Major Psychological Disorders

Major Psychological Disorders

Anxiety is a normal part of life. You feel it before an exam, a visit to the dentist, or a solo performance. That kind of anxiety is expected and even helpful — it motivates you to do your best. But when anxiety becomes intense, persistent, and interferes with your ability to function normally, it crosses the line into a disorder. Anxiety disorders are the most common category of psychological disorders.

The term anxiety itself is defined as a diffuse, vague, and very unpleasant feeling of fear and apprehension. A person experiencing anxiety may show a combination of physical symptoms: rapid heart rate, shortness of breath, diarrhoea, loss of appetite, fainting, dizziness, sweating, sleeplessness, frequent urination, and tremors.

Types of Anxiety Disorders

Generalised Anxiety Disorder (GAD)

This involves prolonged, vague, unexplained, and intense fears that are not attached to any particular object. The person experiences constant worry and apprehensive feelings about the future. They are hypervigilant — always scanning the environment for dangers. Motor tension is a key feature: the person cannot relax, is restless, visibly shaky, and tense.

Panic Disorder

This consists of recurrent anxiety attacks where the person experiences intense terror. A panic attack is an abrupt surge of intense anxiety that rises to a peak, often triggered by thoughts of a particular stimulus, though these thoughts can occur unpredictably. Clinical features include shortness of breath, dizziness, trembling, palpitations, choking, nausea, chest pain or discomfort, and a fear of going crazy, losing control, or dying.

Phobias

Phobias are irrational fears related to specific objects, people, or situations. They often develop gradually or begin with generalised anxiety disorder. There are three main types:

• Specific phobias: The most common type. These include intense fear of a certain animal, or of being in an enclosed space.
• Social anxiety disorder (social phobia): Intense and incapacitating fear and embarrassment when dealing with others.
• Agoraphobia: Fear of entering unfamiliar situations. Many people with agoraphobia are afraid of leaving their home, severely limiting their ability to carry out normal life activities.

Separation Anxiety Disorder (SAD)

Individuals with SAD are fearful and anxious about separation from attachment figures to a degree that is developmentally inappropriate. Children with SAD may have difficulty being in a room by themselves, going to school alone, or entering new situations. They cling to and shadow their parents' every move. To avoid separation, they may fuss, scream, throw severe tantrums, or even make suicidal gestures.

Obsessive-Compulsive and Related Disorders

People affected by obsessive-compulsive disorder (OCD) cannot control their preoccupation with specific ideas or prevent themselves from repeatedly carrying out particular acts. This affects their ability to carry out normal activities.

• Obsessive behaviour: The inability to stop thinking about a particular idea or topic. The person often finds these thoughts unpleasant and shameful.
• Compulsive behaviour: The need to perform certain behaviours over and over again. Many compulsions involve counting, ordering, checking, touching, and washing.

Other disorders in this category include hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder.

Trauma- and Stressor-Related Disorders

People who have experienced a natural disaster, terrorist bomb blast, serious accident, or war-related situation may develop post-traumatic stress disorder (PTSD) . Symptoms vary widely but may include recurrent dreams, flashbacks, impaired concentration, and emotional numbing. Adjustment Disorders and Acute Stress Disorder are also included in this category.

Somatic Symptom and Related Disorders

These are conditions where physical symptoms appear in the absence of a physical disease. The individual has psychological difficulties but complains of physical symptoms for which there is no biological cause.

• Somatic symptom disorder: The person has persistent body-related symptoms that may or may not be related to a serious medical condition. They are overly preoccupied with their symptoms, constantly worry about their health, and make frequent visits to doctors. This causes significant distress and disturbance in daily life.
• Illness anxiety disorder: The person has a persistent preoccupation with developing a serious illness and constantly worries about this possibility. They are overly concerned about undiagnosed disease, do not respond to reassurance from doctors, and are easily alarmed about illness (e.g., upon hearing about someone else's ill-health).

• Conversion disorder: The person reports loss of part or all of some basic body functions, such as paralysis, blindness, deafness, or difficulty walking. These symptoms often occur suddenly after a stressful experience.

Dissociative Disorders

Dissociation involves a severance of the connections between ideas and emotions. It includes feelings of unreality, estrangement, depersonalisation, and sometimes a loss or shift of identity. Sudden temporary alterations of consciousness that blot out painful experiences are a defining characteristic.

• Dissociative amnesia: Extensive but selective memory loss that has no known organic cause (e.g., head injury). Some people cannot remember anything about their past; others cannot recall specific events, people, places, or objects while other memories remain intact. A part of this is dissociative fugue, which involves unexpected travel away from home and workplace, the assumption of a new identity, and the inability to recall the previous identity. The fugue usually ends when the person suddenly "wakes up" with no memory of the events that occurred during it. This is often associated with overwhelming stress.
• Dissociative identity disorder (multiple personality): The most dramatic dissociative disorder, often associated with traumatic experiences in childhood. The person assumes alternate personalities that may or may not be aware of each other.
• Depersonalisation/Derealisation disorder: A dreamlike state where the person feels separated both from self and from reality. In depersonalisation, there is a change in self-perception, and the sense of reality is temporarily lost or changed.

Depressive Disorders

Depression is one of the most widely prevalent and recognised mental disorders. It covers a variety of negative moods and behavioural changes. In everyday life, we use the term to refer to normal feelings after a significant loss, such as a relationship breakup or failure to attain a goal.

Major depressive disorder is defined as a period of depressed mood and/or loss of interest or pleasure in most activities, together with other symptoms that may include:

• Change in body weight
• Constant sleep problems
• Tiredness
• Inability to think clearly
• Agitation or greatly slowed behaviour
• Thoughts of death and suicide
• Excessive guilt or feelings of worthlessness

Factors predisposing towards depression:

• Genetic make-up/heredity: An important risk factor.
• Age: Women are particularly at risk during young adulthood; for men, the risk is highest in early middle age.
• Gender: Women are more likely than men to report a depressive disorder.
• Other risk factors: Experiencing negative life events and lack of social support.

Bipolar and Related Disorders

Bipolar I disorder involves both mania and depression, which are alternately present and sometimes interrupted by periods of normal mood. Manic episodes rarely appear by themselves; they usually alternate with depression. These were earlier referred to as manic-depressive disorders. Types include Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.

Suicide: Understanding and Prevention

Every suicide is a misfortune. It results from a complex interface of biological, genetic, psychological, sociological, cultural, and environmental factors.

Risk factors include:

• Having mental disorders (especially depression and alcohol use disorders)
• Going through natural disasters
• Experiencing violence, abuse, or loss
• Isolation at any stage of life
• A previous suicidal attempt (the strongest risk factor)

Suicidal behaviour often indicates difficulties in problem-solving, stress management, and emotional expression. Suicidal thoughts lead to action only when acting on them seems to be the only way out of a person's difficulties. These thoughts are heightened under acute emotional and other distress.

The stigma surrounding suicide prevents many people from seeking help. Improving identification, referral, and management of behaviour is crucial for prevention.

Measures suggested by WHO include:

• Limiting access to the means of suicide
• Responsible reporting of suicide by media
• Bringing in alcohol-related policies
• Early identification, treatment, and care of people at risk
• Training health workers in assessing and managing suicide risk
• Providing care for people who attempted suicide and community support

Identifying students in distress: Any unexpected or striking change affecting an adolescent's performance, attendance, or behaviour should be taken seriously, such as:

• Lack of interest in common activities
• Declining grades
• Decreasing effort
• Misbehaviour in the classroom
• Mysterious or repeated absence
• Smoking, drinking, or drug misuse

Strengthening students' self-esteem: A positive self-esteem helps in coping with distress. Useful approaches include:

• Accentuating positive life experiences to develop a positive identity …