MODULE-3

MOOD DISORDERS

MOOD DISORDER
Mood is defined as a pervasive and sustained feeling tone that is endured
internally, and that impacts nearly all aspects of a person’s behavior in the external
world. Mood disorders or affective disorders are described by marked disruptions
in emotions (severe lows called depression or highs called hypomania or mania).
These are common psychiatric disorders leading to an increase in morbidity and
mortality.

TYPES OF MOOD DISORDERS

With the update of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) in 2013, mood disorders were separated into two groups: bipolar and
related disorders and depressive disorders.
Types of mood disorders include:
1. Major depressive disorder (MDD):
This is what we often hear referred to as major depression or clinical
depression. It involves periods of extreme sadness, hopelessness, or
emptiness accompanied by a variety of physical, cognitive, and emotional
symptoms.
2. Bipolar I disorder:
This disorder was formerly called manic depression. Mania is characterized
by euphoric and/or irritable moods and increased energy or activity. During
manic episodes, people with bipolar I also regularly engage in risky
activities that can result in negative consequences for themselves and/or
others.
3. Bipolar II disorder:
To be diagnosed with bipolar II, a person must have had at least one episode
of current or past hypomania (a less severe form of mania), and at least one

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 episode of current or past major depression but no history of any manic
episodes.
4. Cyclothymic disorder:
Diagnosis requires a minimum two-year history of many episodes that
resemble hypomania and major depression, but none of which actually meet
the criteria for these conditions.
5. Bipolar and related disorder due to another medical condition:
Some medical conditions can actually cause symptoms of bipolar disorder.
This is diagnosed when there is evidence that the mood disturbance is the
direct physiological result of another medical (not mental) condition.
6. Depressive disorder due to another medical condition:
Similar to bipolar disorder related to another medical condition, this
diagnosis is used for people who have the symptoms of depression;
however, the symptoms are directly caused by an underlying medical
condition such as hypothyroidism.
7. Substance/medication-induced bipolar disorder:
This describes a person who is experiencing symptoms of bipolar disorder as
a result of alcohol, drugs, or medication.
8. Substance/medication-induced depressive disorder:
This diagnosis is used when a person experiences a depressive disorder due
to alcohol, drugs, or medication.
9. Other specified or unspecified bipolar:
These diagnoses may be used when a person doesn't meet the criteria for any
other type of bipolar disorder, but they do experience bipolar symptoms
(such as a hypomanic episode lasting only two days).
10. Other specified or unspecified depressive disorder:
These diagnoses may be used when a person experiences a depressive
disorder, but they don't technically meet the full criteria for any other
depressive disorder. This allows communication around the specific
reasonings the presentation does not meet criteria for any specific depressive
disorder.

New Mood Disorders

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The DSM-5 added three new mood disorders. These include:
1. Disruptive mood dysregulation disorder:
This depressive disorder was added to the DSM-5 for children 6 to 18 years
of age who exhibit persistent irritability and anger and frequent episodes of
extreme temper outbursts without any significant provocation.
2. Persistent depressive disorder:
This diagnosis is meant to include both chronic major depressive disorder
(that has lasted for two or more years) and what was previously known as
dysthymic disorder or dysthymia, a lower grade form of depression.
3. Premenstrual dysphoric disorder:
This diagnosis is based on the presence of one or more specific symptoms in
the week before the onset of menstruation, followed by the resolution of
these symptoms after onset. The symptoms include mood swings, irritability
or anger, depressed mood or hopelessness, and anxiety or tension, as well as
one or more of an additional seven other mood symptoms, for a total of at
least five symptoms.

UNIPOLAR DEPRESSIVE DISORDER

Unipolar depression is a term used interchangeably with major depressive
order,and is characterized by continuous feelings of sadness, low mood, feelings of
worthlessness, lack of interest in activities you used to enjoy, as well as suicidal
ideation. Unipolar disorder is a serious mental health disorder affecting 8.4% of the
U.S. population. The disorder is more prevalent among women than men, and
among younger people (aged 18-25) than older people. In 2020, 14.8 million adults
had a severe episode of unipolar disorder, and 66% of people with the disorder
were treated.

Characteristics and Symptoms

Experiencing unipolar depression, or major depressive disorder, is different from
feeling sad and down from time to time. Unipolar depression is characterized by
feelings of depression that are persistent, intense, and that make it challenging for
you to function normally or relate to others.

Some of the main characteristics of unipolar depression include:

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 ● Feeling sad most days or having a chronic low mood
● Not enjoying activities that used to bring you pleasure
● Finding it difficult to experience joy or happiness
● Feeling emotionally numb
● Having trouble concentrating
● Lack of energy
● Noticeable changes in hunger
● Trouble sleeping
● Feeling agitated
● Having trouble completing tasks
● Feeling like you don’t matter
● Feeling guilty
● Experiencing thoughts of suicide or self-harm

1. MAJOR DEPRESSIVE DISORDER

● Major Depressive Mood Disorder (MDD) is one of the most easily
recognized depressive disorders; it is defined by absence of manic or
hypomanic episode before or during the disorder.
● According to DSM-5, a person experiencing MDD episode has a depressed
mood and/or loss of interest or pleasure in life activities for at least two
weeks (APA, 2000).
● MDD is an episodic disorder, i.e. the symptoms are present for a period of
time and then the person recovers. An untreated episode may stretch for 4-9
months.
● Generally, MDD consists of recurrent episodes of severe depression;
approximately 40 to 50 percent of people with initial episode will go on to
experience another episode (Monroe & Harkness, 2011).
● The probability of recurrences increases with the number of prior episodes.
Occurrences of isolated depressive episodes are rare. Thus, MDD is usually
a chronic condition, consisting of recurrent depressive episode, with an
average number of episodes for an individual to be four.
● DSM-5 lists the nine symptoms for MDD episode; a person needs to be
diagnosed with five out of nine symptoms for diagnosis.
● While making diagnosis for depression, it is important to specify whether it
is: (1) initial/first episode, (2) recurrent episode (preceded by one or more
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 previous episodes separated by at least two months with recover in
between), or (3) chronic (although rare, in some cases major depression does
not remit for over 2 years.

DSM-5 Criteria for Major Depressive Disorder (APA,2013)

A. The individual must be experiencing five or more symptoms during the
same 2-week period and at least one of the symptoms should be either (1)
depressed mood or (2) loss of interest or pleasure.
1) Depressed mood most of the day, nearly every day.
2) Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day.
3) Significant weight loss when not dieting or weight gain, or decrease
or increase in appetite nearly every day.
4) A slowing down of thought and a reduction of physical movement
(observable by others, not merely subjective feelings of restlessness
or being slowed down).
5) Fatigue or loss of energy nearly every day.
6) Feelings of worthlessness or excessive or inappropriate guilt nearly
every day.
7) Diminished ability to think or concentrate, or indecisiveness, nearly
every day.
8) Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing
suicide.
B. At least one of the symptoms is anhedonia or low mood.
C. The symptoms cause clinically significant distress or impairment in social,
occupational or other important areas of functioning.
D. The episode is not attributable to the physiological effects of a substance
or another medical condition.
E. There has never been a manic episode.

2. OTHER FORMS OF DEPRESSION

A. Disruptive mood dysregulation disorder
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Disruptive Mood Dysregulation Disorder (DMDD) is a condition in which children
or adolescents experience ongoing irritability, anger, and frequent, intense temper
outbursts. The symptoms of DMDD go beyond a “bad mood.” DMDD symptoms
are severe. Youth who have DMDD experience significant problems at home, at
school, and often with peers. They also tend to have high rates of health care
service use, hospitalization, and school suspension, and they are more likely to
develop other mood disorders.

DSM-5 Criteria for Disruptive Mood Dysregulation Disorder

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages)
and or behaviorally (e.g., physical aggression) that are grossly out of
proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most
of the day, nearly every day, and it is observable by others
E. Criteria A-D have been present for 12 or more months. Throughout that
time, the individual has not had a period lasting 3 or more consecutive
months without all of the symptoms in criteria A-D.
F. Criteria A-D are present in at least two of three settings
(home/school/peers) and are severe in at least one setting
G. The diagnosis should not be made for the first time before age 6 or after 18
H. The age oat onset of criteria A-E is before 10 years
I. There has never been a distinct period lasting more than 1 day during
which the full symptom criteria, except duration, for a manic or hypomanic
episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the
context of a highly positive event or its anticipation, should not be
considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major
depressive disorder and are not better explained by another mental disorder
(e.g., autism spectrum disorder, PTSD, separation anxiety disorder).
Note: This diagnosis cannot coexist with oppositional defiant disorder,

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 intermittent explosive disorder, or bipolar disorder, thought it can coexist
with others, including major depressive disorder,
ADHD, conduct disorder, and substance use disorders (SUDs). Individuals
whose symptoms meet criteria for both DMDD and oppositional defiant
disorder (ODD should only be given the diagnosis of DMDD. If an
individual has ever experienced a manic or hypomanic episode, the
diagnosis of DMDD should not be assigned.
K. The symptoms are not attributable to the physiological effects of a
substance or to another medical or neurological condition

B. Substance/medication- induced depressive disorder

Substance/medication-induced depressive disorder is characterized by a prominent
and persistent change in mood, exhibiting clear signs of depression or a marked
decrease in interest or pleasure in daily activities and hobbies, and these symptoms
start during or soon after a certain substance/medication has been taken, or during
withdrawal from the substance/medication. The individual’s mental health history,
as well as the nature of the substance/medication taken must be taken into account,
to ensure that the depressive symptoms cannot be better explained by a different
diagnosis.

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The symptoms of the depressive disorder must also be severe enough to cause
impairment in the day to day functionality of the individual. Withdrawal times for
various substances from the body vary, and so the depressive symptoms may
continue for some time after the individual has ceased taking the
substance/medication.

DSM-5 Criteria for Substance/medication- induced depressive disorder

A. A prominent and persistent disturbance in mood that predominates in the
clinical picture and is characterized by depressed mood or markedly
diminished interest or pleasure in all, or almost all, activities.
B. There is evidence from the history, physical examination, or laboratory
findings of both (1) and (2):
1) The symptoms in Criterion A developed during or soon after
substance intoxication or withdrawal or after exposure to a
medication.
2) The involved substance/medication is capable of producing the
symptoms in Criterion A.
C. The disturbance is not better explained by a depressive disorder that is not
substance/medication-induced. Such evidence of an independent
depressive disorder could include the following:
•The symptoms preceded the onset of the substance/medication use; the
symptoms persist for a substantial period of time (e.g., about 1 month)
after the cessation of acute withdrawal or severe intoxication; or there is
other evidence suggesting the existence of an independent non-
substance/medication-induced depressive disorder (e.g., a history of
recurrent non-substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course of a
delirium.
E. The disturbance causes clinically significant distress or impairment in
social, occupational,or other important areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance
intoxication or substance withdrawal only when the symptoms in Criterion
A predominate in the clinical picture and when they are sufficiently severe
to warrant clinical attention

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3. PREMENSTRUAL DYSPHORIC DISORDER
● Premenstrual dysphoric disorder (PMDD) is a very severe form of
premenstrual syndrome(PMS). It causes a range of emotional and physical
symptoms every month during the week or two before your period.
● It is sometimes referred to as 'severe PMS'.PMDD occurs during the luteal
phase of your menstrual cycle. This is the time between when you ovulate
and when your period starts. The luteal phase lasts approximately two weeks
for most people but can be longer or shorter.
● During this time you may experience PMDD symptoms every day, or for a
few days within the phase. Many of us may experience symptoms of PMS.
● But if you have PMDD, these symptoms are much worse and can have a
serious impact on your life. Experiencing PMDD can make it difficult to
work, socialize and have healthy relationships. In some cases, it can also
lead to suicidal thoughts.

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 DSM-5 Criteria for Premenstrual dysphoric disorder.

A. In most menstrual cycles, the following symptoms must be present in the

final week before the onset of menses, start to improve within a few days
after the onset of menses, and become minimal or absent in the week post-
menses. At least one of the symptoms must be either (1), (2), (3), or (4)
and the individual must experience at least five total symptoms:
1) marked affective lability (e.g., mood swings; feeling suddenly sad or
tearful or increased sensitivity to rejection)
2) marked irritability or anger or increased interpersonal conflicts
3) marked depressed mood, feelings of hopelessness, or self-
deprecating thoughts
4) marked anxiety, tension, feelings of being “keyed up,” or “on edge”
5) decreased interest in usual activities (e.g., work, school, friends,
hobbies)
6) subjective difficulty in concentration
7) lethargy, easy fatigability, or marked lack of energy
8) marked change in appetite, overeating, or specific food cravings
9) hypersomnia or insomnia
10) a sense of being overwhelmed or out of control
11) physical symptoms such as breast tenderness or swelling,
joint or muscle pain, a sensation of “bloating,” weight gain
B. The symptoms are associated with clinically significant distress or
interference with work, school, usual social activities, or relationships.
C. The disturbance is not merely an exacerbation of the symptoms of another
disorder.
D. Criterion A should be confirmed by prospective daily ratings during at
least two symptomatic cycles (The diagnosis may be made provisionally
prior to this confirmation.)
E. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication or other treatment) or another medical
condition (e.g., hyperthyroidism).

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4. DYSTHYMIA / PERSISTENT DEPRESSIVE DISORDER
● Dysthymia or Persistent Depressive Disorder as DSM-5 calls it, shares
many features with Major Depressive Disorder, but is different in two
regards.
● First, dysthymia has fewer and less intense symptoms and second,
depression lasts for a long period.
● Depressed mood in dysthymia may last for most of the day, but the
depression is of mild-to-moderate intensity.
● The central feature of dysthymia is its chronicity, DSM-5 specifies, chronic
feeling of depression for at least two years.
● On an average, people with dysthymia have had mild-moderate symptoms
for five years, but in some cases, it may last for 20 years or more. It includes
intense feeling of being sad most of every day with relief from symptoms
never longer than 2 months at a time.

DSM-5 Criteria for Dysthymia/Persistent Depressive Disorder

A. Depressed mood for most of the day, for more days than not, as indicated
by either subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two (or more) of the following:
1) Poor appetite or overeating.
2) Insomnia or hypersomnia.
3) Low energy or fatigue.
4) Low self-esteem.
5) Poor concentration or difficulty making decisions.
6) Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the
disturbance, the individual has never been without the symptoms in
Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2
years.
E. There has never been a manic episode or a hypomanic episode, and criteria
have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective
disorder, schizophrenia, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic disorder.

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 G. The symptoms are not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

CAUSAL FACTORS OF UNIPOLAR DEPRESSIVE DISORDER

Unipolar depression doesn’t have an exact cause, as there are many factors that can
contribute to developing the condition, or put one at risk of developing it.These
risk factors can be split up into three primary categories:

1. Biological factors
● On the level of brain chemistry, a combination of stress and genetic
predisposition can alter the chemical balance within the brain and
diminish the ability to maintain stable moods. Also, changes in
hormonal balances can also increase the likelihood of developing
unipolar depression.
● One of the widely accepted theories is that unipolar depression is
caused by lack of balance in the naturally occurring chemicals known
as neurotransmitters, that are present in the brain as well as the spinal
cord.

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 ● It has been concluded that serotonin and norepinephrine are two of the
neurotransmitters that are responsible for symptoms of the disorder.
2. Psychological Factors
● External events affect all individuals in different ways, and every
person’s thoughts dictate how they will experience their lives. This
can also affect the level of happiness they feel in their lives, as well as
whether or not they will develop a mood disorder like unipolar
depression.
● The way in which we view the world is shaped by our experiences,
with the most impactful phase being in our childhood and teenage
years.
● Parenting also plays a very important role in shaping the
psychological health of children.
● As an example, abusive upbringing full of negative comments will
most likely change that person’s view of the world for the worse.
Later in life when faced with negative situations, individuals with this
kind of past can view situations or themselves worse than others
around them, ultimately contributing to their emotional suffering and
predisposing them to mental illnesses like depression.
3. Environmental Factors
As we go through life, it is natural that we become victims of very stressful
and unfortunate events, which can trigger unipolar depression or other
mental disorders.Some of the common triggers include:

● Extended periods of conflict in relationships, whether with a partner

or with family, friends or co-workers
● The passing of a loved one, divorce, financial struggles, moving, or
job loss
● Lack of socialization or social isolation
● Stress in the workplace due to relationship conflicts or pressure to
perform
● Health challenges, particularly when a person experiences chronic
health issues.

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BIPOLAR MOOD DISORDER
People with bipolar mood disorder alternate between depressive and manic
episode(s) on the depression-elation continuum. Bipolar disorders are classified as
Bipolar I, Bipolar II, and cyclothymic disorder. It is rare for mania to occur by
itself in the absence of a manic episode(s). Bipolar disorders were previously
known as manic-depressive illness. Presence of mania distinguishes bipolar from
unipolar disorders. A person diagnosed with bipolar disorder experiences
depressive episodes that alternate with manic episodes. Mania can be distinguished
into two types depending on severity, hypomania and full-blown mania. Full-
blown mania leads to significant occupational and social functioning.
Hospitalization is often necessary in case of full-blown mania. Manic symptoms in
hypomania are similar, but the severity is lesser. Impairment caused by hypomania
is to a lesser degree than for full-blown mania and hospitalization is not required.
Manic Episode
Mania is an emotional state where intense elation, unusual irritability, or
heightened goal directed activity or energy exists for at least one week. In case of
hypomania, the symptoms last for 4 days in a row and are not severe enough to
require hospitalization. Hypomania may be experiences as pleasurable as it leads to
increased energy and creativity. However, it may have undesirable consequences
like suicidal tendencies when the predominant mood is irritable instead of
euphoric. Psychotic features are also likely to be absent in hypomania.

DSM 5 Criteria for Manic Episode

A. Distinct period of abnormally and persistently elevated, expansive or
irritable mood and abnormally and persistently increased goal directed
activity or energy, lasting at least 1 week and present most of the day
nearly every day (or any duration if hospitalization is required).
B. During the period of mood disturbances or increased activity, three (3) or
more of the following symptoms must be present to a significant degree
and represent a noticeable change from usual behavior.
1) Inflated self-esteem or grandiosity.
2) Decreased need for sleep (e.g., one feels rested after only 3 hours of
sleep).

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 3) More talkative than usual or pressure to keep talking.
4) Flight of ideas or subjective experience that thoughts are racing.
5) Attention is easily drawn to unimportant or irrelevant items.
6) Increase in goal-directed activity (either socially, at work or school;
or sexually) or psychomotor agitation.
C. Excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments).

1. CYCLOTHYMIC DISORDER
Dysthymia is a low grade depression. It comes from the Greek word dysthymia
means bad state of mind. It presents with a chronic feeling of ill being and lack in
interest in any enjoyable activities. Unlike in major depression individuals are
unable to work but in dysthymic are able to work and function at a less than peak
performance. It has been seen that 50% of patients with dysthymic disorder recover
soon than any other depression.
Symptoms
● poor appetite or overeating
● insomnia or hypersomnia
● low energy or fatigue
● low self-esteem
● poor concentration or difficulty making decisions
● feelings of hopelessness low energy,
● sleep disturbances,
● appetite disturbances,
● irritable or angered easily,
● low self-esteem are usually part of the clinical picture as well.
● inability to concentrate,
● feelings of worthlessness,
● sad mood

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 DSM-5 Diagnostic Criteria for Cyclothymic Disorder
A. For at least 2 years (at least 1 year in children and adolescents) there have
been numerous periods with hypomanic symptoms that do not meet
criteria for a hypomanic episode and numerous periods with depressive
symptoms that do not meet criteria for a major depressive episode.
B. During the above 2-year period (1 year in children and adolescents), the
hypoman-ic and depressive periods have been present for at least half the
time and the individual has not been without the symptoms for more than 2
months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never
been met.
D. The symptoms in Criterion A are not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified or unspecified schizophrenia spectrum and other psychotic
disorder.
E. The symptoms are not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social,
occupa-tional, or other important areas of functioning.

2. BIPOLAR DISORDER I
Bipolar disorder or manic depressive disorder, which is also referred to as bipolar
affective disorder or manic depression. It is a psychiatric diagnosis that describes a
category of mood disorders defined by the presence of one or more episodes of
abnormally elevated energy levels, cognition, and mood with or without one or
more depressive episodes.
The elevated moods are clinically referred to as mania or, if milder, hypomania.
Individuals who experience manic episodes also commonly experience depressive
episodes, or symptoms, or mixed episodes in which features of both mania and
depression are present at the same time. These episodes are usually separated by
periods of “normal” mood; but, in some individuals, depression and mania may
rapidly alternate, which is known as rapid cycling.

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Diagnosis is based on the person’s self-reported experiences, as well as observed
behaviour, which includes distress, disruption and risk of suicide. The term
“bipolar disorder” origins and refers to the cycling between high and low episodes
(poles).
Symptoms of Bipolar Disorder I
● Feeling unusually “high” and optimistic or irritibality
● Unrealistic, grandiose beliefs about one’s abilities or powers
● Sleeping very little, but feeling extremely energetic
● Talking so rapidly that others can’t keep up
● Racing thoughts; jumping quickly from one idea to the next
● Highly distractible, unable to concentrate
● Impaired judgment and impulsiveness.

DSM-5 Diagnostic Criteria for Bipolar I Disorder

A. Criteria have been met for at least one manic episode (Criteria A-D under
"Manic Episode" above).
B. The occurrence of the manic and major depressive episode(s) is not better
explained by schizoaffective disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder.

BIPOLAR DISORDER II
According to the definition in the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV), bipolar II disorder is characterised by one or more major
depressive episodes accompanied by at least one hypomanic episode.
The key difference between bipolar 1 and bipolar 2 is that bipolar 2 has hypomanic
but not manic episodes. However, in bipolar II disorder, the “up” moods never
reach full during the mani episodes.
The less intense elevated moods in bipolar II disorder are called hypomanic
episodes, or hypomania. A person affected by bipolar II disorder has had at least
one hypomanic episode in life. Most people with bipolar II disorder also suffer
from episodes of depression.

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This is where the term “manic depression” comes from. In between episodes of
hypomania and depression, many people with bipolar II disorder live normal lives.
Symptoms of Bipolar Disorder II
● Decreased energy
● Weight loss or gain
● Despair
● Irritability
● Uncontrollable crying
Symptoms and characteristics of hypomania include:
● Grandiosity
● Decreased need for sleep
● Pressured speech
● Racing thoughts
● Distractibility
● Tendency to engage in behaviour that could have serious consequences, such
as spending recklessly or inappropriate sexual encounters
● Excess energy

DSM-5 Diagnostic Criteria for Bipolar II Disorder

For a diagnosis of bipolar II disorder, it is necessary to meet the criteria for a
current or past hypomanic episode and the following criteria for a current or past
major depressive episode.
A. Criteria have been met for at least one hypomanic episode (Criteria A-F
under "Hy-pomanic Episode") and at least one major depressive episode
(Criteria A-C under "Major Depressive Episode").
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive
episode(s) is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other
specified or unspecified schizophrenia spectrum and other psychotic
disorder.
D. The symptoms of depression or the unpredictability caused by frequent
alternation between periods of depression and hypomania causes clinically
significant distress or impairment in social, occupational, or other

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 important areas of functioning.

CAUSAL FACTORS OF BIPOLAR MOOD DISORDERS

As is the case with unipolar mood disorder, interaction of biological, psychological
and social causal factors have been posited. However, in case of bipolar disorders
biological causal factors are clearly dominant, and the role of psychological causal
factors has received significantly less attention.
Biological Causal Factors
A number of biological factors are thought to play a causal role in the onset of
bipolar disorder including genetic, neurochemical, hormonal, neurophysiological,
neuroanatomical, and biological rhythm influences.
1. Genetic Factors:
There is greater influence of genes in etiology of bipolar disorder than
unipolar disorder. Studies report that genes account for about 80-90 percent
(Goodwin & Jamison, 2007) of variance in the tendency to develop bipolar
disorder. The heritability estimates are higher than for any other major adult
psychiatric disorders including schizophrenia. Family studies have found
that being related to a person with bipolar disorder (first degree relatives)
increases one’s chances of developing bipolar disorder to 9 percent which is
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 approximately 1 percent for general population. First- degree relatives of
person with bipolar are also at the risk for developing unipolar mood
disorder, although reverse is not true. Twin studies have found concordance
rate to be a high 60 percent for monozygotic twins and 12 percent for
dizygotic twins (Kelsoe, 1997, as cited in Butcher et al., 2017).
2. Neurochemical Factors:
The monoamine hypothesis posits that depression is caused by decrease in
norepinephrine, dopamine and/or serotonin. It was hypothesized that perhaps
mania is caused by excess of these neurotransmitters. Some evidence has
been found for increased norepinephrine activity and dopaminergic activity
in manic phase. Increased dopaminergic activity in several brain areas
maybe related to manic symptoms of hyperactivity, grandiosity, and
euphoria. However, serotonin level has not been found to increase and tends
to remain same in in manic and depressive phases. Lithium is a natural
element and has found to be an effective mood stablizer. It has been
hypothesized that lithium may act as a substitute for sodium ions in neural
conduction.
3. Neurohormonal Factors, Neurophysiological and
Neuroanatomical:
Hypothalamic-Pituitary-Adrenal (HPA) axis is implicated in both unipolar
and bipolar disorder. Cortisol levels are elevated in bipolar depression as
well as manic episodes. Neurophysiological and neuroanatomical findings
have also failed to obtain any difference in unipolar and bipolar depression.
That is, changes seen in unipolar disorder in brain structures (amygdala,
hippocampus, cingulate cortex and anterior cingulate cortex) are also seen in
bipolar disorder. Differences emerge during the manic phase; blood flow to
the brain increases, blood flow to left prefrontal cortex is reduced during
depression, during mania it is reduced in the right frontal and temporal
regions. In normal moods, blood flow across two brain hemispheres is
approximately equal. Brain region involved in reaction to reward is overly
active.
4. Circadian Rhythms:
Given the cyclic nature of bipolar disorders, circadian rhythm disturbances
have been found to be common in bipolar patients, even when symptoms

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 have remitted. Manic episodes may be precipitated by loss of sleep,
pregnancy (post-partum), jet lag etc. Insomnia is the most common symptom
before the onset of the manic phase. Bipolar disorder or tends to show
seasonal pattern. During manic phases patients tend to sleep very little, this
is the most common symptom.
Psychosocial Factors
Although biological factors play a dominant role in etiology of bipolar disorders,
psychosocial factors such as stressful life events, poor social support, and certain
personality traits and cognitive styles have also been identified as important.
Stressful life events are found to precipitate manic/depressive episodes in bipolar
life events. Further, stressors in life make recovery more difficult and more
difficult to recover from the episodes. It has been hypothesized that stress may
disrupt the critical circadian rhythms and trigger manic/depressive episode.

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 MODULE-4
DEVELOPMENTAL DISORDERS

ATTENTION DEFICIT HYPERACTIVITY DISORDER

Attention deficit hyperactivity disorder (ADHD) is one of the most common
mental disorders. It affects 5–8% of children, mostly boys, and often lasts into
adulthood.ADHD affects a child’s learning and their functioning in daily life. It
has three main features:
● inattention – not being able to stay focused
● hyperactivity – excess movement that is not appropriate to the setting or
excessive fidgeting, tapping or talking
● impulsivity – acting hastily without thinking, and in a way that may have
high potential for harm.

Common signs and symptoms of ADHD

The symptoms of ADHD are not the same among all children. The condition can
range from mostly poor attention to mostly hyperactivity and impulsivity or a
combination of both.
The symptoms may occur sometimes in children who do not have the condition;
the difference in children who do is that the symptoms are frequent, severe and
cause problems in functioning:
● Children with poor attention may often be forgetful, easily distracted, not
able to stay focused on a task and finish it, seem not to be listening,
disorganized, take time to start doing things and lose their personal
possessions frequently.
● Children with hyperactivity may often be restless, fidgety, full of energy or
“always on the go”, loud, continuously chattering, unable to stay seated (in
the classroom, workplace, etc.), running about or climbing in inappropriate
places and unable to play or do leisure activities quietly.

ABNORMAL PSYCHOLOGY SUMITUP- 8086037958

 ● Children with symptoms of impulsivity may often do things without
thinking, have difficulty waiting for their turn in games or in a queue,
interrupt people in conversation, blurt out answers before the question is
finished, look intrusive and start using other people’s things without
permission.

DSM-5 Diagnostic Criteria for ADHD

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that

interferes with functioning or development, as characterized by (1) and/or
(2):
1. Inattention: Six (or more) of the following symptoms have persisted for at
least 6 months to a degree that is inconsistent with developmental level
and that negatively impacts directly on social and academic/occupational
activities:
a. Often fails to give close attention to details or makes careless
mistakes in schoolwork, at work, or during other activities (e.g.,
overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities
(e.g., has difficulty remaining focused during lectures,
conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind
seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (e.g., starts tasks but
quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty
managing sequential tasks; difficulty keeping materials and
belongings in order; messy, disorganized work; has poor time
management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (e.g., schoolwork or homework; for older
adolescents and adults, preparing reports, completing forms,
reviewing lengthy papers).q we
g. Often loses things necessary for tasks or activities (e.g., school
materials, pencils, books, tools, wallets, keys, paperwork,
eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents
ABNORMAL PSYCHOLOGY SUMITUP- 8086037958
 and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running
errands; for older adolescents and adults, returning calls, paying
bills, keeping appointments).
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms
have persisted for at least 6 months to a degree that is inconsistent with
developmental level and that negatively impacts directly on social and
academic/occupational activities:
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves a seat in situations when remaining seated is expected
(e.g., leaves his or her place in the classroom, in the office or other
workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is
inappropriate.(Note: In adolescents or adults, may be limited to
feeling restless.
d. Often unable to play or take part in leisure activities quietly.
e. Is often "On the go" acting as if "driven by a motor" (e.g., is unable
to be or uncomfortable being still for extended time, as in
restaurants, meetings; may be experienced by others as being
restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed
(e.g., completes people's sentences; cannot wait for turn in
conversation).
h. Often has trouble waiting his/her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations,
games, or activities; may start using other people's things without
asking or receiving permission;for adolescents and adults, may
intrude into or take over what others are doing).

B. Several inattentive Or hyperactive-impulsive symptoms were present before

age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or

more settings, (e.g., at home, school or work; with friends or relatives; in other
activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality
of, social, school, or work functioning.

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E. The symptoms do not occur exclusively during the course of schizophrenia or
another psychotic disorder and are not better explained by another mental
disorder (e.g., mood disorder, anxiety disorder, substance disorder, dissociative
personality disorder, intoxication Or withdrawal).

CAUSAL FACTORS
The exact causes of ADHD are not clear. Some factors may possibly have a role,
such as:
● genetics – ADHD can run in families
● having a significant traumatic experience as a child
● being born prematurely
● brain injury
● exposure to environmental toxins, such as high levels of lead, at a young age
● the mother smoking, using alcohol or having extreme stress during
pregnancy, or being exposed to lead during pregnancy.
Parents need to remember: this has not happened to your child because you have
not been doing a good job as parents. Do not blame yourselves.

CONDUCT DISORDER
● Conduct disorder is a common mental and behavioral problem which occurs
among 4–10% of children and young people, especially in boys.
● Younger children who display disruptive and aggressive behavior within the
home may be diagnosed as having “oppositional defiant disorder”.
● Any child may sometimes have temper tantrums, display aggressive or
destructive behavior, or not respect rules at home or at school. If this type of
behavior is not unusually frequent or severe then it is just ordinary childish
mischief or adolescent rebelliousness, and does not qualify as conduct
disorder.

Common signs and symptoms of conduct disorder

● Conduct disorder is characterized by repeated and persistent patterns of
antisocial, aggressive or defiant behavior at home and school and with peers

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 – much worse behavior than would normally be expected in a child of that
age.
● Prominent examples of such behavior include excessive levels of fighting or
bullying, cruelty to animals or other people, setting things on fire, severe
destruction of property, stealing, repeated lying and running away from
school or home.

DSM-5 Diagnostic Criteria for Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basic rights

of others or major age-appropriate societal norms or rules are violated, as
manifested by the presence of three (or more) of the following criteria in the
past 12 months, with at least one criterion present in the past 6 months:
Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others
(e.g., abat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse
snatching, extortion, armed robbery)
(7) has forced someone into sexual activity
Destruction of property

(8) has deliberately engaged in fire setting with the intention of

causing serious damage
(9) has deliberately destroyed others' property (other than by fire
setting)

Deceitfulness or theft

(10) has broken into someone else's house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e.,
"cons" others)
(12) has stolen items of nontrivial value without confronting a victim

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 (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning
before age 13 years
(14) has run away from home overnight at least twice while living in
parental or parental surrogate home (or once without returning for a
lengthy period)
(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in

social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for
Antisocial Personality Disorder.
Specify type based on age at onset:

Childhood-Onset Type: onset of at least one criterion characteristic of

Conduct Disorder prior to age 10 years

Adolescent-Onset Type: absence of any criteria characteristic of Conduct

Disorder prior to age 10 years

Specify severity:
Mild: few if any conduct problems in excess of those required to make the
diagnosis and conduct problems cause only minor harm to others
Moderate: number of conduct problems and effect on others intermediate
between "mild" and "severe"
Severe: many conduct problems in excess of those required to make the
diagnosis or conduct problems cause considerable harm to others

CAUSAL FACTORS

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There is no single cause of conduct disorder. Genetics and environmental factors
can both be involved. A child may be more likely to develop an oppositional
defiant disorder or conduct disorder if they:
● have one or more individual factors including a difficult temperament, poor
social and emotional skills, low achievement at school, other mental health
problems (like being hyperactive), or difficulties learning good, acceptable
social behavior;
● have parents who give too little attention to good behaviour and are too
quick to criticize, or who physically punish or neglect the child; or,
conversely, parents who are too flexible about rules, children being involved
with other difficult young people or drug abuse;
● have parents with mental health problems such as depression or substance
abuse; or
● live in poverty.

AUTISM SPECTRUM DISORDER

● Autism spectrum disorders are neurodevelopmental disorders, meaning they
are caused by abnormalities in the way the brain develops and works.
● There are a range of different disorders covered by this term, including
conditions that used to be considered separate such as autism and Asperger’s
syndrome. Some people still use the term “Asperger’s syndrome”. It is
generally thought to be at the milder end of the ASD spectrum.
● People with autism spectrum disorders have problems in social behavior and
communicating with others; they tend to engage in solitary interests and
activities which they do repetitively.
● In most cases, autism spectrum disorders become apparent during the first 5
years of a person’s life. They begin in childhood and tend to persist into
adolescence and adulthood. Globally, 1 in 160 children has an autism
spectrum disorder, and they are more commonly diagnosed in boys than
girls.
● People with autism spectrum disorders often also have other conditions,
including epilepsy, depression, anxiety and attention deficit hyperactivity
disorder (ADHD).

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 ● The level of intelligence and cognitive functioning of people with autism
spectrum disorders is extremely variable, ranging from profound impairment
to superior functioning.

Common signs and symptoms of autism spectrum disorders

Every person with an autism spectrum disorder has a unique pattern of behaviour,
but there are some common signs and symptoms:
● Communication problems (difficulty using or understanding language)
such as delayed speech development and limited vocabulary for their age,
repeating a set of words or phrases, focusing attention and conversation on a
few topic areas, monotonous and flat speech.
● Difficulty in social interaction: This includes having trouble in making
friends and interacting with people, difficulty understanding facial
expressions, difficulty understanding their own and other people’s emotions,
not making eye contact, not wanting to be cuddled, not answering when
called or refusing to do things when asked.
● Repetitive behaviors and following strict routines: This may include
repetitive body movement such as hand flapping and repetitive motions with
objects like spinning the wheels of a toy car, performing activities that could
cause self-harm such as biting or head-banging, sticking to the same routine
every day and having difficulty adjusting to even minor changes.
● Sensory sensitivity: Being over- or under- sensitive to sounds, lights,
touch, tastes, smells, pain and other stimuli.

DSM-5 Diagnostic Criteria for Autism Spectrum Disorder

A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following, currently or
by history (examples are illustrative, not exhaustive; see text):
1) Deficits in social-emotional reciprocity, ranging, for example,
from abnormal social approach and failure of normal back-and-
forth conversation; to reduced sharing of interests, emotions, or
affect; to failure to initiate or respond to social interactions.
2) Deficits in nonverbal communicative behaviors used for social
interaction, ranging, for example, from poorly integrated verbal

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 and nonverbal communication; to abnormalities in eye contact
and body language or deficits in understanding and use of
gestures; to a total lack of facial expressions and nonverbal
communication.
3) Deficits in developing, maintaining, and understanding
relationships, ranging, for example, from difficulties adjusting
behavior to suit various social contexts; to difficulties in sharing
imaginative play or in making friends; to absence of interest in
peers.

Specify current severity:

Severity is based on social communication impairments and restricted,
repetitive patterns of behavior. For either criterion, severity is described in 3
levels: Level 3 – requires very substantial support, Level 2 – Requires
substantial support, and Level 1 – requires support.

B. Restricted, repetitive patterns of behavior, interests, or activities, as

manifested by at least two of the following, currently or by history
(examples are illustrative, not exhaustive; see text):
1) Stereotyped or repetitive motor movements, use of objects, or
speech (e.g., simple motor stereotypes, lining up toys or flipping
objects, echolalia, idiosyncratic phrases).
2) Insistence on sameness, inflexible adherence to routines, or
ritualized patterns of verbal or nonverbal behavior (e.g., extreme
distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat
same food every day).
3) Highly restricted, fixated interests that are abnormal in intensity
or focus (e.g., strong attachment to or preoccupation with
unusual objects, excessively circumscribed or perseverative
interests).
4) Hyper- or hyporeactivity to sensory input or unusual interest in
sensory aspects of the environment (e.g. apparent indifference to
pain/temperature, adverse response to specific sounds or

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 textures, excessive smelling or touching of objects, visual
fascination with lights or movement).

Specify current severity:

Severity is based on social communication impairments and restricted,
repetitive patterns of behavior. For either criterion, severity is described in 3
levels: Level 3 – requires very substantial support, Level 2 – Requires
substantial support, and Level 1 – requires support.

C. Symptoms must be present in the early developmental period (but

may not become fully manifest until social demands exceed limited
capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability
(intellectual developmental disorder) or global developmental delay.
Intellectual disability and autism spectrum disorder frequently co-
occur; to make comorbid diagnoses of autism spectrum disorder and
intellectual disability, social communication should be below that
expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic

disorder, Asperger’s disorder, or pervasive developmental disorder not
otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication, but
whose symptoms do not otherwise meet criteria for autism spectrum
disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:
With or without accompanying intellectual impairmentWith or without
accompanying language impairment.
Associated with a known medical or genetic condition or environmental
factor.
Associated with another neurodevelopmental, mental, or behavioral disorder.

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 With catatonia (refer to the criteria for catatonia associated with another
mental disorder)

CAUSAL FACTORS
● Over the last two decades, extensive research has studied whether there is
any link between childhood vaccinations and autism spectrum disorders. The
results of these researches are clear and unanimous: vaccines do not cause
autism.
● It seems that certain genes which a child inherits from its parents are
involved in ASD. Autism spectrum disorders run in families, and if one
child has one, their siblings are more likely to have one as well.
● Some environmental factors may contribute to autism spectrum disorders,
for example being born prematurely (before 35 weeks of pregnancy), being
exposed to alcohol in the womb, being exposed to certain medicines (e.g.
sodium valproate – used in epilepsy treatment) in the womb.

SPECIFIC LEARNING DISORDERS

Learning disorders are a group of developmental disorders which are significant,
unexpected, specific and persistent difficulties in the acquisition and use of reading
(dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities, despite
conventional instruction, normal intelligence, proper motivation and adequate
socio-cultural opportunity.Child with learning disorder is one who does not meet
expectations for academic performance in school but has intelligence in the normal
range.

TYPES OF LEARNING DISORDERS

1. Dyslexia
The specifier “with impairment in reading” is added to the SLD diagnosis when a
person demonstrates significant impairment in one or more of the reading subskills
including word reading accuracy, reading rate or fluency, and/or reading
comprehension. Dyslexia may be used as an alternative term that refers to

ABNORMAL PSYCHOLOGY SUMITUP- 8086037958

problems with word reading fluency or word reading accuracy, decoding, and
spelling.
Problems in reading may begin even before learning to read. For example, children
with dyslexia may have trouble with breaking down spoken words into syllables
andor recognizing words that rhyme. People with dyslexia often have difficulty
connecting letters they see on a page with the sounds they make. As a result,
reading becomes slow and effortful and is not a fluent process for them. People
with dyslexia may also have difficulty with writing accuracy and spelling.
Adolescents and adults with dyslexia often try to avoid activities that involve
reading when they can (reading for pleasure, reading instructions). They often
gravitate to other media such as pictures, video, or audio.

2. Dysgraphia
An impairment in writing skills is assigned to the specifier “with impairment in
written expression” and refers to those children with impaired spelling and
problems with writing that can include difficulties with accuracy, grammar, and
punctuation accuracy, and/or clarity or organization of written expression.
Problems in reading begin even before learning to read. For example, children may
have trouble breaking down spoken words into syllables and recognizing words
that rhyme. Dysgraphia is athe term used to describe difficulties with putting one’s
thoughts on to paper. Kindergarten-age children with impairment in written
expression may not be able to recognize and write letters as well as their peers.

3. Dyscalculia
Finally, the third SLD specifier “with impairment in mathematics” is for
individuals who demonstrate significantly below average skills in number sense,
memorization of arithmetic facts, accurate or fluent calculation, and/or accurate
math reasoning. The term “dyscalculia” Dyscalculia is a term used to describe
difficulties with learning number number-related concepts, with processing
numerical information, with learning arithmetic facts or with using the symbols
and functions to perform accurate or fluent math calculations.

DSM-5 Criteria for Learning Disability

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 A. Difficulties learning and using academic skills, as indicated by the
presence of at least one of the following symptoms that have persisted
for at least 6 months, despite the provision of interventions that target
those difficulties:
1) Inaccurate or slow and effortful word reading (e.g. - reads single
words aloud incorrectly or slowly and hesitantly, frequently
guesses words, has difficulty sounding out words).
2) Difficulty understanding the meaning of what is read (e.g. - may
read text accurately but not understand the sequence, relationships,
inferences, or deeper meanings of what is read).
3) Difficulties with spelling (e.g. - may add, omit, or substitute
vowels or consonants).
4) Difficulties with written expression (e.g. - makes multiple
grammatical or punctuation errors within sentences; employs poor
paragraph organization; written expression of ideas lacks clarity).
5) Difficulties mastering number sense, number facts, or calculation
(e.g. - has poor understanding of numbers, their magnitude, and
relationships; counts on fingers to add single-digit numbers
instead of recalling the math fact as peers do; gets lost in the midst
of arithmetic computation and may switch procedures).
6) Difficulties with mathematical reasoning (e.g. - has severe
difficulty applying mathematical concepts, facts, or procedures to
solve quantitative problems).
B. The affected academic skills are substantially and quantifiably below
those expected for the individual’s chronological age, and cause
significant interference with academic or occupational performance, or
with activities of daily living, as confirmed by individually administered
standardized achievement measures and comprehensive clinical
assessment. For individuals age 17 years and older, a documented
history of impairing learning difficulties may be substituted for the
standardized assessment.
C. The learning difficulties begin during school-age years but may not
become fully manifest until the demands for those affected academic

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 skills exceed the individual’s limited capacities (e.g. - as in timed tests,
reading or writing lengthy complex reports for a tight deadline,
excessively heavy academic loads).
D. The learning difficulties are not better accounted for by intellectual
disabilities, uncorrected visual or auditory acuity, other mental or
neurological disorders, psychosocial adversity, lack of proficiency in the
language of academic instruction, or inadequate educational instruction.

CAUSAL FACTORS
● Family history and genes. Having a blood relative, such as a parent, with a
learning disorder raises the risk of a child having a disorder.
● Risks before birth and shortly after. Learning disorders have been linked
with poor growth in the uterus and exposure to alcohol or drugs before being
born. Learning disorders also have been tied to being born too early and
having a very low weight at birth.
● Emotional trauma. This could involve a deeply stressful experience or
emotional abuse. If either happens in early childhood, it may affect how the
brain develops and raise the risk of learning disorders.
● Physical trauma. Head injuries or nervous system illnesses might play a
role in the development of learning disorders.
● Poisonous substances. Exposure to high levels of toxins, such as lead, has
been linked to a larger risk of learning disorders.

INTELLECTUAL DISABILITY
● Intellectual disability is a condition that limits intelligence and disrupts
abilities necessary for living independently. Signs of this lifelong condition
appear during childhood. Most people with this will need some degree of

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 assistance throughout their lives. Support programs and educational
offerings can help with managing symptoms and effects.
● An intellectual disability is when limitations in your mental abilities affect
intelligence, learning and everyday life skills. The effects of this can vary
widely. Some people may experience minor effects but still live independent
lives. Others may have severe effects and need lifelong assistance and
support.

Symptoms
The symptoms of intellectual disability revolve around difficulties in different skill
sets, including academic skills, social skills and domestic skills. Intellectual
disability affects:

Intelligence-related symptoms
“Intelligence” is the umbrella term for your ability to understand and interact with
the world around you. It goes beyond the traditional language and math skills an
IQ test measures. Intelligence-related symptoms of intellectual disability can mean
you have any of the following:
● Delayed or slowed learning of any kind (such as in school or from real-life
experiences).
● Slowed reading speed.
● Difficulties with reasoning and logic.
● Problems with judgment and critical thinking.
● Trouble using problem-solving and planning abilities.
● Distractibility and difficulty focusing.

Adaptive behaviors
Adaptive behaviors revolve around abilities and learned skills you need to live and
support yourself independently. Symptoms of adaptive behavior-related limitations
can mean you have any of the following:
● Slower learning of toilet training and self-care activities (bathing, dressing,
etc.).
● Slower social development.
● Little or no fear or apprehension of new people (lack of “stranger danger”
behaviors).
ABNORMAL PSYCHOLOGY SUMITUP- 8086037958
 ● Needing help from parental figures or other caregivers with basic daily
activities (bathing, using the bathroom, etc.) past the expected age.
● Difficulty learning how to do chores or other common tasks.
● Trouble understanding concepts like time management or money.
● Needing help managing healthcare appointments or medications.
● Trouble understanding social boundaries.
● Difficulty with or limited understanding of social interactions, including
friendships and romantic relationships.

DSM-5 Diagnostic Criteria for Intellectual Disability

Intellectual disability (intellectual developmental disorder) is a disorder with
onset during the developmental period that includes both intellectual and
adaptive functioning deficits in conceptual, social, and practical domains. The
following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving,
planning, abstract thinking. judgment, academic learning, and learning
from experience, confirmed by both clinical assessment and
individualized, standardized intelligence testing
B. Deficits in adaptive functioning that result in failure to meet
developmental and socio. cultural standards for personal independence and
social responsibility. Without ongoing support, the adaptive deficits limit
functioning in one or more activities of daily life. such as communication,
social participation, and independent living, across multiple environments,
such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period
Note: The diagnostic term intellectual disability is the equivalent term for
the ICD-11 diag nosis of intellectual developmental disorders. Although
the term intellectual disability is used throughout this manual, both terms
are used in the title to clarify relationships with other classification
systems. Moreover, a federal statute in the United States (Public Law
111-256, Rosa's Law) replaces the term mental retardation with intellectual
disability, and research journals use the term intellectual disability. Thus,
intellectual disability is the term in common use by medical, educational,
and other professions and by the lay public and advocacy groups

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 Specify current severity:
● Mild
● Moderate
● Severe
● Profound

CAUSAL FACTORS
Intellectual disabilities can happen for many reasons. Experts also suspect that in
many cases, there are multiple causes and contributing factors. Causes and
contributing factors can influence the development of intellectual disability before
or during birth or during the earliest years of childhood.

1. Prebirth causes or contributing factors include, but aren’t limited to, the
following:
● Genetics and inheritance. Many conditions that cause intellectual
disability happen because of genetic mutations. Some of these
mutations can be passed from generation to generation. Examples
include Down syndrome, Fragile X syndrome or Prader-Willi
syndrome.
● Infections. Some infections — like toxoplasmosis and rubella — can
disrupt fetal development, resulting in conditions that can cause
intellectual disability, such as cerebral palsy.
● Teratogens. These are substances that can disrupt fetal development.
Examples include alcohol, tobacco, certain medications, radiation
exposure and more.
● Medical conditions. Having certain medical conditions while
pregnant can cause developmental differences in a fetus. Those can
later result in intellectual disability. Examples include hormonal
conditions like hypothyroidism.
2. Causes that can happen during birth include:
● Lack of oxygen (hypoxia).
● Premature birth.
● Other types of brain injury during birth.
ABNORMAL PSYCHOLOGY SUMITUP- 8086037958
 3. Causes that can happen during early childhood include:
● Injuries or accidents. These can cause intellectual disability if they
result in brain damage.
● Toxic exposures. Heavy metals like lead and mercury can damage
your brain and cause intellectual disability.
● Infections. Common infections that spread to your nervous system,
such as measles or meningitis, can cause intellectual disability.
● Tumors or growths in the brain. This includes cancers and benign
(noncancerous) growths.
● Medical conditions. Seizures and various types of epilepsy, such as
Lennox-Gastaut syndrome, can cause brain damage. That can cause
intellectual disability.

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