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.

Sexual Disorders Chapter 7 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Perilaku Seksual Abnormal Perilaku seksual merupakan gangguan psikologik jika disebabkan : membahayakan orang lain, distress menetap atau berulang , atau terganggu fungsi penting pada dirinya. Some behaviors, such as child molestation, can clearly fit the first criterion (causing harm to others) without necessarily causing distress or impairing other functioning in the individual who does these things. It is important to consider context, as well as customs and mores which change over time, when evaluating the normality of a given sexual behavior. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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

Parafilia para = abnormal; philia = ketertarikan Most people with paraphilias are male. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Parafilia Gangguan berulang , dengan bangkitan seksual melalui fantasi, dorongan seksual atau perilaku yang dialami individu dengan : obyek nonhuman, anak atau other nonconsenting persons, atau membuat penderitaan atau mempermalukan diri atau pasangan. Ketidakmampuan mendapatkan kepuasan seksual ketika stimulus yang dikehendaki tak ada Berlangsung sedikitnya enam bulan. Information about the incidence of paraphilias is limited, primarily because people with them are too ashamed or embarrassed to seek help, or have no interest in changing. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Pedophilia Pedophilia: Parafilia dengan dorongan seksual tertuju langsung pada anak Pedophilia is a disorder in which an adult (16 years or over) has uncontrollable sexual urges toward sexually immature children. Because of the extreme harm to innocent victims, this is perhaps the most widely investigated paraphilia. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

PEDOPHILIA Tipe korban Situasional Preferensi Perkosaan anak Situational molesters are primarily interested in relationships with adults (and therefore are not pedophiles). However, in certain contexts, such as during a stressful time, they experience a strong impulse to become sexual with a child. Afterward, they feel distress over what they have done. For the preference molester, pedophilic behavior is ingrained into his personality and lifestyle. He has a clear preference for children, especially boys. He sees nothing wrong with his behavior. The child rapist is a violent abuser whose behavior is an expression of hostile drives. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

PEDOPHILIA 2/3 korban penyerangan seksual anak & remaja Korbannya : anak berumur 12-17, lebih sering anak berumur 14-tahun Untuk anak berumur dibawah 12, paling banyak berumur 4-tahun Korbannya, hampir 2/3 nya perempuan Penyerangnya kebanyakan laki-laki Sekitar 1/3 , korbannya anak-anak Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tipe Umum Penyerang Seksual Terkait perkembangan Fisiologik Kognitif Afektif Another model applies to sexual aggressors, in general, but seems particularly suited for examining pedophilia. The physiological sexual aggressor experiences deviant sexual arousal patterns. The cognitive sexual aggressor plans his sexual aggression, which is more likely acquaintance rape or incest, less impulsive and violent than other kinds. The affective sexual aggressor lacks affective control. His sexual aggression is opportunistic, unplanned, and often violent. The sexual aggressor with developmentally-related personality problems has a long history of personality and adjustment difficulties, family and interpersonal conflicts, and childhood victimization. They tend to engage in violent sexual aggression and have the poorest treatment prognosis. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TEORI PENGALAMAN DALAM KEHIDUPAN DINI KECENDERUNGAN PERSONALITI Kekerasan seksual dan emosional pada masa kanaknya Terjadi siklus korban-penyerang KECENDERUNGAN PERSONALITI Antisocial personality traits Munculnya kemarahan dari perasaan ketidakmampuan, introversi, kognitif yang kaku Many pedophiles were sexually and emotionally abused as children, in which case they were once victims, then grew up to become abusers. However, most abused children do not grow up to become pedophiles. There appears to be a strong antisocial element in the personalities of child molesters, especially among those who prey on unrelated children. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI PENDEKATAN BIOLOGIK DALAM MENDIAGNOSIS Penile plethysmograph. One biologically based diagnostic tool is the penile plethysmograph which measures blood flow to penis. In this case, the individual is measured when shown sexually arousing pictures of children to record his physical response. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI PENDEKATAN BIOLOGIK DALAM MENERAPI menurunkan kadar testosteron. Kastrasi (jarang). Hypothalamotomy. Clinicians and researchers working within a biological perspective focus on finding somatic treatment to reduce sexual urges, such as by reducing testosterone using antiandrogens or the female hormone progesterone, or by surgical removal of the testes. Hypothalamotomy: Destroying ventromedial nucleus of the hypothalamus to change the individual’s sexual arousal patterns. Limited effectiveness. None of these procedures eliminate sexual arousal or the ability to have intercourse. Ini membantu akan membantu membelokan dorongan seksual, namun ketidak tepatan pilihan pasangan juga harus ditangani Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI TERAPI BEHAVIORAL KOGNITIF TERAPI KELOMPOK terapi aversif Ridicule KOGNITIF Pencegahan Kambuhan TERAPI KELOMPOK konfrontasikan denial dan rasionalisasi konteksnya mendukung diskusi tentang keinginan dan konflik Electroshock is used as a form of aversive therapy in which the pedophile receives shock when he demonstrates a sexual reaction to children. Other aversive conditioning might involve talking about his practices to an audience that then ridicules him. In relapse prevention, the therapist helps the client identify problem situations and develop strategies to help avoid and cope more effectively. Group therapy has been found to reduce the number of repeat offenses. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Exhibitionism Exhibitionisme: Paraphilia ketika orang membangkitkan dorongan seksual dan fantasi melalui mempertontonkan genitalnya pada orang-orang tak dikenal. The paraphilia of exhibitionism differs from socially sanctioned displays as would be found at a nudist beach or strip club. One treatment is covert conditioning, a behavioral method in which the client imagines feeling shame when acquaintances observe him engaging in exhibitionistic behavior. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Fetishisme: Paraphilia ketika orang berpreokupasi dengan benda dan bergantung pada benda ini untuk membangkitkan dorongan seksual dan fantasi daripada memilih seksual intim dengan orang untuk mencapai kepuasan seksual A fetish is a strong, recurrent attraction to a nonliving object. The most common fetishistic objects are ordinary items of clothing. Fetishists may fondle or wear the object, wear it during sexual encounters, or masturbate with it. Perilaku tidak fetishistic ketika benda dimaksud dirancang untuk eksitasi seksual (misal vibrator). Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Partialisme: Paraphilia ketika orang hanya mendapatkan kepuasan seksual dari bagian badan yang spesifik seperti kaki. Beberapa ahli menganggap ini sebagai bentuk fetishisme.                                                Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Kontinuum Perilaku Normal-Abnormal Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Frotteurism: bahasa Perancis frotter (“to rub”) Paraphilia ketika individu mempunyai dorongan fantasi dan pembangkitan seksual sangat kuat dengan menggosok-gosokan penis pada orang yang tidak dikenal. The frotteur seeks out crowded places, such as buses or subways, where he can select an unsuspecting victim, then usually rubs up against the person until he ejaculates. He acts quickly and is prepared to run. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Sexual Masochism Merasa tertarik untuk mencapai kepuasan seksual dengan cara menyakiti badan , secara sendiri atau dengan pasangan. People with this condition have recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving real or simulated acts of being humiliated, beaten, bound, or made to suffer in other ways. The term comes from 19th Century writer Leopold Baron von Sacher-Masoch (1836-1895). Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Sexual Sadism Mencapai kepuasan seksual dengan melalui aktivitas melukai atau membahayakan , orang lain. Terminologi sadomasochist merujuk kepada didapatnya kepuasan seksual melalui memberi dan menerima rasa nyeri. Sexual sadism is the converse of sexual masochism in that it involves inflicting pain rather than receiving it. The term comes from 18th Century French author Marquis de Sade. In rare cases, individuals with sexual sadism commit homicide. The vast majority of masochists and sadists never seek treatment. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Beberapa Aktivitas Sadomasokistik spanking master-slave bondage humiliation restraint pain infliction whipping verbal abuse toilet-related activities cutting shocking asphyxiation Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Transvestic Fetishism Paraphilia dimana seorang laki-laki tak dapat dihambat dorongan untuk mencapai kepuasan seksual melalui memakai baju perempuan Transvestic Fetishism Fetishistic cross-dressing is often accompanied by masturbation or fantasies in which the man imagines that other men are attracted to him as a woman, and yet the man sees himself as a man and is heterosexual in orientation. Relatively few seek professional help. They are reluctant to give up their cross-dressing behavior. Lelaki homoseksual yang mengenakan pakaian perempuan namun tidak terdorong nafsu seksual karenanya BUKAN transvestic fetishists. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

dari bahasa Perancis voir (“to see”) Voyeurism: dari bahasa Perancis voir (“to see”) Paraphilia yang individunya mendapat kepuasan seksual melalui menonton orang telanjang atau orang melakukan kegiatan seksual The voyeur derives sexual gratification from observing the nudity or sexual activity of people who are unaware they are being observed. The voyeur feels frustrated and incapable of establishing a regular sexual relationship with the person he observes. The colloquial term “Peeping Tom” refers to the character Tom the Tailor, the only one in town to look during Lady Godiva’s nude ride. Therapy might focus on self-esteem issues. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

BENTUK LAIN PARAPHILIAS Telephone scatologia Merayu melalui pembicaraan telepon Necrophilia Mayat Zoophilia Binatang Coprophilia Feces Klismaphilia Enemas Urophilia Urine Autagonistophilia Sex dihadapan orang lain Somnophilia Tidur dengan orang lain Stigmatophilia Skin piercing atau tattoo Autonepiophilia Menggunakan diapers Paraphilias NOS (Not Otherwise Specified) include a variety of conditions in which the person views, has recurrent fantasies about, or has sexual contact with unusual stimuli. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

FITUR PARAPHILIAS Variannya ditentukan pelaku paraphilia Umumnya, terintegrasi dalam perilaku Faktor Biopsikososial Kausa utamanya adalah pembiasaan Sulit diterapi Jarang datang untuk terapi, biasannya dipaksa oleh hukum Terapi tergantung nature paraphilia Most paraphilias emerge during adolescence, although there is usually a connection with events or relationships in early childhood. Once established, they tend to be chronic. Although biological factors play a role in some paraphilias, psychological factors seem to be central; in most cases, one or more learning events have taken place in childhood involving a conditioned response that results in a paraphilia. Treatment depends on the nature of the paraphilia and may include a biological component (such as medication), a psychological component (such as psychotherapy), and a sociocultural component (such as group or family therapy). Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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

Persepsi individu sebagai laki-laki atau perempuan Identitas Gender : Persepsi individu sebagai laki-laki atau perempuan Gangguan Identitas Gender Suatu kondisi dalam mana ada kesenjangan antara identitas gender individu dan jenis kelamin bologiknya. An individual’s gender identity may or may not match the assigned (biological) sex. Gender roles: A person’s behaviors and attitudes that are indicative of maleness or femaleness in one’s society. Gender identity disorder is more commonly called transsexualism. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

GANGGUAN IDENTITAS GENDER Keyakinan kuat dan menetap (tetapi bukan delusi) bahwa dirinya terperangkap dalam tubuh berjenis kelamin yang salah Penolakan menerima perilaku diri sesuai gender normatif masyarakatnya Fantasi berulang dan mengenakan pakaian jenis kelamin yang berbeda Tidak ada gratifikasi seksual dari penggunaan pakaian dari jenis kelamin yang berbeda Many individuals with gender identity disorder feel deeply depressed because of the “prison” in which they live. They become increasingly isolated and may prefer activities in which gender has no bearing. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TEORI GANGGUAN IDENTITAS GENDER BIOLOGIK Kadar hormon fetal abnormal Kerentanan pada bangkitan sensori tinggi Sensitif terhadap ekspresi emosi orangtua PSIKOLOGIK Harapan orangtua memiliki anak dari jenis kelaminnya berbeda Secara tidak disadari orangtua mendorong perilaku cross-gender SOSIAL – Idealisme budaya memilih jenis kelamin anak tertentu Females exposed to increased androgens before birth are more likely to display stereotypically male gender roles. In rare cases, chromosomal abnormalities are found in which male-to-female transsexuals have an extra X chromosome. Boys with gender identity disorders are acutely sensitive to various sensory stimuli and to their parents’ affect. Psychological theories focus on factors such as the role of a parent's preference for a child of the other gender, the impact of early attachment experiences, and parents' unintentional reinforcement of cross-gender behavior. For some mothers, disappointment with the birth of yet another boy may negatively influence her relationship with younger sons. Birth order findings: Later-born boys have this more often, and they’re likely to have more brothers than sisters. Sociocultural theories consider various ways in which American society idealizes men and women according to certain stereotypical variables. Various factors influence the choice of intervention, with the most extreme method involving sex reassignment surgery. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI PSIKOTERAPI Anak yang sangat muda Anak yang umurnya lebih tua Membantu mengembangkan self-esteem Anak yang umurnya lebih tua Membicarakan perilaku dan fantasi cross-gender, rendahnya self-esteem, peer rejection Dewasa Fokus pada kausa biopsikososial, beri dukungan dan strategi koping Clinical work greatly depends on the age of the individual. The older they are, the more ingrained the condition will be. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

SEX REASSIGNMENT SURGERY Dicari oleh segelintir orang dengan gangguan identitas gender Faktor fungsi yang diperbaiki pasca operasi : Kepuasan lebih besar pada perubahan perempuan menjadi laki-laki Level penyesuaian diri pra-bedah Level komitmen untuk menjadi seks yang dikehendaki Quality dari tindakan bedah Most studies evaluating the effectiveness of sex reassignment surgery indicate psychological improvement following the surgery. The people dissatisfied post-surgery tend to focus on unalterable bodily characteristics, such as large hands and feet, the persistence of the Adam’s apple, and the quality of their voice. Selection criteria have been developed to ensure that individuals seeking sex reassignment are appropriate candidates. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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

DISFUNGSI SEKSUAL Abnormalitas respon atas jenis kelamin individu Didefinisikan oleh Individu Biasanya terkait masalah lain Sepanjang hayat atau didapatkan Generalisasi atau situasional The National Health and Social Life Survey found sexual dysfunction reported by 43% of women and 31% of men. Sexual dysfunctions are usually related to other life problems: relationship, past experiences, depression, physical illness, substance abuse. Clinicians must determine whether the dysfunction has a psychological cause (such as depression or relationship problems) or results from a combination of psychological and physical factors. Masters & Johnson (1966, 1970) identified four phases of the sexual response cycle: arousal, plateau, orgasm, and resolution. Sexual dysfunctions are associated with the arousal and orgasm phases, and with initial sexual desire. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Minat Seksual Hipoaktif Disfungsi seksual dimana individu minat aktivitas seksualnya rendah Kemungkinan Kausa : Kesulitan psikologik Citra diri atau self-esteem buruk Hostilitas Interpersonal Relasi didominasi kekuasaan Individuals who experience lifelong hypoactive sexual desire disorder lack any interest in sexuality from the onset of puberty. Such cases are less common than those of individuals who develop this in adulthood after stress or interpersonal difficulties. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Aversi Seksual Disfungsi seksual khas dengan ketidak sukaan aktif dan menghindari kontak genital dengan pasangan seksual 4 Kausa Primer : Sikap orangtua terhadap seks sangat negatif Riwayat trauma seksual Tekanan seksual oleh pasangan Konfusi identitas gender Aversions: Responses of discomfort or dislike to a particular object or situation. Masters & Johnson identified the four primary causes. Typically, the individual has sexual activity only once or twice a year, if that often. This is a source of strain in long-term, monogamous relationship. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Pembangkitan Seksual Gangguan pembangkitan seksual perempuan Gangguan ereksi pada laki-laki Female sexual arousal disorder: A sexual dysfunction characterized by a persistent or recurrent inability to attain or maintain the normal physiological and psychological arousal responses during sexual activity. Male erectile disorder: A sexual dysfunction marked by a recurrent partial or complete failure to attain or maintain an erection during sexual activity. Also known as impotence. As with other sexual dysfunctions, arousal disorders may be lifelong or acquired; generalized or situational; due to psychological or physical factors. More than half the cases of erectile dysfunction are attributable to physical problems of a vascular, neurological, or hormonal nature, or to impaired functioning causes by drugs, alcohol, and smoking. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan orgasmik seksual perempuan Gangguan orgasmik pada laki-laki Orgasmic Disorder Gangguan orgasmik seksual perempuan Gangguan orgasmik pada laki-laki Female (or male) orgasmic disorder: A sexual dysfunction in which a woman (or man) experiences problems in having an orgasm during sexual activity. 8% of women have never had an orgasm at all. The individual’s concern over the problem or interpersonal difficulties that emerge in his or her close relationship result in psychological distress. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Ejakulasi Prematur Orgasme laki-laki terjadi jauh sebelum waktu yang diharapkan, mungkin sebelum penetrasi. Due to premature ejaculation, the man feels little or no satisfaction. This is more common in younger men, perhaps associated with lack of maturation and experience. Behavioral treatments include the squeeze technique and the stop-start procedure. Lebih umum terjadi pada laki-laki muda , mungkin terkait dengan maturasi dan pengalaman kurang matang Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Gangguan Nyeri Seksual Dyspareunia Nyeri genital berulang atau persisten sebelum, selama, atau sesudah sanggama. Vaginismus Spasme otot vaginal luar involunter berulang atau persisten Dyspareunia: A sexual dysfunction affecting both males and females that involves recurrent or persistent genital pain before, during, or after sexual intercourse. Vaginismus: A sexual dysfunction that involves recurrent or persistent involuntary spasms of the musculature of the outer part of the vagina. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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

TEORI Disfungsi Seksual dapat muncul dari masalah fisik dan/atau psikologik Gangguan neurologik, kardiovaskular Penyakit hati atau ginjal Abnormalitas hormonal Problem dengan sistem reproduksi Penggunaan zat adiktif/obat In recent years, increasing attention has been given to the fact that bodily processes, such as illness, reactions to medications, diet, and even sleep, can cause and aggravate sexual difficulties. Many chemical substances, both medications and illicit drugs, can affect sexual functioning. For this reason, there is a DSM-IV category called substance-induced sexual dysfunction. Low testosterone is associated with sexual dysfunction. For both genders, depression is associated with a reduction in sexual desire and performance; unfortunately, many antidepressants further diminish sexual activity. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI Terapi – terapi dengan menyertakan fisik, edukatif, sikap, intrapsikik, dan interpersonal Variasi terapi tergantung kausa, masalah spesifik dan faktor-faktor yang mempengaruhi. Treatment varies depending on the cause, the specific problem, and influencing factors. For example, if a man’s erectile problems are due to psychological factors, individual or couple therapy is recommended. When the cause is physical, several somatic interventions may be used, such as medication or surgery. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TERAPI Masters & Johnson merekomendasikan fokus pada sensasi : Pasangan mendapat giliran saling menstimuli secara nonseksual namun perlu dengan cara afeksi lebih dahulu ,lalu secara bertahap waktu demi waktu kemudian menstimuli genital . The effectiveness of sex therapy has not been adequately researched.

Sudut Pandang Biopsikososial Sudut pandang perilaku paling mengena untuk menerangkan gangguan seksual Terapi perilaku gangguan seksual dapat diterapkan pada paraphilias dan disfungsi seksual. Sudut pandang biologik penting , terutama pada gangguan identitas gender dan terapi disfungsi ereksi Penting menggali riwayat personal dan kesulitan relasi. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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