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Ratna Widiastuti, S.Psi.,M.A.,Psi.

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Ratna Widiastuti, S.Psi., M.A., Psi.

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ANOREKSIA NERVOSA
• UMUR 16-24 TH
• 5% REMAJA
• KELG STATUS SOSIAL MENENGAH KE ATAS
• PREDISPOSISI :

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• FK BIOLOGIS & GENETIK  DISFUNGSI HIPOTALAMUS,
• INTRAPERSONAL  CEMAS, DEPRESI, INTROVERT,
PERFEKSIONIS, PERFEKSIONIS,
• KELUARGA  kaku, overprotekstif, penuh konflik, ibu tll
berperan & ayah tidak,
• SOSBUD  tuntuan budaya/TV, ekskul balet, penyakit kronik
diabetes melitus
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 MANIFESTASI
• MERASA DIRINYA GEMUK
• SUDAH KURUS PUN MASIH MERASA GEMUK
• KEPRIBADIAN: PENGKRITIK DIRI SENDIRI,

Ratna Widiastuti, S.Psi.,M.A.,Psi.

PERFEKSIONIS, CERDAS & POPULER DI SEKOLAH
• APATIS, TIDAK MAMPU MENGEKSPRESIKAN
KEBAHAGIAAN, TERTEKAN, TIDAK BERGAIRAH,
LEKAS MARAH, MALAS BERGAUL
• DR KELG DG STRES KRONIS  BERCERAI ATAU
BERPINDAH TEMPAT
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• TINGKAH LAKU MAKAN  MEMBATASI MAKANAN BERKALORI
TINGGI, DIBAGI-BAGI DLM PORSI KECIL, DIBUMBUI/DIBUBUHI SST
SHG TIDAK MENARIK, CAMPURAN YG TIDAK WAJAR
• MENGGAMBARKAN DIRINYA 20-80% LEBIH BESAR DR UKURAN
SSGHNYA
• MODEL DI MEDIA ADALAH YG MENARIK YG KURUS, SEMAKIN
KURUS SEMAKIN TINGGI STATUS SOSIAL

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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DIAGNOSIS
• MEMBIARKAN DIRI KELAPARAN
• TAKUT GEMUK; MENGHINDARI MAKAN
• GANGG FISIOLOGIS FS HORMON REPRODUKSI  TDK
MENStruasi

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• DSM III:
• TAKUT GEMUK BERLEBIHAN SHG TJD PENURUNAN BB
DRASTIS
• GANGGUAN PENAMPILAN TUBUH  TAKUT GEMUK SHG TDK
MAKAN
• PENURUNAN BB 25% DR BB SEMULA\MENOLAK
MEMPERTAHANKAN BB NORMAL
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• TIDAK PENYAKIT FISIK LAIN YG MENGAKIBATKAN BB TRN
TATALAKSANA
• REHABILITASI NUTRISI  GASTROINTESTINAL (KALORI
3500/HARI) & EDEMA PERIFER (KURANGI GARAM), OBAT
ANTICEMAS
• PSIKOTERAPI  REGULASI EMOSI KRN CEMAS & TAKUT
• PEMELIHARAAN & TINDAK LANJUT  BERAT BADAN

Ratna Widiastuti, S.Psi.,M.A.,Psi.

NORMAL, TINGKAH LAKU MAKAN NORMAL, KEMATANGAN
SOS. EMOSI, MENS NORMAL, SEKOLAH/KERJA DG EFEKTIF,
HUBUNGAN MEMUASKAN, KEMAMPUAN DIRI CAKAP

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BULIMIA NERVOSA
• EPISODE BINGE EATING
• MERANGSANG MUNTAH, GERAK BERLEBIHAN, PUASA
BERKEPANJANGAN, PENYALAHGUNAAN LAKSAN ATAU
DIURETIK
• TJD DI USIA 13-58

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• 3% DI MASYARAKAT
• SEMUA KELAS MASYARAKAT

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ETIOLOGI
• ADIKSI MAKANAN & PERILAKU
• KELUARGA DISFUNGSI ATAU KEKERASA NFISIK & SEKSUAL
• SOSBUD  MEDIA MASSA
• KOGNITIF & TINGKAH LAKU  IRASIONAL BENTUK TUBUH,

Ratna Widiastuti, S.Psi.,M.A.,Psi.

BERAT BADAN, DIET, KEPERCAYAAN DIRI
• PSIKODINAMIKA  MENGENDALIKAN & MENGHINDARI RASA
TERTEKAN, IMPULSIF, CEMAS

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MANIFESTASI
• BINGE EATING  3000-7000KAL
• PURGING  MEMUNTAHKAN DG MERANGSANG FARING,
LAKSAN, DIURETIK, ENEMA, GERAK BERLEBIHAN
• BODY IMAGE KELIRU

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• DEPRESI, RASA BERSALAH, MENYESAL YG MENDALAM

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GEJALA KLINIS
• PEMBENGKAKAN TANGAN /KAKI
• LEMAH, LELAH
• SAKIT KEPALA
• PERUT TERASA PENUH
• MUAL

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• HAID TDK TERATUR
• KRAM OTOT
• NYERI DADA & RASA TERBAKAR
• MUDAH PENDARAHAN
• DIARE BERDARAH
• PERUBAHAN KULIT JARI, HIPERPIGMENTASI, LUKA PARUT
• PEMBESARAN KELENJAR LUDAH 10

• EROSI EMAIL GIGI

 PSIKOPATOLOGI
• ANOREKSIA NERVOSA • INGIN ORLA
• TAKUT GEMUK MENGHENTIKANNYA
• MENGURANGI MAKAN
• BINGE EATING & PURGING (TDK
HRS ADA)

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• RAHASIA TINGKAH LAKU
• TIDAK ADA KEINGINAN BERHENTI
• BULIMIA NERVOSA
• SAMA
• SAMA
• SAMA (HRS ADA)
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• SAMA
TATALAKSANA
• MENURUNKAN POLA MAKAN BULIMIK
• HINDARI MAKANAN BINGE SPT ES KRIM
• OBAT ANTI DEPRESAN
• PSIKOTERAPI

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• OR RINGAN – SEDANG
• TERAPI KELOMPOK
• DIET RENDAH GARAM U/ YG MEMAKAI DIURETIK
• KONSUL DR GIGI UTK KERUSAKAN GIGI

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DEPRESI
• SEDIH
• GANGGUAN SOMATIK, MUDAH LELAH, KURANG ENERGI
• GANGGUAN PSIKOMOTOR, LAMBAT, KURANG ANTUSIAS,
RAGU2

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• MUDAH TERSINGGUNG
• GAGAL MENAIKKAN BERAT BADAN NORMAL
• WAKTU: SATU TAHUN
• GANGG AFEKSI
• IDE BUNUH DIRI
• MUDAH TERSINGGUNG
• IMSONIA 13
• SULIT BERKONSENTRASI
PENYEBAB
• PSIKODINAMIKA  PUTUS CINTA & INTROYEKSI
• KOGNITIF BEHAVIORAL: PANDANGAN NEGATIF TTG DIRI SENDIRI,
INTERPRETASI NEGATIF TTG HIDUPNYA, HARAPAN NEGATIF TTG
DIRINYA, RASA TAK BERHARGA, HELPLESS, HOPELESS
• LEARNED HELPLESSNESS MODEL

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• KETIDAKMAMPUAN ORTU MENCIPTAKAN HUBUNGAN YG BAIK
• BIOLOGIS  NOREPINEPRIN & SEROTONIN, GANGG HIPOTALAMUS,
HORMON PERTUMBUHAN, TIROID, NEURO IMUNOLOGIS, GENETIK
• PSIKOSOSIAL  MASALAH KELUARGA, KETRAMPILAN SOS
KURANG, CERAI, ORTU MISKIN, SAUDARA BANYAK, FUNGSI
KELUARGA BURUK
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KLASIFIKASI
• AFEKTIF BIPOLAR (satu atau lebih episode energi peningkatan
kadar normal, kognisi , dan mood dengan atau tanpa satu atau lebih
episode depresi. Suasana hati meningkat secara klinis disebut
sebagai mania atau, jika ringan, hypomania . Episode ini biasanya
dipisahkan oleh periode "normal" suasana hati)

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• HIPOMANIA (lht atas)
• DISTIMIA (gangguan mood yang ditandai oleh depresi ringan)
• GANGG PENYESUAIAN ( gangguan sementara/awal ketika gambaran
klinis tidak jelas, namun reaksi thd keadaan lebih dari yang
diharapkan secara norma)
• SIKLOTIMIA, RINGAN SLM 1 TAHUN (Bentuk yang lebih ringan,
dimana periode kegembiraan dan depresi tidak terlalu berat,
berlangsung hanya beberapa hari dan kambuh dalam selang waktu
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yang tidak beraturan. Pada akhirnya penyakit siklotimik
berkembang menjadi penyakit manik-depresif, tetapi tidak pernah
berkembang menjadi depresi maupun mania.)
TERAPI
• PSIKOTERAPI KELUARGA
• OBAT ANTI DEPRESAN
• TERAPI CBT

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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SUICIDE/BUNUH DIRI
• USIA: 15-24 TH,
• POPULASI: 9%

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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FAKTOR RISIKO
• BIOLOGIS  SEROTONIN
• GANGGUAN MENTAL ADHD, DEPRESI, IMSONIA
• PENYALAHGUNAAN ZAT
• MINORITAS, GAY, LESBI,BISEKS

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• MASALAH KELUARGA
• MASALAH SOSIAL  KDRT, MISKIN, SEXUAL ABUSE
• MASALAH SEKOLAH  TEKANAN PELAJARAN, TEMAN SEBAYA
• CINTA

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TERAPI
• CBT (COGNITIVE BEHAVIORAL THERAPY)
• PELATIHAN SOFT SKILL
• FARMAKOLOGI ANTIDEPRESAN

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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ATTENTION DEFICIT
/HIPERACTIVE DISORDER
• Konsentrasi pendek, impulsif, banyak bergerak/tak dapat diam

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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Treatments for ADHD
• Classroom-based interventions include educational strategies,
peer-directed strategies, and self-management strategies.
Treatments have addressed both social and academic
concerns associated with ADHD. Educational and instructional
interventions manipulate classroom organization and

Ratna Widiastuti, S.Psi.,M.A.,Psi.

instructional techniques that minimize the occurrence of
ADHD symptoms (Waschbusch & Hill, 2001). Examples of this
treatment strategy include the use of instructional materials
to increase stimulation to students with ADHD during
academic tasks to enhance attention and improve
performance (Zentall, 1993).
• peer tutoring appears to be an effective strategy for
addressing the academic and behavioral difficulties associated
with ADHD in general education classrooms 21
Treatments for ADHD
• Behavior management focused on increasing on-task
behaviors, task completion, compliance, impulse control, and
social skills. Behavior management aims for a reduction in
hyperactivity, off-task behavior, disruptive behavior, and
aggression. Refers to strategies that use reinforcement and

Ratna Widiastuti, S.Psi.,M.A.,Psi.

punishment to increase or decrease specific behaviors.
Positive reinforcement, punishment, and response cost
techniques are the most widely used of the behavior
therapies (Fiore, Becker, & Nero, 1993).
• Cognitive-behavioral therapy combines behavioral
techniques with cognitive strategies to directly address
problems of impulse control, problem solving, and self-
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regulation. Produce desired changes in sustained attention,
impulse control, hyperactivity, and self-concept (Fiore, Becker,
& Nero, 1993).
Treatments for ADHD
• Self-management strategies have been employed with children who
have ADHD. This type of intervention focuses on teaching students
to systematically rate their own behavior according to the rating of
their teachers. Shapiro, DuPaul, and Bradley-Klug (1998)
conceptualize self-management interventions as existing on a
continuum. On one end, the teacher controls the intervention by
providing feedback regarding whether the student’s behaviors have

Ratna Widiastuti, S.Psi.,M.A.,Psi.

met the desired criteria and delivers appropriate consequences for
the behaviors. On the other end, the student is able to self-evaluate
his or her own behaviors against the criteria set for behavior and
performance. The student also self-administers consequences. The
goal of self-management interventions is to move the student
toward the self-management side of the continuum. Once students
are able to accurately measure their behavior against the standard
set by their teacher, the frequency of teacher feedback on student
judgments is gradually lessened until students are accurately judging
the quality of their behavior without the help of eternal
comparisons. 23
Treatments for ADHD
• Several studies have examined the effectiveness of self-
management techniques with ADHD children. examined the
use of a self-management strategy in a general education
classroom to decrease the disruptive behaviors of three
elementary school students in the fourth grade. The self-

Ratna Widiastuti, S.Psi.,M.A.,Psi.

management strategy was based on a system of rewards for
appropriate behaviors. Behaviors were examined in both
structured and unstructured settings. Results of the study
indicated that the self-management intervention with the
reinforcement led to decreases in disruptive behavior, which
was maintained in the absence of the teacher. These data
adds to the existing literature suggesting self-management as
a viable alternative to traditional contingency management 24
approaches.
SKIZOFRENIA
• Schizophrenia is a mental disorder involving a range of cognitive and
emotional dysfunctions that include perception, inferential thinking,
language and communication, behavioral monitoring, affect, fluency
and productivity of thought and speech, hedonic capacity, volition
and drive, and attention. The diagnosis involves the recognition of a
constellation of signs and symptoms associated with impaired
occupational or social functioning: and no one symptom is

Ratna Widiastuti, S.Psi.,M.A.,Psi.

pathognomonic of the disorder.

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SKIZOFRENIA
• Criterion A: two or more of the following symptoms must be present for a significant portion of
time during a one-month period (if the condition has been treated successfully, then the period
may be less).
• Delusions
• Hallucinations
• Disorganized speech, such as frequent derailment or incoherence
• Grossly disorganized or catatonic behavior
• Negative symptoms, such as affective flattening, alogia, or avolition

Ratna Widiastuti, S.Psi.,M.A.,Psi.

• If there are delusions, and they are bizarre; or if there are hallucinations and they comprise a
voice that keeps up a running commentary on the person’s behavior or thoughts, or there are two
or more voices that are conversing with each other — then only these sole symptoms are
necessary and sufficient for diagnosis; a second symptom is not required. The presence of this
relatively severe constellation of signs and symptoms is referred to as the “active phase”.

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SKIZOFRENIA
• Criterion B: a major area of function such as work, interpersonal
relations or self-care is severely impacted for a significant portion of the
time since the onset of the disturbance.
• Criterion C: the disturbance persists continuously for at least six months.
These six months must include at least one month of symptoms that
meet criterion A. The period may also exhibit prodromal or residual
symptoms, during which the signs of the disturbance may be manifested

Ratna Widiastuti, S.Psi.,M.A.,Psi.

by only negative symptoms. It is also possible that during the six-month
period, two or more symptoms listed in Criterion A present in an
attenuated form.

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SKIZOFRENIA
• Criterion D: during the period of six months described under Criterion C, there have been
no major Depressive, Manic or Mixed Episodes occurring concurrently with the symptoms
of Criterion A. Further, if at all any mood disorder episodes have occurred during the six-
month period, these episodes have been of a duration that is much less than the period
when the Criterion A symptoms were active.
• Criterion E: the disturbance is not an outcome of the physiological effects of a substance or
a general medical condition.
• Criterion F: in case there is a history of autistic disorder or any other pervasive

Ratna Widiastuti, S.Psi.,M.A.,Psi.

developmental disorder, then there must also be the presence of prominent delusions or
hallucinations, for at least one month, in order for the individual to be diagnosed for
schizophrenia.

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• The characteristic symptoms outlined in Criterion A may be conceptualized as falling into two broad
categories:
• Positive Symptoms: These symptoms appear to reflect an excess or distortion of normal functions.
Listed in Criterion A1 to A4, the positive symptoms further comprise two distinct dimensions, each
related to its own underlying neural mechanism and clinical correlates:
• Psychotic Dimension: The following two positive symptoms form part of the psychotic dimension:
• Delusions: distortions in thought content
• Hallucinations: distortions in perception
• Disorganization Dimension: The following two positive symptoms form part of the the
disorganization dimension
• Disorganized speech: distortions in language and thought processes
• Grossly disorganized or catatonic behavior: deficiency in self-monitoring of behavior

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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• Negative Symptoms: Listed in Criterion A5, negative symptoms
include restrictions in the range and intensity of emotions, and take
on the following forms:
• Affective flattening: restriction in emotional expressions
• Alogia: deficit in fluency of thought and productivity of thought and
speech
• Avolition: shortfall in initiating goal-directed behavior

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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• Illness management skills. People with schizophrenia can take an active role in managing their own illness. Once patients
learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care. If they know
how to watch for the early warning signs of relapse and make a plan to respond, patients can learn to prevent relapses.
Patients can also use coping skills to deal with persistent symptoms.
• Integrated treatment for co-occurring substance abuse. Substance abuse is the most common co-occurring disorder in
people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population's
special needs. When schizophrenia treatment programs and drug treatment programs are used together, patients get better
results.
• Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in
their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18
to 35), and because the disease makes normal thinking and functioning difficult, most patients do not receive training in the
skills needed for a job.
• Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use
public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when they
include both job training and specific therapy designed to improve cognitive or thinking skills. Programs like this help
patients hold jobs, remember important details, and improve their functioning.21,22,23

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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• Family education. People with schizophrenia are often discharged from the hospital into the care of their families. So it is
important that family members know as much as possible about the disease. With the help of a therapist, family members
can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with
treatment and stays on his or her medication. Families should learn where to find outpatient and family services.
• Cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and
behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches
people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and
how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse.
• Self-help groups. Self-help groups for people with schizophrenia and their families are becoming more common.
Professional therapists usually are not involved, but group members support and comfort each other. People in self-help
groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that
takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and
community treatment programs. Also, groups may be able to draw public attention to the discrimination many people with
mental illnesses face.
• Once patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care.

Ratna Widiastuti, S.Psi.,M.A.,Psi.

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