मानसशास्त्र Psychology

Quick summary

Abnormal psychology studies unusual behaviour and mental disorders — their symptoms, causes, classification and treatment. Behaviour is judged abnormal using criteria such as deviance, distress, dysfunction and danger (the "four Ds"). Ideas about abnormality have changed from supernatural beliefs to scientific models. Today, disorders are classified using DSM-5 (American Psychiatric Association) and ICD-11 (World Health Organization).

Key points

• Abnormal means "away from the normal". Abnormal behaviour (असामान्य वर्तन) is behaviour that is deviant, distressing, dysfunctional and sometimes dangerous.
• Criteria of abnormality:
• Statistical: behaviour that is rare or far from the average.
• Social norms (deviance): behaviour that violates the norms of society.
• Personal distress: the person suffers emotionally.
• Maladaptiveness (dysfunction): behaviour interferes with daily life, work and relationships.
• Danger: risk to self or others.
• No single criterion is enough; abnormality depends partly on culture and time.
• History: ancient people believed in evil spirits (demonology) and used methods like trephining. Hippocrates said mental illness had natural causes (brain, body fluids). In the Middle Ages, superstition returned. Philippe Pinel removed chains from patients in Paris (moral treatment). Emil Kraepelin gave an early scientific classification.
• Models (perspectives) of abnormality: biological, psychodynamic, behavioural, cognitive, humanistic–existential, and sociocultural.
• Diathesis–stress model: a disorder develops when a person with a predisposition (diathesis) faces stress.
• Biopsychosocial model: biological, psychological and social factors together cause disorders.
• The Mental Healthcare Act, 2017 in India protects the rights of persons with mental illness and decriminalised attempted suicide (presumes severe stress).

Important terms

• Psychopathology – the scientific study of mental disorders.
• Symptom – a sign of a disorder (e.g. sadness, hallucinations).
• Syndrome – a group of symptoms that occur together.
• Diagnosis – identifying a disorder from its symptoms.
• Prognosis – the likely course and outcome of a disorder.
• Aetiology – the study of causes of a disorder.
• Stigma – negative labelling and discrimination against people with mental illness.

Important thinkers and theories

• DSM-5 was published in 2013 (text revision DSM-5-TR in 2022). ICD-11 came into effect in 2022.

5 important questions

Q1. What is the diathesis–stress model?

It states that a mental disorder develops when a person who has a predisposition (diathesis), such as genetic vulnerability, is exposed to stressful life events.

Q2. What is DSM-5?

DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, published by the American Psychiatric Association in 2013, used to classify and diagnose mental disorders.

Q3. Explain the criteria of abnormal behaviour.

• Statistical rarity.
• Violation of social norms.
• Personal distress.
• Maladaptive functioning.
• Danger to self or others.
• Limitations of each; need to combine criteria.

Q4. Trace the historical views of abnormal behaviour.

• Ancient: demonology, trephining, exorcism.
• Greek: Hippocrates' natural causes, four humours.
• Middle Ages: witch-hunts, superstition.
• Asylums; Pinel's moral treatment.
• Modern scientific era: Kraepelin, Freud, classification systems.

Q5. Describe the models of abnormality.

• Biological: genetics, brain, neurotransmitters.
• Psychodynamic: unconscious conflicts.
• Behavioural: learned maladaptive behaviour.
• Cognitive: faulty thinking.
• Humanistic: blocked self-actualisation.
• Sociocultural and biopsychosocial models.

Exam tip

Remember the "four Ds" (deviance, distress, dysfunction, danger). A table of models with cause and treatment helps in many long questions in this paper.

Quick summary

A model (perspective) of abnormal behaviour is a set of assumptions about what causes mental disorders and how they should be treated. The main models are biological, psychodynamic, behavioural, cognitive, humanistic–existential and sociocultural. Today most experts use integrated models such as the diathesis–stress and biopsychosocial models, because no single model explains every disorder.

Key points

• Biological (medical) model – disorders arise from problems in the brain and body: genetics (twin and family studies), neurotransmitter imbalance (dopamine in schizophrenia, serotonin and norepinephrine in depression), brain structure damage, hormones and infections. Treatment: drugs, ECT, brain stimulation.
• Psychodynamic model (Freud) – unconscious conflicts among id, ego and superego, unresolved childhood (psychosexual) conflicts and overuse of defence mechanisms cause symptoms. Treatment: psychoanalysis (free association, dream analysis, interpretation of transference and resistance).
• Behavioural model – abnormal behaviour is learned through classical conditioning (Watson's Little Albert, 1920), operant conditioning (reinforcement of maladaptive behaviour) and modelling. Treatment: behaviour therapy (systematic desensitisation, exposure, token economy).
• Cognitive model – disorders result from faulty thinking: irrational beliefs (Albert Ellis), negative automatic thoughts and the cognitive triad (Aaron Beck). Treatment: REBT, cognitive therapy, CBT.
• Humanistic–existential model – problems arise when growth towards self-actualisation is blocked, when there is incongruence between self and experience (Carl Rogers), or from loss of meaning (Viktor Frankl). Treatment: client-centred therapy, logotherapy, Gestalt therapy.
• Sociocultural model – poverty, discrimination, family conflict, migration, social change, labelling and culture shape disorders. Includes family systems view. Treatment: family and community therapy.
• Diathesis–stress model – a disorder appears when an inherited or early-acquired vulnerability (diathesis) meets enough stress.
• Biopsychosocial model (George Engel, 1977) – biological, psychological and social factors interact; this is the accepted modern view.
• Each model has strengths (useful treatments) and weaknesses (one-sided explanations).

Important terms

• Aetiology – the cause of a disorder.
• Neurotransmitter – chemical messenger between neurons.
• Defence mechanism – unconscious strategy to reduce anxiety (repression, projection, denial).
• Irrational belief – unrealistic "must" or "should" thoughts (Ellis).
• Labelling theory – calling someone "mad" can make them act the role (Thomas Scheff).
• Concordance rate – the percentage of twin pairs who both have a disorder.

Important thinkers and theories

5 important questions

Q1. What is the diathesis–stress model?

It says a mental disorder develops when a person with a vulnerability (diathesis), such as a genetic tendency, faces stressful life events. Neither alone is usually enough.

Q2. What does the biopsychosocial model mean?

It explains disorders as the result of interacting biological (genes, brain), psychological (thinking, emotions) and social (family, culture, poverty) factors (George Engel, 1977).

Q3. Explain the biological model of abnormal behaviour.

• Genetic factors with twin and adoption studies.
• Neurotransmitters and brain structures.
• Treatments: medicines, ECT.
• Strengths and limitations (ignores psychological and social causes).

Q4. Compare the psychodynamic and behavioural models.

• Cause: unconscious conflicts vs learned behaviour.
• Method: interpretation vs conditioning.
• Treatment: psychoanalysis vs behaviour therapy.
• Scientific status: hard to test vs experimentally tested.

Q5. Describe the cognitive and humanistic models.

• Ellis's ABC model and irrational beliefs; Beck's cognitive triad.
• Rogers: conditions of worth, incongruence; Frankl: meaning.
• Therapies from each.
• Evaluation.

Exam tip

End every "models" answer with the biopsychosocial model — examiners expect you to show that modern psychology integrates all perspectives.

Quick summary

Classification means grouping mental disorders into categories with clear criteria so that professionals can diagnose them in the same way. The two main systems are the DSM, published by the American Psychiatric Association, and the ICD, published by the World Health Organization. Classification helps communication, treatment and research, but labels can also lead to stigma.

Key points

• Diagnosis (निदान) – identifying a disorder from its symptoms using standard criteria; classification (वर्गीकरण) – arranging disorders in groups.
• Emil Kraepelin (late 19th century) made the first modern classification, separating dementia praecox (schizophrenia) from manic-depressive illness.
• DSM – Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association): DSM-I (1952), DSM-II (1968), DSM-III (1980) – clear criteria and a multiaxial system, DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013), DSM-5-TR (2022).
• DSM-5 changes: removed the five-axis system, uses Arabic numeral 5, adds dimensional ratings of severity, groups disorders by lifespan order (neurodevelopmental first), autism spectrum disorder as one category, OCD and PTSD moved out of anxiety disorders into their own chapters.
• ICD – International Classification of Diseases (WHO): ICD-10 (1992, mental disorders in Chapter V, "F" codes); ICD-11 adopted in 2019 and in use from 1 January 2022, with mental disorders in Chapter 6. India's health system mainly uses ICD.
• Major DSM-5 groups (examples): neurodevelopmental, schizophrenia spectrum, bipolar, depressive, anxiety, obsessive-compulsive, trauma- and stressor-related, dissociative, somatic symptom, feeding and eating, sleep–wake, substance-related and addictive, neurocognitive, personality disorders.
• Diagnostic tools: clinical interview (structured, e.g. SCID), mental status examination, case history, psychological tests, observation, medical tests.
• Uses: common language among professionals, choice of treatment, prediction of course (prognosis), research and statistics, insurance and legal decisions.
• Criticisms: labelling and stigma (Rosenhan's study "On being sane in insane places", 1973), categories overlap (comorbidity), cultural bias, medicalising normal sadness, low reliability for some diagnoses.

Important terms

• Comorbidity – presence of two or more disorders together.
• Prognosis – expected course and outcome of a disorder.
• Reliability of diagnosis – agreement between two clinicians on the same case.
• Culture-bound syndrome – a pattern of symptoms found in a particular culture (e.g. dhat syndrome in South Asia).
• Categorical vs dimensional – disorder present or absent vs measured on a continuum of severity.

Important thinkers and theories

• D. L. Rosenhan (1973) – eight healthy "pseudo-patients" were admitted to psychiatric hospitals and labelled; the study questioned diagnostic reliability.

5 important questions

Q1. What is DSM-5?

DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013. It gives criteria for diagnosing mental disorders.

Q2. What is comorbidity?

Comorbidity is the occurrence of two or more disorders in the same person at the same time, for example depression with anxiety.

Q3. Explain the need and uses of classification of mental disorders.

• Common language and communication.
• Proper treatment planning and prognosis.
• Research, statistics, mental health planning.
• Legal, insurance and educational decisions.

Q4. Compare DSM-5 and ICD-11.

• Publisher and purpose (US psychiatry vs global health).
• Year and structure.
• Similarities: categorical criteria, many shared groups.
• Differences: ICD is free and used worldwide including India; DSM gives more detailed criteria.

Q5. Discuss the criticisms of diagnostic classification.

• Labelling and stigma; Rosenhan's study.
• Comorbidity and overlapping categories.
• Cultural bias; culture-bound syndromes.
• Over-diagnosis of normal reactions.
• Movement towards dimensional approaches.

Exam tip

Remember three dates — DSM-III 1980, DSM-5 2013, ICD-11 in force 2022 — and mention that DSM-5 dropped the multiaxial system.

Quick summary

Anxiety is a normal feeling of worry and tension before a threat. It becomes a disorder when it is excessive, long-lasting and interferes with daily life. Major anxiety disorders are generalised anxiety disorder, panic disorder, phobias (specific phobia, social anxiety disorder, agoraphobia) and separation anxiety disorder. Obsessive-compulsive disorder (OCD) was earlier grouped with them. Anxiety disorders are caused by biological, psychological and social factors and are treatable.

Key points

• Anxiety (चिंता) involves worry, fear, restlessness and bodily symptoms such as fast heartbeat, sweating and trembling.
• Fear is a response to a present, clear danger; anxiety is about a future or unclear threat.
• Generalised Anxiety Disorder (GAD): excessive, uncontrollable worry about many things for at least 6 months, with restlessness, fatigue, poor concentration, irritability, muscle tension and sleep problems.
• Panic disorder: repeated, unexpected panic attacks — sudden intense fear with palpitations, choking feeling, chest pain, dizziness and fear of dying or "going crazy" — plus worry about future attacks.
• Specific phobia: intense, irrational fear of a particular object or situation (heights, snakes, injections), leading to avoidance.
• Social anxiety disorder (social phobia): fear of being judged or embarrassed in social situations.
• Agoraphobia: fear of places where escape may be difficult (crowds, public transport, open spaces).
• OCD (now a separate category in DSM-5): obsessions (unwanted repeated thoughts) and compulsions (repeated acts like hand-washing, checking, counting).
• PTSD (Post-Traumatic Stress Disorder): after a traumatic event — flashbacks, nightmares, avoidance, hyperarousal (now in "trauma- and stressor-related disorders").

Important terms

• Panic attack – sudden surge of intense fear peaking within minutes.
• Phobia – persistent, irrational fear with avoidance.
• Obsession – intrusive, unwanted thought, image or urge.
• Compulsion – repetitive behaviour done to reduce anxiety caused by obsessions.
• Systematic desensitisation – gradual exposure to feared objects while relaxed (Joseph Wolpe).
• Exposure and response prevention (ERP) – main behavioural treatment for OCD.

Important thinkers and theories

• Mowrer's two-factor theory: fear is acquired by classical conditioning and maintained by operant conditioning (avoidance is reinforced).
• Treatment: CBT, systematic desensitisation, exposure therapy, relaxation training; medicines such as SSRIs and benzodiazepines (short term, under medical supervision).

5 important questions

Q1. Distinguish between fear and anxiety.

Fear is an immediate reaction to a real, present danger. Anxiety is a feeling of worry and tension about a possible future or unclear threat.

Q2. What is agoraphobia?

Agoraphobia is an intense fear of situations where escape might be difficult or help unavailable, such as crowds, markets or public transport, leading to avoidance.

Q3. Describe the symptoms of generalised anxiety disorder.

• Excessive worry for at least 6 months.
• Difficult to control the worry.
• Restlessness, feeling on edge.
• Fatigue and poor concentration.
• Irritability and muscle tension.
• Sleep disturbance.

Q4. Explain the causes of phobias.

• Classical conditioning (Little Albert).
• Observational learning from others' fears.
• Information transmission (stories, warnings).
• Biological preparedness (Seligman): we easily fear snakes and heights.
• Avoidance maintains the fear (Mowrer).

Q5. Explain the treatment of anxiety disorders.

• Cognitive behaviour therapy: challenge catastrophic thoughts.
• Systematic desensitisation: relaxation + fear hierarchy.
• Exposure and response prevention for OCD.
• Relaxation, breathing, mindfulness.
• Medication by a psychiatrist.
• Family support and stress management.

Exam tip

For each disorder, write: definition, key symptoms (with duration if known), causes and treatment. Learn the steps of systematic desensitisation — it is asked often.

Quick summary

In somatic symptom and related disorders, a person has physical complaints or worries about illness that cause great distress, with psychological factors playing a major role. In dissociative disorders, the normal integration of memory, identity, consciousness and perception breaks down. Both groups were earlier called "hysteria" or "neurosis" and are closely linked with stress and trauma.

Key points

• Somatic symptom disorder – one or more distressing bodily symptoms (pain, fatigue) with excessive thoughts, anxiety and time spent on them, lasting usually more than 6 months.
• Illness anxiety disorder – preoccupation with having or getting a serious illness with few or no symptoms (formerly hypochondriasis).
• Conversion disorder (functional neurological symptom disorder) – loss or change of motor or sensory function (paralysis, blindness, seizures) not explained by a neurological disease. Sometimes shows la belle indifférence (strange lack of concern).
• Factitious disorder – deliberately faking or producing symptoms to take on the sick role (Munchausen syndrome); different from malingering, where the motive is external gain (money, avoiding work).
• Somatic symptom and related disorders (DSM-5):
• Causes: stress and trauma, learning and reinforcement of the sick role (attention, relief from duties), cognitive focus on bodily sensations, psychodynamic view of anxiety "converted" into physical symptoms (Freud's work on hysteria with Breuer), cultural acceptance of physical rather than emotional complaints.
• Dissociative amnesia – inability to recall important personal information, usually after trauma; may include dissociative fugue (sudden travel with confusion about identity).
• Dissociative identity disorder (DID) – two or more distinct personality states (alters) with gaps in memory; formerly multiple personality disorder; often linked with severe childhood abuse.
• Depersonalisation/derealisation disorder – persistent feeling of being detached from oneself (like watching oneself in a film) or that the surroundings are unreal, with reality testing intact.
• Dissociative disorders (DSM-5):
• Causes of dissociation: severe trauma, dissociation as a defence or escape, high suggestibility, state-dependent memory.
• Treatment: psychotherapy (CBT, psychodynamic therapy), reassurance and avoiding unnecessary medical tests, stress management, hypnosis in some cases, trauma-focused therapy, medicines for associated depression and anxiety.

Important terms

• Somatisation – expressing psychological distress through physical symptoms.
• Malingering – faking illness for external reward (not a mental disorder).
• Alter – a separate personality state in DID.
• Fugue – flight from home with loss of memory of identity.
• Secondary gain – benefits a person gets from being ill (attention, sympathy, leave).

Important thinkers and theories

• Charcot, Janet, Breuer and Freud studied hysteria in the late 19th century; Pierre Janet introduced the idea of dissociation.

5 important questions

Q1. What is conversion disorder?

It is a disorder in which a person shows neurological symptoms such as paralysis, blindness or fits, but no medical cause is found; psychological stress is believed to underlie it.

Q2. Distinguish between factitious disorder and malingering.

In factitious disorder symptoms are faked to play the sick role, without obvious external reward. In malingering, symptoms are faked for external gain such as money or escaping duty.

Q3. Describe the types of somatic symptom and related disorders.

• Somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder.
• Symptoms and an example of each.
• Causes and treatment in brief.

Q4. Explain dissociative identity disorder.

• Meaning; alters; amnesia between identities.
• Causes: childhood trauma, dissociation as defence, suggestibility.
• Controversy about over-diagnosis.
• Treatment: long-term psychotherapy aiming at integration.

Q5. Discuss the causes and treatment of dissociative disorders.

• Trauma and stress; psychodynamic repression; behavioural escape; cognitive and memory factors.
• Types with key features.
• Treatment: psychotherapy, hypnosis, CBT, medication for co-existing disorders.

Exam tip

Use DSM-5 names (somatic symptom disorder, illness anxiety disorder) but also mention old names (somatoform, hypochondriasis, multiple personality) — many question papers still use the old terms.

Quick summary

Mood disorders are mental disorders in which a person's emotional state is seriously disturbed for a long period. The two main groups are depressive disorders (such as major depressive disorder and persistent depressive disorder) and bipolar disorders (with episodes of mania and depression). They are caused by biological, psychological and social factors. Mood disorders are treatable with medicines and psychotherapy, and suicide prevention is an important concern.

Key points

• Mood (मनःस्थिती) is a lasting emotional state. Mood disorders involve extreme or prolonged sadness or elation.
• Major Depressive Disorder (MDD): at least two weeks of depressed mood or loss of interest/pleasure (anhedonia), with other symptoms such as changes in appetite or weight, sleep problems, fatigue, feelings of worthlessness or guilt, poor concentration, slowed or agitated movements, and thoughts of death or suicide.
• Persistent depressive disorder (dysthymia): milder but long-lasting depression for at least two years in adults.
• Bipolar I disorder: at least one manic episode (often with depressive episodes).
• Bipolar II disorder: at least one hypomanic episode and at least one major depressive episode.
• Cyclothymic disorder: mild mood swings (hypomanic and depressive symptoms) for at least two years.
• Mania: elevated or irritable mood, inflated self-esteem, less need for sleep, rapid speech, racing thoughts (flight of ideas), distractibility and risky behaviour.
• Depression is more commonly diagnosed in women; bipolar disorder affects men and women about equally.
• Treatment: antidepressants (e.g. SSRIs), lithium and other mood stabilisers for bipolar disorder, CBT, interpersonal therapy, and ECT for severe cases.

Important terms

• Anhedonia – loss of interest or pleasure in activities.
• Hypomania – a milder form of mania that does not cause severe impairment.
• Learned helplessness – belief that one cannot control outcomes, developed after repeated uncontrollable bad events (Martin Seligman).
• Cognitive triad – negative view of self, world and future (Aaron Beck).
• Seasonal pattern – depression that occurs in particular seasons, usually winter.
• Suicidal ideation – thoughts about ending one's life.

Important thinkers and theories

• Warning signs of suicide: talking about death, hopelessness, withdrawing from people, giving away possessions, sudden calmness after depression. In India, Tele-MANAS (14416) is the national tele-mental health helpline.

5 important questions

Q1. What is anhedonia?

Anhedonia is the loss of interest or pleasure in activities that the person used to enjoy; it is a core symptom of depression.

Q2. Distinguish between Bipolar I and Bipolar II disorder.

Bipolar I involves at least one full manic episode. Bipolar II involves hypomanic episodes (milder) along with major depressive episodes, but no full mania.

Q3. Describe the symptoms of major depressive disorder.

• Depressed mood most of the day.
• Loss of interest or pleasure.
• Appetite/weight and sleep changes.
• Fatigue, slowed movement or agitation.
• Worthlessness, guilt, poor concentration.
• Thoughts of death or suicide; at least two weeks.

Q4. Explain the causes of depression.

• Genetic and neurochemical factors.
• Stressful life events and loss.
• Beck's cognitive triad and negative thinking.
• Seligman's learned helplessness.
• Low reinforcement; social isolation.
• Diathesis–stress interaction.

Q5. Explain the treatment of mood disorders.

• Antidepressants for depression; lithium/mood stabilisers for bipolar.
• Cognitive therapy (Beck) to change negative thoughts.
• Behavioural activation and interpersonal therapy.
• ECT for severe, drug-resistant depression.
• Family support, lifestyle changes, suicide prevention.

Exam tip

Learn the minimum durations (MDD 2 weeks, dysthymia 2 years) and the symptoms of mania. Beck's cognitive triad and Seligman's learned helplessness are frequent long questions.

Quick summary

Schizophrenia is a severe mental disorder in which a person loses touch with reality. It involves disturbances in thinking, perception, emotion and behaviour, such as delusions, hallucinations and disorganised speech. Symptoms are grouped as positive, negative and cognitive. It is caused by a combination of genetic, brain and environmental factors, and is treated with antipsychotic medicines along with psychosocial support.

Key points

• The term schizophrenia was coined by Eugen Bleuler (1911); it means "split mind" — a split between thought, emotion and behaviour, not a split personality.
• Emil Kraepelin earlier called it dementia praecox.
• It usually begins in late adolescence or early adulthood.
• Positive symptoms (excess or distortion of normal functions): delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour.
• Negative symptoms (loss of normal functions): flat affect, alogia (poverty of speech), avolition (lack of motivation), anhedonia, social withdrawal.
• Cognitive symptoms: problems in attention, memory and planning.
• DSM-5 diagnosis: at least two core symptoms (at least one being delusions, hallucinations or disorganised speech) for a significant part of one month, with signs of disturbance lasting at least six months.
• Older subtypes (paranoid, disorganised, catatonic, undifferentiated, residual) were removed in DSM-5 but are still taught.
• Course: prodromal phase → active phase → residual phase.

Important terms

• Delusion – a firm false belief not shared by others, e.g. persecution (others are plotting against me), grandeur (I am very important), reference (TV is talking about me), control (my thoughts are controlled by others).
• Hallucination – perception without a stimulus; auditory hallucinations (hearing voices) are the most common.
• Loosening of associations (derailment) – thoughts jump from one topic to another without logical connection.
• Neologism – making up new words.
• Catatonia – abnormal motor behaviour, such as remaining fixed in odd postures (waxy flexibility) or extreme excitement.
• Flat affect – little or no emotional expression.
• Expressed emotion – family attitudes of criticism, hostility and over-involvement that increase relapse.

Important thinkers and theories

• Treatment: antipsychotics — typical (e.g. chlorpromazine, haloperidol) and atypical (e.g. clozapine, risperidone); family therapy; social skills training; CBT for psychosis; vocational rehabilitation; day-care and community care.

5 important questions

Q1. What is a delusion?

A delusion is a firmly held false belief that is not shaken by evidence and not shared by others of the same culture, e.g. believing that one is being poisoned by neighbours.

Q2. Distinguish between positive and negative symptoms.

Positive symptoms are additions or distortions of normal behaviour (delusions, hallucinations). Negative symptoms are deficits or losses of normal behaviour (flat affect, lack of motivation, poverty of speech).

Q3. Describe the symptoms of schizophrenia.

• Delusions of various types.
• Hallucinations, mainly auditory.
• Disorganised speech and thinking.
• Disorganised or catatonic behaviour.
• Negative symptoms.
• Cognitive impairment; duration at least six months.

Q4. Explain the causes of schizophrenia.

• Genetic evidence: family and twin studies.
• Dopamine hypothesis.
• Brain abnormalities.
• Prenatal and birth complications.
• Psychosocial stress and family expressed emotion.
• Diathesis–stress view.

Q5. Explain the treatment of schizophrenia.

• Antipsychotic medication; side effects need monitoring.
• Family psycho-education to reduce expressed emotion.
• Social skills and vocational training.
• CBT for psychosis.
• Community rehabilitation and relapse prevention.
• Reducing stigma and supporting the family.

Exam tip

Never write that schizophrenia means "split personality". Learn types of delusions with examples and the positive vs negative symptom table.

Quick summary

A personality disorder is a long-lasting, rigid pattern of inner experience and behaviour that differs markedly from the expectations of the person's culture and causes distress or problems in work and relationships. The pattern begins in adolescence or early adulthood and is stable over time. DSM-5 describes ten personality disorders arranged in three clusters: odd–eccentric, dramatic–erratic and anxious–fearful.

Key points

• Personality disorder (व्यक्तिमत्त्व विकृती) – an enduring, inflexible and pervasive pattern affecting at least two of: thinking (cognition), emotions (affect), interpersonal functioning and impulse control.
• People with personality disorders often do not see their traits as a problem (ego-syntonic), unlike anxiety symptoms, which feel unwanted (ego-dystonic).
• Paranoid – distrust and suspicion of others' motives.
• Schizoid – detachment from relationships, limited emotional expression.
• Schizotypal – odd beliefs, magical thinking, eccentric behaviour, discomfort in close relationships.
• Cluster A – odd or eccentric:
• Antisocial – disregard for and violation of others' rights, lying, aggression, no remorse; diagnosed at 18+ with signs of conduct disorder before 15.
• Borderline – unstable relationships, self-image and emotions, fear of abandonment, impulsivity, self-harm.
• Histrionic – excessive emotionality and attention-seeking.
• Narcissistic – grandiosity, need for admiration, lack of empathy.
• Cluster B – dramatic, emotional or erratic:
• Avoidant – social inhibition, feelings of inadequacy, oversensitivity to criticism.
• Dependent – excessive need to be taken care of, submissive and clinging.
• Obsessive-compulsive personality disorder (OCPD) – preoccupation with orderliness, perfectionism and control (different from OCD, which has true obsessions and compulsions).
• Cluster C – anxious or fearful:
• Causes: genetic temperament, brain differences (e.g. low arousal in antisocial PD), childhood abuse, neglect or inconsistent parenting, insecure attachment, learning and social factors.
• Treatment: difficult and long; dialectical behaviour therapy (DBT, Marsha Linehan) for borderline PD; cognitive therapy, psychodynamic therapy, group therapy; medicines only for associated symptoms.

Important terms

• Ego-syntonic – traits felt as acceptable and part of oneself.
• Psychopathy – a related concept: superficial charm, no guilt, manipulation (Hervey Cleckley; Robert Hare's checklist).
• Splitting – seeing people as all-good or all-bad (common in borderline PD).
• Grandiosity – exaggerated sense of self-importance.
• Perfectionism – setting unrealistically high standards.

Important thinkers and theories

• Marsha Linehan developed DBT (1990s); Hervey Cleckley wrote The Mask of Sanity (1941) on psychopathy.

5 important questions

Q1. Define personality disorder.

A personality disorder is an enduring, rigid pattern of thinking, feeling and behaving that deviates from cultural expectations, begins by early adulthood and causes distress or impairment.

Q2. What is antisocial personality disorder?

It is a pattern of disregard for others' rights shown by lying, cheating, aggression, irresponsibility and lack of remorse, diagnosed only in adults who showed conduct problems before age 15.

Q3. Describe the three clusters of personality disorders.

• Cluster A with three disorders and features.
• Cluster B with four disorders.
• Cluster C with three disorders.
• One example behaviour for each.

Q4. Explain borderline personality disorder and its treatment.

• Symptoms: unstable emotions, relationships, self-image, fear of abandonment, self-harm, impulsivity.
• Causes: biological vulnerability plus invalidating environment.
• DBT: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Q5. Discuss the causes and treatment of personality disorders.

• Biological, psychological (childhood, attachment) and social causes.
• Why treatment is difficult (ego-syntonic, poor trust).
• Therapies and medicines.

Exam tip

Memorise the clusters as "A = weird, B = wild, C = worried" — it helps you place all ten disorders correctly under pressure.

Quick summary

Substance-related and addictive disorders involve repeated use of alcohol, tobacco or drugs (or behaviours like gambling) despite serious harm to health, studies, work and relationships. DSM-5 combines the old categories of "abuse" and "dependence" into one substance use disorder rated mild, moderate or severe. Causes are biological, psychological and social, and treatment combines detoxification, therapy, support groups and relapse prevention.

Key points

• Psychoactive substance – a chemical that changes mood, perception, thinking or behaviour by acting on the brain.
• Main classes: depressants (alcohol, sedatives, sleeping pills), stimulants (nicotine, caffeine, amphetamines, cocaine), opioids (opium, heroin/"brown sugar", morphine, some painkillers), hallucinogens (LSD, some mushrooms), cannabis (ganja, charas, bhang) and inhalants (glue, whitener, petrol).
• DSM-5 substance use disorder – 11 criteria in four groups: impaired control (using more than intended, craving, failed attempts to stop), social impairment, risky use, and pharmacological signs (tolerance, withdrawal). Severity: mild (2–3 criteria), moderate (4–5), severe (6 or more).
• Tolerance – needing more of the substance for the same effect. Withdrawal – unpleasant physical and mental symptoms when use stops (e.g. tremors, sweating, delirium tremens in alcohol withdrawal).
• Gambling disorder is the only behavioural addiction included in DSM-5; internet gaming disorder is listed for further study, and ICD-11 includes gaming disorder.
• Effects of alcohol: liver damage (cirrhosis), memory loss, accidents, family violence; Korsakoff syndrome from thiamine (vitamin B1) deficiency in chronic alcoholism.
• Causes: genetics and family history; brain's dopamine reward pathway; personality (sensation seeking, impulsivity); stress and coping by escape; peer pressure; easy availability, advertising and culture; operant reinforcement and modelling.
• Treatment: detoxification under medical care; medicines (e.g. disulfiram for alcohol, nicotine replacement, methadone or buprenorphine for opioids); CBT, motivational interviewing (Miller and Rollnick), contingency management, family therapy; self-help groups like Alcoholics Anonymous (12 steps, founded 1935); relapse prevention (Marlatt).
• Prevention in India: awareness in schools and colleges, NDPS Act 1985, de-addiction centres, Nasha Mukt Bharat Abhiyaan (2020).

Important terms

• Addiction – compulsive use despite harmful consequences.
• Craving – strong desire or urge to use the substance.
• Relapse – returning to use after a period of abstinence.
• Detoxification – medically supervised removal of the substance from the body.
• Polysubstance use – using more than one substance.

Important thinkers and theories

• Prochaska and DiClemente's stages of change: precontemplation, contemplation, preparation, action, maintenance.

5 important questions

Q1. What is tolerance?

Tolerance is a state in which a person needs larger amounts of a substance to get the same effect, or gets a weaker effect from the same amount.

Q2. What are withdrawal symptoms?

They are unpleasant physical and psychological symptoms, such as shaking, sweating, anxiety and sleeplessness, that appear when a person suddenly stops or reduces a substance on which the body has become dependent.

Q3. Explain DSM-5 criteria for substance use disorder.

• Impaired control, social impairment, risky use, pharmacological criteria.
• Severity levels: mild, moderate, severe.
• Change from DSM-IV abuse/dependence.

Q4. Discuss the causes of substance use disorders.

• Biological: genes, dopamine reward system.
• Psychological: personality, stress, expectancies, learning.
• Social: peers, family, availability, media.
• Biopsychosocial integration.

Q5. Describe the treatment of substance use disorders.

• Detoxification and medicines.
• Psychological therapies: CBT, motivational interviewing, family therapy.
• Self-help groups (AA, NA).
• Stages of change and relapse prevention.
• Role of community and government programmes.

Exam tip

Remember DSM-5's severity counts — 2–3 mild, 4–5 moderate, 6+ severe — and the five stages of change; both appear often in short notes.

Quick summary

Psychotherapy is the treatment of psychological problems through a planned, professional relationship between a trained therapist and a client, using psychological methods rather than medicines. Major types include psychoanalysis, behaviour therapy, cognitive therapies (REBT and Beck's cognitive therapy), humanistic client-centred therapy, and group and family therapies. Biomedical therapies such as drugs and ECT are used alongside where needed.

Key points

• Psychotherapy (मानसोपचार) aims to reduce distress, change maladaptive behaviour, improve self-understanding and help the client function better.
• Common features: a trained therapist, a client who seeks help, a therapeutic relationship (alliance) based on trust, confidentiality and systematic techniques.
• Psychoanalysis (Sigmund Freud): makes unconscious conflicts conscious. Techniques: free association, dream analysis, analysis of resistance and transference, and interpretation.
• Behaviour therapy: based on learning principles. Techniques: systematic desensitisation (Joseph Wolpe), aversion therapy, token economy, modelling (Bandura), flooding, positive reinforcement.
• Rational Emotive Behaviour Therapy (REBT) (Albert Ellis): irrational beliefs cause emotional problems; the ABC model — Activating event, Belief, Consequence; therapist Disputes irrational beliefs.
• Cognitive therapy (Aaron Beck): identifies and changes negative automatic thoughts and cognitive distortions; widely used for depression.
• Cognitive Behaviour Therapy (CBT) combines cognitive and behavioural techniques; it is one of the most researched therapies.
• Client-centred (person-centred) therapy (Carl Rogers): non-directive; therapist offers unconditional positive regard, empathy and genuineness (congruence).
• Gestalt therapy (Fritz Perls): awareness of the "here and now".
• Group and family therapy: problems are worked on in a group or within the family system.
• Yoga and meditation are also used in India as supportive methods for stress and anxiety.

Important terms

• Free association – client says whatever comes to mind without censoring.
• Transference – client shifts feelings about important past figures onto the therapist.
• Resistance – unconscious blocking of therapy progress.
• Token economy – tokens given for desired behaviour, later exchanged for rewards.
• Aversion therapy – pairing an unwanted behaviour with an unpleasant stimulus (e.g. for alcohol dependence).
• Catharsis – release of pent-up emotions.
• Empathy – understanding the client's feelings from the client's point of view.

Important thinkers and theories

• Steps of systematic desensitisation: (1) relaxation training, (2) building a fear hierarchy from least to most feared, (3) gradual exposure to each step while relaxed.

5 important questions

Q1. What is transference?

Transference is the process in psychoanalysis in which the client unconsciously directs feelings felt towards important people in the past, such as parents, onto the therapist.

Q2. What is a token economy?

It is a behaviour therapy technique where tokens are given for desirable behaviour and can later be exchanged for rewards; used in hospitals, schools and hostels.

Q3. Explain Ellis's REBT.

• Emotional problems come from irrational beliefs, not events.
• A = activating event; B = belief; C = emotional consequence.
• D = disputing irrational beliefs; E = new effective outlook.
• Common irrational beliefs: "I must be perfect", "everyone must like me".
• Active, directive therapist.

Q4. Describe the techniques of behaviour therapy.

• Systematic desensitisation for phobias.
• Aversion therapy for addictions.
• Token economy and positive reinforcement.
• Modelling and social skills training.
• Flooding and exposure.
• Based on classical and operant conditioning.

Q5. Explain Carl Rogers's client-centred therapy.

• Humanistic, non-directive.
• Client has capacity for growth.
• Conditions: unconditional positive regard, empathy, genuineness.
• Reflection of feelings, active listening.
• Aim: reduce gap between real and ideal self; self-actualisation.

Exam tip

Use the founder–technique table. For REBT, always write A-B-C-D-E with an everyday example such as failing an exam.