Family functioning and mental illness: a comparison of psychiatric and nonclinical families.

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61), bipolar disorder (n = 60), major depression (n = 111), anxiety disorder (n = 15), eating disorder (n = 26), substance abuse disorder (n = 48), and adjustment disorder (n = 46). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.

Relatives' perceptions of their interactional behavior with a schizophrenic family member.

Relatives' (N = 77) perceptions of their recent interactional behavior with a schizophrenic family member (N = 51), as measured by an adjective checklist, were compared with outside observer ratings of the relatives' Affective Style (AS) and the patients' Coping Style (CS) during a family interaction task. Results indicated that, overall, the relatives in the present sample perceived their own interactional behavior toward the patient, as well as the patients' behavior toward them, in a way that paralleled their affective behavior as assessed by outside raters. Moreover, the relatives' rated their relationship with the patient in a fashion that was more predictive of the observed interactional behavior of both the relatives and the patients than were the outside observers' ratings of the relatives' Expressed Emotion (EE) measured either at the patients' index hospitalization (using the Camberwell Family Interview, CFI-EE) or during the post-discharge period (assessed with a brief Five-Minute Speech Sample method, FMSS-EE).

Relatives' awareness of their own expressed emotion as measured by a self-report adjective checklist.

Relatives' ratings of their affective attitudes toward a schizophrenic family member (N = 54) on a self-report adjective checklist were compared with two methods for rating expressed emotion (EE)--the original Camberwell Family Interview (CFI-EE) and a Five-Minute Speech Sample method (FMSS-EE). Eighty-four relatives were included in the sample. Results indicate that, in general, the relatives in the present sample perceive in themselves attitudes toward the patient that parallel those assessed by outside raters. A higher rate of correspondence was found between adjective ratings and concurrent FMSS-EE status than with prior CFI-EE status. Relatives classified as high-EE, critical by either method, were more readily discriminable in their adjective ratings from those rated low-EE than were relatives rated high-EE on the basis of emotional overinvolvement.