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aspect of the personal identity that evaluates who the individual says he is. This component of the personal self observes, compares, sets standards, and makes judgments that influence an individual's self-evaluation.
the component of the personal identity that strives to maintain a stable self-image. Even if the self-image is negative, because of this need for stability and self-consistency, the individual resists letting go of the image from which he has achieved a measure of constancy.
relates to an individual's perception of what he wants to be, to do, or to become. The concept of the ideal self arises out of the perception one has of the expectations of others. Disturbances in self-concept can occur when individuals are unable to achieve their ideals and expectancies.
Development of self esteem
- Consistently set limits
it is important for individuals to have a feeling of control over their own life situation & ability to claim some measure of influence over the behaviors of others.
self esteem is enhanced when individuals feel loved, respected, and cared for by signigicant others.
individuals feel good about themselves when their actions reflect a set of personal, moral and ethical values.
positive self esteem develops out of one's ability to perform successfully or achieve self-expectations and the expectations of others.
Consistently set limits
a structured lifestyle demonstrates acceptance and caring and provides a feeling of security
Trust vs. Mistrust (Birth to 18 months)
- the development of trust results in a feeling of confidence in the predictability of the environment
- unsuccessful resolution reulsts in the individual experiencing emotional dissatisfaction with the self & suspiciousness of others.
Autonomy vs. Shame & Doubt (18mo -3yrs)
- achievement of the task results in a sense of self-control & ability to delay gratification, aswell of feelings of self-confidence.
- when childs behaviors are restricted=negative self-esteem is promoted by a lack of self-confidence.
Initiative vs. Guilt (3-6yrs)
- positive self-esteem is gained when creativity is encouraged & performance is recognized.
- guidance and discipline that rely heavily on shaming the child creates guilt and results in a decrease in self-esteem.
Industy vs. Inferiority (6-12yrs.)
- self-confidence is gained at this stage through learning,competing,performing successfully.
- negative self-esteem is the result of nonachievements, unrealistic expectations are consistently met with negative feedback.
Identity vs. Role Confusion
- positive self-esteem occurs when individuals are allowed to experience independence by making decisions that influence their lives.
- failure to develop a new self-definition results in a sense of self-consciousness, doubt, & confusion about one's role in life. Lack of parental support.
Intimacy vs. Isolation (20-30yrs.)
- intimacy is achieved when one is able to form a lasting relationship with another person, a cause, and institution. Positive self-esteem is promoted.
- failure to achieve intimacy results in behaviors such as withdrawal, social isolation. When love in the home has been deprived causing low self esteem
Generativity vs. Stagnation (30-65yrs)
- Gratification from personal & professional achievements.
- Failure to achieve generativity occurs when earlier developmental tasks are not fulfilled & individual doesn't achieve maturity required to derive gratification out of a personal concern for the welfare of others.
Ego vs. Despair (65-death)
- sense of self-worth & self-acceptance as one reviews life goals,accepting that some were achieved and some were not. Positive self-esteem is evident.
- despair possess a sense of self-contempt & disgust with how life has progressed. They feel worthless & helpless & they would like to have a 2nd chance at life.
is the immediate concern that is causing the threat to self-esteem & the stimulus that is engendering the current behavior. Ex-termination of a significant relationship,loss of employment, and failure to pass the NCLEX.
are all of the other stimuli present in the person's enfironement that contribute to the behavior being caused by the focal stimulus. Ex-a child of the relationship becoming emotionally disabled in response to the divorce, advanced age interfering with obatining employment.
are factors that may influence one's maladaptive behaviors in response to focal & contextual stimuli. Ex-being reared in an atmosphere of ridicule & deprecation may be affecting current adaptation to failure on the NCLEX.
individuals who have rigid boundaries often have a hard time trusting others. They keep others at a distance and are difficult to communicate with.
Healthy boundaries are healthy. Individuals must be able to let go of their boundaries and limits when appropriate. In order to have flexible boundaries, one must be aware of who is considered safe and when it is safe to let others invade our personal space.
occur when tow people;s oundaries are so blended together that neither can be sure where one stops and the other begins, or one individual's boundaries may be blurred with another's.
NANDA diagnosis relating to self-esteem
- chronic low self-esteem
- situational low self-esteem
- risk for situational low self-esteem
What do you want to do tonight?
whatever you want to do.
Too flexible boundary
Twins Jan & Jean still dress alike even though they are grown and married
Karen's counselor asks her if she would like a hug
Showing respect for the boundary of another
Velma told Betty a secret that Mary told her.
a boundary violation
Tommy says to his friend, "i cant ever talk to my dad until after he has read his newspaper."
Nonassertive Behavior (Valery)
seek to please others at the expense of denying their own basic human rights. They seldom let their true feelings show & often feel hurt & anxious because they allow others to choose for them. They come across as being very apologetic & tend to be self-deprecating. Avoid unpleasant situations & confrontations.
Assertive Behavior (Paula)
individuals stand up for their own rights while protecting the rights of others. Feelings are expressed openly & honestly. They assume responsibility for their own choices & allow others to choose for themselves.
Aggressive Behavior (Nancy)
Defend their own basic rights by violating the basic rights of others. They say what's on their mind, often at the expense of others. They express an air of superiority, & their voices are often loud, demanding, angry or cold. They dominate & humiliate others.
This behavior takes the form of passive,nonconfrontive action. These people are devious, manipulative & sly & they undermine others with behavior that expresses the opposite of wha they are feeling. They are highly critical & sarcastic. Procrastinates & are "forgetful"
Behavioral components of assertive behavior
- Eye contact
- Body posture
- Distance/physical contact
- Facial expression
(Prolonged loss of apetite)is characterized by a morbid fear of obesity. Gross distortion of body image,preocupation with food, refusal to eat. Reduction of food intake & often extensive exercising.
(excessive, insatiable appetite) is an episodic, uncontrolled, compulsive rapid ingestion of large quantities of food over a short period of time (binging) followed by inappropriate compensatory behaviors to rid the body of the excess calories.
has been defined as body mass index (BMI) of 30 or greater. Often present with hyperlipidemia, elevated triglyceride & cholesterol levels. Common have hyperglycemia & are at risk for developing diabetes mellitus. Osteoarthritis is evident because of trauma to weight bearing joints. Angina & resp. insufficiency
BMI range for normal weight is
- fashion models typically have BMIs of 18
BMI range for overweight is
- the average American woman has BMI of 26
BMI range for obesity is
defined as 30.0 or greater
exposure of one's genitals to an unsusecting stranger.
sexual arousing fantasies including nonlivin objects
Frotteurism (rubbing up against)
touching and rubbing against a nonconsenting person
involving in sexual activity with a child
involving the act of being humiliated, beaten, bound or otherwise made to suffer.
sexually arousing fantasies in which the psychological or physical suffering of the victim is sexually exciting to the person.
Voyeurism (Peepin Tom)
the act of observing unsuspecting people who is naked, in the process of disrobing, or engaging in sexual activity
used to decrease libido & thus break the individual patterns of compulsive deviant sexual behavior
The sexual response cycle
Hypoactive Sexual Desire Disorder (low)
a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity.
Sexual Aversion Disorder
avoidance of, all(or almost all) genital sexual contact with a sexual partner. It implies anxiety, fear, or disgust in sexual situations.
Primary erectile dysfunction
refers to cases in which the man has never been able t have intercourse
Secondary erectile dysfunction
cases where a man has difficulty or maintaing an erection but has been able to have vaginal or anal intercourse at least once.
recurrent or persistent genital pain associated with sexual intercourse
involuntary constriction of the outer one-third of the vagina that prevents penile insertion and intercourse
Agoraphobia without history of panic disorder
Examples: being outside of the home alone, being in a crowd or standing in a line, being on a bridge, and traveling on a bus, car or train.
Diagnostic criteria for specific phobia
the presence or anticipation of a specific object or situation (flying, heights, animals, receiving an injection, seeing blood)
Clomipramine & SSRIs
are drugs that have been used successfully in alleviating the symptoms of OCD
For Panic & generalized Anxiety Disorders
- Antihypertensive- Propanol , Clonidine
For Phobic Disorders
- Antidepressants-MAOI & SSRIs
- Antihypertensive-propranolol & atenolol
Antidepressants SSRIs- fluoxetine, paroxetine, sertraline, fluvoxamine
- Antidepressants- SSRIs
- Paroxetine and sertraline
- tricyclic antidepressants- amitriptyline & imipramine
given for therapy regimens for PTSD
Generalized anxiety disorder
is characterized by chronic, unreaistic, & excessive anxiety & worry
is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.
is a marked, persistent, & excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific object or situation.
is a fear of being in places or situations from which escape might be difficult or in which help might not be available in the event that the person becomes anxious
Flooding is a systematic desensitization
Panic Anxiety & Fear
Alprazolam 0.5mg tid
Fluoxetine 20mg q am
Paroxetine 20mg q am
Amenorrhea, cool extremities, and yellowed skin are consistent findings.
ECG changes, Peripheral edema, weight within normal range or slightly higher, hyponatremia are findings consistent findings.
Body Dysmorphic Disorder (Arlene)
characterized by the exaggerated belief that the body is deformed or defective in some specific way. The most common complaint involve imagined or slight flaws of the face or head, such as thining hair, acne, wrinkles, scars, vascular markings, facial swelling, or excessive facial hair.
the inability to recall incidents associated with the traumatic event for a specific time period following the event (usually a few hrs. to a few days)
the inability to recall only certain incidents associated with a traumatic event for a specific period after the event.
the inability to recall events occurring after a specific time up to and including the present
the rare phenomenon of not being able to recall anything that has happened during the individual's lifetime, including personal identity.
with this type of amnesia, the individual cannot remember events that relate to a specific category of informations (ex. ones family) or to one particular person or event.
Dissociative Identity Disorder (DID)
Multiple personality disorder
characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment or a sense of observing oneself from outside the body,