Psychological Disorder- Psychological
disorders, also known as mental disorders, are patterns of behavioral or
psychological symptoms that impact multiple areas of life. These disorders
create distress for the person experiencing these symptoms.We can say that
shychological disorders are “health
conditions that are characterized by alterations in thinking, mood, or behavior
(or some combination thereof) associated with distress and/or impaired
functioning.”
According to International classification
of diseases (ICD-10) states that 'pshychological disorders' comprise of deeply
ingrained and enduring behavioral patterns, manifesting themselves as
inflexible responses to a broad range of personal and social situations. They
represent extreme or significant deviation from the manner in which an average
individual in the given culture perceives, thinks, feels, and particularly
relates to others. They are frequently, though not always, associated with
varying degrees of subjective distress and problems in social functioning and
performance. These patterns are usually evident during late childhood or
adolescence, but the requirement to establish their stability and persistence
usually (but not necessarily) restricts the use of the term 'disorder' for
adults.The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV)
definition is similar, although it is more explicit, and emphasizes the impulse
control problems that many patients with personality disorders would have.
Classification of
Pshychological Disorder –
1. Mood Disorders
2.
Impulse-Control
Disorders
3.
Factitious
Disorders
4.
Eating Disorders
5.
Adjustment
Disorders
6.
Anxiety
Disorders
7.
Cognitive
Disorders
8.
Developmental
Disorders
9.
Dissociative
Disorders
10. Mental Disorders Due to a General
Medical Condition
Causes
of Pshychological Disorder- The main causes of pshyological
disorder in life are:
1.
Genetics (heredity)
2.
Tension at work or within the family
3.
Divorce
4.
Death in family
5.
Moving
6.
Jail term
7.
Marriage
8.
Debt
9.
Unemployment
10.
Major life changes
11. Infections
12.
Brain defects or injury
13. Prenatal damage
14. Substance abuse:
15.
Other factors:-Poor nutrition and exposure to toxins, such as lead, may play a role in
the development of mental illnesses.
How
Prevalent Are Psychological Disorders?
Relatively recent research has revealed that
psychological disorders are far more prevalent that previously believed.
According to the National Institute of Mental Health (NIMH), approximately 26
percent of American adults over the age of 18 suffer from some type of
diagnosable mental disorder in a given year.
The 1994 National Comorbidity Survey (NCS)
indicated that 30 percent of respondents had experienced symptoms of at least
one psychological disorder in the previous year. The survey also indicated that
nearly half of all adults experience some form of mental disorder at some point
in their life.
Clinical
studies-
Early studies (that did not employ diagnostic
instruments or operationalized criteria) on clinical samples from India
reported prevalence rates of 0.3-1.6%. However, the rates were
higher in special populations such as university students (19.1%); criminals (7.3-33.3%); patients with substance use disorders
(20-55%); and patients who
attempted suicide (47.8-62.2%). Studies
employing comprehensive protocols for assessment (which were, however, not
standardized for use in the Indian population) have yielded high rates of
personality pathology in patients with anxiety disorders, such as, social
phobia; drug dependence (25.6%); and mood disorders (37.5% in patients
with bipolar disorder and 40.8% in those with major depressive disorder).The
study on mood disorders used a self-report format for assessing personality
disorders, which is known to overestimate the prevalence of these disorders.
Community
studies-
Four general population studies done in the late
1980s and early 1990s that used assessment instruments specific to personality
disorders established the high (and consistent) prevalence of these disorders
(10.3 to 13.5%) in developed countries.More recent studies have upheld these
results. The sex ratio was different for specific types of personality
disorders, although the overall rate of prevalence was roughly equal for the
two sexes.Reddy and Chandrashekar conducted a meta-analysis of 13 epidemiological
studies from different parts of India.The prevalence of personality disorders
was assessed in seven studies and the rate varied from 0 to 2.8%, with the
weighted prevalence rate being 0.6%. Personality disorder diagnosis was
significantly associated with the male gender. Prevalence rates of personality
disorders may be lower in developing countries, but the methodological
shortcomings of surveys preclude direct comparisons with the western data. Most
of the general population epidemiological studies conducted in India have
neglected co-morbidity and dual diagnosis, and have used screening instruments
with low sensitivity and single informants; hence, they systematically
underreport the prevalence.
Studies
in relation to self-harm-
The rate of personality disorders in subjects who
have demonstrated acts of self-harm have varied from 7% to 64%.Methodological issues probably play a major role in
the discrepancy of prevalence rates between studies. Nath et al, used the International
Personality Disorder Examination (IPDE) to assess outpatients and inpatients,
who presented with a history of self-harm at any point in their life, in two
age groups (15-24 years and 45-74 years). Sixty-four percent of the older group and 58.5% of
the young subjects were reported to have a personality disorder. In the young
group the most common personality disorder was the emotionally unstable
personality disorder (28.6%) and anankastic personality disorder (11.7%); while
in the older group, the anankastic personality disorder (34.5%) and emotionally
unstable personality disorder (13.8%) were the most common personality
disorders. The fact that all patients could be interviewed despite reluctance
on the part of some (due to medico-legal concerns), and because the interview
took approximately one hour (which is shorter than usual for those with a
positive diagnosis), suggests that the subjects may have responded with a
affirmative bias toward the questions. The fact that a local language version
of the IPDE was not yet available, may also have led to some randomness in the
responses. That only 5% of the young and none of the older patients had more
than one personality disorder diagnosis, was surprising, in light of the high
prevalence of personality disorders.
Chandrasekaran et al., assessed 341 survivors
(93% of all survivors, over a one-year period) after their first suicide
attempt from a general hospital. Only 7% received
a personality disorder diagnosis according to ICD 10 IPDE. The inclusion of the
first attempt cases may have led to a low rate of diagnosis of emotionally
unstable personality disorder (and consequently of any personality disorder).
Other systematic biases could have been introduced by use of two interviewers
and consensus diagnosis for all cases (the diagnostic process may have become
too stringent). The article does not explicitly state it, but it is probable
that the authors used the IPDE screening questionnaire for selecting subjects
for the full interview; the sensitivity of the screen should have been
assessed/mentioned to help in the interpretation of the findings of the study.
The authors have quoted a study by Lathaet al., which yielded a (similar)
prevalence rate of 12% for personality disorders in those attempting self-harm,
but the latter study reached a diagnosis without using a standardized
instrument and hence the two studies are not strictly comparable. A study that only assessed the
presence of borderline personality disorder with a semi-structured interview,
in patients who had made a suicide attempt, yielded a much higher rate of 18.3%
for this single diagnosis.
Classification
system preferred in Indian research-
The ICD-10 and DSM-IV are different, but
overlapping classification systems. Both have adopted a polythetic approach as
against a monothetic approach, in which none of the listed criteria are
essential to make a diagnosis, any combination of a required number of criteria
would lead to the diagnosis. There are some differences in the nomenclatures,
for example, anankastic personality disorder in ICD-10 is obsessive-compulsive
personality disorder in DSM-IV. In ICD- 10, schizotypal disorder is considered
to be an attenuated manifestation of schizophrenia and is categorized with
psychotic disorders, while, narcissistic, depressive, and passive-aggressive
personality disorders do not find a mention. There are also several marked
differences in the criteria of the two systems and some minor variations in the
wordings. Finally, the two schemes differ, in that, DSM separates state- and
trait-based disorders on two axis and provides for clusters of personality
disorders; while the ICD-10 diagnostic guidelines do not place the personality
disorders and state disorders on separate axis or subdivide personality
disorders into clusters. It is obvious from the above-mentioned studies that
ICD 10 has found greater favor with the Indian researchers, probably because of
its easier application in clinical practice (retrospective studies) and greater
accessibility of IPDE, as it was developed by the World Health Organization.
What is happening?
When we are under prolonged stress, our
brains search desperately for ways to relieve the pressure. Often, if a person
cannot find effective ways of coping or does not have a good support system,
they can end up sinking deeper into negative thoughts and behaviours that
affect daily functioning. As our bodies and minds are closely linked, a cycle
of reinforcement develops that creates or exacerbates an internal imbalance.
Some of the effects of this imbalance
can include:
o Persistent negative
thoughts including a preoccupation with death or suicide
o Difficulty
concentrating
o Low energy or
severely fluctuating energy levels
o Hearing voices
o Wanting to spend
excessive amounts of time alone
o Inappropriate and
uncontrollable behaviour: excessive anger or sadness for example
o Severe paranoia
Each of our lives is precious for its
unique potential - if something within you is dragging you down, affecting your
abilities and therefore holding you back, you should address it and give
yourself the tools and the strength to get on with your life.
Consclusion-
The field of pshychological disorders is at a
nascent stage of development in India. From a situation of almost no articles
specifically focused on personality pathology till the 1980s, there is now a
trickle. However, to date, the focus is understandably but entirely on clinical
epidemiology. Although there are very few methodologically robust studies, the
increasing familiarity with the field and its methodological nuances augers
well for the future. There is obviously a need for better and more studies in
relation to pshychological disorders on methodology and epidemiology
(particularly community studies), and also on cultural and classificatory
issues. There is also a need for studies to populate the vast open swathes in
terms of etiology, clinical features, assessment, management, course and
outcome, and on the various debates that mark the personality disorder field,
for example, whether personality disorders, as conceptualized today, are valid
entities; the boundary issues between personality disorders and normal
personality traits on the one hand and mental state disorders on the other; and
the organization of personality disorder in dimensional or categorical terms.
