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Self-concept Responses and Dissociative Disorders Chapter 18 Nur 305 Rochelle Roberts RN MSN Self-concept development factors • Interpersonal and cultural experiences generate positive feelings and a sense of worth • Perceived competence in areas valued by the individual and society • Self-actualization- realizing one’s full potential The Self & Significant Others • “Learning about self from the mirror of other individuals.” (Sullivan) • Parental influence • Friends influence • Cultural practices and social class Self-Perceptions • Influenced by needs, values, and beliefs • Self-perceptions are difficult to change • negative self-concept associated with narrow, distorted perceptions. • positive self concept is associated with self actualization Body Image • Is dynamic and constantly changing • Central to one’s self- concept • An anchor for self- awareness Self-Ideal The person’s perception of how to behave, based on certain personal standards. Formulation of the self- ideal begins in childhood and is influenced by significant others. Self-Esteem • A person’s personal judgment of his or her own worth, based on how well behavior matches up with self- ideal. Role Performance • Roles are sets of socially expected behavior patterns associated with a person’s functioning in different social groups. • Roles overlap. Personal Identity • Identity is the awareness of being oneself, derived from self-observation and judgment. • Different from self- concept in that it’s a “feeling of distinctness from others.” Description of a Healthy Personality • A person who is able to perceive both self and the world accurately. • This insight creates harmony and peace. Qualities of a healthy personality based on developmental theory • Positive and accurate body image • Realistic self-ideal • Positive self-concept • High self-esteem • Satisfying role performance • Clear sense of identity Behaviors Associated with Low Self-Esteem • Self-criticism • Guilt and worry • Postponing decisions • Denying oneself pleasure • Disturbed relationships • Self-destructiveness Identity Diffusion • Is the failure to integrate childhood identifications into a harmonious adult psychosocial identity. • A person may fail to establish their own identity and instead fuse their pesonality onto another. Depersonalization • Is the subjective experience of total or partial disruption of one’s ego and disorganization of one’s self-concept. • Involves withdrawal from reality and true alienation from oneself. Behaviors Associated with Depersonalization • Alienation Feeling of unreality about • A heightened sense of parts of the body. isolation Feelings of insecurity • Disturbed body image Loss of impulse control • Auditory and visual hallucinations Disturbance of memory • Confusion Dreamlike view of the world • Disturbed thinking Feeling sof loss of identity • Multiple personality disorder Predisposing factors affecting self-esteem • Genetic • Environmental • Parental rejection- failure to be loved and to love • Feelings of inadequacy • Repeated defeats and failures • overpossesiveness Factors affecting role performance • Gender stereotypes may heighten role strain • Work role stain; women perform dual roles. Factors affecting Personal Identity • Constant parental intervention • Parental distrust • Adolescent peer group identity Precipitating Stressors Trauma- physical, sexual, and psychological abuse in childhood Role strain- developmental and health-illness transitions. Biological- biochemical imbalances, oxygen deprivation, alcohol, and drugs. Coping Resources • All people have some areas of personal strength, no matter how disturbing their behavior. • Sports, hobbies, intelligence, expressive arts, education, imagination, creativity, and self-care Coping Mechanisms • Temporary escape category (exercise, sports) • Temporary substitute identity (joining a club) • Confronting or challenging something (risk-taking and bigotry) • Adopting an identity desired by others (identity foreclosure) Ego defense mechanisms • Patients with alterations in self-concept may use these to protect themselves from confronting their own inadequacies. • Patients may use mechanisms of isolation, projection, displacement, and acting out. Nursing diagnoses • Disturbed body image • Readiness for enhanced self-concept • Low self-esteem • Ineffective role performance • Disturbed personal identity Medical diagnoses • Identity problem- uncertain about multiple issues related to identity • Dissociative amnesia- inability to recall certain personal information • Dissociative fugue- sudden unexpected travel away from home with inability to recall one;s past. Medical diagnoses cont. • Dissociative identity disorder(multiple personality disorder)-presence of 2 or more distinct identitites or personality traits. • Depersonal disorder- persistent experiences of feeling detached from one’s body or mind. (feeling one is in a dream) Medical treatment for dissociative disorders • Sodium pentobarbital and hypnosis are used to facilitate the recovery of repressed and dissociated memories. • Psychotherapy helps patients work through and control access to traumatic memories. Nursing goals and interventions • Level 1: expand the patient’s self-awareness • Interventions: • listen to the patient and develop a trusting relationship • Identify the patient’s ego strength • Increase pt’s participation in the relationship Nursing goals and interventions (cont.) • Level 2: encourage the patient’s self- exploration • Encourage the patient to express emotions and thoughts. • Help patient clarify his concept of self • Respond empathically not sympathetically to patient. Nursing goals and interventions cont. • Level 3: assist the patient’s self-evaluation • Help the patient define the problem clearly. • Explore the patient’s adaptive and maladaptive coping responses to the problem. Nursing goals and interventions cont. • Level 4: Help the patient form a realistic plan of action • help the patient identify alternative solutions. • Help the patient develop realistic goals Nursing goals and interventions cont. • Level 5: help the patient become committed to his decision and then achieve goals. • Reinforce the patients strengths and skills. • Provide the patient with support and positive reinforcement in effecting and maintaining change. • Both the patient and nurse must allow sufficient time for change. Evaluation • Overall success achieved in nursing care can be determined by eliciting the patient’s perception of his/her own personal growth
"Self concept Responses and Dissociative Disorders"