Bipolar Disorder Clinical Syndrome

Bipolar Disorder Clinical Syndrome

Bipolar Disorder (BD) 

Patients with bipolar disorder (BD) experience two main syndromes, mania and depression, and they are at high risk of suicide attempts. Moreover, people with BD may be stigmatized by society, which they may 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 personal and social domains, which causes a large burden on society.

To tackle syndromes and other health outcomes in people with BD, studies have focused on different therapies, including psychoeducation, medication, occupational therapy, psychotherapy, and family therapy. An important issue in treating people with BD is their family system, as family members are usually frontline or primary caregivers, providing direct assistance to the patient. However, family members of people with BD may also be stigmatized.

Because social pressures may incur societal stigma for the family, people with BD may live within an impaired family system with lower functioning. Impairment of the family system or family functioning may worsen BD syndromes.

Family coherence, family adaptability, and family type 

Olson and colleagues delineated two aspects of family behaviors: cohesion and adaptability. Those authors organized these two aspects into a circumplex model to illustrate different types of families. Cohesion indicates the extent to which the family members are emotionally bonded; adaptability refers to the ability of the family system to adjust to situational and developmental stressors. 

A circumplex model can be plotted with one aspect on the x-axis and another aspect on the y-axis. In the circumplex model, four levels of cohesion (from low to high: disengaged, separated, connected, and enmeshed) and four levels of adaptability (from low to high: rigid, structured, flexible, and chaotic) are defined, and 16 types of family are further classified.

Among the 16 types of family, several family types are clustered, finally resulting in three major types of family: 

  • The balanced type of family includes flexible separateness, flexible connectedness, structured connectedness, and structured separateness, which are at the center of the circumplex model; 
  • The extreme type of family includes chaotically disengaged, chaotically enmeshed, rigidly enmeshed, and rigidly disengaged, which are at the margins of the circumplex model; and 
  • The mid-range type of family includes family types other than balanced and extreme types.

McMaster Model of Family Functioning (MMFF) 

In addition to the family types described in the circumplex model,7–9 Epstein, Bishop, and Levin1 0 considered the family complex and proposed the McMaster Model of Family Functioning (MMFF) in family studies.

Family of people with BD 

Among different factors in treating people with BD, family issues may have the potential for investigation by health care providers. Studies have shown that the family is one of the most important factors related to syndromes in people with BD.

Literature gap, study objectives, and hypotheses 

Substantial evidence indicates that different types of families and family functioning are highly associated with the emotions of an individual living in that family.14,18,19 Specifically, extreme-type families and those with poor family functioning contribute to emotional problems in family members.


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