The document discusses various classification systems for mental disorders including ICD-10, DSM-IV, and Indian classifications. ICD-10 is issued by WHO and codes disorders from F00 to F99. DSM-IV is published by the American Psychiatric Association. Indian classifications were proposed by various Indian psychiatrists. The document also reviews theories of personality development including Freud's psychosexual stages, Erikson's psychosocial stages, and behavioral theories. It discusses factors influencing personality formation and defence mechanisms.

1. FLOWOF PRESENTATION
CLASSIFICATION OF MENTAL DISORDERS
REVIEW OF PERSONALITY
THEORIES OF PERSONALITY DEVELOPMENT
DEFENCE MECHANISMS
MALADAPTIVE BEHAVIOR OF INDIVIDUALS AND
GROUPS :
STRESS, CRISIS AND DISASTERS

2. CLASSIFICATION OF MENTAL DISORDERS
Classification is a process by which complex
phenomena are organized into categories,
classes or ranks so as to bring together those
things that most resemble each other and to
separate those that differ.

3. PURPOSES OF CLASSIFICATION
Makes generally acceptable diagnosis
Provides standardized vocabulary that permits
effective communication between psychiatrists, other
doctors and professionals
Makes generalizations in treatment response,
course and prognosis of individual patients
Makes framework for research in psychiatry

4. CLASSIFICATIONOF MENTAL DISORDERS
ICD -10 CLASSIFICATION
DSM –IV (Diagnostic and statistical
manual)
INDIAN CLASSIFICATION

5. ICD-10 classification
ICD 10 (International statistical classification of
disease and related health problems)
Given by WHO in 1992
Chapter “F” classifies psychiatric disorders as mental
and behavioural disorders and codes them on
alphanumeric system from F00 to F99.

6. ICD-10 classification
F00-F09-> Organic including symptomatic mental
disorder:
F10-F19->Mental & Behavioral disorders due to
psychoactive substance use:
F20-F29->Schizophrenia, schizotypal &delusional
disorders:
F30-F39->Mood affective disorder:

7. CONTI…
F40-F49->Neurotic, stress related & somatoform disorders:
F50-F59->Behavioral syndrome associated with physiological
disturbances & physical factors:
F60-F69->Disorders of adult personality & behavior:
F70-F79->Mental retardation:
F80-F89->Disorders of psychological development:
F90-F99->Behavioral & emotional disorders with onset usually
occurring in childhood & adolescence:

8. ICD-10:
F00-F09-> Organic including symptomatic mental disorder:
oF00-dementia in Alzheimer's
disease
oF01-vascular dementia
oF02-dementia in other diseases
oF03-unspecified dementia
oF04-organic amnesic syndrome,
not induced by alcohol & other
psychoactive substances
oF05-Delirium
oF06-Other mental disorders due
to brain damage & dysfunction &
to physical disease
oF07-Organic personality
disorders
oF09-unspecified organic
/symptomatic mental disorders

9. F10-F19->Mental & Behavioral disorders due
to psychoactive substance use:
F10-Due to use of alcohol
F11-Opioid use
F12-Cannabinoids use
F13-Sedative & hypnotics
F14-Cocaine
F15-Stimulants including
caffeine
F16-Hallucinogens
F17-Tubacco
F18-Volatile solvents
F19-Multiple drug & other
psychoactive

10. F20-F29->Schizophrenia, schizotypal &delusional
disorders:
F20-Schizophrenia
F20.0-paranoid Schizophrenia
F20.1-hebephrenic
Schizophrenia
F20.2-catatonic Schizophrenia
F20.3-undifferentiated
Schizophrenia
F20.4-post- Schizophrenia
depression
F20.5-residual Schizophrenia
F20.6-simple Schizophrenia
F20.7-other Schizophrenia

11. Conti……………….
F21- Schizotypal disorder
F22-persistant delusional
disorders
F23-Acute & transient
psychotic disorder
F24-Induced delusional
disorder
F25- Schizoaffective disorders
F26-Other non-organic
psychotic disorders
F29-Unspecified non-organic
psychosis

12. F30-F39->Mood affective disorder:
F30-Manic episode
F31-Bipolar affective
disorder
F32-Depressive episode
F33-Recurrent Depressive
disorder
F34-Persistant mood
(affective ) disorder
F38-Other mood
(affective) disorder
F39-Unspecified mood
(affective) disorder

13. F40-F49->Neurotic, stress related &
somatoform disorders:
F40-Phobic anxiety
disorder
F41-Other anxiety
disorder
F42-Obsessive compulsive
disorder
F43-Reaction to severe
stress & adjustment
disorders
F44-Dissociative
/conversion disorders
F45-Smatoform disorder
F48-Other neurotic
disorder

14. F50-F59->Behavioral syndrome associated with
physiological disturbances & physical factors:
F50-Eating disorder
F51-Non-organic sleep disorder
F52-Sexual dysfunction & caused
by organic disorder or disease
F53-Mental & Behavioral factors
associated with the
puerperium,not elsewhere
classified
F54-Mental & Behavioral factors
associated with disorder or
disease classified elsewhere
F55-Abuse of non-dependence
producing substance
F59-Unspecified behavioral
syndromes associated with
physiological disturbances &
physical factors

15. F60-F69->Disorders of adult personality &
behavior:
F60-Specific personality disorder
F60.0-paranoid personality disorder
F60.1-schizoid personality disorder
F60.2-Dissocial personality disorder
F60.3-Emotionally unstable
personality disorder
>.30-Impulsive type
>.31-Borderline type
F60.4-Histrionic personality disorder
F60.5-Anankastic personality
disorder
F60.6-Anxious(avoidant) personality
disorder
F60.7-Dependent personality
disorder
F60.8-Other specific personality
disorder

16. Conti……………….
F60.9-Unspecified personality
disorder
F61-Mixed & other personality
disorder
F62-Enduring personality changes
not attributable to brain damage &
disease
F63-Habit & Impulsive disorders
F64-Gender identity disorder
F65- Disorders of sexual preference
F66-Psychological & behavioral
disorders associated with sexual
development & orientation
F68-Other disorder of adult
personality & behavior
F69-Unspecified disorder of adult
personality & behavior

17. F70-F79->Mental retardation:
F70-Mild MR
F71-Moderate MR
F72-Severe MR
F73-Profound MR
F78-Other MR
F79-Unspecified MR

18. F80-F89->Disorders of psychological
development:
F80-Specific developmental
disorders of speech &
language
F81-Specific developmental
disorders of scholastic skills
F82-Specific disorders of
motor function
F83-Mixed Specific
developmental disorder
F84-Pervasive Specific
developmental disorder
F89-Unspecified disorder of
psychological

19. F90-F99->Behavioral & emotional disorders with onset
usually occurring in childhood & adolescence:
F90-Hyperkinetic disorder
F91-Conduct disorder
F92-Mixed disorders of conduct
& emotions
F93-Emotional disorders with
onset specific to childhood
F94-Disorders of social
functioning with onset specific
to childhood & adolescence
F95-Tic disorders
F98-Other Behavioral &
emotional disorders with onset
usually occurring in child &
adolescence
F99-Unspecified mental
disorder

20. DSM V CLASSIFICATION
DSM 5 (DIAGNOSITC AND STATISTICAL
MANUAL)
Published on May 18, 2013.
It was introduced to help guide clinical
assessment and ensure adequate attention to
all mental disorders.

21. DSM V CLASSIFICATION
AXIS I : Clinical psychiatric diagnosis
AXIS II :Personality disorders & mental retardation
AXIS III :General medical conditions
AXIS IV :Psychosocial & environmental problems
AXIS V :Global assessment of functioning current &
in past 1 year

22. INDIAN CLASSIFICATION OF MENTAL
DISORDERS
Given by Neki (1963), Wig And Singer
(1971), Vahia (1961) And Varma (1971)
A. PSYCHOSIS
FUNCTIONAL
1.schizophrenia
>simple
>hebephrenic
>catatonic
>paranoid
AFFECTIVE
1.Mania
2.Depression
ORGANIC
1.Acute
2.Chronic

23. CONTI……….
B. NEUROSIS
Anxiety neurosis
Depressive neurosis
Hysterical neurosis
Obsessive compulsive neurosis
Phobic neurosis

24. CONTI……….
C. SPECIALDISORDERS
CHILDHOOD DISORDERS-conduct & emotional disorders
PERSONALITY DISORDERS-sociopath & psychopath
SUBSTANCE ABUSE-alcohol abuse & drug abuse
PSYCHOPHYSIOLOGICAL DISORDERS-asthma & psoriasis
MENTAL RETARDATION-mild, moderate, severe & profound

25. REVIEW
OF
PERSONALITY
DEVELOPMENT

26. DEFINITION
Personality refers to deeply ingrained
patterns of behaviour, which include the
way one relates to, perceives and thinks
about the environment and oneself.

27. FACTORS INFLUENCING PERSONALITY
BIOLOGICAL FACTORS
• Heredity
• Endocrine glands
• Physique
• Nervous system
ENVIORNMENTAL FACTORS
• Family
• School
• Teacher
• Peer group
• Sibling relationships
• Mass media
• Culture

28. THEORIES OF PERSONALITY DEVELOPMENT
PSYCHOANALYTIC THEORY
THEORY OF PSYCHOSOCIAL DEVELOPMENT
THEORY OF COGNITIVE DEVELOPMENT
THEORY OF MORAL DEVELOPMENT
BEHAVIORAL THEORIES

29. PSYCHOANALYTIC THEORY –
Sigmoid Freud (1961)
FREUD’S
STAGES
OF
PSYCHOSEXUAL DEVELOPMENT

30. STAGE AGE MAJOR DEVELOPMENTAL TASK ABNORMALITY
Oral Birth to 18
months
Relief from anxiety through oral gratification of needs Dependent personality traits,
schizophrenia, severe mood
disorders, and alcohol
dependence syndrome and
drug dependence behavior.
Anal 18 months
to 3 years
Learning independence and control, with focus on the
excretory function
To obsessive compulsive
personality traits and obsessive
compulsive disorder.
Phallic 3 to 6
years
Identification with parent of same gender, development of
sexual identity
focus on genital organs
Sexual deviations, sexual
dysfunction and neurotic
disorders.
Latency 6 to 12
years
Sexuality repressed, focus on relationships with same-gender
peers
Neurotic disorders.
Genital 13 to 20
years
Libido reawakened as genital organs mature
focus on relationships with members of the opposite gender.
Neurotic disorders.

31. THEORY OF PSYCHOSOCIAL DEVELOPMENT
ERICK ERICKSON (1963)
STAGES OF DEVELOPMENT IN ERICKSON’S
PSYCHOSOCIAL THEORY

32. STAGE AGE MAJOR DEVELOPMENTAL TASK
Trust vs. mistrust Infancy
(birth to 18 months)
 To develop a basic trust in the mothering figure
and learn to generalize it to others
Autonomy vs. shame &
doubt
Early childhood
(18 months to
3years)
 To gain some self-control and independence
within the environment
Initiative vs. guilt Late childhood
(3 years to 6 years)
 To develop a sense of purpose and the ability to
initiate and direct own activities
Industry vs. inferiority School age
(6 to 12 years)
 To achieve as a sense of self-confidence by
learning, competing, performing successfully,
and receiving recognition from significant others,
peers and acquaintances

33. STAGE AGE MAJOR DEVELOPMENTAL TASK
Identity vs. role
confusion
Adolescence
(12 to 20 years)
 To integrate the tasks mastered in the previous stages
into a secure sense of self
Intimacy vs.
isolation
Young adulthood
(20 to 30 years)
 To form an intense, lasting relationship or a
commitment to another person, cause, institution, or
creative effort
Generativity vs.
stagnation
Adulthood
(30 to 65 years)
 To achieve the life goals established for oneself, while
also considering the welfare of future generations
Ego integrity vs.
despair
Old age
(65 years-death)
 To review one’s life and derive meaning from both
positive and negative events, while achieving a
positive sense of self-worth.

34. COGNITIVE DEVELOPMENT THEORY
JEAN PIAGET( 1969)
PIAGET’S STAGES OF COGNITIVE
DEVELOPMENT

35. STAGE AGE MAJOR DEVELOPMENTAL TASK
Sensori
motor
Birth-2
years
 With increased mobility and awareness, development of a sense of self as separate from
the external environment
 the concept of object permanence emerges as the ability to from mental images evolves
Preopera
tional
2-6 years  Learning to express self with language
 development of understanding of symbolic gestures
 achievement of object permanence
Concrete
operatio
nal
6-12 years  Learning to apply logic to thinking
 development of understanding of reversibility and spatiality
 learning to differentiate and classify
 increased socialization and application of rules
Formal
operatio
nal
12-15+
years
 Learning to think and reason in abstract forms making and testing hypotheses
 capability of logical thinking and reasoning expand and are refined
 cognitive maturity achieved

36. DEFENSE
MECHANISMS

37. DEFINITION
“The individual has mental capacities or devices for
protecting himself against psychological dangers and
distress.” -Bhatia and Craig
OR
An intrapsychic process which provides relief from conflict
and anxiety, operates unconsciously.
- Ann J Zwemer

38. Characteristics of defence mechanisms
•Used by almost all individuals in the process of adjustment,
exhibited in the everyday behaviour of normal people.
•The same individual may use varied mechanisms
simultaneously, as per his need and its pattern of use depends
on one’s own ability.
•Defence mechanism will be used at all levels of the mind either
consciously or unconsciously.

39. CONTI…
•It reduces anxiety, fear, tension, frustration and emotional
distress.
•The individual will feel secure when adjustment mechanisms
are in use.
•If one uses defence mechanism within limits, it will increase
self-satisfaction.
•Promotes individual functioning and development, satisfies
inner motives.
•Maintains balance and moulds the personality of an individual.

40. CONTI…
Defence mechanisms are healthy only when In
frequent use
Protects self-esteem against psychological dangers
Forms acceptable behaviour
Able to change positively the external environment
Modifies and reaches felt needs

41. CONTI…
Defence mechanisms are unhealthy only when Unable to modify
abnormal behaviour
Away from reality
If it interferes with maintenance of self image
Develops inferiority feelings, insecurity and lacks self confidence

42. Types of Defense Mechanisms
(C2 D3 I3P R4 S2U)
1. Conversion
2. Compensation
3. Denial
4. Displacement
5. Fantasy or Day dreaming
6. Identification
7. Introjections
8. Isolation
10. Regression
11. Rationalization
12. Repression
13. Reaction Formation
14. Suppression
15. Sublimation
16. Undoing

43. CONVERSION/SYMBOLIZATION
Emotional tensions will be relieved by changing its
intensity into physical symptoms.
E.g. a student awakens with a migraine headache the
morning of a final examination and feels too ill to take
the test

44. Compensation
Consciously covering up for a weakness by over
emphasizing or making up a desirable trait.
Compensation is a process of psychologically
counterbalancing perceived weaknesses by emphasizing
strength in other areas.
Ex. A physically handicapped boy is unable to participate
in football, so he compensates by becoming a great scholar.

45. Denial
Refusing to acknowledge the existence of a real situation or the
feelings associated with it.
Many people use denial in their everyday lives to avoid dealing
with painful feelings or areas of their life they don’t wish to admit.
Ex. Certain individuals do not accept the death of beloved ones.
A woman drinks alcohol every day and cannot stop, failing to
acknowledge that she has a problem.
If denial used excessively, it may lead to severe difficulties
related to health and lifestyles

46. Displacement
Unconsciously discharging pent-up feelings to a less
threatening object.
Ex. A client is angry at his doctor, does not express
it, but becomes verbally abusive with the nurse.
A husband comes home after a bad day at work and
yells at his wife

47. Fantasy or Day dreaming
Gratifying frustrated desires by imaginary
achievement
It is a means of tension reduction and helps the
individual in deeper part part of imaginative
thinking, planning, achievements, wishful
thinking and satisfaction.

48. Identification
An attempt to increase self worth by acquiring
certain attributes and characteristics of an
individual one admires
Ex. A teenaged boy who required lengthy
rehabilitation after an accident decides to become
a physical therapist as a result of his experiences.

49. Introjections
Integrating the beliefs and values of another
individual into one’s own ego structure Children
integrate their parents’ value system into the
process of conscience formation.
Ex. A child says to friend, “Don’t cheat. It’s
wrong.”

50. Isolation
Separating a thought or memory from the
feeling tone or emotion associated with it
Without showing any emotion,

51. Projection
Unconsciously (or consciously) blaming someone else
for one’s difficulties
Ex. A student who has cheated in an examination may
satisfy herself by saying that others too have cheated.
A surgeon whose patient does not respond as well as
anticipated may blame the theatre nurse who helped the
doctor at the same time of operation.

52. Regression
Unconscious return to an earlier and more comfortable
developmental level
There may be regression to the stage where there was previous
fixation
E.g. an adult throws a temper tantrum when he does not get his
own way
Umar pachpan ki, Akal bachpan ki

53. Rationalization
Attempting to make excuses or formulate logical reasons to justify
unacceptable feelings or behaviors
The sour grapes mechanism: Person insist that things we
cannot achieve are not worth having.
Ex. A student who has failed in an examination may complain that
the hostel atmosphere is not favourable and has resulted in his failure
The sweet lemon mechanism: In this person overrates what
happen to him.
Ex. A person who lives in a small house because of limited financial
resources , may say that they are much more comfortable.

54. Reaction Formation
Replacing unacceptable feelings with their exact opposites
Ex. Jane hates nursing. She attended nursing school to please
her parents. During career day, she speaks to prospective
students about the excellence of nursing as a career.
A woman who is very angry with her boss and would like to
quit her job may instead be overly kind and generous toward her
boss and express a desire to keep working there forever.

55. Repression
(Unconscious forgetfulness)
Involuntarily blocking unpleasant feelings and
experiences from one’s awareness
Pushes threatening thoughts back into the
unconscious
Ex. Forgetting a loved one’s birthday after a fight

56. Suppression
The voluntary blocking of unpleasant feelings and
experiences from one’s awareness
Ex. Shreya says, “I don’t want to think about that
now. I’ll think about that tomorrow.”

57. Sublimation
Rechanneling of drives or impulses that are personally
or socially unacceptable into activities that are
constructive
Ex. A woman who is unable to have children may
engage herself in working with children.
 A mother whose son was killed by a drunk driver
channels her anger and energy into being the president of
the local chapter of Mothers Against Drunk Drivers

58. Undoing
Undoing is the attempt to take back an unconscious behavior or
thought that is unacceptable or hurtful.
By “undoing” the previous action, the person is attempting to
counteract the damage done by the original comment, hoping the
two will balance one another out.
EX. After realizing you just insulted your significant other
unintentionally, you might spend then next hour praising their
beauty, charm and intellect.

59. MALADAPTIVEBEHAVIOROF
INDIVIDUALSAND GROUPS :
STRESS, CRISIS AND DISASTERS
ADAPTATION
MALADAPTATION
STRESS
CRISIS
DISASTER

60. ADAPTATION
•Adaptation affects three important areas: health,
psychological well-being and social functioning.
•A period of stress may compromise any or all of these
areas.
•If a person copes successfully with stress, he returns to a
previous level of adaptation.
•Successful coping results in an improvement in health,
well being and social functioning.

61. MALADAPTATION
•Maladaptation in any one area can negatively affect others.
•The behaviour is considered to be maladaptive when it is age
inappropriate and interferes with adaptive functioning.
•Factors that influence the adaptive functioning are adequate
perceptions of the situation, adequate social support and adequate
coping.
•Adaptive functioning leads to growth, learning and goal
achievement.
•Maladaptive behaviour prevents and interferes with mastery of the
environment.

62. STRESS
“It can be defined as the normal response of the body and mind
to an abnormal situation .”
- stuart (2006)
Two types of stress: eustress- positive
distress- negative
STRESSOR
A stressor is any person or situation that produces anxiety
responses.

63. CRISIS
Crisis is a turning point in an individual’s life that produces
an overwhelming emotional response. Individuals
experience a crisis when confront some life circumstances
or stressor that they cannot effectively manage through
use of their customary coping skills.
DISASTER
Disaster is defined by the WHO as a severe disruption,
ecological and psychosocial which greatly exceeds the
coping capacity of the affected community.

64. Caplan identified the following stages of crisis:
The person is exposed to a stressor, experiences anxiety,
and tries to cope in a customary fashion.
Anxiety increases when customary coping skills are
ineffective.
The person makes all possible efforts to deal with the
stressor, including attempts at new methods of coping
When coping attempts fail the person experiences
disequilibrium and significant distress.

65. Conti…
The most essential element of psychiatric mental
health intervention during a crisis or disaster is the –
Ability of the nurse to provide emotional support
while assessing the individual’s emotional and
physical needs and enlisting his or her co-operation.