Self-concept, the individual’s perception of self, affects relationships, functional abilities, and health. Self-concept (1) is unique to the individual; (2) can be positive or negative; (3) has emotional, intellectual, and functional dimensions; (4) changes with the environmental context; (5) changes over time; and (6) has a powerful influence on one’s life.

The components of self-concept are identity, body image, self-esteem, and role performance. Personal identity is the sense of what sets a person apart from others. It may include the person’s name, gender, ethnicity, family status, occupation, and roles. Personal identity develops during childhood from self-reflection and feedback from others. Erikson’s psychosocial theory stresses the importance of the family, peer group, and community in forming the personal identity.

Body image, the attitude about one’s physical attributes and characteristics, appearance, and performance changes as the body changes over time. The way one perceives the body is affected by personal identity and self-esteem. Self-esteem is the judgment of personal performance compared with the self-ideal. The self-ideal is based on personal standards and self-expectations. Self-esteem is most threatened during adolescence. Self-esteem is associated with locus of control. People with an internal locus of control perceive that they affect their own destiny, as opposed to people with an external locus of control, who perceive that others affect their destiny.

Role is a set of expected behaviors that are determined by familial, cultural, and social norms. People express their self-identity through their roles. Some people take on a “sick role,” a set of social expectations met by an ill person, such as being exempt from role responsibilities, being obligated to get well, and seeking help.

Self-concept develops throughout life. An infant whose needs are met develops a positive self-concept and develops a sense of self distinct from the primary caregiver. Toddlers develop a sense of autonomy and self-image and are self-centered. Positive and negative self-concept develop based on feedback from significant others. Adolescents are quite interested in appearances and social status. They cannot separate their body image from their self-concept and are usually self-critical. Adults gradually adapt to the changes in self-image resulting from physical changes and health challenges, at the same time developing and introducing new roles. The factors affecting self-concept are altered health status from the loss or disruption of a body part; developmental processes, such as pregnancy or menopause; and experience, such as frequently failing.

Assessment of self-concept is often subtle, depending upon the client’s developmental level and chronological age. The nurse should attend to the client’s verbal and nonverbal clues when discussing self-concept, personality, body image, self-esteem, or role changes. Determining the client’s strengths to better understand the person’s ability to form relationships, care for self, and adapt to stressors is also important. Possible nursing diagnoses related to self-concept are Disturbed Body Image, Parental Role Conflict, Disturbed Personal Identity, Ineffective Role Performance, Chronic Low Self-Esteem, Situational Low Self-Esteem, Disturbed Personal Identity, Anxiety, Social Isolation, Hopelessness, and Powerlessness. The major goal of clients with altered self-concept is to gain a sense of well-being and to facilitate growth. Interventions to use are supporting healthy defense mechanisms, examining the client’s options and resources, ensuring the satisfaction of physical and psychosocial needs, and promoting success.