REHAN ALI MALIK

GOLD MEDALIST BS(HONS. )O&P

GENERAL SECRETARY POSP
CPO. ALAC AFIRM RWP.
Introduction To Psychological issues of
Physically Disabled persons
Definitions According To World Health Organization
Impairment
Permanent or Transitory psychological, physiological or
anatomical loss or abnormality

E.g. a missing or defective part, tissue organ or mechanism of the
body such as amputated limb, paralysis after polio, Myocardial
Infarction, cerebrovascular thrombosis, Restricted Pulmonary
capacity, Diabetes, Myopia, Disfigurement, Mental Retardation,
Hypertension, perceptual disturbance and sensory deprivation
Functional Limitation
Impairment may cause functional limitations which are partial or
total inability to perform those activities necessary for motor,
sensory or mental functions within the range and manner of
which the human being is normally capable.
Walking, lifting loads, seeing, speaking, hearing, reading, writing,
counting, taking an interest in and making contact with
surroundings
Functional limitation may last for a short time, long time, be
permanent or reversible
Should be quantified whenever possible
Could be progressive or Regressive
Disability
Impairment or functional limitation is causative factor
Defined as an existing difficulty in performing one or more
activities which in accordance with the subjects age, sex and
normative social role are generally accepted as essential

Depending on the duration of functional limitation:
Disability could be:
Short Term
Long Term
Permanent
Case
5o years old male who has had hypertension for several years suffers a
stroke resulting in right sided hemiparalysis & dysphasia

Impairment:
Hypertension along with disturbance of brain function
Functional Limitation:
Decreased ability to talk
Decreased ability to walk & use right hand
Disability:
Inability to work
Partial inability to look after himself
Reduced ability to interact with surroundings
Some Psychological Stresses Originating From Physical
Disability
I ndividual Consequences:

Decreased Independence

Compromised Mobility

Hampered Leisure Activities

Problems related to Social integration

Decreased economic Viability

Family Consequences
Needs for Constant Care

Constant Liability on Family Members

Disturbed Social and Interpersonal Relationships

Economic Burden

Marital Disharmony and interpersonal conflicts
Societal Consequences
Demands for Care

Fulfillment of special needs

Loss of Productivity leading to inability to fulfill social demands

Disturbed social integration

Stigmatization

Constant sympathy of society leading to low self esteem

Major Psychological Problems Originating As A Result
Of Being Handicapped
Stress, Distress and Depressive Disorder
Post Traumatic Stress Disorder
Anxiety Disorder
Mixed Anxiety and Depressive Disorder
Adjustment Disorder
Acute Psychotic Episode (New onset or Relapse)
Acute Manic Episode (New onset or Relapse)
Agitated Depression
Personality Changes
Substance Misuse ( Alcohol, Cannabis, Opioids,
Benzodiazepines)
Depressive Disorder
Important to differentiate depressive symptoms which
can also be categorized as sadness which requires no
specific treatment


Depressive disorder or agitated depression on other
hand would require specific medical treatment
When to diagnose
Depressive disorder should be diagnosed only:

When persons symptoms are severe enough to fulfill the
criteria

When persons symptoms are severe enough to disable
the individual functionally

Full blown symptoms of depressive disorder would
require both pharmacological and psychological help

Signs and symptoms of Depressive Illness
Depressed mood
Feelings of sadness
Anguish & feelings of agony
Mournful, irritable & anxious
Reduced energy, easy fatigability, decreased activity, marked
tiredness on slightest of effort
Reduced concentration & attention on a task
Reduced confidence & low self esteem
Feelings of guilt & worthlessness
Bleak & pessimistic view of the future
Act of self harm & attempted suicide
Disturbed sleep, diminished libido, reduced appetite

Physical symptoms in Depression
Many patients with Depression present to doctor with
physical symptoms such as:

Headache
Chest Pain
Loss of Appetite
Burning sensations
Pins and needles sensations
Gas, Gola etc

Pharmacological Treatment
Choice of antidepressants would depend upon:

Anticipated side Effects

Safety

Tolerability

Presence of Comorbid physical illnesses

Anxiety Disorders
Anxiety Disorders include:

GAD

Panic Disorders

social and Specific Phobias

PTSD
Signs and Symptoms
Prominent somatic symptoms:
Increased Heart Rate
High Blood Pressure
Palpitations
Muscle tremor
Perspiration
Abdominal discomfort
Hyperventilation
Restlessness
Fidgety feeling

Post Traumatic Stress Disorder
Condition which can occur soon after disability

When people face an overwhelming event in life

Event thats perceived as dangerous & beyond normal
coping capabilities

When ability to respond to such event gets hampered

PTSD is not a single symptom but cluster of symptoms

Symptoms of PTSD
Re-experiencing the event e.g. Nightmares

Routine avoidance of reminders of event

General lack of responsiveness

Diminished interest and engagement

Increased sleep disturbance and poor concentration

Management of PTSD
Psychological First Aid
Psychoeducate patient and family
Help the patient understand his condition
Repeated reassurances that their reactions are b/c of stress
due to traumatic event
support from family, friends, relatives
Let the individual know that he is not alone and is not
responsible for the event
Deep Breathing and Muscle Relaxation Exercises
May require pharmacological Rx for management of anxiety
interpersonal relationships with handicapped
people
Historical perspective:
Historically disabled have been confronted with physical and
mental impediments of their Disabilities
Confronted also by accompanying social stigma and Negative
social attitudes
A persistent negative attitude and social rejection of people with
disabilities is quite evident throughout history and cross culturally
Ancient Roman and Greek cultures viewed disabled as burden on
the society and as less than Human

Interpersonal Difficulties in disabled
Early Research examined interactional Difficulties b/w people
with and without disabilities
A feeling of Discomfort and unease identified as interaction strain
Later on researchers noticed novelty of interactional situation and
self consciousness over appropriate behavior during these
interactions may also contribute to the problem

People without disabilities vs. disabled
According to Fichten, Robillard, Judd and Amsel(1989):
People without disabilities perceive the Disabled to be different
across several social dimensions for e.g.
To be more socially Anxious
Uneasy about keeping social liaisons
To be socially more vulnerable to be picked up by others or being
criticized

Impact of the negative attitudes on disabled
A significant impact on both social & vocational lives
of Disabled
Befriended
Social isolation
Social stigmata
Social distance causing Low self esteem
Self image problems
Conscious of oneself all the time
Feeling of being lonely or left out

How to improve attitudes regarding
interpersonal relationships of Disabled
Increased social contacts with the Disabled
Greater awareness campaigns for the Disabled
Improving societal attitudes about various Disabilities
True understanding about underlying cause
Be more empathic towards the disabled
Addressing the negative perceptions about the Disabled
Fostering the development of more friendly and optimistic
attitude towards the disabled
Role of counselors and Educators regarding awareness generation
about various Disabilities

How to improve social relationships in
physically challenged children
1). Building of self concept & self esteem
2). Confidence Building
3). Fostering involvement in games & creative acts
4). Channelizing energies & reducing frustrations by
involving in certain activities
5). Acceptance of ones disability rather than feeling
ashamed of it
6). Social involvement and Deinstitutionalization
7). Community based rehabilitation
8). Vocational Training ( Knitting, Sewing, Tailoring, cooking)
9). Encouraging to participate into self Help Groups