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Self concept Responses and Dissociative Disorders

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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

				
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posted:7/5/2011
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