Chapter 9

Abnormal Psychology (Mild to

moderate Psychological
Problems)
Abnormal Psychology Concepts & Criteria of
Normality versus Abnormality
 Definition of Abnormal Psychology
 It is a scientific study of abnormal
behavior which is called “Abnormal
Psychology”.
 Criteria or Objective Standards for defining
abnormality.
 1. Unusualness
 2. Discomfort
 3. Mental Illness Criteria
 4. Mal-adaptiveness
Differences between Neurosis
and Psychosis
 Anxiety Disorders
 The term “anxiety” is usually defined as a diffuse,
vague very unpleasant feelings of fear and
apprehension.

 The anxious person worries a lot particularly about

unknown dangers, about possible future events and
outcomes or catastrophic interpretations of past
events. In addition the anxious person shows the
combination of the following symptoms such as rapid
heart rate, shortness of breath, diarrhea, loss of
appetite, fainting, dizziness, sweating, sleeplessness,
frequent urination and tremors.

 All these symptoms accompany fear, however fear

and anxiety are different from one another.
 Common Anxiety Symptoms Indicative Of
High Anxiety
 Nervousness
 Tension
 Feeling Tired
 Dizziness
 Frequent urination or defecation
 Heart Palpitations
 Feeling Faint
 Breathlessness
 Sweating
 Trembling
 Worry and Apprehension
 Sleeplessness
 Difficulty in Concentrating
 Hypervigilance
 Role of Psychological Factors
(Stress) in Heart Diseases
 Heart Disease is the predominant cause of death
and disability all over the world. Out of various
categories Ischemic Heart Diseases (IHD) is
responsible for the great majority of deaths.
 IHD is the narrowing of the arteries. In this
disease four of the syndromes can occur, which
are:-
• Myocardial Infarction (Heart Attack)
• Angina Pectoris
• Chronic Ischemic heart Diseases and
• Sudden Cardiac Death (it may be superimposed on any
of the above three conditions)
 Risk Indicators

 Age
 Sex
 Socioeconomic status
 Elevated Blood Pressure
 Cigarette smoking
 Dietary habits
 Obesity
 Blood lipids
 Intense Behavioral Activation
 Work Overload
 Chronic troubling emotions
 Precursors Of Infarction
 Psychodynamic Precursors
• Psycho-dynamically the personality of a heart
patient is defined as extremely ambitious,
compulsive, active but aggressive, anxious, less
productive, limited creativity, guilt and inner
tension, un-controlling and violent emotional
responses, unstable moods and feelings, oral
dependence, strives excessively to achieve
goals incorporating power and prestige.
 Psychological Precursors
• The other psychosocial factors have also been
identified such as occupational stress as a
major risk factor in heart ailment. The factors
are the same as already discussed.
 Physiological Precursors
• I.e. if we allow ourselves to make extra
efforts and struggle beyond the level of health
fatigue then we are on the down slope the
extra effort increases the arousal and carries
us further down. This gap between what we
actually can do and what we do aggravates
exhaustion.
• This exhaustion and the internalized emotions
of frustration, defeat, despair and anxiety are
dangerous for the individual’s health.
 Cardiological views
• Many cardiologists have directly excessive
tiredness before M. I. ( Myocardial Infarction).
 The Interraction Of Psychological And
Physiological Precursors
 Many cardiologists and psychologists have together
investigated and found certain precursors or symptoms of
M.I. and sudden cardiac death and they term this condition
as “vital exhaustion”.
 The following items of vital exhaustion are found to be
predictive of Myocardial Infarction (heart Attack)
 Often tired
1. Have trouble failing asleep
2. Often wake up during the night
3. Feel weak
4. Feel as though I am not accomplishing much
5. Have difficulties coping with everyday problems
6. Believe to have come to a dead end
7. Feel listless
09. Sexual interest lessened
10. Feel hopeless
11. Have difficulty in grasping a new problem
12. Easily irritated
13. Want to give up trying
14. Feel fine (no)
15. Body is like a battery that is losing its power
16. Want to be dead at times
17. Just don’t have what it takes anymore
18. Feel dejected
19. Feel like crying
20. Wake up exhausted
21. Have difficulty in concentrating
22. Have strange bodily sensations
23. Shrink from regular work
24. Have spells of shaking and trembling all over
 Types of Anxiety Disorders
 Panic
 Phobia
 Generalized Anxiety Disorder
 Obsessive-Compulsive Disorders
 Post-traumatic Stress Disorder
(PTSD)
 Generalized Anxiety Disorder
(GAD)
 The clinical / diagnostic features of generalized
anxiety disorder include excessive anxiety and
worry occurring for at least 6 months and
individual has inability to control over it.
 3 or more of the following symptoms are present
in GAD in case of children it is just 1. The
symptoms are restlessness, feeling on edge,
being easily fatigued, difficulty concentrating,
mind goes blank, irritability, muscle tension,
sleep disturbance, considerable distress or
impairment in social occupational or other
important areas of life.
 Phobia
 Fear is the feeling of anxiety and agitation in
response to a threat. But phobias are irrational
and exaggerated fear of some objects or
situation.
 Different phobias appear at different ages.
 Phobic individuals do not need the actual
presence of feared object or situation to
experience intense tension and discomfort.
 Phobias are grouped into three categories.
 Specific phobia
 Social phobia
 Agoraphobia
 Specific Phobia
 It is an intense irrational fear of objects,
places or situations, e.g. intense fear of
particular animal.
 Three kinds of responses i.e. fear,
avoidance or anxious anticipation are
implicit in phobia.
 Diagnosis of phobia not appropriate if
fear is reasonable.
 Insight tends to increase with age and
maturity.
 SUB-TYPES OF SPECIFIC PHOBIA
1. Animal Type (Insects or animals)
- Childhood onset, zoophobia
2. Natural Environment Type (storms,
heights or water).
_ Childhood onset,
_ Astraphobia (storms, thunder,
lightening)
_Acrophobia (high places)
_ Hydrophobia or aqua phobia (water)
3. Blood-Injection-Injury Type
_ Algophobia (Pain)
_ Hematophobia (Blood)
_ Pathophobia (Disease)
 4. Situational Type (specific situation, e.g.
tunnel, public transportation, elevators, fire, crowd
etc)
- Claustrophobia (closed places)
- Ocholophobia (Crowds)
- Nyctophobia (Darkness)
- Pyrophobia (Fire)
- Agoraphobia (fear or avoidance of a place or
situation from where escape is difficult or
embarrassing or in which help may not be
available, it is also fear of being alone or away
from the security of home)
5. Other types
- Mysophobia (vomiting, catching an illness)
- Spacephobia (fear of falling down)
- Philophobia (Fear of falling in love)
- Children’s fear of loud sounds or costumed
characters
 5. Social Phobia or Social Anxiety Disorder
 Shyness is not the same as Social phobia.
 This phobia is marked and persistent fear across
social or performance situations.
 The personal life of these individuals is often
typically bleak, because they have no friends.
 Also called fear of interpersonal relationship.
There is fear of criticism, fear of assertion, of
making a mistake and fear of public speaking.
 These are the people who are hypersensitive to
criticism, low self-esteem, negative evaluation or
rejection of themselves, feelings of inferiority etc.
 Panic Attack
 It’s a disorder identified by sudden, overwhelming apparently
senseless terror. It comes without any warning is chronic and
debilitating condition.

 The indicators of panic attack / disorder are similar to those of

generalized anxiety disorder except that they are greatly
magnified and usually have a sudden onset.

 The attack usually develops in 10 minutes or less, however there

is a range in length from few seconds to many hours even up to
days and even months. The attacks also differ in severity.

 In panic attack at least 4 of the following 13 somatic or cognitive

symptoms should be present.


 They are palpitations pounding heart or accelerated heart rate,

sweating, trembling or shaking, sensations of shortness of breath,
feelings of choking, chest pain or discomfort, nausea or abdominal
distress, feeling dizzy, unsteady or fainted, de-realization /
depersonalization, fear of losing control or going crazy, fear of
dying, numbness or tingling sensations, chills of hot flushes
 Obsessive-Compulsive Disorder
(OCD)
 The essential features of Obsessive Compulsive Disorder are
recurrent and unwanted thoughts (i.e. obsessions) and or
unwanted rituals or behaviors (i.e. Compulsions) that are
severe enough to be time consuming i.e. they take more than
one hour in a day, also they are so severe as to cause marked
distress or significant impairment.
 The disorder can result in both children and adults. However as
adults mature they gain insight into unreasonableness of their
problem, where as children are not that aware.
 Presentations of OCD in children is similar to that of adults.
 OCD should not be mixed with Obsessive Compulsive
Personality, both are different however OCPD and OCD can
occur in the same individual.
 Obsessions can occur in several forms such as follows:-
 Obsess ional Ruminations- These are internal debates in
which argument for and against even for the simplest every
day actions are reviewed endlessly, such as turning off a gas
tap or securing a door etc.
 Obsess ional Impulses- These are urges to
perform acts usually of a violent or
embarrassing kind for example injuring hitting
a child, shouting irrelevantly bad words in
front of public etc.
 Obsessional phobias – Obsessional phobias
are obsessional thoughts with a fearful
content such as fear of harming others, fear
of harming ones own self, fear of doing
something embarrassing, fear of acting on
criminal impulse, fear that something terrible
might happen (death of a relative / friend,
fear of being held responsible for something
going wrong etc etc
 Contamination Obsession- Concern or disgust
with wastes, secretions (urine, faeces and
saliva) dirt or germs.
 Sexual Obsession-Forbidden or perversive
thoughts or images involving children,
animals, bestiality, homosexuality etc.
 Obsession with a need for symmetry,
exactness or order e.g. intrusive images
sound words music, lucky / unlucky numbers
etc
 Compulsion types
 Checking Ritual-
 Washing Ritual-
 Dressing Ritual-
 Counting Ritual-
 Ordering / Arranging Ritual
 Hoarding / Collecting Compulsion
 Post Traumatic Stress Disorder
(PTSD)
 This disorder follow extreme traumatic
experiences such as natural catastrophe
e.g. recent earth quake, physical assault,
serious car crash etc etc.
 The trauma range from those that are
directly experienced to those that are
witnessed
 Three kinds of essential characteristics or
symptoms appear i.e. hyperarousal,
avoidance and reexperience.
 Interpreting Anxiety Disorders
 Anxiety the single commonest factor among all these
disorders
 Psychodynamic Perspective
 Conflict between intra psychic events and unconscious
motivation.
 Dominant super-ego over other areas of personality
 Behavioral Perspective
 Anxiety a learned or acquired response or behavior. The
concepts such as conditioning, reinforcement,
extinction, modeling etc all apply to anxiety disorders.
 Cognitive Perspective
 Anxiety is due to errors in thinking, unrealistic
appraisals of situations and consistent over estimation
of their dangerous aspects.
 Adjustment disorder
 Adjustment disorder (AD) is a
psychological response from an
identifiable stressor or group of stressors
that causes significant emotional or
behavioral symptoms that does not meet
criteria for more specific disorders.
 The condition is different from
anxiety disorder which lacks the presence
of a stressor, or
post-traumatic stress disorder and
acute stress disorder which usually are
associated with a more intense stressor.
 Risk Factors
 Factors that are intrinsic toward the
development of Adjustment Disorder
include age, gender, ego
development, past experiences and
coping skills.
 Grief
 Grief is a multi-faceted response to loss,
particularly to the loss of someone or
something to which we have formed a
bond.
 Common to human experience is the
death of a loved one, whether it be a
friend, family, or other companion. The
word bereavement often refers to the
state of loss, and grief to the reaction to
loss.
 Communication disorder

 A communication disorder - speech and

language disorders which refer to
problems in communication and in related
areas such as oral motor function. The
delays and disorders can range from
simple sound substitution to the inability
to understand or use language.
Disorder of written expression
 Disorder of written expression is a condition
characterized by poor writing skills.
 Symptoms include
 Avoids written work.
 Poor spelling
 Errors in grammar
 Errors in punctuation
 Poor handwriting
 Composition is poor relative to oral expression
skills; uses simple vocabulary to avoid spelling
difficulty.
 Conduct disorder
 Conduct disorder is a psychiatric
category marked by a pattern of repetitive
behavior wherein the rights of others or
social norms are violated.
 If at least one criterion is present in the
past 6 months such as following then it is
conduct disorder:
• Aggression to people and animals
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules
 The disturbance in behavior causes
significant impairment in social,
academic, or occupational
functioning.
 If the individual is age 18 years or
older, criteria are met for
Antisocial personality disorder.
 Bullying
 Bullying is repeated acts over time that
involves a real or perceived imbalance
of power with the more powerful child
or group attacking those who are less
powerful.
 Bullying can be verbal harassment,
physical assault, or other more subtle
methods of coercion such as
manipulation. Bullying can be defined in
many different ways.
 Bullying can occur in any setting
where human beings interact with
each other.
 Types of bullying
 School bullying
 Workplace bullying
 Cyberbullying
 Political bullying
 Military bullying
 Intermittent Explosive Disorder
 The diagnosis of intermittent explosive disorder is
given to children and adults who for the most part
hold their temper in and then suddenly reach a
point where they explode in anger. Often this
happens to the great surprise of the person as
well as those around him or her. No reasoning will
calm them and no consequence will deter them.
 In DSM-IV the diagnostic criteria for intermittent
explosive disorder are as follows:-
• Several discrete episodes of failure to resist aggressive
impulses that result in serious assaultive acts or
destruction of property.
 The degree of aggressiveness expressed
during the episode is grossly out of
proportion to any precipitating
psychosocial stressors.
• The aggressive episodes are not better
accounted for by another mental
disorder and are not due to a general
medical condition
 Kleptomania
 Kleptomania is the condition of not
being able to resist the urge to collect
or hoard things. People with this
disorder are compelled to steal things,
generally objects of little or no
significant value, such as pens, paper
clips, tape, traffic cones, signs,
mascara, drugs and small toys. Some
kleptomaniacs may not even be aware
that they have committed the theft.
Personality Disorders
 Personality
 What is Personality?
• Personality refers to those
characteristics of the person that
account for consistent patterns of
feeling, thinking and behaving. The
definition covers many different aspects
of the person.
 What are Personality disorders?
 What is Personality Pathology?
 Terms Associated With
Personality
 Personality development
 Personality disorders
 personality pathology
 Personality tests
 Clusters
A. Odd or eccentric behaviors
Paranoid, schizoid, schizotypal
personality disorder
B. Dramatic, emotional or erratic
behaviors
Antisocial, borderline, histrionic,
narcissistic personality disorder
C. Anxious or fearful behaviors
Avoidant, dependent obsessive-
compulsive disorder
40
 Odd- eccentric cluster of PD

Type Characteristics

Paranoid Suspicious & mistrust

Schizoid Hermitlike lifestyle, aloneness

Schizotypal Similar to but less severe than

those of schizophrenia
41
 Types of Personality Disorders
( or Problems)
 Types of Personality Disorders include the
following:-
 Paranoid personality Disorder - It comprises
patterns of distrust and suspicion without sufficient
basis of others motives that they are exploiting,
harming or deceiving the person. Such a person is
unforgiving of insults, injuries etc, is reluctant to
confide in others, reads and interpret hidden
meaning as threatening.

 Work Related Issues of this personality - Poor

interpersonal relationships with boss and peer
group. However, if highly ambitious may meet work
demands if organizational environment is non-
threatening.
 Schizoid and or Schizotypal Personality
Disorder – It is a pattern of detachment
from social or interpersonal relationships
and restricted range of emotional
expressions, beginning by early adulthood.
Such a person neither desires nor enjoys
close relationships including being part of
the family, even to the extent of having
sexual pleasure with the spouse.
 Work Related Issues of this personality
– Work involving interpersonal interactions
is difficult. May work in an environment that
provides social isolation.
 Dramatic-erratic cluster of PD

Type Characteristics
Antisocial Disregard of others’ rights without
guilt
Borderline Problems with self-identity, IPRs,
mood shifts, & self-destructiveness.
Narcissistic Over-evaluation of self, arrogance, &
indifference to the criticism of others
Histrionic Dramatic behaviors, attention seeking,
& superficiality
44
 Antisocial Personality Disorder- It is a pattern of
disregard for violation of the rights of others. This
personality is associated with crime violence and
delinquency occurring after the age of 15. The features
include failure to confirm to social norms, violating
laws, deceitfulness, manipulativeness, playing games
with others, impulsivity, failure to plan ahead,
irritability aggression, recklessness, disregard for the
safety of self & others, consistent irresponsibility and
lack of guilt after having hurt others etc.
 Work Related Issues of this personality – Difficulty
in sustaining productive work. Persons who share only
some of the above characteristics may function
successfully in a work role, however if typical
characteristics exist then that interferes with work roles
effectively and a person can land into trouble.
 Borderline Personality Disorder-
This disorder is a pervasive pattern of
instability of interpersonal relationship,
unstable self-image and affects and marked
impulsivity. There is identity disturbance,
marked reactivity of moods, chronic feelings
of emptiness, intense anger and difficulty
controlling that anger exists.
 Work Related Issues of this
personality – Impulsive behavior
interferes with work role and
interactions at work place resulting in
poor commitment to work.
 Histrionic Personality Disorder – It is a pattern
of excessive emotionality and attention seeking
beginning by early adulthood. This person is
uncomfortable in situations where he / she is not
the centre of attention, interaction with others
often characterized by inappropriate sexually
seductive or provocative behavior, there is also
shallow expression of emotions. The person may
use physical appearance to draw attention to self,
shows self-dramatization, exaggerated
expressions of emotions, considers relationship to
be more intimate than they actually are hence try
to be necessarily intimate to others.
 Work Related Issues of this personality -
Can succeed in work role where person is the
centre of attention such as acting, modeling etc .
 Narcissistic Personality Disorder –
There is a an exaggerated feelings of
grandiosity (in fantasy or actual behavior
i.e. exaggerates achievements and
talents, and expects to be recognized as
superior without achievements even) need
for excessive admiration, lack of empathy,
preoccupied with fantasies of unlimited
success, power, brilliance, beauty or ideal
love, believes that he / she is special and
unique, is interpersonally exploitative
(takes advantages of others) and shows
arrogance behavior or attitude.
 Work Related Issues of this
personality – Exploitation of co-workers,
because of strong need for success and
power they are able to meet job demands
and may excel in work.
 Anxious-fearful cluster of PD

Type Characteristics
Dependent Submissiveness, helplessness, fear of
responsibility, & reliance on others for
decision making
Avoidant Timidity, social withdrawal behavior,
& hypersensitivity to criticism
Obsessive- Indecisiveness, perfectionism,
compulsive inflexibility, & difficulty expressing
feelings
49
 Avoidant Personality Disorder – It is
a pervasive pattern of social inhibition, feelings of
inadequacy and hypersensitivity to negative
evaluation, criticism, disapproval or rejection, is
unwilling to get involved with people unless sure of
being liked, inhibited in new social situations views
him / herself inferior, reluctant to engage in new
activities because they may prove embarrassing.
 Work Related Issues of this personality –
Poor interpersonal skills effect work role. Work
behavior is limited to environment that are
nonthreatening and only requires minimum social
contacts.
 Dependent Personality Disorder – Has
difficulty making everyday decisions without
reassurances from others, gives others
responsibility for most areas of life, has
difficulty expressing disagreement with others
because of fear of loss of support or approval,
goes to excessive lengths to obtain nurturance
and support from others, feels uncomfortable
or helpless when alone, urgently seeks
another relationship as a source of care and
support when any close relationship ends, also
is unrealistically preoccupied with fears of
being left alone to take care of ones own self.
 Work Related Issues of this personality –
Unable to start or initiate projects at ones own
despite capability.
 Obsessive-Compulsive Personality Disorder –
Essentially this personality is preoccupied with
details, rules, order and control of others and
one’s own self. The person is excessively devoted
to work and productivity and avoid leisure
activities, is overly conscious and inflexible about
matters of morality and ethics, is unable to
discard worn-out or worthless objects even when
they have no sentimental value, adopts a miserly
spending style toward both self and others, and
lastly shows rigidity and stubbornness.
 Work Related Issues of this personality –
Because of extreme rigidity and conscientiousness
in these people they work effectively in work. Also
identified as “workaholics” or “type A personality”.
Personality View of Self View of Others Main Beliefs
Disorders

Paranoid Righteous, Interfering, Others motives

Personality innocent, noble, Malicious, are suspect. I
vulnerable Discriminatory, must always be
abusive motives on guard. I
cannot trust
people.
Schizoid Self-sufficient, Intrusive Others are
personality loner, unrewarding
Relationships
are undesirable
and messy so
better stay
away
Schizotypal Unreal, Un trust worthy It’s better to be
personality detached, loner, isolated from
vulnerable, others

Anti-Social A loner, Vulnerable, I am entitled to

Personality autonomous, exploitative break rules
strong
Personality View of Self View of Others Main Beliefs
Disorders

Borderline Vulnerable to Idealization or Others are

Personality rejection, betrayal, expectation of fool, I am
domination, others as powerful, better than
deprived of needed loving, perfect them. I can’t
emotional support, when devaluing cope on my
powerless, out of rejecting, own. I need
control, defective, controlling, someone to
unloveable, bad betraying and rely on. I can’t
abandoning others bear unplesant
feelings. It’s
impossible for
me to control
myself. I
deserve to be
punished. If I
rely on
someone I ll be
mistreated
found wanting
and
abondoned.
Personality View of Self View of Main Beliefs
Disorders Others

Histrionic Glamorous, Seductive, People are there to serve

Personality Impressive receptive, and admire me. They
admirers have no right to deny
me. I can just go by my
feelings.
Avoidant Vulnerable to Critical, It’s terrible to be
personality depreciation, Criticizing, rejected. If people know
rejection, Superior the real me they will
socially reject me, I can’t
ineffective, tolerate those feelings so
incompetent better to avoid
Dependent Needy, weak, Idealized, I need people to survive,
Personality helpless, nurturent, be happy, I need to have
incompetent supportive, a steady flow of support
competent from others
OCPD Responsible, Irresponsible, I know what’s the best,
accountable, Casual, details are crucial,
competent, incompetent, people should do best
Fastidious careless always, they should try
harder
Personality View of Self View of Others Main Belief
Disorders

Narcissistic Special, unique, Inferior Admirers Since I am

personality deserve special special I
attention, superior, deserve special
above the rules rules and I am
above these
rules. I am
better than
others.

Passive Self-sufficient, Intrusive, Others

Aggressive vulnerable to demanding, interfere with
Personality control, interfere interfering, my freedom of
controlling, action, control
dominating by others is
intolerable. I
have to do
things my own
way.
 Identify the disorder
 Case Study 1
 Zahida is extremely concerned with
cleanliness. In fact, before she retires at
night, she goes through a cleaning ritual
of her clothes and body that sometimes
lasts for up to 2 hours. If she misses a
step in the ritual or performs part of it
imperfectly, she starts the ritual all over
again
 Case Study 2
 Hamood periodically suffers from
extremely high levels of anxiety but he
cannot pinpoint the source or otherwise
say why he is so anxious. He is terrified at
times, his heart often races, he feels
wobbly, and has difficulty concentrating.
 Case Study 3
 Saga complains that he is experiencing
recurrent episodes of lightheadedness, rapid
breathing, and dizziness, especially as he
attempts to leave his house. The symptoms
have become so severe that, in
 fact, he is leaving his house less and less
frequently. He now only goes the grocery store
in the company of his sister. Once in the store,
he checks immediately for the exits and
windows.