POLA ASUH OTORITER MENYEBABKAN WAHAM SOMATIK YANG KUAT PADA EPISODE DEPRESI BERAT DENGAN GEJALA PSIKOTIK
DOI:
https://doi.org/10.51878/healthy.v5i4.15770Keywords:
Depresi Berat; Pola Asuh Otoriter; Waham Somatik; Gejala PsikotikAbstract
Severe depressive episode with psychotic features represents a severe mood disorder that can be accompanied by delusions, including somatic delusions that pose a high risk to patient safety. This case report aims to describe the role and relationship of authoritarian parenting and childhood trauma in the emergence of prominent somatic delusions in a patient presenting with a severe depressive episode with psychotic features. Data were collected through autoanamnesis, heteroanamnesis, physical examinations, urinalysis, serial Hamilton Depression Rating Scale (HDRS) assessments, and quantitative electroencephalography (QEEG) during hospitalization from February 17 to February 20, 2026. A 23-year-old female presented with persistent sadness, anhedonia, fatigue, and an unshakeable belief that her genital organs were permanently damaged due to physical abuse by her father at age 12, despite normal physical and anatomical medical evaluations. Developmental history revealed an authoritarian paternal parenting style characterized by strict control, lack of emotional validation, and recurrent physical and verbal abuse. The patient was diagnosed with Severe Depressive Episode with Psychotic Features (F32.2) with a baseline HDRS score of 28, and was treated with combination psychopharmacotherapy (risperidone, amitriptyline, diazepam), management of acute dystonia side effects, and psychosocial interventions comprising supportive psychotherapy and family psychoeducation. Serial clinical monitoring demonstrated significant improvement, as the HDRS score decreased to 10 by the fourth day of hospitalization, accompanied by marked attenuation of somatic delusions. This case emphasizes the critical importance of identifying dysfunctional parenting patterns and past traumatic experiences in the comprehensive biopsychosocial management of psychotic depression presenting with somatic delusions.
ABSTRAK
Episode depresi berat dengan gejala psikotik merupakan bentuk gangguan suasana perasaan (mood) berat yang dapat disertai waham, termasuk waham somatik yang berisiko tinggi terhadap keselamatan pasien. Laporan kasus ini bertujuan untuk menggambarkan peran dan keterkaitan antara pola asuh otoriter serta pengalaman trauma masa kanak-kanak dengan munculnya waham somatik yang menonjol pada seorang pasien episode depresi berat dengan gejala psikotik. Data dihimpun melalui autoanamnesis, heteroanamnesis, pemeriksaan fisik, urinalisis, evaluasi Hamilton Depression Rating Scale (HDRS), serta quantitative electroencephalography (QEEG) selama periode rawat inap pada 17 hingga 20 Februari 2026. Seorang perempuan berusia 23 tahun datang dengan keluhan perasaan sedih berkepanjangan, anhedonia, mudah lelah, serta keyakinan menetap bahwa organ genitalnya rusak akibat pemukulan oleh ayahnya pada usia 12 tahun, meskipun hasil evaluasi medis anatomis menunjukkan kondisi normal. Riwayat perkembangan mengungkap pola asuh ayah yang otoriter, minim validasi emosional, serta diwarnai kekerasan fisik dan verbal berulang. Pasien didiagnosis menderita Episode Depresi Berat dengan Gejala Psikotik (F32.2) dengan skor awal HDRS 28, yang kemudian ditata laksana menggunakan kombinasi psikofarmaka (risperidon, amitriptilin, diazepam), penanganan efek samping distonia akut, serta intervensi psikososial berupa psikoterapi suportif dan psikoedukasi keluarga. Evaluasi berkala menunjukkan perbaikan klinis nyata dengan penurunan skor HDRS hingga mencapai 10 pada hari keempat perawatan disertai memudarnya intensitas waham somatik. Kasus ini menegaskan pentingnya identifikasi pola asuh disfungsional dan trauma masa lalu sebagai bagian dari tata laksana komprehensif depresi dengan gejala psikotik somatik.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.
Antonioni, A., Raho, E. M., Sensi, M., Lorenzo, F. D., Fadiga, L., & Koch, G. (2024). A new perspective on positive symptoms: Expression of damage or self-defence mechanism of the brain? Neurological Sciences, 45(5), 2347–2351. https://doi.org/10.1007/s10072-024-07395-x
Aqila, N., & Prasetya, B. (2025). Brain-derived neurotrophic factor and HPA axis dysfunction in depression. Jurnal Neuropsikiatri Indonesia, 14(2), 77–85. https://doi.org/10.31004/jni.v14i2.2140
Ashar, Y. K., Lumley, M. A., Perlis, R. H., Liston, C., Gunning, F. M., & Wager, T. D. (2023). Reattribution to mind-brain processes and recovery from chronic back pain. JAMA Network Open, 6(9), Article e2333846. https://doi.org/10.1001/jamanetworkopen.2023.33846
Atkinson, R. L., & Ramadani, A. (2024). Definisi depresi sebagai gangguan suasana hati. UI Publishing.
Azzahra, N., Putri, R., & Hidayat, A. (2021). Pengaruh pola asuh orang tua terhadap perkembangan intelektual anak. Jurnal Pendidikan Anak, 9(2), 45–56. https://doi.org/10.21831/jpa.v9i2.34120
Barak, S., Landa, J., Eisenstein, E. M., Gerner, M., Vulkan, T. R., Neeman-Verblun, E., & Silberg, T. (2024). Agreement and disagreement in pediatric functional neurological symptom disorders: Comparing patient reported outcome measures (PROMs) and clinician assessments. Computational and Structural Biotechnology Journal, 24, 350–361. https://doi.org/10.1016/j.csbj.2024.04.045
Bauer, M., & Pfennig, A. (2021). Physical symptoms in depression. European Archives of Psychiatry and Clinical Neuroscience, 271(2), 123–131. https://doi.org/10.1007/s00406-020-01180-8
Baumrind, D. (1967). Child care practices anteceding three patterns of preschool behavior. Genetic Psychology Monographs, 75(1), 43–88. https://doi.org/10.1037/h0024919
Beck, A. T., Brown, G., & Steer, R. A. (2020). Parenting styles and depressive disorders: Associations with self-esteem and long-term stress. Journal of Affective Disorders, 276, 123–131. https://doi.org/10.1016/j.jad.2020.07.034
Beck, A. T., & Ernawati, L. (2022). Cognitive theory of depression. Gadjah Mada University Press.
Cohen, S., & Janicki-Deverts, D. (2023). Stress, autonomic nervous system, and somatic complaints. Psychosomatic Medicine, 85(3), 245–252. https://doi.org/10.1097/PSY.0000000000001180
Departemen Kesehatan Republik Indonesia. (1993). Pedoman penggolongan dan diagnosis gangguan jiwa di Indonesia III (PPDGJ-III). Direktorat Jenderal Pelayanan Medik Departemen Kesehatan RI.
Devita, M. (2020). Hubungan pola asuh orang tua dengan perkembangan emosional dan intelektual anak. Jurnal Psikologi Perkembangan, 7(1), 12–20. https://doi.org/10.31294/jpp.v7i1.1892
Duddy, C. (2020). Cognitive distortions and delusional beliefs in psychotic depression. Psychology and Psychotherapy: Theory, Research and Practice, 93(4), 789–802. https://doi.org/10.1111/papt.12260
Firmawati, L., & Biahimo, R. (2020). Pola asuh otoriter dan perkembangan psikososial anak. Jurnal Psikologi Sosial, 15(1), 44–52. https://doi.org/10.7454/jps.2020.6
Gaebel, W., & Cleveland, H. (2020). Psychotic depression: Clinical features and treatment. The Journal of Clinical Psychiatry, 81(5), Article 19r13125. https://doi.org/10.4088/JCP.19r13125
Gautama, R., Prasetyo, H., & Lestari, D. (2020). Family involvement in psychotic depression therapy. Jurnal Psikiatri Indonesia, 25(2), 112–120. https://doi.org/10.35671/jpi.v25i2.102
Guaiana, G., Barbui, C., & Hotopf, M. (2007). Amitriptyline versus other antidepressants for depression. Cochrane Database of Systematic Reviews, 2007(3), Article CD001860. https://doi.org/10.1002/14651858.CD001860.pub2
Idzha, G. N. (2024). Mekanisme pertahanan ego pada anak jalanan. Cognicia, 1(1), 45–54. https://doi.org/10.22219/cognicia.v1i1.1448
Jowett, S., Shevlin, M., Hyland, P., & Karatzias, T. (2020). Posttraumatic stress disorder and persistent somatic symptoms during the COVID-19 pandemic: The role of sense of threat. Psychosomatic Medicine, 83(4), 338–344. https://doi.org/10.1097/psy.0000000000000890
Jungmann, S. M., Wagner, L., Klein, M., & Kaurin, A. (2022). Functional somatic symptoms and emotion regulation in children and adolescents. Clinical Psychology in Europe, 4(2), Article e4299. https://doi.org/10.32872/cpe.4299
Kao, Y. C., Liu, Y. P., & Lu, C. W. (2021). Depression in adolescents: Prevalence and risk factors. Journal of Adolescent Health, 68(3), 450–457. https://doi.org/10.1016/j.jadohealth.2020.09.015
Kementerian Kesehatan Republik Indonesia. (2023). Survei Kesehatan Indonesia (SKI) 2023. Badan Kebijakan Pembangunan Kesehatan.
Kokoh, A., Pratama, D., & Sari, L. (2024). Serotonin transporter gene variations and mood disorders. Journal of Neuropsychiatry, 32(2), 145–153. https://doi.org/10.1176/appi.neuropsych.230104
Kuehner, C. (2022). Gender differences in unipolar depression: Epidemiological findings. Current Opinion in Psychiatry, 35(1), 19–25. https://doi.org/10.1097/YCO.0000000000000758
Lee, S., Kim, H., & Park, J. (2020). Authoritarian parenting and adolescent mental health. Journal of Adolescent Health, 67(3), 345–352. https://doi.org/10.1016/j.jadohealth.2020.03.018
Leichsenring, F. (2022). Supportive psychotherapy in depression. The Lancet Psychiatry, 9(6), 500–510. https://doi.org/10.1016/S2215-0366(22)00062-8
Lim, M., O’Grady, C., Cane, D., Goyal, A., Lynch, M., Beyea, S., & Hashmi, J. A. (2020). Threat prediction from schemas as a source of bias in pain perception. Journal of Neuroscience, 40(7), 1538–1548. https://doi.org/10.1523/jneurosci.2104-19.2019
Mo, D., Xin, L., Hu, S., Guo, P., Liu, S., Geng, F., Cao, X., Chen, B., & Hui, Z. (2021). Somatization symptoms regulate emotional memory bias in adolescents with major depressive disorder. Frontiers in Psychiatry, 12, Article 656198. https://doi.org/10.3389/fpsyt.2021.656198
Nehme, A., Moussa, S., Fekih?Romdhane, F., Yak?n, E., Hallit, S., Obeïd, S., & Haddad, G. (2024). Expressive suppression moderates the relationship between PTSD from COVID-19 and somatization and validation of the Arabic version of Patient Health Questionnaire-15 (PHQ-15). PLOS ONE, 19(1), Article e0293081. https://doi.org/10.1371/journal.pone.0293081
Parker, G., & Brotchie, H. (2022). Mood disorders and somatic symptoms. Journal of Affective Disorders, 307, 1–9. https://doi.org/10.1016/j.jad.2022.03.045
Prigatano, G. P., McKnight, C. A., Andrews, M., & Caplan, J. P. (2020). Maladaptive denial of severe pain and acute orthopedic injuries in a patient with a schizoaffective disorder. Frontiers in Psychology, 11, Article 574673. https://doi.org/10.3389/fpsyg.2020.574673
Prout, T. A., Zilcha?Mano, S., Doorn, K. A., Békés, V., Christman-Cohen, I., Whistler, K., Kui, T., & Giuseppe, M. D. (2020). Identifying predictors of psychological distress during COVID-19: A machine learning approach. Frontiers in Psychology, 11, Article 586202. https://doi.org/10.3389/fpsyg.2020.586202
Rachmawaty, E. (2015). Pola asuh otoriter dan kecemasan sosial anak. Jurnal Psikologi Klinis, 12(3), 155–162. https://doi.org/10.22219/jpk.v12i3.2412
Rizki, A., Putri, N., & Santoso, B. (2025). Depresi pada remaja: Prevalensi dan faktor risiko. Jurnal Psikiatri Indonesia, 12(1), 15–25. https://doi.org/10.35671/jpi.v12i1.412
Rossini, P. G., Gazzillo, F., & Kealy, D. (2025). Childhood emotional abuse and somatic symptoms: The mediating effect of self?hate. Scandinavian Journal of Psychology, 66(6), 1005–1010. https://doi.org/10.1111/sjop.70008
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.
Sandra, L., & Nadia, P. (2024). Pengaruh pola asuh otoriter terhadap perkembangan emosional anak. Jurnal Psikologi Anak, 10(2), 55–67. https://doi.org/10.31004/jpa.v10i2.152
Sicari, V., & Rossi, M. (2026). Diphenhydramine in acute dystonia management. Journal of Clinical Pharmacology, 66(4), 512–520. https://doi.org/10.1002/jcph.2412
Sorkhabi, N., Middaugh, E., & Wang, Y. (2021). Authoritarian parenting and psychosomatic risk in adulthood: A longitudinal perspective. Journal of Family Psychology, 35(2), 210–222. https://doi.org/10.1037/fam0000780
Stephen, J., & Kokoh, A. (2013). Trauma, stress, and epigenetic changes in depression. Journal of Clinical Psychology, 9(4), 211–220. https://doi.org/10.1002/jclp.21980
Van den Bergh, O., Brosschot, J. F., Critchley, H., Thayer, J. F., & Ottaviani, C. (2020). Better safe than sorry: A common signature of general vulnerability for psychopathology. Perspectives on Psychological Science, 16(2), 225–246. https://doi.org/10.1177/1745691620950690
Wang, Q., Li, X., & Chen, Y. (2020). Authoritarian parenting and somatic symptoms in adolescents: A cross-cultural study. Journal of Child Psychology and Psychiatry, 61(4), 456–465. https://doi.org/10.1111/jcpp.13125
World Health Organization. (2021). Depression. WHO Press.
Yokoi, F., & Nakamura, T. (2021). Trihexyphenidyl in extrapyramidal symptoms. Journal of the Neurological Sciences, 429, 118–124. https://doi.org/10.1016/j.jns.2021.118124
Yulianto, A., Prasetyo, D., & Nugroho, S. (2017). Dampak pola asuh otoriter terhadap kepuasan hidup remaja. Jurnal Psikologi Indonesia, 24(1), 33–41. https://doi.org/10.14710/jpi.24.1.33-41
