Socializacion

Journal of Family Psychology 2010, Vol. 24, No. 4, 371–379

© 2010 American Psychological Association 0893-3200/10/$12.00 DOI: 10.1037/a0020352

Predictors of Relationship Functioning for Patients With Bipolar Disorder and Their Partners
Erin S. Sheets and Ivan W. Miller
Brown University Medical School and Butler Hospital, Providence, RI
Previous investigations have examined familyfunctioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patientmood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients’ depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients’ manic symptomswere associated with partners’ ratings of the romantic relationship. Partners’ total Axis II pathology, but not patients’ Axis II pathology, was associated with patient and partner perception of the couple’s relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact ofpersonality pathology on patients’ and partners’ perceptions of relationship functioning. Keywords: bipolar disorder, family functioning, marital distress, personality disorder

Bipolar disorder is a serious mental health problem that occurs in approximately 2% to 4% of the U.S. population (Kessler et al., 1994; Kessler et al., 2005). The typical course of bipolar I disorder involves multiplerecurrences of mood episodes, leading to significant impairment in psychosocial functioning (Gitlin, Swendsen, Heller, & Hammen, 1995; Goldberg, Harrow, & Grossman, 1995). Bipolar disorder also presents a significant risk of fatality with approximately 10% to 15% of patients dying by suicide (Goodwin & Jamison, 1990). Given the substantial costs of bipolar disorder to patients and their families, it isimperative to identify risk factors for the relapse and recurrence of bipolar mood episodes. A notable body of research has established the marked impact of impairment in family relationships on the course of bipolar disorder and treatment outcome. Within families of patients with bipolar disorder, impairment in family relationships has been associated with in-

Erin S. Sheets and Ivan W. Miller,Department of Psychiatry and Human Behavior, Brown University, and Psychosocial Research Program, Butler Hospital, Providence, RI. Erin S. Sheets is now at the Department of Psychology, Colby College. This research was supported in part by National Institute of Mental Health Grant R01MH 48171. Correspondence concerning this article should be addressed to Erin S. Sheets, Department of Psychology,Colby College, 5550 Mayflower Hill, Waterville, ME 04901. E-mail: Erin.Sheets@brown .edu

creased risk for relapse of mood episodes and poorer treatment outcome (Kim & Miklowitz, 2004; Kleindienst, Engel, & Greil, 2005; Miklowitz, Goldstein, Nuechterlein, Snyder, & Mintz, 1988). Furthermore, investigations have identified family relationship impairment as a predictor of polarity-specific recurrence inbipolar disorder, finding that high levels of expressed emotion (criticism or emotional over-involvement by family members or close collaterals) predict depressive, but not manic, recurrence (Yan, Hammen, Cohen, Daley & Henry, 2004). Similarly, poor social support is associated with depressive, but not manic, recurrence (Cohen, Hammen, Henry, & Daley, 2004; Gitlin et al., 1995; Johnson, Meyer,...