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September 20, 2005

Relatives' Criticism Increases Bipolar Severity

Getting upset due to the criticism of relatives and close friends apparently increases the severity of the symptoms of bipolar disorder. High levels of expressed emotion from those close to the person with bipolar disorder can have adverse effects on their course of illness. Researchers used expressed emotion (EE) levels to predict the course of illness over 1 year.

360 individuals with bipolar disorder took a four-item Perceived Criticism Scale (PCS) for 1 or more of their close relatives or friends. They were then monitored over 1 year for symptoms of mania and depression, as well as the amount of time spent recovering. "Contrary to their expectations, the researchers found that the severity of perceived criticism was not associated with patients' scores on the Montgomery Åsberg Depression Rating Scale (MADRS) or the Beck Depression Inventory (BDI)-II over the study year.

However, the results did show that the degree to which patients reported feeling upset by criticisms from relatives strongly predicted their MADRS scores, even after including all covariates" (

Every 1 point of increase in their distress to criticism on the PCS, led to a 0.33 point increase on the Montgomery Åsberg Depression Rating Scale (MADRS), upon follow up. Those with higher PCS scores (distress from criticism) tended to have higher BDI-II scores on follow up. Researchers noted that those most greatly affected may be "stress sensitive" to their environment. They believe that it may be beneficial for clinicians treating bipolar disorder to include a measure of their perception of their family relationships.

SOURCE: Getting upset by relatives' criticism increases bipolar disorder severity. September 20, 2005.

This research article was published in Psych Res 2005; 136: 101–111.

Here is another study on the effects of expressed emotion in bipolar disorder.

Here is an article on the effects of sociocultural factors on bipolar disorder.

Check out this research article on Family Transactions and Relapse in Bipolar Disorder.

Our site has a coping area for friends and family of someone with bipolar disorder. It gives information on how to deal with your feelings and how to best react to the person with bipolar disorder. Click here to read.


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