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Psychology Assessment

Q1- what are anxiety disorders? (2)

Ans1- Earliest Clinically

onset significant

ANXIETY
Irrational fear
Disabling
intensity

Personal,
Unrealistic economic &
fear Health issue

 Anxiety is described as a feeling of unrealistic and irrational fears of various

intensities and frequencies that causes significant distress or impairment in
functioning. It is a feeling of apprehension and unpleasant emotions about possible
future danger. It is different from fear in the way that we experience fear from an
‘obvious’ source, for eg: fear of spiders, however in Anxiety there is no ‘obvious
source’ for the danger and we cannot specify a cause, for e.g.: worrying about the
school performance.
 The DSM has identified anxiety disorders as those which share the symptoms of
clinically significant anxiety or fear. It describes anxiety as excessive worry and
apprehensive expectations occurring for or more than 6 months, about a number of
events or activities such as work, parent’s health or overall performance.
 Anxiety Disorders create a huge amount of personal, economic and health care
problems for those affected and for society more generally. They have the earliest
onset of all mental disorders.
 There are three components of Anxiety:
Components Anxiety experienced
1. Cognitive / Subjective “I am worried about what will happen in
examination.”
2. Physiological Tension, nausea, chronic over-arousal
3. Behavioural General avoidance
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 The anxiety and worry are associated with three or more of the following six symptoms
with at least some symptoms present for more days or for the past 6 months:

i. restlessness
ii. easily fatigued
iii. difficulty concentrating or mind going blank
iv. irritability
v. muscle tension
vi. sleep disturbance such as difficulty falling or staying asleep, or restless and unsatisfying
sleep

 Some disorders recognised in DSM -5 are:

1. Specific phobia
2. Social anxiety disorder
3. Panic disorder
4. Agoraphobia
5. Generalised anxiety disorder

1. Specific phobia – when a person shows strong and persistent fear that is triggered by
the presence of a specific object or situation. For eg: fear of spiders, blood and
injection.
2. Social anxiety disorder: Social phobia (or social anxiety disorder), as the DSM-5
describes it, is characterized by disabling fears of one or more specific social
situations, for eg: public speaking, urinating in a public bathroom.
3. Panic Disorder : it is defined and characterized by the occurrence of panic attacks
that often seem to come “out of the blue.” According to the DSM-5 criteria for panic
disorder, the person must have experienced recurrent, unexpected attacks and must
have been persistently concerned about having another attack or worried about the
consequences of having an attack for at least a month.
4. Agoraphobia: it is defined as a fear of public places, In agoraphobia the most
commonly feared and avoided situations include streets and crowded places such as
shopping malls, movie theatres and even standing in a line.
5. Generalised anxiety disorder: it is defined as a worry about different aspects of life
even the minor events becomes chronic, excessive and unreasonable. For eg:
worrying about family, work, finances etc.

 Prevalence:
1. Women are more likely than men to have anxiety disorders.
2. 12 % of people have specific phobias at some point in their life. (Kessler, et al,
2005)
3. Social phobia is more common in women about 60% of sufferers are women.
(Bruce,et al, 2005)
4. 2/3rd of people with social phobia suffers from anxiety.
5. GAD is twice as common in women as in men. (Stein, 2004)
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Q2- with the help of a case study explain clinical picture of OCD.
Ans2 –

OCD

Obsessive Compulsive
thoughts behaviour

 Obsessive compulsive disorder is characterised by recurrent, intrusive and obsessive

unwanted thoughts along with repetitive behaviour performed in an attempt to
neutralize or rationalize such thoughts.
 People who suffer from such obsessions actively try to resist or suppress them or
rationalize them with some other thought.
For eg: constant hand washing, checking, counting, saying words again and again.
(Includes both overt and covert behaviour).
 This disorder used to be in the anxiety disorders in DSM earlier, but now in DSM-5
they are given a separate type of disorders.

 General warning signs of OCD:

i. Excessively seeking reassurance

ii. Resisting change
iii. Re-doing tasks
iv. Excessively washing hands, body and so on
v. Time consuming tasks
vi. Experiencing outbursts when not being able to complete things in a certain way
vii. Fear of harming others and themselves
viii. Excessive doubt

 Criteria for OCD according to DSM-5:

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A. Presence of obsessions, compulsions and both, obsessions are recurrent, persistent and
unwanted thoughts that mark anxiety and distress, compulsions are repetitive
behaviours in response to the obsessive thoughts.
B. The obsessions or compulsions are time consuming and cause significant distress and
impairment in social, occupational, and other areas of functioning.
C. These symptoms are not attributable to other physiological effects of a substance like
drug abuse, or another medical condition,
D. The disturbance is not better explained by the symptoms of another mental disorder,
for e.g.: excessive worry in GAD.

 Case study:
Aman is a 54-year-old man has been always described as an anxious person and remembers
being worried about a lot of things throughout his life. For instance, he reported he was very
afraid that he would contract HIV just by touching doorknobs, even though he tells that he
knew this was “irrational.” He then says, that about 10 years ago, following a few life
stressors, his anxiety and intrusive thoughts worsened significantly. He began washing his
hands excessively. He reported that he developed an intense fear that someone would break
into the house and it would be his fault because he left something unlocked. This fear led him
to repeatedly check doors and windows before sleep in a specific order, which was a source
of disagreement with his wife. His fear of making a mistake also leads him to be slow to turn
in work for his job, checking many times to make sure there are no mistakes, for which he
gets praised on occasion.

Aman reports that his symptoms are getting worse, which is why he has sought treatment. For
example, currently he washes his hands until he finishes the whole soap bar, and his hands
are cracked because they are so dry. He continues to check the doors and windows of his
house numerous times throughout the day, not just at night, and has on occasion driven home
from work to be sure everything truly was locked. If he notices even a speck of dust on the
floor, he states he has the urge to clean the whole house and he often complies with that urge.
He expresses significant distress over these symptoms, as they are taking up more of his time
and robbing him of his confidence, as he is increasingly distracted at work and in his family
life.

 In the above case study we can notice several symptoms that are leading to Aman’s
impairment in life and difficult to function, like:

 Anxiety
 Compulsive actions
 Concentration Difficulties
 Intrusive Thoughts
 Obsessive thoughts
 Irrational fear
 Worry
 Significant distress
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 Impairment in functioning
 Time consuming
 ‘stuck- routine’

 Interpretation:

Keeping in mind the criteria of OCD as per DSM-5 and irrational actions like – traveling
back from office to home to check if the door is locked properly, washing hands till the soap
bar is finished, not touching door knobs as to not get contracted with HIV, not able to sleep
properly because of safety issues as a result of obsessive thoughts and always considered as
an anxious person, creates impairment in functioning of a person and thus, this person is
diagnosed with OCD.

 Triggers of OCD:
Ongoing anxiety or stress or being a part of a stressful event like a car accident or starting
a new job could trigger OCD or make it worse.

 General Causes:
Experts are still not able to find the exact cause of OCD, but genetics, brain abnotmality
and environment are thought to play an important role in it.

 Prevalence:
I. Approximately 2-3% of people meet the criteria for OCD at some point in their
lifetime.
II. Over 90% of treatment seeking people suffer from both obsessions and
compulsions.
III. It doesn’t start in early childhood rather teenage or adulthood are the usual bars
for the onset.
IV. Childhood or early adolescent onset is more common in boys than girls and is
associated with greater severity.(Lomax et al,2009)

 Comorbidity with other disorders:

I. It frequently co-occurs with other anxiety disorders most commonly with social
phobia, panic disorder, GAD and PTSD.(Kessler, chiu, demler, et al,2005)
II. 25-50% or sufferers experience major depression at some time in their lives and
80% experience significant depressive symptoms. (Steketee & Barlow, 2002)
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Q3- Describe the clinical picture of Schizophrenia or Bi-polar Disorder.

Ans3-

Split in thought
process

Distorted
speech &
behaviour Impairment in
functioning
Schizophrenia

Complex
Distorted disorder
cognition

Loosing contact
with reality

 Schizophrenia can be defined as a sever disorder characterised by an array of diverse

symptoms which includes extreme impairments in perception, cognition, behaviour,
sense of self and others.
 The hallmark of schizophrenia is a significant loss of contact with reality and is
referred as Psychotic disorder.
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 Schizophrenia comprised of two words ‘schizo’ which means split or crack and
‘phren’ meaning mind, literally means a split in the mind, which gives the essence of
disorganization of thought processes, lack of corelation between thought and emotion
and loosing touch from reality. As it deteriorates the thinking of a person it is jnown
as a ‘debilitating disorder’.
 The social and psychological costs of Schizophrenia are tremendous both to the
patient and their family or society.

 Symptoms: can be divided into three categories-

1. Positive symptoms – excess of thought, emotion and behaviour.

2. Negative symptoms – deficits of thought, emotion and behaviour
3. Psychomotor symptoms

 DSM-5 criteria for schizophrenia are as follows:

A. The presence of at least two of the following five items, each present for a clinically
significant portion of time during a 1-month period, with at least one of them being
items 1), 2), or 3):

1) delusions,

2) hallucinations,

3) disorganized speech,

4) grossly disorganized or catatonic behaviour and

5) negative symptoms -e.g, decreased motivation

B. For a clinically significant portion of the time since the onset of the disturbance, the
level of functioning in one or more major areas (e.g., work, interpersonal relations, or
self-care) is markedly below the level achieved before onset, when the onset is in
childhood or adolescence, the expected level of interpersonal, academic, or
occupational functioning is not achieved.
C. Continuous signs of the disturbance persist for a period of at least 6 months, which
must include at least 1 month of symptoms.
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features
have been ruled out because either no major depressive, manic, or mixed episodes
have occurred concurrently with the active-phase symptoms or any mood episodes
that have occurred during active-phase symptoms have been present for a minority of
the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse or a medication) or another medical condition.
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F. If there is a history of autism spectrum disorder or a communication disorder of

childhood onset, the additional diagnosis of schizophrenia is made only if prominent
delusions or hallucinations, in addition to the other required symptoms or
schizophrenia, are also present for at least 1 month.

 Delusion:
It is a false belief that is firmly held on inadequate ground despite having contradictory
evidence, it is not affected by rational argument and has no basis in reality, It therefore
involves a disturbance in the content of thought.

There are several kinds of delusions:

1. Delusion of persecution: most common delusion in schizophrenia, belief that people
are plotting against them or spying them, feeling of being threatened, attacked or
deliberately victimised.
2. Delusion of reference: in this they attach special meaning to the actions of others or to
objects and events.
3. Delusions of grandeur: people believe themselves to be specially empowered persons
4. Delusions of control: they believe that their feelings, thoughts and actions are
controlled by others.
5. Thought insertion: thoughts are being inserted in their brain by some external agency.
6. Thought withdrawal: someone has robbed their thoughts.
7. Thought broadcasting: their private thoughts are broadcasted to others.

 Hallucinations:
It is a sensory experience that seems real to the person having it, but occurs in the absence of
the external perceptual stimulus.
They are of 5 kinds-
1. Auditory hallucinations are most common in schizophrenia. Patients hear sounds or
voices that speak words, phrases and sentences directly to the patient (second-person
hallucination) or talk to one another referring to the patient as (third-person
hallucination). Hallucinations can also involve the other senses.
2. Tactile hallucinations (i.e. forms of tingling, burning),
3. Somatic hallucinations (i.e. something happening inside the body such as a snake
crawling inside one’s stomach),
4. Visual hallucinations (i.e. vague perceptions of colour or distinct visions of people or
objects),
5. Gustatory hallucinations (i.e. food or drink taste strange), and
6. Olfactory hallucinations (i.e. smell of poison or smoke).
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 Disorganized speech:
It is the external manifestation of a disorder in thought form. Here an affected person
fails to make sense, despite seeming to using language in a conventional way. It is
also known as ‘derailment’ or ‘loosening’ of associations or in the most extreme form
is ‘incoherence’.
The listener is left with little or no understanding of the point the speaker is tryong to
make.
Neologism : words that patients make-up on their own and makes no sense, like: what
‘ding’ you?

 Disorganized behaviour: In this disorder there is an absence of goal-directed

behaviour, thus impairment occurs in in areas of routine daily functions such as work,
social relations and to self, to the extent that observers note that the person is not
himself or herself any-more. For example, the person may no longer maintain
minimal standards of personal hygiene.
 Catatonia: Catatonia is an even more striking behavioural disturbance. The patient
with catatonia may show a virtual absence of all movement and speech and be in what
is called a catatonic stupor.
 Negative symptoms: absence or deficit of behaviours that are normally present.
Important negative symptoms in schizophrenia include flat affect, or blunted
emotional expressiveness, and alogia, which means very little speech. Another
negative symptom is avolition, or the inability to initiate or persist in goal-directed
activities. For example, the patient may sit for long periods of time staring into space
or watching TV with little interest in any outside work or social activities.

 Epidemiology:

 The risk of developing schizophrenia over the course of one’s lifetime is a little under
1 percent- actually around 0.7 % (Saha et al,2005).
 The vast majority of cases of schizophrenia begin in late adolescence and early
adulthood with 18 to 30 years of age being peak (Tandon et al, 2009).
 In men there’s a peak between age 20 to 24, the incidence is same for women but their
peak is less marked than it is for men.
 The male to female ratio is 1:4:1 for every three men who develop schizophrenia only
two women do so (Aleman et al, 2003).
 The reason for better clinical outcome of women with schizophrenia is that female sex
hormones play protective role. When estrogen levels are low or are falling, psychotic
symptoms in women with schizophrenia often get worse (Bergemann et al, 2007).
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 Reference:

Hooley, J. M., Mineka, Susan, & Butcher, J. N. (2021). Abnormal psychology. Pearson
Education Limited.

By- Preshika Sharma

Roll no.- 210087
B.A Programme
(English + Psychology)