1. Describe the continuum of adaptive and maladaptive social responses. 2. Identify behaviors associated with social responses. 3. Analyze predisposing factors, precipitating stressors, and appraisal of stressors related to social responses. 4. Describe coping resources and coping mechanisms related to social responses. 5. Formulate nursing diagnoses related to social responses. 6. Examine the relationship between nursing diagnoses and medical diagnoses related to social responses. 7. Identify expected outcomes and short-term nursing goals related to social responses. 8. Develop a patient education plan to promote adaptive social responses. 9. Analyze nursing interventions related to social responses. • Connectedness indicates that the person is actively involved in satisfying relationships. It involves high levels of belonging, mutuality, reciprocity, and interdependence. • Disconnectedness relates to a lack of involvement that is not satisfactory to the person. • Parallelism is a lack of involvement that is comfortable and acceptable to the individual. • Enmeshment occurs when the person is involved in relationships but is unable to maintain a unique sense of self and ego boundaries. Change continues during late adulthood. Losses occur, such as the physical changes of aging, the death of parents, loss of occupation through retirement, and later the deaths of friends and one’s spouse. This can result in loneliness or eccentric behavior (Magoteaux and Bonnivier, 2009; Theeke, 2009). The need for relatedness still must be satisfied. The mature person grieves over these losses and recognizes that the support of others can help resolve the grief. Personality is a set of deeply ingrained, enduring patterns of thinking, feeling, and behaving. A personality disorder is a set of patterns or traits that hinder a person’s ability to maintain meaningful relationships, feel fulfilled, and enjoy life (Newton-Howes et al, 2008). It begins in adolescence or early adulthood, is stable over time, and leads to distress or impairment (Oldham, 2005). The following are three key features of personality disorders: 1. The individual has an inflexible and maladaptive approach to relationships and the environment. 2. The individual’s needs, perceptions, and behavior tend to foster cycles that promote unhelpful patterns and provoke negative reactions from others. 3. The individual’s coping skills are unstable and fragile, and there is a lack of resilience when faced with stressful situations. 1. Cluster A includes personality disorders of an odd or eccentric nature (paranoid, schizoid, and schizotypal personality disorders). 2. Cluster B disorders are of an erratic, dramatic, or emotional nature (antisocial, borderline, histrionic, and narcissistic personality disorders). 3. Cluster C includes disorders of an anxious or fearful nature (avoidant, dependent, and obsessive-compulsive personality disorders). People with narcissistic personality disorders have fragile self-esteem, driving them to search constantly for praise, appreciation, and admiration (Kay, 2008; Ronningstam, 2011). The following clinical example demonstrates narcissistic entitlement, which describes an egocentric attitude, envy, and rage when others are seen as critical or not supportive. TABLE 21-1 BEHAVIORS RELATED TO MALADAPTIVE SOCIAL RESPONSES
Social Responses and Personality Disorders
Continuum of Social Responses
Development Through the Life Cycle
Late Adulthood
Assessment
Behaviors
Narcissism
BEHAVIOR
CHARACTERISTICS
Manipulation
Others are treated as objects
Relationships center around control issues
Person is self oriented or goal oriented, not other oriented
Narcissism
Fragile self-esteem
Constant seeking of praise and admiration
Egocentric attitude
Envy
Rage when others are not supportive
Impulsivity
Inability to plan
Inability to learn from experience
Poor judgment
Unreliability
Social Responses and Personality Disorders
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