(b) APA (American Psychiatric Association)

The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision) is published by the American Psychiatric Association for the classification and diagnosis of mental disorders.

(c) Bipolar Disorder

Bipolar Disorder involves alternating episodes of mania (elevated mood, excessive energy) and depression (persistent sadness, loss of interest).

(b) Positive symptoms of schizophrenia

Positive symptoms are “additions” to normal experience — delusions (false beliefs) and hallucinations (perceiving things that are not there) are hallmark positive symptoms of schizophrenia.

(b) Specific Phobia

A specific phobia involves intense, irrational fear triggered by a particular object or situation (e.g., fear of heights = acrophobia, fear of spiders = arachnophobia).

(c) Dissociative Identity Disorder (DID)

DID involves the presence of two or more distinct personality states. It was previously called “multiple personality disorder.” Note: Schizophrenia is NOT the same as DID — a common misconception.

The biopsychosocial model proposes that psychological disorders arise from the interaction of three types of factors:

1. Biological factors — genetics, neurotransmitter imbalances, brain abnormalities, hormonal disturbances
2. Psychological factors — maladaptive thinking, unresolved conflicts, faulty learning, low self-esteem
3. Social/cultural factors — family dysfunction, poverty, discrimination, traumatic experiences, cultural pressures

Rather than attributing disorders to a single cause, this model emphasises that it is the combination and interaction of these factors that leads to psychological disorders.

In OCD, obsessions and compulsions are linked — the compulsion is an attempt to neutralise the anxiety caused by the obsession.

Major Depressive Disorder (MDD) is characterised by the following symptoms lasting at least 2 weeks:

1. Persistent depressed mood — feeling sad, empty, or hopeless most of the day
2. Anhedonia — loss of interest or pleasure in almost all activities
3. Significant weight changes — unintentional weight loss or gain
4. Sleep disturbances — insomnia or hypersomnia
5. Psychomotor changes — agitation or retardation
6. Fatigue — loss of energy nearly every day
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating — indecisiveness
9. Recurrent thoughts of death — suicidal ideation or attempts

At least 5 of these symptoms must be present, including either depressed mood or anhedonia.

Anxiety disorders involve excessive, persistent, and often irrational fear or worry that significantly interferes with daily functioning.

General symptoms of anxiety:

• Excessive worry and restlessness
• Rapid heartbeat, sweating, trembling
• Difficulty concentrating
• Muscle tension and fatigue
• Sleep disturbances

Major types:

1. Generalised Anxiety Disorder (GAD): Persistent, excessive worry about multiple areas (work, health, finances) for at least 6 months, even when there is no apparent reason for concern.

2. Panic Disorder: Recurrent, unexpected panic attacks — sudden surges of intense fear reaching a peak within minutes. Physical symptoms include pounding heart, chest pain, shortness of breath, dizziness, and fear of losing control or dying.

3. Specific Phobia: Intense, irrational fear of a particular object or situation (e.g., acrophobia — fear of heights; claustrophobia — fear of enclosed spaces). The fear is disproportionate to the actual danger.

4. Social Anxiety Disorder (Social Phobia): Intense fear of social situations where one might be scrutinised, judged, or embarrassed. This often leads to avoidance of social interactions, public speaking, or performance situations.

All anxiety disorders share the feature of disproportionate fear that is not justified by the actual threat, and they cause significant distress or impairment in daily functioning.

Schizophrenia is a severe, chronic mental disorder that affects thoughts, perception, emotions, and behaviour. It typically appears in late adolescence or early adulthood.

Positive Symptoms (additions to normal experience):

1. Delusions — firmly held false beliefs. Examples: delusions of persecution (believing others are plotting against you), delusions of grandeur (believing one is a famous person or has special powers).
2. Hallucinations — sensory experiences without external stimuli. Most common are auditory hallucinations (hearing voices), but visual, tactile, and olfactory hallucinations can also occur.
3. Disorganised speech — incoherent, tangential, or illogical speech patterns; jumping from topic to topic without logical connection.
4. Disorganised behaviour — unpredictable, inappropriate behaviour; difficulty performing goal-directed activities.

Negative Symptoms (reductions or losses of normal functioning):

1. Flat affect — little or no emotional expression; monotonous voice, blank facial expression.
2. Alogia — poverty of speech; very brief, empty responses.
3. Avolition — lack of motivation to initiate or sustain activities; difficulty maintaining hygiene, work, or social interactions.
4. Anhedonia — inability to experience pleasure.
5. Social withdrawal — reduced desire for social contact.

Note: Positive symptoms tend to respond better to medication (antipsychotics) than negative symptoms, making negative symptoms a significant challenge in treatment.

(a) Both A and R are true and R is the correct explanation of A

The fear of open or public spaces is called agoraphobia. It is a type of phobia characterised by intense, irrational fear that leads to avoidance of the feared situation. The reason correctly explains that phobias involve irrational fears leading to avoidance, which is exactly what the assertion describes.

(i) Vikram is most likely suffering from Post-Traumatic Stress Disorder (PTSD).

(ii) Three supporting symptoms:

1. Flashbacks and nightmares — he re-experiences the traumatic event through vivid flashbacks and nightmares (intrusion symptoms)
2. Avoidance — he avoids driving or being a passenger, avoiding stimuli associated with the trauma
3. Emotional numbness and withdrawal — he has become emotionally numb and distant from family and friends (negative alterations in cognition and mood)

(iii) PTSD falls under Trauma- and Stressor-Related Disorders in the DSM-5-TR.

(iv) Cognitive Behavioural Therapy (CBT), specifically exposure therapy, could help Vikram. In exposure therapy, the therapist gradually and safely exposes Vikram to the feared stimuli (e.g., sitting in a parked car, then a moving car) in a controlled manner. This helps him confront the traumatic associations, reduce avoidance, and learn that the feared situation is no longer dangerous. Over time, the anxiety response diminishes through the process of extinction.

(i) Anorexia nervosa is a severe eating disorder characterised by extreme restriction of food intake, an intense fear of gaining weight, and a distorted body image, leading to dangerously low body weight.

(ii) Two psychological symptoms:

1. Intense fear of gaining weight — despite being severely underweight, the individual is terrified of weight gain
2. Distorted body image — the individual perceives themselves as overweight even when they are dangerously thin

(iii) Anorexia is particularly dangerous because severe malnutrition can lead to life-threatening medical complications including cardiac arrhythmia (irregular heartbeat), kidney failure, bone density loss (osteoporosis), muscle wasting, and in extreme cases, death. It has one of the highest mortality rates of any mental disorder.

(iv) Bulimia Nervosa is another eating disorder. Unlike anorexia, individuals with bulimia:

• May maintain a normal or near-normal weight (rather than being severely underweight)
• Engage in recurrent episodes of binge eating (consuming large amounts of food rapidly) followed by compensatory behaviours (self-induced vomiting, misuse of laxatives, excessive exercise)
• Experience feelings of loss of control during binges and intense shame or guilt afterward

The key difference is that anorexia involves severe food restriction, while bulimia involves a binge-purge cycle.