Abnormal and Clinical Psychology
Role of Managing Emotions
Normal Behavior
• The word “normal” comes from Latin word
“Norma”, which means “a carpenter’s square”.
• A norm therefore, becomes a rule or pattern
or standard of behavior.
• The word abnormal originated from
“anomalous” where “ano” means “not” and
malous means “irregular” so, “Irregular is
abnormal” or different from what is normal.
Characteristics of a Normal Person
1. Sociability
2. Sensitivity
3. Adaption to situations and conditions
4. Clarity on right and wrong in life (moral
education or wisdom)
5. Ability to self evaluate (introspection or self
reflection)
6. Organized and stable personality
7. Respect for others’ emotions and feelings
Criterion of abnormality
1. Social Criterion: Abnormal behavior is one that deviates from
social expectations (Uleman & Karsner, 1960)
2. Statistical criterion: According to Brown, “abnormal
psychological phenomenon are simply exaggerations (i.e. over
development or under development) or disguised (prevented)
development of normal psychological phenomenon.
3. Personality Adaptation: Ability to develop and maintain a
harmonious relationship with others and fulfill your needs
and demands as per time, situation and resources. When a
person fails to do so then it comes under “the category of
abnormality”.
Means of adaptation: Accommodation (use of external resource
to cope with the environment)Assimilation (use of internal
resources to cope with the environment)
Criterion..contd
4. Personality integration: A mismatch between
a person’s intent, thoughts, feelings and actions
is sign of abnormality.
5. Person’s maturity model: According to Kisker,
normality is a personal judgment on the part of
individual. The judgment is made by
establishing oneself as the standard of
comparison. If other people are similar to
ourselves they are consider normal, if
sufficiently different then abnormal.
Criterion…contd.
6. Average personality model; using normal probability
curve, a person in the center is considered normal.
7. Pathological view point: suffering from any mental
illness.
8. Legal criterion: a person who disobey law and creates
threat for one’s or other’s life.
9. Criterion of bizarreness: human behavior which are
strange, unusual, or different are considered abnormal.
10. Criterion of personal distress: when a person appears
dissatisfied and unhappy or extremely serious.
Causes
1. Biological Causes
2. Sociocultural
3. Psychological
Biological Factors
1. Genetic defects
–
–
–
Chromosomal Aberrations
Genetic predisposition to specific mental disorder
Faulty genes
2. Physical Deprivation
–
–
Malnutrition
Sleep disorder
3. Constitutional liabilities & physical handicap
4. Brain pathology
5. Disruptive emotional process
Socio-cultural
1. Violence and war
2. Group prejudice and discrimination
3. Economic problem and poverty or
deprivation
4. Social change
Psycho-social factors
1. Maternal deprivation (deprivation at home)
2. Pathogenic family pattern (over-protection or over-indulgence,
faulty discipline, communication failure, undesirable parental
modeling)
3. Maladaptive family structure (the inadequate family, the
disturbed family, antisocial family, disrupted family)
4. Early psychic trauma (self cognition and perception, requirements
of self, understanding order and predictability, lack of competency,
low belongingness and approval)
5. Disordered interpersonal relationship (marital instability, fraudent
interpersonal contracts, discordial interpersonal contracts)
6. Stresses of modern life (job stress, traffic congestion, work
pressure, work life balance)
Adjustment and Adjustive Demands
• An adjustment is a process by which a living
organism maintains a balance between its needs
and the circumstances and that influence the
satisfaction of these needs (Shaffer).
• Adjustment process
Individual
Barriers
Needs & Goals
• Successful versus failed attempts of efforts
Types of adjustment
1. Accommodation: using external means or resources to
satisfy its needs
2. Assimilation: using internal means or resources for
adaptation
In place of adjustment, many psychologists prefer to use
adaptation.
3. Adjustment process is building of habits, attitude, or change
of environment to fulfill their needs. Adjustment involves a
satisfied relationship of the organism with the environment.
4. Adaptation – Individual does not only evaluate realistically
the situation or the capacity but try to establish a balance
between internal and external demands and resources and
thus having maximum gratification and minimum conflicts in
demands and resources.
Adjustive demands
• Coleman writes, “Life would be simple if one’s
biological and psychological needs were
automatically accomplished or gratified. But
as we know there are several obstacles, both
environmental or personal, that may interfere.
Such obstacles place adjustive demands or
stress on individual.
Stress
• Stress is related to a feeling of pressure or
tension on a person. Stress is a term used for a
reaction to a situation which you perceive you
will be unable to cope with successfully which
result in an unwanted mental, physical and
physiological deterioration.
• Psychologists believes that 75% of
psychological or physical disease are caused
by stress.
Stress as a stimulus
• Stress is any factor that thwarted the health of
the body and has adverse effect on its
functioning such as disease or injury.
• Undemanding situation are not stressful
• There are Individual difference in response to
stressful situation
Stress as a response
• Stress is the specific physiological response of
the body to any demand made upon it.
• But why an individual respond to a situation in
a way that produces stress?
Interactional approach
• It is a mixture of stimulus and response based
approach. Stress is best seen as relationship
between individual and his/her environment and
assessment of demands of situation and the ability
of a person to cope.
• Stress can be prevented by
1. removing threats
2. improving coping ability of the individual
3. by changing the perception of stress producing
situation.
Yerkes-Dodson Law
• Human functioning curve
• Stress and performance has inverted U shaped
relationship. Hans Selye propounded a
concept of “general Adaptation Syndrome,
and has suggested three stages.
1. Alarm Reaction (inability to take action)
2. Resistance (increasing coping ability)
3. Exhaustion (decreasing coping ability)
Stress – Positive & Negative
• Stress is not the result of negative emotions
but also of positive emotions.
1. Hypo-Hyper (Low to high)
2. Eustress-Distress (Positive to negative)
Types of Stress
3. Frustration
4. Conflict
5. Pressure
Frustration
• Frustration (Latin word, Frusta – means in vain, being
blocked, being thwarted) it is a psychological state
resulting from the blocking of goal directed activity.
Sources of frustration
1. Personal – privation (lack of competencies),
deprivation (handicap) and obstruction (inferiority
complex or fears)
2. Situational – privation (not able to get his desired
object), deprivation (loss of something) and
obstruction (lacking resources to fulfill needs)
3. Societal: roles of values, norms and social standards
Conflict
• Conflict is a situation in which two wishes are
so incompatible that fulfillment of one would
preclude the fulfillment of other.
• Conflict is a state of affair in which two or
more incompatible behavior trends are
evoked that can not be satisfied at the same
time.
Types of Conflicts (role of EI)
1. Approach – Avoidance Conflict: it involves strong
tendencies of plus (+) and minus (–) in the same
goal.
2. Double approach conflict: It involves a
competition between two or more desired goals.
3. Avoidance – Avoidance conflict: it involves two
negative goals and wants to avoid both, but chose
one of them under compulsion. It is also a source
of frustration.
Pressure
• Stress may also arose from pressure to
achieve a particular goal or to behave in a
particular way.
• In general, pressure forces a person to speed
up, intensify, or change the direction of goal
oriented behavior.
• E.g., Role overload; targets and goal
Reaction to Life Stress
1. Task oriented reaction
2. Defense oriented reaction
1. Task oriented reaction
1. Attack (1) frustration and direct action (2)
conflict and choice (3) pressure and resistance
2. Withdrawal (accepting defeat, reducing
attachment, flight from a stressful situation)
3. Compromise: This approach may entail
changing one’s method of operation, accepting
substitute goal, or working out some sort of
accommodation in which one settles for part of
what was initially wanted.
2. Defense Oriented Reaction Pattern
• These are called avoiding mechanism or ego
defense mechanisms (EDMs)
• These mechanism maintain the individual
feeling of adequacy and worth rather than to
cope directly with the stress situation usually
they are unconscious and reality distorting.
Forms of Ego Defense Mechanisms
1.
2.
3.
4.
5.
Denial of Reality: (perceptual defense-this is not happening to me)
Fantasy: (imagination or daydreaming)
Repression: (selective remembering, not selective forgetting)
Projection: (attributing to or observing in others one’s own impulses and traits)
Reaction formation: (an undesirable trait is kept in check through the development of
diametrically opposite traits)
6. Displacement: (an emotion originally associated with an idea or object is transferred to some
neutral and inappropriate idea of object)
7. Emotional insulation: (reducing one’s involvement in a disappointing and hurtful situation)
8. Rationalization (justifying one’s maladaptive behavior by faulty logic or ascribing it to a
noble motive that did not inspire it – sour grapes and sweet lemon )
9. Intellectualization: (involves both insulation & rationalization- a painful event is
avoided by rational explanation that divest the event of personal significance and painful
feeling)
EDMs---contd
11. Undoing (atonement): (corrupt people worship more or husband give expensive
gift to hide)
12. Regression: (retreating to an infantile mode of behavior which is less demanding and
less stressful)
13. Identification: (a person moulds his self after that of someone else personality)
14. Introjections: (accepting other’s values as one’s own even when they are contrary
to one ‘s previous assumptions)
15. Compensation: (failure in one place motivates success in another place)
16. Acting out: (permitting the expression of dangerous desires)
17. Attention getting: (exhibiting opposite behavior than expected to get attention)
18. Sublimation: (transformation of instinct into something useful; ethically or
culturally useful)
19. Conversion: (stress is converted into functional symptom of bodily disease)
Psychological Disorders
• Neurosis
1.
2.
3.
4.
5.
Anxiety Neurosis
Phobia
Obsessive Compulsive Disorder
Hysteria-Conversion Disorder (psychosomatic)
Dissociative Conversion- Amnesia, Multiple Personality etc.
• Psychosis
1. Schizophrenia
2. Paranoia
3. Bi-polar disoder or manic depressive psychosis
Forms of Psychological Illness-Neurosis
• Psycho neurosis (William Cullen, 1769) refers to
disordered sensation of the nervous system. Now it is
termed “Generalized Anxiety Disorder” by Diagnostic
and Statistical Manual (DSM-IV) and International
Classification of Disease (ICD-10).
• It is a pattern of maladaptive behavior which occurs
due to a faulty learning often in early childhood,
leading to a persistent feeling of threats and anxiety in
facing the everyday’s problems of living.
• Neurotics are typically anxious, ineffective, unhappy,
and often guilt ridden individuals.
Nature of Neurosis
• Neurotic Nucleus: false assessment of reality
and avoiding the stressful situation rather
adapting with it (Stress-anxiety-avoidance-reinforcement)
Steps: (1) feeling of inadequacy and anxiety (2)
avoidance instead of coping (3) self defeating
behavior and or blocked personal growth
• Neurotic Paradox: tendency to maintain life
style despite its self defeating and
maladaptive nature
Forms of Neurosis: Anxiety Disorder
• it is characterized by Chronic anxiety and
apprehensiveness
• which may be punctuated by recurring
episode of acute anxiety;
• however neither the anxious expectations nor
the acute anxiety attacks appears to stem
from any particular threats,
• the perceived anxiety is said to be “free
floating”
Symptoms
1. Inability to concentrate
2. Difficulty in making decisions
3. Extreme sensitivity in interpersonal
relationships
4. Discouragement
5. Sleep disturbances
6. Excessive sweating
7. Sustained muscle tension
Generalized Anxiety Disorder
vigilance
• GAD is the chronic,
unrealistic, excessive worry • Autonomic hyper activity
which is described by free
1. Irritability
floating anxiety.
2. Short breadth
3. Rapid pulse rate
• Motor related symptom
1.
2.
3.
4.
5.
6.
Trembling or shaking
Muscle tension
Aching
Fatigue
Restlessness
Exaggerated state;
Dry mouth
Sweating
Dizziness
Nausea, diarrhea, gastrointestinal disorder
8. Hot flashed
9. Frequent urination
4.
5.
6.
7.
Phobia
• A phobia is simple the occurrence of the symptoms of
anxiety in a particular situation which most people
would not find stressful. The symptom may occur in a
ship, aircraft, in a cinema, or in a church.
• it is a persistent fear of some object or situation that
present no actual danger to the person or in which the
danger is magnified out of all proportion to its actual
seriousness.
• It is an attempt to reduce internally generated tension
and anxiety by a process of displacement, projection
and avoidance.
Varieties of Phobic Reaction
1. Acrophobia – high places
2. Agoraphobia – open places
3. Astraphobia – storms, thunder and lightening
4. Claustrophobia – closed places
5. Hematophobia – blood
6. Mysophobia – contamination or germs
7. Nyctophobia – darkness
8. Pathophobia – disease
9. Pyrophobia – fire
10. Zoophobia – animals
11. locomotion phobia - walking
Obsessive-Compulsive Disorder (OCD)
• In OCD neurosis, the person feels compelled to
think about something that he does not want to
think about or carry out some action against his
will. As in case of Phobia, the individual usually
realizes that his behavior is irrational but can not
seem to control it.
• The patient lose control over his thoughts and
action in OCD of a specific nature.
• Two types (1) thoughts which are aggressive and
sexual in nature (2) self-corrective tendency
Personal traits in OCD
1. Exaggerated need to be systematic and
organized
2. Rigidity or inflexible behavior in daily life
3. Type C personality- suppressing negative
emotions and demonstrate socially desirable
behavior.
4. Too much emphasis on idealism and morality
5. mostly self driven behavior, not regulated by
others.
symptoms
1. Fears – hearing others, contracting a disease
2. Thoughts – sexual and aggressive thoughts
3. Rumination – unsolved puzzle, problems
4. Rituals – inspection or repetition of same
action
Well aware of his absurd behavior or thoughts
Types of Compulsion
1. Compulsive repetitions (suspicions on a task
and do it again)
2. Serial compulsion (stepwise functioning of a
task)
3. Orderliness Compulsion (too much order or
arrangement in house or office)
4. Self – restrain compulsion (too much
disciplined behavior)
5. Anti social compulsion (1) Pyromania (2)
Kleptomania
Hysteria (conversion or psychosomatic disorder)
• The symptoms were an expression of
repressed and deviated sexual energy – that is
psychosexual conflicts are converted into
bodily disturbances.
• Hysterical reactions are efforts to adjust to life
difficulty to flight into incapacity.
• Conversion reaction is a neurotic defense in
which symptoms of some organic disease
appears without any underlying organic
pathology.
Personality characteristics
1. Personality and role factor – Sick Role
(emotional immaturity)
2. Avoidance defense against threats
3. High dependency on others (over protection)
4. Lack of affection in early childhood
5. Lack of healthy interpersonal relationships
6. Insecurity and inferiority complex
symptoms
1. Sensory symptoms – loss of sensitivity; loss
of sensitivity to pains, exceptional sensations
2. Motor symptoms - cramp; tremors, walking
disturbances; speaking disturbances
(Aphonia)
3. visceral symptoms – headache, lump in
throat, choking sensation, coughing spells,
belching, nausea, sneezing, difficulty in
breathing
Hysteria – Dissociative Type
• Hysterical dissociative neurosis is a pattern of
maladaptive behavior in which that a part of
person known as self, losses his cohesiveness
and separate into two or more psychological
system.
• Dissociative reactions are an attempt to
escape from excessive tension and anxiety by
separating off some parts of personality
function from the rest.
Forms of Dissociative Hysteria
• Amnesia: it is a partial or total inability to recall or
identify past experiences.
1. Localized Amnesia (for temporary and fixed period)
2. Selective Amnesia (loss of memory of particular time
period)
3. Generalized Amnesia (forgetting of past memory)
4. Continuous Amnesia (futuristic forgetting)
5. Fugue (it is defense reaction by actual flight – loss of
personal identity and leaves his physical surroundings)
Multiple Personality Disorder
• Multiple personality is a dissociative reaction to
stress in which the patient manifests two or
more complete system of personality. Each
system of personality has distinct, well
developed emotional and thought process and
represents a unique and relatively a stable
personality.
• The main dynamic is the exaggeration of a cause
of conflict situation between conformity and non
conformity behavior (guilt producing situation)
Psychosis
• Psychosis are more serious and disabling at least
psychologically than neurosis and psychosomatic disorders.
• Psychosis is a serious form of personality disorder. In which
the affected person shows of periodic or prolonged loss of
contact with the world of reality. This loss of contact
reflects in disorder of perception, emotions, personal
disorientation in thinking.
• Serious maladapted behavior, loss of touch with reality,
personality disorganization, need to be admitted to
hospital
1. Organic psychosis (brain pathology)
2. functional psychosis (psychologically generated)
Psychotic behavior
• 99% psychotic have bizarre behavior, they are
dangerous, suicidal, and are disoriented.
• 98% are anti social, destructive, and assaultive
to others
• 90% are emotionally, cognitively and socially
disoriented.
• 56% have speech disorder
• 45% has memory defects
• 40% has psychomotor disturbances
Symptoms
1.
2.
Disturbances of thoughts and perception (Disorientation)
Delusion (these are beliefs that are maintained despite their logical
absurdity or objective evidence showing they lack any foundation in
reality)
–
–
–
–
–
–
3.
4.
5.
6.
7.
Delusion of Grandeur
Delusion of persecution
Delusion of self condemning
Hypochondriacal Delusion
Nihilistic delusion
Delusion of influence
Hallucinations (individual perceive objects and events without physical
stimulation)
Psychological symptoms; use of projection, rationalization, guilt feeling,
dreaming, strong impulse, contradictory behavior.
Cryptic communication (Gibberish)
Neologism (live in imaginary world)
Psychotic body language
Schizophrenia
• It is a group of psychotic reactions marked by
disturbances in reality relationship and emotional
and intellectual process.
• Schizophrenic reactions are regressive attempts to
escape from anxiety and tension by abandoning
realistic interpersonal object relations and
constructing delusion and hallucination.
(1) Withdrawal from reality (2) disorganization of
perception and emotion (3) living in the word of
hallucination and delusions
Types of Schizophrenia
• Process Schizophrenia (symptoms gradually
evolve)
• Reactive Schizophrenia
– Withdrawal from reality
– Common feeling of apathy
– Splitting of thought process
– Emotional instability
– Seclusion
Common symptoms
1. Breakdown of perceptual filtering
2. Disorganization of thoughts (lack of
integration)and emotions (mood switch)
3. Anxiety and Panic (depersonalization)
4. Delusion and hallucinations
5. Withdrawal from reality
6. Motor behavior (no activity or too much)
Types of Schizophrenia
1. Simple Schizophrenia (social derailment, apathetic and irresponsible,
and patient sinks into vagrancy)
2. Hebephrenic (youthful mind) Schizophrenia (disorganized
Schizophrenia – emotional disharmony)
3. Catatonic (lessened muscle tension) Schizophrenia (motor
disturbances, either excited (violent activity) or withdrawn (stupor or
mutism)
4. Paranoid Schizophrenia (suspicion)
5. Acute Schizophrenia: (undifferentiated) suddnely exhibit symptoms of
Schizophrenia patients
6. Childhood Schizophrenia (unable to develop self identity and ego
defenses)
7. Chronic undifferentiated Schizophrenia (depressive and neurotic; waste
basket category)
8. Residual Schizophrenia: after treatment
9. Latent type (Schizophrenic form disease)
Paranoia
• Permanency of delusional component;
however, personality and communication
remain organized and also lacking
hallucinations. It has two types.
1. Delusional psychotic disorder (due to
delusions)
2. Induce psychotic disorder (a connection
between delusions of two persons)
Types of Paranoia
1. Persecutory paranoia: (perception of threats)
2. Jealousy Type Paranoia: (mistrust on each other)
3. Somatic type: (self criticism and inferiority
complex)
4. Greatness (grandeur) (invention type)
5. Erotic paranoia
6. Religious Delusion (religious extremism)
7. Reformative delusions
8. Litigant delusions
Sequence of events in paranoid thinking
1. Suspiciousness / distrust / criticism of others
2. Protective thinking (selective perception of
events) friends and well wishers walk away
3. Hostility (increased friction with others violent
acts against unfair behavior of others)
4. Paranoid illumination (experiencing events
that never occurred)
5. Delusional Belief system: grandeur or
persecution
Bipolar Disorder: Manic-Depressive Psychosis
Bipolar disorders are described by the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a group of brain
disorders that cause extreme fluctuation in a person’s mood, energy, and ability
to function.
Bipolar I disorder is a manic-depressive disorder that can exist both with and without
psychotic episodes
Bipolar II disorder consists of depressive and manic episodes which alternate and are
typically less severe and do not inhibit function
Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and
Depression
• Bipolar and related disorders are given a chapter of their own in the DSM-5,
between depressive disorders and schizophrenia spectrum disorders. People who
live with bipolar disorder experience periods of great excitement, overactivity,
delusions, and euphoria (known as mania) and other periods of feeling sad and
hopeless (known as depression). As such, the use of the word bipolar reflects this
fluctuation between extreme highs and extreme lows. The diagnosis is frequently
assigned to young patients presenting with a (first) major depressive episode.
•
Treatment
• Individual and group therapy
• Chemotherapy (tranquilizers, energizers, antianxiety drugs - chlorpromazine)
• Behavior therapy
• Cognitive therapy
• Half way home method (group therapy)
• Token economy (reinforcement for good acts)
• Milieu therapy (participation in self regulated
activities)