Chapter 4. Psychological Disorders- Lecture notes.pdf
- 1. 4. PSYCHOLOGICAL DISORDERS • Concepts of abnormality and psychological disorders • Classification of psychological disorders • Factors underlying abnormal behaviour • Major Psychological disdorders
- 2. FOUR ‘D’S OF ABNORMALITY DEVIANT (UNUSUAL, EXTREME, BIZARRE) DISTRESSING (UPSETTING TO ONESELF AND OTHERS) DYSFUNCTIONAL (DISRUPT ROUTINE ACTIVITIES) DANGEROUS (TO ONESELF AND OTHERS)
- 3. TWO CONFLICTING VIEWS OF ABNORMAL BEHAVIOUR 1. Deviation from social norms 2. Maladaptive
- 4. 1. DEVIATION FROM SOCIAL NORMS Behaviour that is: ▪Deviant from social expectations ▪Markedly varies from society’s ideas OF PROPER FUNCTIONING. ▪Behaviours, thoughts and emotions that break societal norms
- 5. SOCIAL NORMS ▪ What are norms? Stated or unstated rules for conduct. A society’s norms grow from its particular culture – history, values, institutions, habits, skills, technology, art. As values change over time, what is perceived as psychologically abnormal also changes…. Normality is thus viewed as conformity to social norms.
- 6. 2. MALADAPTIVE ▪ Criteria for normality – Whether it fosters well-being of the individual and therefore community. ▪ Well being – growth and fulfillment in addition to maintenance and survival ▪ Conforming behaviour can be seen as abnormal if it is counter-productive to optimal functioning and growth.
- 7. STIGMATIZING PSYCHOLOGICAL DISORDERS ▪ Associated with shame ▪ Hesitant to seek for help as a result of the stigma ▪ A failure in adaption should be viewed as any other illness
- 8. HISTORICAL BACKGROUND – SUPERNATURAL / MAGICAL SOURCES ▪ Exorcism – removing evil that possesses the individual through countermagic or prayer ▪ Shaman / medicine man (ojha) is believed to have contact with supernatural forces and acts as a medium for communication with spirits
- 9. BIOLOGICAL / ORGANIC APPROACH ▪ Body and brain processes are not working properly ▪ Correcting defective biological processes results in improved functioning
- 10. PSYCHOLOGICAL APPROACH ▪ Psychological problems are attributed to inadequacies in thinking,feeling and perception of the world
- 11. ORGANISMIC APPROACH – HIPPOCRATES, SOCRATES, PLATO Abnormal behaviour results from conflicts between emotion and reason
- 12. GALEN’S 4 HUMOURS Galen posited that material world was made of 4 elements which combined to form 4 body fluids – 1. earth, 2. air 3. fire 4. Water A. Black bile B. Blood C. Yellow bile D. Phlegm
- 13. GALEN’S 4 HUMOURS Each fluid was responsible for a particular temperament Imbalances among humours caused disorders Similar to hindu mythology of 3 doshas – vata, pitta, kapha (Atharva veda and ayurvedic texts)
- 14. MIDDLE AGES - DEMONOLOGY ▪ Many abnormal behaviours were attributed to possession of demons ▪ Belief that people with mental problems were evil and witch hunts were carried out ▪ St.Augustine wrote extensively of feelings, mental anguish and conflict which laid the framework for modern psychodynamic theories of abnormal behaviour.
- 15. RENAISSANCE PERIOD Increased humanism and curiosity about behaviour Johann weyer emphasized psychological conflict and disturbed interpersonal relationships as causes of psychological disorders He insisted that witches were mentally disturbed and required medical treatment
- 16. AGE OF REASON AND ENLIGHTENMENT ▪ 17th and 18th centuries, strong development of scientific method to understand psychological disorders ▪ Reforms movements ensued with increased compassion and empathy for the mentally ill ▪ Asylums were reformed in terms of deinstitutionalization – emphasise community care for recovered mentally ill individuals.
- 17. RECENT YEARS…. Interactional / BIO- PSYCHO-SOCIAL approach Convergence of all approaches Biological,psychological and social realms play vital roles in influencing the expression and outcome of psychological disorders
- 18. CLASSIFICATION OF PSYCHOLOGICAL DISORDERS Grouping of categories of psychological disorders based on shared characteristics PURPOSE: Enable communication amongst psychologists, psychiatrists, social workers to understand causes and processes involved in development and maintenance of disorders
- 19. AMERICAN PSYCHIATRIC ASSOCIATION - APA ▪ Published manual describing and classifying various psychological disorders ▪ Diagnostic and statistical manual of mental disorders, 5th edition (DSM – 5) presents well-defined clinical criteria to indicate absence or presence of disorders
- 20. INTERNATIONAL CLASSIFICATION OF DISEASES (ICD) ▪ ICD – 10 Classification of behavioural and mental disorders – officially used in India. ▪ Prepared byWHO ▪ For each disorder each of the following are provided in the scheme. 1. clinical features 2. Symptoms 3. Diagnostic guidelines 4. Other associated features
- 21. FACTORS UNDERLYING ABNORMAL BEHAVIOUR Different approaches ▪ emphasise different aspects of human behaviour ▪ Explains and treats abnormality in line with that aspect ▪ Highlight the role of biological factors, psychological and interpersonal factors and socio-cultural factors
- 22. 1. BIOLOGICAL FACTORS OF ABNORMAL BEHAVIOUR Faulty genes Endocrine imbalance Malnutrition Injuries Conditions that affect the normal development and functioning
- 23. BIOLOGICAL MODEL - NEUROTRANSMISSION ▪ Abnormal behaviour has a biochemical or physiological basis ▪ Linked to disruption in transmission of messages from 1 neuron to another ▪ Abnormal activity of certain neurotransmitters can lead to specific psychological disorders 1. Low activity of gamma aminobutyric acid (GABA) – ANXIETY DISORDERS 2. Excess activity of dopamine – SCHIZOPRENIA 3. Low activity of serotonin – DEPRESSION
- 24. BIOLOGICAL MODEL – GENETIC FACTORS ▪ Abnormal behaviour has a genetic basis in 1. BIPOLAR AND RELATED DISORDERS 2. SCHIZOPRENIA 3. INTELLECTUAL DISABILITIES The specific genes responsible for the disorders have not been identified yet. Many genes are involved in influencing behaviours – both functional and dysfunctional Biology alone cannot account for most mental disorders.
- 25. PSYCHOLOGICAL MODEL ▪ Psychological and interpersonal factors have a vital role to play in abnormal behaviour. ▪ Maternal deprivation 1. separation from mother 2. Lack of warmth and stimulation during formative years ▪ Faulty parent-child relationships 1. Rejection 2. Overprotection 3. Over-permissiveness 4. Faulty discipline ▪ Maladaptive family structures – inadequate or disturbed family ▪ Severe stress
- 26. PSYCHOLOGICAL MODEL – 1. PSYCHODYNAMIC MODEL ▪ Behaviour is determined by psychological and interpersonal forces within a person that they are not conscious of ▪ These internal forces are: 1. Dynamic and interact with one another 2. Interaction determines behaviour, thoughts and emotions ▪ Freud – 3 central forces shape personality 1. Instinctual needs,drives, impulses (id) 2. Rational thinking (ego) 3. Moral standards (superego)
- 27. PSYCHOLOGICAL MODEL – 1. PSYCHODYNAMIC MODEL ▪ Abnormal behaviour 1. Abnormal symptoms are results of conflicts between these forces 2. Abnormal behaviour is a symbolic expression of unconscious mental conflicts generally traced to early childhood or infancy
- 28. PSYCHOLOGICAL FACTORS – 2. BEHAVIOURAL MODEL ▪ States that both normal (adaptive) and abnormal (maladaptive) behaviour are learned ▪ Disorders are the result of learning maladaptive ways of behaving ▪ Learning can be learned through 1. Classical conditioning (temporal association in which two events repeatedly occur close together in time) 2. Operant conditioning (behaviour is followed by a reward) 3. Social learning (learning by imitating others’ behaviour)
- 29. PSYCHOLOGICAL FACTORS – 3. COGNITIVE MODEL ▪ States that abnormal behaviour results from cognitive functions ▪ Irrational and inaccurate assumptions and attitudes of themselves ▪ Continuously think in illogical ways leading to overgeneralizations (arrive at broad negative conclusions based on a singular insignificant event).
- 30. PSYCHOLOGICAL FACTORS – 4. HUMANISTIC EXISTENTIAL MODEL ▪ Focuses on the broader aspects of human existence ▪ States that humans are born with the freedom to choose and create their own meaning ▪ abnormal behaviour results from ignoring the responsibility to self-actualize (fulfill the potential for goodness and growth) ▪ When individuals fail to engage with the challenges of existence, they experience psychological distress and dysfunction and live empty, inauthentic lives
- 31. SOCIO-CULTURAL MODEL ▪ Abnormal behaviour is understood by considering social and cultural forces ▪ Psychological disorders can ensue stress from socio-cultural factors such as: 1. War and violence 2. Group prejudice and discrimination 3. Economic and employment problems 4. Rapid social change
- 32. SOCIO-CULTURAL MODEL ▪ Behaviour is shaped by societal forces: 1. Family structure and communication: ▪ Overinvolvement and intrusion in each other’s activities can lead to children who struggle being independent 2. Social networks: ▪ People who lack fulfilling interpersonal relationships in social or professional network tend to be and stay depressed
- 33. SOCIO-CULTURAL MODEL 3. Societal labels and roles ▪ Abnormal functioning is influenced by societal labels or roles ▪ Those who break away from norms may be viewed as abnormal, deviant or “ill” ▪ The stigma may encourage the person to accept and act the sick role
- 35. DIATHESIS-STRESS MODEL ▪ Diathesis (biological predisposition to the disorder) is triggered by stress ▪ Three components 1. Diathesis – presence of a biological aberration which may be inherited 2. The diathesis may carry a vulnerability to develop a psychological disorder 3. Presence of pathogenic stressors - factors that lead to psychopathology When “at-risk”persons are exposed to stressors, the predispositions evolve into a disorder Example: Anxiety, depression, schizophrenia
- 36. 1. ANXIETY DISORDERS Most common category of psychological disorders
- 37. ANXIETY VS ANXIETY DISORDERS Anxiety: Diffuse, vague unpleasant feeling of fear and apprehension Symptoms: • Rapid heart rate • Shortness of breath • Diarrhoea • Loss of appetite • Fainting, dizziness • Sweating • Sleeplessness • Frequent urination • Tremors
- 38. 1. GENERALIZED ANXIETY DISORDER ▪ Prolonged vague, unexplained intense fears not attached to any specific object ▪ Symptoms: 1. Worry, apprehensive feelings about future 2. Hypervigilance – constantly scanning for danger 3. Motor tension resulting in restlessness, tenseness and tremors
- 39. 2. PANIC DISORDER ▪ Recurrent anxiety attacks of intense terror ▪ A panic attack is marked by an abrupt surge of intense anxiety peaking when thoughts of a particular stimuli are present ▪ Such thoughts occur in an unpredictable manner ▪ Clinical features Shortness of breath Dizziness Trembling Palpitations Choking Nausea Chest pain or discomfort Fear of going crazy Losing control Dying
- 40. PHOBIA ▪ Irrational fears related to specific objects, people or situations ▪ Develop gradually ▪ Begin mostly with generalized anxiety disorder ▪ Grouped into 1. Specific phobia – irrational fears of an animal or enclosed spaces 2. Social phobia – incapacitating fear or embarrassment while interacting with others 3. Agoraphobia – Fear of entering unfamiliar situations, leaving home, inability to carry out routine activities
- 41. 3. SEPARATION ANXIETY DISORDER (SAD) ▪ Fearful and anxious about separation from attachment figures to a level that is developmentally inappropriate ▪ Children with SAD 1. have difficulty being alone in a room 2. Fearful of going to school alone 3. Fearful of entering new situations 4. Shadow parents’ every move 5. To avoid separation may scream, fuss, throw tantrums, make suicidal gestures
- 43. 2. OCD ▪ Interference with routine activities Inability to 1. control preoccupation with specific ideas 2. Prevent oneself from repeatedly carrying out a particular act/ series of acts
- 44. OBSESSIVE BEHAVIOUR ▪ Inability to stop thinking about a particular idea or topic. The person involved often finds these thoughts to be shameful or unpleasant.
- 45. COMPULSIVE BEHAVIOUR ▪ Need to perform certain behaviours over and over again Many compulsions deal with counting, ordering, checking, touching and washing Hoarding disorder Trichotillomania (hair-pulling) Excoriation (skin-picking)
- 46. 3. TRAUMA AND STRESSOR RELATED DISORDERS ▪ People who have experienced a traumatic incident like tsunami or a bomb explosion suffer from PTSD – Post traumatic stress disorder Symptoms vary and may include: ➢recurrent dreams ➢Flashbacks ➢Impaired concentration ➢Emotional numbing ➢Adjustment disorders and acute stress disorders are also included in this category
- 47. 4. SOMATIC SYMPTOM AND RELATED DISORDERS ▪ Physical symptoms in absence of physical disease ▪ Psychological difficulties with no biological cause
- 48. 4.1 SOMATIC SYMPTOM DISORDER Persistent symptoms which may or may not underlie serious medical conditions Overly preoccupied with their symptoms with frequent doctor visits Results in distress and disruptions to daily routine This disease is associated with physical complaints
- 49. 4.2 ILLNESS ANXIETY DISORDER Preoccupied about: ▪ the possibility of developing a serious illness ▪ Undiagnosed disease ▪ Negative diagnostic results ▪ Disturbed about someone else’s ill-health that may occur to them ▪ This disease is associated with anxiety
- 50. 4.3 CONVERSION DISORDERS Reported loss of part or all of some basic body functions Paralysis, blindness, deafness, difficulty in walking Symptoms often associated with a stressful experience and quite sudden
- 51. 5. DISSOCIATIVE DISORDERS Dissociation ▪ Disconnection between ideas and emotions ▪ Involves feelings of 1. Unreality 2. Estrangement 3. Depersonalization 4. Loss of shift of identity Dissociative disorders: ▪ temporary alterations of consciousness that blots out painful experiences 1. Dissociative amnesia, 2. Dissociative identity disorder 3. Depersonalisation/ Derealisation disorder
- 52. 5.1 DISSOCIATIVE AMNESIA ▪ Extensive but selective memory loss not associated with any known organic cause ▪ It may be an inability to recall anything about past or specific events, places, people ▪ Dissociative fugue is part of dissociative amnesia where the person may assume a new identity with an inability to recall previous identity. ▪ Dissociative fugue ends suddenly with no memory of the events that happened during the fugue. ▪ This disorder leads to overwhelming stress
- 53. 5.2 DISSOCIATIVE IDENTITY DISORDER Referred to as multiple personality disorder – most dramatic of all dissociative disorders Associated with traumatic childhood experiences Person assumes alternate personalities that may or may not be aware of each other
- 54. 5.3 DEPERSONALISATION / DEREALISATION DISORDER ▪ A trance or dream-like state where the person feels a sense of being separated from self and reality ▪ Change of self-perception where persons sense of reality is temporarily lost or changed
- 55. 6. DEPRESSIVE DISORDERS Depression ▪ covers a variety of negative moods and behavioural changes ▪ Can refer to a symptom or disorder ▪ Normal feelings after a significant loss Major depressive disorder: Characterized by ▪ Persistent depressed mood ▪ Loss of interest in most activities ▪ Change in body weight ▪ Constant sleep problems ▪ Inability to think clearly ▪ Greatly slowed behaviour ▪ Thoughts of death and suicide ▪ Excessive guilt, feelings of worthlessness
- 56. PREDISPOSING FACTORS TO DEPRESSION ▪ Genetic make-up ▪ Age - women are at risk during young adulthood, men in early middle age ▪ Gender – Women are more prone to report a depressive disorder ▪ Negative life events ▪ Lack of social support system
- 57. 7. BIPOLAR AND RELATED DISORDERS ▪ Bipolar mood disorders were earlier known as manic – depressive disorders ▪ Examples: Bipolar I disorder, Bipolar II disorder,cyclothymic disorder ▪ Bipolar I disorder involves mania and depression sometimes interrupted by normal mood ▪ Manic episodes rarely appear by themselves usually alternating with depression
- 58. SUICIDE • biological, • genetic, • psychological, • sociological, • cultural and • environmental factors Result of complex interface of
- 59. RISK FACTORS ▪ Mental disorders – depression, alcohol abuse ▪ Natural disasters ▪ Violence, abuse ▪ Isolation at any stage of life ▪ Previous suicidal attempt
- 60. SUICIDAL BEHAVIOUR Indicates difficulties in: Problem- solving Stress- management Emotional expression Suicidal thoughts Suicidal action (only when they seem like the only way out of difficulties) Heightened in acute emotional distress
- 61. PREVENTION OF SUICIDE ▪ Improving identification ▪ Referral ▪ Management of behaviour ▪ Steps involved: Identify vulnerability Comprehend pressing circumstances Plan interventions
- 62. WHO MEASURES TO PREVENT SUICIDE 1. Limit access to the means of suicide 1 2. Media coverage of suicide responsibly 2 3. Bring in alcohol- related policies 3 4. Early identificatio n, treatment and care of people at risk 4 5. Training health workers in assessing and managing for suicide 5 6. Care and community support for those who attempted suicide 6
- 63. IDENTIFYING STUDENTS IN DISTRESS ▪ Lack of interest in common activities ▪ Declining grades ▪ Decreasing effort ▪ Misbehaviour in classroom ▪ Mysterious or repeated absence ▪ Smoking, drinking, drug abuse
- 64. APPROACHES TO FOSTER SELF-ESTEEM Accentuate Accentuate positive life experiences to develop positive identity and confidence Provide Provide opportunities for development of physical,social and vocational skills Establish Establish trustful communication Set Set student goals that are specific, measurable, achievable,relevant, realistic to achieve within time frame
- 65. 8. SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS ▪ Psychotic disorders that hinder • personal • Social • Occupational functioning Due to • Strange perceptions • Unusual emotional states • Motor abnormalities Disturbed thought • Social • Psychological stress Debilitating disorder
- 66. SYMPTOMS OF SCHIZOPHRENIA POSITIVE (EXCESS IN THOUGHT, EMOTION, BEHAVIOUR) NEGATIVE (DEFICITS IN THOUGHT, EMOTION, BEHAVIOUR) PSYCHOMOTOR 1. Pathological excesses, bizarre additions 2. Delusions 3. Disorganised thinking, speech 4. Heightened perception 5. Hallucinations 6. Inappropriate affect 1. Pathological deficits 2. Blunted,flat affect 3. Loss of volition 4. Social withdrawal 5. Alogia (speech poverty) 1. Less spontaneous movement 2. Odd grimaces,gestures 3. Catatonic stupor 4. Catatonic rigidity 5. Catatonic posturing
- 67. DELUSION ▪ A false belief firmly held on inadequate grounds ▪ Not affected by rational argument ▪ Has no basis in reality
- 68. 1. DELUSION OF PERSECUTION Belief of being plotted against Spied on Slandered Threatened Attacked Victimised
- 69. 2. DELUSIONS OF REFERENCE Attach special and personal meaning to the actions of others, or to objects and events.
- 70. Believe to be specially empowered 4. Delusion of control 3. DELUSION OF GRANDEUR Believe to be controlled by others
- 71. FORMAL THOUGHT DISORDER ▪ Unable to think logically ▪ Speak in peculiar ways ▪ Derailment - Communication rapidly shifting from one topic to another ▪ Loosening of associations – muddled thinking ▪ Neologisms – inventing new words or phrases ▪ Perseveration – persistent and inappropriate repetition of same thoughts
- 72. HALLUCINATIONS ▪ Perceptions that happen in the absence of external stimuli ▪ Auditory – Hearing sounds, voices directly to the patient (second-person hallucination) or to one another referring to the patient (third-person hallucination) ▪ Tactile – forms of tingling, burning ▪ Somatic – snake crawling inside body, etc. ▪ Visual – vague perceptions of colour, distinct visions of people or objects ▪ Gustatory – food or drink taste strange ▪ Olfactory – smell of poison or smoke
- 73. INAPPROPRIATE AFFECT ▪ Emotions that are unsuited to the situation
- 74. NEGATIVE SYMPTOMS ▪ Alogia – poverty of speech or reduction in speech and speech content ▪ Blunted affect – less anger, sadness, joy and other emotions ▪ Flat affect – show no emotions at all ▪ Avolition – apathy or inability to start or complete a course of action ▪ Withdrawal – social withdrawal focusing on own ideas and fantasies
- 76. PSYCHOMOTOR SYMPTOMS ▪ Move less spontaneously making odd grimaces and gestures. ▪ Symptoms may take extreme forms known as catatonia ▪ Catatonic stupor – remain motionless and silent for long stretches of time ▪ Catatonic rigidity – rigid, upright posture for hours ▪ Catatonic posturing – assuming awkward, bizarre positions for long periods of time
- 77. 9. NEURODEVELOPMENTAL DISORDERS Manifest in the early stage of development Hampers personal, social, academic and occupational functioning Deficit or excess in a particular behaviour Delay in achieving a particular age- appropriate behaviour These disorders if unattended in childhood, can lead to chronic disorders in adulthood
- 78. 9.1 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) ▪ Two main features – inattention, hyperactivity – impulsivity ▪ Inattention: 1. Difficulty sustaining mental effort during work or play 2. Difficulty focusing on one thing 3. Difficulty following instructions 4. Disorganised, easily distracted 5. Forgetful 6. Quick to lose interest
- 79. 9.1 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) ▪ Impulsivity 1. Unable to control immediate reactions 2. Difficulty to wait or take turns 3. Difficulty resisting immediate temptations 4. Difficulty delaying gratification 5. Clumsy and knocking things over
- 80. 9.1 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) ▪ Hyperactivity 1. In constant motion 2. Fidget, squirm, climb, run around aimlessly 3. Talk incessantly
- 81. 9.2 AUTISM SPECTRUM DISORDER ▪ Range of impairments in social interaction and communication skills ▪ Stereotyped pattern of: 1. Behaviour-like rocking, 2. Interest- like lining up objects, 3. Activities – like self-stimulatory motor movements such as hand flapping or self-injurious activities like banging head against wall
- 82. 9.2 AUTISM SPECTRUM DISORDER Restricted range of interests Strong desire for routine 70% have intellectual disabilities Unable to initiate social behaviour and unresponsive to other’s feelings Abnormalities in language and communication that persist over time Many never develop speech, and those who do have repetitive and deviant speech patterns Difficulties in starting, maintaining and even understanding relationships
- 83. 9.3 INTELLECTUAL DISABILITY ▪ Refers to below average intellectual functioning (IQ 70 or below) ▪ Deficits or impairment manifested before 18 years of age in adaptive behaviour in 1. Areas of communication 2. Self-care 3. Home living 4. Social/interpersonal skills 5. Functional academic skills 6. work
- 84. 9.4 SPECIFIC LEARNING DISORDER ▪ Difficulty in perceiving or processing information ▪ Manifested in early school years with difficulty in basic skills in reading, writing, math ▪ Perform below average for age and individuals may reach acceptable performance levels with additional input and efforts ▪ Impairs functioning and performance in skill-based activities/occupations
- 85. 10. DISRUPTIVE IMPULSE-CONTROL AND CONDUCT DISORDER ▪ Oppositional defiant disorder ▪ Conduct disorder
- 86. 10. 1 OPPOSITIONAL DEFIANT DISORDER (ODD) Display age-inappropriate stubbornness, irritability, defiance, hostility Do not see themselves as angry, oppositional or defiant Justify behaviour as reaction to circumstances Symptoms are entangled with problematic interactions with others
- 87. 10. 2 CONDUCT DISORDER ▪ Age-inappropriate actions that violate family, societal norms and rights of others ▪ Aggressive actions that cause or threaten harm to people or animals ▪ Non-aggressive conduct that causes property damage ▪ Major deceitfulness, theft, rule violations ▪ Forms of aggression in children – Verbal, Physical, Hostile, Proactive
- 88. 10. 2 CONDUCT DISORDER – AGGRESSION Forms of aggression in children: 1. Verbal – name- calling, swearing 2. Physical – hitting, fighting 3. Hostile – inflicting injury to others 4. Proactive – dominating and bullying without provocation
- 89. 11. FEEDING AND EATING DISORDERS I. Anorexia nervosa: 1. Distorted body image as being overweight 2. Refusing to eat when alone or in front of others 3. Exercising compulsively 4. Lose large amounts of weight 5. In extreme cases, starve to death
- 90. 11. FEEDING AND EATING DISORDERS II. Bulimia nervosa: 1. Eat excessive amounts and then purge through vomiting, laxatives or diuretics 2. Feelings of disgust and shame while binging which are relieved after deliberate purging
- 91. 11. FEEDING AND EATING DISORDERS III.Binge eating: 1. Frequent episodes of out-of-control eating 2. Eat at a higher speed than normal 3. Continues eating until uncomfortably full 4. Eating large amounts even when not hungry
- 92. 12. SUBSTANCE RELATED AND ADDICTION DISORDERS ▪ Disorders related to maladaptive behaviours resulting from consistent substance use ▪ Include problems associated with use and abuse of alcohol, cocaine, tobacco,opioids which alter cognitive, affective and behavioural domains
- 93. 12.1 ALCOHOL ▪ Causes dependence on alcohol in difficult situations ▪ Interferes with thinking and behaviour ▪ Higher tolerance builds up leading to craving of higher amounts of alcohol ▪ Induces withdrawal symptoms when quitting drinking ▪ Destroys millions of families, relationships, careers ▪ Intoxicated driving leads to road accidents and fatalities ▪ Children born into these families have higher rates of psychological problems like depression, phobia and substance-related disorders ▪ Detrimental to physical health
- 94. 12.2 HEROIN ▪ Interferes with social and occupational functioning ▪ Leads to dependence on heroin forcing their lives to revolve around the addiction ▪ Leads to higher tolerance to the substance therefore increased craving ▪ Withdrawal symptoms when quitting ▪ Most serious consequence is overdose which leads to slowing down of the respiratory centers of the brain leading to breathing paralysis and death
- 95. 12.3 COCAINE ▪ Leads to intoxication through the day affecting social and work relationships ▪ Problems in short-term memory and attention ▪ Dependence may develop leading to severe addiction ▪ Depression, fatigue, sleep problems, irritability and anxiety on stopping intake ▪ Impairs psychological functioning and physical well-being