Class 12 Physology Notes Chapter 4 (Psychological Disorders) – Physocology Book

Alright class, let's delve into Chapter 4: Psychological Disorders. This is a crucial chapter, not just for your exams but also for understanding human behaviour and mental health. Pay close attention as we break down the concepts.

Chapter 4: Psychological Disorders - Detailed Notes for Exam Preparation

1. Concept of Abnormality and Psychological Disorders

• Definition: Psychological disorders are patterns of behavioural or psychological symptoms that cause significant personal distress, impair the ability to function in one or more important areas of life (dysfunction), or both. They deviate from societal norms.
• Abnormality: Often conceptualized using the "Four Ds":
  • Deviance: Behaviour, thoughts, and emotions that differ markedly from a society's ideas about proper functioning. Norms vary across cultures.
  • Distress: The behaviour or thoughts cause significant unhappiness or torment to the individual.
  • Dysfunction: Interferes with daily functioning (work, social life, self-care).
  • Danger: Behaviour becomes dangerous to oneself or others (though this is less common than the other Ds).
• Historical Background (Brief):
  • Supernatural: Attributed disorders to evil spirits, demons, witchcraft. Treatments included exorcism, trephination.
  • Biological/Organic: Viewed disorders as diseases with physical causes (e.g., Hippocrates' humoral theory). Led to institutionalization, often inhumane.
  • Psychological: Emphasized psychological factors like stress, conflict, maladaptive learning.
  • Interactional/Bio-psycho-social Approach: Contemporary view; disorders arise from an interaction of biological (genetic, neurological), psychological (cognitive, emotional, personality), and social/cultural factors.

2. Classification of Psychological Disorders

• Purpose: Provides a common language for clinicians and researchers, aids in diagnosis, helps predict course, suggests appropriate treatment, and facilitates research.
• Major Systems:
  • DSM (Diagnostic and Statistical Manual of Mental Disorders): Published by the American Psychiatric Association (APA). Currently DSM-5. Widely used in the US and globally for research. Provides diagnostic criteria.
  • ICD (International Classification of Diseases): Published by the World Health Organization (WHO). Currently ICD-11. Used globally for mortality and morbidity statistics, including mental disorders. India primarily follows ICD.
• Key Point: Classification involves identifying specific symptoms that cluster together (syndromes) and meet defined criteria. It is descriptive, not explanatory (doesn't explain why the disorder occurs).

3. Factors Underlying Abnormal Behaviour (Models/Perspectives)

• Biological Factors:
  • Neurotransmitters: Imbalances (e.g., low serotonin in depression, excess dopamine in schizophrenia).
  • Genetic Factors: Predisposition or vulnerability inherited. Not deterministic, but increases risk.
  • Brain Structure & Function: Abnormalities in specific brain regions (e.g., amygdala in anxiety).
  • Endocrine System: Hormonal imbalances.
• Psychological Factors:
  • Psychodynamic Model (Freud): Unresolved unconscious conflicts, often rooted in early childhood experiences. Fixations at psychosexual stages. Role of id, ego, superego.
  • Behavioural Model: Abnormal behaviour is learned through conditioning (classical, operant) or modelling/observation. Faulty learning patterns.
  • Cognitive Model: Maladaptive thinking patterns, irrational beliefs, distorted perceptions, faulty assumptions cause disorders. (e.g., Beck's cognitive triad in depression).
  • Humanistic-Existential Model: Focuses on broader dimensions of human existence – self-awareness, free will, search for meaning. Abnormality arises from blockage of self-actualization (Rogers) or failure to find meaning/take responsibility (Existentialists).
• Socio-Cultural Factors:
  • Societal roles, expectations, family structure, social networks, socioeconomic status, cultural norms, discrimination, and societal labels influence vulnerability and expression of disorders.
• Diathesis-Stress Model:
  • Diathesis: Pre-existing vulnerability (biological predisposition, psychological trait).
  • Stress: Triggering event or condition (environmental or psychological stressor).
  • Interaction: Disorder develops only when the diathesis combines with sufficient stress. Explains why not everyone with a predisposition develops a disorder.

4. Major Psychological Disorders (Based on NCERT/Common Classifications)

• (A) Anxiety Disorders: Characterized by excessive fear, anxiety, and related behavioural disturbances.

  • Generalized Anxiety Disorder (GAD): Persistent, excessive, vague, and uncontrollable worry about numerous events or activities. Symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.
  • Panic Disorder: Recurrent, unexpected panic attacks – abrupt surges of intense fear or discomfort peaking within minutes. Symptoms: palpitations, sweating, trembling, shortness of breath, choking feeling, chest pain, nausea, dizziness, fear of losing control or dying, derealization/depersonalization. Often accompanied by agoraphobia (fear of situations where escape might be difficult).
  • Phobias: Irrational, persistent fear of a specific object, activity, or situation.
    • Specific Phobias: Fear of animals, heights, blood, injections, etc.
    • Social Anxiety Disorder (Social Phobia): Intense fear of social situations involving possible scrutiny by others. Fear of embarrassment or humiliation.
    • Agoraphobia: Fear of public places or situations from which escape might be difficult or help unavailable if panic-like symptoms occur.
  • Obsessive-Compulsive Disorder (OCD): [Note: DSM-5 classifies it separately, but often discussed near anxiety]
    • Obsessions: Recurrent, persistent, intrusive thoughts, urges, or images causing anxiety/distress.
    • Compulsions: Repetitive behaviours (e.g., hand washing, checking) or mental acts (e.g., counting, praying) performed in response to an obsession or according to rigid rules, aimed at reducing distress (but often ineffective or excessive).
  • Post-Traumatic Stress Disorder (PTSD): [Note: DSM-5 classifies it under Trauma- and Stressor-Related Disorders] Develops after exposure to a traumatic event (actual/threatened death, serious injury, sexual violence). Symptoms: Re-experiencing the trauma (flashbacks, nightmares), avoidance of stimuli associated with the trauma, negative alterations in cognitions and mood, marked alterations in arousal and reactivity (hypervigilance, exaggerated startle response).

• (B) Somatic Symptom and Related Disorders: Psychological distress manifests as physical symptoms without adequate medical cause.

  • Somatic Symptom Disorder: One or more distressing somatic symptoms plus excessive thoughts, feelings, or behaviours related to them (e.g., excessive worry, time/energy devoted).
  • Illness Anxiety Disorder: Preoccupation with having or acquiring a serious illness despite mild or no somatic symptoms. High health anxiety, excessive health-related behaviours or maladaptive avoidance. (Formerly Hypochondriasis).
  • Conversion Disorder (Functional Neurological Symptom Disorder): One or more symptoms of altered voluntary motor or sensory function (e.g., paralysis, blindness, mutism) incompatible with recognized neurological/medical conditions. Psychological factors judged to be associated.

• (C) Dissociative Disorders: Disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour. Often linked to trauma.

  • Dissociative Amnesia: Inability to recall important autobiographical information, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting. May involve dissociative fugue (apparently purposeful travel or bewildered wandering associated with amnesia for identity or other important autobiographical information).
  • Dissociative Identity Disorder (DID): Disruption of identity characterized by two or more distinct personality states ('alters'). Recurrent gaps in recall of everyday events, personal information, or traumatic events. (Formerly Multiple Personality Disorder).
  • Depersonalization/Derealization Disorder: Persistent or recurrent experiences of:
    • Depersonalization: Feeling detached from, or an outside observer of, one's thoughts, feelings, sensations, body, or actions (e.g., feeling unreal, like a robot).
    • Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects experienced as unreal, dreamlike, foggy). Reality testing remains intact.

• (D) Depressive Disorders: Presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes significantly affecting functioning.

  • Major Depressive Disorder (MDD): Depressed mood or loss of interest/pleasure (anhedonia) for at least 2 weeks, plus other symptoms like significant weight loss/gain, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue, feelings of worthlessness/guilt, diminished concentration, recurrent thoughts of death/suicide.

• (E) Bipolar and Related Disorders: Characterized by shifts in mood between depression and mania/hypomania.

  • Mania: Distinct period of abnormally elevated, expansive, or irritable mood, and increased goal-directed activity/energy, lasting at least 1 week. Symptoms: Inflated self-esteem/grandiosity, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal-directed activity, excessive involvement in risky activities. Causes significant impairment.
  • Hypomania: Similar to mania but less severe, shorter duration (at least 4 days), not causing significant impairment in functioning, no psychotic features.
  • Bipolar I Disorder: Occurrence of at least one manic episode (may also have hypomanic or major depressive episodes).
  • Bipolar II Disorder: Occurrence of at least one hypomanic episode AND at least one major depressive episode. No history of a full manic episode.

• (F) Schizophrenia Spectrum and Other Psychotic Disorders: Characterized by delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behaviour (including catatonia), and negative symptoms. Significant functional impairment.

  • Symptoms:
    • Positive Symptoms (Excess/Distortion):
      • Delusions: Fixed, false beliefs resistant to evidence (e.g., persecution, grandeur, reference).
      • Hallucinations: Sensory experiences without external stimuli (auditory most common, visual, tactile, olfactory, gustatory).
      • Disorganized Thinking/Speech: Loose associations, incoherence, tangentiality.
      • Grossly Disorganized or Abnormal Motor Behaviour: Childlike silliness, unpredictable agitation, catatonia (marked decrease in reactivity to environment).
    • Negative Symptoms (Deficit/Loss):
      • Diminished Emotional Expression (Affective Flattening): Reduced expression via face, eye contact, intonation.
      • Avolition: Decrease in motivated, self-initiated purposeful activities.
      • Alogia: Diminished speech output.
      • Anhedonia: Decreased ability to experience pleasure.
      • Asociality: Lack of interest in social interactions.
  • Note: Older subtypes (paranoid, disorganized, catatonic, undifferentiated, residual) are no longer used in DSM-5 but might be mentioned in older texts/NCERT. Focus is now on symptom dimensions.

• (G) Neurodevelopmental Disorders: Manifest early in development, often before school entry. Characterized by developmental deficits producing impairments in personal, social, academic, or occupational functioning.

  • Attention-Deficit/Hyperactivity Disorder (ADHD): Persistent pattern of inattention and/or hyperactivity-impulsivity interfering with functioning/development.
  • Autism Spectrum Disorder (ASD): Persistent deficits in social communication/interaction across contexts; restricted, repetitive patterns of behaviour, interests, or activities.
  • Intellectual Disability (Intellectual Developmental Disorder): Deficits in intellectual functions (reasoning, problem-solving, planning, abstract thinking, academic learning) and adaptive functioning (conceptual, social, practical skills).

• (H) Disruptive, Impulse-Control, and Conduct Disorders: Problems in self-control of emotions and behaviours, violating rights of others or bringing individual into conflict with societal norms/authority figures.

  • Oppositional Defiant Disorder (ODD): Pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness.
  • Conduct Disorder: Repetitive, persistent pattern of behaviour violating basic rights of others or major age-appropriate societal norms/rules (aggression to people/animals, destruction of property, deceitfulness/theft, serious rule violations).

• (I) Feeding and Eating Disorders: Persistent disturbance of eating or eating-related behaviour resulting in altered consumption/absorption of food, significantly impairing physical health or psychosocial functioning.

  • Anorexia Nervosa: Restriction of energy intake leading to significantly low body weight; intense fear of gaining weight/becoming fat; disturbance in body image perception.
  • Bulimia Nervosa: Recurrent episodes of binge eating (eating large amounts in discrete period with loss of control) followed by recurrent inappropriate compensatory behaviours to prevent weight gain (vomiting, laxatives, excessive exercise). Self-evaluation unduly influenced by body shape/weight.
  • Binge-Eating Disorder: Recurrent episodes of binge eating, associated with distress, but without the recurrent inappropriate compensatory behaviours seen in bulimia.

• (J) Substance-Related and Addictive Disorders: Cognitive, behavioural, and physiological symptoms indicating continued use despite significant substance-related problems. Involves underlying change in brain circuits persisting beyond detoxification. Includes alcohol, opioids (heroin), stimulants (cocaine), cannabis, hallucinogens, tobacco, etc. Key concepts: Tolerance, Withdrawal.

Key Takeaway: Psychological disorders are complex conditions arising from an interplay of factors. Understanding them helps reduce stigma and encourages seeking appropriate help. Diagnosis should be done by qualified professionals.

Multiple Choice Questions (MCQs)

1. Which of the following is NOT typically considered one of the "Four Ds" used to define abnormality?
   (a) Deviance
   (b) Distress
   (c) Diagnosis
   (d) Dysfunction

2. The classification system for mental disorders published by the World Health Organization (WHO) and commonly used in India is:
   (a) DSM-5
   (b) ICD-11
   (c) PDM
   (d) RDoC

3. The Diathesis-Stress model proposes that psychological disorders result from:
   (a) Primarily biological factors
   (b) Learned maladaptive behaviours only
   (c) An interaction between predisposition and stressful life events
   (d) Unresolved unconscious conflicts from childhood

4. A person experiencing persistent, excessive, and uncontrollable worry about various aspects of life, along with symptoms like restlessness and muscle tension, is likely suffering from:
   (a) Panic Disorder
   (b) Specific Phobia
   (c) Generalized Anxiety Disorder (GAD)
   (d) Obsessive-Compulsive Disorder (OCD)

5. Recurrent, intrusive thoughts are known as ______, while repetitive behaviours performed to reduce anxiety are called ______.
   (a) Compulsions; Obsessions
   (b) Obsessions; Compulsions
   (c) Delusions; Hallucinations
   (d) Hallucinations; Delusions

6. A person who experiences physical symptoms (like paralysis or blindness) with no identifiable medical cause, often following a stressful event, might be diagnosed with:
   (a) Illness Anxiety Disorder
   (b) Somatic Symptom Disorder
   (c) Conversion Disorder
   (d) Dissociative Identity Disorder

7. Which disorder is characterized by distinct periods of elevated mood (mania or hypomania) alternating with periods of depression?
   (a) Major Depressive Disorder
   (b) Schizophrenia
   (c) Bipolar Disorder
   (d) Dissociative Amnesia

8. Positive symptoms of Schizophrenia include all of the following EXCEPT:
   (a) Hallucinations
   (b) Delusions
   (c) Disorganized Speech
   (d) Avolition (lack of motivation)

9. Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and distorted body image are characteristic features of:
   (a) Bulimia Nervosa
   (b) Binge-Eating Disorder
   (c) Anorexia Nervosa
   (d) Pica

10. The behavioural model explains psychological disorders primarily as a result of:
    (a) Imbalances in neurotransmitters
    (b) Faulty learning and conditioning
    (c) Irrational thoughts and beliefs
    (d) Blocked self-actualization

Answer Key for MCQs:

1. (c) Diagnosis
2. (b) ICD-11
3. (c) An interaction between predisposition and stressful life events
4. (c) Generalized Anxiety Disorder (GAD)
5. (b) Obsessions; Compulsions
6. (c) Conversion Disorder
7. (c) Bipolar Disorder
8. (d) Avolition (lack of motivation) - This is a negative symptom.
9. (c) Anorexia Nervosa
10. (b) Faulty learning and conditioning

Make sure you revise these concepts thoroughly. Understanding the core features, classifications, and underlying factors for each disorder is essential for your exams. Let me know if any part needs further clarification.