Abnormal Psychology Clinical Perspectives on Psychological Disorders 5e Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst slides by Travis Langley Henderson State University slides by Travis Langley Henderson State University Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Eating Disorders & Impulse- Control Disorders Chapter 14 Eating Disorders & Impulse- Control Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Makan Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Anoreksia dan Bulimia Anoreksia nervosa: Gangguan makan khas dengan ketidakmampuan mempertahankan BB normal, sangat takut BB naik, dan distorsi persepsi tubuh. Bulimia nervosa: Gangguan makan individu bergantian makan banyak dalam waktu singkat, kemudian mengompensasi dengan muntah atau perlakuan ekstrim lainnya guna menghindari kenaikan BB People with eating disorders struggle to control their disturbed attitudes and behaviors regarding food, and many put their lives at risk. Differences: Anorexics have distorted body image, bulimics have accurate body image; anorexics significantly below normal weight, bulimic’s weight is average or above-average. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Anoreksia dan Bulimia Anoreksia nervosa: Gangguan makan khas dengan ketidakmampuan mempertahankan BB normal, sangat takut BB naik, dan distorsi persepsi tubuh. Numbers of males with anorexia nervosa have increased. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Anorexia Nervosa Anoreksia Nervosa Menolak/ tidak mampu mempertahankan BB dengan 85% dari BB sesuai dengan perbandingan dengan TB. Sangat ketakutan BB naik, meski BB dibawah normal Distorsi persepsi BB atau bentuk tubuh. Amenhorrhea. Four symptoms characterize anorexia nervosa. Amenhorrhea: (for postpubescent females) the absence of at least three consecutive menstrual cycles. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Dampak Anoreksia Nervosa Anorexia Nervosa Makin lama melaparkan diri berlangsung, tanda-tanda gangguan tubuh makin menjadi nyata. Misal : Kulit menjadi kuning Gangguan fungsi organ Kematian (1 dalam 10). 1 in 10 die as a result of starvation, medical complications, or suicide. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Bulimia Nervosa Bulimia Nervosa Orang dengan bulimia nervosa makan dalam jumlah besar dalam jangka pendek, kemudian mengompensasi kalori yang berlebih dengan memuntahkan atau tindak ekstrim lainnya Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Bulimia Nervosa Bulimia Nervosa BINGES: Episode makan banyak , khas dengan : Dalam waktu 2-jam, makan dalam jumlah besar , lebih banyak dari orang biasa makan; Sedikit kendali atas apa dan banyaknya makanan yang dimakan Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Bulimia Nervosa Bulimia Nervosa PERILAKU KOMPENSASI PURGING TYPE – memaksa diri untuk mengeluarkan apa yang baru mereka makan dengan cara : muntah, menggunakan pencahar, atau diuretika, menggunakan enema NONPURGING TYPE – mencoba melakukan kompensasi dengan puasa atau olah raga berlebihan. Some people with anorexia nervosa also engage in compensating behaviors, but their primary symptom is that they starve themselves. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Effects of Bulimia Nervosa Dampak Bulimia Nervosa Effects of Bulimia Nervosa IPECAC SYRUP, jika digunakan reguler untuk membuat muntah, efeknya toksik Gigi rusak Kelenjar ludah membesar Menstruasi tidak teratur PENCAHAR, DIURETIK, dan TABLET DIET juga mempunyai efek toksik jika digunakan jangka panjang Kerusakan gastrointestinal mungkin menetap Also possible: fluid retention in hands and feet; destruction of the heart muscle; collapse of the heart valve. Effects occur throughout the gastrointestinal, cardiovascular, and nervous systems. For girls, the highest risk for development of binge behavior is age 16; purging, 18. 42% of bulimic men identify themselves as homosexual or bisexual; 58% anorexic men, asexual. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TEORI GANGGUAN MAKAN BIOLOGIK – pengaruh sistem neurotransmitter dopamine dan serotonin. PSIKOLOGIK – Makan sebagai pelepas diri dari gejolak dan nyeri dalam diri; dari sudut kognitif, selalu memerangkap diri pada pola makan. SOSIOKULTURAL – Disfungsi keluarga dan obsesi masyarakat akan makanan Norepinephrine and serotonin deficiencies are also implicated in mood and compulsive disorders, so it is interesting to note high co-morbidity between those disorders and the eating disorders. Victims of childhood abuse have higher rates of eating disorders. Individuals with eating disorders tend to avoid problems rather than resolve them; resort to wishful thinking rather than realistic appraisal; and don’t seek social support even when in serious trouble. The pursuit of emotional comfort through eating may also be seen as a desperate expression of unresolved feelings of dependency. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI GANGGUAN MAKAN PENDEKATAN KOMBINASI MEDIKASI PSIKOTERAPI Kognitif/Behavioral Terapi Interpersonal Terapi Keluarga Given the multiple perspectives on the causes of eating disorders and the evidence to support each, it follows that effective treatment usually requires a combination of approaches. Medication: Fluoxetine (Prozac) can help control relapse, maintain weight gains, and reduce other symptoms. Regardless of the potential usefulness of medications, though, psychotherapy is clearly needed. Cognitive/behavioral: Establish good eating patterns; self-monitoring techniques; learn self-control, problem-solving, cognitive-restructuring. Interpersonal therapy: Therapy focuses on helping the client cope with stress in interpersonal situations and with feelings of low self-esteem. Family therapy: A review of research indicates that involvement of the parents and the teen is sufficient to bring about positive change. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI GANGGUAN MAKAN Terapis menggunakan multifamily therapy yang efektif Partisipasi beberapa keluarga dalam sesi terapi kelompok Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Kendali Impuls Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

GANGGUAN KENDALI IMPULS Gangguan ini menyertai ketidak mampuan mengatur impuls spesifik -not attributable to other DSM-IV-TR diagnoses. Impulse-control disorders: Psychological disorders in which people repeatedly engage in behaviors that are potentially harmful, feeling unable to stop themselves and experiencing a sense of desperation if their attempts to carry out the behaviors are thwarted. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Kleptomania Gangguan kendali impuls dorongan untuk mencuri Kegiatan mencuri menarik mereka. Obyek yang dicuri tidak tentu yang diinginkan. Most people with kleptomania are unsure what to do with the stolen items. Mencuri melepaskan ketegangan, meski dorongannya tidak menyenangkan, tidak perasaan. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Kleptomania Kleptomania Barang yang diambil tidak mengandung unsur ekonomi, sementara mencuri/merampok/merampas adalah barang yang diminati atau mempunyai nilai ekonomi bagi yang mengambil People with kleptomania are driven by a persistent urge to steal, although their theft is not motivated by a wish to own the object or by its monetary value. A serotonin deficiency might underlie kleptomania. Clinicians use techniques like covert sensitization to control the urge to steal. However, few cases come to clinical attention. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Pathological Gambling Gangguan kendali impuls untuk selalu melakukan judi tanpa dapat dikendalikan Often gamblers have experienced a big win, a gain of large amounts of money in one bet, propelling them into a pattern of addiction that inevitably becomes almost impossible to break. The big win was so reinforcing, they become obsessed with the need to re-experience it. From a biological perspective, the perpetual pursuit of the big win is similar to effects of substance addiction. Personality influences: High impulsivity and psychopathy are thought to predispose individuals to seek excitement like that provided by gambling. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Pathological Gambling Internet addiction is becoming the newest context for pathological gambling. Although more common among young people, it is also becoming prevalent among the adult population. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Pyromania Dorongan kuat untuk menyiapkan, menunggui dan menyaksikan kobaran api untuk kesenangan, dimotivasi oleh keserakahan atau pemberontakan Achieve intense pleasure, gratification, relief when fire starts. Rooted in childhood problems . Adults often have substance abuse and interpersonal problems. Difficult to treat, but behavioral, cognitive, and psychodynamic therapy may help. Gangguan kendali impuls , persisten dan dorongan sulit diabaikan, harus dilakukan, untuk mengobarkan api. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Sexual Impulsivity Sexual Impulsivity Tak tertera dalam DSM-IV-TR sebagai diagnosis, simtom seksual impulsif tak terkendali. Klinisi melihat adanya peningkatan kasus dorongan seks tidak terkendali. Some experts believe the easy availability of sexuality on the Internet has pulled some people into desperately seeking sexual gratification, addictedly viewing sexual images, participating in sexually oriented chat rooms, or contacting other people seeking sexual encounters. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Sexual Impulsivity Dorongan untuk sering berhubungan seks. Merasa tidak nyaman sesudah melakukan hubungan seks Dapat melebar dengan tindakan kekerasan seperti perkosan, pembunuhan, pembunuhan berantai Biasanya disertai penggunaan zat dan depresi; beberapa dengan simtom disosiatif Like other conditions in the obsessive-compulsive spectrum, this responds to SSRIs. Insight-oriented therapy focuses on analyzing underlying conflicts. Behavioral techniques include covert conditioning, imaginal desensitization, and behavioral contracting. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tindakan kompulsi menarik/cabut rambut Trichotillomania Trichotillomania Tindakan kompulsi menarik/cabut rambut They tend to engage in hair-pulling only when alone. Some may eat the hair they pull out. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tindakan kompulsi menarik/cabut rambut Trichotillomania Trichotillomania Tindakan kompulsi menarik/cabut rambut Gangguan yang terjadi bersamaan - depresi, gangguan anxietas, penggunazat, gangguan makan Dasarnya Biologik – Berkait dengan OCD (abnormalitas ganglia basalis, are kendali motorik) Dasarnya Behavioral – berakar pada lingkungan, dilakukan untuk menurunkan ketegangan Sosiokultural – Akibatnya perasaan terbelenggu, terabaikan, secara emosional terbebani Trichobezoar (“Rapunzel syndrome”): Condition in which swallowed hair solidifies in the stomach or intestines. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

INTERMITTENT EXPLOSIVE DISORDER Gangguan kendali impuls disertai ketidak mampuan menahan kemarahan dan mengekspresikan secara kuat dan diikuti tindak kekerasan. Lebih 90% bersama dengan gangguan mood . Gangguan yang bersama lainnya : gangguan penggunaan zat dan anxietas Features of this disorder suggest a complex interaction of biological and environmental factors leading up to it. Learning theorists feel operant conditioning explains the behavior of people who explode occasionally, that it leads to powerful reinforcement for them. Based on findings of serotonergic abnormalities, clinicians advocates medications. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Adiksi Internet Kondisi kendali impuls dimana individu merasa kebutuhan tak dapat ditunda/dihentikan untuk menggunakan Internet Meski tak ada dalam diagnosis DSM-IV-TR, Adiksi Internet masuk dalam golongan gangguan kendali impuls Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

“Cyber-disorders” Istilah diagnostik informal, klien dengan masalah utama terkait penggunaan internet Information overload involves compulsive Web surfing or database searches. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

“Cyber-disorders” Istilah diagnostik informal, klien dengan masalah utama terkait penggunaan internet Subtipe: cyber-sexual addiction cyber-relation addiction net compulsions (misal online gambling, shopping, trading) information overload compulsive online game playing Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Perspektif Biopsikososial Gangguan Makan dan Gangguan Kendali Impuls Gangguan ini masuk dalam kelompok tidak dapat dikendalikannya impuls untuk bertindak dengan cara destruktif ata merusak eksistensinya. Para ahli menggolongkannya dalam “affective spectrum” sekotak dengan gangguan obsessive atau compulsive . In attempting to explain impulse-control disorders, experts have proposed that they fall on an “affective spectrum” that includes mood disorders, substance abuse disorders, anxiety disorders, and eating disorders. All these conditions share certain symptoms, hypothesized biological mechanisms, and treatments. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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