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PSYCHOPATHOLOGY (BPCE 014)
TUTOR MARKED ASSIGNMENT
(TMA)
Course Code: BPCE-014
Assignment Code: BPCE-014/ASST/TMA/2022-23
Marks: 100
NOTE: All questions are compulsory.

SECTION – A
Answer the following questions in 1000 words each. 3 x 15 = 45 marks

1. Explain various approaches to intervention for anxiety disorders.

Psychodynamic Perspective

This perspective believes in that the major determinant of anxiety disorders is
intra-psychic events and unconscious motivation. It is being accepted that anxiety
is an alarm reaction that appears when person is threatened. It is normal to
experience some overt anxiety, the amount of anxiety and the nature of the threat
that determine whether an instance of anxiety is normal or pathological. The
theorists in this approach targets the causes of anxiety that reaches clinical
proportions like perceptions of oneself as helplessness in coping with surrounding
pressure, privation, loss of emotional support or dangerous impulses which comes
close to breaking into consciousness.

Behavioural Perspective

Behaviour therapists have challenged the approaches of psychotherapists.
Psychotherapists believe that in order to change abnormal behaviour one must
remove or reduce the conflict underlying the behaviour .According to
behaviourists anxiety which reaches clinical proportions is a learned or acquired
response a symptom that has been created by environmental conditions.
B.F Skinner the leading behaviourist preferred exclusively on observable stimulus
and response variable. In this approach the new learning for eliminating anxiety
is associated with conditioning, reinforcement and extinction. Behaviour therapy
has been directed at discovering the variables that help defuse highly emotional
responses.
Expose therapy introduced by the behaviourists has been used in treating phobias,
obsessive compulsive disorders and other anxiety disorders. It motivates the client
or patient to maintain contact with the actual noxious stimuli or with their
imagined presence until he or she becomes used to them. In association to this
technique three other types of therapy also can be used like systematic
desensitisation, implosive therapy and vivo exposure.
In systematic desensitisation the treatment of strong fears is based on
conditioning principles. The patient or client is taught to relax and then is presented
with a series of stimuli that are graded from low to high according to their capacity
to evoke anxiety. Usually the process in reduction of the level of any emotional
response to particular stimulus is gradually.
Implosive therapy is based on the belief that many conditions including anxiety
disorders are outgrowth of painful of prior experiences. Therapists ask their clients
to imagine scenes related to particular personal conflicts and to recreate the anxiety
felt in those scenes. The target of the therapist is to strive to heighten the realism

Cognitive Perspective

Cognitive therapy is highly effective in reducing anxiety, regardless of client
feels relaxed or anxious during their exposure. It seeks to help the patient
overcome the difficulties by identifying and changing dysfunctional thinking,
behaviour and emotional responses.

Modeling proves to be an important cognitive element from overcoming intense
fear and acquire self confidence. Sometimes the way people think about certain
things changes when they acquire new response capacities. According to cognitive
theorists thinking disturbances that occur only in certain places or in relation to
specific problems are the sources of anxiety. These types of thoughts include
unrealistic appraisals of situations and consistent overestimation of their
dangerous aspects. The therapist tries to highlight the distortions and encourages
the patient to change his or her attitudes. T

Combination of Cognitive and Behavioural Approaches

These two approaches in combination aim to solve issues concerning
dysfunctional emotions, behaviours and cognitions through a goal oriented
systematic procedure. The cognitive behavioural technique is effective for the
treatment of a variety of problems including mood, anxiety, personality, eating,
substance abuse and psychotic disorders. The program has been used in a series
of clinical studies with social phobia and generalised anxiety disorder patients.
Thus this therapy involves in helping patients on the overall aspects. It supports
in modifying beliefs, identifying distorted thinking, changing behaviour etc.

Biological Perspective

It has been seen by the psychologists that different reactions are caused by an
individual’s biological state. It is an accepted fact that people whose nervous
system is particularly sensitive to stimulation appear more likely to experience
severe anxiety. Heredity has shown a strong influence on such characteristics as
timidity, fearfulness and aggressiveness. A study found that children of people
treated for anxiety disorders were more anxious and fearful and showed more
school difficulties, worries and had greater number of problems as compared to
children of normal parents. Psychologists have also supported the effect of
more genetic factor and a statistically significant and weaker effect for a family
environment factor.

2. Explain the types and causes of learning disabilities.

psychology professionals should study these seven learning disabilities:

1. Dyslexia

Underneath the learning disability umbrella, many disabilities are categorized as one of three types: dyslexia, dysgraphia, and dyscalculia.¹ Dyslexia is a language processing disorder that impacts reading, writing, and comprehension. Dyslexics may exhibit difficulty decoding words or with phonemic awareness, identifying individual sounds within words. Dyslexia often goes diagnosed for many years and often results in trouble with reading, grammar, reading comprehension, and other language skills.²

2. Dysgraphia

Those with dysgraphia have trouble converting their thoughts into writing or drawing. Poor handwriting is a hallmark of dysgraphia but is far from the only symptom. Sufferers struggle to translate their thoughts into writing, whether in spelling, grammar, vocabulary, critical thinking, or memory.¹ Individuals with dysgraphia may exhibit difficulty with letter spacing, poor motor planning and spatial awareness, and trouble thinking and writing simultaneously.³

3. Dyscalculia

Dyscalculia encompasses learning disabilities related to mathematical calculations. Individuals with dyscalculia struggle with math concepts, numbers, and reasoning.¹ Sometimes referred to as having “math dyslexia,” individuals might have difficulty reading clocks to tell time, counting money, identifying patterns, remembering math facts, and solving mental math.⁴

4. Auditory processing disorder

In auditory processing disorder (APD), patients have difficulty processing sounds. Individuals with APD may confuse the order of sounds or be unable to filter different sounds, like a teacher’s voice versus background noise. In APD, the brain misinterprets the information received and processed from the ear.⁵

5. Language processing disorder

A subset of auditory processing disorder, language processing disorder arises when an individual has specific challenges in processing spoken language, impacting both receptive and expressive language. According to the Learning Disabilities Association of America, in language processing disorder, “there is difficulty attaching meaning to sound groups that form words, sentences, and stories.”⁶

6. Nonverbal learning disabilities

While it may sound like nonverbal learning disabilities (NVLD) relate to an individual’s inability to speak, it actually refers to difficulties in decoding nonverbal behaviors or social cues. NVLD sufferers struggle with understanding body language, facial expressions and tone of voice, or the nonverbal aspects of communication.⁷

7. Visual perceptual/visual motor deficit

Individuals with visual perceptual/visual motor deficit exhibit poor hand-eye coordination, often lose their places when reading, and have difficulty with pencils, crayons, glue, scissors, and other fine motor activities. They may also confuse similar looking letters, have trouble navigating their surroundings, or demonstrate unusual eye activity when reading or completing assignments

3. Explain the socio-cultural factors in the etiology of psychopathology.

Social-Economic Status
Social class is one of the most important causal factors in mental illness. This
has been clearly and consistently demonstrated by studies related to mental
disorder. It was found that those from the lower economic classes are more likely
than those from other classes to be mentally ill. Although mental illness among
the low socio-economic classes is more likely to be reported to the authorities,
surveys on random samples of the population have consistently found a greater
percentage of lower class people suffering from psychological symptoms.
There are two conflicting explanations of this. One, called social causation,
suggest that lower economic class people are more prone to mental disorder
because they are more likely to experience social stress (e.g. unemployment,
separation), to suffer from psychic frailty, infectious diseases, neurological
impairments, and to lack good medical treatment, coping ability and social
support. Through an accumulation of these problems, and the stresses that result,
low social status becomes a cause of mental illness.

Gender
The next social factor associated with mental illness is gender. There are
conflicting findings as to which gender is more likely to become mentally ill. In
most studies women are found to have a higher rate of mental disorder, but some
others find men to be more predominant or no difference between the sexes.
These conflicting findings, however, refer to mental illness most generally. Studies
on specific types of disorders, however, do indicate gender differences. These
usually show that women predominate in depression and anxiety disorders, while
men more commonly have antisocial personalities, paranoia, drug and alcohol
abuse disorders. Most sociologists’ attribute this difference to differences in gender
roles.
The female role is relatively restrictive and oppressive, likely to confine the
woman to her inner self, such that she tends to keep her frustration and anger to
herself rather than aggressively pour it out on others. Hence women are more
likely to fall victim to depression and anxiety. Men, on the other hand, have a
more liberated role, and they are encouraged to be bold, assertive and aggressive
in social relations. If frustrated and angry, they are more likely to take it out on
others — behaving as antisocial and paranoid individuals.

Age
Another social factor that has been associated with mental disorder is age. Studies
conducted before the 1980’s suggested that older persons were more likely to
47
Etiology of Psychopathology suffer from mental disorders. This was attributed to societal neglect of the elderly
eventually resulting in institutionalisation, where the neglect can continue. Yet,
more recent studies in the 1980’s and 1990s show that the elderly are the least
likely among all age groups to become mentally ill.
The increasing prevalence of depression among younger people can be attributed
to changes in modern society, that is an increase in social stresses coupled with
a decrease in social resources for dealing with them. Most of these stresses come
from family problems (e.g. divorce, child abuse, or parental indifference). The
difficulty in coping comes largely from the loss of the extended family and closeknit village-like community in modern society. Research has shown, for example,
that lack of parental love and affection, divorce, and other factors can significantly
contribute to the development of depression, anxiety, or other types of mental
disorder.

Race and Ethnicity
A third social factor in mental disorders is race and ethnicity. Like gender, these
have not been consistently found to be related to mental illness in general. While
many studies have shown higher rates of psychological stress among minorities,
the standard explanation has been that these groups experience more social stresses
stemming from discrimination, poverty and cultural conflict.
On the other hand, there are studies showing no significant difference in
psychological problems between minorities and whites in U.S. An explanation
for this finding could be: minority group identification, group solidarity, or social
networks which protect them against these social stresses, for example people
from India who have settled in west tend to form social groups, clubs or cultural
societies. The same explanation has been offered to account for the lower rate of
mental illness among British minorities.
More consistent data are available on the relationship between race or ethnicity
and specific forms of mental disorder. In the U.S., Puerto Ricans and African
Americans are more likely than Irish or Jewish Americans to have sociopathic
inclinations or paranoid tendencies. Jewish Americans, in contrast, tend more to
manifest depressive disorders. In addition, Americans of Korean ancestry, have
more depressive symptoms than whites.

Urban Environment
An important social factor implicated in mental illness is the urban environment
itself. Community surveys indicate higher rates of mental disorders in urban
areas, particularly the inner city, than in rural areas, including the suburbs and
small towns. It is argued that the urban environment produces a lot of mental
problems because it generates an abundance of physical and social stresses (e.g.
traffic congestion, noise, population density, tenuous social relations, loneliness
and lack of social support). Some community studies also reveal a link between
urban living and specific psychological problems (e.g. neurotic and personality
disorders).
In contrast, more serious psychotic conditions are more prevalent among rural
and small town residents. This could be explained by the argument that rural and
small-town residents find their lives too restrictive, and they are not able to express
Psychopathology frustration and anger in the presence of others — who may easily find out who
the troublemakers are. By suppressing their frustration, they may get deeper and
deeper into themselves until they become psychotic. In contrast, urban dwellers
can get away from family and friends, are freer to express frustration in the
midst of strangers, and tend more to tolerate unconventional behaviour. If they
persist in doing so, urbanites may become neurotics, who, unlike psychotics,
retain their grip on conventional reality. Otherwise, they may develop an antisocial
psychopathic personality, which is essentially an “acting out” disorder.

frustration and anger in the presence of others — who may easily find out who
the troublemakers are. By suppressing their frustration, they may get deeper and
deeper into themselves until they become psychotic. In contrast, urban dwellers
can get away from family and friends, are freer to express frustration in the
midst of strangers, and tend more to tolerate unconventional behaviour. If they
persist in doing so, urbanites may become neurotics, who, unlike psychotics,
retain their grip on conventional reality. Otherwise, they may develop an antisocial
psychopathic personality, which is essentially an “acting out” disorder.

Social Networks
Having caring and close relationships strongly protects against most non psychotic
forms of mental illness. Supportive social networks, particularly family, are crucial
in times of crisis. Such networks extend beyond family and close friends, and in
many communities include religious groups. People with psychological illness
tend to have more impaired social networks than their peers.

Migration
Immigrants are not a homogenous group. Economic immigrants (those who chose
to migrate in search of a better life) often have better than average mental health.
In contrast, refugees from war and persecution have often suffered experiences
that affect their mental health adversely.
Sometimes first generation immigrants appear to have lower rates of mental
illness because of low rates of recognition. By contrast, the second generation
may have higher rates, partly due to conflict between the cultural norms of the
host society and the expectations of their parents. There may also be an effect of
time on presentation. One study of southern European women immigrants found
that they developed depression about fifteen years after arrival.
It was suggested that while initially they were busy helping their husbands and
children to settle (i.e. their children became fluent in English and their husbands
became established in their jobs) the women became increasingly isolated and
eventually lost their meaningful role.

SECTION – B
Answer the following questions in 400 words each. 5 x 5 = 25 marks
4. Describe the causes and interventions for somatoform disorders.

Somatic symptom disorder (SSD) is a condition that causes a person to manifest physical symptoms that can’t be linked to any medical conditions. These symptoms often cause severe distress to a person who has the disorder. Research shows that about five to seven percent of people worldwide have somatic symptom disorder. It also appears to be a lot more prevalent among women than men.1

A person with this condition often experiences excessive concerns about their health and might exhibit odd or unusual behaviors in response to these concerns.

People with SSD will feel overly concerned about any physical symptoms they exhibit and falsely connect them to signs of a more severe illness. They’ll also feel a lot of anxiety about symptoms they have. In cases where a medical condition can be linked to a person with SSD’s symptoms, their fears might be overstated. This condition can develop at any age.

5. Explain the characteristic features of pervasive developmental disorders.

PDD-NOS stands for Pervasive Developmental Disorder-Not Otherwise Specified. PDD-NOS was one of several previously separate subtypes of autism that were folded into the single diagnosis of autism spectrum disorder (ASD) with the publication of the DSM-5 diagnostic manual

In the past, psychologists and psychiatrists often used the term “pervasive developmental disorders” and “autism spectrum disorders” (ASD) interchangeably. As such, PDD-NOS became the diagnosis applied to children or adults who are on the autism spectrum but do not fully meet the criteria for another ASD such as autistic disorder (sometimes called “classic” autism) or Asperger syndrome.

Like all forms of autism, PDD-NOS can occur in conjunction with a wide spectrum of intellectual ability. Its defining features are significant challenges in social and language development.

Some developmental health professionals refer to PDD-NOS as “subthreshold autism.” In other words, it’s the diagnosis they use for someone who has some but not all characteristics of autism or who has relatively mild symptoms. For instance, a person may have significant autism symptoms in one core area such as social deficits, but mild or no symptoms in another core area such as restricted, repetitive behaviors.

As a diagnosis, PDD-NOS remains relatively new, dating back only 15 years or so. As a result, some physicians and educators may not be familiar with the term or may use it incorrectly.

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) spells out the criteria for a diagnosis of PDD-NOS. Unfortunately, this description consists of a single paragraph, which mainly asserts what it is not:

“This category should be used when there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes “atypical autism” – presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.”

6. Explain neuropsychological assessment in psychopathology.

7. Describe the treatment for alcohol related disorder.

To assess your problem with alcohol, your provider will likely:

• Ask you some questions related to your drinking habits. The provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your provider from giving out any information about you without your consent.
• Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use.
• Suggest lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test results may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests.
• Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may be asked to complete a questionnaire to help answer these questions.

8. Differentiate between conduct disorder and oppositional defiant disorder.

SECTION – C

Answer the following questions in 50 words each. 10 x 3 = 30 marks
9. Bulimia nervosa

Bulimia nervosa, also called bulimia, is an eating disorder. Eating disorders are mental health conditions that can be potentially life-threatening. If you have an eating disorder, you may have an obsession with food and weight. This obsession can harm your physical and emotional well-being.

Bulimia nervosa can be defined as a pattern of eating characterized by:

1. Consuming an unusually large amount of food in a short period of time (binge eating).
2. Getting rid of the food (purging). Purging may involve making yourself throw up (vomiting) or taking laxatives. Laxatives are medications that speed up the movement of food through your body.

Other characteristics of bulimia nervosa may include:

• Misuse of water pills (diuretics) or diet pills.
• Eating very little or not at all (fasting).
• Excessively exercising.
• Hiding food to binge and purge later.

10. Childhood disintegrative disorder

Childhood disintegrative disorder (CDD), also known as Heller’s syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language (receptive and expressive), social engagement, bowel and bladder, play and motor skills Researchers have not been successful in finding a cause for the disorder. CDD has some similarity to autism and is sometimes considered a low-functioning form of it.In May 2013, CDD, along with other sub-types of PDD (Asperger’s syndrome, autism, rett’s disorder and PDD-NOS), was fused into a single diagnostic term called “autism spectrum disorder” under the new DSM-5 manual.

CDD was originally described by Austrian educator Theodor Heller (1869–1938) in 1908, 35 years before Leo Kanner and Hans Asperger described autism. Heller had previously used the name dementia infantilis for the syndrome.

An apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills.The age at which this regression can occur varies, after three years of normal development is typical.The regression, known as a ‘prodrome,’ can be so dramatic that the child may be aware of it, and may in its beginning even ask, vocally, what is happening to them. Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost.

11. Projective tests

Projective tests are a type of personality test in which the individual must respond to ambiguous scenes, words or images or in some cases even draw. It differs from objective tests in that the answers can be very varied, there are no correct or incorrect answers. Although there are guidelines for correcting projective tests (and even extensive training is necessary), it can happen that two experts come to different conclusions from the same tests. This, however, is almost impossible in objective tests.

12. Symptoms of catatonic schizophrenia

Catatonia isn’t just a syndrome that occurs in psychiatric diagnoses. Experts haven’t been able to pinpoint the exact cause of catatonic behavior but it reportedly occurs in more than 10% of people with acute psychiatric illnesses. Some research suggests anxiety (including an intense fear of dying) is an important component of catatonia. Other research suggests genetics, dysfunction and neurological variations in certain regions of the brain (especially the basal ganglia), and underlying mood disorders (i.e. depression).

It can also be related to a physical/non-psychiatric problem. It can occur with certain conditions such as stroke or Parkinson’s disease, explains Danesh Alam, MD, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois.

13. Symptoms of avoidant personality disorder

No one enjoys criticism, rejection, or embarrassment, but sometimes people spend their entire life avoiding them. A socially challenged person with a hypersensitivity to rejection and constant feelings of inadequacy may have a mental illness known as avoidant personality disorder (AVPD).

People with avoidant personality disorder experience social awkwardness. They spend a lot of time focusing on their shortcomings and are very hesitant to form relationships where rejection could occur. This often results in feelings of loneliness and becoming disengaged from relationships at work and elsewhere. People with AVPD might also refuse a promotion, make excuses to miss meetings or be too fearful to engage in events where they might make friends.

14. Transvestism

ransvestic disorder occurs when an individual experiences recurrent, intense sexual arousal from cross-dressing, or dressing as the opposite gender, and in which that person’s urge to do so causes significant distress or impairment to their daily life. Transvestic disorder is a rare diagnosis and is classified as a paraphilia, or atypical sexual behavior.

An individual with transvestic disorder may experience depression, guilt, or shame because of their urge to cross-dress. These feelings are often a result of disapproval from their partner or their own concern about negative social or professional ramifications.

Most people who cross-dress do not fit into the diagnostic standards of transvestic disorder. Cross-dressing is done for many reasons, including a desire to subvert gender norms. It can be seen as an act of sexual liberation or an exploration of one’s gender identity. Most people who experience transvestic disorder are heterosexual men.

One of the most common reasons people seek treatment for transvestic disorder is because it interferes with their romantic relationships or marriages with women.

15. Postpartum depression

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes.  Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns.  Onset is typically between one week and one month following childbirth.  PPD can also negatively affect the newborn child.

While the exact cause of PPD is unclear, the cause is believed to be a combination of physical, emotional, genetic, and social factors. These may include factors such as hormonal changes and sleep deprivation.  Risk factors include prior episodes of postpartum depression, bipolar disorder, a family history of depression, psychological stress, complications of childbirth, lack of support, or a drug use disorder. Diagnosis is based on a person’s symptoms.   While most women experience a brief period of worry or unhappiness after delivery, postpartum depression should be suspected when symptoms are severe and last over two weeks.

16. Pedophilia

Pedophilia is an ongoing sexual attraction to pre-pubertal children. It is a paraphilia, a condition in which a person’s sexual arousal and gratification depends on objects, activities, or even situations that are considered atypical. Pedophilia is defined as recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children—generally age 13 years or younger—over a period of at least six months. Pedophiles are more often men and can be attracted to either or both sexes.

Pedophilic disorder can be diagnosed in people who are willing to disclose this paraphilia, as well as in people who deny any sexual attraction to children but demonstrate objective evidence of pedophilia. For the condition to be diagnosed, an individual must either act on their sexual urges or experience significant distress or interpersonal difficulty as a result of their urges or fantasies. Without these two criteria, a person may have pedophilic sexual desires but not pedophilic disorder.

The prevalence of pedophilic disorder is unknown, as the social stigma around it does not invite people to self-identify. Estimates of its prevalence range from one to five percent of the male population. There are believed to be only a small fraction of a percent of women, if any at all, who experience pedophilia.

17. Sub-categories of ADHD

Attention deficit hyperactivity disorder (ADHD) is not a new condition. In fact, references to patients who had trouble focusing were observed by Hippocrates in ancient Greece.¹ Over time our understanding of ADHD has evolved and the terminology has changed.

The DSM (the official diagnostic manual used by clinicians to diagnose mental disorders) did not officially recognize the condition until 1980 Although initially described by the American Psychiatric Association as attention deficit disorder with or without hyperactivity, or ADD, today the term ADD is considered outdated (Inattentive Type ADHD is used instead).

In general, ADHD affects males differently than females—boys tend to externalize their ADHD symptoms (i.e. the stereotypical fidgety boy who can’t stay seated at school) making the symptoms more obvious than girls. Females tend to internalize their symptoms which may explain why boys are diagnosed with ADHD at higher levels than girls.³

“ADHD is not a single disorder,” says Alex Dimitriu, MD, founder of Menlo Park Psychiatry and Sleep Medicine in California. “It is a syndrome that involves dysregulation of certain neurological functions and a number of related behaviors.”

18. Dissociative amnesis

Dissociative amnesia is one of several dissociative disorders in which a person forgets key elements of their life, and is therefore divorced from a full understanding of themselves and their current state. It often following trauma or severe stress. In the case of dissociative amnesia, individuals suffer abnormal memory loss in ways that significantly disrupt their lives. They may forget a specific event, or they may forget who they are and everything about themselves and their personal history.

The person may or may not be aware of their memory loss though they may appear confused. Unlike those who develop medical amnesia after an injury or stroke, however, someone with dissociative amnesia rarely shows concern about their condition. It’s estimated that 1.8 percent of American adults experience dissociative amnesia in a given year.