CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi AbnormalGanjil 2009 Kuliah

CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi Abnormal-Ganjil 2009 -Kuliah 2

Kriteria Abnormal Statistical Infrequency Menggunakan pengukuran statistik dimana semua variabel yang akan diukur didistribusikan ke dalam suatu kurva normal atau kurva dengan bentuk lonceng Biasa digunakan dalam konteks medis atau psikologis. Misalnya mengukur tekanan darah, tinggi badan, intelegensi, ketrampilan membaca Namun, kita jarang menggunakan istilah abnormal untuk salah satu kutub (sebelah kanan). Tidak selamanya yang jarang terjadi adalah abnormal perlu informasi lain untuk mendiagnosa abnormalitas

Unexpectedness Biasanya merupakan suatu respon yang tidak diharapkan terjadi. tiba-tiba menjadi cemas Tiba-tiba mengalami kesedihan mendalam tanpa ada penyebab

Violation of norms Perilaku abnormal ditentukan dengan mempertimbangkan konteks sosial dimana perilaku tersebut terjadi. Jika perilaku sesuai dengan norma masyarakat, berarti normal. Sebaliknya jika bertentangan dengan norma yang berlaku, berarti abnormal. Kriteria ini mengakibatkan definisi abnormal bersifat relatif tergantung pada norma masyarakat dan budaya pada saat itu. Misalnya di Amerika pada tahun 1970 -an, homoseksual merupakan perilaku abnormal, tapi sekarang homoseksual tidak lagi dianggap abnormal. Walaupun kriteria ini dapat membantu untuk mengklarifikasi relativitas definisi abnormal sesuai sejarah dan budaya tapi kriteria ini tidak cukup untuk mendefinisikan abnormalitas. Misalnya pelacuran dan perampokan yang jelas melanggar norma masyarakat tidak dijadikan salah satu kajian dalam psikologi abnormal.

Personal distress menimbulkan penderitaan dan kesengsaraan bagi individu Tidak semua gangguan (disorder) menyebabkan distress. Tidak semua penderitaan atau kesakitan merupakan abnormal bersifat subjektif karena susah untuk menentukan setandar tingkat distress seseorang agar dapat diberlakukan secara umum.

Disability Individu mengalami ketidakmampuan (kesulitan) untuk mencapai tujuan karena abnormalitas yang dideritanya

Mitos atau Fakta?

Perilaku abnormal sangat aneh dan sangat berbeda dengan orang normal Gangguan mental akibat adanya kekurangan dalam diri yang tidak teratasi Gangguan mental dipengaruhi sihir atau magic Penderita gangguan sukar dibedakan dengan orang normal Setiap orang punya potensi dan kesempatan sama untuk terganggu dan bertingkah laku abnormal Banyak orang-orang yang percaya Tuhan terkena gangguan mental dan masyarakat kurang mengetahui pengetahuan ilmiah.

Paradigma Psikologi Abnormal

Current Paradigms: Genetic 10 Heredity plays a role in most behavior Genes Carriers of genetic information (DNA) Impacted by environmental influences e. g. , stress, relationships, culture Relationship between genes and environment is bidirectional Nature via nurture (Ridley, 2003)

Important Genetic Terms 11 Gene expression Polygenic transmission Proteins influence whether the action of a specific gene will occur Multiple gene pairs vs. single gene gen carrier Heritability Extent to which variability in behavior is due to genetic factors Heritability estimate ranges from 0. 00 to 1. 00 Group, rather than, individual indicator “keturunan” tidak digunakan untuk menyatakan satu jenis gangguan perilaku atau gangguan klinis seseorang, melainkan untuk menjelaskan probabilitas gangguan itu muncul dalam masyarakat. ADHD 0. 70 : 70% genetis, 30% lingkungan

Environmental Effects 12 Shared environment Events and experiences that family members have in common Nonshared environment Events and experiences that are unique to each family member Andi (30) dan Tini (24) adalah kakak beradik. Andi merupakan seorang pekerja kantoran yang sukses. Sementara Tini merupakan seorang pecandu alkohol dan selalu gagal dalam pekerjaannya. Semasa sekolah dulu Andi merupakan murid yang periang dan mudah bergaul, sementara Tini merupakan murid yang bermasalah dan selalu membuat keributan. Keluarga mereka merupakan keluarga yang kurang hangat dan individualis.

Behavior Genetics 13 Study of the degree to which genes and environmental factors influence behavior Genotype Genetic material inherited by an individual Unobservable Phenotype Expressed genetic material Observable behavior and characteristics Depends on interaction of genotype and environment Contoh: Inteligensi dan potensi kecerdasan

Current Paradigms: Neuroscience Examines the contribution of brain structure and function to psychopathology Gangguan mental diasosiasikan dengan terganggunya proses neurotransmiter dalam otak. Four mechanisms: Neurons and neurotransmitters Brain structure and function Autonomic system Neuroendocrine system

Figure 2. 3 The Neuron Basic Unit of the Nervous System 15

Neurons and Neurotransmitters 16 Neurotransmitter Receptor sites on postsynaptic neuron absorb neurotransmitter Chemicals that allow neurons to send a signal across the synapse (gap) to another neuron. Excitatory creation of a nerve impulse Inhibitory less likely to create a nerve impulse Reuptake Reabsorption of leftover neurotransmitter by presynaptic neuron

Neurotransmitters and Psychopathology 17 Serotonin and dopamine Norepinephrine Anxiety and other stress related disorders Gamma-Aminobutyric Acid (GABA) Depression, mania, and schizophrenia Anxiety Possible mechanisms Excessive or inadequate levels Insufficient reuptake Excessive number or sensitivity of postsynaptic receptors

Figure 2. 5 The Process by which a Second Messenger is Released 18

Figure 2. 6 Brain Structure and Function 19 Sulci define regions or lobes: Frontal (motor) Parietal (somatosensory) Temporal (auditory) Occipital (visual)

Autonomic Nervous System (ANS) 20 Sympathetic Nervous System Excitatory Heartbeat acceleration, pupil dilation, gastrointestinal inhibition, electrodermal activity increases Parasympathetic Nervous System Quiescent Heartbeat deceleration, pupil constriction, gastrointestinal activation Involved in anxiety disorders, especially Panic and PTSD

Neuroscience and Treatment 21 Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes A neuroscience view does not preclude psychological interventions

22 Evaluating the Neuroscience Paradigm Reductionism View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior

Current Paradigms: Psychodynamic 23 Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment

Role of the Unconscious 24 Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions Implicit memory Cognitive The neuroscience paradigm unconscious may reflect efficient information processing rather than a repository for troubling material

25 Importance of Interpersonal Relationships Object relations theory Longstanding patterns of relating to others Attachment theory Type and style of infant’s attachment to caregivers can influence later psychological functioning. Relational self Individuals will describe themselves differently depending upon which close relationships are told to think about (Chen et al. , 2006)

Neuroscience and Treatment 26 Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes A neuroscience view does not preclude psychological interventions

27 Evaluating the Neuroscience Paradigm Reductionism View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior

Current Paradigms: Psychodynamic 28 Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment

Role of the Unconscious 29 Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions Implicit memory Cognitive neuroscience paradigm The unconscious may reflect efficient information processing rather than a repository for troubling material

30 Importance of Interpersonal Relationships Object relations theory Longstanding patterns of relating to others Attachment theory Type and style of infant’s attachment to caregivers can influence later psychological functioning. Relational self Individuals will describe themselves differently depending upon which close relationships are told to think about (Chen et al. , 2006)

Factors Common to Paradigms 31 Emotion Components Expressive Experiential Physiological Most psychopathology includes disturbances of one or more component e. g. , flat affect in schizophrenia Cultural factors influence ideal affect (Tsai, 2007)

Factors Common to Paradigms 32 Sociocultural Factors Culture, ethnicity, gender, & social relationships May increase vulnerability to psychopathology e. g. , women more likely to experience depression than men May also serve as a buffer e. g. , social support Some disorders specific to certain cultures Hikikomori in Japanese culture

Table 2. 2 Lifetime Prevalence Rates of DSM-IV-TR Disorders among Different Ethnic Groups 33

Diathesis-Stress 34 Integrative model that incorporates multiple causal factors (Zubin & Spring, 1977) Diathesis Underlying predisposition Increases one’s risk of developing disorder Stress Environmental events May be biological or psychological May occur at any point after conception Triggering event Psychopathology unlikely to result from one single factor

Diagnosis Multiaksial DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric Association (APA) In Indonesia, mental disorder diagnosis classify in PPDGJ (Pedoman Penggolongan dan Diagnostik Gangguan Jiwa) based on DSM and ICD (International Classification of Diseases) published by WHO

Diagnosis Multiaxial Classification in DSM (1994) are description, atheoretical, and multiaxial more comprehensif (Millon & Davis, 2000) DSM-IV-TR includes five axes = multiaxial classification system, by requiring judgements on each of the five axes, forces the diagnostician to consider a broad range of information

5 Axes in DSM-IV-TR Axes I: Clinical Disorder Other conditions that may be a focus of clinical attention Axes II: Personality Disorder Mental Retardation Axes III: General Medical Condition Axes IV: Psychosocial and environmental problems Axes V: Global Assesment of Functioning (GAF) Scale

GAF Scale Consider psychological, social, and occupational functioning on a hypothetical continuum of mental heal/illness. Do not include impairment in functioning due to physical (or environment) limitations. 0 : Inadequate information 1 -10 : Persistent danger of severely hurting self or others/ persistent inability to maintain minimal personal hygiene 51 -60 : moderate symptoms/moderate difficulty in social, occupational, or school functioning 91 -100: No symptoms, superior functioning in a wide range of activities

Diagnosis Multiaxial Axes III Axess IV Axes V : (296. 23) Severe major depression, without psychotic feature : (301. 6) Personality disorder, defence mechanism denial : none : Occupational Problem : GAF=35 (current)

Current issues related to DSM-V Disorder that might include in DSM-V Behavioral Addiction Definition: excessive use sex, shopping, or computers may signal addiction. These behavior can be taken to such extremes that they easily mimic the behaviors of drug addicts. Binge Eating Disorder Definition: individuals who binge are unable to control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.

Current issues related to DSM-V Complicated Grief Definition: after the death of someone close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer.

Current issues related to DSM-V Disorder that might exclude in DSM-V The Paraphilia: Intense sexual urges involving animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias – a term that was thought to be relatively non judgmental when it replaced “perversions” in 1980. Gender Identity Disorder: Since the DSM-III appeared in 1980, individual who wish to be of the opposite sex-and who are uncomfortable with their own-have been diagnosed with Gender Identity Disorder.