Presentation on theme: "Self-concept Responses and Dissociative Disorders"— Presentation transcript:
1Self-concept Responses and Dissociative Disorders Chapter 18 Nur 305Rochelle Roberts RN MSN
2Self-concept development factors Interpersonal and cultural experiences generate positive feelings and a sense of worthPerceived competence in areas valued by the individual and societySelf-actualization- realizing one’s full potential
3The Self & Significant Others “Learning about self from the mirror of other individuals.” (Sullivan)Parental influenceFriends influenceCultural practices and social class
4Self-Perceptions Influenced by needs, values, and beliefs Self-perceptions are difficult to changenegative self-concept associated with narrow, distorted perceptions.positive self concept is associated with self actualization
5Body Image Is dynamic and constantly changing Central to one’s self-conceptAn anchor for self-awareness
6Self-IdealThe 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.
7Self-EsteemA person’s personal judgment of his or her own worth, based on how well behavior matches up with self-ideal.
8Role PerformanceRoles are sets of socially expected behavior patterns associated with a person’s functioning in different social groups.Roles overlap.
9Personal IdentityIdentity 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.”
10Description of a Healthy Personality A person who is able to perceive both self and the world accurately.This insight creates harmony and peace.
11Qualities of a healthy personality based on developmental theory Positive and accurate body imageRealistic self-idealPositive self-conceptHigh self-esteemSatisfying role performanceClear sense of identity
12Behaviors Associated with Low Self-Esteem Self-criticismGuilt and worryPostponing decisionsDenying oneself pleasureDisturbed relationshipsSelf-destructiveness
13Identity DiffusionIs 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.
14DepersonalizationIs 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.
15Behaviors Associated with Depersonalization AlienationA heightened sense of isolationDisturbed body imageAuditory and visual hallucinationsConfusionDisturbed thinkingMultiple personality disorderFeeling of unreality about parts of the body.Feelings of insecurityLoss of impulse controlDisturbance of memoryDreamlike view of the worldFeeling sof loss of identity
16Predisposing factors affecting self-esteem GeneticEnvironmentalParental rejection- failure to be loved and to loveFeelings of inadequacyRepeated defeats and failuresoverpossesiveness
17Factors affecting role performance Gender stereotypes may heighten role strainWork role stain; women perform dual roles.
18Factors affecting Personal Identity Constant parental interventionParental distrustAdolescent peer group identity
19Precipitating Stressors Trauma- physical, sexual, and psychological abuse in childhoodRole strain- developmental and health-illness transitions.Biological- biochemical imbalances, oxygen deprivation, alcohol, and drugs.
20Coping ResourcesAll people have some areas of personal strength, no matter how disturbing their behavior.Sports, hobbies, intelligence, expressive arts, education, imagination, creativity, and self-care
21Coping 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)
22Ego 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.
23Nursing diagnoses Disturbed body image Readiness for enhanced self-conceptLow self-esteemIneffective role performanceDisturbed personal identity
24Medical diagnosesIdentity problem- uncertain about multiple issues related to identityDissociative amnesia- inability to recall certain personal informationDissociative fugue- sudden unexpected travel away from home with inability to recall one;s past.
25Medical 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)
26Medical 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.
27Nursing goals and interventions Level 1: expand the patient’s self-awarenessInterventions:listen to the patient and develop a trusting relationshipIdentify the patient’s ego strengthIncrease pt’s participation in the relationship
28Nursing goals and interventions (cont.) Level 2: encourage the patient’s self-explorationEncourage the patient to express emotions and thoughts.Help patient clarify his concept of selfRespond empathically not sympathetically to patient.
29Nursing goals and interventions cont. Level 3: assist the patient’s self-evaluationHelp the patient define the problem clearly.Explore the patient’s adaptive and maladaptive coping responses to the problem.
30Nursing goals and interventions cont. Level 4: Help the patient form a realistic plan of actionhelp the patient identify alternative solutions.Help the patient develop realistic goals
31Nursing 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.
32EvaluationOverall success achieved in nursing care can be determined by eliciting the patient’s perception of his/her own personal growth