1.What is a psychological disorder?

A psychological disorder or mental disorder is a condition characterized by abnormal thoughts, behaviors and feelings.

2.What is abnormal behavior?

Abnormal behaviors refer to those behaviors which are unusual, maladaptive and impairing overall functioning of the individual.

3.Define normal people.

Normal people may be referred to as those who have optimum intellectual capacity, organized personality patterns and are well adjusted with their social environment.

4.Define Abnormal people.

Abnormal people are those who exhibit maladjustment with social environment and uncontrolled emotional expressions.

5.List the features of abnormal behavior.

• Deviant Behavior, which usually deviates from social norms and rules, i.e., the behavior which is quite different from what we accept as the norms of society. For example, theft
• Dysfunctional Behavior, which interfere with person’s ability to perform day-to-day activities properly. For example, bullying
• Distressing Behavior are emotional behaviors which are unpleasant and upsetting to the persons and others. For example, aggression
• Dangerous Behavior, that causes harm or injury to the individual’s own self or to others. For example, reckless driving

6.Explain the different perspectives of abnormal behavior.

• Biological or Medical Perspective: This perspective tries to explain abnormal behavior in terms of some anomalies in the biological or physiological systems of the body. It considers faulty genes, physical illness, damage or of the brain, etc. This, in turn give rise to psychological or mental disorders. For example, Low levels of activity of neurotransmitter GABA may lead to anxiety disorders.
• Psychoanalytic or Psychodynamic Perspective: the psychological perspective of abnormal behavior attempts to explain unconscious repressed desires and motives as causes of abnormal behavior. It was developed by Sigmund Freud. According to him, unconscious includes all hurtful memories, forbidden desires, unresolved conflicts and experiences. If primitive, sexual and aggressive urges which are hidden in the unconscious mind seep into the person’s consciousness, the conscious mind would be flooded with profound anxiety. This anxiety gets manifested in the form of various symptoms of mental or psychological disorders or abnormality. Thus, according to this perspective psychological disorders are the outbursts of various primitive, forbidden thoughts, unresolved conflicts and motives in different ways that were repressed in the unconscious.
• Socio-cultural Perspective: According to the socio-cultural perspective, abnormal behaviors or psychopathologies develop he due to the adverse effects of society on the person rather than the person himself. Various societal frameworks such as family dynamics, cultural expectations, societal biases cause abnormality. Socio-cultural factors like poverty, unemployment, negative environment, etc. play a significant role in causing mental disorders. Profound malnutrition, lack of education, poor mental support and a lack of sympathy during childhood make individuals prone to stress and other psychopathologies.

7.Why is it important to classify mental disorder?

It involves gathering information of the problems the person is facing, inquire about his present and past lives, etc. These information gathering steps are called assessment. They are used for diagnosis, i.e., identify the person’s problem.

Necessity of classification of mental disorders-

• Facilitating communication between researchers and clinicians, clinicians and patients through the use of a common language or a precisely defined nomenclature (a naming system), terms and description. 
• Providing a nosographic (classification and description of diseases) reference system, used in the diagnosis and treatment.
• Helping research by ensuring that sample cases are homogeneous or similar as possible.
• Facilitating statistical record for public health institutions.
• It also helps to find which types of psychological disorders guarantee insurance reimbursement and how much reimbursement.

8.List the systems established for classifying mental disorders.

Two widely established systems for classifying mental disorders are used. They are as follows-

1. International Classification of Diseases (ICD-10) produced by the World Health Organization (WHO).
2. Diagnostic and Statistical Manual of Mental Disorders (DSM) produced by American Psychiatric Association (APA).

Among the two, DSM-IV, that is, fourth edition (1994) of Diagnostic and Statistical Manual of Mental Disorders, is the most popular classification.

9.Explain DSM-IV

DSM-IV is the fourth edition of Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association (APA).

The categorized the mental disorders along with their clinical features and diagnostic criteria, predisposing factors, prevalence etc. DSM has been revised and published due to upgradation of the mental disorders and incorporation of new mental disorders.

DSM-IV classified all mental disorders into 5 axis, each relating to different aspect of a mental disorder.

Axis I: It reports all the different clinical disorders excepting Personality Disorders and Mental Retardation. For example, Disruptive Behaviour Disorders, Schizophrenia, Mood Disorders, Anxiety disorders, Eating Disorders, etc.

Axis II: This axis reports Personality disorder and Mental Retardation. It checks the prominent maladaptive personality features. It is a separate axis to ensure that they do not get overlooked when the attention is given to the Axis I disorder. This axis includes Paranoid Personality Disorder, Anti-social Personality Disorder, Histrionic Personality Disorder, Avoidant Personality Disorder, Mental Retardation (Mild, Moderate, Severe and Profound), etc.

Axis III: This axis reports the general medical condition of the individual while diagnosing the mental disorders. This is important in understanding and management of the individual’s mental disorder. General medical conditions are very often related to or are causal factors of mental disorders. This includes Respiratory System Diseases, Digestive System Diseases, Injury, etc.

Axis IV: This axis reports the psychosocial and environmental conditions that may affect the diagnosis and treatment of the mental disorders. These can be problems with primary support group (death/ill health of a family member, etc.), Education (illiteracy), Occupational factors (unemployment), Housing (homelessness), etc.

Axis V: This reports the clinician’s evaluation of the individual’s overall functioning. It can be done using Global Assessment Functioning Scale (GAF). GAF provides quantifiable information about the progress of a patient’s mental health.

Advantage: the multiaxial system of DSM-IV is a convenient format for organising clinical information. It helps clinicians to get a comprehensive understanding of every patient’s current state and psychological functioning.

Limitations of DSM-IV:

• classifications are not descriptive by nature
• only state the symptoms without describing the causes of the mental disorders
• DSM-IV classification actual leads to labelling the people according to their abnormal behaviour. This may encourage normal people to exhibit stereotyped attitude towards them.
• It states some gender-based classifications for certain disorders like severe depression is more common in a particular gender which may show gender bias in the social attitude.

DSM- IV defines mental disorders as:

• A clinically significant behavioural or psychological syndrome or pattern that is associated with distress or disability. Not simply a predictable and culturally sanctioned response to a particular event (death of loved one)

10.What is anxiety?

Anxiety is a general feeling of fear and apprehension about possible danger. It is of three types – Generalized Anxiety Disorder (GAD), Phobic Disorder, Obsessive Compulsive Disorder (OCD).

11.Explain GAD.

Generalized Anxiety Disorder (GAD) may be diagnosed for all those people whose level of worry and anxiety becomes excessive, chronic and unreasonable.

Clinical features (Symptoms):

1. Uncontrollable, excessive anxiety and worry persisting for more than 6 months about a number of events or activities.
2. Difficult to control the worry
3. Over vigilant to find possible signs of threat in the environment.
4. Feeling of restlessness and irritability.
5. Excessive worry about some impending danger or unforeseen circumstances.
6. Being easily fatigued.
7. Suffer from muscle tension and hear
8. Sleep disturbance and difficulty in concentrating.

Causes: Although exact causes of GAD are still unknown, different experiments show the contribution of following factors-

1. Personality factor: It is conceptualised inherited and basic personality trait of neuroticism (proneness to experience negative emotions) is responsible for causing GAD.
2. Neurological factor:  anxiety producing hormone called corticotrophin releasing hormone affects the bed nucleus of the stria terminalis of the brain, which is involved in thinking and emotion, to produce anxiety. Low level of activity of Gamma aminobutyric acid (GABA), serotonin is also responsible in inducing GAD.
3. Psychoanalytic factor: anxiety is caused when primitive, sexual and aggressive id impulses are blocked from expression. An unconscious conflict between id and ego arises and the person’s defense mechanisms break down. All these instances leave the person highly anxious.

12.What is Phobia?

Phobia means an extreme and irrational fear of some specific object or situation that leads to avoidance of these objects or situations by the persons. DSM-IV has classified phobias into three categories of specific phobia, agoraphobia and social phobia.

Causes:

1. Genetic factors: Children of phobic parents often display phobia for the same object or situation similar to the parent.
2. Personality factors: children, who are shy, timid are likely to develop phobias for different objects or situations as an adult.
3. Behavioural approach: they are considered to be learned behaviour. A person is believed to acquire irrational fears or phobia through classical conditioning. When a neutral stimuli (lightening) is paired with a traumatic or painful event (death of a loved one), the fear response associated with the painful event may get conditioned. So, the fear response may get evoked in case of the occurrence of neutral stimuli (i.e., lightening) in future.
4. Psychodynamic approach: This view suggests that phobias are a kind of defence adopted by individuals against anxiety stemming from some repressed id impulses. Since, it would be very upsetting and harmful for the person to become aware of the repressed id impulse, so the anxiety is displaced on to some external object or situation. This object or situation bears some symbolic relationship to the real object or situation of anxiety.

13.Explain Specific Phobic Disorder.

It is a specific phobia, formerly called simple phobia is characterised by an intense and persistent fear of a specific object or situation such as snakes, heights, blood, insects, etc.

Clinical features (Symptoms):

1. Intense, excessive and unreasonable fear of a specific object or situation.
2. The level of fear is usually inappropriate to the situation as the object or situation presents very little or no actual danger.
3. This unusual fear compels the person to avoid the particular object or situation or endure the situation with great level of distress.
4. The fear is uncontrollable in spite of best efforts.
5. Person recognises that the fear is unreasonable.
6. Exposure to phobic stimulus or mere anticipation of the same results in extreme fear and anxiety.
7. Duration of the symptoms must be for at least 6 months to diagnose the person with specific phobia.

14.Explain Agoraphobia Phobic Disorder.

The word ‘agoraphobia’ was thought to be fear of ‘agora’, i.e., a Greek word meaning public places.

It is characterised by extreme fear of certain public places like shopping malls, market place, crowded streets, movie halls, etc. Person with agoraphobia feels trapped or helpless in all these aforesaid places. They generally fear all those places from where they feel that escape will be difficult or embarrassing. These people experience panic attacks in all the feared situations, So, they start avoiding these situations.

People with agoraphobia are also frightened by their bodily reactions showing very little level of arousal. As they feel it to be the triggering point of a panic attack. So, these people avoid any activities associated with arousal like exercising, watching horror movies, etc.

In severe level of agoraphobia, a person might feel scared to even move out of the house or even his/her room.

Clinical Features (Symptoms):

1. Extreme fear and anxiety of places from where the person feels escape or getting help will be difficult and embarrassing.
2. Afraid of leaving their homes for extended periods.
3. Afraid of losing control in a public place, fear of a panic attack
4. Situations are avoided or are tolerated with severe level of distress.  

15.Explain Social Phobic Disorder.

Social phobia is a type of phobia in which an individual experiences extreme and irrational fear of social situations. They may have trouble in meeting and interacting with new people, in attending social gatherings, or public speaking. They have an excessive fear of being negatively judged and scrutinized by others. They may also fear that they may act in an embarrassing and humiliating way. They fail to overcome their fear even though they understand how irrational their fear is. It can be manifested in selective social situations like only when eating in front of strangers. The exact reason for social phobia is unknown, a combination environmental factors like bullying, family conflict, or physical abnormalities like serotonin imbalance could be causal factors.

Clinical Features (Symptoms):

1. Extreme fear and worry about social situation.
2. Avoiding social situations and trying to blend in the background.
3. Excessive worry about being scrutinised and embarrassed in social situation.
4. Exposure to social situation induces extreme fear or panic attack.
5. Person realizes the fear to be unreasonable.

16.Explain OCD.

Obsessive Compulsive Disorder (OCD) is a potentially disturbing anxiety disorder. It is characterized by occurrence of repeated unwanted and intrusive thoughts or images called obsessions. These thoughts are usually accompanied by some repeated behaviors called compulsions, performed to get rid of such thoughts which provide temporary relief from the anxiety provoking thought. Compulsions involve repetitive behaviors like hand washing, checking, ordering, or mental activities like counting, praying, repeating certain words silently, etc. For example, intrusive thought of contamination by germs may compel the individual to wash his hands over and over again to the extent of adversely affecting the skin of the hands.

Clinical features (Symptoms):

1. Recurrent and persistent obsessive thoughts, impulses or images which are intrusive and inappropriate, causing marked anxiety.
2. Person tries to suppress or neutralise such thoughts or impulses by some other thoughts or actions.
3. Person realizes that these thoughts are inappropriate and originate from his or her own mind.
4. Repetitive behaviour or a mental activity that the person feels driven to perform in response to a recurrent thought.
5. These behaviours are performed to remove distress or uneasiness or neutralise the effect of some dreaded obsessive thoughts or images.
6. The obsession or compulsion causes significant distress, and great waste of time. This happens to the extent that this disorder may interfere with a person’s daily activities and functioning.

Causes:

1. Genetic factor: Researches show that, OCD does run in families. Genes play an important role in the development of the disorder.
2. Neurochemical factor: Due to increased level of activity in brain areas like caudate nucleus and orbital frontal cortex. The orbital frontal cortex controls all primitive urges regarding sex, aggression, hygiene. and danger. Caudate nucleus filters these urges: Dysfunction in these regions result in peculiar obsessive thoughts and compulsions related to sex, aggression, etc. Increased level of serotonin activity results in OCD.
3. Psychodynamic perspective: obsessions and compulsions stem due to unconscious conflict arising when primitive id impulses are at odds with socially acceptable behaviour. The persons try hard to suppress, resolve or cope with the conflict. Since the conflicts are highly distressing and repulsive, the persons try to deal with them indirectly. So, they may resort to something more manageable like an intrusive thought and an associated compulsive behaviour. It helps to cope with the anxiety related with the unconscious conflict.

17.Explain mood disorders.

Mood disorders include severe alterations in mood, ranging from either highest level of elation or deep depression. It is of two types – Major Depressive Disorder or Unipolar disorder and bipolar disorder

18.Explain Major Depressive Disorder.

Major Depressive Disorder or Unipolar disorder or severe depression is marked by presence of at least a single major depressive episode. This episode is characterized by depressed mood during which everything seems to be unpleasant to the person followed by a loss of interest in all daily activities for at least two weeks.

Clinical Features (Symptoms):

1. Depressive mood with a feeling of sadness or, emptiness and tearfulness. Among children and adolescents, depressive mood is expressed in the form of irritability.
2. Feelings of unpleasantness and gradual lowering of interest in almost all aspects of life.
3. Feelings of being worthless with low self-confidence and feelings of inappropriate guilt.
4. Significant weight loss with decrease in appetite.
5. Insomnia or Hypersomnia (increased sleep).
6. Diminished ability to think or concentrate.
7. Recurrent thoughts of death or suicide, suicide attempts.
8. Fatigue or loss of energy.

Causes:

1. Genetic factor: Family history of depression increases the risk of depression. Prevalence of severe depression is approximately three times higher among children of depressed persons.
2. Neurochemical factor: low level of thyroid hormone, low level of serotonin may affect the level of other neurotransmitters such as dopamine and norepinephrine which may cause depression.
3. Psychodynamic factor: childhood grief caused as a result of loss, like death of a parent or withdrawal of affection can result in self-blame and criticism. Thus, the child starts exhibiting depressive symptoms. Also, feelings of inadequacy may be the result of failure to meet the expectations of parents in the early childhood years. The child feels that whatever he/she does, will never be enough to please the parent. So, he/she may set high expectations which they may not achieve. This failure will result in depression.

19.Explain Bipolar disorder.

Bipolar Disorder, also known as, ‘Manic Depression’, is expressed through serious shifts in mood, energy, thinking and behaviour. The term ‘bipolar’ refers to the presence of two extreme types or poles of mood with mania (i.e., elation or euphoria) on one pole to depression (melancholy or sadness) on the other pole. One episode of each type (mania and depression) comes one after the other in cyclic order and might last for days, weeks and months.

Clinical features (Symptoms) of manic episode:

1. Persistently elevated or irritable mood at least for 1 week.
2. Irrationally optimistic and highly talkative than usual.
3. Unrealistic belief cult about one’s own power or ability (inflated diff self-esteem).
4. Decreased need of sleep, extremely active, high level of energy
5. Superfast thinking ability, jumping from one idea to other (racing thoughts or flight of ideas and easily distracted.
6. Impaired judgment and impulsiveness resulting in excessive involvement in pleasurable but risky activities (such as risky business and investments, unrestrained shopping sprees).

Causes:

1. Genetic factor: There is a greater genetic influence in case of bipolar disorder than unipolar depression. The children of a person with bipolar disorder are at a greater risk of developing both bipolar disorder or severe depression disorder
2. Neurochemical factor: Increased norepinephrine activity is associated with manic episodes, while its decreased activity is found during depressive episodes. Serotonin activity appears to be low. Increased activity of dopamine may trigger manic symptoms like elated mood or euphoria. Few drugs like cocaine stimulate dopaminergic activity. Brain scans report that blood supply is lowered in right frontal and temporal regions during mania, while it is reduced in the left prefrontal cortex during depression. Enlargement of certain brain areas like basal ganglia and amygdala may be the causal factor for bipolar disorder.
3. Psychodynamic factor: depression is caused when feelings of aggression are turned inward towards self or when feelings of inadequacy is generated and sustained due to repeated failure to achieve certain unrealistic targets.

Manic phases are assumed to be a defence mechanism based on denial used by ego. Ego tries to camouflage (cover up) the feelings of worthlessness and inadequacy, depressed mood with some totally opposite feelings of inflated self-esteem, elevated mood and optimism. But ego often fails to sustain this defence mechanism for a long time. So, the person again collapses to his/her depressive phase.

20.What are personality disorders?

Personality disorders are marked by inflexible and extreme personality traits and behaviors that are deviations from social norms and expectations.

21.Explain Anti-social personality disorder.

An individual of at least 18 year of age, whose behaviour show continuous disregard for or violation of the rights of others, is diagnosed to have anti-social personality disorder. This disorder is also called psychopathy or sociopathy.

Clinical features (Symptoms):

1. Repeated failure to conform to social norms and behave lawfully.
2. Engaging in various deceitful criminal or delinquent activities without any remorse or feelings of guilt.
3. Excessive impulsivity, irritability and aggressiveness.
4. Consistent irresponsible behaviour.
5. A possible history of conduct disorder or presence of symptoms of conduct disorder (childhood disorder marked by aggressive and anti- social behaviour) in childhood.
6. Disregard for safety of self or others.

Causes:

1. Genetic factor: Parents having psychopathic traits like aggression, impulsive callousness may have children who might develop anti-social personality disorder adulthood.
2. Neurochemical factor: abnormal functioning of serotonin or temporal lobes and prefrontal cortex may lead to the impulsive and aggressive behaviour associated with anti-social personality disorder.
3. Environmental factor: Dysfunctional family environment in terms of poverty, illiteracy, broken homes, etc leads to inappropriate nurture and supervision of the child. Parent supervision is lacking in a family already overburdened the above issues leads the child to be selfish, indifferent to others. Lack of discipline results in little regard for rules. Absence of proper parental guidance and care, he/she lacks an appropriate role model. So, he/she uses aggression to solve disputes which leads to rejection by peers. They may lead form gangs to carry out various anti-social activities.

22.Explain Histrionic personality disorder.

A person with histrionic personality disorder has excessive attention seeking behaviour and heightened emotionality. In an attempt to be the centre of attention their behaviour melodramatic and even seductive.

Clinical features (Symptoms):

1. Constant attention-seeking behaviour and discomfort in situations in which he/she is not the centre of attention.
2. Using provocative or sexually seductive behaviour to draw attention.
3. Overly dramatic behaviour and exaggerated emotional expressions.
4. Easily influenced by others.
5. Adopt a speech style to impress others.
6. Considers relationships to be more intimate than they actually are.
7. Low level of tolerance for frustration or delayed gratification.

Causes:

1. Genetic and personality factor: personality trait that leads to histrionic personality disorder in women while anti-social personality disorder in men are neuroticism and extraversion. According to Big five factor model of Costa and McCrae, high levels of extraversion include high level of adventure and excitement seeking, talkativeness, positive emotions. The high level of neuroticism involves low frustration, tolerance and heightened emotionality. It is also found that children of parents (specially the mother) having histrionic personality disorder run a greater risk of developing it.
2. Behavioural factor: result from positive reinforcement of certain attention seeking behaviour of the person. The attention seeking behaviour may include using provocative gestures, or using speech loaded with sexual overtones.
3. Psychodynamic factor: It may stem from some traumatic childhood experiences, disapproval in early parent-child relationship, poor resolution of the Oedipus complex associated with the phallic stage of psychosexual development. As a result, as an adult, the child displays provocative behaviour (due to unresolved Oedipus Complex), to seek the love and attention (of which he/she is deprived), especially from people of opposite sex.

23.Explain Avoidant personality disorder.

Individuals with avoidant personality disorder is marked by behaviour pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation by others. As a result, they’re reluctant to enter into any social interactions and has limited social relationships. It is also known as Anxious personality disorder.

Clinical features (Symptoms):

1. Self-imposed social isolation.
2. Preoccupation of being criticised or rejected and hyper sensitivity to rejection or criticism.
3. Extreme shyness or anxiety in social situations due to fear of being shamed or ridiculed.
4. Low self-esteem and feelings of inadequacy.
5. Self-critical.                                                                                                   

Causes:

1. Personality factor: There are three inheritable personality traits of neuroticism and introversion are implicated in this disorder. According to Big Five factor model of Costa and McCrae, high levels of introversion is indicated by their inhibited and shy behaviour, feelings of inferiority. While high levels of neuroticism are indicated by their fear and anxiety of being shamed, ridiculed.
2. Psychodynamic factor: This disorder arises out of early painful experiences of chronic parental or peer criticism or rejection. As a result, they adopt avoidant tendencies as a defence to protect self against further criticism from anyone.

24.Explain Dependent personality disorder.

Dependent Personality Disorder is also known as asthenic personality disorder. A person with this personality disorder has a profound psychological dependence on other people. It is a long-term condition in which people depend on others to meet their emotional and physical needs. They generally show clinging and submissive behaviour. They show acute fear on separation or at the possibility of separation. They always suppress their views and needs to avoid disagreement.

Clinical features (Symptoms):

1. Inability to decisions without advice and reassurance from others.
2. Needs others to assume responsibility for most of major aspects of his/her life.
3. Has difficulty in expressing disagreement with o because of fear of loss of support or approval.
4. Has difficulty in initiating any project or things on his or her own.
5. Can do anything to gain support and care from others.
6. uncomfortable or helpless when alone due to exaggerated fears of being lonely.
7. Crave relationship for care and support immediately after a close relationship ends.
8. Unreasonable preoccupation with fear of being left alone or abandoned by others.

Causes:

1. Genetic and personality factor: Inheritable personality traits of neuroticism and agreeableness leads to anxiety, fear of being left alone and excessive trusting and clinging behaviour.
2. Behavioural factor: The result of authoritarian parents reinforcing dependent behaviour without encouraging the development of autonomy and individuation in their child. So requiring others to survive becomes dominant and gets expressed pervasively in the behaviour.
3. Cognitive factor: Due to beliefs of incompetency, requiring others to survive becomes dominant and gets expressed pervasively in the behaviour

25.Explain Passive-Aggressive personality disorder.

Passive-aggressive personality disorder is a provisional category of personality disorder as listed in DSM-IV. It is also known as negativistic personality disorder. A person diagnosed with this disorder seems to actively comply with the orders of others, but actually passively resists them. Their ways of resistance can range from relatively mild resistive behaviour like making excuses to extreme form of showing scornful behaviour.

Clinical features (Symptoms):

1. sulky or argumentative behaviour towards other people’s requests.
2. Try to avoid taking responsibility by claiming to have forgotten.
3. Being intentionally inefficient by delaying or making mistakes when dealing with others.
4. Blaming others, showing pessimistic and cynical behaviour.
5. Complaining about most things.
6. Constant feeling of resentment.
7. Being afraid of authority.
8. Unexpressed hostility and anger.
9. Resists advice and suggestions from others.

Causes:

1. Psychodynamic factor: result due to specific unpleasant situations in childhood (dominating parent, bullying). These situations triggered anger in the child. But the child did not feel safe to express the anger. So, the child adopts various passive aggressive ways to deal with the unexpressed anger. For example, losing things or forgetting things may be a way of expressing this anger.
2. Family dynamics: Families that do not encourage honest expression of feelings, especially frustration and anger, compel the children to repress their feelings. Thus, they start using passive aggressive behaviour.

26.Explain behavioural and development disorders.

Children show some disruptive behaviour at some time or the other, like not paying attention in class or being defiant to elders. When such behaviours last for about 6 months and result in trouble at school and other social places, it can be called a Behavioural Disorder

Severe and chronic physical and mental impairment of an individual that is shown up by 22 years of age and results in impending the functions of the individual in at least 3 major areas of the individual’s life, is termed as developmental disorder.

Caused by certain biological factors like,

1. Physical illness or disability
2. Malnutrition
3. Brain damage
4. Hereditary factors
5. Divorce of parents

27.Explain ADHD.

The children who cannot pay attention and have difficulty in sitting quietly for some time mg, showing signs of ADHD. Such children can also be impulsive and cannot resist temptations. They end up doing things without thinking.

Symptoms:

1. They cannot concentrate on a work.
2. They are forgetful.
3. They cannot resist temptations.
4. They have difficulty in sitting still.
5. They talk a lot.

28.Explain conduct Disorder.

Some children behave in ways not appropriate for their age that violate social norms, destruct own or other people’s belongings. They break a lot of serious social and also family rules. kind of behaviour is termed as Conduct disorder.

Symptoms:

1. Violation of family expectation
2. Damaging property
3. Deceit, fraud and theft
4. Aggression causing or threatening to cause harm to individuals and animals:
5. this could be verbal aggression in the form of name calling or swearing.
6. physical aggression in the form of fighting or beating someone.
7. proactive aggression in the form of bullying others.

29.Explain Autism-Spectrum Disorder. 

Children with this disorder lack the social interaction skills and face difficulty in communication

They are most comfortable in a routine schedule and any kind of deviation from routine upsets them. Around 70% children with autism show intellectual disabilities.

Symptoms:

1. Difficulty in relating to others
2. Do not understand others’ feelings
3. Inability to start a social interaction
4. Inability to express their emotions
5. They have very narrow range of interest\
6. They show repetitive behaviour like rocking or putting things in line or even self-injurious movements like banging the head against the wall.

30.Explain Separation Anxiety Disorder.

some children are extremely and inappropriately fearful about being separated from their primary care giver or someone they are attached to. They are afraid of staying in a room alone, going to school or entering a new situation and try to find solace in the protection of the primary care giver. This disorder can be grouped with the other anxiety disorders also.

Symptoms:

1. Experiencing extreme distress at the thought of or when going through separation from home or primary care giver.
2. May throw up a tantrum, scream, fuss or even attempt suicide to avoid the separation.

31.What is Schizophrenia.

The term schizophrenia was coined by Eugen Bleuler. It is referred to as split in the thought, split between thought and emotion, split between thought and external reality.

Schizophrenia refers to a complex mental disorder in which a person loses contact with reality. People with schizophrenia have misperception, that is, they hear, see or have such sensations which are not there in reality (hallucinations). They develop certain rigid, false beliefs that have no basis in reality (delusions). Their ability to work and their communication with others declines gradually due to their confused and disorganized thinking. This occurs along with significant impairment in intellectual and emotional functioning.

Schizophrenia is usually diagnosed after a long period of onset due to its gradual outward expression.

DSM-IV has presented the criteria for the diagnosis of schizophrenia through positive and negative symptoms. Positive symptoms include the disturbances or behavior patterns which are ‘added’, which were not present normally. Negative symptoms include those abilities of individual which are lost from the individual. In other words, it includes absence of all those behaviors that are normally present in all individual.

• Symptoms:

Positive symptoms: –

1. Delusions (False ideas) – These mean firmly held rigid beliefs that have no basis in reality. For example, individual may believe that someone is spying on him or her.
2. Hallucinations: These mean detailed sensory experiences of something that does not exist in reality. For example, seeing, feeling, tasting, hearing or smelling something that does n really exist. The most common experiences are hearing imaginary voices that give commands or running commentary to the individual of what he/she is doing.
3. Disorganized thinking and speech: Jumping from one topic to another in a meaningless manner (loosening of associations). Often one idea in the thought process do not follow a logical sequence to another idea in the same thought (derailment). In extreme cases, ideas seem to be totally unconnected (incoherence). Thus, it becomes totally incomprehensible to what the person is trying to communicate. Individuals often create new words (neologism) which have no existence in the vocabulary. For example, using ‘head socks’ to denote cap. Schizophrenics may also keep on repeating the same thoughts (perseveration). In extreme cases they may only utter few jumbles of unconnected words (word salad) or may imitate of what others say (echolalia).
4. Bizarre motor behaviour: They may show odd motor behaviour. Schizophrenics may either show very little or too much of movement. Catatonia is an umbrella term used to des these variety of bizarre motor behaviours. These may include- Repetitive, unnecessary movements (stereotypy) like flapping the fingers. Normal goal directed activity that is socially approved but is repeated out of context (mannerisms) like bowing head repeatedly. Imitating movements of another person (echopraxia). A state of total immobility and mutism, but the person remains conscious (catatonic stupor). Uncontrolled and aimless motor activity (catatonic excitement) Increased flexibility where a person’s limbs can be moved into any posture and the patient will retain these postures (waxy flexibility).

Negative symptoms:

• Social withdrawal: They usually have a complete lack of concern for their social environment. They are unable to maintain appropriate social behaviours like communicating with others or maintaining proper hygiene as per the social standards. Due to disorganized thinking and speech, they even cannot respond to others appropriately. Few patients remain silent and withdrawn from the external world.
• Lack of drive or initiative (volition): This means that they usually have to motivation or drive to do anything or for taking initiative to complete any task.
• Loss of emotional responsiveness (Affective flattening): This means that lose their emotional expressions. This means, they do not show appropriate emotional response to any external stimulation, even in extreme moments. Thus, they show total apathetic behaviour to others. Otherwise, they show very little or inappropriate emotional reactions to certain situations. For example, a patient may start laughing loudly when somebody inquires his/her name.
• Anhedonia: It means, they are unable to experience pleasure and joy from activities usually enjoyed by others. For example, a football fan does not enjoy when the team he/she supports wins.
• Alogia: It means that they do not speak, or reply, or tries to do with brief, one-word replies.

• Types of Schizophrenia

common types of schizophrenia are:

1. Paranoid schizophrenia: It is the most common form of schizophrenia. It is marked by presence of high level of suspicion and mistrust towards others.

Symptoms:

1. Patients have delusions or false, absurd, illogical beliefs that any person or some individuals (that may be his/her close relatives, friends too) are plotting against them or against the members of their family. These delusions are termed as delusion of persecution. They may complain of being followed, poisoned, or talked about by others.
2. They also have a false belief about themselves. As a result, they may claim to be some influential or powerful or wealthy or famous person like a great politician or an industrialist (delusion of grandeur).
3. Comparatively, patients with paranoid schizophrenia exhibit fewer problems with their cognitive skills, emotions and attention. This allows them to think about the wide range of peculiar ideas and plots. But their delusions are illogical and are often combined with hallucinations.

b. disorganized schizophrenia: It is characterized by disorganized behaviour, disorganized speech, affective flattening and gradual social withdrawal. It is also known as hebephrenia

Symptoms:

1. Disorganized thought and speech: The patient is unable to form coherent or logical thoughts, which is evident in their speech. Speech is difficult to understand as it may be marked by loosening of associations or derailment, echolalia or baby talk.
2. Grossly disorganised behaviour: Patients may have severe problem in their abilities to take care of themselves and perform regular activities such bathing, eating, dressing, etc. They may display odd behaviours like facial grimacing (making odd facial expressions), talking to themselves, mannerisms, stereotypy or echopraxia.
3. Inappropriate affect: Affective flattening or lack of emotional expressions get display through monotonous voice, blank face with no eye-contact in some patients. While, so patients show very inappropriate emotions. They may giggle aimlessly, or may have sudden uncontrollable laughing or weeping spells.
4. Social withdrawal: it may lead to severe disruption in communication, maintaining proper hygiene. This makes the patients gradually decline into reclusion. Thus, the patients get shelled in his own world of some hallucinations, delusions away from reality.

c. Catatonic schizophrenia: It is marked by presence of unusual motor characteristics.

Symptoms

1. Patients may assume a particular posture and remains in that posture for hours, even days (catalepsy).
2. They may be totally immobile and mute. This condition is called catatonic stupor.
3. They may also resist any effort by others to change their position. They may even refuse attempt of feeding and refuse other requests (negativism).
4. The person sometimes exhibits excessive movement without any reason (catatonic excitement).
5. The person senselessly repeats the words spoken to him or her (echolalia) or
6. Involuntarily imitates the movements of another person (echopraxia).

32.What is Psychotherapy?

Psychotherapy refers to the treatment procedures or techniques of psychological disorders.

Its basic purposes are:

1. To offer an individual a safe, confidential and supportive environment, where he or she can have the liberty to voice his/her problems.
2. To facilitate an understanding of past experiences and their impact on current life-events.
3. To help people to heal emotional and psychological wounds.
4. It also assists people to develop skills and techniques to cope with various stressors in life.

Types of therapy: therapy can be of different types. These include individual therapy, group therapy, marital or couples’ therapy and family therapy. Depending on the nature the problems, the particular therapy is administered.

33.Explain Psychodynamic therapy.

Psychodynamic Therapy is based on the individual’s unconscious processes as they are manifested in a person’s present behaviour. The goal of this therapy is to make the individual aware of his/ her unconscious wishes, urges, desires and its influence his/her present behaviour. It enables the individual to examine unresolved conflicts resulting from past dysfunctional relationships and experiences. These repressed materials and conflicts get manifested in the form of various symptoms and disorders. The psychodynamic therapy is based on the psychoanalytical theory by Sigmund Freud.

According to Freud, an individual’s personality is made up of three basic factors- Id, Ego and Superego. Id works on the pleasure principle (immediate satisfaction of need), ego works by reality principle (reasoning and rationality), and superego works by morality principle (conscience, ethics, social customs and norms). Whenever id seeks to gratify any unacceptable wish, threatening or undesirable to ego, ego suppresses it deep into the unconscious mind. It is done to maintain social customs and norms. Which, in turn, are expressed through different symptoms. This therapy thus involves making the individuals aware, how unconscious factors affect behaviour patterns, relationships and overall mental health.

This therapy involves the following techniques-

1. Free association: It involves exploring a person’s unconscious and preconscious thoughts of the client by the therapist. The client gives a running account of all thoughts, feelings, desires of a client coming to the mind at the moment of the therapy while relaxing on a couch. Client is encouraged to talk spontaneously, whatever comes to his or her mind, no matter how illogical or irrelevant they seem to be. The therapist always remains away from the sight of the client, often sitting or standing at the back. This arrangement is done to facilitate free flow and verbalization of thoughts without any inhibition. The therapist interprets the responses and tries to find out the associations between the ideas expressed freely. According to Freud, allowing a person to talk freely helps the person, release a lot of emotional loadings associated with any psychological problem. It also enables the person to voice out the significant incidents of life which may have been left unshared till now (e.g., an incident of child abuse). Person may unknowingly express certain trivial matters that may have significant implications for his psychological problems.

1. Dream analysis: according to Freud, our repressed feelings have another pathway, i.e., the dreams. Dreams are symbolic representation of unconscious thoughts. This technique involves thorough examination and analysis of the various content of dreams. Dream analysis is a very difficult task due to its complexity. This is because the symbols used in dreams have their very personal and own meanings that cannot be generalized. Since, different parts of dreams are forgotten rapidly, it becomes quite complex for the analyst to associate the fragmented details of the dreams.

1. Transference: Transference is a phenomenon occurring during an ongoing therapy characterized by unconscious re-direction of feelings from one person to another. It occurs when one carries over feelings, attitudes and expectations one has towards a significant person like a parent or spouse, and unconsciously apply them towards the therapist Therefore, therapist may become a parent figure or other significant figure to the client. So, client start displaying same emotions like love or hatred towards the therapist as he/she had for that significant person. Transference are of two types–positive and negative. In case of positive transference, client has positive emotions towards the therapist. So, he/she feels secure and express thoughts safely. But, in case of negative transference, negative emotions, such as hostility, aggression emerge. This hinders the therapeutic process.

1. Counter transference: Counter transference is the same process like transference. But in this process, instead of the patient, the therapist becomes emotionally dependent on the patient. In case of counter transference, the therapist projects his or her personal emotions, onto the client, which are originated and directed towards the significant people in the life of the therapist. Counter transference must be properly handled by the therapist. Failure to do so leads to mere repetition of typical relational difficulties characterizing the client’s life.

• Resistance: During the process of free association, the client may be unwilling to talk about certain thoughts or experiences. For example, a person may abruptly stop talking or may switch to some other topic while stating a childhood experience. They may stubbornly refuse to report certain experiences even. This phenomenon is termed as resistance. Here, resistance simply means blockage of mind. It is the patient’s strong refusal to express certain thoughts motives or wishes which appear to be threatening and painful or unacceptable from a social perspective. Resistance may even get expressed when client refused to accept therapist’s interpretation or comes late or forgets an appointment for the therapeutic session.

Disadvantages:

• a highly subjective, time consuming and expensive technique lacking empirical support.
• it focuses on the past rather than the patient’s immediate problems.

Therefore, its practice is becoming less frequent.

34.Explain client-centered therapy.

Client-centered Therapy is also known as person-centered therapy. It is developed by humanist psychologist Carl Rogers. Rogers believed that unrealistic conditions of worth acquired early in life results in incongruence and consequent psychological problems. The aim of this therapy is to reduce the incongruence, increase the client’s feelings of self-worth and help the person become more of a fully functioning person. Rogers believed that the therapy may lead to insights and lasting changes in the client

The therapist acts as a guide in achieving the goal of fulfilling their potential and desire to be self-actualized. He used the term ‘client’ instead of patient, because the term ‘patient’ implies that the individual is sick and seeks cure from the therapist. But, by using the term ‘client’, emphasized the importance of the individual, seeking only assistance in controlling their destiny and overcoming their difficulties. The therapist and client are seen as equal partners or friends rather than an expert treating a patient. The therapist should not direct the client, should not pass judgment on the client’s feelings, and should not offer suggestions or solutions. Instead, the therapist should only guide the client to develop the necessary skills to overcome his/her problems.

The key principles:

1. The therapist allows the client to discuss his/her problems. The therapist should not try to provoke the client in a particular direction.
2. The therapist must show complete acceptance and support for his or her client.
3. According to Carl Rogers, a therapist adopting client-centered therapy should have certain qualities or abilities. These are-
4. Unconditional positive regard: The therapist must accept the client unconditionally throughout the session. The therapist must value and support the client, the latter’s feelings, behaviour and thoughts without being judgmental. By creating such a supportive environment, the therapist facilitates the client to feel safe and able to express his or her emotions without fear of rejection.
5. Genuineness: The therapist must have the ability to openly share his/her own thoughts and feelings with others. They need not hide their true feelings by appearing too professional or authority figure. The therapist must disclose certain aspects of his life to a fair amount. Such disclosure allows the client to see the therapist as a real, living person. This may help to create an environment that promotes trust and honest expression of thoughts and feelings.
6. Empathy: Empathy is the ability to understand the client’s feelings and thoughts. It refers to how sensitively and accurately the therapist understands the client’s experience and feelings. The therapist must communicate this understanding to the client. This allows the client to gain a clearer understanding of his/her own inner thoughts, behaviour and emotions.
7. Free will: It refers to the client’s choice to change himself/herself out of his own will, and not be guided by the therapist in this direction. He should identify the aspects that need change, and find out techniques of bringing about the change, with respect to his environment, ability and situation. Rogers developed a ‘non-directive’ and ‘client-centered approach’ of counselling and psychotherapy. However, this approach makes some professionals feel that their knowledge expertise is being side-lined.

35.Explain behavioral therapy.

Behaviour therapy is focused on human behaviour and works to remove unwanted or maladaptive behaviours. This therapy induces positive behaviour change. This therapy considers the patient’s past when the unwanted behaviour was learned. However, it focuses on the present behaviour and the ways in which the same can be rectified. The premise of behaviour therapy is that behaviour can be both learned and unlearned and the goal is to help the individual in learning new, positive behaviours. Behaviour therapy is primarily based on Classical conditioning and Operant conditioning.

1. Classical Conditioning based Therapeutic Techniques

The theory of classical conditioning states that a maladaptive behaviour is learned by association between a stimulus and unwanted behaviour. So, the therapies based on this approach aim to break this association. A few techniques are:  

1. Flooding: It is a process generally used for removing phobias and anxiety. It is also called implosion therapy. Here, the patient is directly exposed to the fear or phobia-producing or anxiety stimulating objects or situations for a prolonged period under a safe and controlled environment. For example, a person, afraid of cockroaches is locked up in a room filled with cockroaches for an extended period of time. This method is based on the premise that phobia, fear or anxiety are time limited responses. Initially, with exposure to the fear producing stimuli, the person experiences extreme anxiety. The person tries every method to escape or avoid the situation. Since they are not provided any choice than to confront the situation, eventually their anxiety or the fear subsides or gets removed. This exposure also leads to creation of new association between the feared object and some positive behavior like lack of anxiety. But this method cannot be used in certain situations such as in cases of people with heart disease. It must be used with caution or else it may elevate the fear levels instead of reducing it. Some people even fail to tolerate the high levels of anxiety evoked in this therapy. So, they often terminate the therapy before getting their fears or phobias or anxiety removed.
2. Systematic desensitization: In this technique, the patient is exposed to the objects as in flooding, but in a more slow and gradual manner. This technique involves repeated pairing of stimuli that leads to relaxation in the person with the feared stimuli. First, through deep muscle relaxation, a relaxed mental state of the patient is created. Then the patient is asked to think or is exposed to the fear-producing object in a hierarchical manner. This begins with thinking or imagining about the feared object in such a way that induces least level of anxiety. Gradually, one moves to either imagining or actual exposure to the feared stimulus, that evokes extreme level of anxiety or fear. The person is asked to repeatedly imagine every situation until it fails to evoke any anxiety. For example, if a person has a fear of open spaces, while a relaxation technique is going on, he is asked to think of such a place and ultimately, he is sent to such a place.

B. Operant Conditioning based Therapeutic Techniques

The theory of operant conditioning states that maladaptive or unwanted behaviours is learned and repeated based on their consequences.

The behaviours, yielding a positive outcome of consequence (reinforcement) are likely to be learned and repeated. While the behaviours yielding negative outcome or consequence (punishment) are likely to be unlearned an avoided.

So, these therapies try to identify and change the outcomes that reinforce the maladaptive behaviour. A few techniques are:

1. Token economy: This strategy uses positive reinforcements by offering individual ‘tokens’ for exhibiting positive behaviours. These tokens may be exchanged for obtaining privileges or rewards like extra pocket money, movie trip, chocolates, etc. The nature of the privilege for that behaviour should be stated clearly beforehand. This is a very commonly used technique by the parents, teachers and in rehabilitation centers for developing and maintaining positive and healthy behaviours.
2. Shaping: It involves the reinforcing successive behaviours that are required to achieve the target behaviour. It may be used to overcome phobias by reinforcing gradual steps towards facing the feared object or situation. For example, a person with aquaphobia might be told to slowly start swimming in a pool and then enter larger water bodies.

36.Explain cognitive behavior therapy

The Cognitive Behaviour Therapy or CBT is popularized due to its effectiveness in short duration. It has shown to be effective in anxiety, depression, panic attacks and borderline personality.

A combination of Cognitive Therapy and Behavioural Techniques, CBT takes a biopsychosocial approach. Assuming that the causes of the client’s distress could be biological, psychological or social, it tries to tackle all the three components.

It uses relaxation techniques for the biological components, behavioural and cognitive therapy techniques for the psychological component and environmental manipulations for the social component.

Cognitive therapy which is, popularized by Albert Ellis and Aaron Beck.

37.Explain Modelling

This technique is based on the social learning theory developed by Bandura. It involves learning through observation and imitation of others. In this technique, the client tries to learn new skills, modify or unlearn the maladaptive behaviours by watching any role model displaying the desired behaviour.

For example, A younger client may be exposed to behaviours of their peers who may act as behavioural assistants to therapists. Then, the younger client may be encouraged to imitate and practice the desired new behaviours.

Modelling may be used to teach simple skills like brushing the teeth, self-dressing etc.in case of mentally retarded people.

38.Explain Albert Ellis’ rational emotive therapy.

Rational emotive behavior therapy (REBT) by Albert Ellis is a type of cognitive behavioral therapy (CBT). It is an action-oriented approach that’s focused on helping people deal with irrational beliefs and negative thinking patterns to overcome mental distress and manage their emotions, thoughts, and behaviors in a healthier, more realistic way.

These irrational thoughts and beliefs distort the perception of an event and are called dysfunctional cognitive structures. REBT uses the ABC model. A is for activating event, B is for beliefs and C is for Consequences.

A is the initial situation or triggering event. Example: Imagine someone didn’t return your phone call. It can be of two types- External Activating Event which refers to events or situations that occur outside of an individual and may trigger emotional responses. Example: Someone criticizing you, facing a traffic jam, or receiving a challenging task at work. Internal Activating Event which refers to thoughts, interpretations, or self-talk that occur within an individual’s mind and contribute to emotional responses. Example: Telling yourself, “I can’t handle criticism,” or thinking, “This traffic is unbearable; I’m going to be late.”

B includes the thoughts and beliefs you have about the activating event. Example: “They must not like me. I’m not important to them.”

It can be of two types – Rational Beliefs which are the realistic, flexible, and adaptive beliefs that are based on evidence and contribute to healthy emotional responses. Example: “Criticism is a part of life, and I can learn from it,” or “Traffic is frustrating, but I can use this time to listen to a podcast.” Irrational Beliefs which are rigid, unrealistic, and maladaptive beliefs that contribute to unhealthy emotional responses. Example: “I must be perfect, and if I’m criticized, it means I’m a failure,” or “This traffic is a disaster, and it ruins my entire day.”

C includes the emotional and behavioural responses that result from your beliefs. Example: Feeling sad, rejected, or maybe even angry. You might avoid the person or become passive-aggressive.

It can be of two types – Adaptive Consequences which are healthy emotional and behavioral responses that result from holding rational beliefs. Example: Feeling mildly disappointed about criticism but using it as an opportunity for self-improvement or feeling annoyed by traffic but remaining calm and patient. Maladaptive Consequences which are unhealthy emotional and behavioral responses that result from holding irrational beliefs. Example: Feeling devastated by criticism, becoming defensive or aggressive, or experiencing extreme anger and frustration due to traffic.

39.Explain Rehabilitation.

Rehabilitation in context of clinical psychology refers to the reintegration of a psychologically ill individual into mainstream society.

It also includes the restoration of his/her rights, facilities and privileges which he/she would have normally enjoyed if he was not ill, convicted, or mentally challenged. Furthermore, rehabilitation aims to enhance and restore functional ability and quality of life of those with some of either physical or mental impairment and disabilities.

Rehabilitation may be done simultaneously or after medical treatment and psychotherapy.

It works successfully in case of juvenile delinquency, the mentally challenged, socially and emotionally challenged persons and mentally disordered persons.

A person placed under rehabilitation may learn some skills, regain his or her strength or re-learn skills or find new ways of doing things.

In case of mentally challenged persons or persons with severe psychological disorder, rehabilitation programs generally have an institutional setup. These programs do not attempt to cure the disorders. These are designed to help these persons to live a life as close as normal.

Rehabilitation includes training, where the individual is taught some practical skills like how maintain personal hygiene, interact with others, etc. Attempts are made for special education and vocational training.

Rehabilitation can simultaneously treat the individual both by medical intervention and various forms of psychotherapies and counselling.

It uses individual and or group counselling. Vocational training is imparted so that he/she can sustain on his/her own in future. Family and friends counselling are also organized so that the individual gets the environmental support outside the rehabilitation center.

Growing evidence suggests that rehabilitation helps the persons with serious mental disorders to cope in an effective way. It reduces the crises that makes the individual dysfunctional. However, it is beneficial when it continues on a regular basis.