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Expressed Emotion Attitudes and Individual Psychopathology Among the Relatives of Bipolar Patients
Abstract
This study investigated the relationships between expressed emotion (EE) and individual psychopathology among 82 biological and non-biological relatives of 66 patients with bipolar I disorder. Relatives' psychopathology was assessed via the Structured Clinical Interview for DSM-III-R, Patient Version (SCID-P) and the General Behavior Inventory (GBI), a self-report measure of lifetime subsyndromal mood disturbances. We hypothesized that relatives who held high-EE critical, hostile, and/or overinvolved attitudes toward their bipolar family member, as measured via the Camberwell Family Interview, would be more likely to have DSM-III-R Axis I diagnoses on the SCID, as well as more mood and temperamental disturbances on the GBI, than those who held low-EE attitudes. The findings did not support a significant relationship between overall EE status and psychopathology in family members. However, relatives without significant Axis I pathology scored significantly higher than those with Axis I pathology on one measure of EE, emotional overinvolvement. The findings are discussed with reference to explanations for the genesis of high-EE attitudes.
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Relatives who live with patients with severe mental disorders present mood disorders, mostly depressive.
“trastornos del estado de ánimo (mayoritariamente depresivos)”
From Intervención psicológica grupal, basada en la aceptación y el entrenamiento en comunicación, con familiares de personas con trastorno mental grave (2015) · cites this paper as Goldstein, Miklowitz y Richards, 2002
Relatives who live with patients with severe mental disorders present anxiety disorders.
“y de ansiedad”
From Intervención psicológica grupal, basada en la aceptación y el entrenamiento en comunicación, con familiares de personas con trastorno mental grave (2015) · cites this paper as Goldstein, Miklowitz y Richards, 2002
These positions have left aside attention to other psychological issues of relatives of patients with severe mental disorders, such as depressive and anxious symptomatology.
“estas posiciones han dejado un poco al margen la atención de otras cuestiones psicológicas de los familiares de los pacientes con TMG, como la presencia de sintomatología depresiva y ansiosa”
From Intervención psicológica grupal, basada en la aceptación y el entrenamiento en comunicación, con familiares de personas con trastorno mental grave (2015) · cites this paper as Goldstein et al., 2002
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Cited by
Sorted by citations
Expressed Emotion and Relapse of Psychopathology
Hooley, J. M. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.2.022305.095236 · Cited by 499
Psychiatric symptoms in caregivers of patients with bipolar disorder: A review
Steele, A., Maruyama, N., & Galynker, I. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.04.020 · Cited by 160
“Goldstein et al. (2002) found that non-biological caregivers (e.g. partners or spouses) had more Axis I and anxiety diagnoses than biological caregivers.”
BackgroundMethodResultInfluentialFamily‐focused treatment for caregivers of patients with bipolar disorder
PERLICK, D. A., Miklowitz, D. J., López, N., Chou, J., Kalvin, C. B., Adzhiashvili, V., & Aronson, A. C. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00852.x · Cited by 154
“The interaction of treatment group with change in caregiver depression score (QIDS) from pre- to post-treatment was a significant predictor of patient HAM-D post-treatment [F(1,37) = 4.”
Self-citationMiklowitz, D. J. (2004) · Development and Psychopathology · doi:10.1017/s0954579404004729 · Cited by 138
Self-citationFamily-focused treatment for adolescents with bipolar disorder
Miklowitz, D. J., George, E. L., Axelson, D., Kim, E. Y., Birmaher, B. B., Schneck, C. D., Beresford, C. A., Craighead, W. E., & Brent, D. A. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.05.020 · Cited by 195
Self-citationThe role of family interventions in bipolar disorder: A systematic review
Reinares, M., Bonnín, C. D. M., Hidalgo‐Mazzei, D., Sánchez‐Moreno, J., Colom, F., & Vieta, E. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.11.010 · Cited by 115
Early-onset bipolar disorder: A family treatment perspective
Miklowitz, D. J., Biuckians, A., & Richards, J. A. (2006) · Development and Psychopathology · doi:10.1017/s0954579406060603 · Cited by 107
Self-citationImpact of living with bipolar patients: Making sense of caregivers’ burden
Pompili, M. (2014) · World Journal of Psychiatry · doi:10.5498/wjp.v4.i1.1 · Cited by 89
Family interventions for bipolar disorder.
Justo, L. P., Soares, B. G. D. O., & Calil, H. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005167.pub2 · Cited by 70
Caregiver burden in bipolar hypomania and mania: a systematic review.
Beentjes, T., Goossens, P., & Poslawsky, I. (2012) · Perspectives in psychiatric care · doi:10.1111/j.1744-6163.2012.00328.x · Cited by 69
Perlick, D., Berk, L., Kaczynski, R., Gonzalez, J. M., Link, B. G., Dixon, L., Grier, S., & Miklowitz, D. (2016) · Bipolar Disorders · doi:10.1111/bdi.12379 · Cited by 57
“Studies of non-biologically related as well as biologically related caregivers of people with bipolar disorder have found that 43% meet SCID-P criteria for a mood disorder (9), and between 33% and 46% meet criteria for major depression (6).”
BackgroundSelf-citationPerlick, D., Jackson, C., Grier, S., Huntington, B., Aronson, A., Luo, X.-D., & Miklowitz, D. (2018) · Bipolar Disorders · doi:10.1111/bdi.12621 · Cited by 42
Self-citationPediatric obsessive compulsive disorder: Family climate as a predictor of treatment outcome
Peris, T. S., Yadegar, M., Asarnow, J. R., & Piacentini, J. C. (2012) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2012.07.003 · Cited by 40
McMurrich, S. L., & Johnson, S. L. (2008) · Behavior Therapy · doi:10.1016/j.beth.2008.09.003 · Cited by 25
“Previous studies found that EE was unrelated to major depressive disorder (Goldstein et al., 2002).”
BackgroundResultBipolar Disorder in Young People
Macneil, C. A., Hasty, M. K., Conus, P., Berk, M., & Scott, J. L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511757389 · Cited by 29
The impact of significant other expressed emotion on patient outcomes in chronic fatigue syndrome.
Band, R. J., Barrowclough, C., & Wearden, A. J. (2014) · Health Psychology · doi:10.1037/hea0000086 · Cited by 23
Staff working with people who have intellectual disabilities within secure hospitals
Langdon, P., Yágüez, L., & Kuipers, E. (2007) · Journal of Intellectual Disabilities · doi:10.1177/1744629507083584 · Cited by 22
“…relationships play an important role in continued recovery from psychiatric disorder (Bebbington and Kuipers, 1994; Butzlaff and Hooley, 1998; Goldstein et al., 2002; Hooley et al., 1986; Kavanagh, 1992; Miklowitz et al., 1988; Priebe et al., 1989; Szmukler et al., 1985; Vaughn and Leff,…”
BackgroundRienecke, R. D., & Richmond, R. L. (2017) · Eating Disorders · doi:10.1080/10640266.2017.1289795 · Cited by 19
Millman, Z. B., Weintraub, M. J., & Miklowitz, D. J. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.10.054 · Cited by 17
“with BD found no relation, although approximately half of the participating relatives in this study were spouses with no genetic relation to the patient (Goldstein et al., 2002).”
ResultSelf-citationParenting adult children – invisible ties that bind?
Gower, M., & Dowling, E. (2008) · Journal of Family Therapy · doi:10.1111/j.1467-6427.2008.00438.x · Cited by 13
Chen, P., Zhao, Y., An, F., Li, X.-H., Lam, M. I., Lok, K.-I., Wang, Y., Li, J.-X., Su, Z., Cheung, T. C. C., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05194-w · Cited by 13
La sobrecarga del cuidador en el trastorno bipolar
Gutiérrez-Rojas, L., Martínez-Ortega, J. M., & Rodríguez, F. D. (2013) · Anales de Psicología · doi:10.6018/analesps.29.2.124061 · Cited by 11
“…de cuidados van a depender también del modo de ser del cuidador, de sus experiencias, del contexto en el que se encuentre, etc. Algunos trabajos han encontrado que los cuidadores no biológicos cumplen criterios de trastornos afectivos con más frecuencia que los biológicos (Goldstein et al., 2002).”
BackgroundJonn-Seed, M. S., & Weiss, S. (2005) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390305279025 · Cited by 10
Roldán, G. M., Salazar, I. C., Garrido, L., & Cuevas, A. M. (2015) · Anales de Psicologia · doi:10.6018/analesps.31.3.154071 · Cited by 9
“…significativo en el campo, no obstante, estas posiciones han dejado un poco al margen la atención de otras cuestiones psicológicas de los familiares de los pacientes con TMG, como la presencia de sintomatología depresiva y ansiosa (Goldstein et al., 2002; Rascón et al., 2010; Steele et al., 2010).”
BackgroundExpressed emotion measure adaptation into a foreign language.
Rein, Z., Duclos, J., Perdereau, F., Curt, F., Apfel, A., Wallier, J., Verdier, A., Fermanian, J., Falissard, B., Zaden, S., et al. (2011) · European eating disorders review · doi:10.1002/erv.1008 · Cited by 8
Behavior Therapy and Cognitive‐Behavioral Therapy
Craighead, W. E., Craighead, L. W., Ritschel, L. A., & Zagoloff, A. D. (2012) · Wiley eBooks · doi:10.1002/9781118133880.hop208012 · Cited by 5
Disability and Overall Burden Related with Bipolar Disorder
Fountoulakis, K. N. (2014) · Springer eBooks · doi:10.1007/978-3-642-37216-2_12 · Cited by 4
Les hypothses tiopathogniques des troubles bipolaires
Hamdani, N., & Gorwood, P. (2006) · L Encéphale · doi:10.1016/s0013-7006(06)76197-8 · Cited by 4
“De même, l’intensité des émotions exprimées par l’entourage semble corrélée à l’intensité des symptômes maniaques et à une moins bonne évolution (22).”
Zanjani, Z., Hadavand, M., Omidi, A., Atoof, F., & Fakharian, E. (2022) · Archives of Trauma Research · doi:10.4103/atr.atr_4_22 · Cited by 3
Lin, C.-C., Lee, Y., Chiu, N., Lin, P., Huang, Y., Hung, C., & Wang, L. (2025) · International Journal of Bipolar Disorders · doi:10.1186/s40345-025-00383-w · Cited by 2
“Goldstein et al. (2002) found that 43% of relatives of acute bipolar patients met the criteria for a mood disorder diagnosis, with 30% fulfilling the diagnoses of major depressive disorder.”
Anxiety, Depression and Coping Mechanisms in Caregivers of Psychiatric Patients
Fatima, S., Bashir, N., Ain, Q., Assad, F., Naheed, A., Siddiqa, S., & Babar, B. (2025) · Foundation University Journal of Psychology · doi:10.33897/fujp.v9i1.773
“Goldstein et al. (2002) suggest depression and anxiety in caregivers in not only because they render services, but other factors also play significant role, like caregivers experience social isolation, economic difficulties, and stigmatization.”
Ogawa, H., Shiraishi, N., Yatsu, H., & Akechi, T. (2024) · Psychiatry and Clinical Neurosciences · doi:10.1002/pcn5.70029
De rol van gezinsinterventies bij bipolaire stoornis: een systematische review
Reinares, M., Bonnín, C. D. M., Hidalgo‐Mazzei, D., Sánchez‐Moreno, J., Colom, F., & Vieta, E. (2016) · Gezinstherapie Wereldwijd · doi:10.1007/s12440-016-0027-z
Metadata
- Authors
- Goldstein, T. R., Miklowitz, D. J., & Richards, J. A.
- Affiliations
- University of Colorado Boulder (US)
- Corresponding author
- Goldstein, Tina R.
- Venue
- Family Process
- Publisher
- Wiley
- Published
- 2002-12
- Volume
- 41
- Issue
- 4
- Pages
- 645-657
- ISSN
- 0014-7370 (ISSN-L)
- 1545-5300
- OpenAlex
- W2128346441
- Cited by
- 40
- References
- 0
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 1 · 2012: 4
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Process (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r21mh055101-01, 5r29mh043931-05)
- National Institute of Mental Health (MH-62555, MH43931, MH-55101, R21MH062555)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- expressed emotion, bipolar I disorder, family psychopathology, emotional overinvolvement, critical attitude, Camberwell Family Interview, Axis I diagnoses
- MeSH terms
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Mental Disorders, Bipolar Disorder, Colorado, Family, Female, Humans, Male, Middle Aged, Regression Analysis, Expressed Emotion
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