Dysfunctional Family Processes is a nursing diagnosis that refers to the family’s inability to function due to multiple internal conflicts.
There are many instances of abuse, concealment, and apathy or denial in this setting. Children’s emotional needs are overlooked in these situations because the parent’s needs/demands hold priority.
Signs and Symptoms of a Dysfunctional Family
- ineffective communication
- verbal or physical abuse
- reversal of roles (parentification)
- rejection
- hopelessness
- lack of identity
- absence of parental-child boundaries
- dependency
- alcohol abuse
- incapacity to express and accept a wide variety of emotions
- agitation
- isolation
- self-blame
- conflicts over communication or control
- unresolved grief
- prolonged resentment
- anger
- unhappiness
- guilt
Types of Dysfunctional Family
- Pathological Family. This type of dysfunctional unit is represented by either parent’s substance abuse, alcoholism, or mental illness, often leading to dysfunctional children since they are deprived of even the most basic bodily and mental necessities. Reversed family roles are common in this setting. And because of their dysfunctional parents, children are more in charge of their daily life.
- Chronic Conflict Family. When family members are constantly arguing, the situation can become extremely stressful for everyone. As a result of these poor encounters, family conflicts may implode.
- Chaotic Family. Parental neglect and abuse are common in a chaotic family setting. These families are characterized by a lack of consistency. When it comes to family dynamics, it can be challenging to identify what is expected of everyone when parents come and leave on a regular basis. When they are present, their parenting abilities are inadequate, or they are the ones who cause harm to the children. Children who have witnessed domestic abuse may also suffer the same devastation as those who have been abused themselves. Childhood trauma and neglect can alter the developing brain, placing children at risk of developing mental health problems and substance dependence.
- Dominant-Submissive Family. These families, also known as authoritarian families, are governed by an authoritarian parent who has no respect for the opinions or feelings of others in the family. Depending on the severity, punishment for mistakes might involve scolding, spanking, or any other type of physical discipline. As tyrants, parents impose their will on their children with very little regard for their well-being and create the rules in accordance with their views.
- Emotionally Detached Family. Marked by a lack of affection and warmth, this type of dysfunctional family is frequently associated with a person’s social position or cultural upbringing. These are families that don’t talk about feelings. Children learn to suppress their feelings due to parental indifference and lack of empathy. This can lead to a string of failed relationships since they are unable to open up to others. Additional implications include feelings of unworthiness, fear of abandonment, academic difficulties, and psychological difficulties (personality disorders).
Dysfunctional Family Roles
- Enabler. This codependent role is also termed “the caretaker .” The enabler of the family is the individual who strives to keep the family together despite its dysfunction. This role can be taken on by a child (acting as a surrogate parent), especially if the parent or caretaker is exhibiting troubling behavior (e.g., mental illness, substance abuse, instability). Parentification occurs when a child assumes parental responsibilities such as housekeeping, meal preparation, or the care of a younger sibling. By taking on the role of enabler, the family is spared from going into conflict or crisis since he/she is there to shield and cover up dysfunctional conduct.
The counterintuitive aspect of being the caregiver is that by preventing the dysfunctional parent’s recession, he or she simultaneously averts the painful, corrective experience that crisis entails, which may be the only thing that motivates the dysfunctional parent to reverse the downward cycle of addiction.
- Mastermind. The opportunist child exploits the family’s dysfunction to achieve what they want.
- Hero. Like the caretaker or enabler, the family hero typically assumes responsibility for making it appear as though the family looks normal or without problems. They often mask the inner struggles to make up for the dysfunctional home life. In many cases, they are the only ones in the family who have a deeper knowledge of the family dynamics (or what goes behind closed doors), yet no matter how hard they try, no one else will listen. Extremely self-sufficient and responsible, the hero is frequently a perfectionist, an overachiever, or someone who appears to have it all. They must continually demonstrate their strength of character to succeed.
- Mascot. In a way, the mascot serves as a comical member of the family. To cope with or distract from the stresses of family life, they often resort to humor and mischief. They are referred to as the cute ones or the jester and frequently strive to be the family’s center of attention, frequently entertaining them to make everyone feel better.
A toddler who feels helpless in the face of family conflict, violence, or other unpleasant dynamics may attempt to diffuse the situation by stepping in. However, the clowning of a mascot is only a temporary consolation. In the long run, they may develop anxiety or depression. Mascots are more likely to be involved in abusive relationships in an effort to save the other person.
- Lost Child. This person (also referred to as the quiet one) usually prefers to maintain a low profile and spend their time alone and away from their dysfunctional family. They are better described as being invisible or loners since they try to make themselves appear little and quiet as much as possible. Moreover, they deliberately avoid conflict in order to keep the peace. Thus, their needs are frequently overlooked or ignored.
Since the quiet one generally keeps out of trouble, the family can assert that everything appears to work perfectly fine in his/her life, implying that things cannot be too bad in the family. But this is not true, as avoiding interactions with other members might impair communication and social skills.
- Scapegoat. As the family’s “black sheep” or “problem child,” the scapegoat is the one who is blamed for any misbehavior. This family member causes trouble and appears to be stubborn, unfriendly, and angry due to the child’s choice to portray the rebellious character. Often, the scapegoat is the person who talks about or acts out the problem that the family is attempting to conceal.
Since violence is their sole way of communicating, they usually find themselves in trouble at school. The defiant child and the weak child are both subtypes of this group, where the former is more likely to engage in conflict and self-destructive behavior. Parents who single out and criticize their children in a way that resembles bullying may be to blame for this personification.
Related Factors to Dysfunctional Family Processes
- Economically marginalized families
- Substance abuse in the family
- Lack of problem-solving skills
- Intimacy dysfunction
- Family history or genetic predisposition to substance misuse
Treatment for Dysfunctional Family Processes
Being aware that one’s family is dysfunctional can be helpful, but it isn’t enough to break the cycle.
- Individual therapy
- Group therapy. Learn healthy strategies to express feelings and connect with people. Explore new ways of relating in a group setting.
- Recovery program. Provides direction, coaching, and support for individuals undergoing recovery. Support services are developed and implemented by peers who have faced and overcome the same experience (substance dependence).
- Family therapy
Prevention of Dysfunctional Family Processes
- Recognize dysfunctional family patterns and allow time for reflection
- Refuse to be a part of a toxic environment
- Stay informed about dysfunctional families
- Establish a new support system
Dysfunctional Family Scenarios
- Addiction. This scenario comes in two circumstances:
(1) Having an affair. For example, a husband takes advantage of his wife’s late-night shifts to fulfill his fantasies. These extramarital affairs may result in a child being born.
(2) Gambling, hoarding, and shopping addiction of parents.
- Control. A spouse explicitly prohibits his wife from socializing with male acquaintances or coworkers outside of the workplace. Emotionally manipulating her into feeling bad every time she joins for lunch, dinner, break, or happy hour may result in her agreeing to discontinue attendance.
- Perfectionism. Parents expect their children to earn straight A’s in school, participate in at least two extracurricular activities, and volunteer at least once a week for a local charity.
- Lack of diversity. Following in the footsteps of a family member, like being a lawyer or a physician, and trying to keep the family’s legacy alive.
- Conflict. Bickering over what to eat for supper, what to watch on television, and where to go on a holiday.
- Abuse. Resorting to physical and verbal abuse as a form of punishment, such as hitting the child when the mother/father is drunk.
- Poor communication. Refusing to acknowledge or express one’s emotions (isolation). Putting up a brave face in front of others. Ignoring and blaming negative feelings.
- Fear. The wife/mother becomes physically aggressive if something triggers her. Her anger outbursts make children feel terrified and unsafe.
Dysfunctional Family Processes Nursing Diagnosis
Nursing Care Plan for Dysfunctional Family Processes 1
Nursing Diagnosis: Dysfunctional Family Processes related to a change in the patient’s health status secondary to bipolar disorder, as evidenced by alteration of communication patterns, problem-solving participation, and incapacity to cope with the crisis.
Desired Outcomes:
- Family members and significant others will actively communicate their need for support and information.
- Family and significant others will demonstrate a better understanding of the condition by attending bipolar support groups.
| Nursing Interventions for Dysfunctional Family Processes | Rationale |
| Assist family members in recognizing the needs of all family members | Members of the family who are ill may receive much more attention, that other family members may feel alienated or neglected, which can be detrimental to family growth and togetherness. |
| Educate family members about the disease and possible symptoms. | When a family member begins to exhibit strange, out-of-control, and hostile conduct, it is typical for families to be shaken and confused. |
| Spend time with family members on the first or second day of patient hospitalization to ascertain their informational needs about the condition. | Families need to know more about the disease and the treatment choices available, and where they can turn for help with their concerns. |
| Recognize what information the family needs about antimanic drugs (e.g., dosing, adherence). | Reduce the likelihood of complications or fatalities by providing more information to affected families. |
| Be on the lookout for signs of approval-seeking behavior, whether verbal or nonverbal. | Families, just like the patient, must be supported for change to occur. Acknowledging their fears and feelings allows them to gain good self-recognition. |
| Refer the patient, family, or significant others to support groups. | Comprehensive patient care includes intensive outpatient programs, engagement of family members, and psychosocial therapies (e.g., psychotherapy for depression, psychoeducation, suicide prevention). Family members who are going through a crisis can benefit from learning about local bipolar support groups and how they can help them cope with their feelings and accept their situation more readily. |
Nursing Care Plan for Dysfunctional Family Processes 2
Perinatal Loss
Nursing Diagnosis: Dysfunctional Family Processes related to loss of a child secondary to perinatal loss.
Desired Outcome: The family members will take an active role in resolving the crisis and demonstrate personal involvement in their care.
| Nursing Interventions for Dysfunctional Family Processes | Rationale |
| Assess the family’s situation and psychological well-being. | This examination assesses the patient’s current situation, coping skills, parenting abilities, and condition. Dispute, denial, anguish, and grief may impair parenting abilities temporarily, and other children may be neglected or ignored following the infant’s death. |
| Evaluate the family’s previous adaptive responses, strengths, and resources | Some family members may be depressed, feel vulnerable, have difficulty eating or functioning, or be generally lethargic. The family may have to reconsider what happened and determine their goals to cope better. |
| Accept the family’s behavioral responses and encourage communication of feelings. Take note of verbal clues suggesting feelings of inadequacy, guilt, or anger. Emphasize the normality of emotions. | Helping the family realize and communicate their feelings of helplessness, anger, or denial to acknowledge the situation will aid in the grieving process. Improved comprehension of the sources of these experiences can be used to rationalize the acceptability of feelings. Moreover, they may repeatedly refuse to describe negative emotions, thus exacerbating mental distress. Recognizing that grief, guilt, and rage are all-natural emotions may help reduce the parents’ sense of failure. |
| Educate and aid parents in coping with the situation (e.g., addressing emotional demands, self-care, parental duties). | Grieving the loss of a child is often accompanied by unanticipated changes in parental roles. This could hinder parenting ability, resulting in neglect or disregard for other children. Feelings of failure or remorse can contribute to an overall sense of inadequacy. |
| Refer family members for counseling or psychotherapy if necessary. | Additional grief assistance may be necessary to help with coping. Psychotherapy may be beneficial in the treatment of traumatic grief. |
Nursing Care Plan for Dysfunctional Family Processes 3
Substance Abuse
Nursing Diagnosis: Dysfunctional Family Processes related to a genetic predisposition to addictions secondary to substance abuse, as evidenced by anger, disturbed family dynamics, impaired communication, refusal to get help, and dependency.
Desired Outcomes:
- The family will communicate awareness of the dynamics of enabling behaviors.
- The family will reduce self-destructive behavior and partake in individual family programs.
| Nursing Interventions for Dysfunctional Family Processes | Rationale |
| Examine the family’s character: history, involvement, the different situations in which addictive behavior occurs, and their relative strengths and weaknesses. | This assessment indicates areas of focus and potential modifications, resulting in a more individualized approach. |
| Assess the family’s adaptive responses in relation to the patient’s substance abuse. | How a family has coped with issues in the past may be a reliable indicator of how they will deal with the present situation. |
| Assess the extent to which family members demonstrate enabling behaviors (e.g., shielding, rationalizing, assumption of responsibilities). | This occurs when family members and significant others verbally and physically support the patient’s addictive behaviors. In order to mask their failure to deal with day-to-day duties, the substance abuser (user) frequently looks to others for support. The most common form of enabling is offering financial assistance to a family member struggling with addiction. |
| Discuss the implication of enabling behaviors and the features of addiction to the patient and their significant others. | Personal understanding and knowledge of enabling behaviors allow individuals to begin the process of self-reflection and self-improvement. |
| Address the sabotage behaviors of family members. | While family members may proclaim a desire for the patient to overcome their addiction, the reality of interaction dynamics is that they may unconsciously impede the patient’s recovery due to the influence of their own position/roles within the relationship. |
Nursing Care Plan for Dysfunctional Family Processes 4
Nursing Diagnosis: Dysfunctional family processes related to a change in the patient’s health status secondary to schizophrenia, as evidenced by refusal to engage in decision-making, alteration of stress-reduction behaviors, lack of awareness about the condition, and community support groups, and alteration of mutual support.
Desired Outcome: The family and significant others will be involved in the discharge planning process and will attend at least one family support group.
| Nursing Interventions for Dysfunctional Family Processes | Rationale |
| Determine the current level of understanding among family members regarding the condition and its treatment options. | Family members may be unaware of schizophrenia or how it is treated and managed. |
| Help the family comprehend the disease and its treatment options using terms they can comprehend. Make sure patients are well-informed about the potential side effects, dosage, duration, and toxicity of the medications used by patients. | Families and patients alike benefit from improved awareness of the condition and its treatment. |
| Educate the patient and their family members on the signs and symptoms of relapse. | There are times when the symptoms of schizophrenia reappear (relapse) and can be so severe that the patient experiences a psychotic episode. Preventing a recurrence can be accomplished by seeking urgent medical care if warning signs are noticed. An effective approach is more likely to be sustained if the entire family is actively involved and dedicated. |
| Assess the family’s level of functioning and their ability to cope (e.g., lack of support, loss, caregiver burden) | Allows the nurse to determine the family’s ability to cope with the current situation. |
| Allow the family to voice their thoughts and concerns regarding the ill family member. Encourage ongoing, open communication amongst family members. | Nurses and other staff members are more equipped to assist families if they are aware of the problems they are experiencing. Additionally, family members can better understand each other and manage conflicts more successfully if they can communicate effectively. |
| Refer the patient, family, or significant others to support groups (e.g., psychoeducational programs, community respite centers, organizations). | Patients and their families benefit from support groups and psychoeducational facilities because they can receive assistance, acquire new skills, and access the resources they need to get through a difficult time. In addition, it reduces tension and stress and enhances the entire family’s well-being. |
Nursing Care Plan for Dysfunctional Family Processes 5
Eating Disorders (Anorexia and Bulimia)
Nursing Diagnosis: Dysfunctional family processes related to situational crisis, secondary to eating disorders (Anorexia and Bulimia), as evidenced by unmet familial obligations, unclear family rules and functions, and discord amongst family members.
Desired Outcome: The family and significant others will be involved in the discharge planning process and will attend at least one family support group.
| Nursing Interventions for Dysfunctional Family Processes | Rationale |
| Assess the family’s level of functioning and their ability to cope (e.g., lack of support, loss, caregiver burden) | Allows the nurse to determine the family’s ability to cope with the current situation. |
| Discuss medical interventions and provide relevant information to the family. Encourage and permit the expression of emotions (crying, fear, anger) | Encouraging emotional expression assists family members in initiating the grieving process. For example, “You seem distressed about your husband/wife/relative/child’s refusal to eat.” They may also be worried due to the patient’s nutritional state deteriorating, necessitating additional hospitalization and the use of tube feedings. |
| Involve all members of the patient’s family in accommodating the patient’s special dietary needs. | Commitment and effort may be required in order to provide support in the home setting. Helping the family to re-define their responsibilities could clear up any misunderstandings and create a sense of direction. |
| Acknowledge the family’s engagement in the patient’s care and accentuate their strengths. | This measure reinforces constructive responses to crises and fosters a sense of involvement. |
| Assist parents in resolving their differences and conflicts. | A parent-child alliance could result in triangulation, and the child may be forced to choose between the two parents. Alternatively, they may deny that they are the source of the issue (anorexia) or that they are exacerbating it |
| Instill a sense of importance in parents, their connection, and their inherent right as a couple. | Since the situation may threaten their marital status, the couple must first analyze and reestablish their connection to preserve their marriage from falling apart. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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