Inability to maintain an integrated and complete perception of self

• Excessive stress
• Gender conflict
• Impaired family processes
• Inadequate self-esteem
• Perceived social discrimination
• Values incongruent with cultural norms

• Mental disorders
• Pharmaceutical preparations

• Choices of vocation, sexual orientation, religious orientation, and friendships
• Ability to defend choices regarding long-range goals, to recognize alternatives, and to appreciate consequences
• Comfort level with decisions made about long-range goals
• Degree of anxiety or depression about long-range goals
• Loss of interest or social isolation from usual activities or friends
• Level of irritability about long-range goals
• Sleep difficulties
• Changes in eating habits
• Rape trauma
• Family status, including method of dealing with general conflicts, level of patient's communication with parents, handling of negotiations regarding restriction of freedom, degree of patient's separation from family, tolerance of patient's expressed opinions, reaction of parents to patient's long-range goals, and age-appropriateness of dating, curfew regulation, and money responsibilities
• Family and cultural standards related to separation issues

• Altered body image
• Confusion about cultural values
• Confusion about goals
• Confusion about ideological values
• Feeling of emptiness
• Feeling of strangeness
• Fluctuating feelings about self
• Impaired ability to distinguish between internal and external stimuli
• Inadequate interpersonal relations
• Inadequate role performance
• Inconsistent behavior
• Ineffective use of coping strategies

• Patient will establish trusting relationship with caregiver.
• Patient's issues will be discussed.
• Family's issues will be discussed.
• Patient will establish a firm, positive sense of self and personal identity.
• Patient will choose long-range goals using problem-solving techniques and will be comfortable with choices.
• Family will accept patient's choices of long-range goals.

Suggested NOC Outcomes

• Assess patient alone without family to gather baseline data and begin a therapeutic relationship.
• Explain your role as a patient advocate; negotiate rules of interaction, including confidentiality and depth and breadth of discussion to establish your role as a resource for patient rather than as family's agent.
• Explore personal identity issues distressing to patient to isolate issues into smaller, more solvable units.
• Help patient identify own values, beliefs, hopes, dreams, skills, and interests. Patient's deficits may lie in a lack of self-exploration, problem-solving methods used, or separation issues with parents.
• Instruct patient to write about feelings in a journal and to list coping strategies. Journaling can help patient maintain self-control and may increase insight.
• Integrate personal identity issues into decisions and choices to help patient develop skill in problem-solving methods.
• Help patient identify the likely consequences of each choice. Discussion and explanation aid problem-solving skills.
• Promote choices with the most likelihood of success. Specific instructions can help patient gain problem-solving ability and maturity.
• Encourage family conferences to explore potential reactions to patient's choices, and promote support for patient's independent decision-making. Meetings can help patient and family members identify problems and find better ways to interact. Meetings also allow patient and family members to ventilate true feelings in a safe environment.
• Encourage peer support groups to explore and share personal identity experiences. Adolescents and young adults commonly accept support from peers more readily than from older adults.
• Promote outpatient counseling and family meetings as appropriate to reinforce progress. Establishing outpatient support systems can reduce regression.
• Listen to patient's personal values and beliefs, but remain nonjudgmental, even if patient's values and beliefs differ from those of your own. Remaining nonjudgmental but attentive shows your support.
• Refer patients to mental health services for medication and symptom management. Disturbed personal identity may require ongoing mental health care.

Suggested NIC Interventions

• Patient openly discusses concerns with caregiver.
• Patient describes personal identity struggles.
• Family members discuss their reactions to patient's personal identity choices.
• Patient describes values, beliefs, skills, and interests in a positive way.
• Patient identifies choices and possible alternatives, postulates consequences, and makes decisions about long-range goals.
• Family members accept patient's choices of long-range goals.

• Assessment of patient's initial issues and problem-solving ability, including family's reactions, as well as assessment of level of separation achieved by patient
• Patient's level of emotional distress and changes in sleep and eating, initially and as hospitalization continues
• Patient's progress in problem solving and making choices
• Patient-family interactions and content of family meetings
• Patient's interaction in peer-group meetings
• Outpatient resources identified and suggested to patient and family members
• Evaluations for expected outcomes

• Albert Sznitman, G., Van Petegem, S., & Zimmermann, G. (2019). Exposing the role of coparenting and parenting for adolescent personal identity processes. Journal of Social & Personal Relationships, 36(4), 1233-1255. doi:10.1177/0265407518757707
• Lannegrand-Willems, L., Chevrier, B., Perchec, C., & Carrizales, A. (2018). How is civic engagement related to personal identity and social identity in late adolescents and emerging adults? A person-oriented approach. Journal of Youth & Adolescence, 47(4), 731-748. doi:10.1007/s10964-018-0821-x
• Meca, A., Sabet, R. F., Farrelly, C. M., Benitez, C. G., Schwartz, S. J., Gonzales-Backen, M., … Lorenzo-Blanco, E. I. (2017). Personal and cultural identity development in recently immigrated Hispanic adolescents: Links with psychosocial functioning. Cultural Diversity & Ethnic Minority Psychology, 23(3), 348-361. doi:10.1037/cdp0000129
• Notini, L., Gillam, L., & Pang, K. C. (2018). Facial feminization surgery: Private, personal identity, compensatory justice, and resource allocation. American Journal of Bioethics, 18(12), 12-15. doi:10.1080/15265161.2018.1531168