Hello young people, budding psychologists. Ready to learn more about psychology? Yes, we have just started and I am sitting out of Adayu, a Fortis network hospital, which is an acute psychiatry and de-addiction facility and my colleague Manya. You should know that this is the person who's managing the back end. This is the person who's deleting your messages and removing you and banning you and things like that, which I think is a fabulous thing to do because I do feel that academics is about dignity, enjoyment and not about unkind messages. Having said that, today is very important. We look at various disorders and we look at various disorders with the ultimate OG Dr. Mimansa Singh Tanwar and we'll flip a coin and see whether we are going to be able to hear Mimansa Singh Tanwar ma'am or not. Uh Mimansa, can you please introduce yourself so that we can know whether how much I'll have >> Are you able to hear me? >> Sort of. >> Are you able to hear me? >> Yes, loud and clear and if you can maintain it uh throughout the session, it'll be nice. I'm fine, thank you all of you. Pleasure meeting young people and more importantly people who are going to shape the future of psychology and Mimansa is gone, so I think we'll let Manya continue with the sessions. Uh so um as we continue, uh Manya, can you also put on the presentation slides, please? And we start. Today we are going to talk about spectrum of mental disorders developing the clinical understanding. For some reason, you may have an issue with the alignment, but I'm not sure whether it is me, you, or clearly them. Since it is them, then you know the person doing it. They know it, so you can just change the slide and not embarrass me or yourselves. And I will let these two brilliant people talk about this, but more importantly, I'm going to just share my thoughts. People will come and tell you why use diagnosis. People will come and tell you why do you have a diagnostic name. People will use the wrong terms of labeling, but they don't say that for diabetes, they don't say that for hypertension, they don't say that for cardiac, they don't say it for other illnesses. I think it's time that one needs to understand an illness is an illness. The labeling happens when we use mental illnesses as slurs. When we start using them loosely, and that creates stigma. That's create perceived sense of discrimination. The stigma and the perceived sense of discrimination put together reduces help-seeking behavior. The reduced help-seeking behavior makes individuals and their families struggle in silence, whereas treatment is available. Today, three in four people do not seek treatment primarily because of these factors, and that's why it is important to be a change maker. On that note, we'll let Mimansa speak, and we'll wish a happy deleting day to Manya. >> Mam, have you also pinned the attendance since all the students are asking for it? >> Uh she was busy here, and she didn't know that I was going to get her on live, so I think she's just coming out of that that shock, so I have to say. Also, when we talk about illness, focus on the last line on this slide, and for a change, I'm actually able to read it because after 3 days, they've been actually able to take care of the font size, haven't they? It is impairment of functionality, which basically means mere presence of a symptom is not the disorder. Mere presence of a symptom is not a disorder. An illness becomes an An illness becomes an illness when there is also impairment of functionality, which is psychosocial functioning, emotional functioning, occupational works, all this stuff, academics, so on and so forth. Like functionality. Second, it's not half an hour, 1 hour kind of thing. Based on illnesses, there is a very clear duration. And in that duration, you have a consistency of symptoms. They tend to be pervasive, and they cause impairment. So, before we go to specific diagnosis, we need to understand this aspect. Attendance link is going to be shown put up. It will also be put as pin. Uh Manya.Kanna at fortishealthcare.com. If you could kindly do the needful and change the slide. So, from emotional changes, which is mood, from changes in our physiological aspect, appetite, weight, sleep, from changing in our social aspect, which is friends, family, colleagues, our interactions, more, less, different, behavioral changes, withdrawn, uh substances, aggressive outbursts, violent behavior, uh sense of disinhibited behavior or withdrawn, or changes in our output, which is academic performance or day-to-day functioning. We talked about judgment the other day, right? So, when a cluster of this put together, then it may be a mental illness if there is impairment of functionality, if there is consistent presence of symptoms. And now we let Mimansa speak about her thing, but okay, I I Oh my god, the font is back just when I thought they won't do the font on me again. They did the font again, but okay, I'll ask the question. You people answer. Mimansa will do the explanation. Seven-year-old brought by the school counselor. Concerns are social interaction and behavioral patterns. Teachers reported that this child prefers playing alone, often focuses on personal interest, struggles to understand peer emotions. At home, parents realize that this child becomes distressed when their daily routine are impacted. Can recall details about a favorite cartoon character, but finds it difficult to engage in other topics. Parents also observed a struggle with eye-to-eye contact during conversation. Loud noises bring irritability, bring a startled response. Academically performs well, but teachers have also started noticing certain repetitive movements. Tell me, what is the diagnosis, young people? Okay, ignore the attendance and focus on the question and give me a diagnosis. >> What are the signs that you can see over here? >> need your attendance. Give me the diagnosis. >> Yes, some people have given the right answer. >> Yes, two have. I like more, and then I'll tell you what it is. Now, give me the full answer. Full answer. Give me the full thing. Yes, and there you go. Now, it's all yours. >> Autism spectrum disorder. That's correct. And that's what we call this. We call it as a spectrum of disorder and not just merely autism. And that's a change in the new DSM-5 TR our manual for clinical diagnosis where we look at what are some of the symptoms. Symptoms are persistent pervasive deficits in social communication, in social interaction across multiple contexts. That means it's not merely connected to the home environment or merely to the school environment. If it is merely school where a child is not speaking, there is also a clinical diagnosis and a term for that which is selective mutism. But what we are looking at over here is that there is a difficulty that the child tends to face in social communication where it's about the social emotional emotional understanding. And that's how then the child is able or unable to reciprocate to what the parent or the teacher or a same-age peer is saying. So deficits in social and emotional reciprocity difficulty in nonverbal communicative behaviors as well. So unable to either understand nonverbal communication or even communicate through nonverbal gestures. And at the same time, what they also find difficult is difficulty in developing maintaining and understanding relationships because communication and social interaction is one of the significant aspects to maintain relationships. So for a moment, let's take example of you are unable to understand the emotionality of what your friend is saying to you. You also tend to feel a certain sense of awkwardness in how you are feeling or let's say communicating to your friend. And that aspect in itself makes me recognize that I'm unable to maintain my social communication and conversations. So there is a deficit in that and along with that there are other symptoms and signs that you look at which is restricted, repetitive patterns of behavior, interests, or activities. So stereotypical or a repetitive motor movement, stereotyped, or a repetitive motor movement where an object um an interest in a certain part of the object. So let's say if the child is playing with car, uh the interest of the child is to continue to just keep opening the entire mechanism of the car and then redoing the car and having that kind of an obsessive interest in that. Um motor movement would be something like, you know, for example, just moving back and forth as a repetitive motor movement. Speech, echolalia, stereotyped or repetitive speech is echolalia. What we also did in day one. Insistence on sameness or inflexible adherence to routine, which means there is a certain ritualization that needs to be there. There has to be a certain sense of predictiveness that needs to be there in the day. What time they eat, what do they eat, what do they wear. All of these things there can be a rigidity to that, because they may be quite uncomfortable to change. Highly restricted or fixed interests, and Manya is wants me to go ahead quickly. Fixated interests that are abnormal in intensity. Fixated as in if I have an interest in one particular thing, so I continue to just keep doing that. And hypo or hyper-reactiveness to sensory input. For example, a certain decibel of a sound, which is not very high, may still make me feel quite uncomfortable about that. Or a certain kind of a uh touch, noise, sound of a whistle, for example, could be quite uncomfortable for my sensory receptiveness. What we look at as a prevalence rate, and it's important for us to also understand the prevalence rate, because we do tend to sometimes very loosely misdiagnose ourselves when we read online the kind of symptoms that you may experience, or the way we think that this particular disorder is so if I can see in this this this this this, I see that around in my friends, you must understand that there is a prevalence rate, a statistical ratio to each disorder that is prevailing um in in the population. So over here it is 1 to 2%, and it's similar the estimates are the ratio is the similar when it comes to adults and child. Another case study for you. A 9-year-old is referred by the school counselor. Uh Ongoing concerns are around behavior and classroom performance. Teachers report that frequents clearly leaves the seat during the class, talks excessively, interrupts others while speaking. Even during quiet activities, there is restlessness, there is there is frigidity, struggle to stay focused on tasks. At home, parents are also finding it difficult. Yes, a lot of you've already given the answer to this. Rarely able to finish the task that they are given, and the answer is yes, attention deficit hyperactivity disorder. Before I could even finish it. Um A lot of you've been able to guess what the correct answer is. So, attention deficit hyperactivity disorder. ADD would mean there is no hyperactivity in that. Over here, what we look at as signs and symptoms are of inattention. Fails to give close attention to details, tends to make a lot of careless mistakes, even carelessness in, let's say, losing books every now and then. Losing one's stationery every now and then, water bottles. Sometimes you do tend to hear parents talk about that as a part of the cluster of symptoms that they're narrating to you. Difficulty having sustained attention. And it's often times parents also tend to say that something of their interest they're able to sit for long. But, when it comes to something which is not of their interest and which could be academics or any other activity or a play or a hobby, they tend to lose their interest. Because there is a difficulty in sustained attention. So, something of their interest they're able to still put in a little of that extra effort. However, the attention, per se, is uh something that they're struggling with. Seems not to listen when spoken to directly. Unable to follow through instructions. Difficulty in terms of organizing activities or tasks and which is why they find it difficult to follow timelines, complete assignments based on the deadline that is given, avoids, dislikes or is reluctant to engage in something that feels a lot of mental effort that requires a lot of that effort, loses things unnecessarily. Easily distractible, there is a sound outside, starts to look outside the window a lot more often, are forgetful in their daily activities, just can't remember what they had planned and what they need to do next. In adults as well, you do tend to see adult form of or version or symptoms of attention deficit disorder where you would see that the adults would have a lot of these symptoms but there also has to be a clinical history of the same as a child. So, it's not possible that you don't have this history as a child and yet you are having these symptoms as an adult because it's a neurodevelopmental disorder. Hence, there has to be a history and a clinical picture of sorts of something like this during your childhood years, during your school years and so you continue to experience challenges even in your adulthood. That's attention. Hyperactivity and impulsivity would mean and would seem like a lot of fidgety ness that you would see. So, tapping on their feet or moving their feet restlessly or their hands, something or the other needs to be there in the hands. So, the fidget toy is what you would see a lot many times in people with fidgety ness or hyperactivity. Tends to leave the seat in the classroom or even in other situations. you would see kids running or climbing in inappropriate areas. Sometimes it could also hurt them, but their one is not thinking of that consequence. Difficulty playing or engaging in activities of their interest or what they like. Always on the go, motor driven behavior. Talks excessive excessively even before the question is completed. Tends to blurt out answers in the classroom and have difficulty waiting for their turn. So, you would see them not being able to stand in a line. You would find them running here and there and you know, the parent going and bringing them back and tends to interrupt and intrude a lot when a conversation is going or there is any kind of an engagement that is happening. How does ADHD occur? Like I said, it's a neurodevelopmental disorder which means there's genetics and the neurodevelopmental aspect which has a certain kind of a deficit is the reason why there are inattention and hyperactivity symptoms that you tend to see. When we look at the prevalence rate in the population, it it shows that worldwide 7.2% of children tend to have signs and symptoms of ADHD and in adults you would see at around 2.5%. You cannot cure neurodevelopmental disorder, but with the help of treatment at the right time at the at the earliest intervention possible, you can actually look at a better management of a lot of these symptoms and hence a better adaptability to their day-to-day routine and activities that they're engaging in. Specific learning disorder. I'm sure a lot of you have heard about this as well where there is difficulty in learning and using the academic skills. Where there is presence of at least one of these symptoms >> >> for 6 months. So, specific learning disorder is something that you diagnose by the from the age of and you look at the signs and symptoms from the age of 6 to 7 years. So, when you do assessment for specific learning disorder, it starts from that age where one is able to identify certain patterns of difficulty. So, inaccurate or slow or effortful word reading, the child would have difficulty in reading, difficulty understanding the meaning of what is read. So, the comprehension aspect is something which is yes, affected. Dyscalculia is around mathematics, a lot of difficulty around calculations and comprehension, verbal comprehension of those um mathematical verbal mathematics. Dyslexia is where yes, there is a reading issue and understanding and comprehension of the reading part that is there. Difficulty with the spelling is also part of dyslexia because you can't read properly, phonetics is something that's a struggle for the child neuro-developmentally wired in a way where they find it difficult to recognize and understand the phonemes and hence um produce it in the right way. Difficulties in written expression, over here we look at dyscal dysgraphia. So, the written expression aspect, how the handwriting also sometimes can be illegible is part of dysgraphia. And when it comes to number sense, number facts, calculation, mathematical reasoning, yes, that is called dyscalculia. The prevalence rate of this is around 5 to 15% worldwide. So, which means in a classroom you would see at least one child with learning specific learning disorder. If there is a classroom of uh And over there I mean in in in a classroom, at least one child may have a specific learning disorder. That's the prevalence rate that we are looking at over here. And the other important aspect in this is that children with specific learning disorder do not have a problem in their intellectually uh ability. So, their IQ would be some in the in the average range or in the below average range. However, uh the academic performance based on their intellectual quotient, it doesn't match with that. And that's where we make the diagnosis for specific learning disorder. Intellectual developmental disorders, which means over here what we are looking at is intellectual disability, which is also known as that, which means the IQ range is 70 plus minus five. Um the average range of an IQ is 90 plus. Below 90, it's below average. Uh till 80, it's borderline IQ. And less than 80 um is again borderline. And 70 plus minus five is intellectual disability. So, this means over here as according to your age, you find it difficult to do or understand some of the tasks. And that would also lead to academic challenges and being able to adjust in the same curriculum as others. Communication disorders over here, what you look at in the spectrum of autism, um the repetitive movements and a lot of restrictiveness is not there, but communication is the challenge. And that's where you would see that the social interaction part and how one decodes the verbal and the non-verbal is a challenge over here. In motor disorders, again, it's to do with the motor aspect of the body, and over here, again, neurodevelopmentally you would see that there are certain tics or certain kind of a syndrome where the signs and symptoms could be seen. And may involve uh repetitiveness or involuntariness in the motor behavior. Next, we come down to disruptive impulse control and conduct disorders. How do you help someone with learning specific learning disorder? You start with the clinical diagnosis where you one goes to a clinical psychologist, gets the assessments done, and from there special remediation experts works work with children with specific learning disorder. And yes, school also provides the right kind of support that is needed. Okay. A case study another Guess this one. A 9-year-old referred to the school counselor for frequent conflicts with teachers and family members, referred by the teacher, reports that A often argues with the adults, refuses to follow classroom rules, and tend to deliberately ignore instructions even after repeated reminders. At home, parents have noticed that A tends to become easily annoyed over small situations, tend tend to blame frequently blames others for their own mistakes, and whenever they are corrected, they tend to feel or express it or retaliate with a lot of anger. And deliberately does the opposite of what is asked. Over here, they may also hold grudge for long periods. For example, in one of the episodes when A was asked not to eat the ice cream by the parents. What he did was picked up all the ice cream from the freezer and just put them in the balcony. Interesting. Okay. Relationships with peers and adults have become increasingly challenging because of their argumentative defiant and vindictive behavior. What is this? Yes, ODD, right answer. Oppositional defiant disorder because what is it that you're saying? No, there's a difference between conduct and oppositional defiance. And so we will come down to conduct as well. But what we see over here is that it is characterized by problems of self-control of emotions and behavior. So there is lack of a poor control in how one is feeling and how one is behaving. And the common symptoms over here that you would look at is angry and irritable mood, vindictiveness, and a lot of argumentative and defiant behavior. So does the opposite of what is asked, tend to be quite sensitive um to certain suggestions or reminders or even checking on their behavior. And it lasts at least for 6 months. Yeah, and four of any of these symptoms that comes in these categories is what needs to be exhibited by the individual. Okay. The prevalence rate is around 3.3%. Which means in every 100 people, there is going to be three people or more than three person that may be diagnosed with oppositional defiance. Another case study. Hm, a 14-year-old was brought for counseling after repeated complaints from school authorities, neighbors regarding behavioral problems. Tends to bully younger students, gets involved in physical fights, caught damaging school property on multiple occasions, and disregards rules. Over here, vindictiveness is being spiteful. I mean, doing the opposite and and and having those kind of thoughts that I'm going to do something uh to sort of get back to this person. Those kind of thoughts and sometimes getting into that kind of an action. Yes, it is conduct. I'm sure a lot of you've already read what I what is written over here. That is conduct disorder, and before I could complete All right, conduct disorder. A repetitive and persistent pattern of behavior in which basic rights of the others, societal norms, or rules are violated. So, the difference between ODD and conduct is this. Then in ODD, where these are some early symptoms that you tend to see where there is defiance, there is disregard of rules. And if, let's say in some of those, um people with ODD or even if there aren't early signs of ODD that you would see. However, in conduct, this is what you would see. There is aggression towards people, and not just towards people, but even towards other species. It could be animals, destruction of the property, deceitfulness, or theft, serious violation of rules. And this is happening at least for 1 year. And despite basic interventions or corrections or consequences, this is not changing. Now, what's the prevalence rate of this is 2 to 10% of children and adolescents globally are diagnosed with conduct disorder. So, you would see one in 100 two in 100 or 10 in 100 up to may have conduct disorder, impulse control disorder. Now, over here what we look at is the impulse aspect, which means I had the impulse to cause a certain kind of a harm without even thinking of the consequence at that point in time. And the impulse is so strong that I actually end up doing it. So, it is not in my control. One is intermittent explosive disorder, which means the anger comes in once in, let's say, uh 4 months, 6 months. But, the intensity of the anger is so strong that in that impulse I tend to cause a certain kind of a harm. So, maybe let's say break a mobile or even sometimes tend to hit someone. Um and it's it's explosive, which is why intermittent, it's not something which is regular, but something that comes in as a um intermittently explosive, the intensity is that high and lack of control in what one is experiencing as the impulse. Pyromania, yes, is any guesses? Urge to or the impulse to put things on fire. Yes. And kleptomania is to steal something, to pick things. Burn things, yes, that's pyromania. Kleptomania is picking things and not having control over that. Now, we come down to anxiety disorders. First, we start with separation anxiety disorder, which we see in children, where developmentally inappropriate and excessive fear or anxiety in being separated from their significant other, which is over here parents or the attachment figure. And it lasts at least six four four weeks in the child where there is a lot of distress when they're anticipating or experiencing separation. They may also worry about losing that major attachment figure or maybe something harmful or bad may happen, let's say to my mother or my father or my sibling. Uh worry about experiencing an untoward event that causes separation. Something bad may happen, a war may happen, or I may get kidnapped or somebody my my my parent my sibling may get kidnapped. So, an untoward event may cause the separation. That kind of a worry or a thought process runs in the child's mind. Reluctance or refusal to go out, be away from home, fear of being alone at home without the attachment figure. Nightmares can also be there depending upon the intensity of the anxiety that the child is experiencing. And there could also be physical symptoms when separation occurs or the child knows they are going to be separated from the attachment figure. The prevalence rate over here is 4% which means 4% of of the population can have of children population can have these signs and symptoms. Social anxiety disorder which means I'm sure all of you are aware of some signs and symptoms of social anxiety disorder. Anxiety in a social setting. And anxiety in a social setting would happen because I am worried about or I'm extremely fearful about negative evaluation by the others. That they are going to scrutinize me in a negative way. For children, it would happen in their peer setting and not just their interaction with the adults. There is a lot so a fear that their interaction or their engagement or any kind of a communication that they're engaging with may lead to rejection, humiliation, or embarrassment that they may feel in that social setting. And hence, social situations they tend to evoke a lot of fear and anxiety, which the person then starts to either avoid or endure with a lot of intense fear. And this is persistent lasting for at least 6 months or more. Prevalence rate is approximately 7%. And globally, one would look at less than um 7% where it's around 0.25 to 2%. In a less than 1 year time period that one would look at. Specific phobia over here, the term is phobia means there is a lot of fear against specific, which means it is specific to a particular object, situation, and there is a lot of fear and anxiety around it. For example, it could be phobia of dogs, phobia of snakes, phobia of uh reptile-like animals, lizards, or natural environment, or yes, in some cases blood injury in injection injury, where there is a heightened fear and emotional response uh to being injected or any kind of a blood injury that may happen. It could also be a specific to a situation or any other kind of a phobia that is connected to a particular situation or an object. And as a result of that, these situations are avoided and the fear or the anxiety which the person shows is out of proportion to the actual danger of what it may cause. And these symptoms are not specific or connected to the socio-cultural context. They may exist despite whatever the context that there is. However, there is a lot of fear that is attached to a particular object or a situation. The prevalence rate for that is 8% to 12% which is pretty high as if you look at it. So, social anxiety disorder is one of the common forms of anxiety disorders. Okay. Another case study for you. A 24-year-old post-graduate repeatedly visiting emergency room with complaints of sudden chest tightness, dizziness, sweating, difficulty breathing. And medical examination shows that there is no significant physical health concern. As reported, they tend to experience these episodes suddenly with a lot of fear and unexpectedly in any ordinary situation as well. And as a result of this they feel that something terrible is going to happen. They feel that they may have fear of losing control or even dying because the the the fear at that point in time and the symptoms that are experienced are are at a very high intensity. A has also become increasingly worried of having another episode and as a result of that have started avoiding going in places, long commutes. And this is now affecting their functioning as a result of these signs and symptoms that they've been experiencing. Now, what yes, some of you have given the correct answer, which is it is panic disorder, not generalized. In generalized, you would not have these peaks. >> >> So, in a panic disorder, there is palpitation, there is an abrupt surge of intense fear and discomfort that reaches a peak within minutes, where you worry about having almost like a heart attack kind of an experience, and which is why you'd see people tend to go a lot to emergencies or a cardiac specialist because the symptom gives you that kind of an experience. It's maladaptive. Um because it again in increases the anticipation of having this kind of an episode again and again. So, the person, once they've had it once or twice, may feel I may get it at any given point in time. And there is trembling, sweating, shaking, sensations of shortness of breath, feelings of being choked, chest pain, discomfort, impending doom kind of a feeling, sometimes even derealization, chills, feeling dizzy, unsteady, light-headedness, and that kind of a feeling. And that is what is called panic attack. And the nature of the panic attack is that once you have it, it has to come down. Once you reach the peak, eventually, it has to come down. The prevalence rate for this is around 2 to um 3% in adults and adolescent over a 12-month period. And globally, you would see around 1.5 to 5%. Generalized anxiety disorder, and somehow, despite us working on the alignment, huh, it's half cut. That's all right. Excessive and uncontrollable worry that occurs more days than not for at least 6 months. So, it's not just 2 days, 3 days, but at least for for a consistent longer duration, you're experiencing generalized anxiety where there is restlessness, feeling on the edge, easily fatigued, difficulty concentration, mind going blank, feeling irritable, tenseness in the muscles, sleep disturbances, and also negative thought pattern of a worrisome nature about anything and everything. And this is why it is generalized. So, you may feel worried or excessive worry, uncontrollable worry about anything around you. It could be about examinations, it could be about going to a party, it could be around waking up in the morning, it could be around how would I do this and how would I do that. That kind of a thought process. And this is one of the most common form of mental health condition, generalized anxiety disorder, where you see 355 million people globally tend to have some form of an anxiety disorder. >> I think what one needs to understand when we talk about some of these figures is that even though these figures are significant, somehow we just don't end up giving the kind of importance to it. In my opinion, a lot of time because we end up using the words very loosely. Can I experience anxiety? Yes. Does that mean I have an anxiety disorder? No. But if I have an anxiety disorder, do I need an intervention? Yes. And that's the difference. Now, because of a lot of these factors, the kind of importance that health care providers, society at large, need to give to mental health conditions, That unfortunately has not been there. Uh so, if your question is it wouldn't be important to take therapy for generalized anxiety, yes. If you have a diagnosed generalized anxiety disorder, therapy would definitely be a part of the intervention. Hyperventilation is seen during a panic attack. Uh it's one of the uh let's say symptoms of a panic attacks. Uh anxiety disorders are seen across the age group. And there has been a 20% 25% increase in anxiety and depressive illnesses as per WHO post COVID. You may have panic attack precipitated because of a psychosocial stressor. But a panic attack in itself is not the illness. It is the recurrent attacks coming in which cause impairment in functionality where an individual is worried about the next attack is where the disorder is. Yes, it can happen in adolescence also. Like I said, anxiety disorders are there across the age group. No, panic attack would be the right term. Anxiety attack, not really. They'll be called panic attacks. Lots of people call a panic attack an anxiety attack, but the right term would be panic attack. We'll move forward. Okay, let's do one more case study. A 27-year-old working professional, significant changes in behavior over a few months. What this individual was enjoying earlier, they are not able to enjoy them now, like friends, movies. Is struggling to concentrate, difficulty in managing simple decisions, has become withdrawn, difficulty in getting out of bed. Sleep has been impacted, feels hopelessness, worthlessness. And feels a sense of guilt and disconnection. What could this be? And yes, you're quite right. We are talking about depression. >> Major depressive disorder. >> Major depressive disorder, you are looking at some of these key aspects. Two-week period, consistent symptoms, pervasive sadness is experienced, anhedonia. I'm not able to have experience pleasure, withdrawn. Low moods, diminished interest, impact on my weight and appetite, impact on my sleep, impact on my psychomotor activity, fatigue, loss of interest, the thought triad, the Beck's triad, hopeless, helpless, worthless. Worthless, I don't feel good about myself. Hopeless, I feel the future is dark. Helpless, I don't think anybody can help me out of it. Depression does in people, in some people, bring thoughts around death. And yes, there is uh with this, suicidal ideation, which is a part of the illness, and which is why early identification intervention is so important for depression. And you're looking at 5.7% of adults struggling with depression. That's just just imagine this this these two figures that have been just shared with you of depression, anxiety, and a um 25% increase that happened around 2022 post COVID. Uh and now look at the number of psychiatrists and psychologists. Now look at how many people are actually seeking help. Look at the efficacy of treatment. Look at the efficacy of therapy, efficacy of medication. So, if you are to look at efficacy at even 70%, let's say, a very moderate figure, although it is 80 plus. But if you look at that efficacy, and you look at the number of people, and you look at the percentage of people who are seeking help, and 70% or 80% of them are getting help, imagine if all of these people were coming for help, how many lives would have been helped so much. And how many millions of lives are affected because help is not taken, which is effective. Okay, I'm all ears. >> Okay, now we go on to the next case study, which is a 35-year-old marketing executive brought for psycho- psychological consultation by the family members due to noticeable and extreme changes in mood and behavior over the past year. What the person is experiencing is unusually energetic, confident, and highly active phases, where family members report that during these phases he tends to sleep very less, yet feel that has a lot of energy, and feels completely rested. Mind is full of ideas, tends to talk rapidly, moves from one topic to the other, takes on multiple projects simultaneously without being able to complete it. Family also notice that there is an impulsive increase in spending on expensive gadgets and risky decisions, quitting job or work. And as a result of that, after this short phase is gone, one also tends to experience phases of extreme sadness, exhaustion lasting for weeks. There is withdrawnness that happens socially, and there is a significant impairment, as you see, in the professional life in being able to manage day-to-day life, and even self. Yes, the answer is bipolar disorder. So, it's one of the mood disorders where you see that there are manic episodes which are happening in which there is an inflated sense of self-esteem. There could be grandiose ideas of what all one can achieve and be decreased need for sleep, more talkativeness than the usual, the pressured need to speak and talk, like we discussed in our first uh on day one when you're doing the mental status examination, there is flight of ideas going from one big thing to the other, easy distractibility, increase in goal-directedness of the activity. So, one would keep doing something without even knowing that there it need there has to be a goal-directedness to do it. Or there is Sorry, there is an increase in goal-directedness of the activity, which means if I have to exercise, then I have to keep exercising for 2 hours, 3 hours, that kind of a thing that can happen. And I'm going to do this, and I'm going to achieve this. So, there is a certain sense of goal-directedness. Excessive involvement in pleasure-related activities that may have high potential for some kind of a consequence that they make bear later on. Now, over here, what we look at is that this is a distinct period where all of these mood, increased activity is elevated for at least that last at least for a weeks. And the presence of at least one of these episodes is there in mania and hypomania. In hypomania, there is a slight reduction in the intensity of all of these symptoms or some of these symptoms that the person or the individual would experience. In mania, it's more intensity as compared to the hypomanic episode. Lasting from 4 days to a week. The prevalence rate you would look at is 1.5%. So, in a bipolar, one pole bi means two poles. One is the manic or the hypomanic episode and then the other is the major depressive episode and which is why it's called bipolar. Now, we come down to obsessive, compulsive, and related disorders. Now, if you look at and understand the word obsessive and then look at the word compulsion. Obsession would mean intrusive thoughts which are coming in again and again despite you not wanting them. Recurrent, persistent, it could be images, it could be urges, it could be a certain kind of a thought process which cause a lot of anxiety and distress to the individual. The individual would try to ignore it, try to suppress it, try to neutralize them yet are unable to do it and sometimes either they tend to be preoccupied with kind of a thought process, feeling anxiety or guilt other or other emotions based on the kind of a thought process or the image that the person is having or it can also be accompanied by what are called compulsions. Compulsions are repetitive acts, behaviors where the person feels driven to perform which means yes, if there is a washing obsession thought process about cleanliness, one would engage in washing multiple times on in the day. It could be taking significant period of the individual's time of the day in just cleaning, washing, and engaging in activities that are accompanied by some of these obsessive thoughts regarding cleanliness. In response to the obsession, there could also be rules that are applied in a very ritualistic way. These rules are followed very rigid. Others are also sometimes involved in it, and the person imposes these rules for the others to also follow. The main function of that is to reduce anxiety or the distress which is caused because of this uncomfortable thought. And it's it Obviously, these thoughts have an irrationality to it, which is why they're called obsessions, and compulsion is the act part of this. Now, some of the common obsessions would be fear of contamination, some forbidden or taboo thoughts which could be sexual or religious in nature. Certain kind of an obsessive or rigidity obsession or rigidity with the orderliness or the symmetry of things. You would see people putting their books in a certain color form format or aligning their cupboards in a certain symmetrical way. And there could also be aggressive or disturbing thoughts about losing control or harming somebody. So, these are more covert in nature, which means inside the mind the obsessions that are happening. Common compulsions, which you tend to see what the individual does, cleaning, washing, repeatedly checking, let's say door knobs, gas knobs, silently repeating prayers, counting to a whatever they're doing to a specific pattern, to a specific number, certain kind of an orderliness, strict routine, and at the same time demanding reassurance by the others to also do the same thing. So, these are common compulsions, some of the common compulsions. Now, what are some of the other obsessive-compulsive related disorders is one, body dysmorphic disorder, which means preoccupation around part of the body which the person feels is inappropriate. So, for example, my nose looks twisted. So, despite seeking reassurance and people telling them that there is nothing wrong with the nose, the person may still feel this is twisted. And sometimes, in extreme form, you would also see surgeries being done by people with body dysmorphic disorder, also in um some of the syndrome that you would have in one of the syndromes that you would have heard earlier, which is the Barbie syndrome, where the certain obsession around looking uh like a Barbie, leading to a lot of surgeries because the person would start to feel uh that the body is not good enough and needs to go through a certain kind of a change. And what we need to understand over here is sometimes also the influence um of what we tend to see in our external environment, how it can impact our thought process. But, when we talk about um obsessive-compulsive disorders or mental health disorders, we also have to understand the predisposition of the biological aspect to a lot of these symptoms. Hoarding, which means I hoard a lot of things, even they don't have much of an value to me, but I keep hoarding. Trichotillomania is picking on the hair and plucking the hair. Sometimes, you would also see patches of baldness that would be there. Again, uncontrollable because there is um the the act the individual is unable to control. Excoriation means skin picking, and you may see that sometimes people, in order to hide it, um tend to wear things so that it doesn't is not visible to the others, but skin picking could leave marks for the individual. And again, it is to do with the intense anxiety that the individual experiences. So, obsessive-compulsive disorder has a lifetime prevalence of roughly around 1.2 to 2.3% globally. We have to understand the harm that it is causing us. It's causing us harm in the way of the amount of time and the dysfunctionality that it is leading to in our day-to-day life. So, harm in that sense is what one needs to understand. Having a patch of a hair, the baldness, um how it impacts us is that one would feel awkward or sense of embarrassment or shame, and so would hide the head with a scarf or something because this is uncontrollable. Again, hide the body or the hand because the skin ex- excoriation is uncontrollable, or would not be able to do a lot of things normally what the individual or the others are able to do in their day-to-day life because hours of time is spent in washing, in cleaning, or doing some of these activities. Schizophrenia spectrum or other psychotic disorders, we Okay. Right. So, a 19-year-old recently starts to show some major changes in thinking pattern where uh T was social and academic consistent, but in the past um year, there It been an increased concern with secretively feeling that people are watching which with T feeling that people are watching trying to harm also believing that strangers on the street are spending certain sending certain special messages through conversations and gestures. As a result of this T is having a significant fear of engaging in a social Yes. Um The title should have come in a little later. I already gave you the answer before I could even complete the case study and that yes, that is schizophrenia where you would see delusions. So people talking about me thought broadcasting This is part of delusion. A fixed firm false belief. So even if you say that is not true, that is not happening, the person would say no, you're not being able to understand. I know it. I can sense it. People are doing this. Hallucinations like I explained the last time, it is about having extra sensory perception to not having an external stimuli. So you may feel crawling on the body or you may feel that you're smelling something. You may also have auditory hallucinations hearing certain voices. And again over here, there is lack of a stimuli and yet the person is experiencing this. Disorganized speech, incoherence could be there. A lot of slowness slowness could be there. Word salad that we had spoken about on our day one. That again is part of one of the symptoms. Grossly disorganized or catatonic behavior. Catatonic means something which is has a certain rigidity to it. Negative symptoms for example anhedonia, not having interest in doing things that they would do earlier. Negative means something that is taken away. Um and positive symptoms means something that gets added. So, delusions and hallucinations are positive symptoms. Negative symptoms would be, for example, anhedonia, flat affect. There are no emotions that one is able to express or show. And this leads to impaired functioning in their work, interpersonal relationships, and self-care. Some of the other forms of psychotic disorders are one delusional disorder. So, there are delusional aspect that is there, but all the other symptoms are not there. Uh the thought process the the thought broadcasting, people persecutory delusions are some of the uh common symptoms that would come in and you would see in delusional disorder. Or even the fact that people are going to harm me, paranoia. Brief psychotic disorder, which is for less than a month. Schizo, um freniform is up to 6 months. Schizoaffective disorder would be symptoms of schizophrenia mixed along with mood disorder symptoms, which may have a certain kind of a mood affect, um bipolarity, or depressive element, or a bipolar element. So, symptoms of schizophrenia combined with mood disorder. And then, catatonia. Lifetime prevalence rate for schizophrenia is approximately 0.3% to 0.7%. Now, understand that when we look at some of the perception that has been built around mental illnesses, where for the longest period of time, what was shown was more around this particular um mental illness and the way portrayal has been made of how uh some of these symptoms can be a harm harm to the society, the disorganizedness, the incoherence, and a lot of that around it uh that has been portrayed in media, in what we've seen, in what we've read, and still continues to be so. The percentage of some of the chronic symptoms is so less, while the larger population tends to experience some of these common disorders of anxiety, depression, where the functional impairment is there, yet person is not people are not able to see covertly so much on in terms of overtly so much in terms of what the changes that the person may be going through. So, the silent aspect of mental health uh illnesses needs to be understood, and that's why it's important for us to continue to break the myths and the stereotyping that has been prevailing for a very long time, and we need to unmute ourselves and speak up about the challenges that we tend to experience. No, it's not just merely about unresolved emotions. We have to understand that uh these disorders that we are talking about, the clinical disorders, there has to be a biological predisposition, and the imbalance in the neurotransmitter that is playing over here as a role, as one of the causes and causal factors. Somatic symptom disorder, soma means body, symptom means the symptom that one is experiencing in the body without having um a cause to it, a a physical or neurological cause to it. One or more somatic symptoms that are dis- distressing, excessive thoughts, feelings, or behaviors which are related to the symptom. It could be associated with the health or anything else. And anyone somatic symptom may not continuously be present in the state of being sym- symptomatic, which is persistent. So, the fact that you have uh some kind of a change in an experience, the stress that you're experiencing in your body stays as persistent though the symptoms related to what you're experiencing in the body can change. The prevalence rate for this is around 4% to 6% in the general adult population. Again, this can happen at any age. Now, the types one illness anxiety disorder. Over here what we see there is a preoccupation with around having a serious illness. Let's say for example, having cancer, just a worry that can happen as a result of again, the environment plays a role if you've seen anything distressing in your environment. So, that kind of an illness may play a role in your anxiety around it. So, there could be an element in the environment or could not be an element in the environment. Somatic symptoms are not present but are there only mildly. So, one may experience uh certain one would go to get the test done. Yes, earlier it was called hypochondria but in the recent diagnostic manual the word has been changed to illness anxiety disorder. And what one you would see that because of the anxiety around the illness one would engage in those kind of behaviors to get the test, the checking, all of that done despite the doctors giving you reassurance that nothing is wrong. So, let's say you go for a scan because you have anxiety around cancer and the and the doctor says that yeah, they could see one or two nodes but they are benign or they are not worrisome. Yet, the mind would continue to think about it and yet you would go uh to get another scan done maybe let's say in another month's time. High anxiety around health, easily alarmed about health status, also tends to read uh or perform health related check tests a lot more. So, all of your behaviors are around that which are maladaptive and also tends to lead to a lot of avoidance so that you don't catch this illness or in order to don't have this kind of an illness, you would do a lot many tests and going to the doctor and getting it checked. The prevalence rate for this is 2.2 to 8%. Okay, another case study for you. Which is a 30-year-old recently starts to show signs of feeling anxiety and sadness post a major competitive examination uh which S has had been preparing for long. The symptoms got worsened. There have been fainting episodes. The episodes that may last for a few minutes to 30 minutes or more in which S appears unresponsive and despite medical examinations which could not identify any clear neurological um any clear neurological cause, there is always a medical cause uh to our mental health conditions. But yeah, neurological cause. On regaining consciousness, S still feels difficulty in recalling what was the exact trigger or what were the detailing details around it the episode. On further exploration, it was found that there has been an emotional distress uh because of the repeated unsuccessful attempts in during the examinations of the examinations and the most recent outcome causing a significant disappointment and feeling of hopelessness. There has also been a history of ongoing family distress when it comes to financial pressures, interpersonal conflicts, or pressure at home. And there is also a history that uh S tends to have a very poor coping mechanism, tends to internalize emotions a a more. And a lot of you are giving wrong answer over here. You're focus on the symptoms over here. There is unconsciousness, unresponsiveness, there are episodes which are happening. And over here, again, it is impacting their day-to-day functioning. >> What is the answer? Uh that's close. No, that's not. Those all of them certainly not. No, there's nothing like that. No, that we already done. Why would we repeat it? No, it is not this. I mean, you're close. You need to be nice. >> It's a kind of somatic disorder. >> Can you just make the next slide because kind of this will be endless otherwise. Conversion disorder, also known as functional neurological symptom disorder. And also typically when you have a starting of a uh paragraph or a sentence >> Right. Yes, there has to be a yes, there has to be a yes, there has to be >> That's okay. We are we are very very open, non-judgmental people. I have a lot of empathy. >> >> And it's absolutely fine. I mean, I mean, who cares about perfection? I mean, if it just comes and goes. Right? I mean, uh sporadic perfection is also a version of perfection. Whereas, I don't think intermittent is perfection. But then it is what it is. And acceptance, like you were taught yesterday, acceptance commitment therapy. It is my commitment of my acceptance, which is therapeutic for everybody else. >> And I look at reality as is. Yes, so I made >> So >> the error and the error is an error. >> altered voluntary motor or sen- sensory. Altered voluntary motor or sensory. Right? The answer is conversion. Conversion. Old school, my stress is converted to my symptom. But But old school, not any longer because now it is established that you may not be able to always have an identifiable psychosocial stressor. That's that's how it is seen as now but conversion. Hm? Okay, we will move forward. And apparently a 12-month prevalence rate amongst the general population is .012%. Such such mathematical geniuses we have in our program. Okay, dissociative disorder and the beauty of dissociation is that actually the D in dissociation got dissociated and as you see the D This is profound, right? Profound dissociation just happened where the D itself got dissociated and uh since the D got dissociated I'll just go, come back, and uh in your good hands of the OG Mimansa Singh Thakur. >> So what we look at over here is dissociation, means lack of association with our own sense of self, our sense of agency. So there is a disruption of or discontinuity in our sense of self as a result of alterations in consciousness, memory, identity, emotion, perception, body representation, sensory motor functioning, and behavior. So what are these dissociative disorders? Dissociative identity disorder means that my one identity is separate from the other identity. I end up taking two identities, also called alter egos. Dissociative amnesia means I would not remember some part of my past or my ongoing present, and there is an amnesia that one is experiencing over here, forgetfulness. So, dissociation from a part of my life that I just don't remember at all. Depersonalization, like we had spoken about on day one, means I am not being able to feel who I am or feel connected with who I am. And derealization is feeling of unreality, not being able to feel connected with the real sense of the world. Uh so, the split over here is seen as the split in the ego and which is why there are altered egos is what why is it called uh dissociative dissociation. So, from one identity, I may take on a completely different identity. Lifetime prevalence rate for all dissociative disorders range is 1.1 to 1.2%. And the alignment continues to be so despite uh trauma and stress-related disorders. Yes, the session will remain on the link for the whole week, so you can always go back and uh revisit anytime you want these to see these sessions again. Uh A 36-year-old paramedic sought counseling for experiencing increasing emotional and physical distress over the past several months. A year ago, D was involved in responding to a a severe road accident in which multiple people were critically injured. D has found it difficult to return to a normal daily functioning. Yes, now you get it right. Earlier you were giving it wrong. Frequent nightmares related to the incident, waking up to the feeling. Yes, it is post-traumatic stress disorder. You got it right. So, what happens over here is there is exposure to actual or threatened traumatic event. Whether it is a direct experience, whether it's something that you witness, whether you learned about it from a closed one, or there is a repeated or extreme exposure to details. So, even when we hear about somebody going through trauma and a lot of those detailing, that can also lead to a traumatic response or a reaction or symptomatic experience. Now, following symptoms for more than 1 month, which is one involuntary or intrusive distressing memories of the event or what has been shared. Flashbacks is what you may get about the episode or the event in the form of memory, image, or again thought process. Avoidance of the stimuli, thoughts, feelings, conversations around the traumatic incident of the episode. Intense prolonged distress on exposure to anything that makes you reminds you of it. Negative alterations with cognition and mood. Not able to recall, feeling detached, unable to experience positive emotions at the same time. There is also alterations in the arousal or the reactivity, which means there could be a subtle response that you may give with just a sudden with a small noise or a sound. Or even when you are remembering something, there is certain subtle response. You may have anger, which may be with a lot more intensity where the person may not be able to understand where did this comes from. And there could also be self-destructive form of behavior engagement that one may have. The lifetime prevalence for this is 3.9% in the general population. Now, we come down to adjustment disorder, where we see that the emotional and behavioral symptoms in response to the identifiable stressor within the 3 months from the onset of the stressor is happening more and more and the amount of distress that the person is experiencing, the proportion uh to what the stressor is, the intensity, the severity is a lot more. So, the emotional and the behavioral response or the reaction in the form of stress to what the actual stress is, there is a marked difference in the proportion of what is being experienced. So, taking it into the external context to the cultural factors that might influence some symptom severity and presentation, there is a significant impairment um in social, occupational, and other important areas of functioning. Yes, again, PTSD can occur in any age. And I think Manya has taken a break because maybe she is tired right now. Hm, adjustment disorder are uh commonly affected with an estimate of 5 to 20% of the population. And it continues to keep going on the left despite me making all the corrections last night. Substance-related and addictive disorder. Substance means and addiction. What you're looking at over here is when you continue to keep using substances that you should not be using, it eventually causes an impairment in the neural pathway where you are unable to control your urge, your craving to have the substance. So, there is impaired control, there are cravings that are experienced, there is a higher and higher tolerance that you tend to develop for that kind of substance that you're consuming whether cannabis, alcohol or any other form, vape, smoke, nicotine, so on and so forth. And when you try and stop it, you also experience withdrawal symptoms of anxiety, tremblingness, pain in the body, irritability, and a lot many other symptoms along with it. And yes, there is a social impairment. Eventually, it would start to impact your social engagement because of the impaired change and because of the changes that you would experience as a result of consuming this for a very long time. So, there is a dependence that one would develop over these substances because you're consuming it maybe let's say as a result of social occasions or as a result of peer pressure or as a result of because you just wanted to do it because it feels very cool even though it is not. Or to fit in or because you were just curious and you wanted to experiment. And then slowly and steadily you started to pair it when you're feeling anxious, when you want to relieve yourself from stress, when let's say you're getting bored and that's how it begins. A case study. 18-year-old student has shown major changes in behavior and daily routine over the past several months. Parents noticed that she has started spending more and more time with a new group of friends and often returns home with red eyes or a strong unusual smell on clothes. She appears unusually relaxed and detached while others at other times becomes irritable when questioned about activities or whereabouts. It has also been reported that it has started to impact his ability to concentrate and be attentive in classrooms, tends to forget instructions because now you tend you see that there are cognitive changes that are happening. Academic performance has gone down. There is a sleepiness that the individual is experiencing, loss of interest in extracurricular activities, changes in eating and sleeping patterns. And eating is at odd hours, sleeping at long periods of time or at odd hours. Yes. Yes. Yes. Cannabis use disorder. And the difference is the redness in the eye. So, uh while the other symptoms, yes, would match any other form of substance use, over here what we're talking about is cannabis use disorder. 2 to 3% among adolescent adolescent age group and adults is what you would see. Other kind of substance-related and addictive disorders is alcohol, caffeine, caffeine. So, a lot of you who ask if I can have this much amount and this much amount, you must understand that that also has an addictive component to it. Cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, or anxiolytics, stimulants, and tobacco. There are also behavioral addictive disorders, gambling in which you tend to engage in gap in in gambling where you are using money and as a result of inability to control and to have the desired effect of that reward seeking and that um that effect that you want to have, you tend you tend to gamble more, put in more money, and then you lose it, and then you put in more money, and then to then you tend to lose it. And that's where the consequence aspect is now impaired. The control is impaired. So, no matter how much you want to control it, yet to have the reward seeking and the desire to fit, you continue to keep doing it. Same with the internet gaming disorder, where the fact that you want to just engage in in the gaming part, where you want to then go on to the next level and the next level and the next level. And sometimes even the amount of aggression that one is engaging in in some of these games, again, your tolerance window for a lot of this just goes up and up and up. And you don't recognize how it becomes a preoccupation because it has an addictive element. And so, you tend to spend a lot of time on games. You tend to spend a lot of time hiding from people around you, your parents or your teachers or your peers, that you are gaming and spending a lot of time over there. It again impacts your sleep, your eating habits. There is lying that tends to happen so that you can continue to keep doing it. It also impacts your mood. It makes you irritable. You may be snappy. So, on and so forth. So, there are behavioral changes and despite you knowing that it is impairing your academic performance, your social engagement, yet you're unable to control it. And we have eaten the E in the eating disorder. Uh the line over here has eaten the E. Even though in eating disorder, yes, one either is not eating or is eating a lot more. So, feeding and eating disorders, there's a persistent disturbance of eating or eating-related behavior results in altered consumption or absorption of food. And it begins to significantly impact your physical health and your psychosocial functioning. The three types are anorexia nervosa, bulimia nervosa, and binge eating disorder. Now, you tell me which one of this is there in this case study? 15-year-old student studying uh over the past few months, parents, teachers have noticed significant change in eating habits where there is extreme consciousness around body weight, often talks about feeling overweight even though weight is already below what is considered healthy for their age. Um E avoids eating meals with family, often claims have already eaten or is not hungry. As a result of this, tends to skip lunch or eat very small portions. Counts calories, checks weights, considers one has fattened um or there is a fattening that is happening around body. There is preoccupation around body loss, body size, body weight. Yes, this is anorexia nervosa disorder. Anorexia nervosa disorder where there is restriction of energy intake relative to the requirement that is there as uh as compared to the BMI that you need to have to maintain a normal BMI. Body mass index, significantly low body weight, less than minimally normal in the context of age, sex, developmental trajectory, and physical health. Intense fear around gaining weight, persistent behavior that inter- Fears with weight gain. Undue influence of body weight or shape on self-evaluation. So, how am I looking today? Am I looking fatter than yesterday or am I looking thinner than yesterday? Would also define my mood. My mood could be quite bad if I wake up in the morning and I step on the weighing scale and see that there are 500 g more. That is the kind of impact that it has on the individual. And there is persistent lack of recognition of the seriousness of the current body weight. So, you would see that a lot many times when a person tends to severity of the impact that the individual experiences as a result of anorexia nervosa because of the kind of impairment it has on the physical health where one may also experience a lot of other changes. Sometimes in chronic cases we also look at how it is important to engage in admissions so that eating is monitored and basic food, the amount that the person or the individual has to eat is given and some of the other nutritional aspects are also looked at. All of these things is something which is a part of the treatment process. The two types is restricting type which means where you're restricting food and the other is purging type which means you eat and then you purge. The prevalence rate of anorexia nervosa is.6 to.8%. Bulimia nervosa, lack of sense of control over eating during episodes and these episodes are recurrent, eating within only two hour period and amount of food that is definitely much larger than what most individuals would eat in a similar time period under similar circumstances. And over here what one look at is engaging in compensatory behavior which means to prevent weight gain. You may engage in self-induced vomiting, misuse of laxatives, or fasting or excessive exercising. Binge eating and inappropriate compensatory behaviors both occur on an average at least once a week for three months. And again over here self-evaluation to body shape and weight is given. Now, we must understand that what is the role of what we see in our external environment in our environment also has a role to play in how some of us who may have a predisposition to feeling conscious about our body weight and shape and size can develop and have a predisposition to a mental health condition can develop some of these symptoms. So how the media tends to influence how we look at ourselves. Uh while we talk about body positivity, we also are in the world where we look at filters to sort of look a certain way. The certain desirability, the likeability element that continues to influence um on how we want people to look at us. So the self-esteem part and the part around how we tend to measure our self-worth over here is a significant aspect to understand. Prevalence of bulimia nervosa ranges from 0.14 to 0.03%. Binge eating disorder over here, what you see is eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because feeling embarrassed about how much people would see you're eating and at the same time feeling guilty or disgusted with oneself because you've eaten so much. Again, recurrent episodes of binge eating within two-hour period, lack of sense of control is something that the individual experiences a lot over here. And which is why it is binging. Binge continue to binge. And yes, binge binge watching is also is not something which is healthy and we must know how to exercise self-control than continue to keep watching series after series at night impacting our sleep. Prevalence of binge eating disorders range from 0.85% to 2.8%. So the difference as you see is in anorexia there is a restriction of food in bulimia you eat a lot more and then you urge and binge you continue to keep binging without even recognize that you are binging and binging and then there is a the self shame and guilt aspect that is there. In bulimia you're engaging in purging in some form or the other. Personality disorders and enduring pattern of inner experience and behavior which deviates from the normal expectation of an individual's culture and this is not something which is flexible it's something which is pervasive inflexible and the onset happens at an adolescent or an early adulthood time period. It's stable over a period of time and it does tend to lead to a lot of distress and impairment specifically in interpersonal relations. The clusters over here are paranoid personality disorder where you tend to experience a lot of paranoia. >> Cluster A is more old school you can say the more psychosis tendency. Cluster B which is the most common one where the emotionality component the self component is there and then C where there are the more either depressive the anxious avoidant obsessive personality type. So those are the clusters the ones that you need to know is borderline personality disorder which statistically the prevalence is higher antisocial personality disorder and the histrionic and narcissistic as well. So those are the three clusters the key difference between personality disorder and any other disorder or illness is that personality disorders will never have a clear onset which other disorders would have. Uh Look at this as genetic biopsychosocial and the uh component of uh economic and probably that makes modern-day uh psychiatry diagnosis clearer. Genetic component, which is the genes, the biological component of the neuroplasticity, neurochemicals, neurodegenerative processes, the psychological, which is the self, social, which is the environment, and in my opinion, economic factors also, because they do have an impact. It is this cluster of factors which would be when working together, having an impact on diagnosis. And that therein lies also the treatment. For the biological component, the medications, the psychological component, the various therapeutic interventions, and the social skill component for the self and the social support for the environment. That's how we look at treatments of psychiatric disorders. Unmute yourself. Let's do some summer projects and let's spread the awareness amongst people. Uh bipolar disorder is a disorder. I'm taking some answers. We can move forward. And borderline personality is a personality disorder. In bipolar disorder, you have depressive and manic episodes. In borderline personality, you have emotional lability. Not depressive and manic episodes. No, there would not be an opposite of a sudden illness what is Social support is in is important but then it's also an external locus. We still try and figure out whatever the best we can do as far as internal locus is concerned. Your attendance you can mark based on the links that have been shared every day and you can go ahead and do that. Yes. You will get the certificate. Not to worry on that. In any case I think the learning matters and I hope the learning is happening and um 10 years down the lane the certificate won't matter to you. I can guarantee that. No anxiety disorders would be a separate category and obsessive compulsive disorder in the spectrum would be a separate category. Although years back um and OCD was as a part of the anxiety disorders, now it's considered as separate. Multiple personality would be the dissociative identity disorders where you'll have alters um which is multiple identities in individuals. Okay, thank you and we've had a another day of learning with Mimansa Singh Tanwar ma'am and tomorrow she teaches us a fabulous interesting aspect. She's an expert in this um has a strong social media presence and she'll talk tomorrow about social psychology and a unique expertise that Mimansa has and I we look forward to >> >> tomorrow. Hello young people and I'll see you tomorrow. Thank you.