Patients With Bipolar Disorder in The Family

Bipolar Disorder (BD)

Patients with bipolar disorder (BD) have two main syndromes, mania, and depression, and they are at high risk of suicide attempts. In addition, people with BD can be stigmatized by society, which they can internalize. As a result, people with BD may have low motivation to treat their condition with formal treatment, including medication, because they believe they do not deserve a happy life.

In other words, people with BD have a high degree of disability with respect to the personal and social domain, which causes a great burden on society.

To address the syndrome and other health outcomes in people with BD, there needs to be research focusing on different therapies, including psychoeducation, medication, occupational therapy, psychotherapy, and family therapy.

An important issue in caring for people with BD is their family system, as family members are usually front-line or primary caregivers, providing immediate assistance to the patient.

However, family members of people with BD can also be stigmatized, because social pressure can create social stigma for families, people with BD can live in a disturbed family system with lower family functions. Disorders of the family system or family functioning can worsen BD syndrome.

Family coherence, family adaptability, and family types

The results of the study conducted by Olson and colleagues describe two aspects of family behavior, namely cohesion and adaptability. they organized these two aspects into a circumplex model to describe different types of families.

Cohesion indicates the degree to which family members are emotionally attached; adaptability refers to the ability of the family system to adjust to situational and developmental stressors.

In the circumplex model, there are four levels of cohesion (from low to high: detached, separated, connected, and entangled) and four levels of adaptability (from low to high: rigid, structured, flexible, and chaotic). The several family types are then classified into three main family types: 

  1. Balanced family types include flexible separateness, flexible connectedness, structured connectedness, and structured separateness, which are at the center of the circumplex model; 
  2. Extreme family types include chaotically Unbound, chaotically bound, rigidly bound, and rigidly Unbound, which are on the periphery of the circumplex model; and 
  3. Intermediate family types include family types other than the balanced and extreme types

Family Function Model

In addition to the family types described in the circumplex model, Epstein, Bishop, and Levin consider the family complex and propose the primary function of the family is a laboratory for the Social, Psychological, and biological development and maintenance of family members.

Families of people with BD

Among the various factors in caring for people with BD, family problems may have the potential to be investigated by health care providers. Studies have shown that family is one of the most important factors associated with the syndrome in people with BD. Sullivan and Miklowitz found that adolescents with BD tend to live in families with worse coherence and adaptability than the families of their peers.

Substantial evidence shows that the different types of families and the functioning of the family are strongly linked to the emotions of the individuals who live in that family. in particular, extreme-type families and those with poor family functioning contribute to emotional problems in family members. in addition, to the relationship between family coherence, adaptability, and family functioning.

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Zhang, X., Zhao, M., Li, J., Shi, L., Xu, X., Dai, Q., ... & Lin, C. Y. (2019). Associations between family cohesion, adaptability, and functioning of patients with bipolar disorder with clinical syndromes in Hebei, China. Journal of International Medical Research, 47(12), 6004-6015.

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