The Dynamics of Abusive Experiences Play a Role in The Emergence of Schizophrenia Symptoms: A Case Study Using the Diathesis-Stress Model
DOI:
https://doi.org/10.30872/4r0e5g95Keywords:
Diathesis-stress, Hebephrenic schizophrenia, Abusive experienceAbstract
Childhood marked by abusive experiences may serve as a vulnerability factor (diathesis) that can interact with stressors in adulthood and contribute to the emergence of schizophrenia symptoms. However, how such experiences are related to the emergence of schizophrenia symptoms at the individual level remains relatively underexplored, particularly through a qualitative approach. This study aimed to explore the dynamics of abusive experiences and the emergence of schizophrenia symptoms based on the diathesis-stress approach. A qualitative approach with a single-case study design was employed. The participant was a 47-year-old man diagnosed with hebephrenic schizophrenia (F20.13), who was hospitalized after approximately nine years of outpatient treatment. Data were collected through in-depth interviews, clinical observations, medical record review, and all anamnesis with three significant others. Data were analyzed using thematic analysis with source triangulation. The findings revealed three main themes: (1) abusive experiences contributed to psychological vulnerability, (2) this vulnerability developed into schizophrenia symptoms, and (3) stressors in adulthood triggered and maintained the symptoms. Physical abuse by the father, unstable attachment, and a passive parenting style of the mother contributed to the development of psychological vulnerability (diathesis) from childhood. This vulnerability then interacted with stressors in adulthood, including divorce, loss of a relationship with the child, and limited social support, which were associated with the emergence of psychotic symptoms, emotional dysregulation, cognitive distortions, and social withdrawal. These findings suggest that the diathesis-stress approach can help explain the relationship between abusive experiences, life stressors, and the emergence of schizophrenia symptoms in the participant.
Masa kecil yang diwarnai pengalaman abusive diduga menjadi salah satu faktor kerentanan (diathesis) yang dapat berinteraksi dengan stresor kehidupan dewasa dan berkaitan dengan munculnya gejala skizofrenia. Namun, bagaimana pengalaman tersebut berhubungan dengan munculnya gejala skizofrenia pada individu masih belum banyak dikaji, terutama melalui pendekatan kualitatif. Penelitian ini bertujuan mengeksplorasi dinamika pengalaman abusive dan kemunculan gejala skizofrenia berdasarkan pendekatan diathesis-stress. Penelitian menggunakan pendekatan kualitatif dengan desain studi kasus tunggal. Partisipan merupakan seorang pria berusia 47 tahun dengan diagnosis skizofrenia tipe hebefrenik (F20.13) yang menjalani rawat inap setelah sekitar sembilan tahun menjalani rawat jalan. Data dikumpulkan melalui wawancara mendalam, observasi klinis, telaah rekam medis, dan alloanamnesis dengan tiga significant other. Data kemudian dianalisis menggunakan analisis tematik dengan teknik triangulasi. Hasil penelitian menunjukkan tiga tema utama, yaitu (1) pengalaman abusive membentuk kerentanan psikologis, (2) kerentanan tersebut berkembang menjadi gejala skizofrenia, dan (3) stresor kehidupan dewasa memicu serta mempertahankan gejala. Kekerasan fisik oleh ayah, kelekatan yang tidak stabil, dan pola asuh ibu yang pasif menjadi bagian dari terbentuknya kerentanan psikologis (diathesis) sejak masa kanak-kanak. Kerentanan tersebut kemudian berinteraksi dengan stresor kehidupan dewasa, seperti perceraian, kehilangan relasi dengan anak, dan minimnya dukungan sosial, yang berkaitan dengan munculnya gejala psikotik, disregulasi emosi, distorsi kognitif, dan penarikan sosial. Temuan ini menunjukkan bahwa pendekatan diathesis-stress dapat membantu menjelaskan keterkaitan antara pengalaman abusive, stresor kehidupan, dan munculnya gejala skizofrenia pada partisipan.
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