Psychological Disorders | CBSE Class 12 Psychology Notes

This note covers abnormality, the classification and causes of psychological disorders, anxiety, obsessive-compulsive and trauma-related disorders, bodily symptoms and dissociation, mood disorders, schizophrenia, developmental difficulties, disruptive behaviour, eating disorders and substance use.

How is abnormal behaviour understood?

Adaptation means changing behaviour in response to changing environmental requirements. Behaviour becomes maladaptive when it cannot be modified to meet the situation. Abnormal psychology studies maladaptive behaviour, its causes, consequences and treatment.

Definition: Most definitions of abnormality share features often called the four Ds: deviance, distress, dysfunction and danger. No definition has won universal acceptance, and psychological disorders are only possibly dangerous to the person or others.

Social norms and maladaptation

Social norms are stated or unstated rules of proper conduct. One approach identifies abnormality through marked departures from a society's expectations. Norms grow from culture and may change over time, so judgements of abnormality may also change.

A culture valuing competition and assertiveness may accept aggression. One emphasising cooperation and family values, such as India, may consider it unacceptable. The difficulty is that social acceptance alone does not establish healthy functioning.

The maladaptation approach considers whether behaviour supports individual well-being, growth and fulfilment. Even conforming behaviour can interfere with development. A student who remains silent despite having questions illustrates how socially acceptable conduct can restrict functioning.

Stigma, the shame attached to mental illness, can discourage consultation with a doctor or psychologist. Psychological disorder should be viewed as any other illness. Knowing symptoms does not qualify someone to diagnose or treat themselves or others.

How have explanations and classifications of disorders developed?

Historical perspectives

The supernatural approach attributed disturbed behaviour to magical forces or spirits. Exorcism meant attempting to remove such supposed influences through countermagic and prayer. A shaman, or medicine man, was believed to communicate with supernatural forces.

The biological or organic approach linked disturbed behaviour to malfunctioning bodies and brains. The psychological approach explained problems through inadequacies in thinking, feeling or perceiving. These perspectives have recurred throughout the history of Western civilisation.

Hippocrates, Socrates and particularly Plato developed an organismic approach, relating disturbance to conflict between emotion and reason. Galen proposed four humours, or essential body fluids: blood, black bile, yellow bile and phlegm. Their imbalance was believed to cause disorders.

During the Middle Ages, demonology, the belief linking mental problems with evil, gained renewed importance. St. Augustine's writing about mental anguish and conflict helped lay foundations for later psychodynamic theories.

In the Renaissance, Johann Weyer stressed psychological conflict and disturbed interpersonal relationships. He argued that people accused of witchcraft required medical treatment. The Age of Reason and Enlightenment encouraged scientific approaches, while later reforms increased compassion and improved asylums.

Deinstitutionalisation emphasised community care for recovered individuals. The bio-psycho-social approach brings together biological, psychological and social influences on the expression and outcome of disorders.

Classification systems

Classification groups disorders by shared characteristics. It enables psychologists, psychiatrists and social workers to communicate and helps understanding of causes, development and maintenance.

These systems organise clinical descriptions. They do not replace the specialised training needed for psychological diagnosis and assessment.

How do biological and psychological models explain disorders?

Biological influences

The biological model explains abnormal behaviour through bodily and biochemical processes. Faulty genes, endocrine or hormone imbalances, malnutrition and injuries may interfere with development and functioning. Psychological disorders are often related to problems in communication between nerve cells.

A synapse is the tiny space separating one neuron, or nerve cell, from another. A neurotransmitter is a chemical released at a nerve ending to carry a message across this space. Studies indicate that abnormal activity of certain neurotransmitters can lead to specific psychological disorders.

Genetic factors have been linked to several disorders. It appears that in most cases no single gene is responsible for a particular behaviour or disorder. Many genes combine in shaping behaviour and emotional reactions. Biology alone cannot account for most mental disorders.

Psychological explanations

Psychological and interpersonal influences include maternal deprivation, meaning separation from the mother or lack of early warmth and stimulation, faulty parent-child relationships, disturbed family structures and severe stress.

Freud's psychodynamic model explains behaviour through interacting unconscious forces. The id represents instinctual needs and impulses, the ego rational thinking, and the superego moral standards. Abnormal behaviour symbolically expresses conflicts that can generally be traced to infancy or early childhood.

The behavioural model holds that both normal and abnormal behaviour are learned. Disorders involve learned maladaptive responses. What has been learned can be unlearned. Three routes help explain learning:

• Classical conditioning: two events repeatedly occur close together in time and become associated.
• Operant conditioning: behaviour is followed by a reward.
• Social learning: behaviour is learned by imitating others.

The cognitive model focuses on problems in thinking. People may hold inaccurate assumptions or reason illogically. Overgeneralisation means drawing broad negative conclusions from a single insignificant event.

The humanistic-existential model considers broader human existence. Humanists emphasise self-actualisation, fulfilling the potential for goodness and growth. Existentialists stress freedom and responsibility to give life meaning; avoiding this responsibility is associated with empty, inauthentic and dysfunctional living.

How do social conditions and vulnerability interact with stress?

The socio-cultural model understands abnormal behaviour through the social and cultural forces shaping individuals. War, violence, prejudice, discrimination, economic difficulties and rapid social change put stress on most people and can lead to psychological problems in some individuals.

Relationships and labels

Family structure and communication matter. In an enmeshed family, members are overinvolved in one another's activities, thoughts and feelings. Children from such families may have difficulty becoming independent.

Social support means strong and fulfilling interpersonal relationships. People who are isolated and lack support are likely to become more depressed and remain depressed longer than those with good friendships.

Societal labels also influence functioning. A person labelled mentally ill may gradually accept the expected sick role. The model therefore considers family relationships, wider social networks, social conditions and the roles assigned to troubled people.

The diathesis-stress explanation

A diathesis is a biological predisposition to a disorder. The diathesis-stress model explains how such a predisposition can be set off by a stressful situation. Its three components are:

• A biological abnormality that may be inherited.
• Vulnerability, meaning that the person is at risk of developing a disorder.
• Pathogenic stressors, meaning factors that may lead to psychological disorder.

When an at-risk person encounters these stressors, the predisposition may actually develop into a disorder. This explanation has been applied to anxiety, depression and schizophrenia. Vulnerability therefore indicates risk rather than an inevitable outcome.

When does anxiety become a disorder, and what forms can it take?

Anxiety is usually defined as a diffuse, vague and very unpleasant feeling of fear and apprehension. Anxiety before an examination or performance is normal and can motivate effort. High anxiety that causes distress and interferes with effective functioning indicates an anxiety disorder.

Physical symptoms occur in combinations and can include a rapid heartbeat, breathlessness, sweating, dizziness, tremors, sleeplessness, frequent urination, diarrhoea, fainting and loss of appetite.

Generalised anxiety and panic

Generalised anxiety disorder involves prolonged, vague, unexplained and intense fears without a particular object. Hypervigilance means constantly scanning the environment for danger. Motor tension appears as restlessness, shakiness, bodily tension and inability to relax.

Panic disorder consists of recurrent attacks of intense terror. A panic attack is an abrupt surge of intense anxiety rising to a peak. Associated thoughts occur unpredictably. Symptoms include breathlessness, trembling, palpitations or pounding heartbeat, choking, nausea and fear of losing control or dying.

Deb's experience illustrates disabling anxiety: while driving, he developed a racing heart, heavy sweating and breathlessness. As attacks increased, he feared being caught in traffic during one and eventually refused to leave home.

Phobias and separation anxiety

Phobias are irrational fears involving particular objects, people or situations. They often develop gradually or begin with generalised anxiety disorder.

Children with SAD may struggle to stay alone, attend school alone or enter unfamiliar situations. They may cling to parents and react strongly to separation. The significant feature is the developmentally inappropriate extent of fear.

How do obsessive-compulsive and trauma-related disorders differ?

Unwanted thoughts and repeated actions

Obsessive-compulsive disorder, abbreviated OCD, involves uncontrollable preoccupation with specific ideas or repeated actions that interfere with ordinary activities. Its two central features concern thoughts and behaviour.

An obsession is an inability to stop thinking about a particular idea or topic. The person often finds the thoughts unpleasant and shameful. A compulsion is the need to perform an action repeatedly.

Many compulsions involve counting, ordering, checking, touching or washing. Repeatedly washing hands after touching objects, washing coins or stepping only within patterns on a floor illustrate such behaviour. The difficulty lies in loss of control and interference with functioning.

Related disorders include trichotillomania, or hair-pulling disorder, and excoriation, or skin-picking disorder. These belong to the obsessive-compulsive and related category.

Responses to trauma

Post-traumatic stress disorder, abbreviated PTSD, can follow terrifying experiences. Very often, people exposed to natural disasters, terrorist bomb blasts, serious accidents or war-related situations experience PTSD.

Symptoms vary widely but may include recurrent dreams, flashbacks, or reliving the traumatic experience, impaired concentration and emotional numbing, a reduced emotional response.

The distinction concerns the central pattern: OCD involves persistent ideas or repeated acts, whereas PTSD concerns psychological disturbance following traumatic experiences. Neither should be inferred merely from one familiar feeling or isolated action.

How are somatic symptom, illness anxiety and conversion disorders distinguished?

Somatic means body-related. In somatic symptom and related disorders, psychological difficulties are expressed through bodily concerns or reported losses of bodily function. The distinction between persistent physical complaints and anxiety about possible illness is particularly important.

Physical complaints and fear of illness

Somatic symptom disorder involves persistent bodily symptoms that may or may not be related to a serious medical condition. People tend to be overly preoccupied with their symptoms, worry continually about health and make frequent visits to doctors.

The resulting distress and disruption affect daily life. A medical condition may be absent; when present, it may not be as serious as the symptoms presented. The definition should therefore not be reduced to an absolute claim that medical illness is impossible.

Illness anxiety disorder involves persistent preoccupation with developing a serious illness. People worry about undiagnosed disease, remain concerned despite negative diagnostic results and do not respond to doctors' reassurance. Hearing about someone else's illness can easily alarm them.

Loss of bodily function

Conversion symptoms generally include paralysis, blindness, deafness or difficulty walking. They often occur after a stressful experience and may appear quite suddenly. Here, motor refers to movement and sensory to functions such as seeing and hearing.

What changes occur in dissociative disorders?

Dissociation is a severance of connections between ideas and emotions. It involves feelings of unreality, estrangement, separation from oneself and sometimes a loss or shift of identity. Sudden temporary changes of consciousness that blot out painful experiences characterise dissociative disorders.

Memory and identity

Dissociative amnesia means extensive but selective memory loss without a known organic cause such as head injury. Some people cannot recall their past; others lose memory for particular events, people, places or objects while retaining other memories.

Dissociative fugue is part of dissociative amnesia. Its essential features could include unexpected travel away from home or work, adoption of a new identity and inability to remember the previous identity.

The fugue usually ends when the person suddenly becomes aware again without remembering events during the fugue. It is often associated with overwhelming stress.

Dissociative identity disorder, often called multiple personality, involves alternate personalities that may or may not know about one another. It is often associated with traumatic childhood experiences. The personalities are separate and contrasting.

Self and reality

Depersonalisation/derealisation disorder involves a dreamlike sense of separation from both self and reality. Depersonalisation concerns a changed perception of oneself; derealisation concerns the experienced separation from reality.

The person's sense of reality is temporarily lost or changed. Distinguishing memory loss, changes of identity and altered self-perception helps separate these forms without treating every dissociative experience as the same disorder.

How do depressive and bipolar disorders affect mood?

Depression can refer to a symptom or a disorder. Everyday sadness following loss or failure differs from the wider pattern of mood and behavioural changes associated with depressive disorders.

Major depressive disorder involves a period of depressed mood and/or loss of interest or pleasure in most activities, together with other symptoms. These may include weight change, persistent sleep problems, tiredness, difficulty thinking clearly, agitation, slowed behaviour and thoughts of death or suicide.

Other symptoms include excessive guilt and worthlessness. Heredity is an important risk factor. Women are particularly at risk during young adulthood, while risk for men is highest in early middle age. Women are more likely than men to report a depressive disorder.

Negative life events and lack of social support are additional risk factors. Risk factors describe vulnerability, rather than proving that a particular individual has a disorder.

Alternating mood states

Bipolar I disorder involves both mania, a state of markedly elevated or irritable mood, and depression. They alternate and are sometimes interrupted by normal mood. Manic episodes rarely occur by themselves; they usually alternate with depression.

Bipolar mood disorders were earlier called manic-depressive disorders.

Distress and prevention

Suicide involves a complex interaction of biological, genetic, psychological, social, cultural and environmental factors. Previous suicidal attempt is the strongest risk factor. Other risks include mental disorders, violence, abuse, loss, disasters and isolation.

Stigma can obstruct help-seeking. Identification, referral and management are crucial. Prevention requires contributions from government, media and civil society. WHO's suggested measures include:

• Limiting access to means of suicide and responsible media reporting.
• Alcohol-related policies and early identification, treatment and care of people at risk.
• Training health workers to assess and manage risk.
• Care after an attempt and community support.

Unexpected changes in attendance, performance or behaviour should be taken seriously. Supporting self-esteem includes recognising positive experiences, developing physical, social and vocational skills, establishing trustful communication and setting specific, measurable, achievable, relevant goals within a relevant time frame.

What are the main symptoms of schizophrenia?

Schizophrenia describes a group of psychotic disorders involving disturbed thinking, unusual perceptions and emotions, and movement abnormalities. Psychotic disturbances here include false beliefs and perceptions without external stimuli. Personal, social and occupational functioning deteriorate.

Positive symptoms

Positive symptoms are pathological excesses or additions to behaviour. They include delusions, disorganised thinking and speech, heightened perception, hallucinations and inappropriate affect.

A delusion is a firmly held false belief based on inadequate grounds. Rational argument does not alter it, and it has no basis in reality.

Formal thought disorders affect logical thought and communication. Derailment, or loosening of associations, means rapid shifts between topics. Neologisms are invented words or phrases. Perseveration is persistent, inappropriate repetition of the same thoughts.

Hallucinations are perceptions without external stimuli. Auditory, or hearing, hallucinations are most common in schizophrenia. Voices may address the person directly in second-person hallucinations or discuss the person in third-person hallucinations.

Other forms are tactile, involving touch sensations; somatic, involving events apparently occurring inside the body; visual, involving sights; gustatory, involving taste; and olfactory, involving smell. Inappropriate affect means emotions unsuited to the situation.

Negative and psychomotor symptoms

Negative symptoms are deficits in thought, emotion or behaviour. Alogia means reduced speech and speech content. Blunted affect means reduced emotional expression, while flat affect means showing no emotions.

Avolition means apathy and inability to start or complete an action. People may withdraw socially and become absorbed in their ideas and fantasies. Positive and negative refer to excesses and deficits, not desirable and undesirable symptoms.

Psychomotor symptoms concern movement, such as reduced spontaneous movement or odd gestures. Extreme forms are called catatonia. Catatonic stupor means remaining motionless and silent for long periods; rigidity means holding a stiff upright posture; posturing means maintaining awkward, bizarre positions.

How do attention difficulties and autism affect development?

Neurodevelopmental disorders appear early in development, often before school or during early schooling. They hamper personal, social, academic and occupational functioning through behavioural deficits, excesses or delayed age-appropriate behaviour.

Attention and activity

Attention-Deficit/Hyperactivity Disorder, abbreviated ADHD, has two main features: inattention and hyperactivity-impulsivity. Inattention includes difficulty sustaining mental effort, concentrating, following instructions and completing assignments.

Children may be disorganised, easily distracted or forgetful. Impulsivity means difficulty controlling immediate reactions or thinking before acting. Waiting, taking turns, resisting temptation and delaying gratification can be difficult.

Hyperactivity involves excessive activity. Children may fidget, squirm, run or climb aimlessly and talk incessantly. Minor mishaps are common, while more serious injuries can also occur.

Social communication and restricted patterns

Autism spectrum disorder involves widespread difficulties in social interaction and communication, together with restricted, repetitive patterns of behaviour, interests and activities. Children have marked difficulties across contexts and a strong desire for routine.

They experience profound difficulty relating to others and sharing experiences or emotions. Many never develop speech; those who do have repetitive and deviant speech patterns. Difficulties in verbal and non-verbal communication affect starting, maintaining and understanding relationships.

Children often show narrow interests and repetitive behaviours, such as lining up objects or rocking. Stereotyped movements are repeated patterns of bodily movement. These may serve self-stimulation, such as hand flapping, or may be self-injurious.

Early developmental difficulties require attention because, if unattended, they can lead to more serious and chronic disorders in adulthood. The defining patterns involve functioning and development, rather than an isolated instance of distraction or repetitive activity.

How do intellectual disability and specific learning disorder differ?

Intellectual disability involves below-average intellectual functioning, with an intelligence quotient, abbreviated IQ, of approximately 70 or below, together with deficits in adaptive behaviour appearing before 18 years of age. IQ is a score used to express intellectual functioning.

Adaptive behaviour includes communication, self-care, home living, interpersonal skills, functional academic skills and work. Intellectual functioning and everyday adaptation must therefore be considered together.

Levels and areas of functioning

Levels differ across self-help, communication, academic, social, work and adult-living skills. Receptive language concerns understanding communication; expressive language concerns communicating through language. Vocational adjustment concerns functioning in work.

Specific learning difficulties

Specific learning disorder involves difficulty perceiving or processing information efficiently and accurately. It appears in early school years through problems with reading, writing and/or mathematics.

The child tends to perform below average for age. However, acceptable performance may be reached with additional inputs and effort. The disorder is likely to impair activities or occupations dependent on the affected skills.

The distinction is between intellectual functioning with adaptive deficits and difficulties processing information for particular academic skills. A reading or writing difficulty should not automatically be equated with intellectual disability.

What characterises disruptive behaviour and eating disorders?

Defiance, conduct and aggression

Oppositional Defiant Disorder, abbreviated ODD, involves age-inappropriate stubbornness, irritability, defiance, disobedience and hostility. Individuals do not see themselves as angry or defiant and often explain their behaviour as a response to circumstances or demands.

Conduct disorder and antisocial behaviour involve age-inappropriate actions and attitudes violating family expectations, social norms or other people's personal and property rights. Typical patterns include aggression, property damage, serious deceit or theft, and serious rule violations.

Disturbed eating patterns

Anorexia nervosa involves a distorted body image through which the person sees themselves as overweight. Often refusing food, exercising compulsively or avoiding eating in front of others, the person may lose large amounts of weight and may starve to death.

Bulimia nervosa involves eating excessive amounts followed by purging, attempts to remove the food, including vomiting or use of certain medicines. The person often feels disgust and shame after bingeing and relief from tension after purging.

Binge eating involves frequent episodes of eating without control. The person tends to eat faster than normal and continues until uncomfortably full. Large quantities may be eaten without hunger.

Distorted body image, eating and purging, and repeated loss of control while eating are distinct patterns. These distinctions help separate the disorders instead of treating every disturbed eating pattern as identical.

How do substance-related disorders impair functioning?

Substance-related and addictive disorders involve maladaptive behaviour resulting from regular, consistent substance use. Alcohol, cocaine, tobacco and opioids are among the substances associated with changes in thinking, feeling and behaviour. Opioids include morphine and heroin.

Alcohol and its effects

People who abuse alcohol drink large amounts regularly and rely on it in difficult situations. Drinking eventually interferes with social behaviour, thinking and work. Tolerance means needing greater amounts to experience the effects; withdrawal means reactions that occur when consumption stops.

Alcohol misuse can damage families, relationships, careers and physical health. Children of people with this disorder have higher rates of psychological problems, particularly anxiety, depression, phobias and substance-related disorders.

Alcoholic beverages contain ethyl alcohol. Its effects develop through absorption and changes in nervous-system functioning:

1. Ethyl alcohol enters the blood and reaches the central nervous system, the brain and spinal cord, where it slows functioning.
2. It depresses brain areas controlling judgement and inhibition; people become more talkative and feel more confident and happy.
3. As further brain areas are affected, sound judgement, clear speech and memory deteriorate. Many people become emotional, loud and aggressive.
4. Movement difficulties increase, with unsteadiness, clumsiness, blurred vision, hearing difficulties and impaired driving or simple problem-solving.

Heroin and cocaine

Heroin significantly interferes with social and occupational functioning. Most abusers develop dependence, organise life around the substance, build tolerance and experience withdrawal. Overdose slows respiratory centres in the brain, almost paralysing breathing and in many cases causing death.

Cocaine use may lead to intoxication throughout the day and poor social or work functioning. It may also affect short-term memory and attention. Dependence may develop, with increasing amounts needed for the desired effects.

Stopping cocaine can produce depression, fatigue, sleep problems, irritability and anxiety. Its effects on both psychological functioning and physical well-being are dangerous. Tolerance, withdrawal and impaired functioning are therefore important features when understanding substance-related difficulties.

Glossary

• Adaptation — The ability to modify behaviour in response to changing environmental requirements.
• Maladaptive behaviour — Behaviour that fails to adjust to situational needs and interferes with functioning or growth.
• Deinstitutionalisation — The emphasis on providing community care for individuals who have recovered from mental illness.
• Neurotransmitter — A chemical released at a nerve ending that helps transmit messages between neurons.
• Diathesis — A biological predisposition that can make an individual vulnerable to developing a psychological disorder.
• Hypervigilance — Constant scanning of the environment for possible danger, associated with generalised anxiety disorder.
• Obsession — An uncontrollable preoccupation with a particular idea or topic, often experienced as unpleasant.
• Compulsion — A need to repeat particular behaviours, such as checking, counting, ordering or washing.
• Dissociation — A severance of connections between ideas and emotions, involving unreality or changes in identity.
• Delusion — A false belief firmly held on inadequate grounds and unaffected by rational argument.
• Hallucination — A perception occurring without an external stimulus, which may involve hearing or other senses.
• Avolition — Apathy and an inability to begin or complete a course of action.
• Adaptive behaviour — Everyday functioning in areas such as communication, self-care, home living, social skills and work.
• Tolerance — The need for greater amounts of a substance to experience its effects.
• Withdrawal — Reactions experienced when a person stops taking a substance on which they have become dependent.

Common errors and misconceptions

• Misconception: Every unusual behaviour proves a disorder. Correct: Context, distress, functioning and adaptation matter; no definition of abnormality has universal acceptance.
• Misconception: Every psychological disorder makes someone dangerous. Correct: The four Ds include possible danger, not an inevitable characteristic of every person.
• Misconception: Genetic vulnerability guarantees a disorder. Correct: In the diathesis-stress model, predisposition may develop into a disorder when pathogenic stressors occur.
• Misconception: Obsessions and compulsions both mean repeated actions. Correct: Obsessions concern uncontrollable thoughts; compulsions concern repeated behaviours.
• Misconception: Somatic symptom disorder rules out any medical condition. Correct: Persistent symptoms may or may not be related to a serious medical condition.
• Misconception: Positive symptoms of schizophrenia are beneficial. Correct: Positive means excesses or additions; negative means deficits in thought, emotion or behaviour.
• Misconception: Dissociative identity disorder and schizophrenia are the same. Correct: Alternate personalities characterise the former; disturbed thought, perception, emotion and movement characterise schizophrenia.
• Misconception: Knowing a list of symptoms qualifies someone to diagnose friends. Correct: Information alone does not provide diagnostic or treatment skills; specialised training is required.

Exam-style questions with model answers

Q1. Distinguish an obsession from a compulsion, giving the defining feature of each. [2 marks]

1. An obsession is an inability to stop thinking about a particular idea or topic, often experienced as unpleasant and shameful.
2. A compulsion is the need to perform a behaviour repeatedly, such as checking, counting or washing.

Q2. Explain the four Ds commonly used to describe abnormal behaviour. Preserve the qualification attached to danger. [4 marks]

1. Deviance means behaviour that is different, extreme, unusual or bizarre compared with the relevant expectations or standards.
2. Distress means experiences that are unpleasant and upsetting to the person and to others.
3. Dysfunction means interference with the person's ability to carry out daily activities constructively.
4. Danger means the behaviour is possibly dangerous to the person or others. It does not mean every psychological disorder necessarily involves danger.

Q3. Describe the three components of the diathesis-stress model and their relationship. [3 marks]

1. Diathesis is a biological predisposition to a psychological disorder. It involves a biological abnormality that may be inherited.
2. The predisposition may carry vulnerability, meaning that the individual is at risk of developing the disorder, rather than certain to develop it.
3. Pathogenic stressors are factors that may produce psychological disorder. Exposure to these stressors may turn the at-risk person's predisposition into an actual disorder.

Q4. Deb experiences repeated attacks involving a racing heart, heavy sweating, breathlessness and intense fear of dying. He avoids driving because he fears an attack in traffic and eventually refuses to leave home. Identify the anxiety pattern illustrated, explain the evidence, and explain why functioning is impaired. [3 marks]

1. The repeated attacks illustrate a panic-disorder pattern: recurrent anxiety attacks accompanied by intense terror, rather than merely a single episode of nervousness.
2. The racing heart, sweating, breathlessness and fear of dying provide physical and emotional evidence of the intense anxiety described in panic attacks.
3. Functioning is impaired because fear changes daily behaviour. Deb avoids driving and then refuses to leave home, restricting his ordinary activities.

Q5. Explain six features of the psychodynamic, behavioural, cognitive, humanistic-existential, socio-cultural and biological models, giving one separate point for each model. [6 marks]

1. The psychodynamic model views symptoms as expressions of unconscious conflict between internal forces. Freud related these conflicts generally to experiences in infancy or early childhood.
2. The behavioural model treats maladaptive behaviour as learned through conditioning or imitation. It proposes that learned responses can also be unlearned.
3. The cognitive model explains problems through inaccurate assumptions, illogical thinking and overgeneralisations, such as broad negative conclusions based on one insignificant event.
4. The humanistic-existential model emphasises fulfilling human potential and accepting responsibility for giving life meaning, rather than avoiding that responsibility.
5. The socio-cultural model examines family relationships, social networks, societal conditions and labels, because social and cultural forces shape individual behaviour.
6. The biological model considers bodily and biochemical influences, including genes, hormone imbalances and neurotransmitter activity. Biology alone cannot explain most mental disorders.

Q6. Distinguish positive, negative and psychomotor symptoms of schizophrenia. Give a definition and examples for each category in six separate points. [6 marks]

1. Positive symptoms are pathological excesses or additions to thought, emotion and behaviour. The term describes the nature of symptoms, not beneficial effects.
2. Examples include delusions, hallucinations, disorganised thinking and speech, and inappropriate affect. Hallucinations are perceptions that occur without external stimuli.
3. Negative symptoms are pathological deficits in thought, emotion or behaviour. They involve reduction or loss of functioning in these areas.
4. Examples include alogia, meaning reduced speech and speech content, blunted or flat affect, avolition and withdrawal from social contact.
5. Psychomotor symptoms concern movement. People may move less spontaneously or make unusual grimaces and gestures; extreme forms are called catatonia.
6. Catatonic stupor involves prolonged motionlessness and silence. Catatonic rigidity involves a stiff upright posture, while catatonic posturing involves prolonged awkward positions.

Q7. Explain the defining patterns of anorexia nervosa, bulimia nervosa and binge eating. [3 marks]

1. Anorexia nervosa involves distorted body image, through which a person sees themselves as overweight. Food refusal and compulsive exercise may produce severe weight loss.
2. Bulimia nervosa involves excessive eating followed by purging. The person often experiences shame after bingeing and relief from tension after purging.
3. Binge eating involves frequent episodes of uncontrolled eating. The person tends to eat rapidly until uncomfortably full and may consume large quantities without hunger.

Q8. Explain two reasons why classification of psychological disorders is useful. [2 marks]

1. Classification groups disorders by shared features, helping psychologists, psychiatrists and social workers communicate clearly about the disorders they encounter.
2. It helps understanding of disorders' causes and the processes involved in their development and maintenance.

Key takeaways

• Abnormality involves context, distress and impaired functioning; deviation from social norms alone does not settle whether behaviour is maladaptive.
• Biological, psychological and social factors interact, while the diathesis-stress model links vulnerability with exposure to pathogenic stressors.
• Anxiety becomes clinically significant when high levels are distressing and interfere with effective functioning in daily life.
• Obsessions involve uncontrollable thoughts, compulsions involve repeated actions, and dissociative disorders involve disruptions of memory, identity or experienced reality.
• Depressive disorders involve mood and behavioural changes, while Bipolar I includes alternating manic and depressive phases, sometimes separated by normal mood.
• Schizophrenia includes positive excesses, negative deficits and psychomotor disturbances, affecting personal, social and occupational functioning.
• Neurodevelopmental disorders begin early and affect functioning; intellectual disability combines intellectual limitations with deficits in adaptive behaviour.
• Substance-related disorders can impair relationships and work; tolerance and withdrawal help explain the difficulties associated with dependence.

Test yourself

Why can socially accepted behaviour still be maladaptive?

It may interfere with growth and effective functioning, as when a student stays silent despite having questions.

What is hypervigilance?

It is constantly scanning the environment for danger, a feature associated with generalised anxiety disorder.

How does illness anxiety differ from somatic symptom disorder?

Illness anxiety centres on fear of developing serious illness; somatic symptom disorder expresses concern through persistent physical complaints.

What can occur during dissociative fugue?

The person may unexpectedly travel away, assume a new identity and be unable to recall the previous identity.

How does a delusion differ from a hallucination?

A delusion is a firmly held false belief; a hallucination is a perception occurring without an external stimulus.

What are the two main features of ADHD?

They are inattention and hyperactivity-impulsivity, affecting sustained attention, activity levels and control of immediate reactions.

What distinguishes hostile aggression from proactive aggression?

Hostile aggression aims to inflict injury; proactive aggression involves dominating or bullying others without provocation.

How do tolerance and withdrawal differ?

Tolerance means needing greater amounts for an effect; withdrawal means reactions experienced when substance use stops.