Important Questions for IGNOU PGDCFT MSCCFT MCFT002 Exam with Main Points for Answer - Unit 11

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Unit 11 Neurotic Disorders

1. List the major anxiety disorders which are classified under neurotic disorders.

The major anxiety disorders which are classified under the neurotic disorders are listed below:

i) Social phobias,

ii) Panic disorder,

iii) Generalised anxiety disorder,

iv) Obsessive compulsive disorder, and

v) Agoraphobia.

2. Name the theories that explain causes of neurotic disorders.

The theories that explain the causes of neurotic disorders are given below:

i) Neurotransmitter theory,

ii) Psychoanalytic theory,

iii) Learning theory,

iv) Social learning theory,

v) Cognitive theory, and

vi) Trauma theory

3. What are the common co-existing mental illnesses with neurotic disorders?

The common co-existing mental illnesses with neurotic disorders are listed below:

i) Depression,

ii) Anxiety disorders, (Specific phobias, Social phobia, Generalised anxiety disorder and Panic disorder),

iii) Substance use, (nicotine, alcohol, cannabis and benzodiazepines),

iv) Personality disorders, and

v) Somatoform disorders.

4. What are the predominant irrational fears in social phobias?

The predominant irrational fears in social phobias are given below:

i) Fear of scrutiny or evaluation by other people,

ii) Fear of criticism by other people,

iii) Fear of rejection by other people, and

iv) Fear of losing control in front of others.

5. Enumerate the main clinical characteristics for recognising social anxiety disorders.

The main clinical characteristics for recognising social anxiety disorders are listed below:

i) The individual has noticeable or persistent fear of one or more social (social get-togethers, marriages) or performance situations (oral presentations, group discussions) in which the person faces possible evaluation by others. The person feels that he or she would behave in a manner or display anxiety symptoms that would be humiliating or embarrassing for him or her.

ii) When the individuals face these feared social situations, it always provokes anxiety within them. Anxiety symptoms are characterised by increased heart rate, sweating, feeling of shortness of breath, feeling of choking, stammering or discomfort, nausea, numbness, fear of losing control or going crazy.

iii) The individual avoids the feared social situations or performance situations.

iv) Social anxiety interferes significantly with occupational functioning or social activities or relationships.

6. How can you identify that a person is suffering from generalised anxiety disorder?

Following are the clinical characteristics to recognised the generalised anxiety disorder:

The individual experiences frequent, persistent, excessive worry and anxiety,
The individual finds it difficult to control the worry,
Presence of apprehensive expectation which is typically of negative outcome about a number of events or activities (such as work or school or college or office performance),
The individual’s anxiety and worry is usually associated with some of the following symptoms which are present on most of the days for at least a period of six months.

Restlessness or being unable to relax or feeling of being on edge,
Easily fatigued,
Difficulty in concentrating on activities,
Irritability in most activities,
Muscular tension, and
Sleep disturbances (difficulty in falling asleep or staying asleep or restless/unsatisfying sleep).

The anxiety or worry is not related to any particular set of events or situations and is prevalent across all situations and tasks (free floating anxiety), and
The individual’s anxiety, worry or physical symptoms cause significant amount of distress or lead to impairments in social and occupational functioning.

7. List the clinical characteristics of obsessive compulsive disorder

The clinical characteristics of obsessive compulsive disorders are described below:

i) Obsessions are repetitive, persistent, thoughts, images or impulses,

ii) Obsessions experienced are excessive, distressing and/or anxiety provoking.

iii) The individual is able to recognise that the obsessions are coming from his or her own mind,

iv) Unable to suppress or ignore obsessions, however, the individual performs repeated acts (compulsions) that may provide transient reduction in anxiety/discomfort,

v) Compulsions are repetitive behaviours or mental acts that the individual feels driven to perform when obsessions occur,

vi) Compulsions are performed for preventing or reducing distress or preventing occurrence of some unfavorable event or situation.

vii) Compulsions are recognised by the individuals as excessive, distressing or unreasonable, and

viii) Both obsessions and compulsions significantly interfere with the individuals’ normal routine, occupational functioning or usual social activities or relationships.

8. Give examples of some common obsessions and compulsions.

Some common obessions are:

i) Repeated thoughts about contamination (individual feels excessively concerned with contamination from dirt, germs, urine faeces, or other environmental contaminants).

ii) Repetitive doubts (whether doors, locks, taps, gas stove knobs have been closed property or not).

iii) A need to have things in a particular order (excessive need for arranging clothes, shoes, papers and items at home properly and meticulously),

iv) Aggressive impulses (fearing that they might physically hurt someone), and

v) Sexual thoughts or imagery (individual gets personally unacceptable sexual thoughts and images).

Some common compulsions are as follows:

i) Washing and cleaning (excessive hand washing, bathing, tooth brushing, grooming, excessive cleaning of items and objects used by others and avoiding to use them),

ii) Counting (counting number of stairs, number of tiles used for walking over),

iii) Repetitive checking (doors, locks taps, gas stove knobs),

iv) Arranging clothes, shoes, papers, and other items properly and meticulously,

v) Repeating daily activities, and

vi) Re-reading re-writing.

9. List the clinical characteristics of a panic attack

The clinical characteristics of a panic attack are given below:

i) Increased heart rate or pounding heart or palpitations,

ii) Sweating,

iii) Trembling or shaking,

iv) Sensations of shortness of breath or breathlessness,

v) Sensations of choking,

vi) Feeling dizzy, lightheaded and unsteady,

vii) Nausea or abdominal discomfort,

viii) Fear of losing control or going crazy,

ix) Fear of dying,

xi) Sensations of numbness or tingling sensations, and

xi) Restlessness.

10. How can one identify that a person is suffering from a panic disorder?

The following characteristics indicate that the person is suffering from a panic disorder:

i) Recurrent panic attacks in circumstances where there is no objective danger,

ii) The unexpected occurrence (panic attacks without any reason) of panic attacks without being confined to known or predictable situations,

iii) A persistent fear of having another panic attack (anticipatory anxiety), and

iv) Individual worries about the consequences of a panic attack (for example losing control, having a heart attack or going crazy).

11. What are the predominant irrational fears in agoraphobia?

The predominant irrational fears in agoraphobia are given below:

i) Fear of not finding easy escape,

ii) Fear of losing control in front of others,

iii) Fear of moving away from home,

iv) Fear of having dizziness and falling down, and

v) Fear of something going wrong and not being able to get easy help.

12. What are the risk factors that are associated with somatoform disorders?

Following are the risk factors that may lead to somatoform disorders:

i) Severe ongoing stressors,

ii) Marital/family discord,

iii) Poor social support,

iv) Financial loss,

v) Living with a family member who has the disorder,

vi) Parental substance abuse, and

vii) Antisocial personality disorder in a family member.

13. What are the three domains of post traumatic stress disorder?

Following are the three domains of post traumatic stress disorder:

i) Re-experiencing and re-living the traumatic event (repeated thoughts/ images/flash backs/dreams/nightmares);

ii) Avoidance of the stimuli associated with the trauma; and

iii) Experiencing symptoms of increased autonomic arousal (sweating, increased heart beat, difficulty in falling asleep or staying asleep, excessive vigilance of environment).

14. What are the stages of normal grief?

The three stages of normal grief are given below:

i) First phase: Shock, disbelief, numbness and denial followed by searching behaviours lasting for days to weeks.

ii) Second phase: Intense somatic distress, preoccupation with the deceased, anger, restlessness, bargaining, feeling of sadness, guilt, depressive symptoms, helplessness, hopelessness and impairment in functioning lasting for days to weeks.

iii) Third phase: Restitution and reorganisation (acceptance) lasting months.

15. How do you differentiate between neurosis and psychosis?

Signs and Symptoms

Neurotic disorders: Anxiety attacks, worry, multiple aches and pains, poor attention and concentration, recurrent thoughts, and other stress-related symptoms.
Psychotic disorders: Delusions, hallucinations, and disorganization.

Occurrence

Neurotic disorders: 15-20%
Psychotic disorders: Less than 1%

Insight into their illness

Neurotic disorders: Usually present
Psychotic disorders: Usually absent

Behaviour of the patients

Neurotic disorders: Usually does not violate social norms
Psychotic disorders: Usually violates social norms

Rational thinking

Neurotic disorders: Usually present
Psychotic disorders: Usually absent

Disability

Neurotic disorders: Present
Psychotic disorders: Present

16. Explain the types of social phobia.

Types of social anxiety disorder (Social Phobia)

Generalised Social phobia: Involves almost all social situations outside the family circle. Extreme cases may result in almost complete social isolation
Performance related Social Phobia: Restricted to public speaking, to eating in public, or to encounters with the opposite sex

17. Write a short note on somatoform disorder.

Somatoform means taking the “form of” or “in soma” (that is, body), which implies that this illness is nonsomatic. Somatoform disorders are usually encountered in primary health care and general hospital settings.

In somatoform disorders, a common feature is the presence of multiple physical symptoms (abdominal pain, headaches, back ache, neck pain, joint pains, nausea, vomiting, impaired balance, loss of touch and unusual sensations of pain or discomfort) which cannot be fully explained by presence of general medical conditions or illness. Hence, these symptoms are also called, ‘medically unexplained symptoms’.

Individuals with somatoform disorders usually describe their physical complaints in an exaggerated and dramatic manner.

18. Explain the management of neurotic disorders. Illustrate with the help of examples.

Neurotic disorders are a group of mental disorders that cause distress and impairment in functioning, but don't involve a break from reality like psychosis. They are characterised by symptoms like anxiety, obsessions, compulsions, and physical complaints that can't be fully explained by medical conditions.

There are several key approaches to managing neurotic disorders:

Assessment: A thorough evaluation is crucial, involving a detailed history of the patient's symptoms, their impact on daily life, and any past medical or psychiatric history. This helps to arrive at a diagnosis and plan the most appropriate treatment.
Psychoeducation: Educating the patient and their family about the disorder is vital. This helps to demystify the condition, reduce stigma, and improve treatment adherence. Key aspects include explaining the nature of the disorder, its potential causes, treatment options, and the importance of family support.
Medication Management: Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for neurotic disorders. They work by increasing the availability of serotonin in the brain, which helps regulate mood and anxiety. It's crucial to individualise the dosage and monitor for side effects.
Stress Management: Many neurotic disorders worsen during stressful times. Stress management techniques can help patients cope with anxiety and prevent relapses. These techniques include relaxation methods, time management, problem-solving skills, and healthy lifestyle habits.
Supportive Therapy: This form of therapy provides a safe and non-judgmental space for patients to discuss their feelings and develop coping mechanisms. It can help reduce anxiety, build self-esteem, and improve problem-solving abilities.
Cognitive Restructuring: This technique helps patients identify and challenge negative thought patterns that contribute to their anxiety. By learning to reframe their thoughts, they can reduce anxiety and improve their emotional responses.

Examples of how these techniques are used in specific neurotic disorders:

Social Anxiety Disorder: Exposure therapy, a form of cognitive-behavioural therapy, is often used. It involves gradually exposing the individual to feared social situations while practicing coping skills to manage anxiety.
Panic Disorder: Interoceptive exposure can be helpful. This involves intentionally inducing panic-like sensations, such as increased heart rate, to help the individual become habituated to these feelings and reduce their fear.
Obsessive Compulsive Disorder: Exposure and response prevention is a common approach. It involves exposing the individual to their obsessions while preventing them from engaging in compulsions, thereby breaking the cycle of anxiety and ritualistic behavior.

It is important to involve the family in the management of neurotic disorders. Family members can provide support, encouragement, and assistance with treatment adherence. Family therapy can also help address any family dynamics that might contribute to the disorder.

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