Block-3PSYCHOLOGY AND LIVING

BPCG-175
Block-III
Self, Maladjustment and
Mental Disorders
Mental Disorders
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Self and Maladjustment
UNIT 7 SELF AND MALADJUSTMENT*
Structure
7.1 Learning Objectives

7.2 Introduction
7.3 Anxiety
7.4 Stress
7.5 Impulsivity
7.6 Cognitive Rigidity
7.7 Maladaptive Coping
7.8 Dysfunctional Attitude
7.9 Let Us Sum Up
7.10 Key Words
7.11 Answers to Self-Assessment Questions
7.12 Unit End Questions
7.13 References
7.14 Further Learning Resources
7.1 LEARNING OBJECTIVES

After studying the Unit, you would be able to:
 Know the concept of anxiety and its symptoms;
 Understand stress and methods of managing stress;
 Understand impulsivity and its manifestation;
 Differentiate between adaptive and maladaptive coping;
 Explain cognitive rigidity and ways to address it; and
 Understand the concept of dysfunctional thinking, methods of assessment,
and modification.
7.2 INTRODUCTION
‘Self’ refers to a person’s sense of who he/she is. The experience of one’s self is
composed of awareness of one’s physical attributes and psychological attributes,
such as thoughts, feelings, goals, values, preferences that distinguish one
individual from another. You have read in detail about the meaning, components,
and correlates of self in the earlier units. In the present Unit, we will discuss how
one’s sense of self can havea tremendous influence on one’s thought process,
emotions, and behavior. Individuals often think, feel and behave in a certain way
*
Krishna Kumari K, Ph.D. Scholar & Manjula M, Professor, Department of Clinical Psychology,
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. 113
Self, Maladjustment and to preserve their sense of self. Thus, the sense of self you possess has profound
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implications for your adjustment to the needs or demands in the environment.
Maladjustment can occur when our sense of self prevents us from making a
normal adjustment to some need or demand in our environment. Let us see the
examples below.
When Rama went to another city for her college education, she had to stay in the
hostel there, sharing the room with another girl from a different culture than her
own. Rama, being the single child of her parents, had never experienced staying
with others on a continuous basis and requiring to adjust to so many things. She
has always perceived herself as being independent, and her needs to be fulfilled on
a priority basis. She faced a lot of difficulties in adjusting to staying with a roommate
in the hostel, and it resulted in frequent arguments and fights with her roommate.
Rajesh, an idealistic young man, frequently had disputes with his wife Seema,
because he was often finding faults with her. Rajesh had unreasonable expectations
from his wife, and he would constantly compare her actions to his fixed standards.
When she didn’t match his standards, he became angry and even aggressive
towards her. Seema became quite frustrated as it continued for long term and told
him several times that she would consider divorce if he continues to behave in
the same way. Despite the fact that his marriage is in jeopardy, Rajesh refuses to
change his behavior due to his rigid thinking patterns.
Anu, an intelligent and high-performing student, scored less than expected in
her annual exam. Looking at her exam results, she realized that though she had
passed her examinations, she had scored far lower than she had ever previously.
Thus made her very frustrated and depressed as she was to apply for studies
abroad based on the performance in this exam. Now she cannot apply and lost
the opportunity. She was quite dejected and rushed to her room immediately
without talking to anyone. She closed the door of her room and consumed an
overdose of sleeping tablets her grandfather takes, to put an end to her suffering
immediately. Anu’s impulsivity made her engage in self-harm behavior without
considering the impact of her actions on herself and her loved ones.
We can see from the above examples that various factors can contribute to
maladjustments, such as a sense of impulsivity, cognitive rigidity, and faulty or
maladaptive coping. Further, our perception of ourselves in terms of our thinking,
personality, emotions, etc., can create a dysfunctional attitude and lead to
dysfunctional relationships. The outcome of all these may beanxiety and stress
experienced in relation to oneself, and also with family, friends, and at the
workplace. In addition, it may also lead to various mental disorders (you will
learn about it in detail in the next Unit 8).
In the following sections, you will learn about two significant manifestations of
maladjustment as ‘anxiety’ and ‘stress’. Thereafter you will learn about important
factors contributing to maladjustments such as impulsivity, cognitive rigidity,
maladaptive coping, and dysfunctional attitude.
7.3 ANXIETY
Anxiety is a very commonly used term which almost all of us experience in our
daily life. It refers to an unpleasant feeling resulting from the perception of danger.
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Such perceived danger can be real, or it can be imagined. It can be noted here Self and Maladjustment
that anxiety is different from fear. Fear is an alarm reaction to the real
immediatedanger.When the cause of danger is evident, the emotion felt is called
asfear (e.g., you are about to step on a snake as you are walking, and you
immediately jump aside with increased heartbeats and sweating). However, in
anxiety, we often cannot explicitly specify thedanger (e.g., feeling anxious
regarding your job interview next week or appearing in the final board exam).
There are various symptoms based on which we can identify that anxiety is being
experienced by an individual.
7.3.1 Common Symptoms of Anxiety

 Physical symptoms: Shortness of breath, restlessness, palpitations, sweating,
dry mouth, nausea, fatigue, sleep disturbances.
 Cognitive and Emotional symptoms: Poor concentration, negative thoughts,
irritability, uneasiness, worry, apprehension, feeling overwhelmed,
nervousness.
 Behavioral Symptoms
o Avoidance of situations or objects which produce anxiety.
o Involving in high-risk or self-destructive behaviors (excessive smoking,
drinking alcohol, or drug consumption with the intention of getting rid
of anxiety).
o Safety behaviors to prevent anticipated anxieties from coming true and
to feel more comfortable (a person with social anxiety might carry a
water bottle while facing any social situations so that he/she can drink
water if they feel anxious, excessive preparation etc.)
o Limiting one’s daily activities to reduce anxiety (e.g., remaining at home
most of the time to feel safe).
o Getting excessively attached to an object/individual producing a sense
of safety (e.g., not going out, to school/college, or work to avoid getting
separated from the object or the individual who produces a sense of
safety).
When does anxiety become a mental disorder? When anxiety goes beyond the
normal level and starts interfering with day-to-day functioning, it results in
disorder. Occasional anxiety is completely normal and inevitable. However,
persistent, intense, or pervasive anxiety might have a negative impact on one’s
overall health and can interrupt daily functioning, indicating an anxiety
disorder. Anxiety can be a disorder when it is disproportionate to the situation
and results in considerable avoidance of the problem, and interferes with one’s
day-to-day functions.
7.3.2 Types of Anxiety Disorders:

 Social Phobia (Social anxiety disorder) refers toan intense and irrational
fear of a specific social situation. For example, speaking in public, using
public toilets/bathrooms, or eating when one is in the company of others, 115
Self, Maladjustment and etc. In such situations, the person feels frightened that she/he may be
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negatively evaluated by others or that she/ he might end up acting in an
embarrassing manner. Because of the intense fear, the person with social
phobia either avoids such situations altogether or faces them with intense
distress.
 Specific Phobia is characterized by an intense and irrational fear of some
specific object, such as an animal or an insect (e.g., cat, spider, cockroach,etc.)
or a situation, like being inside an elevator or enclosed places.
 Generalized Anxiety Disorder involves excessive and irrational anxiety and
worries about various everyday events of life (including trivial events). For
instance, the person might get excessive worries regarding his/her own safety
or the safety of one’s loved ones, or the person might get worried that
something bad might happen to him/her or their close relatives.
 Panic Disorder is characterized by recurring panic attacks and a fear of getting
a panic attack.Panic attacks are brief episodes of excessive anxiety
accompanied by physical symptoms such as dizziness, increased heartbeat,
difficulty in breathing, sweating, and nausea. The person might also fear that
he would lose control over his/her body, or he/she would go crazy or might
die due to a heart attack.
7.3.3 Causes of Anxiety
Following are some of the important psychosocial and biological causal factors
in anxiety.
Psychosocial Factors:
o Learning through Conditioning
Anxiety reactions can be easily conditioned to previously neutral stimuli
when such stimuli are associated with traumatic/ painful events, and then
they may be generalized to other similar objects/situations which were not
there in the initial situation. For example, a person who has been exposed to
multiple incidents of being locked in closets as a child might show an intense
and irrational fear of elevators as well as other enclosed places.
o Learning through Observation (Vicarious Learning)
Many times, individuals learn to show anxious responses simply by observing
or watching another person behaving anxiously towards a particular object
or situation. This is because anxiety can be transferred from one individual
to another through vicarious learning. For instance, a child who observers
his/her parent showing anxious response to the sight of pet animals like dog
or cat might herself /himself develop an intense fear of such animals.
o Stressors in the Environment (Environmental Stressors): Relationship
breakups, job loss, increased work pressure, or ongoing interpersonal issues
with family members may also be responsible for the development of anxiety
in individuals.
 Biological Factors
Most of us can experience occasional anxiety. However, some individuals
116 are more prone to anxiety due to their biological makeup. Because of the
genes inherited or difficult temperaments, perhaps as a result of under-or Self and Maladjustment
over-activity of specific areas in the brainor because of neurochemical
imbalances,some individuals are more vulnerable to react with anxiety to
neutral stimuli or situations that are not actually dangerous.
7.3.4 Managing Anxiety and Anxiety Disorders

Various counseling techniques and interventions can help reduce anxiety in
individuals. Further, medication and psychotherapies are useful in the treatment
of anxiety disorders.
Psychotherapy: Anxiety disorders can be usually treated successfully
with psychotherapyalone or often in combination with pharmacotherapy.
Cognitive-Behavioral Therapy (CBT) is one of the most effective treatment
options for anxiety. In CBT, the person learns mainly to challenge his/her
distortedor rigid patterns of thinking,which produce distress along with other
behavioral techniques.
Exposure therapy, in which the person is gradually and safely exposed to objects/
situations triggering anxiety so that they no longer avoid them, is an important
behavioral technique in the treatments for anxiety.
Relaxation Techniques like progressive muscle relaxation, deep breathing, guided
imagery, mindfulness meditation are often used in managing the increased
physiological arousal associated with anxiety.
Lifestyle Changes: These are simple yet powerful tools in managing anxiety.
Exercising, having a balanced diet, practicing healthy sleep habits are often
recommended in addition to psychotherapies and medications in the long-term
management of anxiety.
Pharmacological Treatment (Medication):Various types of medications are used
to treat anxiety disorders,such as anti-anxiety drugs, beta-blockers, and
antidepressants. Pharmacotherapy is mainly intended to manage the symptoms
rather than cure the underlying causes of anxiety.
7.4 STRESS
Like anxiety, stress is also a commonly used term and is also experienced by all
individuals. It can be described as an unpleasant emotional experience
accompanied by physiological, cognitive, and behavioral changes which are either
intended to alter the sources of stress (the stressors) or adapt to its effects. The
crucial question here is we need to know why does stress occur. You may have
noticed that the same situation, e.g., appearing in an exam or speaking on stage
in the college function, can create different levels of stress in individuals. So,
there are individual differences in experiencing stress. Here it is important to
know how do we perceive the situation, assess or appraise it and what coping
resources we have to deal with the situation. This will determine our level of
stress.
Thus, stress is the result of a person’s appraisal process. The transactions in stress
usually involve an assessment process known as cognitive appraisal. There are
two types of cognitive appraisals: 117
Self, Maladjustment and  Primary appraisal
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Primary appraisal refers to assessing the meaning or significance of the
stressor for one’s well-being, such as whether the stressor is posing any threat
or whether it is challenging. Primary appraisal tries to answer questions like,
“Whether it is upsetting or painful to me?” “Is this challenging or
threatening?”. Events can be assessed as harmful, challenging, and
threatening, and so on.
 Secondary appraisals
Secondary appraisal refers to the assessment of resources that one has to
deal with the stressor. Although these assessments are carried out on an
ongoing basis in our day-to-day life, it is more evident when we perceive a
situation as stressful and try to figure out whether the resources we have are
sufficient to address the stressor we are facing. For instance, based on the
availability of resources, we may say, “I will be able to handle it,” “I don’t
think I can do it.”
It is important to remember here that stress can be a motivator also to put your
best foot forward and give your best in any situation. For instance, the stress
associated with completing a project in a time-bound manner makes you give
your best effort to it. However, one needs to be cautious as to when this positive
stress turns into negative and affects your mental health and functioning. That is,
stress can be helpful up to a point, and beyond that, it affects the individual
negatively. This optimal point will vary from individual to individual.
Performance
Fig. 7.1 Relationship Between Stress and Performance

(Adapted from Yerkes&Dodson, 1908, p.479.)
7.4.1 Types of Stress

Stress may arise from various sources and thus can be of varied types. But it can
broadly be categorized under two types of stress:
 Eustress: Eustress refers to a positive response to a stressor that may
rely on factors such as one’s current sense of control, desirability, place,
and time of the stressor, etc.One of the characteristics of eustress includes
responding to a stressor with a sense of meaning and hope, e.g., starting
a new job on a voluntary basis, receiving a job promotion, going on a
holiday, having a child, etc. These are the events and situations we want
for ourselves, and we knowingly take the stresses associated with these.
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 Distress is the most frequently referred to form of stress, having negative Self and Maladjustment
consequences. Persistent stress,which is not addressed through coping
or adaptation, is known as distress. Physical signs of distress often include
prolonged increased blood pressure, increased gastric acid secretions,
and some of the psychological signs of distress are depression, anxiety,
insomnia.
7.4.2 Types of Stressors

A stressor refers to “any event, experience or environmental stimulus which causes
stress to the person.” The person perceives such events, experiences, stimuli as
either threats or challenges to himself/herself. A stressor can be either physical or
psychological. The following are various types of stressors:
 Crises or catastrophes: refers to unforeseen/ unpredictable events, and
therefore, they are usually not underthe control of individuals, for
example, natural disasters, such as major floods, hurricane, earthquakes,
tsunami, etc.
 Major life events: involves marriage, going to school or college, the
death of close relatives or loved ones, the birth of a child, shifting to a
new house, etc. These events, whether positive or negative, can create a
sense of uncertainty or fear which will lead to stress.
 Daily hassles or micro stressors: are encountered on a day-to-day basis,
such as making decisions, meeting deadlines at work or college, traffic
jams, meeting with irritating or annoying personalities, etc. This type of
stressor also includes conflicts with other people.
 Ambient stressors:These are low-level global stressors that are usually
part of the background environment, e.g., noise, pollution, crowding,
heavy traffic, etc.
7.4.3 Effect of Stress on Our Health

Research studies (Mishra et. al., 2020; Sarkar et. al., 2018) have found that stress
affects our physical health as well as mental health and well-being.
There may be long-term negative consequences of stress on health. Usually, the
ability of the immune system to stop inflammation gets impaired due to chronic
stress. Thus, stress may compromise the functioning of the immune system.
Stress can cause cardiovascular reactivity and thereby lead to the development
of coronary heart disease.
Metabolic syndrome is a series of risk factors, such as high levels of cholesterol
and other blood fats, increased blood pressure, impaired insulin capacity to
promote the transfer of glucose out of the bloodstream, and higher deposits of fat
in the abdomen. This can also be caused due to stress.
Stress-related psychosocial factors have also been shown to predict the course
of cancer and also the chances of survival and death from cancer.
Psycho-physiological Disorders refer to physical symptoms that result from the
interaction of various physiological and psychological factors. Some of the 119
Self, Maladjustment and common psycho-physiological illnesses aredigestive system disorders such as
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ulcers, irritable bowel syndrome, asthma, headache (tension-headache or migraine
headache), and other disorders like dysmenorrhea, rheumatoid arthritis, eczema,
psoriasis.
What is the mechanism through which stress impacts our health? The following
can be cited as the mechanisms/processes through which stress has an effect on
our physical and mental health.
 Alters physiological functioning
Stress can alter physiological functioning by interacting with existing
risk factors or genetic predispositions and determine the kind of illness a
person develops. Some of the direct physiological effects of stress include
increased blood pressure, a decreased immune system that affects the
body’s ability to control infection, alteration in lipids. All these may lead
to various physical health problems and illnesses.
 It affects the health habits negatively
People exposed to chronic stress have negative health habits such as
consumption of substances/drugs, alcohol, unhealthy eating, and sleeping
habits. These poor health habits might lead to specific illnesses in the
long run.
 Affects psychosocial resources
Social support can protect our health, but a person who is experiencing
chronic stress might avoid social contacts or behave in ways that might
make other people stay away from the person. Further, stress hinders our
ability to think clearly and respond to situations in a proper manner.
7.4.4 Management of Stress

Stress is a fact of life. So, the key to deal with stress is to manage stress in an
effective way. Management includes ways/strategies to reduce the potential for
stress as well as reduce stress reaction. Some of the stress management techniques
are as follows:
 Reframing or Cognitive Restructuring: It is a process in which thoughts
or beliefs provoking stress reactions are replaced with more constructive
and realistic thoughts or beliefs.This can help ease orreduce the unpleasant
feelings that are generated when we appraise the situation as threatening
or harmful.
 Problem Solving: One of the main sources of stress is inability or difficulty
in solving problems. Finding a solution to the problem becomes much
easier if it is approached in a systematic and rational manner. There are
fourbasic steps in problem-solving (a) defining the problem, i.e., diagnosing
the situation so that focus is on the problem, not just on its symptoms, (b)
generating alternative solutions, (c) evaluating and selecting an alternative,
(d) implementing and following up on the solution.
 Time Management: It includes actively planning ahead and exercising
120 deliberate control over the amount of time spent on specific tasks in
order to maximize one’s performance, level of productivity, or efficiency. Self and Maladjustment
One of the common methods used is prioritization based on criteria such

as the importance of the task.
 Relaxation: Relaxation is a mechanism that reduces the impact of stress
on the mind and body. Relaxation exercises can help you deal with daily
stress and stress-related to different health conditions. Following are some
of the relaxation techniques used to manage stress:
o Progressive muscle relaxation:This involves focusing your attention
on specific muscle groups as you alternately tighten and loosen these
muscles.
o Autogenic training: is a method of relaxation which teaches your
body to respond to your verbal commands. These commands instruct
your body to relax and control breathing, heartbeat,blood pressure,
and temperature of the body. The purpose of autogenic training is to
attain deep relaxation and reduction of Stress. Autogenic training
comprises six standard exercises which make the body feel warm,
heavy, and relaxed.
o Self-hypnosis and Imagery:In this method of relaxation, the person
uses auto-suggestion as well as imagery to calm oneself down. This
technique uses both relaxation and affirmative statements to induce
relaxation and relieve stress.
 Physical Activities and Diet
Practicing different physical exercises and yoga ‘asana’ (yoga postures)
canhelp you in reducingstress.It can also improve your mood and sense
of well-being. As stress affects the brain and its many nerve connections,
the rest of the body is also affected. A number of yoga poses, also known
as postures, can have a positive impact on the brain and the nervous
system. Physical activities produce a chemical called “endorphins” in
the brain, which acts as natural painkillers. In addition to this, they can
improve your sleep, which in turn can reduce your stress.
Healthy and balanced foods are the simplest means of stress relief.
Consumption of foods with enough vitamins and minerals can help in
reducing stress levels. Certain foods and drinks such as tea, coffee, cocoa,
energy drinks, fast food, sugar, alcohol, and soft drinks may trigger or
increasestress. These should be consumed in moderation.
Self Assessment Questions 1
I. Fill in the blanks with appropriate words:
1. When the source of danger is obvious, the experienced emotion is called
as ————, and a general feeling of apprehension about unknown danger,
whether real or imagined, is called —————————.
2. Anxiety can be a disorder when it is ———————————to the
situation and results in considerable ——————————of the
situation and interferes with one’s day to day functioning.
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3. —————————refers to a positive response one has to a stressor.
Persistent stress that is not resolved through coping or adaptation is known
as——————————.
4. —————————— is any event, experience, or environmental

stimulus that causes stress in an individual.
II. Each of the questions or incomplete statements below is followed by

four suggested answers or completions. In each case, select the one
that best answers the question or completes the statement.
1. Shortness of breath, restlessness, palpitations, sweating, dry mouth, and

nausea are some of the —————————— symptoms of anxiety.
(A) Cognitive (B) Behavioural
(C) Physical (D) Emotional
2. Avoiding to face anxiety-producing situations is one of the ————

—————————symptoms of anxiety.
(A) Cognitive (B) Physical
(C) Unusual (D) Behavioural
3. All of the following are anxiety disorders EXCEPT:
(A) Generalized Anxiety Disorder (B) Panic Disorder
(C) Maj————or Depressive Disorder (D) Specific Phobia
4. Many a time, individuals learn to show anxious responses simply by

watching another person behaving anxiously towards a particular object
or situation. This is called as —————————————
(A) Classical Conditioning (B) Vicarious Learning
(C) Motivational Learning (D) Environmental Learning
5. Following are all different management approaches to anxiety EXCEPT:
(A) Cognitive Behaviour Therapy (B) Exposure Therapy
(C) Avoidance Therapy (D) Pharmacotherapy
6. Devastating natural disasters, such as major floods or earthquakes, are

examples for:
(A) Major life events (B) Crises/catastrophes
(C) Ambient stressors (D) Micro Stressors
7. Transactions in stress generally involve an assessment process that is called

as ——————
(A) Cognitive perception (B) Stress evaluatin
(C) Cognitive appraisal (D) Situational assessment

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8. Seeking answers to such questions as, “what does this mean to me?” and
“Will I be okay or will end up in trouble?” are examples for:
(A) Secondary appraisal (B) Primary appraisal
(C) Problem solving (D) Self reflection
9. —————————— refers to our assessment of the resources we
have available for coping with stress.
(A) Secondary appraisal (B) Primary appraisal
(C) Self-appraisal (D) Personal assessment
10. ———————————————is not one of the stress management
techniques.
(A) Time management (B) Relaxation
(C) Rumination (D) Problem solving
Now let us discuss the various factors contributing to maladjustment.
7.5 IMPULSIVITY
Impulsivity refers to “an inability to wait, a preference for risky outcomes, a
tendency to act without foresight, without sensitivity to the consequences, and/
or an inability to inhibit inappropriate behaviors.” Purchasing things that you did
not intend, interrupting others who are talking, blurting out something that you
later wish you should not have said - these are all examples of impulsivity.
Impulsivity is like not being able to press a ‘pause button, for example, not being
able to stop speaking or doing things without thinking about the possible
consequences. Being impulsive can be useful, as well as problematic. Following
an idea without thinking can sometimes work out well, such as a quick action
taken during an emergency or any spontaneous action. However, in most situations,
impulsivity can be problematic or dangerous and may have serious negative
consequences, e.g., buying things that are not affordable, gambling, overspeeding
the car when you are on highway enjoying a trip with your friends.
There are mainly three aspects to impulsivity:
 An immediate and unplanned reaction to stimuli before processing the
information adequately.
 A decreased sensitivity to negative consequences of behavior
 Lack of regard for long-term consequences of a behavior
7.5.1 Classification of Impulsivity

Impulsivity is primarily classified as impulsive choice (or decision making) and
Impulsive action (or disinhibition)
 Impulsive Choice (or decision making): This can be evident when one
has to make a choice, i.e., a choice between rewards with various costs.
Such choices typically involve choosing between a lower reward at a 123
Self, Maladjustment and lower cost and a higher reward at a higher cost, for example, randomly
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choosing to watch a TV show instead of doing exercises that could have
greater benefits of good health, physical fitness, etc. in the long term.
 Impulsive Action (or disinhibition): refers to a lack of inhibition or
difficulty in withholding the reaction. This usually involves acting without
foresight, not paying attention to the consequences of one’s actions, and
lack of inhibition of inappropriate behavior.There are two types of
impulsive actions. They are:
o Waiting impulsivity: In waiting impulsivity, one can’t wait for the
required period of time, and he/she prematurely respond to a situation.
For instance, while waiting in the signal, you are expecting a traffic
signal to change, but you might respond prematurely by pushing the
accelerator before the signal actually changes.
o Stopping Impulsivity: In stopping impulsivity the person fails to
stop an action or behavior when necessary. For instance, you reach
out to touch a prohibited object and fail to stop reaching the object
even when told not to touch it, and doing so will result in negative
consequences.
Serious Impulsive Behaviours
Some of the impulsive behaviors are more serious than others as they can have
serious consequences on health and other major areas of a person’s life such as
relationship, finance, occupation. Individuals who engage in impulsive behaviors
such as substance abuse or binging, impulsive overeating, impulsive shoplifting,
gambling, self-harm might require immediate intervention from mental health
professionals as they are more serious.
7.5.2 Management of Impulsivity

Following strategies can be used in managing impulsivity:
 Identify and manage the triggers:
Identify internal and external triggers (emotions, events) that provoke
the urge to engage in impulsive behaviors and manage the triggers using
stimulus control. For instance, if you find that keeping the wallet filled
with money or having a credit card in your wallet tempts you to go
shopping which you have not planned or intended, then do not keep
extra money /credit card in your wallet.
 Replacing impulsive behaviors with alternative healthy behaviours:
Impulsive behaviors may be serving some purpose at the moment. For
example, they may be helping you in coping with your unpleasant
emotion. Therefore, one way of stopping impulsive behaviors is finding
another, healthier behavior thatwould serve a similar purpose such as,
writing about the distressing experience and associated emotions, talking
to a friend, or any other healthy behavior which can relieve your emotional
pain. For example, an alternative to interrupting conversations due to
impulsivity is to write the thought down (on paper or on a cell phone)
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 Involve significant others Self and Maladjustment
Ask your loved ones or significant others to indicate when you engage
in impulsive behaviors. They can also be informed to use verbal and
nonverbal prompts to stimulate you to engage in healthy alternative
behaviors.
 Practice conscious decision-making:
Following the steps of decision-making will help you in dealing with
impulsive decision-making. The following steps can be followed while
taking important decisions –(1) Defining the nature of the decision you
need to make, (2) Gathering relevant information,(3) Identifying the
alternatives,(4) Placing the alternatives in priority order,(5) Choosing
among alternatives, (6) Taking action, and (7) Reviewing your decision
and its consequences.
7.6 COGNITIVE RIGIDITY

Cognitive rigidity is the “inability to mentally adapt to new demands or
information.” In other words, it is the difficulty in changing one’s mental set. An
individual with cognitive rigidity is unable to switch from thinking about things
in one way to think about them in a different way. Individuals who can do this
easily are called cognitively flexible.
All of us might have experienced cognitive rigidity at some point. For example,
it is common to think that you can only solve certain things your way. Also, some
people are convinced that their values and beliefs are universal truths. However,
excessive and pervasive cognitive rigidity can affect your everyday functioning
and important areas of life such as work, social function, and interpersonal
relationships.
7.6.1 Characteristics of Cognitive Rigidity

Following are some of the characteristics observed in individuals with cognitive
rigidity:
 Intolerance of uncertainty: The person might show a high need for
structure.
A cognitively rigid person is likely to show a preference for order and
predictability.
Often, he/she is compelled to impose structure in order to dissipate
uncertainty and ambiguity.
 Inability to adapt to change: To be able to adapt to change effectively,
one is often required to change his/her perspective, which is difficult for
a person with high cognitive rigidity. For example, a person with high
cognitive rigidity might quit a newly joined course because the college
management has added extracurricular activities as a major area of
evaluation, and he/she thinks that it is completely a waste of time and
plans to quit the course. The person here is not able to come up with a
different perspective about this situation other than the one perspective 125
Self, Maladjustment and which he/she has, i.e., it is a waste of time, and there is no relevance of
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extracurricular activities in academic training centers.
 Difficulty in prioritizing: Individuals with high cognitive rigidity can
mis-prioritize, failing to fulfil major responsibilities, such as a deadline
at work while spending endless hours on something trivial.
 Restricted by fixed rules: people with high cognitive rigidity often go
by fixed rules of their own.
 High need for cognitive closure: The person shows a high need for
cognitive closure, i.e., s/he assigns explanations prematurely to things
with a determination that this is true and finding that resolution of the
dissonance as reassuring as finding the truth.
Thus, cognitively rigid people do not adopt flexible ways of responding to dealing
with life stressors, and they are also likely to use inflexible problem-solving.
This, in turn, can affect a person’s capacity to cope and can predispose him/her to
various mental health problems. Individuals with cognitive rigidity are more
vulnerable to repetitious behavior, extreme perfectionism, compulsive behaviors,
self-injurious and suicidal behaviors.Cognitive rigidity is often associated with
reduced ability to regulate destructive emotions such as anger, aggression, and
interpersonal behavioral difficulties such as relational problems, and social
avoidance, and isolation.
7.6.2 Techniques to Overcome Cognitive Rigidity

The world around us can be largely unstructured and unpredictable. This climate
of change can be distressing for some individuals. However, this does not always
have to be the case. A flexible mind can help us overcome extreme thinking,
which leads to negative consequences. Following are some of the techniques
which can be practiced to overcome cognitive rigidity:
 Monitoring: Many times, people are not aware when they are having a
rigid pattern of thinking. If you want to change your rigid thinking pattern,
first, it is important that you have to become aware of it when you are
engaging in such a thinking pattern. Usually, when you are using rigid
thinking patterns, you tend to use absolutistic or generalized vocabularies
such as “must,””should,” “shouldn’t,”, “not right”, “always”, “never”
etc. These are red flags that your thinking pattern is moving towards
rigidity. Catch yourself when you are using such vocabularies. You can
also ask your family members, partners, friends to indicate to you when
you use such vocabularies in your speech. Spend a few days observing
your routines, interaction with other people, how you solve day-to-day
problems and make decisions.
 Cost-benefit analysis: Listing out the advantages and disadvantages of
rigid thinking patterns which you might have identified, and spend some
time every day reading these advantages and disadvantages. Also, come
up with an alternative thought which is more flexible.
 Identify the fixed rules and challenge them:
Individuals who are high in cognitive rigidity often tend to have several
fixed rules for themselves, others, and the world, and they go by them.
126
For example, “one should always be perfect if one has to be an efficient Self and Maladjustment
worker,””I will be loved by others only if I keep myself fit and attractive.”
Identify such fixed rules and challenge them. Check whether your rules
correspond with the facts. Identify the evidences for and against the
identified fixed rules (Evidences have to be based on facts. Your belief
can’t be produced as evidence). Find out whether you are missing out a
lot of factual information which does not fit with your rules or which is
contradictory to that.
 Practice viewing situations from multiple perspectives:
Examine different situations you encounter every day from various
perspectives by considering different possibilities and different sides of
the situations. Remeber that there are different ways of viewing the same
situation.
 Use positive coping statements:
After you challenge your fixed rules, make a positive coping statement.
Such statements can be used to address the fixed rules such as, “I will try
to do this task up to the standard I have kept, but if I don’t succeed, it
doesn’t make me a failure as a person.” or they can be used to encourage
yourself such as “I can do it on time,” “I like to keep myself fit and
attractive but sometimes it is all right if I don’t look fit and attractive.”,
“People can like me for various other reasons even if I don’t look
physically attractive.”
 Practice mindfulness: Practice paying attention to your moment-to-
moment experiences (sensations, thoughts, and feelings) as they unfold
without being judgemental. This might help you in not getting trapped
by your thought processes and to be more open and acceptable towards
yourself and others.
1. ——————————— refers to an inability to wait, a preference for
risky outcomes, a tendency to act without forethought, an insensitivity to
consequences, and/or an inability to —————————inappropriate
behaviors.
2. ————————————is like not being able to press a ‘pause’
button.
3. —————————————— is the inability to mentally adapt to new
demands or information.
4. People who can switch from thinking about things in one way to thinking
about them in a different way easily are called —————————
————-.
127
Mental Disorders 1. Which among the following is not an aspect of impulsivity:
(A) Decreased sensitivity to negative consequences of behavior.
(B) Immediate and unplanned reaction to stimuli before processing the
information thoroughly.
(C) Being able to inhibit inappropriate behaviors.
(D) No regard for long-term consequences of a behavior.
2. The driver anticipates a traffic signal changing but accelerate before the
signal actually changes. This can be an example for:
(A) Impulsive decision making (B) Stopping impulsivity
(C) Waiting impulsivity (D) Breaking impulsivity
3. Which of the following is one of the serious impulsive behaviors?
(A) Self-harm
(B) Acting quickly and saving a life in an emergency
(C) Engaging in a spontaneous creative action
(D) Helping someone who is in need
4. Arrange the below-mentioned steps in decision making in the appropriate
order:
1. Take action, 2. Place the alternatives in priority order, 3.Review your
decision and its consequences, 4. Gather relevant information, 5. Identify
the alternatives, 6. Define the nature of the decision you need to make,
7. Choose among alternatives
(A) 1,2,3,4,5,6,7 (B) 6,4,5,2,7,1,3
(C) 2,4,5,1,3,7,6 (D) 7,6,5,4,3,2,1
5. Purchasing things that you are not intended without forethought can be an
act of
(A) Thoughtfulness (B) Impulsivity
(C) Ambitiousness (D) Laziness
6. Which of the following is not a characteristic of a person with cognitive
rigidity?
(A) Inability to adapt to change
(B) Difficulty in Prioritizing
(C) Being able to think from multiple perspectives
(D) Restricted by fixed rules
7. Individuals with high cognitive rigidity might fail to meet big obligations,
like a deadline at work, while spending countless hours on something
insignificant. This is mainly because they have —————————
128 ——————
(A) Difficulty in prioritizing
(B) Low brain capacity to understand the projects
(C) High creativity (C) Remarkable flexibility
8. Cognitively rigid people are more susceptible to develop various mental
health problems mainly because they are more likely to use————
——————
(A) Flexible problem solving (B) Inflexible problem solving
(C) Openness and acceptance (C) Creativity
9. Listing out the advantages and disadvantages of rigid thinking patterns
and spending sometime every day reading these advantages and
disadvantages is called as ——————.
(A) Budget line (B) Cost-Benefit analysis
(C) Monitoring (D) Mindfulness
10. Catch yourself when you are using absolutistic or generalized vocabularies
such as “must,””should,” “shouldn’t,” “not right,””always,””never”
because you may be engaging in —————————-
(A) Flexible thinking pattern (B) Rigid thinking pattern
7.7 MALADAPTIVE COPING

People respond to stress in various ways, many of which are called as “coping.”
Coping is defined as “constantly changing cognitive and behavioral efforts to
manage the stress.” Coping can be either adaptive coping or maladaptive coping.
Adaptive coping involves confronting the stressful situation directly by appraising
the stressful situations in a realistic manner and recognizing and managing the
resulting unpleasant feelings without causing adverse effects on the body and
mind. Maladaptive coping on the other hand, involves using various cognitive
and behavioral strategies to deal with stress and associated negative emotional
reactions, which can result in adverse effects on the body and mind.
Why do people use maladaptive coping? People use maladaptive coping strategies
because they can temporarily relieve or diminish the intense and overwhelming
unpleasant feelings they are experiencing. However, in the long term, such coping
strategies might intensify the perceived stress or maintain the unpleasant emotions
experienced by the individual.
7.7.1 Maladaptive Coping Strategies

Maladaptive coping strategies are usually based on an emotion-focused coping
style in which the individual uses cognitive and behavioral efforts to alter the
emotional reactions triggered by the stressor. Though the emotion-focused coping
style itself is not maladaptive, some of the strategies used in such a coping style
can become maladaptive, specifically when the strategies used are characterized
by avoidance, distortion of reality, and results in maintenance of the problem.
129
Self, Maladjustment and Following are some of the maladaptive coping strategies adopted by individuals
Mental Disorders
to deal with the perceived stress and anxiety:
 Escapism: Escapism is a coping strategy in which an individual avoids
stressful situations or negative thoughts and emotions by engaging in
activities involving imagination and entertainment. For example, you
have an annual examination coming in the next week, and you are feeling
anxious because you have not prepared well. Instead of finding better
ways of preparing for the exam in the available time, you might engage
in watching television or sleep excessively to escape from anxiety.
 Wishful thinking: is a coping strategy in which the individual thinks
what is pleasing or according to his wishes rather than evidence,
rationality, or fact. For example, You are expected to finish your under-
graduation course, say a maximum of 6 years, and you are in the 6th year
with a backlog. When it is few days for the exam, you feel tensed and
start thinking that in case if you don’t manage to pass the exam this year,
you might still get a chance in the next year to write the exam since you
have cleared all the other papers and have only one paper pending which
is considered toughest by most of the people, though such information is
not provided by the concerned university board.
 Using substances: This involves using alcohol, tobacco, drugs, or any
other addictive substances to get temporary relief from the negative
thoughts, emotions, or unpleasant bodily experiences or to enhance
positive feelings. For instance, you have a job interviewthe next day,
and you start feeling very anxious the previous day. In order to get rid of
the anxiety and to focus better on interview preparation, you order an
alcoholic beverage and go on drinking till you get intoxicated and do not
feel anxiety. Though substances can help the individual in getting rid of
the negative feelings in the short run, they might have serious negative
consequences and intensify the stress in the long run.
 Emotional eating: Emotional eating refers to eating as a response to
negative emotion or mood. This kind of hunger does not emerge from
the stomach, such as hunger pangs, but tends to begin when an individual
thinks about a craving or wants some specific food to eat. Feelings of
heightened tension and low energy are primarily involved in emotional
eating since they usually underlie the unpleasant mood (depression/
anxiety). In an attempt to self-medicate and self-regulate the mood, the
individual uses food.
 Procrastination: is a voluntary delay of the intended task, despite being
aware of negative consequences for doing so. The task so delayed is
usually perceived as difficult or stressful. For example, if someone has a
week to finish an assignment, and he/she keeps postponing working on
it until right before the deadline, despite the fact that he/she requires a
minimum of one week time to finish the work assigned. In this case, the
person is procrastinating on the assigned task.
 Self-harm: refers to “the act of deliberately inflicting physical injury on
oneself.” Some of the self-harm behaviors are inflicting cut on the body,
deliberately ingesting toxic substances, banging, slamming against hard
130
surfaces. Individuals engage in self-harm behaviors because doing so Self and Maladjustment
provides them an outlet for the expression of their pent-up unpleasant
feelings. Self-harm behaviors are also thought to provide temporary relief
from stress and other negative emotions through the body’s physiological
response to pain.
 Denial: Denial is a coping strategy in which you try to protect yourself
from unpleasant thoughts and feelings by refusing to accept the truth
about something that is happening in your life, which is stressful. For
instance, your boyfriend or girlfriend broke up with you a week before,
and he/she made it very clear that your relationship is not going to work
out and he/she is getting married in a week. However, you think that he/
she was just disturbed last week and it was not a breakup.You fail to
accept the breakup because thinking so is so unpleasant for you, and you
might not even be aware that you are denying it.
 Self-Blame: In Self-blame, a person blames himself/herself or attributes
the occurrence of a stressful event or negative consequences to oneself.
For example, a mother, after knowing that her daughter has failed in the
exam, says to herself, “It’s my fault that she failed in the exam; if I had
motivated her to study regularly, she would not have failed.”
 Rumination: Rumination refers to “repetitive and passive focus on the
causes and consequences of one’s distress without actively engaging in
solving the problem to ease the distress.” For example, ruminative
thoughts can go like this “Why do I feel so bad?” “Why can’t I sleep?”,
“I will never get a job. What am I doing?” Rumination can be dangerous
to your mental health, as it can prolong or intensify the distress.
7.8 DYSFUNCTIONAL ATTITUDE

Attitudes represent our evaluation of people, groups, objects, self, events, things,
or experiences. Attitudes may be positive or negative. According to Baron &
Byrne (1984),”attitudes are relatively lasting clusters of feelings, beliefs, and
behavior tendencies directed towards specific persons, ideas, objects or groups.”
The multi-component model of attitude posits that attitude has cognitive, affective,
and behavioral components. The affective component refers to the object-related
feelings; the cognitive component refers to the object-related beliefs, thoughts,
and attributes. Cognitive, affective, and behavioral components are interrelated,
while cognitive and emotional components predict how an individual behaves in
a particular situation (Eagly & Chaiken, 1993; Zanna & Rempel, 1988).
Dysfunctional attitudes are negatively biased, rigid, maladaptive beliefs/
assumptions and about self, the world, future, things, or experiences.
Dysfunctional attitudes are said to act as vulnerability factors that predispose
individuals to develop psychological disorders.
7.8.1 Characteristics of Dysfunctional Attitudes

Dysfunctional attitudes involve rigid, if-then, conditional beliefs for evaluating
the situations/experiences. They are often illogical and interferes with the well-
being and functioning of the individual (Weissman & Beck, 1978), for example, 131
Self, Maladjustment and ‘If I fail partly, it is as bad as being a complete failure,’ ‘I can be happy only if I
Mental Disorders
am loved by other people,’ ‘One is safe only when there is no danger at all’,
‘Unless I do something perfectly, it will be viewed as useless,’ ‘If I let people see
the real me, they will reject me,’ etc. In the short run, they may be useful but, in
the long run,they can lead to harmful patterns.
Dysfunctional attitudes are said to develop through early experiences of the person
and get modified or strengthened through the experiences an individual goes
through. Though dysfunctional beliefs may be present in all individuals, those
who develop psychological problems are found to be more rigid and have a higher
conviction (stronger belief) in their belief and do not change their beliefs in the
presence of contrary evidence/information. Whereas beliefs of individuals without
any psychological disorders are found to be amenable for change, more flexible,
and do not lead to dysfunctional behaviors or distress.
Dysfunctional attitudes are said to be dormant until the individual faces a stressful
situation beyond their resources to cope (critical incident). When these
dysfunctional attitudes are activated, it is said to result in biased/distorted
information processing (biased interpretations such as all-or-none thinking,
arbitrary inference, overgeneralization etc.).
7.8.2 Models of Dysfunctional Attitudes

The cognitive model of depression by Beck (1967) proposes that dysfunctional
thinking acts as a vulnerability factor when associated with stressful life events
and results in depression (diathesis-stress model). According to Beck, certain
individuals have higher dysfunctional thinking styles (depressogenic schemata),
which are understood as cognitive vulnerability. When these individuals are faced
with life stressors, the dysfunctional thoughts are activated, leading to negative
beliefs about self, the world, and the future, ultimately resulting in depression.
Similarly, dysfunctional attitudes related to self, i.e.,being vulnerable, lacking
skills/abilities, problems as difficult challenges that one is not equipped to manage
are associated with anxiety disorders. Research studies demonstrate that
dysfunctional attitudes predispose individuals to develop anxiety and mood
disorders (Kendler, 1996). A higher level of dysfunctional attitudes is associated
with a longer duration of an ongoing episode and a shorter time to relapse (Scott
et al., 1995; Lam et al., 1996; Weich et al., 2003).
Another important cognitive theory proposed by Albert Ellis (1955) talks about
irrational beliefs. He posits that emotional dysfunction is caused by irrational
thoughts and beliefs. He has given 11 types of irrational beliefs, which were
subsequently divided into 4 categories: (1) demandingness – absolutistic demands
placed on self and others, e.g.,”musts” “shoulds,””have to’s,””oughts”;(2)
awfulizing (or catastrophizing) - evaluation of a bad event as worse than it should
be;(3) low frustration tolerance – belief that it is not possible to bear certain
circumstances which cause distress; and (4) global evaluation (or self-downing)
- pervasive negative evaluation of oneself and the world.
Assessment of dysfunctional attitudes
One of the popular and most frequently used across the disorders and in the
general population is the Dysfunctional attitude scale (DAS) by Weissman and
Beck (1978). This is a self-report scale to measure the presence and intensity of
132
dysfunctional attitudes. It consists of 40 items rated on a 7-point Likert scale Self and Maladjustment
(7 = fully agree; 1 = fully disagree). Some of the examples of the items are, “I
should be happy all the time” and “My life is wasted unless I am a success.”The
total score ranges from 40–280. A higher score indicates a more dysfunctional
attitude of an individual. The scale is found to have good psychometric properties.
The revised scale of DAS (form A) has 17 items with 2 domains - ‘dependency’
and ‘perfectionism/performance evaluation’ (Graaf, Roelofs, & Huibers, 2009).
Common Beliefs Survey-III (CBS-III) by Thorpe, Parker, & Barnes (1992) is a
54-item measure with six subscales and a 5-point Likert-type scale for each item;
29 items pertaining to irrationality, and 25 items pertaining to rationality. The
scale showed good psychometric properties.
Evaluative Beliefs Scale (EBS) by Chadwick, Trower, and Dagnan (1999) is a
cognitive measure of negative evaluative beliefs. It is an 18-item, self-report
instrument rated on a 5-point scale, which measures negative person evaluations
across three dimensions: where aperson believes that others are making
evaluations of him/her, where the person makes an evaluation of himselfor herself,
and where the person evaluates others. The scale is found to predict anxiety and
depressive symptoms.
In addition to a number of scales to assess dysfunctional thinking, thought
monitoring methods like dysfunctional thought diaries/records, which are
maintained by the individuals, are widely used in Cognitive Behaviour Therapy
(CBT).
7.8.3 Modifying Dysfunctional Attitudes

Maladaptive cognitions, including negative automatic thoughts, dysfunctional
attitudes, and schemas/core beliefs, are directly addressed in Cognitive Behaviour
Therapy (CBT). Though other therapies also address unhelpful thoughts, CBT
specifies methods used for modification of thoughts and beliefs. Both behavioral
and verbal reattribution methods are used in CBT. The methods used for modifying
the negative thoughts and dysfunctional attitudes and schemas are called cognitive
restructuring methods. The cognitive restructuring aims at bringing about changes
in the way one appraises and makes sense of events. It uses a set of techniques
for becoming more aware of and for modifying them. This process is also called
reappraisal, relabeling, reframing, and attitude adjustment. However, one needs
to note that changing the beliefs is a slow process, and one needs to consciously
make an effort for it.
Steps in modifying beliefs:
 Awareness – recognizing and recording the thoughts when it occurs
(thought diary)
 Reappraisal – logical analysis of the thoughts/beliefs (examining the
evidence for the thoughts) and generating adaptive thoughts/beliefs
(consider all possibilities/ alternative hypotheses to the belief).
 Adapting alternative/helpful ways of thinking
 Evaluating the results/consequences with respect to emotions, behaviors,
and outcomes in the interpersonal context. 133
Self, Maladjustment and Techniques of modifying dysfunctional beliefs:
Mental Disorders
There are a number of verbal reattribution strategies used in the modification of
dysfunctional attitudes. A few examples of such methods are given below.
Pie chart: This method is used for an inflated sense of responsibility, e.g., blaming
oneself for all the hardships of the family. Here the person is made to consider
many factors which may have contributed to a particular outcome rather than
blaming it on self or considering a single factor as responsible.
Perspective-taking: Thinking from the perspective of others to broaden the view.
When individuals are distressed, they may not be able to think from different
perspectives, which makes them become narrowly focusing on one/few things.
Thinking in shades of grey: Rather than thinking about all-or-nothing extremes,
assess situations on a scale of 0 to 100. Instead of saying either success or failure,
one might consider saying partial success.
The double-standard method: Often, people use different standards to evaluate
themselves as opposed to others. They may be more strict or critical when it
comes to self/others. This method helps in being more compassionate towards
self and others.
The semantic method: Substitute language that is less colorful and emotionally
charged. For example, instead of telling yourself, “I shouldn’t have made that
mistake,” you can say, “It would have been better if I hadn’t made that mistake.”
Analysis of benefits/disadvantages of the belief: Listing out the benefits and
disadvantages of holding a certain belief, e.g.,’I am inadequate.’ This would make
the person realize the negative consequences of the belief and would reduce
importance given to such belief as well as taking actions based on them.
Socratic Questioning: This is a method of questioning that helps the individual
to challenge irrational, illogical thinking. Some of the examples of the questions
are: ‘Is this thought realistic?’ ‘Am I basing my thoughts on facts or on feelings?’
‘What is the evidence for this thought?’ ‘Could I be misinterpreting the evidence?’
etc.
The behavioral methods of modifying beliefs would include behavioral
experiments to test the beliefs, role play, exposing/facing the situations to modify
the dysfunctional/unrealistic beliefs about certain situations, people events, etc.
Logical disputation: Asking the individual whether or not the belief held is
logical and asking for evidences for the belief, and examining if the belief is
helpful (consequences of the belief).
1. ———————————— involves using various cognitive and
behavioural strategies to manage stress and associated negative emotional
reactions, which can result in adverse effects on body and mind.
2. People use maladaptive coping strategies because they can temporarily
———————the intense and overwhelming —————————
they are experiencing.
134
3. The first step in modifying dysfunctional beliefs is ———————.
4. Absolutistic demands placed on self and others according to Ellis theory
is termed as ——————————————.
5. Using different standards to evaluate themselves as opposed to others is
called——————————.
6. ———————————— is a method of questioning which helps in
challenging irrational thinking.
1. Using any addictive substances to get temporary relief from stress is an
example for
(A) Healthy Coping (B) Maladaptive Coping
(C) Self-coping (D) Adaptive Coping
2. ——————————— refers to eating in response to negative
emotion or mood.
(A) Emotional eating (B) Obesity
(C) Healthy eating (D) Depressed eating
3. Which of the following is not a maladaptive coping?
(A) Using excessive alcohol (B) Problem solving
(C) Denial (D) Procrastination
4. ———————————— involves a repetitive and passive focus on
the causes and consequences of one’s distress without engaging in active
coping or problem solving to alleviate the distress.
(A) Wishful thinking (B) Rumination
(C) Denial (D) Self-blame
5. —————————— is a coping strategy in which you try to protect
yourself from unpleasant thoughts and feelings by refusing to accept the
truth about something that is happening in your life which is stressful.
(A) Self-blame (B) Denial
(C)Wishful thinking (D) Self-harm
7.9 LET US SUM UP

The present Unit focused on maladjustment in relation to the self. We discussed
two significant manifestations of maladjustment, such as anxiety and stress, and
also focussed on a few important factors that can contribute to maladjustments,
such as impulsivity, cognitive rigidity, maladaptive coping, and dysfunctional
attitude. 135
Self, Maladjustment and Anxiety is an unpleasant feeling resulting from the perception of danger that can
Mental Disorders
be real or imagined. Whereas occasional anxiety is normal and inevitable, anxiety
can be a disorder when it is disproportionate to the situation and results in
considerable avoidance of the problem, and interferes with one’s day to day
functions. Social Phobia, specific phobia, generalized anxiety disorder, panic
disorder are different types of anxiety disorders. Interaction of a number of
psychosocial and biological factors are indicated in the causal factors of Anxiety.
Psychotherapy, specifically cognitive behavioral therapy (CBT), is one of the
most effective treatment options for anxiety. Stress is an unpleasant emotional
experience accompanied by physiological, cognitive, and behavioral changes
which are either intended to alter the stressor or adapt to its effects. Eustress
refers to a positive response to a stressor, whereas distress is persistent stress,which
is not addressed either through coping or adaptation. Cognitive appraisal plays
an important role in the assessment and perception of stress. Intervention strategies
mainly use cognitive restructuring to modify the thought processes related to
stress.Time management, relaxation, physical activities are some of the other
techniques used to manage stress.
Impulsivity refers to an immediate and unplanned reaction to stimuli before
processing the information thoroughly and a decreased sensitivity to negative
consequences of behavior. It is primarily classified as Impulsive choice (or decision
making) and Impulsive action (or disinhibition). Substance abuse or binging,
impulsive overeating, impulsive shoplifting, gambling, self-harm are a few of
the serious impulsive behaviors.Various behavioral and cognitive strategies can
be used in managing impulsivity.
Cognitive Rigidity is the inability to mentally adapt to new demands or
information. Cognitively rigid people adopt less flexible ways of responding to
dealing with life stressors. One can use various cognitive and behavioral
techniques to overcome cognitive rigidity, such as monitoring, cost-benefit
analysis, viewing situations from multiple perspectives, using positive coping
statements, and practicing mindfulness.
Maladaptive Coping involves using various cognitive and behavioural strategies
to manage Stress and associated negative emotional reactions which can result
in adverse effects on body and mind. People use maladaptive coping strategies
because they can temporarily relieve or diminish the intense and overwhelming
unpleasant feelings they are experiencing. Maladaptive coping strategies are
usually based on emotion-focused coping style in which the individual uses
cognitive and behavioral efforts to alter the emotional reactions triggered by the
stressor. Individuals might use various maladaptive coping strategies to deal with
the perceived stress. Escapism, wishful thinking, substance use, emotional eating,
procrastination, self-harm, denial, self-blame, ruminations are some of the most
commonly used maladaptive coping strategies.
Dysfunctional attitudes are negatively biased, rigid, maladaptive beliefs and
assumptions about self, the world, future, things, or experiences. Such irrational
thoughts and beliefs lead to emotional dysfunction, as proposed by the cognitive
theory of Albert Ellis. Awareness, reappraisal, adapting alternative ways of
thinking, and evaluating the consequences are the steps in modifying dysfunctional
attitudes. Various techniques like pie chart, perspective taking, thinking in shades
136
of grey, analysis of benefits/disadvantage of the belief, socratic questioning and Self and Maladjustment
logical disputation can be used to modify dysfunctional beliefs/attitudes.
7.10 KEYWORDS
Maladjustment occurs when our sense of self prevents us from making a normal
adjustment to some need or demand in our environment.
Self refers to a person’s sense of oneself which is composed of awareness of
one’s physical attributes and psychological attributes, such as thoughts, feelings,
goals, values, preferences that distinguish one individual from another.
Cognitive-Behavioral Therapy (CBT) aims at challenging one’s distorted or
rigid patterns of thinking which produce distress in the individual.
Eustress refers to a positive response to a stressor where a positive event/situation
creates stress that is taken by the person with a willingness.
Micro stressors are the daily hassles that are encountered on a day-to-day basis.
Cognitive Restructuring is a process in which thoughts or beliefs provoking stress
reactions are replaced with more constructive and realistic thoughts or beliefs.
Autogenic training is a method of relaxation which teaches your body to respond
to your verbal commands.
Adaptive coping involves confronting the stressful situation directly by appraising
the stressful situations in a realistic manner and recognizing and managing the
resulting unpleasant feelings without causing adverse effects on the body and
mind.
Rumination refers to repetitive and passive focus on the causes and consequences
of one’s distress without actively engaging in solving the problem to ease the
distress.
Socratic Questioning is a method of questioning that helps the individual to
challenge irrational, illogical thinking.
7.11 ANSWERS TO SELF ASSESSMENT QUESTIONS

I. 1) Fear, Anxiety 2) Disproportionate, Avoidance 3) Eustress, Distress 4)
Stressor
II. 1) C, 2) D, 3) C, 4) B, 5) C, 6) B, 7) C, 8) B, 9) A, 10) C
I. 1) Impulsivity, Inhibit 2) Impulsivity 3) Cognitive Rigidity 4) Cognitively
Flexible
II. 1) C, 2) C, 3) A, 4) B, 5) B, 6) C, 7) A, 8) B, 9) B, 10) B
I. 1) Maladaptive Coping 2) Relieve or Diminish, Unpleasant feelings
3) Awareness 4) Demandingness 5) Double standards 6) Socratic questioning
II. 1) B, 2) A, 3)B, 4)B, 5)B
137
Mental Disorders 7.12 UNIT END QUESTIONS
1. What is anxiety? Explain different types of anxiety disorders and various
causal factors in anxiety.
2. What is stress? Elucidate long-term negative effects of stress on health and
various stress management techniques.
3. Give the classification of impulsivity. Name some of the serious impulsive
behaviors and explain various strategies one can use to manage impulsivity.
4. Distinguish between adaptive and maladaptive coping. Explain various
maladaptive strategies used by individuals to deal with perceived stress and
experienced unpleasant emotions.
5. Describe the common characteristics observed in individuals with high
cognitive rigidity.
6. Write a short note on the role of cognitive rigidity in mental health and various
techniques to overcome cognitive rigidity.
7. List out the techniques used in changing maladaptive thinking.
8. What are dysfunctional attitudes, and how do you assess them.
9. Describe the models which explain dysfunctional attitudes.
10. What are the steps in modifying dysfunctional beliefs?
7.13 REFERENCES
Adwas, A. A., Jbireal, J. M., & Azab, A. E. (2019). Anxiety: Insights into Signs,
Symptoms, Etiology, Pathophysiology, and Treatment. East African Scholars
Journal of Medical Sciences, 2(October), 80–91.
Bakhshani, N.-M. (2014). Impulsivity: A Predisposition toward Risky Behaviors.
International Journal of High-Risk Behaviors and Addiction,3(2). https://doi.org/
10.5812/ijhrba.20428
Beck, A. T. (1967). Depression: clinical, experimental, and theoretical aspects.
New York, NY: Harper & Row.
Chadwick, P., Trower, P., & Dagnan., D. (1999) Measuring negative person
evaluations: The evaluative beliefs scale. Cognitive Therapy and Research, 23(5),
549-559
Dean, R. S., & Garabedian, A. (1981). The personality characteristics of the rigid
learner. Journal of School Psychology, 19(2), 143–151. https://doi.org/10.1016/
0022-4405(81)90056-X
De Graaf, L. E., Roelofs, J., & Huibers, M. J. (2009). Measuring Dysfunctional
Attitudes in the General Population: The Dysfunctional Attitude Scale (form A)
Revised. Cognitive therapy and research, 33(4), 345–355. https://doi.org/10.1007/
s10608-009-9229-y
Ellis, A., Dryden, W., & Wozencraft, T. A. (1998). The Practice of Rational
Emotive Behavior Therapy.Journal of Cognitive Psychotherapy, 12, (4). https://
138 doi.org/10.1891/0889-8391.12.4.345
Grant, J. E., Donahue, C. B., & Odlaug, B. L. (2011). Treating impulse control Self and Maladjustment
disorders/ : a cognitive-behavioral therapy program/ : therapist guide in
Treatments that work. Oxford University Press: US.
Harada, K., & Chen, C. J. (1984). Analysis of a Resonant Converter Controlled
by Triac. IEEE Transactions on Industry Applications, IA-20(1), 236–240. https:/
/doi.org/10.1109/TIA.1984.4504398.Adaptive and Maladaptive Coping Strategies
for Perceived Stress. (2018). May.
Hodgins, D. C., & Peden, N. (2008). Cognitive-behavioral treatment for impulse
control disorders. Revista Brasileira de Psiquiatria, 30(SUPPL 1), 31–40. https:/
/doi.org/10.1590/s1516-44462006005000055
Honess, T., & Yardley, K. M. (1987). Self and Identity: Perspectives Across the
Lifespan. Routledge & Kegan Paul.
Manjula, M. (2016). Academic stress management: An intervention in pre-
university college youth. Journal of the Indian Academy of Applied Psychology,
42(1), 105–113.
Morris, L., & Mansell, W. (2018). A systematic review of the relationship between
rigidity/flexibility and transdiagnostic cognitive and behavioral processes that
maintain psychopathology.Journal of Experimental Psychopathology, 9(3). https:/
/doi.org/10.1177/2043808718779431
Mishra, A., Podder, V., Modgil, S., Khosla, R., Anand, A., Nagarathna, R.,
Malhotra, R., & Nagendra, H. R. (2020). Higher Perceived Stress and Poor
Glycemic Changes in Prediabetics and Diabetics Among Indian
Population. Journal of Medicine and Life, 13(2), 132–137. https://doi.org/
10.25122/jml-2019-0055
Owens, T. J. (2006). Self and Identity. In Delamater J. (Ed.), Handbook of Social
Psychology. Springer. https://doi.org/https://doi.org/10.1007/0-387-36921-X_9
Sarkar, S., Gupta, R., & Menon, V. (2018). A systematic review of depression,
Anxiety, and Stress among medical students in India. Journal of Mental Health
and Human Behavior, 22. https://doi.org/10.4103/jmhhb.jmhhb_2017
Stevens, J. R., & Introduction. (2017). The Many Faces of Impulsivity. In J. R.
Stevens (Ed.), Impulsivity (pp. 1–6). Springer International Publishing. https://
doi.org/10.1007/978-3-319-51721-6
Thorpe, G.L., Parker, J.D. & Barnes, G.S. (1992) The Common Beliefs Survey
III and its subscales: Discriminant validity in clinical and non-clinical subjects.
Journal of Rational-Emotive and Cognitive-Behavior Therapy, 10(2), 95-104.
Wit, Harriet, &Jentsch, J. D. (Ed.). (2020). Recent Advances in Research on
Impulsivity and Impulsive Behaviors (1st ed.). Springer International Publishing.
https://doi.org/10.1007/978-3-030-60511-7.
Weissman, A. N., &Beck, A. T. (1978). “Development and validation of the
dysfunctional attitudes scale: preliminary investigation,” in Annual Meeting of
the American Educational Research Association. (Chicago, IL). Available online
at: http://files.eric.ed.gov/fulltext/ED167619.pdf
Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to
rapidity of habit-formation. Journal of Comparative Neurology and
Psychology, 18(5),459– 482. https://doi.org/10/cfnwhw 139
Mental Disorders 7.14 FURTHER LEARNING RESOURCES
Books
1. Bridges, K. & Harnish, R. (2010). Role of irrational beliefs in depression
and Anxiety: A review. Health. 02. 10.4236/health.2010.28130.
2. Ellis, A.,&Robert, A.(1975). A Guide to Rational Living. Wilshire Book Co
3. Grant, J.E.,&Odlaug, B.L., (2016). Why Can’t I Stop? Reclaiming Your Life
from a Behavioral Addiction. Johns Hopkins University Press.
4. Edward P. &Sarafino, T. W. S. (2016). Health Psychology: Biopsychosocial
Interactions (9th ed.). Wiley.
5. Butcher J.N., Hooley, J.M., &Mineka, S. (2014). Abnormal Psychology (16th
ed.). Pearson.
6. Hofmann, S.G. (2014) (Editor). The Wiley Handbook of Cognitive Behavioral
Therapy. John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118528563.wbcbt02
Videos
7. https://www.youtube.com/c/americanpsychologicalassociation/videos
8. Psychological Flexibility:How love turns pain into purpose by Steven Hayes
https://contextualscience.org/psychological_flexibility_how_love_turns_
pain_into
9. Defining Cognitive Therapy by Dr.Judith Beck
https://www.youtube.com/watch?v=ZZt-Q1DR3Ds
11. CBT Techniques for Anxiety Disorders by Aaron T.Beck &Judith Beck
https://www.youtube.com/watch?v=3maymp7K4q0
12. CBT Exposure Techniques for Anxiety Disorders by Aaron T.Beck &Judith
Beck
https://www.youtube.com/watch?v=Y2gJWtdPesc
13. Relaxation Response: Dr.Herbert Benson teaches you the basics by Dr. Herbert
Benson
https://www.youtube.com/watch?v=nBCsFuoFRp8
140
UNIT 8 MENTAL DISORDERS*
Structure
8.1 Learning Objectives

8.2 Introduction
8.3 Mood Disorders
8.4 Eating Disorders
8.5 Internet Gaming Disorder
8.6 Personality Disorders
8.7 Substance Use Disorder
8.8 Let Us Sum Up
8.9 Key Words
8.10 Answers to Self Assessment Questions
8.11 Unit End Questions
8.12 References
8.13 Further Learning Resources
8.1 LEARNING OBJECTIVES

After studying the Unit, you would be able to:
 Explain the meaning, types, causal factors, and treatment used for mood
disorders;
 Explain the meaning, types, causal factors, and treatment used for eating
disorders;
 Explain the meaning, causal factors, and treatment used for Internet gaming
disorders;
 Explain the meaning, types, causal factors, and treatment used for personality
disorders; and
 Explain the meaning, types, causal factors, and treatment used for substance
use disorders.
8.2 INTRODUCTION
In the previous Unit, you learned about how maladjustment can affect the
development and functioning of oneself in a negative way. In severe cases, it can
result in various mental disorders also. In this Unit, we will focus on understanding
the various mental disorders.
According to American Psychiatric Association (2018), mental disorders are
clinically significant conditions characterized by changes in thinking, emotions
*
Sayma Jameel, PhD Scholar & Manjula M, Professor, Department of Clinical Psychology,
National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. 141
Self, Maladjustment and or behaviours. These conditions are also associated with significant distress and
Mental Disorders
/or lead to impaired functioning.In simple terms, it means that mental disorders
may interfere in carrying out day to day activities efficiently such as daily routine,
studies, work, household chores, and interaction with others etc. and cause distress
to self and others.
Mental health disorders are common and can occur to anyone. In 2017, 197·3
million people were found to have mental disorders in India (Sagar, et al., 2020).
National Mental Health Survey (2015-16) has estimated that 150 million people
in India require mental health care at any given point. It is also important to note
that not all human distress are mental disorders. One incident or occasional
maladaptive behaviour or disruption in the normal functioning does not signify
the presence of mental illness. In order to be considered as mental disorder, these
dysfunctional behaviours must persistently occur and cause significant impairment
in personal-socio-occupational functioning. To diagnose and accurately identify
symptoms of mental illness, mental health professionals use the Diagnostic and
Statistical Manual of Mental Disorders (DSM) published by the American
Psychiatric Association, or International Classification of Diseases (ICD) by the
World Health Organization (WHO). Both systems of classification of mental
disorders have set criteria specifying clinical presentation, course, intensity and
duration of symptoms to officially diagnose and classify these as mental disorders.
Currently we have DSM 5 version and ICD 11 version of the classification system.
Generally there are a number of factors implicated in any mental disorder ranging
from biological to psychological and socio-cultural aspects. It is important to
remember that some factors may act as risk factors for the disorder, and some
may play a role in maintaining the disorder. Thus one needs to do a holistic
assessment involving the individual as well as their family members, parents,
siblings, peer, colleagues, teachers etc. who can contibute information about the
individual. This helps in understanding the disorder and adopt appropriate
treatment and intervention measures.
In the present Unit we will discuss a few most commonly occuring mental
disorders such as mood disorder (bipolar and related disorder and depressive
disorder), eating disorder, internet gaming disorder, personality disorder,and
substance use disorder.
8.3 MOOD DISORDERS

Human beings experience a varietyof emotions over a course of time. All emotions
are important for rich and fulfilling life. You may feel joy when you get surprise
visit or gift from friend, you may feel down after getting low grade in exam or
because of relationship problems or financial problem or because you had a bad
day at work. These are normal ups and down and different range of emotions that
come and go in their own course. But, in mood disorder, people experience
emotions that are extreme and often disproportionate to the context. So, mood
disorders can be understood as characterized by a drastic and extreme shift in
mood that disrupts daily life activities. It can be understood as agroup of mental
disorders in which the root problem centres on person’s ongoing emotional state
(their mood). Mood disorders also formally called as “affective disorders”.
142
Mood disorders can have depressive episode only (also known as “unipolar Mental Disorders
depression”) or they may include one or more manic episodes (referred to as
bipolar disorder). Mood disorders createsevere distress and impairment in social,
occupational, educational and other essential areas of functioning.
Meaning and Prevalence
In mood disorder, the disturbances of mood are intense and persistent enough to
be evidently maladaptive and can lead to serious problems in functioning. Mania
and depression are two key mood states involved in mood disorders. Mania is
often characterized by intense feelings of euphoria and elation, whereas depression
involves feelings of persistent and pervasive sadness and dejection. Mood disorder
is an episodic illness which means a person with mood disorder may experience
manic episodes at certain time points and depressive episodes at other times.
Normal mood is at the middle of mood continuum whereas manic and depressive
mood states are at the opposite ends of a mood continuum. Normal mood can
occur between two episodes. It is also important to note that the symptoms of
mania and depression can also occur during the same time period which is termed
as mixed-episode. In mixed episodes, a person experiences rapid cycling of mood
states such as sadness, euphoria, and irritability, all within the same episode of
illness.
In India, bipolar affective disorder was detected more among males of the urban
metro areas (National Health Survey, 2016).Women are twice as likely as men to
suffer from depression, with almost one-quarter of women experiencing a
depressive episode at some point in their lives. Depression is the most prevalent
mood disorder, according to the World Health Organization (WHO), and is listed
as the leading cause of disability worldwide.
Types of Mood Disorder
Mood disorder can be categorised into ‘bipolar and related disorder’and
depressive disorder. Let us first discuss the ‘bipolar and related disorder’.
‘Bipolar and related disorder’ is identified by at least one manic or mixed episode
(mania and depression) with or without a history of major depression.
Bipolar and Related Disorder
There are three types of bipolar and related disorder.
 Bipolar I Disorder- The sign of Bipolar I disorder includes manic
episodes that last at least for 7 days, or by manic symptoms that are so
serious and disruptive that the person needs immediate hospital care.
The episode of depression might also occur for at least consecutively 2
weeks. Episodes of depression with mixed features (having depressive
and manic symptoms in one episode) are also possible under this category.
 Bipolar II Disorder - A presence of depressive episodes and hypomanic
episodes are indicators of Bipolar II disorder. However, the full-blown
manic episodes that are typical of Bipolar I Disorder should not be present.
Hypomanic episode means a milder intensity of symptoms which are
found in manic episodes and duration needs to be of 4 days. Because of
milder form of mania in bipolar II disorder, hospitalization is generally
not required. 143
Self, Maladjustment and  Cyclothymic Disorder (Cyclothymia) - Cyclothymia is characterized by
Mental Disorders
the presence of hypomanic episodes as well as periods of depressive
symptoms lasting for longer duration of at least 2 years (1 year in children
and adolescents).
The following case illustrates symptom manifestation in Bipolar disorder:
Mr M, a 36-year-old married male, separated from his wife was brought to
hospital by his family members.
They gave a history of the last 1 month where M was restless, over talkative and
felt a decreased need for sleep. The current episode was precipitated by verbal
fight with his wife. Family member reported that he was found to be awake most
part in night and would engage himself in some non important task. He keeps on
shifting to several tasks and was found overly active and hasten over everything
he engages in. He was also found to be overly interested in religious activity. His
family members’ complaint about over- aggressive behaviour also which leads
to verbal and physical fight.
A detailed clinical assessment involving detailed history and mental status
examination revealed that there have been 2 past episodes of similar kind. On
account of his past and current history, he was diagnosed with Bipolar affective
disorder currently in manic episode.
The bipolar disorder in its severe form may also be presented with psychotic
symptoms like hallucinations or delusions. Bipolar disorder is often a chronic
condition which has its onset in childhood and requires long term treatment.
Diagnosing bipolar disorder can be sometime difficult due to presence of comorbid
conditions such as anxiety, substance abuse, attention deficit hyperactive disorder
etc.
Depressive Disorder
Depression is a common disorder that affects over 264 million people worldwide
(WHO, 2019). The symptoms of depressive disorder are the presence of low or
irritable mood, with somatic and cognitive changes that significantly affects
person’s daily functioning. In depression, life seems negative and future looks
gloomy. Person would also experience feelings of worthlessness and exhibit loss
of interest in nearly everything even in those activities that used to be pleasurable
earlier. Suicidal thinking, difficulty sleeping, socially withdrawal, and changes
in appetite are also commonly seen in depression. Therefore, it often affects weight
due to either loss of interest in eating or may feel overly hungry and gain excess
weight.
Consider the feelings presented in following verbatim from a person, who was
diagnosed with ‘major depressive disorder’:
I didn’t want to face anyone; I didn’t want to talk to anyone. I didn’t really want
to do anything for myself…I couldn’t sit down for a minute really to do anything
that took deep concentration…It was like I had big huge weights on my legs and
I was trying to swim and just kept sinking. And I’d get a little bit of air, just
enough to survive and then I’d go back down again. It was just constantly,
constantly just fighting, fighting, fighting, fighting... (National Institute of Mental
144 Health, 2010).
Suicide death is very common in people suffering from major depression. Mental Disorders
Depression may also involve psychotic features as well like delusional thinking
and may experience hallucinations.
In DSM-5, the types of depressive disorders include the following:
 Disruptive mood dysregulation disorder is commonly found among
children consulting in pediatric mental health clinics. Chronic and
constant irritability is the core of disruptive mood dysregulation disorder.
Frequent temper outbursts and chronic, irritable or angry mood that is
present between the severe temper outbursts are two clinical
manifestations found in children presented with disruptive mood
dysregulation disorder.
 Major depressive disorder (including major depressive episode). For
diagnosis of major depressive disorder,the symptoms need to be present
nearly every day, for at least two consecutive weeks. The symptoms
include either markedly depressed moods or marked loss of interest in
pleasurable activities. In addition to one or both of these symptoms, the
person must experience additional cognitive and vegetative symptoms
in the same time duration.
 Persistent depressive disorder (dysthymia) is usually mild to moderate
intensity depressive disorder and its core feature is its chronicity. For the
diagnosis of persistent depressive disorder a person must have a
persistently depressed mood most of the dayfor at least 2 years (1 year
for children and adolescents). The intermittent normal mood can also
occur in dysthymic disorder.
 Premenstrual dysphoric disorder. It is a form of depression which can
be considered as an extension of premenstrual syndrome (PMS). Mood
changes is common in both PMS and Premenstrual dysphoric disorder
(PMDD), but they are more intense and disturb areas of daily functioning
in PMDD. The symptoms usually start before 7-10 days of menstrual
cycle in PMDD.
 Substance/Medication-induced Depressive Disorder. Some medical
conditions and injection/inhalation of a substance (e.g., drug of abuse,
toxin, psychotropic medication, and other medication) can also trigger
depressive disorder. These categories are known as substance/medication-
induced depressive disorder.
Causal Factors of Mood Disorder
Mood disorder can be explained from a combination of behavioural, social,
cognitive and biological perspective.
Biological explanation focuses on brain chemicals such as serotonin,
norepinephrine, and dopamine. The medication given for treatment of depression
and mania usually affects these three neurotransmitters, either alone or in
combination (Cummings & Coffey, 1994; Ruhe et al., 2007). Mood disorders
have a strong genetic basis, because they are heritable (Berrettini, 2006).There
are a few structural differences noticed in the brain with mood disorder from
those without them. 145
Self, Maladjustment and While biological factors play a significant role in the onset of bipolar disorder,
Mental Disorders
psychosocial factors have also been implicated in the disorder’s aetiology. Of all
psychological factors, stressful life events, lack of social support, certain
personality traits and cognitive styles have been given more importance because
of their most influencing role in mood disorders. Stressful life events can also
trigger manic episodes (Goodwin & Jamison, 2007). Moreover, it can also affect
the onset and timing of episodes.
There are social contextual factors that may influence the maintenance of bipolar
disorder. According to a study, people with bipolar disorder who reported low
social support showed more depressive recurrences over a 1-year follow-up,
independent of the effects of stressful life events, which also predicted more
recurrences (Cohen et al., 2004).The relapse and recurrences also get affected by
personality and cognitive factor which further interact with stressful life events
and determine the likelihood of relapse. From social cognitive perspective,
depressed people persistently have negative, self-defeating and self depreciating
thoughts about themselves which is called as depressogenic cognitions, which
maintain their depression. Social cognitive theorists pointed towards the role of
various cognitive distortions like maximisation and minimization etc. in the onset
of mood disorders (Beck, 1979).
Treatment of Mood Disorders
There are wide varieties of treatments available for treating mood disorder.
Treatment is found to be effective in most severe cases of mood disorder as well.
The combination of medication and psychotherapy makes a successful and
effective management plan for mood disorders.
 Pharmacotherapy
Antidepressant, mood-stabilizers, and antipsychotic class of medications
are used in the treatment of mood disorders.
 Electroconvulsive therapy (ECT)
ECT is often used in severe depressive cases who do not respond to drug
therapy, are psychotic, or are suicidal or dangerous to themselves.
 Cognitive behavioural therapy (CBT)
This kind of treatment focuses on changing dysfunctional thinking and
behaviour. Recent evidences suggest that CBT and medications are
equally effective in the treatment of severe depression (DeRubeis et al.,
1999; Hollon et al., 2006).
 Behavioral activation treatment
Behavioural activation is relative new but effective form of treatment
particularly used for depression.This approach focuses intensively on
making people with depression more active and engaged with their
environment and life.
 Interpersonal and social rhythm therapy
This approach deals with interpersonal relationship pattern, and helps
the person understand and change maladaptive interaction patterns
146
(Bleiberg & Markowitz, 2008). Individuals with chronic depression can Mental Disorders
benefit from interpersonal therapy as it helps in reducing the rate of relapse
also. Regular daily schedule and maintaining routine act as preventing
factor in reducing onset of manic episodes.
 Family focused therapy/marital therapy
This form of treatment helps in enhancing family coping strategies, such
as recognising new episodes early and helping their loved one. This
therapy alsoimproves communication, problem solving, leadership and
support among family members.
1. What are the two key mood states involved in mood disorder?
2. In which condition an individual is likely to have a decreased need of
sleep - depressed episode or manic episode?
3. Name the type of depressive disorder which is also known as dysthymia.
4. What are the brain chemicals involved in the biological explanation of
mood disorder?
5. Mention non-pharmacotherapy methods used in the treatment of mood
disorder.
8.4 EATING DISORDERS

Eating disorders are often fatal illnesses characterised by changes in people’s
eating patterns, as well as associated thoughts and emotions. The excessive
preoccupation with food, body weight, and body shape are the indicators of eating
disorders. According to the DSM-5 (APA, 2013), persistent disturbance in eating
behaviour is the core feature of eating disorders. Anintense fear of becoming
overweight and associated behaviours directed towards desire of thinness is
common in all eating disorder which sometimes can lead to uncontrollable
behaviour and serious consequences.
According to National survey report, 20 million women and 10 million men in
the United States will suffer from an eating disorder at some stage in their lives.
(Wade, Keski-Rahkonen, & Hudson, 2011). Eating disorders can affect individuals
of all ages or gender, but prevalence rates are found to be higher in women. It is
most often seen in females during adolescence and young adulthood. Eating
disorders has affected at least 9% of the population worldwide (Galmiche et al,
2019). The rate of anorexia nervosa as per an Indian study from Tamil Nadu is
ten per 100,000 in Indian males, and 37.2 per 100,000 in Indian females
(Mohandoss, 2018).
The persistent disturbance of eating or eating-related behaviors often results in
the disturbed metabolism that significantly impairs physical health as well as
psychosocial functioning.
Symptoms of Eating Disorders
Let us now look at the common signs and symptoms of eating disorder before we
discuss the types of eating disorder. 147
Self, Maladjustment and Emotional and behavioral
Mental Disorders
 Behaviour indicating weight loss, dieting, and control of food as they
become the primary concerns in individuals life.
 Preoccupation with food related measurements like weights, calories,
carbohydrates intake etc.
 Excessive avoidance of certain kinds of food item leading to strict
restrictions in food items (like no fatty or carbohydrates containing food
items etc.)
 Apprehension about eating in public
 Performing food related rituals (e.g., eats only a particular food category)
 Excessive and frequent dieting plans
 Withdrawal from usual friends and social and recreational activities
 Constantly inspecting one’s appearance in the mirror for perceived defects
or flaws
Along with the above mentioned symptoms, physical symptoms like
noticeable fluctuations in weight and other non-specific gastrointestinal
complaints, disturbed blood reports on laboratory findings (anemia,
fluctuations in thyroid level and other hormones levels, low white and
red blood cell counts), dizziness, excessive weakness and fatigue,
impaired immune functioning etc are also common in eating disorders.
Case example
B was 20 years old single, Hindu female. She was second year graduation student
of fashion designing course. She had been staying with her aunt in different city
for educational purpose. Among her classmates, she was the youngest and was
in the company of weight conscious mates and elders.B recalled an incident
where her friend made a remark that she looked obese. She reported that the
statement from her friend prompted her to take care of her food intake and she
started exercising regularly. She decreased intake of fat and carbohydrates and
started taking only salads, fruit and juices. This was accompanied by rigorous
workout daily. The aim was to get thin. She reported that she “felt fat” during
history taking. Her BMI was calculated and found much less than appropriate at
her age. After knowing her BMI, she kept a close watch on her weight and food
intake.She also began having binge eating episodes, in which she would consume
big amounts of sweet and fried foods on one day and then consume no solids or
even semisolids for many days. She also began using laxatives such as Isabgol 4
teaspoon following her periodic binges, which occurred once every two weeks.
(Mendehkar, Arora, Jiloha & Baweja, 2003).
There are a number of famous celebrities who have struggled and came out to
speak about their struggle and challenges of eating disorder. Celebrities are often
put under a lot of pressure and scrutiny from media and public to look a certain
way, which can lead to excessive dieting and eating disorders. Read the following
newspaper report to get a sense of a celebrity’s struggle with eating disorder.
148
When speaking at an event in 2012, Lady Gaga opened up about her struggles Mental Disorders
with eating disorders. “I used to throw up all the time in high school. So I’m not
that confident,” she said “I wanted to be a skinny little ballerina but I was a
voluptuous little Italian girl whose dad had meatballs on the table every night.”
At one point, her bulimia started to affect her singing. “It made my voice bad, so
I had to stop.” (Greenwald, 2012).
Types of Eating Disorders
There are three types of eating disorders which include anorexia nervosa, bulimia
nervosa, and binge-eating disorder.
 Anorexia Nervosa
A type of eating disorder in which an individual restricts food intake to
the level that 15 percent weight loss which is below the ideal body weight
or more occurs. The three characteristics of anorexia nervosa are:
excessive food intake restriction, excessive fear of being overweight or
persistent behaviour that may lead to preventing weight gain, and
disturbance in body image.There is also behaviour like weighing oneself
repeatedly, persistently restricting food intake, exercising excessively,
and/or they may even do forceful vomiting or use laxatives for losing
weight. The long term physical effect may develop overtime like irregular
hormone secretion particularly in the thyroid and adrenal glands, which
can have long-term physical consequences. Heart muscles weaken, and
heart rhythms can change.Diarrhea, loss of body tissue, loss of sleep,
low blood pressure, and lack of menstruation in females are some of the
other physical consequences of anorexia.
 Bulimia Nervosa
Bulimia nervosa, also known as bulimia, is a type of eating disorder in
which an individual begins a cycle of “bingeing,” or consuming a large
amount of food in one sitting, and then uses unhealthy strategies to prevent
weight gain (Rideout, 2005).The three characteristics features of bulimia
nervosa are: Recurrent periods of binge eating, recurrent unhealthy
compensatory activities to avoid weight gain, and self-evaluation
influenced by body appearance and weight. The symptoms must occur
on an average, at least once per week for 3 months. Bulimia nervosa
patients may be slightly underweight, medium weight, or overweight.
Most people with bulimia engage in “purging” behaviours like
intentionally vomiting after a binge or abusing laxatives, but others don’t,
opting instead for other unhealthy weight-loss strategies like fasting for
a day or two after the binge or engaging in excessive exercise. (American
Psychiatric Association, 2000).
 Binge-Eating Disorder
People who suffer from binge eating disorder lose control over their
eating. Periods of binge-eating are not accompanied by compensatory
strategies like purging, excessive exercise, or fasting, as is the case for
bulimia nervosa. Consequently, binge-eating disorder often lead to
making individual overweight or obese. Eating excessively large
149
Self, Maladjustment and quantities of food in a short period of time, such as two hours and eating
Mental Disorders
even when not hungry, eating alone or in secret to prevent embarrassment,
and feeling distressed, ashamed, or guilty about eating later are all
symptoms of binge eating disorder.
Causal Factors of Eating Disorder
A dynamic interaction among genetic, biological, psychological, and social factors
influences the onset of eating disorders.
Genetics: People who have first-degree relatives, siblings or parents, with eating
disorder tend to be at a higher risk of having one as well. Thehormone named
serotonin is also found to be involved in eating disorder.
Social factors: People are put under undue pressure to meet unrealistic
expectations by cultural forces that idealise a specific body type. Thinness (for
women) or muscularity (for men) are often associated with popularity, success,
strength, happiness and beauty in popular culture and media depictions. This can
be a very strong force when it comes to young people. Other factors like peer
pressure can occur in the form of teasing, bullying or humiliating because of
one’s appearance and can lead to developing eating disorder.
Psychological factors: Perfectionism, impulsive behaviour, and challenging and
difficult relationships can all lower a person’s self-esteem and make him more
prone to eating disorders. Although there is no single cause of eating disorders,
studies suggest that body dissatisfaction is the most prominent and well researched
factor in the development of anorexia and bulimia nervosa. (Stice & Whitenton,
2002). Factors like anxiety, depression, and addiction can run in families and
have been linked to an increase in the likelihood of developing an eating disorder.
Treatment of Eating Disorder
Eating disorder treatment usually consists of a combination of psychological and
dietary counselling, as well as medical and psychiatric supervision. An effective
treatment plan would focus on both symptoms and medical effects of the eating
disorder, as well as the psychological, biological, interpersonal, and cultural forces
that lead to or contribute in maintenance of the disorder.
 Medications
While there is no evidence that antidepressants are particularly effective
in the treatment of eating disorders, they are sometimes used. Many
individuals who suffer from an eating disorder may also have a comorbid
condition such as depression or anxiety, and they find that these
medications help them deal with their underlying problems(Hudson et
al., 2007; O’Brien & Vincent, 2003; Brown & Keel, 2012b)
 Psychotherapy
In the treatment of eating disorders, cognitive-behavioral therapy (CBT),
which consists of modifying behaviour and maladaptive thought patterns,
has proven to be very effective (Vitousek, 2002; Wilson, 2010). Family-
based counselling, in which parents of adolescents with anorexia nervosa
150 participate in the treatment process tends to be very effective in helping
people gain weight, change eating patterns, and improve their moods (le Mental Disorders
Grange & Lock, 2005).
1. What kind of fear is seen in eating disorders?
2. Name the type of eating disorder in which an individual sees himself as
fat, even when he is underweight.
3. Name the type of eating disorder in which a person has recurrent and
frequent episodes of eating excessively large amounts of food and feeling
a lack of control and guilt over these episodes.
4. What psychological factors can cause eating disorder?
5. Mention two therapies which are found effective in eating disorder.
INTERNET GAMING DISORDER
A 16-year-old boy, student of class XI was among the top three students in school.
He received a computer after his midterm examinations. During school vacations,
he started playing online video games. Subsequently, he started spending 12–14
hours a day on the computer, started skipping his classes and his academic
drastically declined. He could not clear his final examination. Following which,
he stopped going to school and has not been interacting with his friends.He
preferred to take all his meals at his computer table and even play while eating
his meals. He did not even watch television and abandoned his hobby of playing
basketball. His behaviour became oppositional; he would break things and tear
clothes if he was asked to stay away from the computer. He experienced neck
pain and eye strain as a result of his prolonged and excessive online activities
but he continued to play online games amid his problems.
The example above highlights the transition of normal behaviour into addictive
behaviour.
Playing video games can be a source of entertainment, and it’s easy to get caught
up in the competition, but are they also addictive? This is an issue that researchers
and health practitioners are still debating. Internet gaming disorder is one type of
behaviour addiction that has gained popularity in recent years, although there is
still a lot of controversy on whether it should be considered as a separate disorder.
Regardless of its exact medical status, gaming addiction has caused untold
suffering to countless people over the last few decades.
Gaming disorder is defined in the 11th Revision of the International Classification
of Diseases (ICD-11) as a pattern of gaming behaviour characterised by a loss of
control over gaming, making gaming a higher priority than other activities to the
point where gaming takes precedence over other interests, and continuing gaming
despite negative consequences.To be diagnosed with gaming disorder, the
behaviour pattern must be severe enough to cause significant impairment in
personal, family, social, educational, occupational, or other significant areas of
functioning over a period of at least 12 months.
It may be noted here that gaming disorder and Internet Addiction are two entirely
different categories (Griffiths, & Pontes, 2014; Griffiths, 2018). Internet addiction
151
Self, Maladjustment and disorder (IAD) is characterized by excessive or poorly controlled preoccupations,
Mental Disorders
urges, or behaviors regarding Internet use that lead to impairment or distress.
Person with this kind of behavioural addiction may use the Internet for extended
periods, isolating themselves from other forms of social contact, and focus almost
entirely on the Internet rather than broader life events. Internet addiction Disorder
(IAD) was considered in 2013 for inclusion in DSM-5 but is not yet recognised
as a disorder; however, internet gaming disorder was listed in the appendix of
DSM-5 for future review and study.
Gaming must cause “serious disability or distress” in several areas of a person’s
life. This proposed condition only applies to gaming and excludes concerns with
general internet use, online gambling, social media, or smartphone use. The
proposed symptoms of internet gaming disorder include:
o Preoccupation/salience with gaming
o Withdrawal symptoms when gaming is taken away (sadness, anxiety,
irritability)
o Tolerance, the need to spend more and more time gaming to satisfy the
urge
o Unsuccessful attempts to quit gaming
o Abandoning other hobbies and interest, loss of interest in previously
enjoyed activities as gaming becomes most important activity
o Continuing to game despite problems
o Lying to family members or others about how much time you spend
gaming
o The use of video games to alleviate emotions like shame or hopelessness.
o Possibility of endangering or losing a job or relationship as a result of
gaming.
Five or more of the above symptoms are required to diagnose with internet gaming
disorder.The duration of experiencing these symptoms can be within a year.
The prevalence of Internet gaming disorder in adolescents ranged from 1.3 percent
to 19.9 percent, with males showing higher prevalence than females (Mihara &
Higuchi, 2017). Different findings have been published in epidemiological studies
on the prevalence of Internet gaming disorder owing to the use of various
assessment methods and criteria. Due to unavailability of enough research
evidence and no consensus about the types of internet gaming disorder among
researchers, there are no well-researched subtypes for Internet gaming disorder
to date. Some researchers suggested that an individual’s addiction to gaming
may be either online or offline, while others pointed out that massively multiplayer
online role-playing games are linked to substantially more disability than other
types of Internet gaming.
Causal Factors ofInternet Gaming Disorder
Online gaming disorder is the product of a variety of interconnected causes.
Researchers assume that problematic online gaming might share similar
152
neurobiological mechanism as pathological gambling and substance dependence Mental Disorders
(Kuss et al., 2018). Personality traits can play a role in addictive behaviour.
Problematic players are thought to spend more time gaming in order to escape
real-life social interactions that seem intimidating due to poor social skills or
stressful situation. Online environments may seem secure to certain people, and
they may prefer them to real-life circumstances.
Certain risk factors, in particular, have been described as leading to higher rates
of video game addiction. These include: low self-esteem, neglected parenting,
mood modifying qualities in gaming, neuroticism, loneliness etc. In addition to
these there are some motivational aspects. Multiple reinforcements are used in
online gaming, and different features can be more or less rewarding to different
people. In order to keep the diverse gaming community engaged, the games are
constructed and designed to satisfy as many different psychological needs as
possible. Therefore, there are some structural aspects of the game itself that
contribute to its addictive quality.
Treatment of Internet Gaming Disorder
 Medications
People with internet gaming disorder are prescribed antidepressant
medication to alleviate the underlying symptoms. Medications can be
used in treating the consequences or condition accompanying disorder
like an addict suffering from sleeplessness may need sleeping pills.One
drug that has recently been used to treat this addiction is ibupropion.
The medication works by changing the chemistry of the brain, which
helps to alleviate video game cravings.
 Psychotherapy
Therapies which are found effective for other behavioral addictions like
behavioral therapy, cognitive behavioral therapy (CBT), motivational
interviewing are mostly used for internet gaming disorder as well. CBT
focuses on improving problem solving skills and also strengthen adaptive
coping skills to prevent relapse. Having support groups (online or in
vivo) along with therapy is found to be helpful.Finding new and adaptive
ways to meet underlying needs that were previously met by dysfunctional
behaviour is often critical in preventing relapse in addictive disorder
(Griffiths, 2008).
1. Is internet gaming disorder a category in main section of DSM-5?
2. Name few psychological factors which are considered as risk factors for
gaming behaviour.
3. Which psychological treatment are used for internet gaming disorder?
8.6 PERSONALITY DISORDERS

Personality disorders are a set of mental disorders which develop early and are
characterized by maladaptive patterns of behaviour, cognition (thinking) and 153
Self, Maladjustment and feeling which deviate from expectations of his/her cultural background and social
Mental Disorders
norms, is exhibited across the situations, lasts over time, causes dysfunction in
personal, interpersonal, social and occupational domains and distress to the person
and significant others. The disturbance in functioning caused by personality
disorder is similar to that of a major mental illness. Higher rates of interpersonal
difficulties such as separation and divorce; unemployment; poor quality of life
for themselves and family members; and poor social functioning; and higher
suicidal risk are reported in literature (Moran et.al., 2016; Nakao, Gunderson,
Phillips, 1992; Oldham, 1994; Singh, Sharma, Janardhan Reddy, 1999). They
often do not recognize that they have problems which might make it difficult to
treat.
Roughly 10-13% of the general population and up to half of the psychiatric patients
were found to have personality disorder in developed countries (de Girolamo &
Reich, 1993); and
0-2.8% in the Indian context (Reddy & Chandrashekar, 1998). In patients attending
a psychiatric hospital, one of the Indian studies found that 1.07% were diagnosed
with personality disorder (Gupta & Mattoo, 2012).
For a diagnosis of personality disorder the person has to meet the following DMS-
5 criteria:
 Chronic and pervasive patterns of behavior that affect social functioning,
work, school, and close relationships
 Symptoms that affect two or more of the following four areas: thoughts,
emotions, interpersonal functioning, impulse control
 Onset of patterns of behavior that can be traced back to adolescence or
early adulthood
 Patterns of behaviors that cannot be explained by any other mental
disorders, substance use, or medical conditions
Classification of Personality Disorders
DSM-5 lists 10 personality disorders clustered into three groups.
Cluster A Personality Disorders:
These disorders are also termed as odd and eccentric disorders, and are often
associated with schizophrenia; however, they have a better sense of connection
with reality as compared to schizophrenia. Individuals with cluster A personality
disorder have a higher probability to have a family member/first degree relative
with schizophrenia. They exhibit odd and eccentric modes of speaking, are
suspicious, and have difficulty in relating to others. The three disorders classified
under this category are:
Paranoid personality disorder.Individuals with paranoid personality disorder have
a pervasive, chronic mistrust of others; they suspect that they are being misled or
exploited by others, and they view people’s motivations as malevolent.
Schizoid personality disorder. These individuals detach from social relationships,
they are not interested in relationships, appear cold and withdrawn, and are
restricted in emotional expression.
154
Schizotypal personality disorder. These individuals experience extreme Mental Disorders
discomfort interacting socially, and have distorted cognition and perceptions.
They exhibit odd speech, behavior, and appearance, often have difficulty in
forming relationships and hold strange beliefs.
Cluster B Personality Disorders:
They experience intense emotions, engage in extremely impulsive, dramatic,
promiscuous, or law-breaking behaviors. Following are the disorders under this
cluster.
Antisocial personality disorder. These individuals show disregard for rules and
social norms, they violate rights of others, lack empathy, do not show remorse
for their acts, they show manipulative and impulsive behaviours.
Borderline personality disorder. they show pervasive pattern of dysregulation
of emotions, instability in relationships, problems in self-image and identity,
involve in maladaptive behaviors to manage affect such as self-harm behaviours,
substance use, impulsive behaviours etc.
Histrionic personality disorder. Individuals with this disorder show pervasive
pattern of attention seeking behavior, excessive emotionality often resulting in
socially inappropriate behaviour. They often use physical attractiveness to get
attention.
Narcissistic personality disorder.They have high need for admiration, exhibit
pervasive pattern of superiority/grandiosity and self-centeredness, they lack
empathy. They have difficulty trusting people, they demand excessive attention,
and take advantage of others.
Cluster C Personality Disorders:
Individuals having the cluster C traits experience excessive anxiety and fears
and tend to involve in maladaptive behaviours to reduce their anxiety.
Avoidant personality disorder. They experience pervasive feelings inadequacy
and as a result they are social inhibited, are extreme sensitivity to negative
evaluation.
Dependent personality disorder. These individuals have pervasive psychological
need to be cared by other significant people in their lives. They feel helpless,
withdraw from responsibilities, they see themselves as incompetent, show
dependency in taking decisions, ask for reassurance, and fear being abandoned
by significant people in their lives.
Obsessive-compulsive personality disorder: They hold rigid set of rules and
adhere closely to the rules; they are perfectionistic to the extent of dysfunction
and often expect things to be in their way and get distressed when there are
deviances from the perfection.
Case example:
M, age 32, single woman without a job, presented with depressed mood, suicidal
thoughts and complete withdrawal from social life. She had spent the last six
months alone in her apartment, lying in bed, eating junk food and watching TV.
Herfamily includes parents and two siblings. She is the middle of three children.
155
Self, Maladjustment and Her elder sister is manager in multinational company and younger brother is
Mental Disorders
doing graduation. Her mother seems to value perfections and has shown
dissatisfaction over her academic, career and personal life. She felt alone through
her school years and reportedly had no close friends. In college, she had fights
with a roommate and a professor. She reported that people take undue advantage
of her and she has no trust on anyone and that is why she kept herself distant
from close relationships. M sometimes cut herself when she feels empty and
depressed. Occasionally, she would act on impulse with great risk to her safety
by involving in drug abuse and reckless driving. She feels better for short term
after doing these impulsive acts.
She could not stay at several previous jobs due to interpersonal conflicts with
either boss or colleagues. M was found to have problems with anger control,
impulsive acts, self-harm (such as cutting), feeling empty and depressed.
After detailed history taking and assessments, she was diagnosed with borderline
personality disorder and major depressive disorder.
Causal Factors of Personality Disorders
Multiple causes have been identified to play a role in the development of
personality disorders. While further research is required to fully understand the
causes, genetic and environmental factors have been identified as important
contributors.
A systematic review by Stepp, Lazarus, and Byrd (2016) found that several
contributory factors play a role in developing personality disorder. Some of the
social-environmental and individual factors included low socio-economic status,
stressful life events, and family adversity; maternal psychopathology and parenting
styles which involved low warmth, hostility, harsh punishment; and exposure to
physical or sexual abuse or neglect; and low IQ, high levels of negative affectivity
and impulsivity, and internalizing and externalizing psychopathology in the child.
There was significant relationship found between a history of childhood trauma
and verbal abuse, and personality disorders. It was found that children who
experience verbal abuse were three times more likely to develop borderline,
narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood
(APA, 2010).
Treatment of Personality Disorders
Psychological interventions are recommended as primary treatment for personality
disorders and pharmacotherapy is used only as an adjunct treatment. However,
the evidence base for effectiveness of psychotherapy is insufficient. Most research
focuses on borderline personality disorder compared to other disorders. Unlike
other mental disorders, personality disorders require longer therapy and follow-
up. The goal of therapy in personality disorders include the following: reducing
subjective distress and symptoms such as anxiety and depression, insight
facilitation, changing maladaptive behaviours, addressing the interpersonal
difficulties as well as improving quality of life.
A few frequently researched therapies are given below.
 Dialectical behavior therapy (DBT) is specifically developed for
156 Borderline personality disorder by Marsha M. Linehan (and currently
used for other disorders such as substance abuse, mood disorders, eating Mental Disorders
disorders, suicidal ideation, post traumatic stress disorder etc. It uses a
biosocial approach to understand the development of personality
pathology and uses a number of cognitive behavioural strategies in
therapy. This therapy teaches a set of coping methods for handling urges
related to self-harm, suicidal behaviours, substance use etc. It includes
four sets of skills (a) mindfulness skills (b) emotion regulation (c) distress
tolerance and (d) interpersonal effectiveness. The duration of therapy is
generally one year to one and half years carried out in individual as well
as group sessions. It is one of the most effective therapies for Borderline
personality disorder.
 Schema therapy (ST) developed by Young et al (2003) has been found
to be effective for personality disorders as well other chronic disorders
such as depression. It incorporated concepts from attachment theory,
cognitive behaviour therapy, gestalt therapy and cognitive behaviour
therapy. We use schema to better understand ourselves, the behavior of
others, and events in the world. Schemas are mental representations of
what we learn and experience. Schemas are mental structures for
organizing the stimuli into psychologically relevant aspects. When a
number of maladaptive schemas are active in an individual, it might
result in a dysfunctional schema.
People with personality problems have developed maladaptive schemas
and therefore handle life in a less effective way. According to Young et
al. (2005), these maladaptive schemas are developed at an early age as a
result of the interactions between factors such as the temperament of the
child, the parenting style of the parents, and any significant adverse
relational experiences resulting in basic psychological needs being unmet.
When the schemas are activated an individual may respond using
maladaptive coping methods such as ‘giving up’ ‘overcompensation’ or
‘avoidance’.
The main focus of the schema therapy is to address the early maladaptive
schemas and the schema modes of the person. Early maladaptive schemas
can be defined as stable, trait-like, enduring beliefs about oneself and
the world that are rooted in early adverse childhood experiences (Young
et al., 2003). It has a number of cognitive behavioural and experiential
techniques to change the schema modes, schemas and coping methods
used by the individual. Experiential techniques such as imagery
rescripting, chair work, role play is found to be effective. The therapist
assumes a supportive role in facilitating the change process.
 Mentalization-based therapy (MBT). Mentalization refers to the
process by which we make sense of others as well as ourselves.It teaches
people to notice and reflect on their internal states of mind and those of
others. Deficits in mentalization are seen across various mental disorders.
MBT developed by Bateman & Fonagy (2004) is found to be effective
for borderline personality disorders, post traumatic stress disorder
(PTSD), depression and eating disorders. The therapy aims to stabilize
emotional expression and reinstate the mentalizing abilities in the patients.
It borrows techniques from a number of schools of therapy (Bateman &
Fonagy, 2010). 157
Self, Maladjustment and  Transference focused therapy: It is a psychoanalytic therapy for severe
Mental Disorders
personality disorders based on object relations theory of Kernberg (2006).
The dominant object relations are addressed in the therapy by activation
of these relationships within the transference relationship of therapy. The
split between the idealized and persecutory parts of the object is addressed
in order to foster the development of normal identity (Yeomans, Clarkin,
& Kernberg, 2015).
Most of these therapies are largely tried out in Borderline personality disorder
and other personality disorders are not explored much. There is a need for
establishing the effectiveness of these therapies across other personality disorders.
1. Name the personality disorder under cluster A.
2. What is common defining feature of cluster B personality disorders?
3. Which cluster includes Obsessive-compulsive personality disorder?
4. Name the therapies which are used in the treatment of personality disorder.
5. Name the four sets of skills included in Dialectical behavior therapy.
8.7 SUBSTANCE USE DISORDER

National Mental Health Survey (NMHS-2016) by NIMHANS, Bangalore
conducted across the 12 States of India shows that alcohol use disorder was
found in 4.6% of the adults, tobacco use disorder was found in 13.1%, other
substance use disorders was 0.6%, mental and behavioural disorders due to
substance use is 5%. Overall, 22.4% of the adults across the States had one or the
other substance use disorder. Higher percentage of males have alcohol, tobacco
use and other substance use disorders (32.8, 9.1, and 1.1 respectively) compared
to females (9.8, 0.5, and 0.1 respectively).
DSM 5 defines Substance Use Disorder (SUD) as “persistent use of substances
(drugs) despite experiencing substantial harm and adverse consequences”.
Individuals with SUD experience significant dysfunction in areas of health, family
relationships, work/school, roles and responsibilities. The SUD includes misuse
of both illicit/illegal (marijuana/hashish, cocaine, heroin, inhalants etc.)substances
as well as legal substances (alcohol, nicotine, prescription drugs).
DSM-5 lists out a set of symptoms to diagnose SUD:
 Persistent use of substance despite knowing/having the negative
consequences (physical, social, psychological, financial, work) of the
same.
 Though they may want to stop and have persistent wish to stop but they
fail to reduce or control substance use.
 They experience withdrawal symptoms when not using substance, they
use larger amounts over the time to get the same effect as earlier.
 They spend lot of time and money to obtain the substance
158
 Give priority to substance over other domains of life such as work, family, Mental Disorders
relationships, responsibilities, hobbies etc.
 They experience strong urge to use the substance.
The severity of the SUD is determined based on how many of the above criteria
the person fulfils. The severity is categorised as mild, moderate and severe.
The international Classification of diseases 11th revision (ICD-11) categorise the
SUDs into two: (i) Harmful pattern of substance use (clinically significant harm/
damage to the person’s physical, mental, social and behavioural domains), and
(ii) Substance dependence. ICD-11 defines the substance dependence as a
“disorder of regulation of the use of a psychoactive substance as a resultant of
repeated/continuous use of substance”. They emphasize on impaired control over
substance use in terms of onset, quantity, circumstances, and termination.
Substance taking becomes the priority over other things in life and they continue
to use despite negative consequences/problems. The physiological manifestations
include (a) tolerance, (b) withdrawal symptoms when not using or reducing
substance use, and (c) using the substance to prevent/reduce withdrawal
symptoms.
Types of Substance Use Disorders
The most commonly used substances are as follows:
Alcohol: An alcoholic drink contains ethanol. It produces euphoria, reduces
anxiety, and increases sociability, sedation, results in impairment in cognition,
memory, motor function and acts as a central nervous system depressant. The
alcohol is formed using different procedures and accordingly it is categorised as
fermented alcohols (beer, wine, cider), distilled alcohols (vodka, gin, rum, brandy
etc), and others (cocktail bitters, alcopopos). Excessive use causes damage to
brain, liver, heart and development of hypertension.
Opioids: They are naturally found in opium poppy plant. It works on the brain to
produce relief in pain. So, it is frequently used in the health set up to relieve pain.
It includes both legal (codeine, morphine, oxycodone etc.) and illegal drugs (e.g.
heroin). Misuse results in dependence, severe respiratory depression and even
death.
Stimulants:They include amphetamines, methamphetamines and cocaine. They
increase the heart rate, alertness, and blood pressure. Misuse of the drug can
result in seizures, heart failure as well as hostility and psychosis.
Hallucinogens: These substances distort the perception, awareness of the
surroundings, thoughts and feeling. Persons using these substances also experience
hallucinations. These substances are found in natural substances (mushrooms,
peyote etc.) as well as chemically synthesized (phencyclidine, lysergic acid
diethylamide etc.).
Cannabis : Also known as marijuana, cannabis is a substance obtained from
plant.These are used for medicinal purposes and for recreation. Excessive use of
this drug causes memory problems, difficulty in learning, thinking, problem
solving skills, perception, and loss of motor coordination. Excessive use increases
the risk for cognitive difficulties and mental illness.
159
Self, Maladjustment and Tobacco: It is a leafy plant, the dried leaves are used for smoking (cigarettes,
Mental Disorders
cigars, pipes, snuff, chewing tobacco). It contains stimulant substance nicotine.
It increases the risk of cancer, coronary heart disease, lung and liver damage.
Case example
F, 32 years old single male, engineer by profession. He was brought by his family
to the hospital. F started consuming heroin when he was 25 years old. For few
initial months, he has been taking drugs in the company of his peers. His needs
keptincreasing and he started taking it secretly. He has been seen to have increased
irritability and aggressive behaviour, disturbances in sleep and appetite, severe
withdrawal, severe craving and use of injectable.He hadbecomecompletely
dependent on family for financial assistance. He was not motivated to leave
drugs and never felt the need for treatment. Initial few weeks of the treatment
were spent educating him about drug dependence and in enhancing his motivation.
Causal Factors of Substance Use Disorder
Multiple biopsychosocial factors contribute to developing SUDs. Some of the
identified factors include: alcohol use in parents, which acts as both biological
vulnerability as well as learning through observation. In addition, children in
these families may not consider alcohol use as having negative consequences or
may use as a coping method. When individuals start using alcohol early on, they
have higher risk for having SUD as an adult.
In adolescents the risk factors identified include:
 familial factors – substance abuse in the family, lower psychoeducation
in the parents, neglectful (failure to provide basic facilities, like food,
clothing, health care, safety) and abusive parenting
 adverse experiences - such as physical, sexual or emotional abuse
 social factors – deviant peer relationships, bullying experiences, involving
in gang activities/substance abuse for recognition in the group
 mental health – Attention deficit hyperactivity disorder, and depression
(NIDA, 2020; Whitesell et al 2013)
In adults, social and family factors such as being divorced, separated, being single,
experiences of loss, financial difficulties or having more financial resources are
associated with risk of SUD (Kuerbis et al. 2014)
Some of the common risk factors identified in the clinical literature are being a
male, age under 25 years; having other mental health problems; lack of family
support, and monitoring/supervision; personality factors such as high sensation
seeking, impulsivity, aggressive behaviour, neuroticism, openness to experience
and low conscientiousness (Bartoli et. al., 2020; Belcher et. al., 2014).
Assessment
There are a number of screening tools used in the assessment of SUDs apart
from the clinical interview and substance use history. A few instruments with
sound psychometric properties are given below:
 CAGE: developed by Ewing (1984) assesses lifetime alcohol or drug
consumption. It has 4 questions and each scored as yes or no, each “yes”
160
response receives 1 point. A score of 2 or higher indicates clinically Mental Disorders
significant substance use problem.
 The Alcohol Use Disorders Identification Test (AUDIT) was developed
by the World Health Organization in 1982. This is used as a screening
tool to identify people who are at risk for developing alcohol problems
(preliminary signs of harmful drinking and dependence). It has 10 items;
3 to assess hazardous alcohol use; 3 for dependence symptoms and 4 for
harmful alcohol use. Each item is rated on a 5 point scale with higher
score indicating greater risk.
 Tobacco, Alcohol, Prescription medication, and other Substance use
(TAPS): Consists of 2 formats, screening (TAPS-1) followed by a brief
assessment (TAPS-2) for those who screen positive. It can be used as a
self-administered tool or administered by a clinician. It assesses the
substance use over 12 months period. The risk is assessed as 0 – if there
is no use in the past 3 months, 1 if there is problem use, and 2+ if there
is higher risk.
Intervention for Substance Use Disorder
Both pharmacological and psychosocial interventions/treatments are used for
substance use disorders. Often combination of both are found to be effective
than single therapy (Douaihy et al 2013).
 Pharmacological management
Pharmacological management is used for management of acute
withdrawal syndromes resulting from detoxification, to reduce the craving
for using the drug, and to prevent relapse.
Nicotine replacement therapy (NRT) is one of the most frequently used
pharmacological treatment for nicotine dependence. NRTs use medication
to replace the effect of nicotine such that the withdrawal symptoms (cold
turkey) are taken care of. Some of the NRT formulations include the
transdermal nicotine patch, nicotine gum, nicotine lozenge, nicotine vapor
inhaler, and nicotine nasal spray.
 Psychosocial interventions
Generally, the psychosocial interventions are combined with
pharmacological treatments. They aim at reducing the craving, withdrawal
symptoms as well as factors maintaining the substance abuse. Some of
the commonly used interventions are described below ((Jhanjee, 2014):
Brief intervention (BI)
This is a brief intervention aims at educating the patient about the risk of the
substance use and motivate them to reduce or stop use of the substance.The
session usually lasts from 5 – 30 minutes done in the outpatient, primary health
care, general hospital and specialist hospital settings. This is largely useful for
those with risky substance use, and those with serious substance use problems
might require more intense therapy. The main components of this therapy would
include feedback, responsibility, advice, menu of options, empathy and self-
efficacy, popularly used acronym is FRAMES. It is found to be highly cost-
effective therapy.
161
Self, Maladjustment and Motivational enhancement/interviewing (MI)
Mental Disorders
MI aims to explore and resolve the ambivalence about the substance use in people
with SUD thus facilitating the change in the beliefs and behaviours. The main
principles of MI include: the therapist expresses empathy through reflective
listening, facilitates developing discrepancy between patients’ goals or values
and their current behaviors, avoid argument and direct confrontation, adjusts to
client resistance and support self-efficacy and optimism. MI is found to be one of
the most cost-effective psychosocial intervention. It is used as stand-alone therapy
as well as with pharmacotherapy.
Cognitive Behaviour Therapy (CBT)
CBT is a structured time limited therapy based on learning principles and cognitive
theories. It focuses on identifying and modifying the irrational thoughts/beliefs,
negative moods and behaviours that maintain the substance use and leading to
relapse. Behvaioural techniquesinclude exposure to the cues, promoting non-
drug related healthy activities, coping with urge, contingency management,
relaxation training, effective problems solving and communication skills. It is
one of the most effective interventions across all SUDs.
Relapse prevention strategies developed based on CBT principles are also found
to be effective. It emphasizes on identifying high-risk situations and triggers for
craving, developing skills to manage cravings, difficult emotions, and coping
with lapses and relapses and develop skills to lead a balanced life.
Contingency management based on behavioural principles is also found to be
effective. In this approach, positive behavioursare encouraged through positive
reinforcement and negative behaviours are punished or reduced through
withholding the positive reinforcement. Rewards/positive reinforcers such as
vouchers, privileges, prizes, and money are used.
Therapeutic communities
These are residential rehabilitation programs, where people with SUDs live and
work. The aim of these programs is to help people develop skills to live without
use of substance. A number of skills such as life skill, employment, education,
vocational skills etc. are taught to prepare them to return to the community. This
is not a well-researched therapy in SUDs.
Self-help groups
These self-help groups are formed on the basis of Narcotics Anonymous and
Alcoholics Anonymous (AA). They emphasize on complete abstinence. They
use behavioral, spiritual and cognitive principles to facilitate the process of
recovery. They acknowledge the damage caused by the substance and trust the
higher power to help them in recovery.
1. What are the effects of misuse of stimulants?
2. Name the screening tool used to identify people who are at risk for
developing alcohol problems.
3. Name few screening tools used in the assessment of SUDs.
162
Mental Disorders
4. What is the name of pharmacological treatment used for nicotine
dependence?
5. Mention few psychosocial interventions used in substance use disorder.
8.8 LET US SUM UP

In this Unit you learned about various mental disorders that may be manifestations
of maladjustment. These disorders were described in terms of their clinical
features, types, causal factors and treatment/ intervention procedures.
Mood disorders can be understood by extreme change in mood states that can
lead to significant disturbance in daily life activities. It represents a category of
mental illnesses in which the prominent problem centres on person’s persistent
emotional state. There are several inter related biological, social, cognitive factors
which contributes to mood disorders. The treatment of mood disorder is largely
pharmacotherapy but the combination of psychotherapy along with
pharmacotherapy are found to be most effective.
Eating disorder is characterized by persistent disturbance in eating behaviour
which is accompanied by an intense fear of becoming overweight/ fat and an
accompanying pursuit of perfect body appearance. There are various causal factors
which in combination and individually contribute to precipitate eating disorder.
The multidisciplinary approach including psychological and dietary counselling,
along with medical monitoring is proved to be effective treatment for eating
disorder.
Internet gaming disorderis one of the most recent forms of addiction to emerge.
To be diagnosed with gaming disorder, the behaviour pattern must be severe enough
to cause significant impairment in important areas of functioning over a period of
at least 12 months. Internet gaming disorder is the consequence of many different
integrated factors involving biological, motivational, cognitive, behaviours and
personality factors. Treatment focusing on underlying condition along with addictive
behaviour is found to be effective for treating gaming disorder.
Personality disorders are a set of mental disorders which develop early and are
characterized by maladaptive patterns of behaviour, cognition (thinking) and
feeling and causes significant distress across different domains of the individual’s
life. DSM-5 lists 10 personality disorders clustered into three groups: Cluster A,
B and C. Multiple factors are found to contribute to the development of personality
disorder. Both genetic and environmental factors are identified to play an important
role in the development of personality disorders. Psychological interventions are
recommended as primary treatment for personality disorders and pharmacotherapy
is used only as an adjunct treatment.
Substance use disorder (SUD) is defined as”persistent use of substances (drugs)
despite of experiencing substantial harm and adverse consequences” by the DSM
5. Commonly used substances include alcohol, cannabis, tobacco, opioids,
stimulants and hallucinogens. Multiple biopsychosocial factors contribute to
development of SUDs such as family factors, individual factors and environmental
factors. A combination of both pharmacological and psychosocial interventions/
treatments are found to be effective than single therapy. 163
Mental Disorders 8.9 KEY WORDS
Manic Episode: Manic episode is characterized by intense feelings of euphoria
and elation, increased talkativeness, over activity and over religiosity and when
manic symptoms are serious and disruptive the person needs immediate hospital
care.
Depressive Disorder: depressive disorder is marked by presence of persistent
low moods or marked loss of interest in pleasurable activities, with somatic and
cognitive changes that significantly affects person’s daily functioning. The
symptoms need to be present nearly every day, for at least two consecutive weeks
Anorexia Nervosa: A type of eating disorder in which an individual restricts
food intake to the level that 15 percent weight loss which is below the ideal body
weight or more occurs.
Bulimia nervosa: Bulimia nervosa is a type of eating disorder in which an
individual begins a cycle of “bingeing,” or consuming a large amount of food in
one sitting, and then uses unhealthy strategies to prevent weight gain.
Binge-Eating Disorder: it is a type of eating disorder in which person lose control
over their eating. Binge-eating disorder often lead to making individual overweight
or obese
Cognitive behaviour therapy: It is a type of psychotherapy approach which
focuses on changing dysfunctional thinking and behaviour.
Gaming disorder: it is a kind of behavioural addiction in which a pattern of
gaming behaviour characterised by a loss of control over gaming, making gaming
a higher priority than other activities to the point where gaming takes precedence
over other interests, and continuing gaming despite negative consequences occurs.
Personality disorder: Personality disorders are a set of mental disorder which
are characterized by maladaptive patterns of behaviour, cognition (thinking) and
feeling which deviate from expectations of his/her cultural background and social
norms, is exhibited across the situations, lasts over time, causes dysfunction in
personal, interpersonal, social and occupational domains and distress to the person
and significant others.
Substance Use Disorder: Substance Use Disorder can be definedas persistent
use of substances (drugs) despite experiencing substantial harm and adverse
consequences.
Contingency management: A techniques based on behavioural principles in
which positive behaviours are encouraged through positive reinforcement and
negative behaviours are punished or reduced through withholding the positive
reinforcement.
Relapse: a relapse is the worsening of a medical condition that had previously
improved. Relapse is defined as the recurrence of behavioral or other substantive
indicators of active disease after a period of remission.
Withdrawal: Withdrawal is the combination of physical and mental effects that
a person experiences after they stop using or reduce their intake of a substance
164 such as alcohol and prescription or other drugs.
Mental Disorders
8.10 ANSWERS TO SELF ASSESSMENT QUESTIONS
Answers to Self Assessment Questions 1
1. Euphoria/elation and depressed/ sad
2. Manic episode
3. Persistent depressive disorder
4. Serotonin, norepinephrine, and dopamine
5. Cognitive behaviour therapy, Behaviour activation, Interpersonal and social
rhythm therapy
1. Intense fear of becoming overweight and fat
2. Anorexia nervosa
3. Bulimia nervosa
4. Perfectionism, body dissatisfaction and low self esteem
5. Cognitive behaviour therapy and family therapy
1. No
2. low self-esteem, neglected parenting, neuroticism, depression, loneliness etc
3. Behavioral therapy, cognitive behavioral therapy (CBT), motivational
interviewing
1. Paranoid personality disorder, Schizoid personality disorder and Schizotypal
personality disorder
2. Individuals withCluster B disorders are known to have emotional, dramatic/
erratic behaviours
3. Cluster C
4. Dialectical behavior therapy (DBT, Schema Therapy, Mentalization-based
therapy (MBT), Transference focused therapy
5. (a) mindfulness skills (b) emotion regulation (c) distress tolerance and (d)
interpersonal effectiveness
1. Misuse of the stimulants can result in seizures, heart failure as well as hostility
and psychosis.
2. Alcohol Use Disorders Identification Test (AUDIT)
3. CAGE, Alcohol Use Disorders Identification Test (AUDIT), Tobacco,
Alcohol, Prescription medication, and other Substance use (TAPS) 165
Self, Maladjustment and 4. Nicotine replacement therapy (NRT)
Mental Disorders
5. Motivational enhancement/interviewing (MI), Brief Intervention (BI),
Cognitive Behaviour Therapy (CBT)
8.11 UNIT END QUESTIONS

1. Discuss the symptoms and types of depressive disorder.
2. Compare and contrast manic and depressive episode.
3. Explain various causal factors of eating disorder.
4. What are the clinical features of binge eating disorder?
5. Differentiate between anorexia nervosa and bulimia nervosa.
6. Explain the risk factor for developing internet gaming disorder.
7. Define personality disorders.What are the criteria for diagnosing personality
disorders?
8. Explain the causal factors contributing to the development of personality
disorders.
9. Define substance use disorders. What are the psychosocial factors causing
SUD?
10. Describe the psychosocial interventions in SUD.
8.12 REFERENCES
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8.13 FURTHER LEARNING RESOURCES

Websites
American Psychiatric Association
http://www.psychiatry.org
American Psychological Association
http://www.apa.org/
National Alliance for the Mentally Ill
http://www.nami.org/
National Institute of Mental Health
http://www.nimh.nih.gov/
Mental Health America
http://www.nmha.org/
https://www.who.int/news-room/q-a-detail/addictive-behaviours-gaming-disorder
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https://www.psychguides.com/behavioral-disorders/video-game-addiction/
170
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https://www.nationaleatingdisorders.org/treatment
https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-
tools-resources/chart-screening-tools
Buchheim, A., & Diamond, D. (2018). Attachment and Borderline Personality
Disorder. Psychiatric Clinics of North America, 41(4), 651–668. https://doi.org/
10.1016/j.psc.2018.07.010
Butcher, J. N., Hooley, J. M., & Mineka, S. (2013). Abnormal Psychology. (16
ed.) Pearson
Ciccarelli, S. K., & White, J. N. (2012). Psychology. 3rd ed., Pearson Education.
Davison, G.C., Neale J.M. & Kring, A.M. (2004). Abnormal psychology: An
experimental clinical approach. New York: John Wiley and Sons, Inc.
Eating disorder statistics. (2021, January 5). National Association of Anorexia
Nervosa and AssociatedDisorders. https://anad.org/get-informed/about-eating-
disorders/eating-disorders-statistics/
Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala journal of
medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.
1526235
Sarason, I.G. & Sarason, B.R. (2002). Abnormal psychology: The problem of
maladaptive behavior. New Delhi: Pearson Education Inc
Saveanu, R. V., & Nemeroff, C. B. (2012). Etiology of Depression: Genetic and
Environmental Factors. Psychiatric Clinics of North America, 35(1), 51–71. https:/
/doi.org/10.1016/j.psc.2011.12.001
Sudak, D. M. (2012). Cognitive Behavioral Therapy for Depression. Psychiatric
Clinics of North America, 35(1), 99–110. https://doi.org/10.1016/
j.psc.2011.10.001
https://youtu.be/UP8JwNYZBpI Cognitive Behaviour Therapy - Vicious Cycles
https://youtu.be/lDnvZS5DP68 What is Dialectical Behavior Therapy?
171

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7.1 Learning Objectives

7.1 LEARNING OBJECTIVES

7.3.1 Common Symptoms of Anxiety

7.3.2 Types of Anxiety Disorders:

7.3.4 Managing Anxiety and Anxiety Disorders

Fig. 7.1 Relationship Between Stress and Performance

7.4.1 Types of Stress

7.4.2 Types of Stressors

7.4.3 Effect of Stress on Our Health

7.4.4 Management of Stress

One of the common methods used is prioritization based on criteria such

4. —————————— is any event, experience, or environmental

II. Each of the questions or incomplete statements below is followed by

1. Shortness of breath, restlessness, palpitations, sweating, dry mouth, and

(A) Cognitive (B) Behavioural

(C) Physical (D) Emotional

2. Avoiding to face anxiety-producing situations is one of the ————

(A) Cognitive (B) Physical

(C) Unusual (D) Behavioural

3. All of the following are anxiety disorders EXCEPT:

(A) Generalized Anxiety Disorder (B) Panic Disorder

(C) Maj————or Depressive Disorder (D) Specific Phobia

4. Many a time, individuals learn to show anxious responses simply by

(A) Classical Conditioning (B) Vicarious Learning

(C) Motivational Learning (D) Environmental Learning

5. Following are all different management approaches to anxiety EXCEPT:

(A) Cognitive Behaviour Therapy (B) Exposure Therapy

(C) Avoidance Therapy (D) Pharmacotherapy

6. Devastating natural disasters, such as major floods or earthquakes, are

(A) Major life events (B) Crises/catastrophes

(C) Ambient stressors (D) Micro Stressors

7. Transactions in stress generally involve an assessment process that is called

(A) Cognitive perception (B) Stress evaluatin

(C) Cognitive appraisal (D) Situational assessment

Now let us discuss the various factors contributing to maladjustment.

7.5.1 Classification of Impulsivity

7.5.2 Management of Impulsivity

7.6 COGNITIVE RIGIDITY

7.6.1 Characteristics of Cognitive Rigidity

7.6.2 Techniques to Overcome Cognitive Rigidity

7.7 MALADAPTIVE COPING

7.7.1 Maladaptive Coping Strategies

7.8 DYSFUNCTIONAL ATTITUDE

7.8.1 Characteristics of Dysfunctional Attitudes

7.8.2 Models of Dysfunctional Attitudes

7.8.3 Modifying Dysfunctional Attitudes

7.9 LET US SUM UP

7.11 ANSWERS TO SELF ASSESSMENT QUESTIONS

8.1 Learning Objectives

8.1 LEARNING OBJECTIVES

8.3 MOOD DISORDERS

8.4 EATING DISORDERS

8.6 PERSONALITY DISORDERS

8.7 SUBSTANCE USE DISORDER

8.8 LET US SUM UP

8.11 UNIT END QUESTIONS

8.13 FURTHER LEARNING RESOURCES

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