Chapter 4: Psychological Disorders

1. Concept of Abnormality and Psychological Disorders

The term abnormal means something that deviates from what is typical, usual, or expected. In psychology, abnormality refers to behaviour, thoughts, or emotions that significantly deviate from accepted social norms and cause distress or impairment in functioning. Although the distinction between normal and abnormal behaviour is not always clear, psychologists use certain criteria to define abnormality.

Most definitions include four common features known as the Four Ds — Deviance, Distress, Dysfunction, and Danger. These features collectively describe the nature of abnormal behaviour.

• Deviance: Behaviour, ideas, or emotions that differ from social expectations or norms. For example, talking to oneself in public or experiencing hallucinations.
• Distress: Feelings of suffering, pain, or discomfort caused to the person or to others around them. Behaviour that is upsetting and unwanted is often considered abnormal.
• Dysfunction: Impairment in the individual’s ability to carry out everyday responsibilities or function productively in work, relationships, or society.
• Danger: Behaviours that may be harmful to self or others, such as suicidal tendencies or aggression.

Abnormal behaviour can be defined through two major perspectives:

• Deviation from Social Norms: Behaviour that violates accepted cultural or social rules is considered abnormal. However, norms vary across societies and cultures.
• Maladaptive Behaviour: Behaviour is abnormal if it interferes with personal well-being, growth, and the ability to adapt effectively, even if socially accepted.

2. Historical Background

Understanding of abnormal behaviour has evolved over centuries. Different cultures and times have attributed mental illness to various causes.

• Supernatural or Magical Approach: Ancient societies explained abnormal behaviour as possession by evil spirits or demonic forces. Treatment involved rituals like exorcism, prayers, or sacrifices to drive out spirits.
• Biological or Organic Approach: This view regarded mental disorders as diseases caused by biological abnormalities such as brain injury, heredity, or chemical imbalances. The Greek physician Hippocrates proposed that abnormality resulted from an imbalance in body fluids called humours.
• Psychological Approach: Later, thinkers emphasized the role of psychological and social factors such as emotional conflict, stress, and trauma.
• Interactional or Bio-Psycho-Social Approach: Modern psychology views abnormal behaviour as a product of interaction between biological, psychological, and socio-cultural factors.

3. Classification of Psychological Disorders

Classification helps to organize information, identify disorders accurately, and facilitate research and treatment. It provides a common language for professionals to communicate about mental disorders.

• DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) — developed by the American Psychiatric Association; it provides detailed descriptions and diagnostic criteria for each disorder.
• ICD-10 / ICD-11 (International Classification of Diseases) — developed by the World Health Organization (WHO), used internationally including in India.

These systems describe symptoms, onset, duration, and severity, helping psychologists and psychiatrists to reach accurate diagnoses.

4. Factors Underlying Abnormal Behaviour

Causes of psychological disorders are called etiological factors. They include biological, psychological, and social dimensions.

I. Biological Factors

• Genetic Influences: Many disorders run in families. Research shows genetic contribution to schizophrenia, mood disorders, and anxiety disorders.
• Neurotransmitter Imbalance: Abnormal levels of chemicals such as serotonin, dopamine, and GABA are linked to depression, schizophrenia, and anxiety disorders respectively.
• Brain Dysfunction: Structural abnormalities or injuries in brain areas like the frontal lobe or limbic system can affect emotions and behaviour.
• Hormonal Imbalance: Endocrine disturbances, such as excess thyroid hormone, may influence anxiety and mood.

II. Psychological and Interpersonal Factors

• Maternal Deprivation: Lack of early emotional bonding and care may lead to maladjustment in later life.
• Faulty Parent–Child Relationships: Overprotection, rejection, or inconsistent discipline can foster dependency, hostility, or low self-esteem.
• Maladaptive Family Structures: Families with high conflict, poor communication, or instability may contribute to the development of disorders.
• Stressful Life Events: Loss of loved ones, trauma, or chronic stress can precipitate psychological disorders.

III. Psychological Models or Theoretical Perspectives

• Psychodynamic Model: Proposed by Sigmund Freud; behaviour is influenced by unconscious conflicts between the id, ego, and superego. Unresolved conflicts may manifest as anxiety or depression.
• Behavioural Model: Suggests that both normal and abnormal behaviours are learned through classical and operant conditioning. Maladaptive behaviours can be unlearned by modifying reinforcement patterns.
• Cognitive Model: Focuses on distorted thinking patterns and irrational beliefs that produce maladaptive emotions and behaviours.
• Humanistic-Existential Model: Abnormal behaviour arises from the blockage of self-actualisation or the failure to find personal meaning in life.
• Diathesis-Stress Model: States that a predisposition (diathesis) combines with environmental stress to trigger a disorder.
• Socio-Cultural Model: Social factors like poverty, discrimination, or cultural expectations influence mental health.

5. Major Psychological Disorders

A. Anxiety Disorders

These disorders involve excessive and irrational fear, tension, and apprehension. Anxiety interferes with daily functioning.

• Generalised Anxiety Disorder (GAD): Persistent and chronic anxiety about various life events, accompanied by restlessness, muscle tension, and irritability.
• Panic Disorder: Sudden attacks of intense fear, heart palpitations, trembling, or choking sensations.
• Phobic Disorders: Unrealistic and intense fear of specific objects or situations such as animals, heights, or closed spaces.
• Social Anxiety Disorder: Intense fear of social situations, leading to avoidance of public performance or interactions.
• Obsessive–Compulsive Disorder (OCD): Involves persistent, unwanted thoughts (obsessions) and repetitive actions (compulsions) to relieve anxiety.
• Post-Traumatic Stress Disorder (PTSD): Occurs after experiencing traumatic events; symptoms include flashbacks, nightmares, emotional numbness, and hyperarousal.

B. Depressive and Mood Disorders

• Major Depressive Disorder: Deep sadness, hopelessness, loss of interest, fatigue, and thoughts of death or suicide lasting for weeks or months.
• Persistent Depressive Disorder (Dysthymia): Chronic low mood lasting at least two years.
• Mania: Elevated or irritable mood, overactivity, inflated self-esteem, decreased need for sleep.
• Bipolar Disorder: Alternating episodes of mania and depression, causing extreme mood swings.

C. Schizophrenia Spectrum Disorders

Severe and chronic disorders affecting thought, perception, and emotion. The person loses touch with reality (psychosis).

• Positive Symptoms: Hallucinations, delusions, disorganised thinking, and speech.
• Negative Symptoms: Emotional flatness, apathy, lack of motivation, and social withdrawal.
• Causes include genetic vulnerability, neurotransmitter imbalance (dopamine hypothesis), and psychosocial stressors.

D. Somatic Symptom and Related Disorders

These disorders involve physical symptoms without identifiable medical cause, resulting from psychological distress.

• Somatic Symptom Disorder: Multiple physical complaints causing distress or disruption.
• Conversion Disorder: Loss of motor or sensory function (e.g., blindness, paralysis) without physiological basis.
• Illness Anxiety Disorder: Preoccupation with having a serious illness despite medical reassurance.

E. Dissociative Disorders

• Dissociative Amnesia: Inability to recall important personal information, often after trauma.
• Dissociative Fugue: Sudden travel away from home with loss of identity and memory.
• Dissociative Identity Disorder: Existence of two or more distinct identities within the same individual.
• Depersonalisation/Derealisation Disorder: Persistent feeling of detachment from one’s body or surroundings.

F. Neurodevelopmental Disorders

• Autism Spectrum Disorder: Deficits in social communication and restricted, repetitive behaviours.
• Intellectual Disability: Significantly below-average intellectual functioning and adaptive behaviour.
• Attention Deficit Hyperactivity Disorder (ADHD): Inattention, impulsivity, and hyperactivity beyond developmental levels.

G. Disruptive, Impulse-Control and Conduct Disorders

• Oppositional Defiant Disorder (ODD): Persistent pattern of angry, argumentative, and defiant behaviour.
• Conduct Disorder: Violation of societal norms and rights of others (aggression, theft, destruction).
• Intermittent Explosive Disorder: Repeated outbursts of uncontrolled anger or aggression.

H. Eating Disorders

• Anorexia Nervosa: Restriction of food intake, intense fear of gaining weight, distorted body image.
• Bulimia Nervosa: Binge eating followed by compensatory behaviours like vomiting or fasting.
• Binge Eating Disorder: Recurrent episodes of excessive eating without purging.

I. Substance-Related and Addictive Disorders

• Substance Use Disorders: Maladaptive pattern of using substances leading to significant impairment (alcohol, drugs).
• Gambling Disorder: Persistent gambling behaviour despite harmful consequences.

6. Summary and Integration

Psychological disorders are complex and multifactorial, influenced by biological, psychological, and socio-cultural factors. Classification systems such as DSM and ICD help in diagnosis, communication, and research. Treatment involves an integrated approach using biological (medication, ECT), psychological (psychotherapy, cognitive-behavioural therapy), and social (supportive relationships, community programs) interventions.

Understanding abnormal behaviour helps reduce stigma and promotes empathy, early diagnosis, and effective management, contributing to overall mental health and well-being.