chapter 17: adjustment disorders & life-cycle transitions
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Chapter 17: Adjustment Disorders &
Life-Cycle Transitions
Fall, 2012
Dr. Mary L. Flett, Instructor
Overview Upsetting but normal emotions may result from
difficult life events. Adjustment disorders are a response to stress
that, while clinically significant, are not severe enough to be diagnosed as a mental disorder
Other conditions that may be the focus of clinical attention include partner relational problems bereavement phase of life problems
Adult development includes its own challenges Life cycle transitions (adulthood, family transitions, later life)
Adjustment Disorders: Symptoms
Clinically significant symptoms in response to stress, but not severe enough to be diagnosed as a mental disorder Similar to acute stress DSM does not go into detail on these issues Erik Erikson’s Stages of Development
Focus is on resolving conflict of particular stage Is not pathological unless conflict remains unresolved and
causes problems
Adjustment Disorders: Symptoms
Adjustment Disorders: Symptoms Erikson believes resolution of identity crisis
allows young adults to embark on a journey toward achieving long-term life goals (first crisis of adulthood)
One life-goal is forming intimate relationships and true intimacy (second crisis of adulthood)
Third crisis of adult life is generativity vs. stagnation – career and family achievements
Last stage – integrity vs. despair integrity comes from acceptance instead of regret Despair comes from impossible desire to change
the past and yearning for a second chance
Adjustment Disorders: Symptoms Other adult stage theorists focus on social
relationships Daniel Levinson
“Seasons” in a Man’s Life (roughly 20-year intervals) Early adult transition Midlife transition Late adult transition
Caution in interpreting stages of adult development Many factors that influence adult development Transitions may not be so predictable Don’t know when life will “end” so how can transitions be
predicted
Adjustment Disorders: Symptoms
Don’t ask “who am I” until young adulthood Create a life story Resolve identity crisis Changes in roles and relationships
College, career, family Conflicts in parent-child relationships
Individuation Conflicts between moving toward, moving away, moving
against (Horney, 1939) Increased relationships with peers; decreased relationships
(and influence) by parents
Adjustment Disorders: Symptoms
Emotional Turmoil Young people experience more intense & volatile
emotions than adults Uncertainty about relationships and roles
increases feelings of anxiety
Adjustment Disorders: Diagnosis
DSM-III listed “identity disorder” as a mental disorder; DSM-IV demoted it to focus of clinical attention
Frequency of Identity Conflicts Takes longer to become an “adult” than a
generation ago Cultural climate plays role Economics play role
Adjustment Disorders: Diagnosis
Causes of Identity Conflicts Most successful young adults have parents who
continue to provide support and supervision while allow them to increase independence
Identity crisis may be reflection of Western, industrialized societies
Gender roles influence formation of identity Women may form an identity based on relationships rather
than career
Adjustment Disorders: Treatment
Evidence suggests many young adults seek counseling during this time of life, but no one approach has been studied to determine effectiveness
Supportive, non-directive therapy seems to be the best
Family Transitions: Symptoms
Typically involve addition or loss of members Includes marriage Parenting Empty nest Divorce/re-marriage
Family Life Cycle
Family Transitions: Symptoms
Family conflict Marital satisfaction declines after birth of first child Power struggles and intimacy struggles Reciprocity
Positive feelings reflected back; negative feelings overlooked Negative feelings reflected back; positive feelings overlooked
Demand & withdrawal pattern Wife becomes more demanding; husband withdraws Conflicts go unresolved Marital conflicts lead to fights with children
Family Transitions: Symptoms
Emotional Distress How the conflict is expressed
Sharing of anger Use of “you” is predictor of problems; “I” a predictor of
resolution of problems Unresolved conflicts lead to emotional distress
Emotional distress linked with depression Painful part of separation and divorce
Family Transitions: Symptoms
Cognitive Conflicts Changes in family roles cause problems; “Who
am I now?” Role change in divorce; death of spouse
Acceptance and change a must if harmony is to be achieved
Family Transitions: Diagnosis
Families and relationships not in DSM; just individuals Some argue there needs to be categories for
families & partnerships known as relational disorders
Frequency Census Bureau collects information on certain
family transitions Marriage & Divorce Childbirth outside of marriage
Family Transitions: Causes
Psychological Factors Communication includes
verbal and nonverbal behaviors John Gottman identified following styles of
communication as being critical in a relationship Criticism Contempt Defensiveness Stonewalling
Family Transitions: Causes
Psychological Factors Family Roles
“Traditional” roles vs. “Androgynous” Androgynous is happier!
Social Factors Poverty, unemployment, crowded living
conditions, limited social support can cause substantial distress
Teenage pregnancy, non-marital childbirth divorce, family violence
Family Transitions: Causes
Biological Factors Chicken and Egg debate: Does family distress
cause individual distress or vice versa? Onset of menstruation (menarche) has interesting
biological correlation step father in home, earlier menarche mother’s early age of menarche, early age for daughter(s)
Family Transitions: Treatment
Prevention Programs “Couples Weekends” & “Encounter Groups”
Historically run by the Church Few data on couples of color or LGBT couples
Pre-Marital Counseling Work on communication issues, explore values, identify
potential conflicts and learn problem-solving skills Couples Therapy & Family Therapy
Focus is on changing relationships, not individuals Negotiation skills Break cycles of negative interactivity
Family Transitions: Treatment
Cognitive Behavioral Couples Therapy Emphasizes moment-to-moment interactions
Styles of communication Strategies for solving problems
Later-Life Transitions:
When does “old” start? 65 is an arbitrary marker Physical and emotional changes occur in the 40’s
and 50’s Menopause for women
60s typically is a change from working to retired 70’s and 80’s are focused more on physical
ailments and mortality 90s and 100+ typically housed in long-term care
facilities, out of “mainstream”
Later-Life Transitions:
Ageism Form of social prejudice View of elders as stubborn, irritable, bossy, and
complaining Elders “disappear” into 55+ retirement
communities or nursing homes Frequent observations that “I am not useful any
more”
Later-Life Transitions: Symptoms
Physical Functioning and Health Decline with age when disease process is present Physical activity is a good predictor of
psychological well-being Menopause
Average age of onset in US is 51 years “Hot flashes” Mood swings Memory changes Hormonal changes and role changes
Later-Life Transitions: Symptoms Sensation & Physical Movement
Gradual decline of sensory systems throughout life, but most noticeably after age 70 Eyes adapt to darkness or light more slowly Hearing loss Sensitivity to taste, smell, and touch decline
Muscle mass changes 80% of muscle strength retained Bone loss, particularly after menopause, is problem form
women Chronic illness
Arthritis, cardiovascular disease, cancer, diabetes, sleep disorders
Later-Life Transitions: Symptoms
Life Satisfaction, Work & Relationships Psychological well-being remains remarkably
intact, in spite of physical changes Positive relationships Spiritual/Religious beliefs
Greater sense of “mastery” in personal and work relationships
Retirement a “mixed” blessing For those who want to continue to work, it brings more choice For those who have to work, it brings stress For those who can’t work, it brings loss and status changes
Later-Life Transitions: Symptoms
Erikson’s Integrity v. Despair Finding meaning in life
Who am I now? How do I compare to who I thought I was?
Relationships Quality of friendships is important, not number Having a support system Family relationships
Siblings Children Grandchildren
Later-Life Transitions: Symptoms
Relationships Loss of spouse/partner particularly difficult Remarriage/new relationships
Health issues, including HIV Concerns by children; elder abuse
Grief & Bereavement “Grief” is the emotional and social process of
coping with loss “Bereavement” is a specific form of grieving in
response to loss of a loved one (may include pets!)
Later-Life Transitions: Symptoms
Grief & Bereavement Elizabeth Kubler-Ross – 5 stages of dying
denial anger bargaining depression acceptance
Actual experience for most people is not linear, but all stages are experienced universally
Later-Life Transitions: Symptoms
Grief & Bereavement Experience of loss is different at different times of
life Loss of child Unexpected death of “young” person More prepared for death of an elder because “s/he lived a long
life” Bereavement is in DSM as a disorder
Later-Life Transitions: Symptoms
Mental Health Mood and anxiety disorders most common Psychological issues are under-treated in elders Suicide risk is especially high
Rational suicide Assisted suicide
Later-Life Transitions: Diagnosis
Gerontology is the multidisciplinary study of aging Young-old (65-75) Old-old (75-85) Oldest-old (85+) More women in oldest-old
Later-Life Transitions: Frequency
1 in 8 people living in the US is over 65 3.5 million are 85+ Baby boomers will be a wave of aging challenges Poverty rates are higher among elders More women than men; more women living alone Community-dwelling elders are more common
than long-term care/residential care; this is changing
Later-Life Psychological Problems: Causes
Good physical health is most important contributor to feelings of life satisfaction
Health behavior associated with better outcomes Exercise, good diet, moderate Etoh consumption All tied to improved cognitive functioning Not about longevity; healthy active life until death
Spiritual belief and practices very important Help to deal with loss Help to cope with decline in physical functioning
Later-Life Psychological Problems: Treatment
Good medical care and collaboration among providers is key Behavioral gerontology
Focus is on maintaining or improving quality of life End of life issues
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