Expressed emotion, emotional distress, and individual and familial history of affective disorder among parents of adolescents with bipolar disorder

Psychiatry Res. 2018 Dec:270:656-660. doi: 10.1016/j.psychres.2018.10.054. Epub 2018 Oct 24.


Parental expressed emotion (EE) attitudes are important prognostic indicators in the course of bipolar disorder (BD) in adolescents and adults. This study examined the hypothesis that parents' own susceptibility to affective disturbances contributes to their likelihood of high-EE attitudes. We examined past-week levels of emotional distress, lifetime affective diagnoses, and family histories of affective disorder among high- and low-EE parents of 86 adolescents with bipolar I or II disorder who were recovering from an episode of depression or (hypo) mania. High EE parents endorsed higher concurrent levels of depression, anxiety, and anger/hostility than low EE parents, and reported a greater familial history of depression and BD. No differences between high and low EE parents were found in concurrent levels of interpersonal sensitivity, lifetime rates of affective disorders, or familial loading of anxiety disorder. Parents' distress at the time of the EE assessment was the strongest correlate of EE. The results suggest that susceptibility to affective psychopathology may be an important contributor to the development of EE attitudes among parents of adolescents with BD.

Keywords: Expressed emotion; Family history; Pediatric bipolar disorder.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Bipolar Disorder / complications
  • Bipolar Disorder / psychology*
  • Child
  • Expressed Emotion*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mood Disorders / complications
  • Mood Disorders / psychology*
  • Parents / psychology*
  • Stress, Psychological / complications
  • Stress, Psychological / psychology*