mental anguish and conflict. Modern psycho-dynamic theories of abnormal behaviour has developed from it.
The Renaissance Period was marked by increase humanism and curiosity about behaviour. Johan Weyer emphasised psychological conflict and distributed interpersonal relationships as causes of psychological disorders. He believed that ‘witches’ were mentally disturbed who required medical treatment.
The seventeenth and eighteenth centuries were known as the Age of Reason and Enlightenment, as the scientific method replaced faith and dogma (belief) as ways of understanding abnormal behaviour.
In the eighteenth century, the growth of a scientific attitude towards psychological disorders contributed to the Reform Movement and increased compassion for people who suffered from these disorders.
Reforms of asylums were initiated in both Europe and America. The aspect of the reform movement was the new inclination for deinstitutionalisation which placed emphasis on providing community care for recovered mentally ill individuals.
Bio-psycho-social Approach
In this approach, all three factors i.e. biological, psychological and social play important roles in influencing the expression and outcome of psychological disorders.
Classification of Psychological Disorders
Classification of psychological disorders consist of a list of categories of disorders on the basis of some shared characteristics. Classifications are useful because they enable users like psychologists, psychiatrists and social workers to communicate with each other about the disorder. They help in understanding the causes of psychological disorders and the processes involved in their development and maintenance.
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, 5th edition (DSM-5), evaluates the patient on five dimensions 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 is the tenth revision of the International Classification of Diseases, which is known as the ICD-10 Classification of Behavioural and Mental Disorders. It was prepared by the World Health Organisation (WHO). For each disorder, a description of the main clinical features or symptoms and other associated features including diagnostic guidelines is provided in this scheme.
Factors Underlying Abnormal Behaviour
Psychologists use different approaches to understand abnormal behaviour. These approaches also emphasise the role of different factors such as:
Biological Factors
The factors influence all aspects of our behaviour. A wide range of biological factors such as faulty genes, endocrine imbalances, malnutrition, injuries and other conditions may interfere with normal development and functioning of the human body. These factors may be the potential causes of abnormal behaviour.
According to biological model, abnormal behaviour has a biochemical or physiological basis. Biological researchers have found that psychological disorders are related to problems in the transmission of messages from one neuron to another.
When an electrical impulse reaches a neuron’s ending, the nerve ending is stimulated to release a chemical, called a neuro-transmitter.
Studies indicate the abnormal activity by certain neuro-transmitters can lead to specific psychological disorders. Anxiety disorders have been linked to low activity of the neuro-transmitter Gamma Amino Butyric Acid (GABA), schizophrenia to excess activity of dopamine and depression to low activity of serotonin.
Genetic Factors
These factors have been liked to mood disorders, schizophrenia, mental retardation and other psychological disorders. Researchers have not, however, been able to identify the specific genes that are the culprits. In most cases, no single gene is responsible for a particular behaviour or a psychological disorder. Infact, many genes combine to bring about our various behaviours and emotional reactions, both functional and dysfunactional.
Genetic/biochemical factors are involved in mental disorders such as schizophrenia , depression , anxiety, etc. But it is also important that biology alone cannot account for most mental disorders.
Psychological Models
There are several psychological models which provide a psychological explanation of mental disorders. The psychological and interpersonal factors have a significant role to play in abnormal behaviour. These factors include:
- Maternal deprivation (separation from the mother or lack of warmth and stimulation during early years of life).
- Faulty parent-child relationships (rejection, overprotection, over permissiveness, faulty discipline, etc.)
- Maladaptive family structures (inadequate or disturbed family) and severe stress.
The psychological models include the psychodynamic, behaviour , cognitive and humanistic-existential models.
Psychodynamic Model
Psychodynamic model is the oldest and most famous of the modern psychological models. Psychodynamic theorists believe that behaviour, whether normal or abnormal is determined by psychological forces within the person of which she/he is not consciously aware. These internal forces are considered dynamic i.e. they interact with one another and their interaction gives shape to behaviour, thoughts and emotions.
Abnormal symptoms are viewed as the result of conflicts between these forces. This model was first formulated by Freud who believed that three central forces shape personality:
(i) Instinctual needs, drives and impulses (id)
(ii) Rational thinking (ego)
(iii) Moral standards (superego)
Freud stated that abnormal behaviour is a symbolic expression of unconscious mental conflicts that can be generally traced to early childhood or infancy.
Behavioural Model
Behavioural model states that both normal and abnormal behaviours are learned and psychological disorders are the result of learning maladaptive ways of behaving. The model concentrates on behaviours that are learned through conditioning. It proposes that what has been learned can be unlearned. Learning can take place by
- Classical conditioning (temporal association in which two events repeatedly occur close together in time).
- Operant conditioning (behaviour is followed by a reward).
- Social learning (learning by imitating others’ behaviour).
These three types of conditioning account for behaviour, whether adaptive or maladaptive.
Cognitive Model
Psychological factors are emphasised by the cognitive model. This model states that abnormal functioning can result from cognitive problems. People may hold assumptions and attitudes about themselves that are irrational and inaccurate. They may also repeatedly think in illogical ways. Sometimes they make overgeneralisations and draw broad, negative conclusions on the basis of a single insignificant event.
Humanistic-Existential Model
Humanistic-existential model focuses on broader aspects of human existence. Humanists believe that human beings are born with a natural tendency to be friendly, cooperative and constructive. They 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 avoid the responsibility would live empty, inauthentic and dysfunctional lives.
Socio-Cultural Model
In addition to the biological and psychological factors, socio-cultural factors also put stress on us. Some important socio-cultural factors are war and violence, group prejudice and discrimination, economic and employment problems and rapid social change. All these can lead to psychological problems in some individuals.
According to the socio-cultural model, abnormal behaviour is best understood by the social and cultural forces that influence an individual. Factors such as family structure and communication, social networks, societal conditions and societal labels and roles become more important as these societal forces shaped the behaviour. Some family structure can produce abnormal functioning among its members. In some families, members are over involved in each other’s activities, thoughts and feelings. Children from these families may face difficulty in becoming independent in life.
The broader social networks in which people operate include their social and professional relationships. People who are isolated and lack social support, i.e. strong and fulfilling interpersonal relationships in their lives are likely to become more depressed and remain depressed longer than those who are good friendships.
Socio-cultural theorists suggests that abnormal functioning is influenced by the societal labels and roles assigned to the troubled people. When people break the norms of society , they are regarded as ‘mentally ill’ and are encouraged to act sick. Gradually, the person starts to believe that he is really sick and beings to act in a disturbed manner.
Diathesis-Stress Model
This model states that psychological disorders develop when a diathesis (a tendency to suffer from a particular medical condition) is set off by a stressful situation. This model has three components:
(i) The first component is the diathesis or the presence of some biological disorder which may be inherited.
(ii) 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 ‘predisposed’ to develop the disorder.
(iii) The third component is the presence of pathogenic stressors i.e. factors/stressors that may lead to psychopathology.
This method has been applied to several disorders including anxiety, depression, and schizophrenia.
Major Psychological Disorders
The major psychological disorders are anxiety disorders, somatofarm disorders, dissociative disorders, mood disorders, schizophrenia, disorders, behavioural and development disorders and substance-use disorders.
Anxiety Disorders
The term anxiety is usually defined as a diffuse, vague (unclear), very unpleasant feeling of fear and apprehension. The anxious individual shows combinations of the following symptoms:
- Rapid heart rate
- Diarrhoea
- Fainiting
- Sweating
- Frequent urination
- Shortness of breath
- Loss of appetitie
- Dizziness
- Sleeplessness
- Tremors
Anxiety disorders includes the following disorders:
Generalised Anxiety Disorder
It consists of continued, vague (unclear), 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 (weak) and tense.
Panic Disorder
It consists of recurrent anxiety attacks in which the person experiences intense terror. A panic attack denotes an abrupt rise 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, palpitation, choking, nausea, chest pain or discomfort, fear of going crazy, losing control or dying.
Phobia
People who have phobias have irrational fears related to specific objects, people, or situations. Phobias can be grouped into three main types, i.e. specific phobias, social phobias, and agoraphobia.
(i) Specific Phobia : It is the most commonly occurring type of phobia. This group includes irrational fears such as intense fear of a certain type of animal, or of being in an enclosed space.
(ii) Social Phobia : Intense fear and embarrassment when dealing with others characterizes social phobias.
(iii) Agoraphobia : It is the term used when people develop a fear of entering unfamiliar situations. Many agoraphobias are afraid of leaving their home. So their ability to carry out normal life activities is severely limited.
Separation Anxiety Disorder (SAD)
Individuals with this type of disorder are fearful and anxious about separation from attachment figures to such an extent which is developmentally not appropriate. For example, children with SAD may have differently being in a room by themselves, going to school alone are fearful of entering in new situation. They even throw severe tantrums and make suicidal gestures.
The ways in which children express and experience depression are related to their level of physical, emotional and cognitive development. An infant may show sadness be being passive and unresponsive; a pre-schooler may appear withdrawn and inhibited; a school-age child may be argumentative and comabtive and a teenager may express feelings of guilt and hoeplessness.
Obsessive-Compulsive Disorder
People affected by obsessive-compulsive disorder are unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series of acts that affect their ability to carry out normal activities. Obsessive behaviour is the inability to stop thinking about a particular idea or topic.
Compulsive behaviour is the need to perform certain behaviours over and over again. Many compulsions deal with counting, ordering, checking, touching and washing. Other disorder in this category include hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder etc.
Trauma and Stressor Related Disorders
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 may include recurrent dreams, flashbacks, impaired concentration, and emotional numbing. Adjustment Disorders and Acute Stress Disorder are also included in this category.
Somatic Symptom and Related Disorders
These are conditions in which there are physical symptoms in the absence of a physical disease. In somatoform disorders, the individual has psychological difficulties and complaints of physical symptoms for which there is no biological cause.
These include somatic symptom disorder, illness anxiety and conversion disorder.
Somatic Symptom Disorder
It involves a person having body-related symptoms which may or may not be related to any serious medical condition. People having this disorder always worry about their health and make frequent visit to doctors. They experience distress and disturbances in their daily life.
Illness anxiety Disorder
It develops when the individual persistently is preoccupied with developing a serious illness and worry about it. He is always anxious about his own health.
He becomes tensed by hearing someone else’s ill health or some such news. He does not respond to doctor’s assurance, always thinks about undiagnosed disease and negative diagnostic results.
Both Somatic symptom and Illness anxiety disorder are concerned with medical illness. In somatic symptom it is concerned with physical complaints but in illness anxiety disorder is purely mental.
Conversion Disorders
The symptoms of conversion disorders are the reported loss of part of all of basic body functions. Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms reported. These symptoms occur after stressful experience and develop suddenly.
Dissociative Disorders
Dissociation involves feelings of unreality, estrangement, depersonalisation and sometimes a loss or shift of identity. Sudden temporary alterations of consciousness that mark out painful experiences are a defining characteristic of dissociative disorders.
Four conditions are included in this disorder:
Dissociative Amnesia
It is characterised by extensive but selective memory loss that has no known organic cause (e.g. head injury). Some people cannot remember anything about their past. Others can no longer recall specific events, people, places or objects, while their memory for other events remains intact. This disorder is often associated with an overwhelming stress.
Dissociative Fugue
It is a part of dissociative amnesia. It is characterised by the assumption of a new identity and the inability to recall the previous identity. The fugue usually ends when the person suddenly ‘wakes up’ with no memory of the events that occurred during the fugue. It is associated with overwhelming stress.
Dissociative Identity Disorder
It is often referred to as multiple personality disorder and is the most dramatic of the dissociative disorders. It is often associated with traumatic experience in childhood. In this disorder, the person assumes alternate personalities that may or may not be aware of each other.
Depersonalization
It involves an imaginary state in which the person has a sense of being separated both from self and from reality. In depersonalisation, there is a change of self-perception and the person’s sense of reality is temporarily lost or changed.
Depressive Disorders
These are characterised by disturbances in mood or continued emotional state. The most common mood disorder is depression. Depression covers a variety of negative moods and behavioural changes.
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 : It is defined as a period of depressed mood and/or loss of interest or pleasure in most activities, with other symptoms like change in body weight, constant sleep problems, tiredness, inability to think clearly, agitation, greatly slowed behaviour and thoughts of death and suicide. Other symptoms include excessive guilt or feelings of worhlessness.
Factors Predisposing Towards Depression : Genetic make-up or heredity, age, gender, negative life events and lack of social support are some important risk factors for major depression.
Mania : People suffering from mania become euphoric (‘high’), extremely active, excessively talkative and easily distractible.
Bipolar Mood Disorder
It is a mood disorder, in which both mania and depression are alternately present, is sometimes interrupted by periods of normal mood. Bipolar mood disorders were earlier referred to as mania-depressive disorders.
Some types of bipolar and related disorders include ‘Bipolar I Disorder’, ‘Bipolar II Disorder’ and ‘Cyclothymic Disorder’.
Among the mood disorders, the lifetime risk of a suicide attempt is high in case of bipolar mood disorders.
Suicide : Several risk factors in addition to mental health status of a person predict the likelihood of suicide. Every suicide is a misfortune.
It may take place through-out the lifespan. It is a result of complex interface of biological, genetic, psychological, sociological, cultural and environmental factors. Suicidal attempt is the strongest risk factor for mental disorder.
Suicidal behaviour indicates difficulties in problem-solving stress management and emotional expression. These may aggravate under acute emotional stress. Important research works are done in this field. Still there is stigma surrounding suicide. For this many people prone to suicide do not take medical help.
To prevent suicide we need to identify vulnerability, comprehend the circumstances leading to such behaviour etc. Suicides are preventable. Some measures suggested by WHO are:
- 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
Some common factors are found in students who are in distress. These include, declining grades, decreasing effort, misbehaviour in the classroom, lack of interest in common activities, mysterious or repeated absence, smoking, drinking or drug misuse etc.
Strengthening Student’s Self-esteem
Some factors can enhance self-esteem of students. These include:
- Positive life experiences to develop positive identity which increases confidence in self.
- Opportunities are given to develop physical, social and vocational skills.
- Establish a trustful communication.
- Goals should be measurable, achievable which can be completed within specific time frame.
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. It is a debilitating disorder. The social and psychological causes of schizophrenia are tremendous, both to patients as well as to their families and society.
Symptoms of Schizophrenia
The symptoms of schizophrenia can be grouped into three categories:
1. Positive Symptoms
These are ‘pathological excesses’ or ‘bizarre (strange) additions’ to a person’s behaviour. Delusions, disorganised thinking and speech, heightened perception and hallucinations and inappropriate affects are some positive symptoms in schizophrenia.
Delusions : 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. People with this delusion believe that they are being plotted against, slandered, threatened, attacked or deliberately victimised. Mainly there are three types of delusions:
(i) Delusion of Reference : Schizophrenic people attach special and personal meaning to the actions of others or to objects and events.
(ii) Delusion of Grandeur : Schizophrenic people believe themselves to be specially empowered persons.
(iii) Delusion of Control : Schizophrenic people believe that feeling, thoughts and actions are controlled by others.
Formal Thought Disorders : People with schizophrenia may not be able to think logically and may speak in strange ways. These formal thought disorders can make communication extremely difficult.
These include rapidly shifting from one topic to another so that normal structure of thinking becomes illogical (loosening of associations, derailment), inventing new words or phrases (neologisms) and persistent and inappropriate repetition of the same thoughts (perseveration).
Hallucinations : Schizophrenia may have hallucinations. It is a perception that occurs in the absence of external stimuli. Auditory hallucinations are most common in schizophrenia. Parents hear sounds or voices that speak words, phrases and sentences directly to the patient (second-person hallucination) or talk to one another referring to the patient as she/he (third-person hallucination). Hallucinations can also involve the other senses.
Hallucinations includes some senses like:
- Tactile hallucinations (i.e. forms of tingling, burning)
- Somatic hallucinations (i.e. something happening inside the body such as a snake crawling inside one’s stomach)
- Visual hallucinations (i.e. unclear perceptions of colour or distinct visons of people or objects)
- Gustatory hallucinations (i.e. food or drink taste becomes strange)
- Olfactory hallucinations (i.e. smell of poison or smoke)
People with schizophrenia also show inappropriate affect, i.e. emotions that are unsuited to the situation.
2. Negative Symptoms
These are ‘pathological deficits’ and include poverty of speech, blunted and flat affect, loss of volition (self determination) and social withdrawal. People with schizophrenia show alogia or poverty of speech i.e. a reduction in speech and speech content.
Many people with schizophrenia show less anger, sadness, joy and other feelings than most of the people which is called blunted affect. Some show no emotions at all which is a condition known as flat affect.
Patients with schizophrenia also experience avolition or apathy (unconcern) and an inability to start or complete a course of action. People with this disorder may withdraw socially and become totally focussed on their own ideas and fantasies.
3. Psychomotor Symptoms
People with schizophrenia show psychomotor symptoms i.e. they move less spontaneously or make odd grimaces (ugly expression with face) and gestures. These symptoms may take extreme forms known as catatonia. People in a catatonic stupor (unconsciousness) remain motionless and silent for long stretches of time.
Some show catatonic rigidity i.e. maintaining a rigid, upright posture for hours while some others exhibit catatonic posturing i.e. assuming awkward, strange positions for long periods of time.
Neurodevelopmental Disorders
Neurodevelopmental disorders manifest in the early stage of development. Often these appear very early stage of childhood or during the early stage of schooling. These result in hampering personal, social, academic and occupational functioning.
Attention-Deficit Hyperactivity Disorder (ADHD)
Two main features of ADHD are inattention and hyperactivity impulsivity.
Inattention : Children who are inattentive find it difficult to sustain mental effort during work or play. Some common complaints are that the child does not listen, cannot concentrate, does not follow instructions, is disorganised, easily distracted, forgetful, does not finish assignments, and is quick to lose interest in boring activities.
Impulsivity : Children who are impulsive seem unable to control their immediate reactions or to think before they act. They find it difficult to wait or take turns, have difficulty in resisting immediate temptations or delaying gratification.
Hyperactivity : Children who are hyperactive seem unable to control their motion. It is impossible for them to sit stable and quiet. The child may fidget, squirm (jiggle), climb and run around the room aimlessly. Boys are four times more likely to be given this diagnosis than girls.
Autism Spectrum Disorder
It is one of the most common of these disorders. Children with autistic disorder have marked difficulties in social interaction and communication, a restricted range of interests and strong desire for routine. Children with autism experience profound difficulties in relating to other people.
These difficulties are:
- They are unable to initiate social behaviour and seem unresponsive to other people’s feelings.
- They are unable to share experiences or emotions with others.
- They show serious abnormalities in communication and language that persist over time.
- Many autistic children never develop speech and those who do, have repetitive and deviant speech patterns.
Children with autism often show narrow patterns of interests and repetitive behaviours such as lining up objects or stereotyped body movements such as rocking.
These motor movements may be self-stimulatory such as hand flapping or self-injurious such as banging their head against the wall. People with autism tend to experience difficulties in starting, maintaining and even understanding relationships.
Intellectual Disability
Intellectual disability refers to below average intellectual functioning (an IQ of approximately 70 or below) and deficits in adaptive behaviour (i.e. in the areas of communication, self-care, home living, social/interpersonal skills, functional academic skills, work, etc.) which are manifested before the age of 18 years.
Specific Learning Disorder
In case of specific learning disorder, the individual experiences difficulty in perceiving or processing information correctly. During early school years students face problems in basic skills in reading, writing and mathematics. They perform poorly but with additional efforts can do better.
Disruptive, Impulse-Control and Conduct Disorders
The disorders included under this category are Oppositional Defiant Disorder (ODD), Conduct Disorders and Other.
Oppositional Defiant Disorder (ODD)
Children with Oppositional Defiant Disorder (ODD) are irritable, defiant, disobedient and behave in a hostile manner. Individuals with ODD do not see themselves as angry, oppositional, or defiant and often justify their behaviour as reaction to circumstances/demands. Thus, the symptoms of the disorder become entangled wit the problematic interactions with others. Unlike ADHD, the rates of ODD in boys and girls are not very different.
Conduct Disorder (CD) and Anti-Social Behaviour
It refers to age inappropriate actions and attitudes that violate family expectations, societal norms and the personal or property rights of others. The behaviours in conduct disorder include aggressive actions that cause or threaten harm to people or animals, non-aggressive conduct that causes property damage, major deceitfulness or theft and serious rule violations.
Some types of aggressive behaviour are:
- Verbal aggression (i.e. name-calling, swearing)
- Physical aggression (i.e. hitting, fighting)
- Hostile aggression (i.e. directed at inflicting injury to others)
- Proactive aggression (i.e. dominating and bullying others without provocation).
Feeding and Eating Disorders
There are three types of eating disorders:
(i) Anorexia Nervosa : In this, the individual has a disfigured body image that leads her/him to see herself/himself as overweight. By refusing to eat, exercise compulsively and developing unusual habits such as refusing to eat in front of others, the anorexic may lose large amounts of weight and even starve herself/himself to death.
(ii) Bulimia Nervosa : In this, the individual may eat excessive amount of food, then clear her/his body of food by using medicines such as laxatives or diuretics or by vomiting. The person often feels disgusted and ashamed when she/he binges and is relieved of tension and negative emotions after purging.
(iii) Binge Eating : In this, there are frequent episodes of out of control eating. In this case individual eats large amount of food, even he is not feeling hungry. He tends to eat at a higher speed than normal and continues eating till the feels uncomfortably full.
Substance Related and Addictive Disorders
It involves excessive intake of high calorie food resulting in extreme obesity and the abuse of substances such as alcohol or cocaine. Disorders relating to maladaptive behaviours resulting from regular and consistent use of the substance involved are included under substance related and addictive disorders.
These disorders include problems associated with using and abusing drugs such as alcohol, cocaine and heroin. These are two sub-groups of substance-use disorders:
(i) Substance Dependence : In this, there is intense need for the substance to which the person is addicted and the person shows tolerance, withdrawal symptoms and compulsive drug-taking. Tolerance means that the person has to use more and more of a substance to get the same effect. Withdrawal refers to physical symptoms that occur when a person stops or cuts down on the use of a psychoactive substance. It means a substance that has the ability to change an individual’s consciousness, mood and thinking processes.
(ii) Substance Abuse : In this, there are recurrent and significant adverse consequences related to the use of substances. People who regularly ingest drugs damage their family and social relationships, perform poorly at work and create physical hazards.
The three most common forms of substance abuse are:
1. Alcohol Abuse and Dependence
People who abuse alcohol, drink large amount of alcohol regularly and rely on it to help them face difficult situations. The drinking interferes social behaviour and ability to think and work.
For many people the pattern of alcohol abuse extends to dependence i.e. their bodies build up a tolerance for alcohol and they need to drink even in greater amount to feel its effects.
Some effects of alcohol abuse are:
- Alcoholism destroys millions of families, social relationships and careers. Intoxicated drivers are responsible for many road accidents.
- 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-related disorders.
- Excessive drinking can seriously damage physical health.
Effects of Alcohol : Some Facts
- All alcohol beverages contain ethyl alcohol.
- This chemical is absorbed into the blood and carried into the central nervous system (brain and spinal cord) where it depresses or slows down functioning.
- Ethyl alcohol depresses those areas in the brain that control judgement and inhibition; people become more talkative and friendly and they feel more confident and happy.
- As alcohol is absorbed, it affects other areas of the brain. For example, drinkers are unable to make sound judgements, speech becomes less careful and less clear and memory falters, many people become emotional, loud and aggressive.
- Motor difficulties increase due to alcohol intake. For example, people become unsteady when they walk and clumsy in performing simple activities; vision becomes blurred and they have trouble in hearing they have difficulty in driving or in solving simple problems.
2. Heroin Abuse and Dependence
Heroin intake significantly interferes social and occupational functioning. Most abusers further develop a dependence on heroin and experience a withdrawal reaction when they stop taking it.
The most direct danger of heroin abuse is an overdose, which slows down the respiratory centres in the brain, almost paralysing breathing and in many cases causing death.
3. Cocaine Abuse and Dependence
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. It may also cause problems of short-term memory and attention.
In case of dependency, cocaine dominates the person’s life as more 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 well-being.