The relationship of family factors and psychiatric symptoms in patients with bipolar disorder

Expressed Emotion (EE), Affective Style (AS), and Coping Style (CS) as measures of the intrafamilial environment have been shown to be predictive of outcome in a variety of psychiatric and physical disorders, as well as across several different cultures. In addition, strong interrelationships have been found between all of these variables, most particularly with schizophrenic patients and their biological relatives. The present investigation sought to examine the interrelationships between EE, AS, and CS in a sample of 38 bipolar patients and their spouses. In addition, the relationships between these three variables and marital distress in each of the pair, Axis I illness in the spouse, and Axis II pathology in each member of the couple was assessed. A significant relationship was found between EE and AS, indicating that critical attitudes held by the spouse were reflected in interactional exchanges with their patient partner. Patient and spouse marital distress was found to be correlated with both EE and AS. This indicates that marital distress in each of the pair is related to the critical attitudes which the spouse holds with respect to the patient, and how critical or disparaging the patient is in direct interaction with their mate. None of the other analyses produced significant results. There are several factors which may inhibit the interpretation and the generalizability of the results. First, as the analyses used were correlational in nature, causality cannot be inferred. Second, this group of patients was considerably older, with a longer duration of illness than other research samples. Third, the sample size was somewhat small. Future research should focus an determining more precisely the actual correlates of EE, AS, and CS. In addition, sequential analyses of the interactional exchanges between family members would help to clarify what actually occurs during these critical interchanges. Finally, as the relationship between EE, AS, and CS and marital distress is a relatively unique finding, it would be interesting for future studies to try to explore this relationship more thoroughly