Introduction To Maladaptive Patterns of Behavior: Amelia Z. Manaois RN, MAN

INTRODUCTION TO
MALADAPTIVE
PATTERNS
of
BEHAVIOR
Amelia Z. Manaois RN, MAN

DISCLAIMER
This power point presentation is an academic and educational tool intended to
lecture and discuss Maladaptive Patterns of Behavior among Third Year
Nursing Students of PLM. Its main purpose is to enhance the knowledge and
skills of the Nursing Students on the care of client with Maladaptive Patterns of
Behavior. Materials presented in this presentation should not be considered
as substitute for medical advice, diagnosis and treatment and does not
promote self diagnosis either and best to seek medical professional help if
needed. During discussions, maladaptive behaviors will be mentioned a lot
either based on hypothetical situations or real life occurrences wherein identity
of the person/s will remain confidential. If conditions, situations, pictures and
the likes sound and look familiar, it is purely coincidence and are necessary to
mention for learning purposes.
Furthermore, the materials used on this presentation are products of research
and various verifiable references and expert resources from authors cited on
our bibliography and not merely of the presenter’s own views and opinions
only.
I. OVERVIEW OF PSYCHIATRIC NURSING
A. HISTORICAL PERSPECTIVE
EVOLUTION OF MENTAL ILLNESS CONCEPT
Primitive beliefs
1.Dispossessed by his or her soul

2.Possessed by evil spirits
3.Witchcraft
Hippocrates (400 BC)

1. DISEQUILIBRIUM and irregularities in the interaction
of the four body fluids or humors (blood, black bile,
yellow bile, and phlegm)
2. Treatment should be initiated with potent cathartic

agents: Fever Bath, Charcoal Wrap, Purgative Means,
Enema, Forced Fluids
Middle Ages
1. Middle Eastern Islamic countries start to believe that
people with mental illness are actually ill
2. Establishment of special units within general hospitals
16th and 17th Centuries

1. USA - Mental institutions are yet to be established
2. Care for the mentally ill is a family responsibility
3. Those without family - responsibility of the community
and are incarcerated – patients are whipped, beaten
and starved
1790s – The Period of Enlightenment

Phillippe Pinel of France (Physician)
William Tuke of England (Philanthropist)
• Formulated the concept of ASYLUM as a safe refuge or
haven offering protection
• Moral Therapy VS institutions: where mentally ill are
whipped, beaten, and starved
18th Century
1. First US hospital for the mentally ill was established
2. Benjamin Rush – father of American Psychiatry,
introduced more humane treatment but also used
methods like bloodletting, purging, restraints, and
extremes of temperatures
19th Century
1. Dorothea Dix - Nurse, Educator and Reformer -
advocate for mentally ill, reformed the way mentally ill
patients are treated: Humanistic therapeutic care
2. Asylums became overcrowded over time and
conditions deteriorated and therapeutic care reverted
to custodial care.
19th Century - 1873

Linda Richards
The first professionally trained American Nurse
Graduated from New England Hospital for Women and
became known as the first American Psychiatric Nurse
Linda Richards
1. Established numbers of psychiatric hospitals and the

first school of psychiatric nursing at the McLean
Asylum in Massachusettes in 1882
2. Focus: training on how to provide custodial care in
psychiatric asylums with emphasis on assessing
both physical and emotional needs of the patients
Linda Richards
Mentored by Florence Nightingale
“The mentally sick should be at least as

well cared for as the physically sick”
After WWII
1. US government passed the National Health Act of
1946
2. This legislation provided funds for the education of
psychiatrists, psychologists, social workers, and
psychiatric nurses
3. Introduction of antipsychotic medications
20th Century onwards
• Development of Psychopharmacology
Began in about the 1950s
• Chlorpromazine (Thorazine), and lithium – the first to
be developed
• Over the following 10 years – MAOIs, haloperidol
(Haldol), TCAs and benzodiazepines
• Hospital stays were shortened and many people were
well enough to go home
20th Century onwards
Diagnostic and Statistical Manual of Mental Disorders
DSM I – 1952
DSM II - 1962
DSM III – 1980
DSM III-R – 1987
DSM IV – 1994
DSM IV-TR – 2000
DSM V – 2013
PSYCHIATRIC NURSING TURNS
PROFESSIONAL
1950 - 1955
1. Incorporation of psychiatric nursing curricula
2. National League for Nursing required nursing schools to
include psychiatric nursing in their clinical practice for
national accreditation
3. Incorporation of nursing interventions in the somatic
therapies (insulin shock and electroconvulsive therapy)
B. Concepts of
Mental Health &
Mental Illness
B. CONCEPTS OF MENTAL HEALTH & MENTAL ILLNESS
Mental Health
“A state of well-being in which the

individual realizes his or her own abilities,
can cope with the normal stresses of
life, can work productively and fruitfully,
and is able to make a contribution to his or
her community“
(World Health Organization)

Mental Health
The following six criteria are indicators of mental health
1. Positive attitude towards self (self-awareness)
2. Growth, development and self-actualization: Maturity
3. Integration (Fantasy vs Reality; id vs superego)
4. Autonomy (Dependence vs Independence)
5. Reality perception (Challenge vs Punishment)

(Motivation vs Frustration)
6. Environmental mastery (Adaptation)
Mental Health
KEY TO MENTAL HEALTH:
ABILITY TO BALANCE
Integration: Fantasy vs Reality
Fantasy Reality
YOU
Have to do something
Dream
Make actions
Wish
Struggle
Hope Your ability to Tiring
Long for balance through
Feel Relaxed integration
Mental Health
ABILITY TO BALANCE
Reality
Fantasy
YOU
Don’t Have to do anything

Dream
No actions
Wish
No Struggle
Hope You gave in to Never Tiring
Long for Fantasy than
Feel Relaxed reality
Mental Health
ABILITY TO BALANCE
Fanta
sy
Reali
ty
YOU
Exhausting everything
You stick with
Too much actions
reality and never
Always Struggling
fantasize
Tiring; Never Relaxed
Mental Health
ABILITY TO BALANCE
Autonomy (Dependence vs Independence)
Dependence Independence
YOU
When to act alone
When to seek
When to decide alone
help and
support Your ability to
balance
Mental Health
ABILITY TO BALANCE
Reality perception (Challenge vs Punishment)
(Motivation vs Frustration)
Negative Positive
YOU
See things as challenges of
Life is a punishment
life
Life is frustrating
See challenges as
Life is unfair Your reality motivation
perception
Mental Health
ABILITY TO BALANCE
MASTERY OF YOUR SELF & YOUR
ENVIRONMENT
Negative Positive
Bad Good
YOU
Mental Illness
Mental illness is regarded to as any deviation
from what is perceived to be normal
behavioral pattern
General criteria to diagnose mental illness:

a. Dissatisfaction with one’s characteristics, abilities, and
accomplishments
b. Ineffective or unsatisfying relationships
c. Dissatisfaction with one’s place in the world
d. Ineffective coping with life events
e. Lack of personal growth - REGRESSIVE
Mental Illness
A. PREDISPOSING FACTORS
– Risk factors that influence both the type and

amount of resources the person can handle
stress.
“VULNERABILITY”
- KEY WORD: BALANCE

 Psychological
 Sociocultural
 Biological (Neuroscience)
Mental Illness
– Psychological
• Intelligence, verbal skills, morale, personality,
past experiences, self-concept, motivation,
psychological defenses, locus of control, sense
of control over one’s own fate
Mental Illness
– Sociocultural
• Age, gender, education, income, occupation,
social position, cultural background, religious
upbringing and beliefs, political affiliations,
socialization experiences and level of social
integration or relatedness.
Mental Illness
– Biological
• Genetic background, nutritional status, general
health, exposures to toxins
oNEUROTRANSMITTERS
oHORMONES
oENZYMES
Mental Illness
– NEUROTRANSMITTERS / HORMONES
oSerotonin(S),
oNorepinephrine(NE),
oDopamine(D)
oAcetylcholine
oMelatonin
oTryptophan
Mental Illness
– NEUROTRASNMITTERS / HORMONES
ANXIETY – S, NE
DEPRESSION – S, (NE, D)
MANIA – S, (NE, D)
VIOLENCE – S, NE, D
PSYCHOSIS – D
MEMORY - Acetylcholine
SLEEP - Melatonin Hormone
EATING/APPETITE – Tryptophan (triggered by S)
Mental Illness
B. PRECIPITATING STRESSORS
Are stimuli or triggering factors that are challenging,
threatening, or demanding to the individual.
These require excessive energy to produce a state

of tension and stress.
Elements:
• Nature
• Origin
• Timing
• Number
Mental Illness
B. PRECIPITATING STRESSORS
Elements:
• Nature
• Biological, Sociocultural, Psychological
• Origin
• Internal or External environment
• Timing
• When & how long stressors occurred
• Number
• Volume & frequency within a certain time
period
Mental Illness
C. APPRAISAL OF STRESSORS
Refers to the individual’s evaluation or interpretation
of an event, its meaning, intensity and importance in
relation to a person’s well being
 Cognitive Response (Understanding)

 Affective Response (Feeling)
 Physiological Response (Physical manifestations)
 Behavioral Response (Use of defenses)
 Social Response (Effects to IPR)
Mental Illness
C. APPRAISAL OF STRESSORS
THE WAY A PERSON VIEWS AN EVENT

IS THE PSYCHOLOGICAL KEY
TO UNDERSTANDING COPING EFFORT
AND THE NATURE AND INTENSITY OF THE
STRESS RESPONSE
Mental Illness
COPING MECHANISM
(Ego Defense Mechanism)
Coping mechanisms may be viewed as reactions
to conflict which are associated with one of
the three major defense patterns:
1. Flight (Withdrawal) – moving away from

conflict
2. Fight (Aggressive) – moving against the
conflict
3. Compromise – moving towards the conflict
to meet goals without giving up
Mental Illness
COPING MECHANISM
Coping mechanism can be constructive when

mental conflict is treated as a warning
signal and the individual accepts it as a
challenge to resolve such conflict
(ADAPTIVE COPING MECHANISM)
Mental Illness
Coping mechanism can be destructive when mental
conflict is ward off without resolving it, using
evasion instead of resolution thus become
pathological to the extent of attracting attention
and requiring treatment
MALADAPTIVE COPING MECHANISM
MENTAL ILLNESS

Introduction To Maladaptive Patterns of Behavior: Amelia Z. Manaois RN, MAN

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INTRODUCTION TO

Amelia Z. Manaois RN, MAN

1.Dispossessed by his or her soul

Hippocrates (400 BC)

2. Treatment should be initiated with potent cathartic

16th and 17th Centuries

1790s – The Period of Enlightenment

19th Century - 1873

1. Established numbers of psychiatric hospitals and the

Mentored by Florence Nightingale

“The mentally sick should be at least as

“A state of well-being in which the

(World Health Organization)

1. Positive attitude towards self (self-awareness)

2. Growth, development and self-actualization: Maturity

3. Integration (Fantasy vs Reality; id vs superego)

4. Autonomy (Dependence vs Independence)

5. Reality perception (Challenge vs Punishment)

Don’t Have to do anything

General criteria to diagnose mental illness:

– Risk factors that influence both the type and

- KEY WORD: BALANCE

These require excessive energy to produce a state

 Cognitive Response (Understanding)

THE WAY A PERSON VIEWS AN EVENT

1. Flight (Withdrawal) – moving away from

Coping mechanism can be constructive when

MALADAPTIVE COPING MECHANISM

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