Running head: CONCEPT ANALYSIS: LOW SELF ESTEEM

Concept Analysis: Low Self Esteem Student Name: Dermot Connolly Stenberg College Surrey BC 0312 PSYN 111-3 (A) Kim Bagshaw Dec 23rd 2012.

CONCEPT ANALYSIS: LOW SELF ESTEEM

Abstract This paper explores the concept of low self esteem in psychiatric nursing. In particular, three different insights to low self esteem are explored; domestic abuse, suicide and alcohol abuse. The causes of low self esteem are also explored and the role self esteem plays in the onset and development of more serious psychiatric conditions. The implications for psychiatric nursing are also investigated. In particular the importance of recognizing a patient with low self esteem and the development of nursing interventions that allow for the development of patient empowerment and self worth. Keywords: low self esteem, domestic abuse, suicide, alcohol abuse.

CONCEPT ANALYSIS: LOW SELF ESTEEM

Concept Analysis: Low Self Esteem By the age of five, a child will already have judged the world as either a safe or dangerous place in which to live. (Aquilina, 2010). Parents, family, friends and social interactions play a major role in forming this judgment. Exposure to daily interactions formulates the childs own opinion of oneself in a way that is either positive or negative. (Aquilina, 2010). If a child is exposed to an environment that is nurturing where growth is encouraged, then they are likely to have normal or high self esteem levels. If on the other hand a child is exposed to an environment where they are criticized and discouraged, then their levels of self esteem may suffer. Low self esteem can lead to the development of self limiting thoughts and a lack of self confidence. (Aquilina, 2010). Other influences on an individuals self esteem include physical, emotional or sexual abuse, lack of success and perceived problems with ones appearance. These influences can have a profound effect on the emotional condition of the individual and in extreme cases may lead to mental illness. (Aquilina, 2010). There are of course exceptions to this rule. Although low self esteem has being shown to be a precursor to the development of a mental illness, it is not accurate to assume that all patients diagnosed with a mental illness suffer from low self esteem. Analysis has shown that positive levels of self esteem also exist in many mentally ill patients with significantly higher levels recorded in employed patients vs. those without employment. (Van Dongen, 1998). In addition, positive social experiences and engagement in meaningful tasks has being shown to contribute to

CONCEPT ANALYSIS: LOW SELF ESTEEM

increased levels of self esteem in patients. (Van Dongen, 1998). Patient involvement in treatment options has also being shown to be related to levels of self esteem. In an environment where positive levels of self esteem are promoted, improved patient participation in nursing interventions has being noted. (Van Dongen, 1998). The purpose of this discussion is to explore the concept of low self esteem in more detail and in particular its relationship with domestic abuse, suicide and alcohol abuse. This discussion will also explore the importance of understanding low self esteem and its interaction with psychiatric nursing. This discussion will begin by exploring the role of low self esteem in the onset of domestic violence where levels of self esteem are often low in both the abusers and the abused. The link between low self esteem, depression and suicidal ideations are also explored on an international level on both adolescents and the older adult. This discussion is brought to a close by reviewing low self esteem, social interactions and its relationship with alcohol consumption. Domestic abuse and in particular, intimate partner violence is a serious problem and one that is not fully understood because of the various factors that contribute to its existence. (Tilley et al, n.d). Studies have shown that men who physically abuse their partners are more likely to have being previously exposed to domestic violence themselves. Studies also show that they are more likely to abuse substances, suffer from depression and exhibit signs of low self esteem. (Tilley et al, n.d). While low self-esteem is a contributing factor to the onset of domestic violence, it also has a significant impact on the victims. Studies reveal low self esteem is common among women in abusive relationships, where they are regularly exposed to physical, verbal and sometimes sexual abuse. In a study carried out on Jordanian pregnant women, a correlation was drawn between abused women and low self esteem. (Oweis, Gharaibeh &

CONCEPT ANALYSIS: LOW SELF ESTEEM Alhourani, 2010). Self esteem was measured using the Rosenberg Self Esteem Scale which showed that women with low levels of self esteem and who viewed their husbands to have violent tendencies were more likely to suffer from abuse. (Oweis, Gharaibeh & Alhourani, 2010). Low self esteem in domestic relationships also impacts the level of mental health care obtained by the victim. Feelings of worthlessness often mean that the victim is reluctant to seek mental help to treat their condition. Many victims report the perception that they are wasting the time of nursing staff with their problems while others will go to great lengths to hide it (Jones, 2011). Other victims expressed shame for receiving healthcare for a violence related injury and some victims remained concerned for their privacy, fearing their abuser would learn of their treatment. (Wilson et al, 2007). The empathetic psychiatric nursing training has important implications for the treatment of low self esteem. Non judgmental supportive nursing care can help build a relationship of trust with the victim. This relationship forms the cornerstone from which the victim can overcome her feelings of inadequacy and foster a relationship where the patient recognizes her own self worth. (Jones, 2011). Examining this relationship in more detail, it begins with a proper assessment of the

patients condition. Patients suffering from chronic self esteem from an abusive relationship will display negative self characteristics along with feelings of worthlessness, powerlessness and despair. (Schultz & Videbeck 2009). Working with the patient, the desired nursing outcome should reflect the patients ability to access their own strengths and weaknesses. (Schultz & Videbeck, 2009). Interventions with the abused patient should focus on forming a therapeutic relationship where you express your belief that the patient has a lot of offer. The patient should be encouraged to express their feelings and participate in more challenging activities where

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positive outcomes are recognized. Coping and decision making skills are also very important for the patient where successes can be recognized and failures properly interpreted and understood. (Schultz & Videbeck, 2009). Low self esteem has also being shown to be closely linked to suicidal tendencies across all age groups. In fact a case study carried out by the University of Cleveland concluded that low levels of self esteem are related to depression and suicidal ideations. (Western Sydney suicide prevention and support network, 2012). Emotional instability is particularly associated with adolescents, making them quiet susceptible to suicidal behaviors. Individualization, social exclusion and isolation are also quiet common with this age group which contributes to lower levels of self esteem and depression. (Tapia et al, 2007). Older adults are also susceptible to suicidal thoughts as a result of low self esteem and depression where growing old can result in lifestyle changes such as death of a loved one and loss of health. (Western Sydney suicide prevention and support network, 2012). At an international level, low levels of self esteem have also been shown to be related to higher levels of suicide rates. This relationship is consistent across all age groups and does not distinguish between genders. (Chatard et al, 2009). If we look at the suicide rates across the globe, there is a considerable difference between nations. Traditionally higher levels of suicide are found in more developed countries with a higher standard of living. (Chatard et al, 2009). Rates are also higher in some Eastern European countries following the collapse of communism. (Chatard et al, 2009). Whats interesting about these figures is the correlation that was found when the suicide rates were cross referenced against self esteem levels for the same countries. The analysis showed that countries with lower levels of self esteem also have higher levels of suicide even after other controls such as depression were removed. (Chatard et al, 2009).

CONCEPT ANALYSIS: LOW SELF ESTEEM In contrast, other studies have shown no significant link between low self esteem and

suicidal ideation (Tapia et al, 2007) but suggest the reason for this is the fact that low self esteem is traditionally associated with suicidal behavior. (Tapia et al, 2007). The same study also showed a direct link between depressive symptomatologies and suicidal ideations. The link between self esteem and suicide ideation is explained as a domino effect where depression is first experienced which leads to suicidal ideations which in turn is reflected in low level of self esteem. (Tapia et al, 2007). This has important considerations for the psychiatric nurse who can expect the patient to verbalize negative thoughts or characteristics about themselves in addition to feelings of guilt or shame. (Schultz & Videbeck, 2009). Nursing interventions should focus on enabling the patient to identify positive aspects about themselves without resorting to flattery. (Schultz & Videbeck, 2009). Adolescents and adults exposed to an environment where they are ridiculed, scorned or abused are at an increased risk of suffering from low levels of self esteem. Feelings of worthlessness in an environment where they feel they have nothing to contribute can quickly spiral down a self destructive path of alcohol and substance abuse where they are free from judgment. (Bennett, 2009). The need to belong and feel included is an important human motivation. It is not surprising then that social environments with ones peer groups instigates important psychological feelings of inclusion. (DeHart, et al, 2009). Studies have shown that in social interactions, people seek out both positive and negative interpersonal experiences. When these interactions revolve around the consumption of alcohol they can have a profound effect on an individuals self esteem. (DeHart, et al, 2009). Responses to negative interactions largely depend on the individuals own level of self esteem. People with low self esteem will generally

CONCEPT ANALYSIS: LOW SELF ESTEEM have experienced negative interactions in the past and equate those feelings with a continued sense of unacceptance. (DeHart, et al, 2009). Models of alcohol consumption indicate that people drink to either regulate negative experiences or enhance positive ones (DeHart, et al, 2009). This helps explain why people with low self esteem turn to alcohol after being exposed to a negative interaction. It also highlights that fact that people with low self esteem lack other adaptive skills to help them cope with rejection. (DeHart, et al, 2009). Studies have also shown that people with low levels of self esteem consumed more alcohol on days when they were exposed to negative interactions. It has also being shown that on days where these individuals were exposed to positive interactions, their desire to consume alcohol decreased. This is an important observation as it indicates that the amount of alcohol consumed by people with low self esteem is directly related to the type of

interactions they are exposed to. (DeHart, et al, 2009). As a psychiatric nurse, interacting with a patient who abuses alcohol and demonstrates low levels of self esteem involves first recognizing that they will likely display feelings of guilt and insecurity. (Schultz & Videbeck, 2009). Nursing interventions should focus on educating the patient on alcoholism while encouraging them to focus on the present and allow the past to be forgotten. (Schultz & Videbeck, 2009). While low self esteem is not in itself a mental illness, if allowed to develop through lack of support and encouragement, it can lead to the development of a mental condition. Low self esteem is also a consequence of a mental illness. This discussion has shown that self esteem plays a large role in the onset and development of domestic violence. Abusers often suffer from lower than normal levels of self-esteem, (Tilley et al, n.d) and as a consequence; the abused victims also display low levels of self-esteem. (Tilley et al, n.d.) This discussion has also demonstrated the link between international suicide rates and low levels of self-esteem. (Chatard

CONCEPT ANALYSIS: LOW SELF ESTEEM et al, 2009). In addition, the link between self-esteem and suicide rates in adolescents and older adults (Tapia et al, 2007) has also being highlighted. The role of self-esteem in the onset and development of alcoholism has also being reviewed. In social situations, we typically look for positive and negative interactions among our peers. Regular exposure to negative interactions can result in a person with low self esteem consuming more alcohol as they tend to lack any

other mechanism of coping with such rejection. (DeHart, et al, 2009). In addition, the importance of nursing inventions cannot be overstated, through the proper recognition and nursing intervention, patients suffering from low self esteem will develop increased feelings of self worth and indentify their personal strengths.

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References: Aquilina, R. (2010). Causes of low self esteem. Retrieved from: http://www.insightzonecoach.com/blog/12-steps-to-raise-your-self-esteem/causes-of-lowself-esteem Bennett, C. (2009). How low self esteem can lead to substance abuse. Retrieved from: http://www.huffingtonpost.com/carole-bennett/how-low-self-esteem-canl_b_270791.html Chatard, A., Selimbegovic, L. & Konan, P. N. (2009). Self-esteem and suicide rates in 55 nations. European Journal of Personality. 23. 19-32. DOI: 10.1002/per.701 Retrieved from: http://web.ebscohost.com/ehost/resultsadvanced?sid=46ed3818-6ec6-4630-b7e5e7386781c501%40sessionmgr15&vid=15&hid=12&bquery=Selfesteem+AND+suicide+rates+%22in %22+55+nations&bdata=JmRiPXJ6aCZkYj1wYmgmdHlwZT0xJnNpdGU9ZWhvc3Qtb Gl2ZQ%3d%3d DeHart, T., Tennen, H., Armeli, S., Todd, M. & Mohr, C. (2009). A diary study of implicit selfesteem, interpersonal interactions and alcohol consumption in college students. J Exp Soc Psychol. 45 (4). 720-730. doi:10.1016/j.jesp.2009.04.001. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717559/ Jones, B et al (2011). Improving the healthcare of women living with domestic abuse. Nursing standard. 25 (43). 35-40. Retrieved from:

CONCEPT ANALYSIS: LOW SELF ESTEEM http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=11&hid=15&sid=bda2330912ec-4245-8c64-5b2bf7d132f6%40sessionmgr4 Oweis, A., Gharaibeh, M. & Alhourani, R., (2010). Prevalence of violence during pregnancy: Findings from a Jordanian survey. Matern Child Health. 14. 437-445. DOI 10.1007/s10995-009-0465-2. Retrieved from: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=4&hid=12&sid=46ed38186ec6-4630-b7e5-e7386781c501%40sessionmgr15 Schultz, J. M & Videbeck, S.L. (2009). Lippincotts Manual of Psychiatric Nursing Care Plans (8th ed.) Lippincott Williams & Wilkins Tapia, J. A., Barrios, L., M. & Gonzalez-Forteza, C. (2007). Self-Esteem, depressive symptomatology, and suicidal ideation in adolescents: Results of three studies. Salud Mental. 30 (5). 20-26. Retrieved from: http://www.inprfcd.org.mx/pdf/sm3005/sm300520.pdf

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Tilley, D., S., Rugari, S., M., Walker, C., A. (n.d.). Development of violence in men who batter intimate partners: A case study. The Journal of Theory Construction & Testing. 12 (1). 28-33. Retrieved from: http://web.ebscohost.com/ehost/resultsadvanced?sid=46ed38186ec6-4630-b7e5 e7386781c501%40sessionmgr15&vid=6&hid=12&bquery=Development+%22of %22+violence+%22in%22+men+who+batter+intimate+partners %3a+A+case+study&bdata=JmRiPXJ6aCZkYj1wYmgmdHlwZT0xJnNpdGU9ZWhvc3 QtbGl2ZQ%3d%3d

CONCEPT ANALYSIS: LOW SELF ESTEEM Van Dongen, C. J. (1998). Self esteem among persons with severe mental illness. Issues in Mental Health Nursing. 19. 29-40. Retrieved from: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=12&hid=12&sid=46ed38186ec6-4630-b7e5-e7386781c501%40sessionmgr15 Western Sydney suicide prevention and support network (2012). Self esteem and its impact on suicidal tendencies. Retrieved from: http://supportaftersuicide.com.au/self-esteem-andits-impact-on-suicidal-tendencies/

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Wilson, K. S., Silberberg, M. R., Brown, A. J. & Yaggy, S. D. (2007). Health needs and barriers to healthcare of women who have experienced intimate partner violence. Journal of Womans Health. 16 (10). 1485-1498. DOI: 10.1089/jwh.2007.0385. Retrieved from: http://web.ebscohost.com/ehost/resultsadvanced?sid=46ed3818-6ec6-4630-b7e5e7386781c501%40sessionmgr15&vid=6&hid=12&bquery=Development+%22of %22+violence+%22in%22+men+who+batter+intimate+partners %3a+A+case+study&bdata=JmRiPXJ6aCZkYj1wYmgmdHlwZT0xJnNpdGU9ZWhvc3 QtbGl2ZQ%3d%3d

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