Critical life event

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A critical life event is an event that changes a person's existing life situation and forces them to take measures to cope with and adapt. Examples of critical life events (including stressful life events , life crises , stressful life events, adversity) are: job loss, separation / divorce, death of partner or child, serious illness / accident or family member as well as life-threatening events (trauma). Critical life events occur in every resume. They are examined by social epidemiology as possible causes or triggers of physical and mental illnesses. They increase the risks of various diseases. However, the majority of the affected people cope with critical life events to the extent that they do not become manifestly or not in the long term.

In the context of developmental psychology, the importance of critical life events for developmental changes over the life span is examined. Development tasks and role transitions are also counted among the critical events. They trigger developmental change. Regardless of a possible illness, a critical life event often influences a person's entire life situation and can take their life course in an unfavorable direction. - More recently, the effects of critical life events have been classified in the context of the vulnerability-stress-coping model. Furthermore, the coping strategies and the triggers of critical events are examined.

Definition and characteristics

Critical life events "attack a person's structure of fit with their environment". They shake previously unquestioned certainties and can trigger violent emotions. "If all attempts to reorganize the person-environment fit [coping] seem to fail and the associated negative affect cannot be regulated ," a crisis occurs , the outcome of which can be positive or negative.

"Critical life event" summarizes very heterogeneous events over the entire life span, with considerable overlap with " stress " and " trauma ":

  1. critical life events in the narrower sense, life changing events
  2. normative events, development tasks
  3. chronic stress factors (e.g. caring for a chronically ill relative)
  4. Everyday stress (daily hassels, e.g. long journeys to work)
  5. major stressful events (e.g. economic crisis, natural disaster)
  6. Non-events (e.g. involuntary childlessness, failure to promote promotion)
  7. Trauma in the narrower sense: a trauma event occurs when the life or physical integrity of the person is injured or threatened (e.g. victim of physical violence, rape , act of war). Sometimes serious, but not life-threatening events are also referred to as "trauma".
  8. critical life events or trauma events in childhood ( childhood trauma ), especially sexual abuse , mistreatment and neglect .

Whether a critical life event leads to an increased risk of illness depends on both the characteristics of the event and the characteristics of the person concerned. Relevant event characteristics are:

  • Uncontrollability : the event or its consequences cannot be prevented or influenced by one's own action;
  • Severity, intensity, number of areas of life affected by the event ("degree of effectiveness");
  • Duration of the event and its consequences: one-off / short-term event ( type I trauma) vs. chronic or repeated event ( type II trauma).

Relevant personal characteristics are:

  • Age at entry
  • gender
  • personal evaluation of the event
  • Coping skills and resources, personal protective factors
  • available social support.

Investigation methods

In empirical research , lists of critical life events are often used, on the basis of which the respondents are asked to indicate the events they have experienced. The survey is carried out by means of a questionnaire and / or by trained interviewers. One of the first instruments was the "Social Readjustment Rating Scale SRRS" by Holmes & Rahe (1967). The scale contains 43 negative and positive life events, the respective degrees of severity are numerically determined by the so-called readjustment effort (life change unit; e.g. death of spouse = 100, marriage = 50, job loss = 47; see article stressor ). The stress values ​​of the individually specified life events are added to a total stress value. Empirically it has been shown that only negative life events increase the risk of illness.

There are several methodological problems associated with using event lists. A large number of different event and trauma lists are used, so that the results are only partially comparable. If a list also includes less serious events, the result is a higher number of people affected. The subjective evaluation and affective significance of the events as well as the triggering conditions are often not recorded. Serious or traumatic events have a low probability of occurrence and are often not included in the lists. The recording is mostly done retrospectively , which can lead to memory errors; z. B. the memory of the event can be influenced by the consequences of the event. - An alternative approach is to examine people who have been confronted with a specific critical life event, e.g. B. Cancer diagnosis. How affected persons interpret and cope with this event and its consequences is examined in detail.

Frequency of critical life events

Separation / divorce and unemployment are common occurrences. In the period from World War II to 1995, the risk of divorce tripled. In 2012, more than a third of marriages in Germany were divorced up to a duration of 25 years . In 2014, a total of 2,950,250 people were registered as unemployed in Germany .

Trauma events in the strict sense are significantly less common. A representative German sample of the population (Maercker et al. 2008; age 14–93 years) was surveyed in 2005 with regard to trauma events in all previous life; Multiple mentions were possible. Symptoms of post-traumatic stress disorder were also recorded. Table 1 shows the lifetime prevalence for war and civil trauma .

Type of trauma Prevalence of trauma%
1. direct acts of war 8.2
2. bombed out in war 7.0
3. Displaced from their homes 6.7
4. Captivity / hostage-taking 1.6
5. Rape 0.75
6. Child abuse 1.2
7. serious accident 4.6
8. physical violence 3.8
9. life threatening illness 3.0
10. Natural disaster 0.8
11. Witness a trauma 8.5
12. Other traumas 3.6

Tab. 1 Lifetime trauma prevalence (Maercker et al. 2008); 1st - 4th War traumas; 5th - 12th civil traumas;

The most common trauma event was witnessing another person being traumatized (8.5%). War-related trauma was also not uncommon. A total of 24% of the respondents had experienced one or more trauma events in their life; 28.0% of women, 20.9% of men. - In a representative US-wide sample of the population (Kessler et al. 1995), people between the ages of 15 and 54 were asked about the occurrence of trauma events and about symptoms of post-traumatic stress disorder in their previous life (lifetime prevalence); Multiple mentions were possible. The three most common events were averaged over the sexes: witnessing an accident or violence (25.0%); personal accident (19.4%); Disaster (fire, flood, natural disaster 17.1%). Of those surveyed, 60.7% of men and 51.2% of women had experienced one or more trauma in their lifetime. - The surveys consistently show that trauma events in the course of life are by no means rare; in Germany around a quarter of the population has experienced at least one trauma, in the USA more than half.

Critical life events as triggers for diseases

At first it was assumed that critical life events - especially when they accumulate - cause illness . In a sample of 88 medical assistants, Holmes & Masuda (1974) found a significant relationship between general medical illnesses and exposure to critical life events in the 2 years before the onset of the illness. - Unemployment affects health. The empirical findings show unanimously: "The unemployed are in a significantly poorer state of health compared to employees. The risk of illness for the unemployed is [...] significantly higher , especially in the field of mental illness. It rises sharply with the duration of unemployment." With regard to the cause, it must be taken into account that an illness existed before the job was lost and may have triggered it. In any case, persistent unemployment is a serious health burden.

Of the life events that can trigger an illness, trauma has a special meaning. A trauma event can immediately trigger an acute stress reaction that generally subsides within hours or days. Post-traumatic stress disorder may develop as a delayed response to a trauma event . According to the ICD-10 ( International Classification of Diseases-10 ), trauma in the previous 6 months is a necessary condition for this diagnosis.

In the study by Maercker and others, the symptoms of post-traumatic stress disorder were also recorded. In the month before the survey, 2.3% of all respondents suffered from full post-traumatic stress disorder and a further 2.7% from individual symptoms (partial post-traumatic stress disorder), a total of 5.0% (one-month prevalence). The lifetime prevalence is assumed to be higher. Among the respondents who had suffered one or more trauma (risk persons), the probability of currently suffering from post-traumatic stress disorder (full picture) is 12%, a further 12.8% suffer from individual symptoms, a total of 24.8%. The most serious trauma events, i.e. those that most often trigger post-traumatic stress disorder (full screen), are:

  • Rape (38% of people affected develop post-traumatic stress disorder)
  • Child abuse (35%)
  • life-threatening illness (23%)

Trauma events therefore sometimes lead to a dramatically high risk of post-traumatic stress disorders. However, this risk is less than 50% for all forms of trauma. - In the US sample by Kessler et al., After one or more trauma, the risk of post-traumatic stress disorder is 20.4% for women and 8.1% for men. The most serious events for one or both sexes are:

  • Rape (46% of women affected, 65% of men affected develop post-traumatic stress disorder)
  • sexual harassment (women 27%, men 12%)
  • War battle (only men 39%)
  • Threat of armed violence (women 33%, men 2%)
  • Childhood abuse (women 49%, men 22%).

"It has been shown that, on the one hand, the willful trauma caused by humans (man made disaster) and, on the other hand, the longer-lasting type II trauma in many cases can lead to more impairing and more chronic psychological consequences than the other forms."

Post-traumatic stress disorder distinguishes between disorders / illnesses that are triggered by critical, but non-traumatic life events, that is, "after a decisive change in life, after a stressful life event or even after severe physical illness". They are diagnosed as adjustment disorders in the ICD-10 .

Critical life events, especially uncontrollable loss events, e.g. B. widowhood increase the risk of depression until disease control. But only a "relatively small number of those [affected by a critical event]" actually develop depression. Critical events play only a minor role as triggers for later depressive episodes. - Individual life events can violate norms or basic convictions of justice ; z. B. when a person who has sacrificed himself at work is fired or in the event of a neighborhood conflict. In addition to experiencing injustice, there are feelings of degradation, aggression against the perpetrator as well as helplessness and being at the mercy. This can lead to bitterness which, if stopped , can lead to the disease of post-traumatic bitterness . The bitterness disorder is counted among the adjustment disorders; (see also gratification crisis ).

Critical life events and especially chronic stresses lead to physical changes, including an increased stress reaction (increased release of stress hormones ) and impairment of the immune system ; s. Main article stress .

Critical and trauma events can trigger schizophrenic symptoms. Young adults from a representative German population sample (Lataster et al. 2012) who had experienced critical life events (adversities) both in their early years and recently have an increased risk of psychotic (schizophrenic) symptoms of 21.6%. Of the respondents without critical events, only 5.2% show psychotic symptoms.

In general, critical life events increase the risk of illness. However, only a minority of people who have been exposed to one or more critical events or trauma become ill ; ie critical events are not necessary for the respective illness (exception: post-traumatic stress disorder). On the other hand, only a fraction of the people who have a certain illness have previously been confronted with a critical event; ie critical life events are also not sufficient for the disease . In summary, Filipp & Aymanns write: "The exposure to critical life events [seems] in no way suitable to the extent to increase the risk of an illness and / or to influence its course, as was originally suspected in traditional life event research."

Vulnerability-Stress-Coping Model

Critical life events require appropriate efforts to cope with (coping). Illness as a result of a critical life event means failed coping. What is the difference between people who get sick and those who cope with a comparable event without being sick? It must be up to the people. In the case of infectious diseases, one speaks of diathesis (susceptibility). In the case of mental illnesses, one speaks more of vulnerability (vulnerability; see diathesis stress model ). Without vulnerability, a person would cope with the respective life event without illness. On the other hand, a vulnerable person would not fall ill without a critical life event. - Vulnerability depends, among other things, on the genetic makeup, stressful experiences of the child and personality traits, e.g. B. low self-esteem . If personal protective factors and / or social support are available, even a vulnerable person can cope with life events without becoming ill. The earlier assumption that life events diseases cause , is replaced by the vulnerability-stress-coping model. The "critical life events" largely correspond to the "stress factors" in the vulnerability-stress model.

Critical life events from a development perspective

From a developmental perspective, the effects of critical life events on the entire life cycle are considered. To what extent do they act as incentives for positive development? When does the adage »Damage makes you wise« applies? Normative events ( development tasks , e.g. exams, starting a partnership, starting employment, retirement) require effort and can lead to failure. They influence the course of life and the way of life. In the autobiographical memory, life events serve as marker points in the life course.

Secondary school pupils who were confronted with a divorce of their parents or the death of a parent / sibling at the end of their final school year slackened in their efforts to look for an apprenticeship position (primary control striving). However, this decrease was only slight if they were able to maintain or increase the attractiveness of the apprenticeship target for themselves or to block competing targets (secondary striving for control). - Critical life events are often the reason to change goals in life and / or to modify beliefs about the world ( cognitive schemata ). On the other hand, affected persons try to fall back on tried and tested routines through which the self is to be preserved, defended or secured in its consistency. One year after diagnosis, those people with cancer who have had a largely unchanged life since then and who reported fewer negative and less positive changes from this period show greater emotional well-being.

Critical life events can lead to further negative events and lead to persistent life disadvantages. Widowing leads to a reduction in social exchange and the emptying of everyday life; in the absence of coping, loneliness and premature death can ensue. Job loss can result in massive financial deterioration if unemployment persists. On the other hand, after experiencing trauma, some of those affected report " post-traumatic growth ", with changes in behavior in the sense of improved adaptation as well as changes in attitudes, assessments and objectives.

Critical life events in childhood and adolescence

→ Main article childhood trauma

People who were exposed to critical life events or trauma in childhood exhibit more risk behaviors, which means that more critical events are more likely to occur. In addition, early life events can increase vulnerability and thus the probability of later illnesses. When protective factors are available and childhood burdens are successfully coped with, the life event acts like a kind of vaccination, increasing the person's coping skills and resilience .

Coping with critical life events

" Stress management refers to a person's active and / or cognitive [and emotional] confrontation with stressful features of the environment and with themselves", regardless of their success. The coping activities can be fundamentally differentiated according to whether they begin with the life situation changed by a critical event or with the affected person himself. In "offensive" coping, the person tries "the source of stress, the stress perception, the stress assessment and Actively influencing the various levels of stress responses. " In "defensive" coping, the person "avoids greater exertion and largely foregoes offensive confrontation." According to Lazarus & Folkman (1984) , an affected person first evaluates the stressful situation and their coping skills. In their subsequent activities, a distinction is made between problem-centered and emotion-centered coping and reappraisal. The following strategies for coping with stress are described in detail (Tab. 2).

Coping is sought by influencing the ... Offensive coping Defensive coping
the source of stress 1. Planned action to influence the source of stress 2. Consciously avoiding confrontation with the source of stress
the perception of stress 3. Inform about the source of stress 4. Denying / ignoring or hiding the source of stress
the stress assessment 5. Encourage yourself by reevaluating 6. Acceptance by reevaluating
the physical stress response 7. Active calming and stimulation 8. Passive calming and stimulation
of stress expression 9. Expressing stressful emotions, reacting, communicating 10. Control / suppress stress emotions

Tab. 2 Stress management strategies (Schulz 2005)

Influencing the source of stress (1st and 2nd) and gathering information (3rd) are also referred to as instrumental coping: Anticipatory coping comprises all measures to avoid possible or foreseeable negative events or to mitigate their consequences, e.g. B. Taking out insurance (mainly 1st and 3rd). In all critical life events, both offensive and defensive coping activities are necessary to cope with. In the case of loss events, "defensive" coping is first in the foreground, but then "offensive" coping is also necessary, e.g. B. to develop and achieve new goals. "It is about the coexistence of different modes of coping, their flexible (willful and involuntary) use and their oscillation over time." Acceptance through reevaluating (6.) includes, among other things, processes of finding meaning and comparative processes with which the life event is interpreted and evaluated; z. B. "It hit others much worse" (see also forgiveness (psychology) ). Individual strategies of defensive coping can also be viewed as defense mechanisms , e.g. B. Denial (4th).

Process models describe different phases of coping (e.g. Horowitz 1979):

  • Outcry
  • Denial
  • intrusive thoughts (intrusion)
  • Working through
  • Completion.

Often there is a frequent change from denial or avoidance and intrusive thoughts before problem processing can begin. - Kübler-Ross (1971) formulated five phases in a similar way for "coping with" a disease that leads to death . Here, too, the order, duration and repetitions of the phases vary individually. - Various therapeutic techniques can help in coping with critical life events, e.g. B. relaxation techniques; (See article Stress , Section 6). Various stress management trainings have been developed.

Social support

Coping also includes looking for, mobilizing and receiving social support . This includes: emotional support and care, cognitive or informational support and instrumental support. The latter intervenes in solving the problem by making material contributions and / or taking on individual tasks (temporarily) in a compensatory or substitute manner. Providing social support means supporting the person concerned in coping with the event and its consequences, i.e. helping them to help themselves. After trauma, social support reduces the severity of symptoms of post-traumatic stress disorder; the longer it is granted, the greater the mitigating effect. Above all, emotional support has the effect of reducing symptoms . In a partnership, a critical event usually affects both partners (e.g. serious illness, job loss). The coping of the person directly affected depends largely on the support from the partner (partnership or dyadic coping).

It is not uncommon for people affected by critical life events to experience inappropriate reactions from their wider, but also closer social environment. People around them distance themselves, trivialize the event or behave awkwardly; improperly attributing responsibility or blaming the victim; it can also lead to excessive concern and interference. For a person affected by a life event, it can also be stressful if he or she cannot (later) make amends for assistance received . Having been dependent on help can also affect a person's self-esteem . Supportive behavior leads less to a feeling of inferiority and is more effective if it is done more casually or "invisibly". Helpers can be overwhelmed by serious events / trauma. Overall, however, it is true that social support is extremely important for those affected in order to cope with a critical life event.

Uneven distribution of critical life events

Originally it was assumed that the occurrence of a critical life event was purely random (bad luck) and that the probability of occurrence was the same for all people. In fact, however, the risk of many critical life events varies with personal characteristics (including age and gender) and impersonal characteristics (e.g. place of residence in the event of natural disasters). - Male adolescents are more often confronted with critical events in the performance area (e.g. school failure) and are victims of physical violence and verbal aggression , especially when they are with deviant adolescents ("false friends"). Female adolescents report more often stress in family or friendship relationships (e.g. divorce of parents, quarrel with a friend). Men are more likely to experience, or witness, trauma events where their physical integrity is damaged or threatened. Women are at a significantly higher risk of rape or other sexual assault (especially in young adulthood) or of domestic violence. The risks for individual types of critical life events are therefore gender-dependent. In the total number of critical events in the previous life course, however, the sexes hardly differ.

The risk of divorce is "socially inherited". In relation to first marriages with a marriage duration of 20 years, children whose parents divorced by the age of 15 have about twice as high a risk of divorce in their own marriage (33%) than children who grew up with both parents (15%) ). There is a gender difference: sons of divorced parents have a significantly higher risk of divorce in their own marriage than daughters of divorced parents.

Contrary to the initial hypothesis that critical life events cause illness, illnesses can in turn trigger critical events. z. B. A mentally ill person can lose their job or their spouse due to underperformance. People with depression experience a higher number of stressful events, even when they are in a symptom-free phase.

Critical life events are often the result (often unexpected consequence) of one's own actions or decisions: People choose situations, interaction partners or activities that are associated with increased risks. For example, a person's misconduct may lead their partner to file for divorce. In a sample of the population from an American inner-city catchment area, people with severe substance dependence and / or severe dissocial behavior (see dissocial personality disorder ) were more than five times more likely to be confronted with critical life events than inconspicuous persons. However, if the symptoms of both disorders had not occurred for more than a year ( remission ), the probability of occurrence of critical events fell almost to the level of people without these disorders at all.

If the reactions to a life event trigger further life events, one speaks of a cascade effect in systemic social work .

Protection factors are also unevenly distributed, especially in material terms. Social support not only helps to cope with critical life events, but also often prevents them from occurring in the first place.

Prevention and intervention in critical life events

Primary prevention encompasses all measures that are intended to prevent critical life events from occurring in accordance with the maxim "If you put yourself in danger, you perish in it". These include B. Measures and regulations for accident prevention , industrial safety and fire protection . - In order to avoid negative life events in connection with normative transitions in the life course, there are various institutions and programs: parenting advice , career and study advice , marriage preparation courses , parenting courses to promote parental upbringing skills, measures of the mother's convalescence work , relief and advice for caring relatives , self-defense courses .

When a critical event has occurred, it is about coping with the situation by the person concerned. Individual events, e.g. B. separation, widowhood, are usually mastered alone or with support from the private environment. Self-help groups offer support for (chronically) ill people . - Often professional support services are required ( secondary prevention, early treatment). Physical injuries and illnesses must primarily be treated medically. It is also about securing the material livelihood (housing and income situation). If an acute stress reaction has occurred after a trauma event, short-term intervention may be required to reduce the risk of post-traumatic stress disorder.

If coping efforts remain unsuccessful, the critical life event triggers a personal crisis . Secondary prevention therefore also includes: professional crisis intervention , telephone counseling , women's emergencies , psychosocial emergency care , child protection . A combination of different measures and the mobilization of (private) social support is often required. - If the life event is related to a conflict of norms, criminal or civil proceedings may arise. In civil legal disputes, mediation may be indicated. - Like social support in general, professional crisis intervention aims to make coping strategies (again) available for the person concerned (help for self-help).

If people affected by critical events become physically and / or mentally ill, e.g. If, for example, the consequences of an accident, depression , anxiety disorder or post-traumatic stress disorder, disease-specific treatments are indicated ( tertiary prevention ); furthermore also medical rehabilitation and / or psychotherapy . Wisdom therapy was developed to treat the bitterness disorder . For people with an adjustment disorder, a (therapeutically guided) life review of the challenges they have mastered so far can help to activate resources. It is often only through treatment or psychotherapy that a person is enabled to deal with and cope with the critical event and its consequences.

See also

literature

  • SH Filipp, P. Aymanns: Critical life events and life crises. Dealing with the dark side of life. Kohlhammer, Stuttgart 2010.
  • T. Klauer, W. Greve: Critical life events and health. In: R. Schwarzer (Ed.): Health Psychology . (= Encyclopedia of Psychology. Series X, Volume 1). Hogrefe, Göttingen 2005, pp. 237-259.

Individual evidence

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  49. ↑ J. Bengel, K. Becker-Nehring: Psychological early interventions. In: A. Maercker (Ed.): Post-traumatic stress disorders. 4th edition. Springer, Berlin 2013, pp. 175–204.
  50. ↑ S. Forstmeier: Life review with adjustment problems and life crises. In: A Maercker , S. Forstmeier (Hrsg.): The review of life in therapy and counseling. Springer, Berlin 2013, pp. 85-105.