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• A heightened sense of

isolation• Disturbed body image• Auditory and visual

hallucinations• Confusion• Disturbed thinking• Multiple personality

disorder

Feeling of unreality about parts of the body.

Feelings of insecurity

Loss of impulse control

Disturbance of memory

Dreamlike view of the world

Feeling sof loss of identity

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