Self Esteem and Body ImageIdentity and Relationships after Stroke

Introduction• After a stroke, an individual’s body image can be severely

affected which can then have a negative impact on self esteem.

• Problems with body image are most often brought up as an issue by working aged adults who suffer a stroke, although older adults do experience this too.

• As we know, stroke can cause many physical effects, leaving some people with a body which seems very different to the body they had before their stroke – often with many more limitations.

• They may feel very conspicuous when out and about, leading them to stay at home more and avoid social activities.

How to Spot Problems• The issue of body image is rarely brought up with

patients after stroke, especially in an acute setting as ensuring that an individual is medically well takes priority.

• However, at an appropriate time, usually when someone is getting close to discharge, it can be an idea to bring the topic up if you feel as though it could be an issue.

• In the toolkit, you will find a screening tool called the distress scale which asks patient’s if they are distressed about their appearance.

• There is also a self esteem scale which can be used to screen for any problems. It consists of 10 simple questions so can be carried out quickly and easily by any member of staff.

Activity• In the toolkit, there is a copy of the self esteem scale.• In pairs, complete the self esteem scale with each other,

either as yourself or “in character” as a patient.• Think of ways you could use the scale to open up a

conversation about self esteem.• Do you like the self esteem scale? What are it’s good points?

What are it’s negative points? Could you see yourself using the scale with patients?

How Can You Help?• Explore Values

• In the toolkit, there is a worksheet that looks at values, and explores what a person values in their life.

• By looking at an individual’s values, we can help to show them that despite any physical/cognitive changes that they have experienced, they can still live up to their values in many different ways.

• The values worksheet in the toolkit looks at a person’s values in different areas of their lives – for example, parenting, spirituality, marriage, physical wellbeing and employment.

Activity- Case Study• Mr L has been very low and feeling distressed

following his stroke as he no longer feels that he can be a good parent or grandparent. His stroke has left him with mobility problems which mean that he needs help with many aspects of his personal care and he can no longer get around independently.

• Mr L feels as though roles have been reversed and this his son now acts like his parent. He also feels like a bad grandparent as he can no longer get out to watch his grandson play football after school.

• On the values worksheet – Mr L indicated how important it was for him to be a good dad and a good grandad. How else can Mr L live up to these values?

How Can You Help?• Positive Personal Qualities

• In the toolkit, there is a positive personal qualities survey sheet which you can give to patients experiencing low self esteem.

• The sheet basically asks family members and friends of the patient to describe the patient positively in three words.

• We tend not to tell people as often as we should, what their positive qualities are and why we like/love them as a person.

• The positive personal qualities sheet can be

How Can You Help?• Negative Self-Evaluations

• People with low self esteem or low confidence often get into the habit of looking at their actions in a much more negative light than they look at the actions of others. They tend to be very harsh on themselves, often thinking the worst and feeling as though others will also judge them in this way.

• In the toolkit, there is a worksheet that looks at such negative self-evaluations and explores the evidence for evaluation a situation in a certain way, as well as exploring how helpful the evaluation is, and how we would see the situation if another person was in our position.

How Can You Help?• Biased Expectations

• Similar to negative self-evaluations which we looked at on the previous slide, people with low self esteem tend to expect the worst of upcoming situations.

• For example, if they are invited out to a quiz night with friends, rather than thinking about how they will have a good time, and a good laugh – they might worry about not knowing the answers, making a fool of themselves, and letting the team down.

• In the toolkit, there is a worksheet that helps to challenge such biased expectations, again looking at the evidence for and against them and trying to help the individual form a more realistic expectation.

• Goals

• Work with your patient to ensure the goals that they set are realistic and achievable.

• It can be a real knock to self confidence, and self esteem if you seem to be constantly falling short of reaching targets/goals.

• One of the best ways of doing this is to break goals down into small steps so that even if an ultimate goal seems a long way away, there are smaller, “mini goals” leading up to that which can give your patient a feeling of achievement.

How Can You Help?

Summary• Sometimes a person will experience low self esteem in the

short term following a stroke, and with time, as they adjust, their self esteem will improve again.

• Other times however, low self esteem can persist and affect an individual’s rehabilitation in all areas of their life. In this situation, it is important that an intervention is in place and that all staff working with the patient, work with this in mind.

• Most of us suffer with low self esteem at times during our lives – self esteem is one of the things that sets us humans apart from other animals. Reassure your patient that many people feel the same way after stroke, it’s completely normal for their self esteem to take a knock after such a big change.