Family Environment and Emotion Regulation in Bipolar Disorder Open Access

Muralidharan, Anjana (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/d504rk912?locale=en
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Abstract

Expressed emotion (EE), or the presence of criticism, hostility, or emotional overinvolvement on the part of a caregiver, is a predictor of poorer clinical outcomes in bipolar disorder. The mechanism of this association is unclear. The present study examined two potential correlates of parental criticism in young adults with bipolar disorder: emotional reactivity to negative feedback, and cognitive schemas of self-criticism and perfectionism. Twenty young adults with bipolar disorder and 20 matched control subjects completed an interview, questionnaires, and a computer-based task with false negative feedback; mood reactivity to this feedback was assessed. For each clinical subject, at least one parental caregiver was interviewed regarding the caregiver-subject relationship. Clinical subjects exhibited a greater increase in negative affect in response to negative feedback than control subjects. Clinical subjects also exhibited higher levels of self-criticism following negative feedback than control subjects, even when controlling for mood symptoms. These findings support the Behavioral Activation System (BAS) dysregulation model of bipolar disorder. Additionally, in clinical subjects, two aspects of caregiver-subject relationships were associated with an increase in negative affect in response to negative feedback: low perceived paternal care and the presence of caregiver emotional overinvolvement. These findings support the hypothesis that disturbances in caregiver-subject relationships may be associated with later emotion dysregulation, or more specifically, a particular sensitivity to negative feedback, in bipolar patients. One important focus of family-based intervention for bipolar disorder may be building attachment, warmth, and positive communication in caregiver-patient relationships.

Table of Contents

Table of Contents

Introduction............................................. 1

Method.................................................... 6

Results.................................................... 14

Discussion................................................ 21

References............................................... 33

Table 1.................................................... 40

Table 2.................................................... 41

Table 3.................................................... 42

Table 4.................................................... 43

Table 5.................................................... 44

Table 6.................................................... 45

Figure 1................................................... 46

Appendix A............................................... 47

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