Adjustment Disorders

Abstract

Adjustment disorder has been a diagnostic category in classification systems of mental disorders since the 1970s but has received little attention from basic or treatment research. It is particularly common in consultation liaison services. Evaluation is problematic since it may be mistaken for major depression, generalized anxiety, or nonpathological reactions to stress. Its measurement by structured interview is difficult since it is not included in many instruments and, in others, cannot be diagnosed once the threshold for another disorder is reached. There are new approaches to diagnose adjustment disorder in line with a stress‐response model of the disorder. Few evidence‐based treatments exist. Adjustment disorder generally carries a favorable prognosis, but in some individuals risk of self‐harm and suicide is elevated.

Childhood trauma and resilience in old age: applying a context model of resilience to a sample of former indentured child laborers

“…Previous findings on the current sample showed that only a small proportion of the former indentured child laborers suffer from mental disorders as defined by the DSM-IV (e.g., 23% PTSD, 24% major depressive disorder, 8% generalized anxiety disorder; Kuhlman et al, 2013;Maercker et al, 2014). The majority of the participants show indications of resilience, despite having suffered from high amounts of childhood or lifetime trauma or adversities.…”

“…This group of Swiss former indentured child laborers (Verdingkinder) has already been intensively investigated (e.g., Burri et al, 2013;Kuhlman et al, 2013;Maercker et al, 2014). As an exemplar of childhood traumatization, individuals in the Verdingkinder population share some features of childhood institutional abuse with populations from Austria, Ireland, and other European countries.…”

“…The present study was part of a larger project on trauma aftermath and psychological processes in indentured child laborers, with particular emphasis on PTSD, complex PTSD, and late-life depression (see Maercker, Krammer & Simmen-Janevska, 2014;Burri, Maercker, Krammer, & Simmen-Janevska, 2013). Initial recruitment of participants and the cross-sectional data collection took place between 2010 and 2012; this was considered the baseline time point for the present study (T1).…”

“…Individuals in this sample were former indentured child laborers who experienced harsh living conditions and a high probability of aversive or traumatic events. Previous historical and psychological research has shown that these former indentured child laborers have experienced high levels of aversive stress and traumatic exposure (i.e., physical, sexual violence, and high mortality rates of fellow child laborers during forced labor) (Furrer, Heiniger, Huonker, Jenzer, & Praz, 2014;Schoch, Tuggener, & Wehrli, 1989); yet, more than half of them did not develop psychopathology in old age (Kuhlman, Maercker, Bachem, Simmen-Janevska, & Burri, 2013;Maercker, Krammer, & Simmen-Janevska, 2014). In our conceptual model, we assumed that four factors predicted well-being and lack of depression: trauma exposure, resilience predictors (e.g., social support), the interaction between trauma exposure and resilience predictors, and the decentralized resilience factors (see Figure 1).…”

“…Until the 1960s, these children were removed from their parents by the Swiss authorities and sent to work on farms. Historic studies have shown that many of these children suffered extreme forms of abuse, as they were regularly beaten, emotionally and sexually abused (Leuenberger & Seglias, 2008;Maercker et al, 2014). Reasons for the separation from their biological family were the violation of Swiss social norms including, single motherhood (even in case of widowhood), alcoholism of a parent, being of gipsy origin, and presumed poverty of the parents.…”