INTRODUCTION
Deviant eating behavior or commonly called eating
disorders is a complex eating behavior disorder and has an effect on physical
or mental health or both (Didie & Fitzgibbon, 2005). This usually
occurs due to excessive attention to weight and body shape. Deviant eating
behavior has a fairly serious influence on its prevalence and has the potential
to affect growth, mental development and physical activity (Doll, Petersen, & Stewart-Brown, 2005). According to the
Mental Health Guidelines there are three categories of deviant eating behavior,
namely anorexia nervosa, bulimia nervosa and eating disorder not otherwise
specified (EDNOS) which includes binge eating disorder (Foote, Smolin, Kaplan, Legatt, & Lipschitz, 2006).
Eating disorders, such as anorexia nervosa and bulimia
nervosa, are generally experienced by women and are associated with several
other health problems. In patients with anorexia nervosa chronic hunger can
cause endocrine gland abnormalities, less than optimal growth during
adolescence, osteoporosis, anemia, hypothermia, sinus bradycardia, and several
other diseases (McIntire & Lacy, 2007). Fairburn and Brownell (2005)
state that people with anorexia will generally experience amenorrhea. According
to a journal released by the National Institute of Mental Health (NIMH) in 2007
people with anorexia nervosa have a mortality rate ten times higher than those
without this disorder.
The effects that can be suffered by binge eating are high
blood pressure, high cholesterol levels, coronary heart disease, diabetes
mellitus (Association, 2013), and Gallbladder
disease (Smith, Marcus, Lewis, Fitzgibbon, & Schreiner, 1998). People with binge
eating disorder often end up being overweight or obese which will later develop
into hypertension and heart disease (NIMH, 2007).
In Indonesia, there are still not many studies and
publications that report on eating behavior deviations. A study among
adolescents conducted by Tantiani and Syafiq (2008)
proved that 34.8% of adolescents in Jakarta experienced eating behavior
deviations, with specifications 11.6% suffering from anorexia nervosa and 27%
suffering from bulimia nervosa. Another study conducted by Putra (2008)
on students of SMAN 70 South Jakarta, it was found that 88.5% of respondents tended
to deviate from eating behavior with a distribution of types of deviation
tendencies, 11.8% tended to anorexia nervosa, 23.3% tended to bulimia nervosa,
5% on Binge Eating Disorders and 48.5% on Eating Disorder, Not Other Specified.
The binge eating is generally done quietly even though the
patient feels full and includes foods with high caloric value. In contrast to
the previous two categories of eating disorders, BED patients were found to
have no excessive desire to achieve lean body proportions, or compensatory
behaviors after binge eating, such as trying to vomit, overly restricting diet,
or using laxatives to expel food that has been eaten.
In general, people with eating disorders are people who
have low self-confidence, feelings of helplessness, and feelings of not being
comparable to others. They use food and diet as a way to deal with problems in
their lives. Many of them think that food is a source of comfort or stress
relief while weight loss is seen as a way to be accepted by friends and family (Rooslain,
2013).
Symptoms of binge eating disorder (BED) were discovered by
a psychiatrist named Stunkard in 1959. The diagnosis of BED was included in the
Diagnostic and Statistical Manual of Mental Disorders (DSM) IV. BED is a
separate condition from bulimia. This condition is considered a general
disorder due to food, but is defined in DSM IV as a part of EDNOS (Eating
Disorder Not Otherwise Specified).
According to DSM-IV, the criteria for binge eating
disorder (BED) consist of episodes of binge eating, the same as Bullimia
Nervosa (BN), but the difference is that BED does not involve actions to combat
overeating behaviors, such as vomiting back food, using laxatives and fasting
regularly. excessive. People with EDNOS are people who eat uncontrollably and
often secretly.
In PPDGJ-III, this BED is found at F50.4, i.e. overeating
associated with other psychological disorders.
a) Overeating
as a reaction to things that create stress, resulting in "reactive
obesity", especially in individuals with a predisposition to gain weight.
b) Obesity
as a cause of various psychological disorders is not included here (obesity can
cause a person to be sensitive to his appearance and increase lack of
confidence in interpersonal relationships).
c) Obesity
as a side effect of using drugs (neuroleptics, antidepressants, etc.) is also
not included here.
Adolescents in psychology are introduced by other terms
such as puberty, adolescence and youth. The Indonesian dictionary explains that
adolescence is related to puberty. WHO defines adolescents based on their
chronological age. If a child has reached the age of 10 to 18 years, it can be
said to be a teenager. Meanwhile, according to Law no. 4 of 1975, adolescents
can be categorized as individuals who are not yet 21 years old and unmarried (Budiyono, 2017).
Developments in adolescence occur dynamically both
physically, psychologically, intellectually and socially related to puberty
problems. This period is a transition period from childhood to adulthood. This
characteristic pattern of rapid growth and development causes adolescents to
have a great curiosity, like adventure and challenges and tend to dare to take
risks without careful consideration (Tamza & Suhartono, 2013).
According to Beck, Davis, and Freeman (2015)
CBT is a counseling approach designed to solve individual problems at this time
by restructuring cognitive and deviant behavior. The CBT approach is based on
the formulation of cognitive, disruptive beliefs and behavioral strategies. The
counseling process is based on an individual's conceptualization or
understanding of specific beliefs and individual behavior patterns. The hope of
CBT is the emergence of distorted cognitive restructuring and belief systems to
bring changes in emotions and behavior for the better (Edy, 2019).
Cognitive therapy is therapy that focuses on how to change
negative thoughts or beliefs (Antony & Swinson, 2000; Beck, 1979). CBT is very
effective for treating various problems, including mood, anxiety, personality,
eating, substance abuse, and psychotic disorders (Anisa, 2016).
Based on several things that have been described
previously, it can be seen that the case of eating behavior deviation among
adolescents is one of the disorders. One way to deal with adolescents with BED
disorders is to use interventions with CBT techniques.
METHOD
The research method used
is an experimental study, namely a single experimental design in a home
setting, where the subject is treated with CBT (Cognitive Behavior Therapy)
therapy to overcome Binge Eating Disorder (BED). The stages of therapy used
are:
1) Initial assessment and diagnosis, building
report cards with clients and obtaining commitment, and determining therapeutic
targets.
2) Find the root cause of the problem that comes
from negative emotions, thought process deviations, and main beliefs related to
the disorder.
3) Develop an intervention plan by providing
positive and negative consequences to the client
4) Making monitoring tables
5) Establishing the formulation of status,
therapeutic focus, and follow-up interventions
6) Relapse prevention
7) Evaluating the results of the intervention
Data collection in this
study used the method observation, interviews and psychological tests (DAP,
BAUM, HTP, and SSCT).
Data analysis in this
study uses evaluation which is also continuously monitored using a monitoring
table during the implementation of the intervention. Thus, the success of the
CBT intervention was seen based on the achievement of the targets previously
agreed upon by the subjects, especially in the Binge Eating Disorder (BED)
eating disorder.
RESULTS AND DISCUSSION
Based
on previous research conducted by Indrawati (2021)
CBT was applied to clients who experienced Binge Eating Disorder in adulthood,
were working, and lived with their parents. Meanwhile, in this research, the
client is still in his teens, still in school, and does not live with his
parents.
Sally, Kuntjara, and Sutanto (2020), analyzed clients
with Binge Eating Disorder were given a food diary mobile app based on Android
as a tool to help cognitive behavior therapy. While in this study, the authors
only use CBT and table monitoring as a tool that helps to monitor overeating
behavior in clients.
Since
the client was a child, the client felt that he was always treated differently
from his older sibling. The client is a polite person, has no trouble starting
new topics of conversation even with new people, likes to joke, and so on.
Every time they meet with practitioners, clients almost always bring their
snacks. The client always does not stop chewing the food in front of him. It is
very visible when the client tells things that make him upset, it will be more
and more quickly the client feeds food into his mouth. Clients also almost always
respond warmly to practitioners. In communicating, the client is also quite
active and uses appropriate feedback. Similar to the attitude of the client
when the practitioner explains everything, the client always listens well, is
quite excited to learn new things, and is cooperative, so that everything goes
quite smoothly.
Behind
the treatment of her parents, especially mothers who treat clients unfairly,
but her mother is often always looking for clients when her mother is having
problems. Her mother shared stories about the difficulties her mother had
experienced. This sometimes makes clients confused, because her mother often
ignores her, but when a problem strikes, it's still the client she is looking
for. In fact, at that time the client had moved to settle down with one of his
aunts. Clients who are still not mature enough often feel confused about what
their mother is complaining about, and often clients are required to comply
with her mother's wishes, as if she has no right to say no.
His
mother often used him as a trash can to make the client jealous of his sister.
The client feels why he, who is still younger in status, is required to
understand his parents' situation rather than his older brother who is more
mature than him as if he is justified in being indifferent to whatever
condition his parents are in at that time. The client also said that at that
time her sister was only busy in her own world, having fun, dating, traveling
with her friends, going to the salon, and so on. Some of the things that often
happen that then make the client finally be able to compare people who can
really love him sincerely and who don't. Clients also feel that not always
those who have brotherly ties have more sincere love and affection than others.
Because in fact, the client only felt the warmth and love language after he
lived with his aunt, and also his grandmother. Until finally the client feels
grateful because there is still love for him.
The
treatment of his parents was considered unfair. The absence of warmth that he
gets at home is also one of the factors that cause clients to not feel at home.
According to the client's statement, at that time both of his parents were busy
working. The client's parents work from morning to evening, and it is not
uncommon for the mother to come home late at night when she is working
overtime. The client's mother and father work as private employees. Because the
client's mother has an important role in the company, communicating with her
mother is quite difficult. In fact, for their daily meals at home, the two
brothers subscribe to catering, because the mother does not have time to cook
food for her two children.
The
client said that he was a moody type of woman. The client's mood in a full day
is often changing and erratic. Sometimes a happy and cheerful mood can turn bad
in an instant just because he gets into an argument with someone he doesn't
like while shopping at the cafeteria. Therefore, again and again the client
vent it through eating together with his friends. In fact, it is not uncommon
for clients to finish their friend's food, or even take half a portion of their
friend's food who is not too hungry. However, according to the client's
statement, most of his friends at school are also the type of people who like
to eat, it's just that his friends have body proportions that are still quite
ideal.
The
client said that he had difficulty controlling his appetite, especially when
the client's mind was in a state of chaos. The more pressure and emotion the
client feels, the more food the client consumes. Clients almost never leave
their food. Clients always finish their food. Between eating and drinking
balanced, even every time he walks, the client never misses a moment of eating.
According to the client, he not only consumes heavy food, but he also consumes
light food.
Based
on the results of psychological tests that have been carried out, the results
obtained that the client fulfills the symptoms of Binge Eating Disorder (BED).
Based on the results of the graphical test given, the client has a personality
that is quite easy to interact with in the new environment, because the client
is a person who tends to be extroverted. The client's way of thinking is still
immature, so the client is still less stable, both in terms of affection and
emotion, so that the client is quite easily offended.
In
socializing, the client has aggressive indications, but the client does not
want to show it for fear of hurting others and losing sympathy from the
surrounding environment if he shows such aggressiveness. This is also seen in
the daily lives of clients who when they are feeling upset about something, the
client will tend to take it out on food with the excuse that no other party
feels hurt and harmed behavior binge eating in the client. This is because
clients are still able to channel what they need without having to violate the
norms that apply in the environment.
The
client is a realistic person and quite confident in his abilities. However, the
client still finds it difficult to control the impulses that exist within him.
Clients still tend to be controlled by the subconscious, are less able to think
for the long term, are less consistent, and tend to follow their heart's
desires, so they tend to be impulsive in their actions. This is also in
accordance with the behavior of binge eating found in the client. Clients
prefer to vent all the emotions they feel on food. The more pressure or
negative emotions the client feels, the more food the client consumes.
Based
on the HTP test kit that the client is working on, it shows that the client
feels that he has less role in his family. Clients feel less trusted, less
cared for, and less valuable. Therefore, there is a desire in the client to
leave the activities in his family. This then made the client decide to leave
his parents' house and prefer to live with his aunt. Similar to the results of
the SSCT, which states that the client has conflicts with the past, guilt,
fear, father, mother, and family life.
Thus,
in their daily lives, clients often suppress every emotion they feel. The
negative emotions felt by clients are often vented to food. The more pressure
and emotion the client feels, the more the amount of food consumed by the
client. The speed of the client in consuming the food will also be faster when
the client is feeling upset and emotional. In addition, the client also has
difficulty controlling his overeating behavior even though the client feels
that his stomach feels uncomfortable and very full.
After
carrying out the intervention process in the form of cognitive behavior therapy
(CBT) for 10 days, the practitioner got quite satisfactory results. This is
also in accordance with the client's good prognosis. The client is able to
control the desire to eat excessively, even the client also changes his snacks
to healthier foods, so that it does not interfere with his health.
The
intervention can be said to be going well because the client and the aunt who
lived with him were cooperative during the intervention. One of the forms of
support from the client's aunt is to replace the stock of snacks with healthy
foods. Clients also like various types of food, so it is not difficult to
replace unhealthy foods with healthy foods, such as vegetables, fruits, yogurt,
fruit juices, and so on. The following are the results before and after
intervening with the client:
Table 1
The Results of Intervention
|
Before The Intervention
|
After The Intervention
|
|
The client is not aware of the situation and the disturbance he is
experiencing
|
The client understands the circumstances and disorders he is currently
experiencing.
|
|
Client Mindset:
|
|
- The client thinks that eating is not wrong. The eating pattern that
the client has been doing is still in a normal phase like people in general.
- The client thinks that the more food the client consumes, the easier
it is for the client to find a comfortable feeling.
- Clients think that even achieving achievements will not make their
parents feel proud and make their parents behave fairly towards clients.
|
- The client thinks that eating
is not wrong, it's just that if the portion and frequency are excessive, it
will have a negative effect on the client's health. The client also realizes
that his eating pattern has exceeded the capacity of people in general.
- Clients think that without consuming excessive food can make the
client feel comfortable. Consuming food in moderation is much healthier and
more comfortable. Foods consumed in excess actually make the client feel
bloated, uncomfortable, nauseous, and easily sleepy.
- The client thinks that to achieve excellence in the things the client
does is to please the client himself, not to please others. Doing what the
client likes will make the client happy, and the achievements he gets are a
bonus, as are other people's attitudes towards clients. The achievements that
clients achieve will add value and pride for themselves in the future. Even
if they can't make their parents proud, there are still many people around
them who are proud and appreciate every achievement that the client gets.
|
|
Client Behaviour:
|
|
- Consuming food in excess, with frequency and large portions.
- Clients often consume fast food, ice cream, chocolate, and so on.
Clients never feel bored and full at all, especially on foods such as
chocolate and ice cream.
- The client has no diversion to vent overeating.
- The client's aunt stocked up a lot of unhealthy snacks, such as
chocolate and light snacks.
|
- The client reduces overeating behaviour slowly.
- Clients slowly replace these foods and snacks into healthy foods, such
as fruits, salads, wheat-based breads, and so on.
- The client has another outlet, namely in the form of writing poetry.
- The client's aunt replaces the stock of snacks with healthy foods,
such as vegetable/fruit salads, fruits, whole wheat bread, and yogurt.
|
CONCLUSION
Based on the explanation that
has been described previously, it can be concluded that the client was
diagnosed with Binge Eating Disorder (BED) which the client had experienced
since adolescence. Therefore, the client is given an intervention in the form
of cognitive behavior therapy (CBT).
Intervention cognitive behavior
therapy that had been carried out for 10 days showed that the client was able
to control his excessive eating behavior. Clients are also able to replace
their food with foods that are healthier and do not endanger their health. The
client has also been able to change his negative thoughts into more positive
thoughts. Thus, it can be concluded that cognitive behavior therapy (CBT)
intervention is quite effective in controlling overeating behavior in clients
with Binge Eating Disorder (BED).
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