Psychological Disorders

This is the fourth chapter of NCERT's Class 12 Psychology textbook (pages 69–88). It opens with the concepts of abnormality and their history, explains how disorders are classified, sets out the models that explain them, and then describes the major psychological disorders in the order of the American DSM-5. It has five activities, Tables 4.1–4.2, Boxes 4.1–4.3, a panel on suicide and students in distress, eleven review questions and three project ideas; there are no photographs or figures.

• Builds on the live chapters Meeting Life Challenges (Chapter 3: stress, coping, social support — the ‘stress’ in the diathesis–stress model), Self and Personality (Chapter 2: Freud's id, ego and superego; Maslow's self-actualisation; the tridosha) and Variations in Psychological Attributes (Chapter 1: IQ and intellectual disability). From Class 11, Sensory, Attentional and Perceptual Processes introduced ADHD and attention, and Human Development covered adolescence.
• Leads into Chapter 5 (Therapeutic Approaches: psychotherapy, behaviour and cognitive therapy, rehabilitation) — the treatments that match the models here.
• UPSC: psychology has no GS paper of its own. This chapter serves GS1 (Indian society: suicide among young women, 2023; the youth, loneliness and social media — Essay 2024), GS2 (health and vulnerable sections: mental-health law and programmes, disability), GS4 (empathy and compassion towards people in distress, non-stigmatising conduct by officials) and Essay. Prelims has asked what hypochondria is (1983) and what a hallucination is (1984) — both defined here.

• Four Ds: deviance, distress, dysfunction, danger. Two views: deviation from social norms (critics: normality ≠ conformity) vs maladaptive behaviour (blocks well-being and growth). Stigma stops people seeking help; NCERT: view a disorder like any other illness.
• History: supernatural (bhoot-pret, ojha, exorcism), biological/organic (Galen's humours ~ tridosha), psychological; Middle Ages demonology; Weyer; Reform Movement and deinstitutionalisation; today the bio-psycho-social approach.
• Classification: APA's DSM (NCERT: DSM-5; now DSM-5-TR, 2022) and WHO's ICD (NCERT: ICD-10; now ICD-11, in effect 2022). Models: biological (GABA, dopamine, serotonin — simplified), psychodynamic, behavioural, cognitive, humanistic-existential, socio-cultural (labels, sick role), diathesis–stress.
• Anxiety (GAD, panic, phobias — specific, social, agoraphobia — separation anxiety); OCD (obsessions = thoughts, compulsions = acts); PTSD; somatic symptom, illness anxiety, conversion; dissociative amnesia (fugue), identity, depersonalisation/derealisation.
• Depression and bipolar (mania + depression); suicide is preventable — WHO's measures, noticing students in distress. Schizophrenia: positive (delusions, hallucinations, derailment), negative (alogia, flat affect, avolition), psychomotor (catatonia).
• Neurodevelopmental: ADHD, autism spectrum, intellectual disability (IQ ~70, adaptive deficits, before 18 in NCERT), specific learning disorder. Also ODD and conduct disorder; anorexia, bulimia, binge eating; alcohol, heroin, cocaine — tolerance and withdrawal.

The study of psychological disorders has intrigued every culture for more than 2,500 years. NCERT calls unhappiness, anxiety and unrealised potential ‘failures in living’, mainly failures in adaptation: adaptation is the ability to modify behaviour as the environment changes, and behaviour that cannot be modified to suit the situation is maladaptive. Abnormal psychology studies maladaptive behaviour — its causes, consequences and treatment. No definition of abnormality has won universal acceptance, but most share the ‘four Ds’: disorders are deviant (different, extreme, unusual, even bizarre), distressing (unpleasant and upsetting to the person and to others), dysfunctional (interfering with daily activities) and possibly dangerous (to the person or others).

‘Abnormal’ literally means ‘away from the normal’, yet psychology has no ideal or even ‘normal’ model of behaviour to compare against. Two basic, conflicting views emerge. The first treats abnormality as deviation from social norms — stated or unstated rules for proper conduct that grow out of a culture's history, values and institutions. A culture that prizes competition may accept aggression; one stressing cooperation and family values (NCERT's example: India) may see it as unacceptable or even abnormal; and values change over time. Critics ask whether this makes normality nothing more than conformity. The second treats abnormality as maladaptive behaviour: the test is whether behaviour fosters the well-being — survival, but also growth and fulfilment (Maslow's self-actualisation) — of the person and eventually the group. On this test, conforming behaviour can still be abnormal — NCERT's example is a student who stays silent in class despite having questions. Calling behaviour maladaptive implies a problem and suggests vulnerability, inability to cope or exceptional stress behind it.

Stigma. NCERT notes that people's ideas about psychological disorders are often vague and shaped by superstition, ignorance and fear, and that a disorder is commonly seen as something to be ashamed of. The stigma attached to mental illness makes people hesitant to consult a doctor or psychologist. NCERT's own view: a psychological disorder, which indicates a failure in adaptation, should be viewed as any other illness.

NCERT finds three perspectives recurring in history. The supernatural view explains abnormal behaviour by magical forces such as evil spirits (bhoot-pret) or the devil (shaitan); exorcism — removing the evil through counter-magic and prayer — is still commonly used, and in many societies a shaman or medicine man (ojha) is believed to contact spirits and learn which ones trouble a person and how to appease them. The biological or organic view holds that body and brain are not working properly; modern evidence links body and brain processes to many kinds of maladaptive behaviour, and for certain disorders correcting them improves functioning. The psychological view locates problems in how a person thinks, feels or perceives the world.

In the ancient Western world, NCERT says, Greek philosopher-physicians such as Hippocrates, Socrates and especially Plato developed an organismic approach, seeing disturbed behaviour as arising from conflict between emotion and reason. Galen elaborated the role of the four humours: the four elements (earth, air, fire, water) combine into four body fluids (blood, black bile, yellow bile, phlegm), each responsible for a temperament, and imbalance causes disorder — similar, NCERT says, to the Indian three doshas (vata, pitta, kapha) mentioned in the Atharva Veda and Ayurvedic texts. In the Middle Ages, demonology and superstition revived — people with mental problems were seen as evil, and there were many ‘witch-hunts’ — though in the early Middle Ages the Christian spirit of charity prevailed and St Augustine wrote extensively on feelings, mental anguish and conflict, laying groundwork for psychodynamic theories. The Renaissance brought humanism: Johann Weyer stressed psychological conflict and disturbed relationships as causes, and insisted that so-called ‘witches’ were mentally disturbed and needed medical, not theological, treatment. The seventeenth and eighteenth centuries — the Age of Reason and Enlightenment — replaced faith and dogma with the scientific method; a scientific attitude in the eighteenth century fed a Reform Movement, asylum reform in Europe and America and greater compassion, including a turn to deinstitutionalisation — community care for people who had recovered. In recent years the approaches have converged in an interactional, or bio-psycho-social, approach: biological, psychological and social factors all shape how disorders appear and turn out.

A classification of psychological disorders is a list of categories grouped into classes by shared characteristics. It lets psychologists, psychiatrists and social workers communicate, and helps in understanding causes and the processes by which disorders develop and continue. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders; NCERT calls its 5th edition (DSM-5) current, with discrete clinical criteria indicating the presence or absence of a disorder. NCERT says the scheme officially used in India and elsewhere is the WHO's ICD-10, which gives for each disorder the main clinical features and diagnostic guidelines.

Biological model. Faulty genes, endocrine imbalances, malnutrition, injuries and other conditions may disturb development and functioning, and NCERT says abnormal behaviour has, on this view, a biochemical or physiological basis. Researchers have linked disorders to problems in the transmission of messages across the synapse: when an impulse reaches a nerve ending it releases a neurotransmitter, and abnormal activity of certain neurotransmitters has been linked to specific disorders — anxiety to low GABA activity, schizophrenia to excess dopamine activity and depression to low serotonin activity. Genetic factors have been linked to bipolar disorders, schizophrenia and intellectual disability, but no specific culprit genes have been found; usually many genes combine. NCERT concludes that genetic and biochemical factors are involved in many disorders, but biology alone cannot account for most.

Psychological models stress psychological and interpersonal factors — maternal deprivation (separation from the mother, or lack of warmth and stimulation early in life), faulty parent–child relationships (rejection, overprotection, over-permissiveness, faulty discipline), maladaptive family structures and severe stress. The psychodynamic model, the oldest and most famous, holds that behaviour is shaped by dynamic, interacting forces of which the person is not aware; Freud saw abnormal behaviour as a symbolic expression of unconscious conflicts among id, ego and superego, usually traceable to early childhood. The behavioural model says both normal and abnormal behaviour are learned — through classical conditioning, operant conditioning and social learning — so what is learned can be unlearned. The cognitive model locates abnormality in irrational, inaccurate assumptions and illogical thinking such as overgeneralisation — broad negative conclusions from a single insignificant event. The humanistic-existential model: humanists see people as naturally friendly, cooperative and constructive, driven to self-actualise; existentialists hold that we are free to give our existence meaning, and those who shirk this responsibility live empty, inauthentic and dysfunctional lives.

Socio-cultural model. War and violence, group prejudice and discrimination, economic and employment problems and rapid social change stress everyone and can lead to problems in some. Family structure and communication, social networks, societal conditions, and labels and roles become important. Some families have an enmeshed structure — members over-involved in each other's activities, thoughts and feelings — and their children may find it hard to become independent. People who are isolated and lack social support are likely to become more depressed and stay depressed longer than those with good friendships. Labels also matter: people who break norms may be called deviant and ‘mentally ill’; the label sticks, others treat them as ‘crazy’, and they may gradually learn to play the sick role.

Diathesis–stress model — in NCERT's words one of the most widely accepted explanations — holds that disorders develop when a diathesis (a biological predisposition) is set off by a stressful situation. It has three components.

Some anxiety before an examination, a visit to the dentist or a solo performance is normal and even motivating. High levels of anxiety that are distressing and interfere with effective functioning indicate an anxiety disorder — NCERT calls it the most common category of psychological disorders. Anxiety is a diffuse, vague, very unpleasant feeling of fear and apprehension, with symptoms such as a rapid heart rate, shortness of breath, diarrhoea, loss of appetite, fainting, dizziness, sweating, sleeplessness, frequent urination and tremors.

Obsessive-compulsive and related disorders. People with obsessive-compulsive disorder cannot control their preoccupation with specific ideas, or cannot stop themselves repeating a particular act, to the extent that daily activities suffer. An obsession is an inability to stop thinking about a particular idea or topic, often felt as unpleasant and shameful; a compulsion is a need to perform certain behaviours over and over — counting, ordering, checking, touching, washing. Related disorders include hoarding disorder, trichotillomania (hair-pulling) and excoriation (skin-picking). Trauma- and stressor-related disorders: people caught in a natural disaster such as a tsunami, a terrorist bomb blast, a serious accident or war may experience post-traumatic stress disorder (PTSD), with symptoms such as recurrent dreams, flashbacks, impaired concentration and emotional numbing; adjustment disorders and acute stress disorder also belong here.

Somatic symptom and related disorders involve physical symptoms without a physical disease to explain them; the person has psychological difficulties and complains of bodily symptoms for which there is no biological cause. Somatic symptom disorder: persistent body-related symptoms, which may or may not relate to a serious medical condition, with heavy preoccupation, constant worry about health and frequent visits to doctors, causing significant distress. Illness anxiety disorder: persistent preoccupation with developing a serious illness; such people worry about undiagnosed disease and negative test results, are not reassured by doctors, and are easily alarmed by news of others' illness. Both concern medical illness, but in somatic symptom disorder the concern is expressed as physical complaints, in illness anxiety disorder as anxiety. Conversion disorders involve a reported loss of part or all of some basic body function — paralysis, blindness, deafness, difficulty walking — often sudden, after a stressful experience.

Dissociative disorders. Dissociation is a severance of the connections between ideas and emotions, with feelings of unreality, estrangement and depersonalisation, and sometimes a loss or shift of identity; sudden temporary alterations of consciousness that blot out painful experiences define the group. Dissociative amnesia: extensive but selective memory loss with no known organic cause — some cannot recall their past at all, others specific events, people, places or objects. Part of it is dissociative fugue — unexpected travel away from home and work, assuming a new identity and being unable to recall the old one; the fugue usually ends when the person suddenly ‘wakes up’ with no memory of it, and is often linked to overwhelming stress. Dissociative identity disorder, often called multiple personality, is the most dramatic: the person assumes alternate personalities that may or may not be aware of each other, often linked to childhood trauma. Depersonalisation/derealisation disorder is a dreamlike state of separation from self and reality.

Depression is, NCERT says, one of the most widely prevalent and recognised of all mental disorders; the word can mean a symptom or a disorder, and in daily life we use it for normal sadness after a loss. Major depressive disorder is a period of depressed mood and/or loss of interest or pleasure in most activities, with other symptoms that may include changes in body weight, constant sleep problems, tiredness, inability to think clearly, agitation, greatly slowed behaviour, thoughts of death and suicide, and excessive guilt or feelings of worthlessness. Predisposing factors: heredity is an important risk factor; age matters — women are particularly at risk in young adulthood, men in early middle age; women are more likely than men to report a depressive disorder; negative life events and lack of social support add risk. Bipolar I disorder involves both mania and depression, alternating and sometimes separated by periods of normal mood; NCERT says manic episodes rarely appear alone. Bipolar disorders were earlier called manic-depressive disorders; the group includes Bipolar I, Bipolar II and cyclothymic disorder.

Suicide — NCERT's frame (pages 80–81). NCERT calls every suicide a misfortune, occurring across the lifespan and resulting from a complex interplay of biological, genetic, psychological, sociological, cultural and environmental factors. Risk factors it names include mental disorders (especially depression and alcohol use disorders), natural disasters, violence, abuse, loss and isolation; a previous suicide attempt is the strongest risk factor. Suicidal behaviour often reflects difficulties in problem-solving, stress management and emotional expression; thoughts become action only when acting seems the only way out, and they intensify under acute distress. The effects on families and communities are devastating and long-lasting. Stigma still stops many people who are thinking of or have attempted suicide from seeking help, so better identification, referral and management are crucial. NCERT's key message: suicides are preventable, through a comprehensive, multi-sectoral approach in which government, media and civil society are all stakeholders.

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational functioning deteriorate through disturbed thinking, strange perceptions, unusual emotional states and motor abnormalities. NCERT calls it debilitating, with heavy social and psychological costs to the person, the family and society. Its symptoms fall into three groups.

Positive symptoms are ‘pathological excesses’ or ‘bizarre additions’. A delusion is a false belief firmly held on inadequate grounds, unaffected by rational argument and with no basis in reality. Delusions of persecution are the most common (being plotted against, spied on, slandered, attacked); delusions of reference attach special personal meaning to others' actions, objects or events; delusions of grandeur make people believe they are specially empowered; delusions of control make them believe their feelings, thoughts and actions are controlled by others. Formal thought disorders make communication hard: rapid shifts between topics (loosening of associations, derailment), invented words (neologisms) and persistent, inappropriate repetition (perseveration). Hallucinations are perceptions in the absence of external stimuli; auditory ones are most common — voices speaking to the person (second-person) or about the person (third-person) — but tactile, somatic, visual, gustatory and olfactory hallucinations also occur. Inappropriate affect means emotions unsuited to the situation.

Negative symptoms are ‘pathological deficits’: alogia (poverty of speech), blunted affect (less anger, sadness or joy than most people) or flat affect (no emotion shown), avolition (apathy, inability to start or complete a course of action) and social withdrawal into one's own ideas and fantasies. Psychomotor symptoms: less spontaneous movement, odd grimaces and gestures, and in extreme form catatonia — catatonic stupor (motionless and silent for long periods), rigidity (a rigid, upright posture for hours) and posturing (awkward, bizarre positions held for long periods).

Neurodevelopmental disorders appear early in development — often before school or in the early school years — and hamper personal, social, academic and occupational functioning, through deficits or excesses in behaviour or delays in age-appropriate behaviour. NCERT warns that, if not attended to, they can lead to more serious and chronic problems in adulthood.

Disruptive, impulse-control and conduct disorders. Children with oppositional defiant disorder (ODD) show age-inappropriate stubbornness, irritability, defiance, disobedience and hostility; they often do not see themselves as angry or defiant, and justify their behaviour as a reaction to circumstances, so symptoms become entangled with problem interactions. Conduct disorder and antisocial behaviour mean age-inappropriate actions and attitudes that violate family expectations, social norms and others' rights: aggression that causes or threatens harm to people or animals, property damage, serious deceit or theft, and serious rule-breaking. NCERT names four kinds of aggression: verbal (name-calling, swearing), physical (hitting, fighting), hostile (aimed at injuring others) and proactive (dominating and bullying without provocation).

Feeding and eating disorders, of special interest to young people: in anorexia nervosa a distorted body image makes a person see herself or himself as overweight, leading to refusing food, compulsive exercise and unusual habits, with severe weight loss that can even be fatal; in bulimia nervosa a person eats excessive amounts and then purges by laxatives, diuretics or vomiting, feeling disgust and shame at bingeing and relief after purging; in binge eating there are frequent episodes of out-of-control eating, fast and beyond fullness, even when not hungry.

NCERT calls addictive behaviour — whether excessive intake of high-calorie food leading to extreme obesity or misuse of substances such as alcohol or cocaine — one of the most severe problems facing society today. Substance-related and addictive disorders cover maladaptive behaviour from regular, consistent use of substances such as alcohol, cocaine, tobacco and opioids, which alter how people think, feel and behave.

Alcohol. People who misuse alcohol drink large amounts regularly and rely on it to face difficult situations; eventually drinking interferes with social behaviour and the ability to think and work. They build tolerance (needing more for the same effect) and experience withdrawal when they stop. NCERT notes the damage to families, relationships and careers, road accidents caused by intoxicated drivers, higher rates of anxiety, depression, phobias and substance-related problems among children of people with alcohol use disorders, and serious harm to physical health. Heroin use significantly interferes with social and occupational functioning; dependence makes life revolve around the drug, with tolerance and withdrawal; the most direct danger is overdose, which slows the brain's respiratory centres and can be fatal. Cocaine use can lead to intoxication through the day, poor functioning at work and in relationships, and problems with short-term memory and attention; on stopping, people may feel depression, fatigue, sleep problems, irritability and anxiety.

The chapter has five activities and three project ideas. Short outlines follow. Activities that involve other people should be done respectfully, with consent, and without naming anyone; none of them is a way to diagnose a person.

The eleven review questions at the end of the chapter (page 87). Try each first, then open the outline.

Numbers

One-liners

• Most definitions of abnormality share the four Ds: deviance, distress, dysfunction, danger.
• Conforming behaviour can still be maladaptive.
• NCERT: a psychological disorder should be viewed as any other illness.
• Johann Weyer held that so-called witches needed medical, not theological, treatment.
• Today's approach is bio-psycho-social.
• DSM is the American Psychiatric Association's; ICD is the WHO's.
• Diathesis–stress: a predisposition set off by stress.
• The behavioural model says what is learned can be unlearned.
• Labels can push a person into the sick role.
• Obsessions are thoughts; compulsions are acts.
• Illness anxiety disorder replaced the older term hypochondriasis.
• Positive symptoms are excesses; negative symptoms are deficits.
• A hallucination is a perception without an external stimulus.
• A previous attempt is the strongest risk factor for suicide; suicides are preventable.
• Alcohol depresses the central nervous system.

Traps to avoid

• The four Ds do not include ‘disease’ or ‘delusion’.
• NCERT's DSM-5 and ICD-10 are no longer the latest: DSM-5-TR (2022) and ICD-11 (2022).
• DSM is American (APA); ICD is the WHO's.
• Low GABA goes with anxiety, excess dopamine with schizophrenia, low serotonin with depression — and all three links are simplifications.
• PTSD is a trauma- and stressor-related disorder in DSM-5, not an anxiety disorder.
• Somatic symptom disorder is expressed as complaints; illness anxiety disorder as anxiety.
• Dissociative fugue is part of dissociative amnesia.
• Schizophrenia is not ‘split personality’.
• Changing topics frequently (derailment) is a positive symptom.
• Blunted affect means reduced emotion; flat affect means none.
• Bulimia involves purging; binge eating does not.
• Tolerance means needing more; withdrawal means reactions on stopping.
• NCERT calls Socrates a philosopher-physician; he was a philosopher.

Prelims — what UPSC asks

• Two Prelims questions in the bank are taught here. Prelims 1983 asked what hypochondria is — a state of morbid anxiety about one's own health with complaints of imaginary disorders; NCERT's illness anxiety disorder is the current name (key d stands). Prelims 1984 asked which is a perception without stimuli — a hallucination, as NCERT defines it (key a stands; the question also sits on the Class 11 perception chapter). Likely future items: DSM vs ICD and their bodies and current editions; the four Ds; positive vs negative symptoms; delusion types; neurotransmitter links; Box 4.3 classes; the Mental Healthcare Act 2017.

Mains — where it appears and how to answer

• GS1 — suicide among young women: 2023 asked why it is increasing in Indian society. Use NCERT's frame — an interplay of biological, psychological, social, cultural and environmental factors; women's particular risk of depression in young adulthood; isolation, violence, abuse and lack of social support; stigma blocking help — then the sociology of marriage, gender and expectations from the live Sociology chapters. Conclude with NCERT's ‘suicides are preventable’, the WHO measures, Section 115 of the 2017 Act and the 2022 national strategy. Avoid unsourced figures.
• Essay — social media and youth: 2024 ‘Social media is triggering “Fear of Missing Out” amongst the youth, precipitating depression and loneliness’. Draw on NCERT's socio-cultural model (isolation and lack of support deepen depression), depression's symptoms and risk factors, and the diathesis–stress caution that pressures affect people differently; set out the debate on causation as attributed positions; the weakest of the links kept.
• GS2 — health and vulnerable sections (not linked as PYQs here): questions on mental-health law, disability and drug use can use this chapter's definitions with the Mental Healthcare Act 2017, the Rights of Persons with Disabilities Act 2016 and the NDPS Act 1985.
• Answer frame: define with NCERT's term → name the classification or model (attributed) → social and cultural context → a rival view (medical vs social, cross-cultural) → policy and care, with person-first language → one-line conclusion against stigma.

Tap an option. NCERT's own exercise questions come first; the rest test the figures and common confusions.

Open any question to attempt it in the Question bank — your attempt is saved to your progress.