NCERT Solutions - Psychological Disorders

Q1: Identify the symptoms associated with depression and mania.
Ans: Symptoms associated with depression include marked change in body weight or appetite, persistent sleep problems (insomnia or oversleeping), constant tiredness or loss of energy, difficulty concentrating or making decisions, psychomotor agitation or retardation (restlessness or greatly slowed behaviour), and recurrent thoughts of death or suicide. Other common features are excessive feelings of guilt or worthlessness and loss of interest or pleasure in usual activities.
Symptoms associated with mania include an abnormally elevated or irritable mood, increased activity and energy, inflated self-esteem or grandiosity, decreased need for sleep, pressured or excessively talkative speech, distractibility, and engaging in risky or impulsive behaviours. These mood states typically produce noticeable changes in functioning at home, school, or work.

Q2: Describe the characteristics of children with hyperactivity.
Ans: Hyperactive children often meet the criteria for Attention-Deficit Hyperactivity Disorder (ADHD), which, if left unrecognised, can lead to academic and social difficulties. They commonly show externalising or disruptive behaviours. The two main feature clusters of ADHD are:

Inattention: These children have difficulty sustaining attention in tasks or play and often show:
(i) Difficulty listening or concentrating
(ii) Problems following instructions
(iii) Disorganisation and forgetfulness
(iv) Inability to finish assignments or chores
(v) Quickly losing interest in activities that are not stimulating

Hyperactivity-Impulsivity: Children may act without thinking and display high activity levels. Typical signs include:
(i) Fidgeting, squirming or an inability to sit still
(ii) Running or climbing in inappropriate situations
(iii) Excessive talking and interrupting others
(iv) Difficulty waiting for turns or controlling impulses

Parents and teachers often describe such children as being "driven by a motor." Boys are diagnosed with ADHD more frequently than girls, although girls may show more inattentive symptoms and therefore can be under-identified. Early recognition, structured routines, behavioural interventions and school support can help manage ADHD effectively.

Q3: What are the consequences of alcohol substance addiction?
Ans: Substance abuse and dependence produce a range of significant adverse consequences across several areas of life. Common consequences include:

• Damage to family and social relationships, leading to conflict, isolation or breakdown of support networks.
• Poor performance at school or work, absenteeism and job loss.
• Physical health problems (for example liver or cardiovascular damage in alcohol dependence) and increased risk of accidents or injury.
• Legal and financial difficulties arising from compulsive use or related behaviours.

In substance dependence, the person experiences a strong craving for the substance and shows tolerance, withdrawal symptoms and compulsive drug-taking. Tolerance means that increasing amounts of the substance are needed to achieve the same effect. Withdrawal refers to unpleasant physical and psychological symptoms that occur when the person reduces or stops the substance. Together these features make it difficult to stop using the substance despite harmful consequences.

Q4: Can a distorted body image lead to eating disorders? Classify the various forms of it.
Ans: Yes, a distorted body image can lead to eating disorders. The main forms of eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder:
(i) Anorexia nervosa: The individual has a distorted perception of being overweight despite being underweight. They may refuse to eat, engage in excessive exercise, or develop rigid eating rituals (for example avoiding eating with others). Severe weight loss and starvation can result, and in extreme cases this may be life-threatening.
(ii) Bulimia nervosa: The person has recurrent episodes of eating very large amounts of food (bingeing) followed by attempts to rid the body of the food, for example by self-induced vomiting, misuse of laxatives or diuretics, fasting or excessive exercise. Feelings of shame, guilt and loss of control commonly follow binge episodes.
(iii) Binge eating disorder: This disorder involves repeated episodes of eating large amounts of food in a short time while feeling a loss of control, but unlike bulimia there are no regular compensatory behaviours such as purging. Binge eating disorder often leads to distress, weight gain and health problems related to overeating.
Early identification and psychological support are important in treating eating disorders and improving physical and emotional recovery.

Q5: "Physicians make diagnosis looking at a person's physical symptoms". How are psychological disorders diagnosed?
Ans: Psychological disorders are diagnosed using a comprehensive approach that goes beyond physical symptoms. Common methods include careful observation, clinical interviews, psychological assessment and, where appropriate, medical tests to rule out organic causes. Historically, abnormal behaviour was sometimes attributed to supernatural forces, but modern practice recognises multiple interacting causes. Two broad perspectives are:

• Biological approach: Suggests that many disorders have biological roots, such as genetic factors or brain chemistry, and that medical interventions can sometimes correct or reduce symptoms.
• Psychological approach: Emphasises patterns of thought, emotion and learning that contribute to difficulties.

The American Psychiatric Association (APA) publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which classifies disorders and provides diagnostic criteria. In India and many other countries clinicians also use the International Classification of Diseases (ICD-10) from the World Health Organisation (WHO), which offers clinical descriptions and guidelines. A modern diagnosis typically considers biological, psychological and social factors together - for example family history, current life stressors, symptom severity, duration and the degree of functional impairment - before reaching a conclusion.

Q6: Distinguish between obsessions and compulsions.
Ans: Obsessions are intrusive, unwanted and persistent thoughts, images or urges that the person finds distressing or shameful and cannot easily dismiss. For example, recurrent thoughts about contamination or fears of harming others.
Compulsions are repetitive behaviours or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules (for example repeated hand washing, checking, counting or repeating words silently). Compulsions are performed to reduce anxiety or prevent a feared outcome, but they provide only temporary relief and interfere with daily life. People with Obsessive-Compulsive Disorder (OCD) typically experience both obsessions and compulsions, and struggle to control them despite recognising that they are excessive.

Q7: Can a long-standing pattern of deviant behaviour be considered abnormal? Elaborate.
Ans: The concept of abnormal behaviour can be approached in more than one way. Two common perspectives are:
Deviation from social norms: Behaviour may be considered abnormal if it significantly departs from the norms and expectations of a society. Norms are shaped by culture, history and shared values, so what is abnormal in one culture may be acceptable in another. For example, expressions of aggression may be viewed differently across societies. As societies change, so do their ideas about normal and abnormal behaviour.
Maladaptive behaviour: Another approach defines abnormality in terms of whether behaviour interferes with an individual's ability to function, grow and meet basic needs. Maladaptive actions hinder personal well-being and social functioning. For instance, a student who cannot ask questions because of extreme anxiety may be displaying maladaptive behaviour that limits learning and development.
Most modern definitions combine several features, often called the four Ds:

• Deviance: Unusual or statistically rare behaviour.
• Distress: Behaviour that causes significant suffering to the person or others.
• Dysfunction: Behaviour that impairs daily functioning at work, school or in relationships.
• Danger: Behaviour that poses risk of harm to self or others.

Thus, a long-standing pattern of deviant behaviour may be classed as abnormal if it causes distress, dysfunction or danger in addition to being deviant from social norms.

Q8: While speaking in public the patient changes topics frequently, is this a positive or a negative symptom of schizophrenia? Describe the other symptoms and sub-types of schizophrenia.
Ans: Changing topics frequently while speaking (loose or disorganised speech) is a positive symptom of schizophrenia because it reflects a pathological excess or addition to normal functioning, namely disorganised thinking and speech.

• Positive symptoms: These are pathological excesses, for example delusions (false, fixed beliefs), disorganised thinking and speech, heightened perceptual experiences and hallucinations (seeing or hearing things that are not present), and inappropriate affect (emotional responses that do not fit the situation).
• Negative symptoms: These are deficits or losses of normal functions, such as poverty of speech (alogia), blunted or flat affect (reduced emotional expression), loss of volition or motivation (avolition), and social withdrawal. Negative symptoms lead to reduced initiative and poorer social functioning.

Sub-types of schizophrenia: According to DSM-IV-TR, subtypes included:

• Paranoid type: Dominated by delusions or auditory hallucinations, with relatively preserved organisation and affect.
• Disorganised type: Marked by disorganised speech and behaviour and inappropriate or flat affect.
• Catatonic type: Characterised by marked motor disturbances, such as stupor, rigidity, extreme negativism or excessive purposeless activity.
• Undifferentiated type: Symptoms meet general criteria for schizophrenia but do not fit a specific subtype.
• Residual type: Previous episodes of schizophrenia with no prominent positive symptoms at present, but with lingering negative or mild symptoms.

Q9: What do you understand by the term 'dissociation'? Discuss its various forms.
Ans: Dissociation refers to a disruption in the normal integration of consciousness, memory, identity or perception of the self and environment. It often serves as a way to block out or distance oneself from traumatic or overwhelming experiences. Sudden, temporary alterations of consciousness that remove painful memories or feelings are characteristic of dissociative disorders. 
Major forms include:
(i) Dissociative amnesia: Selective but extensive memory loss for important personal information, usually following severe stress or trauma. Memory for other matters may remain intact.
(ii) Dissociative fugue: Involves unexpected travel away from home or work, adopting a new identity, and inability to recall one's past. The fugue typically ends abruptly with partial or full recovery of memory for pre-fugue identity.
(iii) Dissociative identity disorder: Formerly called multiple personality disorder; the person displays two or more distinct identity states or personality fragments, often linked to severe childhood trauma. The alternate identities may have different memories, behaviours and ways of relating.
(iv) Depersonalisation disorder: The individual experiences persistent or recurrent feelings of unreality or detachment from oneself (as if observing oneself from outside), and/or derealisation, where the external world feels unreal. These experiences are distressing but insight into their unreality is often preserved.

Q10: What are phobias? If someone had an intense fear of snakes, could this simple phobia be a result of faulty learning? Analyse how this phobia could have developed.
Ans: Phobias are intense, irrational fears of specific objects, situations or activities that lead to avoidance and significant distress. They are commonly classified as:

• Specific phobias: Fear of particular animals, objects or situations (for example snakes, heights).
• Social phobia: Marked fear of social situations and potential embarrassment.
• Agoraphobia: Fear of unfamiliar situations or places where escape might be difficult.

If someone has an intense fear of snakes, this specific phobia can develop through learning processes. Faulty learning mechanisms that may contribute include:

• Classical conditioning: A neutral stimulus (a snake) becomes associated with a frightening event (for example being bitten or seeing someone panic), producing a learned fear response.
• Modelling (observational learning): Observing a parent or significant other react with fear to snakes can teach the child to fear them.
• Information transmission: Hearing alarming stories or warnings about snakes from others can create or heighten fear.

Other contributing factors include a general tendency to anxiety, repeated negative encounters with snakes, or evolutionary preparedness that makes humans more likely to fear certain animals. Thus, faulty learning can play a central role, often interacting with biological and cognitive factors in the development of a phobia.

Q11: Anxiety has been called the "butterflies in the stomach" feeling. At what stage does anxiety become a disorder? Discuss its types.
Ans: Anxiety becomes a disorder when it is excessive or persistent, not proportionate to the situation, and interferes with daily functioning or causes marked distress. Normal anxious feelings are short-lived and situation-specific, but an anxiety disorder involves ongoing worry, physiological symptoms and avoidance that harm work, study, relationships or health. Common symptoms include rapid heartbeat, shortness of breath, dizziness, sweating, sleep disturbance, trembling and gastrointestinal upset.
Different types of anxiety disorders include:

• Generalised Anxiety Disorder (GAD): Persistent, excessive worry about multiple life domains (for example health, work or family) that is difficult to control and lasts for months.
• Panic Disorder: Recurrent, unexpected panic attacks - sudden episodes of intense fear accompanied by physical symptoms such as palpitations, chest pain, breathlessness and fears of losing control or dying.
• Obsessive-Compulsive Disorder (OCD): Marked by obsessions (intrusive thoughts) and compulsions (repetitive behaviours or mental acts) performed to reduce anxiety, which impair functioning.
• Phobias: Specific phobias (fear of animals, heights, needles), social phobia (fear of social situations) and agoraphobia (fear of being in places where escape may be difficult).
• Separation Anxiety Disorder: Excessive distress when separated from attachment figures, beyond what is typical for the person's developmental stage.

Early recognition and appropriate treatment - psychological therapies, lifestyle changes and, where indicated, medication - can reduce symptoms and restore functioning.