INTRODUCTION TO THE 2008 EDITION
I am pleased to welcome Dr. Lauren Papp aboard this year as co-editor of the Online Encyclopedia. The project started in the summer of 2007, when I was a visiting instructor at the
University of Wisconsin-Madison, teaching
Family Stress and Coping. As a way to allow the students' research papers to make some lasting contribution, I told the class we'd post the papers on the web in the form of this encyclopedia.
I came back to UW-Madison to teach in the summer of 2008, but this time I taught the course,
A Family Perspective in Policymaking (HDFS 535). I thus no longer had a group of students who could be assigned to write about family stress and coping (other than where there was a policy connection).
This is where Dr. Papp came in. As a researcher of couple relationships (including conflict) and, periodically, a teacher of the Family Stress and Coping course, her academic interests fit well with the content of the Online Encyclopedia. After a conversation with her early in my 2008 visit to Madison, she generously agreed to have the students in her lab group write a set of entries during the Fall semester to create a 2008 version of the Encyclopedia. So it lives on!
It also probably helped that Taylor Reineke, a student in my 2007 class who is also in Dr. Papp's lab group, spoke well of the Encyclopedia project. Taylor enjoyed a
successful volleyball career for the Badgers and appears on her way to a promising career studying and/or working with families.
All of the 2008 entries are listed (alphabetically by topic) in the right-hand column, under "Previous Posts." Just click on whatever topic interests you. To see the previous year's entries, click on "August 2007" in the right-hand column under "Archives."Thank you,
Alan Reifman, Ph.D.
Co-Editor, Online Encyclopedia of Family Stress and Coping
Texas Tech University, Professor, Human Development and Family Studies
University of Wisconsin-Madison, Visiting Lecturer
Alzheimer's Disease
by Nikki WittAlzheimer’s is a neurological condition impacting cognitive abilities and personality, eventually leading to dementia and death. This disease destroys brain cells and causes problems with memory, thinking and behavior. Currently, Alzheimer’s disease is the sixth leading cause of death in the US, and there is no cure (1).
10 Warning Signs of Alzheimer's (from the
Alzheimer's Association)
1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation to time and space
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative
Who suffers from Alzheimer’s disease?It is common in individuals over 65, with an estimated 5.2 million Americans being afflicted. AD counts for over 70% of dementia cases in Americans over 71 (1).
More women than men have Alzheimer’s, but this is in part due to the fact that women have a longer life expectancy.
It is estimated that 1 out of 6 women and 1 out of 10 men at the age of 55, will develop Alzheimer's in their remaining lifetime (1).
People with lower education are more likely to develop AD as are African Americans; however, this may be tied to other risk factors.
Who provides care for the millions of Americans suffering from AD?In 2007, 9.8 million family members, friends, and neighbors provided unpaid care for a person with Alzheimer’s disease (1). While it is common for adults to provide care for their elderly parents, studies have reveled that amount of care provided to individuals with Alzheimer’s disease is over twice as much, around 40 hours per week (1).
Most often the burden of caregiving falls on women in the family, although care provided by male spouse and relatives is increasing.
What is the impact of caring for a person with Alzheimer’s disease?Financial/Income - 57% of people providing care are employed full or part time (1). The demands of caregiving may lead a person to reduce or change his or her work hours or possibly even quit. From this, there may be less income to support the family, increasing the financial strain.
Levels of Stress – Caregivers report that the experience is very stressful (3). These high levels of stress are related to poorer physical health. Physical effects include impaired immune system functioning, elevated blood pressure and risk of poor self-care, such as loss of sleep (2).
Caregivers may also experience secondary stress. This may result from competing demands from a spouse, children or work leading to role conflict or overload (4).
Mental Health/Depression - Around one third of caregivers report symptoms of depression and other mental health problems and these persist even after death of the patient or nursing home placement (1).
Is the impact the same for everyone?Female caregivers have a greater reaction to problem behaviors and are overall more impacted by caregiving (4). Women are more likely to report higher levels of burden and increased role restriction than men.
This could be due to the fact that when men are caregivers, there is typically someone else around to help, serving as a source of informal support, therefore reducing burden. On the other hand, women who provide care often experience an isolating effect and are deprived of social interaction (3).
What can be done?Caregiver stress can be mediated through the use of coping strategies such as social support and positive reappraisals (4). Emotional and outside support also reduces rates of depression in caregivers. Other forms of support include support groups, educational programs and respite care.
Caregiver information programs may be helpful to provide education, teach problem solving skills and enhance social support. In addition, family meetings are important in order to provide support and reduce the burden of the primary caregiver
Health professionals devote time and energy to monitor the health of caregivers as well as patients.
ResourceTake care of yourself: 10 ways to be a healthier caregiver (Alzheimer's Association)
References(1) Alzheimer’s Association. (2008).
Alzheimer’s disease facts and figures.
(2) Haley, W.E. (1997). The family caregiver's role in Alzheimer's disease.
Neurology, 48, 25S-29S. (Abstract available
here)
(3) Papastavrou, E., Kalokerinou, A., Papacostas, S.S., Tsangari, H., & Sourtzi, P. (2007). Caring for a relative with dementia: Family caregiver burden.
Journal of Advanced Nursing, 58, 446-457. (Abstract available
here)
(4) Robinson, K.M., Adkisson, P., & Weinrich, S. (2001). Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer's disease.
Journal of Advanced Nursing, 36, 573-582. (Abstract available
here)
[Editor's Note (AR): Please consult the Archives in the right-hand column for other entries on the general topic of caregiving.]
Attention Deficit (Hyperactivity) Disorder and the Family
by Sarah WierADD stands for
Attention Deficit Disorder, one of the most prevalent mental disorders affecting children today. ADD is a biological, brain-based condition that is distinguished by poor attention and lack of focus. Many people use the terms ADD and ADHD (Attention Deficit
Hyperactivity Disorder) interchangeably. ADHD is ADD that also includes hyperactive and impulsive behaviors.
There are three different types within this definition of ADHD (2). Symptoms include lack of concentration, distractibility, impulsivity, and hyperactivity (3). These symptoms do not usually show themselves until the child enters school. Difficult behavior can continue through adolescence and adulthood. An estimated 3-5% of preschool and school-age children are affected by AD(H)D (1). This means around 2 million children or about 1 in every 25-30 students have the disorder.
The exact cause of AD(H)D is unknown. However, it is believed to be genetic since risk is higher among family members. Risk factors also include being male, having brain abnormalities, and maternal use of cigarettes or alcohol during pregnancy (2). Those who have AD(H)D usually have one or more simultaneous conditions as well. These could include behavioral problems, learning disabilities, anxiety, language disabilities, and depression.
AD(H)D in a marriageThere are two instances in which AD(H)D can affect family relationships. One instance is when a spouse has AD(H)D, causing stress on the marital relationship. The second instance is when a child has AD(H)D, putting strain on both the siblings and the parents. In a marriage, the spouse can bring into the relationship the characteristics that go hand in hand with AD(H)D. Examples of this could include getting distracted easily during conversations, having trouble setting clear limits resulting in unfinished tasks or missed appointment times, missing social cues such as facial expressions, voice tone, body language, etc., having trouble trusting oneself, or resenting the criticism of others which can lead to lack of motivation or hypersensitivity. These characteristics can put extreme tension on a marriage if not for the spouse’s patience and understanding (4).
AD(H)D in a parent-child relationshipIn a parent-child relationship, the child can exemplify the same type of characteristics. Oftentimes, parents are not sure how to deal with their child’s behavior, so they react on impulse based off of their “gut” feelings at the moment. Unfortunately, their response is not always the best, making the matter worse than before. This turns into a cyclical pattern of stress. As mentioned before, children usually have other disorders that accompany AD(H)D that can also exacerbate the parent-child relationship (5). These can include learning disabilities, tourette syndrome, oppositional defiant disorder, conduct disorder, anxiety, depression, and bipolar disorder (6).
TreatmentsThere are several treatments for AD(H)D that can also relieve the stress on the family. Treatments usually consist of medication, psychotherapy, behavioral therapy, social skills training, support groups, and parenting skills training (6). Parents can also create situations that are less threatening to the child. This can include only allowing a couple of friends over at a time, dividing up big tasks into little steps to increase attention span, or giving immediate positive feedback after accomplishments. The goal is to teach the children how to control their behavior and choose the more desired conduct. Parents can also try to practice patience in an effort to understand where the AD(H)D individual is coming from (5).
ResourcesCHildren and Adults with Attention Deficit/Hyperactivity DisorderADD SupportReferences(1) Gallagher, T. (Undated).
What is ADD? Retrieved September 8, 2008.
(2) Low, K. (2008).
What is ADD/ADHD? Retrieved September 8, 2008.
(3) Revolution Health Group. (2007).
Attention-deficit/hyperactivity disorder (ADHD). Retrieved September 8, 2008.
(4) White, M. (2004).
How adult ADHD affects relationships: Strategies for coping. Retrieved September 8, 2008.
(5) Robin, A.L.
Principles for parenting the adolescent with ADHD. Retrieved September 8, 2008.
(6) The National Institute of Mental Health (NIMH). (2008).
Attention Deficit Hyperactivity Disorder.
[Editor's Note (AR): One of my faculty colleagues at Texas Tech, Miriam Mulsow, has done extensive research on ADHD and families.]
Caregiver Stress
by Kayla MontgomeryWhat is a caregiver?In order to discuss caregiver stress, one must first discuss
what is and
who is a caregiver. Caregiver can be both formal (or paid) and informal (unpaid). A caregiver is an individual who provides help to another person who is incapacitated and in need of help (2). Often, the recipient is elderly or suffering from problems such as Alzheimer's, strokes, cancer, brain injury and more. Because of these problems, they need help with daily activities such as shopping and cleaning and more "intense" things like taking medicine, personal hygiene needs, etc. (1).
Today, the most common type of informal caregiver is that of an adult child taking care of his or her elderly parent(s) (2). According to the Family Caregiver Alliance, 52 million Americans serve as informal or family caregivers and 59-75% of these are women. Furthermore, at least 59% of all informal caregivers are employed full-time or part-time, in addition to their caregiving responsibilities (1).
What is “caregiver stress”?Because of the emotional and financial pressures of caregiving and the challenge of juggling work responsibilities, many caregivers experience high levels of emotional and physical "strain", termed
caregiver stress. Caregiver stress can manifest in emotions such as loneliness, exhaustion, anger, frustration, and more (2).
Not only are these difficult emotions to deal with, but they have also been shown to negatively affect health. According to research, caregiver stress can increase blood pressure, decrease immune system functioning, and increase the development of depression and anxiety issues, among other physical and mental health problems. Furthermore, studies have shown that elderly spousal caregivers' mortality rate is 63% higher than that of their non-caregiver peers (1).
How can individuals prevent or relieve caregiver stress?While informal caregiving is extremely stressful, it is also vitally important. Therefore, steps can be taken by the caregiver in order to help prevent the mental and physical effects of caregiver stress. First and foremost is recognizing that this stress is real and important. Becoming more informed on the disease through talking to doctors and nurses, or studying books and websites, can help alleviate pressure. Setting aside personal time to connect with friends and other family members can help a caregiver feel less isolated and burdened (2).
Also, there are caregiver support groups that allow one to connect with other caregivers. Setting realistic goals and prioritizing can make the task seem less insurmountable. Reaching out to friends/family and saying no to extra requests are vital ways of alleviating caregiver stress and avoiding the health problems that accompany it (2).
ResourcesFamily Caregiver AllianceNational Alliance for CaregivingNational Family Caregivers AssociationReferences(1) Family Caregiver Alliance. (2001/2005).
Selected caregiver statistics. Retrieved October 10, 2008.
(2) Greene, R.C. (2008).
Caregiver stress. Retrieved October 10, 2008.
Emotionally Abusive Relationships
by Sarah JanusWhen thinking about abusive relationships, many people often believe that emotional abuse is not as serious as physical abuse. While it may not be causing damage that is visible, it is still very harmful to a person’s self-esteem, and is a serious matter that should be dealt with in the early phases before it escalates.
There are many different tactics that the abusive partner may use that constitute emotional abuse, some of which may be easier to identify than others. A couple of these include making threats and using intimidation to make the victim fear the abuser. These threats can range from threatening to leave the relationship to threatening to hurt the victim or someone close to him or her. Emotional abuse can also take the form of manipulating the victim, playing mind games, using humiliation, and making the victim feel bad about him or herself by name calling or blaming.
Isolation and economic abuse are also common tactics that can be used by trying to control or limit the partner's freedom of travel, behavior, and use of money. The abuser often tries to justify these behaviors by saying that he or she cares about the victim’s well-being and is just trying to take care of the partner, or because the abuser is jealous and doesn’t want to lose the partner. In reality, these abusive behaviors all boil down to a need for control and power in the relationship(3).
The cycle of abuseMany abusive relationships travel through a cycle which is commonly referred to as “The Cycle of Abuse.” It has 4 main steps, which continues throughout the duration of the couple’s relationship. The cycle is illustrated at
this website.
The length and intensity of each phase may vary each time the couple travels through the phases, but there are some characteristics of each that are commonly known as the warning signs of abuse. Phase 1 begins with tension among the couple increasing, often followed by a decrease in communication. This is the time when the victim begins to feel fearful of the partner, and may compromise his or her own choices to help calm down the abuser.
The cycle then goes on to Phase 2, commonly labeled as “the incident,” where the abuser uses some form (or forms) of abuse on the victim, ranging from verbal, emotional, physical and sexual abuse. All of these different types often include some combination of anger, threats, and intimidation. After the abuse stops, the Reconciliation phase (Phase 3) is when the abuser tries to make up for his or her actions and make things right again. The abuser either apologizes and gives excuses for why the behavior occurred, or denies/minimizes the abuse, often making the victim believe it was his or her own fault that the abuse occurred.
The fourth and final phase is the Calm phase (Phase 4). The previous abusive incident is often forgotten or overlooked and the partners go back to being in their “honeymoon phase” again. There is no mention of the abuse and everything returns to normal, until something happens causing tension to build, taking the couple back to Phase 1 (1).
As an abuser goes through this cycle, it is very common for the victim to not even realize the detrimental effect that the abuser's conduct is having. While friends and family members may see the abuse, it is very common for the victim to be oblivious to the abuser’s mind games.
Some predictorsThere are several factors that have shown strong correlations to being emotionally abused (2). Some of these include:
• Being female
• Being involved in a romantic relationship
• Having been physically abused by a romantic partner in the past
• Being above 20 years old
If you or someone you know is in an abusive relationship, do not hesitate to seek help. While the abuse may not seem very serious, emotional abuse has a tendency to turn into physical abuse very quickly, and the longer the relationship lasts, the harder it is to break the cycle of abuse and get out of it. There are many resources with helpful information for both men and women who are suffering in abusive relationships.
ResourcesHeart 2 HeartKids HealthJournal of Emotional Abuse [added by Co-Editor AR]
ReferencesKnox, D., Custis, L.L., & Zusman, M.E. (2000). Abuse in dating relationships among college students.
College Student Journal, 34, 505-508.
Nemours Foundation. (2007).
Teens health. Retrieved October 2008.
Pipes, R.B. & LeBov-Keeler, K. (1997). Psychological abuse among college women in exclusive heterosexual dating relationships.
Sex Roles, 36, 585-603.
Media, Society, and Relationships
by Crystal CayembergThe way in which a couple forms and carries out a relationship changes for each generation. Changes in society cause us to change our attitudes and opinions. The advancement of technology allows these new trends to spread and reach a much broader audience. For our generation, media and society influence relationships in multiple ways; a few of the largest impacts are seen through job market change, advancement of the Internet, and sexuality in television.
Job market changeAccording to Elizabeth Kelleher, writer for USINFO, more than half of all families in the United States are comprised of dual-earner families (1). Due to increasing financial demands, more and more families feel the need to have both parents working. This creates a difficult caseload of work for both spouses to juggle, especially when children are involved.
Oftentimes, conflicting demands from work and family tug on an individual’s limited resources and time, creating very stressful environments. The shift to women in the workforce has also shaped new gender roles within American families. Mothers find themselves especially torn between the roles of mother, worker, and spouse. This gradual shift can even create some tension between couples that are deciding how to budget for a family.
Advancement of the InternetThe advancement of the Internet has made dating a worldwide market. Many people use the Internet as a means to meet new partners. The Internet also allows today’s generation to stay connected with people around the world, thus making long-distance relationships more easily attainable. However, the Internet dating scene also has its problems. The Internet allows for a gray area in which people may explain themselves however they’d like. Couples must be careful not to get involved with an over-exaggerated Internet description of another person. The Internet also allows for very impersonal communication. Although it allows long-distance couples the chance to communicate, it does seem to bring a certain impersonal factor to communication.
Sexuality in televisionAccording to the Teen Relationship Project, 52% of students said they feel they are influenced by the media in their dating and sexual relationships (2). Recently, sex has become a part of mainstream television. Shows are more provocative, sexual scenes are seen more frequently, the media stereotypes men and women, and sex is much more casual than it used to be. Within American society, sex has become a much more casual act. Couples are engaging in sex at an earlier age and it may be due to its exposure on TV.
As media influence society, we see the carryover effects on relationships. Although the media contain many detrimental influences and create opportunities for stress, they also allow individuals an easier means to discuss stressors caused by their families. As relationships form and families deal with changing roles, they can choose to focus on the positive impacts on their lives. They can use changing gender roles as a means to explore new opportunities. The Internet can be used as a resource for anyone dealing with stress.
Finally, television is not viewed as strictly sexual in content. There are many educational programs aired on TV as well. Couples and families can choose to use the changing trends of society as a means to discuss new attitudes and beliefs the others feel.
ResourcesCox NewspapersBook chapter from Managing Work and Family
Stephen Blake, author on long-distance relationships
References(1) Geed, S. (2007).
Dual-earner couples.
Online Encyclopedia of Family Stress and Coping. Retrieved October 15, 2008.
(2) Pepler, D., & Craig, W. (2000).
Making a difference in bullying. LaMarsh Research Programme, Report Series, Report #60. LaMarsh Centre for Research on Violence and Conflict Resolution. York University. Toronto, Ontario, Canada. Retrieved October 15, 2008.
Mental Illness and Family Conflict
by Aviva LeviWhile every family undoubtedly faces difficult circumstances and adjustment to new situations, families with a mentally ill loved one face a variety of unique stressors and must cope with a range of family conflicts. Not only must families facing mental illness watch a family member struggle or deteriorate; they must also learn to adjust to a changing family structure and to new familial relationships. In addition, families affected by mental illness must also face further challenges such as economic stress and social stigma. Moreover, the cumulating effect of such circumstances can lead family members to experience tension and disagreement within their relationships.
Basic Contributors to Family ConflictMentally ill family members are often faced with the daily stressors that all families experience regularly. For example, they must perform duties as parents, employees, and spouses and their compromised capacity often hinders their ability to do so successfully. Specifically, parents diagnosed with a mental illness face countless obstacles that may certainly contribute to future family conflict. Most basically, families touched by mental illness are often faced with significant financial burdens that arise from insurance and healthcare costs and job loss (4).
In addition, research reveals that mothers with a serious mental illness are less likely than other women to receive prenatal care and more likely to use drugs and alcohol while pregnant (6). Although many factors may contribute to such findings, the complications that result from such maternal behaviors can undoubtedly lead to future family stressors and conflicts.
Furthermore, research reveals that seriously mentally ill mothers also report struggling with daily parenting responsibilities and they may subsequently lose custody of their children. Correspondingly, such mothers are less likely to seek help, thus fostering their pattern of family distress. It is not surprising, then, that mentally ill mothers frequently reported being unsatisfied with their relationship to their children (6), a finding that holds implications for the entire family system.
Family relationship outcomesIn addition to the findings that mothers with mental illness have an increased chance of being involved in the child welfare system (6), researchers have also discovered the stressful toll mental illness can take on a family within the home. In fact, current research suggests that families faced with mental illness experience significantly more days of conflict in a month than families not facing mental illness.
Moreover, specific psychopathological symptoms such as paranoia and psychotic behavior have been found to be positively correlated to instances of family conflict. The severity of such symptoms is also positively correlated to increased conflict. It is important to note, however, that the age of the mentally ill family member is negatively correlated to family conflict. That is, as a family member suffering from mental illness ages, family conflict decreases (5).
Sadly, some family members may feel skeptical or resentful of their mentally ill relative and resort to blaming or rejecting the family member. While such negative reactions may seem cruel or insensitive, research often points to family members’ high levels of emotional exhaustion resulting from the stress and conflict within the family system (1).
Interestingly, current research finds caregivers to experience a significant increase in multiple psychological symptoms. For instance, caretakers of mentally ill family members report more feelings of uncertainty, lack of continuity, frustration, and reluctance to accept their role as a caregiver (3). In addition, the disruption of the parent-child bond and the shift in family dynamics proves to be especially taxing on the family system as both phenomena reportedly lead to increased conflict. More specifically, families tend to experience more verbal abuse and physical threats or assaults from their mentally ill loved one (3).
Additional pressures affecting family relationshipsAs a result of such conflict, many family members of those who are mentally ill may begin to associate their home with feelings of burden, anxiety, or confusion. Additionally, some families must face the pressure of keeping a family mental illness secret to avoid the judgment and stigma that too often accompany such conditions. While attitudes and perceptions of mental illness vary widely by culture, family members faced with stigma and constant secrecy often show higher rates of depressive symptoms, as well as feelings of anger or resentment toward the mentally ill family member (4). Such emotions truly have the potential to impact multiple family relationships.
Correspondingly, siblings of those struggling with mental illness often experience a decrease in the attention they receive as their parents must spend time helping their mentally ill brother or sister get well. Feelings of resentment, jealousy, and subsequent guilt may arise in siblings when they must adjust to fewer family activities, as well as to ridicule from peers about their sibling’s condition.
Perhaps most difficult for siblings as well as other family members is the need to adapt to the cyclical nature of many severe mental illnesses. Siblings, parents, and extended family members must cope with the recurring and possibly unpredictable symptoms of a loved one (4). The erratic and inconsistent nature of many severe mental illnesses can certainly increase the stress levels of all family members and contribute to conflicting familial interactions.
Lastly, the conflict and upset in many families coping with mental illness are exacerbated by the lack of adequate community resources available. Families are often left with deficient community resources that are commonly not culturally sensitive or accommodating to families’ specific needs (2).
Conflict preventionFortunately, despite the stress and conflict surrounding many families touched by mental illness, families can take a variety of measures to both prevent and minimize conflict. Specifically, families must strive to involve all members in the treatment process and recognize that all family members have a vital role and a clear purpose within the family system (1).
Families must also maintain frequent and meaningful contact with mental health professionals to ensure ongoing and consistent support (2). With the help of more comprehensive and culturally sensitive resources, families can develop supportive relationships between members which will, in turn, encourage resilience and strength within the family system. Similarly, increased use of improved mental health services will help families foster positive traits such as warmth, affection, emotional support, and optimism (1).
ResourcesMental Health AmericaNational Alliance on Mental IllnessReferences(1) Cant, I.R. (2007). The secondary family: The result of strong community partnering.
The Mental Health Review, 3, 30-34.
(2) Cohen, A.N., Glynn, S.M., Murray-Swank, A.B., Barrio, C., Fischer, E.P., & McCutcheon, S.J. (2008). The family forum: Directions for the implementation of family psychoeducation for severe mental illness.
Psychiatric Services, 59, 40-48.
(3) Kokanovic, R., Petersen, A., & Klimidis, S. (2006). Nobody can help me… I am living through it alone: Experiences of caring for people diagnosed with mental illness in ethno cultural and linguistic minority communities.
Journal of Immigrant and Minority Health, 8, 125-136.
(4) McGinty, K., Worthington, R., & Dennison, W. (2008). Patient and family advocacy: Working with individuals with comorbid mental illness and developmental disabilities and their families.
Psychiatry Quarterly, 79, 193-203.
(5) Murray-Swank, A., Glynn, S., Cohen, A.N., Sherman, M., Medoff, D.P., Fang, L.J. et al. (2007). Family contact, experience of family relationships, and views about family involvement in treatment among VA consumers with serious mental illness.
Journal of Rehabilitation Research and Development, 44, 801-812.
(6) Park, J.M., Soloman, P., & Mandell, D.S. (2006). Involvement in the child welfare system among mothers with serious mental illness.
Psychiatric Services, 57, 493-497.
