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Othello Syndrome Othello Syndrome OTHELLO SYNDROME (SINDROM OTHELLO) Oleh: Hesty Novitasari1, Marlina S. Mahajudin2 1 Dokter umum, peserta PPDS I Ilmu Kedokteran Jiwa Depatemen/SMF Ilmu Penyakit Jiwa FK Universitas Airlangga/RSUD Dr. Soetomo Surabaya. 2 Guru Besar, Dokter Spesialis Kedokteran Jiwa/Psikiater (Konsultan), Staf pengajar pada Depatemen/SMF Ilmu Penyakit Jiwa FK Universitas Airlangga/RSUD Dr. Soetomo Surabaya. 1 Othello Syndrome ABSTRAK Othello syndrome didefinisikan sebagai waham dari ketidaksetiaan pasangan, lebih banyak pada laki-laki, jarang pada wanita. Bentuk psikopatologi yang paling umum adalah waham, obsesi dan ide-ide berlebihan. Gangguan waham tipe cemburu merupakan waham mengenai perselingkuhan pasangan. Diagnosis Othello syndrome harus ada anamnesis tentang morbid jealousy, perasaan cemburu yang jelas atau tidak jelas, terdapat usaha pencarian bukti-bukti yang melelahkan dan sangat mengganggu kenyamanan pasangan. Terapi kognitif efektif pada Othello syndrome, sedang couple therapy dan individual dynamic psychotherapy merupakan terapi pendukung yang lain, karena banyak pasien dengan Othello syndrome mengalami gangguan kepribadian borderline dan ciri-ciri paranoid. Kata kunci: Othello syndrome, morbid jealousy, couple therapy, borderline personality ABSTRACT Othello syndrome was defined as delusions of infidelity of a spouse or partner, more in males, rarely in females. The most common forms of psychopathology are delusions, obsessions and exaggerated ideas. Jealousy type of delusional disorder is about the partner affair. The diagnose of Othello syndrome should be done by history taking about morbid Jealousy, factual or imaginative jealousy. There is a tiring effort to search for evidence and it is very disturbing for the couple. Cognitive therapy is effective for Othello syndrome, as well as dynamic couple therapy and individual psychotherapy which are other supportive therapies, because many patients with Othello syndrome suffered of borderline personality disorder and paranoid traits. Keywords: Othello syndrome, morbid jealousy, couple therapy, borderline personality. 2 Othello Syndrome PENDAHULUAN Awal mula Othello syndrome dipublikasikan pada tahun 1955 oleh seorang psikiater berkebangsaan Inggris John Todd bersama dengan teman yang membantu publikasinya yaitu K. Dewhurst dalam tulisannya yang berjudul “The Othello syndrome: A Study in the psychopathology of Sexual Jealousy”. Rasa cemburu merupakan suatu perasaan emosi yang umum dan rumit. Menurut The Oxford English Dictionary, cemburu adalah perasaan yang menunjukkan rasa marah/ dendam terhadap seseorang yang dianggap sebagai rival, dan hal ini mengindikasikan bahwa keyakinan akan adanya rival merupakan poin utama. Rasa cemburu dalam sebuah hubungan seksual merupakan sebuah perilaku posesif terhadap pasangan dihadapan rivalnya, namun ketika keyakinan tersebut salah, banyak waktu dan usaha yang mungkin telah terbuang dalam upaya menyingkirkan hal yang dianggap sebagai ancaman (Chiu 2012). Orang normal hanya akan menjadi cemburu apabila ada bukti yang kuat untuk itu, mereka memiliki kemampuan untuk memodifikasi keyakinan dan reaksi mereka terhadap informasi baru saat dihadapkan pada saingan. Sebaliknya, individu dengan kecemburuan yang tidak wajar, mempersepsi kejadian yang tidak relevan atau tidak berkaitan sebagai ketidak setiaan, menolak untuk mengubah keyakinan mereka, walaupun diberikan informasi yang bertentangan dengan bukti-bukti yang ada dan cenderung menuduh pasangan berselingkuh dengan beberapa orang (Kingham & Gordon 2004). Rasa cemburu yang tidak wajar menggambarkan berbagai pikiran dan emosi yang tidak rasional, disertai perilaku ekstrim yang tidak dapat diterima, di mana tema utama adalah preokupasi bahwa pasangannya tidak setia, dan hal ini tidak terbukti. Hal yang perlu diperhatikan adalah bahwa individu tersebut merasa tidak nyaman dengan perasaan cemburu tidak wajar yang mereka rasakan dengan bukti yang tidak benar dan biasanya mereka berespon secara tidak wajar atau berlebihan (Easton, Shackelford & Schipper 2008). Rasa cemburu yang tidak wajar dikenal juga dengan nama “Othello syndrome”, mengacu pada kecemburuan irasional Othello dari karya Shakespeare (Chiu 2012). Hal ini sebenarnya menyesatkan, karena menunjukkan rasa cemburu yang tidak wajar sebagai suatu sindrom, padahal seharusnya dianggap sebagai hasil dari sejumlah psikopatologi dalam diagnosis psikiatri yang terpisah (Berks 2009). 3 Othello Syndrome PEMBAHASAN 1. Definisi Othello Syndrome didefinisikan sebagai waham dari ketidak setiaan pasangan. Waham dari ketidak setiaan disebut juga delusion of infidelity, conjugal paranoia, morbid jealousy, delusional jealousy, sexual jealousy, erotic jealousy syndrome, psychotic jealousy dan pathologic jealousy. Othello syndrome lebih banyak pada laki-laki, jarang pada wanita. Manifestasi klinis adalah tuduhan perselingkuhan yang berulang, mencari bukti, interogasi berulang pada pasangan, tes-tes perselingkuhan pasangan dan kadang-kadang menguntit. Sindroma ini dapat muncul dengan sendiri atau merupakan perjalanan penyakit dari skizofrenia paranoid, ketergantungan alkohol atau kokain. Seperti dalam Othello, lakon dalam Shakespeare, sindroma ini bisa sangat berbahaya yang berakibat hancurnya perkawinan, terjadinya pembunuhan dan bunuh diri (Chiu 2012; Leong et al. 1994; Famuyiwa & Ekpo 1983). 2. Epidemiologi Pada 20 kasus waham cemburu yang diteliti di California, ditemukan bahwa usia rata-rata onset psikotik adalah 28 tahun dan rata-rata 10 tahun kemudian dapat berkembang menjadi waham cemburu, dengan pasien tertua berusia 77 tahun. Dari 20 kasus tersebut didapatkan 19 orang laki-laki, yang delapan puluh persennya telah menikah dan hidup dengan pasangannya (Coltheart, Langdon & Mckay 2011). 3. Etiologi: (1) Psikologi, pada pasien ini, dibawah alam tak sadar dapat dirubah sebagai suatu daya ingat atau perilaku sehingga menginterpretasi secara salah perilaku pasangan, (2) Kepribadian, pola asuh insecure attachment berhubungan erat dengan kelompok kepribadian borderline, (3) Gangguan otak organik, (4) Lingkungan (Kingham & Gordon 2004). 4. Psikopatologi dan diagnosis Othello syndrome terkait dengan empat ciri (1) gangguan mental yang mendasari munculnya sebelum atau bersamaan dengan cemburu, (2) ciri-ciri yang mendasari gangguan selalu berdampingan dengan cemburu, (3) perjalanan penyakit Othello syndrome berhubungan erat dengan gangguan yang mendasarinya, dan (4) kecemburuan tidak memiliki dasar nyata. Dalam Othello syndrome, isi dari pengalaman psikopatologi adalah preokupasi dengan perselingkuhan pasangan seksualnya. Bentuk psikopatologi yang paling umum adalah waham, obsesi dan ide-ide berlebihan (Kingham & Gordon 2004). 5. Teori terbentuknya OTHELLO SYNDROME 5.1.Psikodinamik 4 Othello Syndrome Individu yang tumbuh dengan perasaan insecure, terutama mereka yang mempunyai tipe preokupasi dan penuh ketakutan terhadap penolakan dan pengkhianatan, beresiko menjadi cemas akan adanya kemungkinan kelekatan partner mereka terhadap dirinya. Model kelekatan yang insecure ini terkait erat dengan kepribadian borderline (Agrawal et al. 2004). 5.2.Kognitif Agrawal et al. (2004) melihat adanya perasaan yang inadequate, sensitif berlebihan dan insecure sebagai faktor predisposisi utama dalam perkembangan Othello syndrome. Dalam formulasi kognitif gangguan pasien Othello syndrome, orang dengan karakteristik tersebut, cenderung mengalami distorsi yang sistematik, salah persepsi, dan salah dalam menginterpretasikan suatu kejadian dan informasi, sehingga suatu kejadian pencetus dapat menimbulkan asumsi yang salah dan memicu timbulnya Othello syndrome (Kingham & Gordon 2004). 5.3.Disfungsi seksual Othello syndrome dapat terjadi sebagai respon dari berkurangnya fungsi seksual. Diduga bahwa hypophallism baik yang nyata atau imajiner dapat menimbulkan perasaan rendah diri yang mengarah pada terbentuknya Othello syndrome (Kingham & Gordon 2004). 5.4.Perkawinan dan faktor-faktor sosial Tabel: Kontribusi orang cemburu dan pasangannya pada jealous interaction (Crowe 1995) Cemburu Pasangan Dependen Ramah dan independen Mengharapkan hubungan eksklusif Kurang berkomitmen Insecure Merasa tidak menarik Interogasi Menolak tetapi membatasi aktifitas “Mematai-matai” Benci Kekerasan Depresi sekunder Gangguan psikiatri (contoh: ide-ide paranoid, depresi, Ciri kepribadian (suka menggoda atau alkoholik) provokatif) 5.5.Terkait alkohol dan penggunaan obat Othello syndrome terkait erat dengan penyalahgunaan alkohol. Penggunaan amfetamin dan kokain dapat menimbulkan waham perselingkuhan yang persisten setelah intoksikasi berhenti. Pada sebuah laporan kasus digambarkan seorang pria yang menggunakan dexamphetamine untuk gangguan ADHD dewasa, dapat berkembang menjadi Othello syndrome. Ada yang berpendapat bahwa Othello syndrome dapat muncul akibat intoksikasi alkohol. Individu yang kembali menggunakan narkoba akan dapat mengalami gejala Othello syndrome lagi, yang mungkin berkomorbid dengan kepribadian borderline atau paranoid (McCann & Ricurte 2009). 6. Penyakit terkait dengan OTHELLO SYNDROME 5 Othello Syndrome Adrenocortical suppression, cerebrovascular infarction, chronic alcoholism, epilepsy, hyperthyreoidism, Normal Pressure Hydrocephalus (NPH), parkinson’s disease, senile dementia. 7. Diagnosis Diagnosis Othello syndrome harus ada anamnesis tentang morbid jealousy, perasaan cemburu yang jelas atau tidak jelas, terdapat usaha pencarian bukti-bukti yang melelahkan dan sangat mengganggu kenyamanan pasangan. 8. Penatalaksanaan 8.1. Pengobatan Prinsip penanganan pada Othello syndrome
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