Undergraduate Honors Theses

Thesis Defended

Spring 2011

Document Type



Psychology & Neuroscience

First Advisor

David J. Miklowitz


Objective. The objective for this study is to better understand the etiology of expressed emotion (EE) attitudes in parents by evaluating differences in psychopathology and family history among high- and low-EE parents of youth with bipolar disorder (BD). The primary hypotheses were: (1) high-EE parents are more likely than low-EE parents to have a personal history of psychiatric disorders, and (2) high-EE parents are more likely than low-EE parents to have a family history of major affective disorders. Method. Levels of family psychopathology were assessed based on semi-structured interviews using the Family History Sheet to evaluate personal and familial psychiatric history. Included was a total of 63 parents of 56 bipolar adolescents who reported an acute mood episode within the past 3 months and were enrolled in family therapy. Parents were presented with a series of cards listing symptoms associated with various psychiatric conditions and were asked to indicate how many of the symptoms described themselves or first-degree relatives at any point in life. Parental EE attitudes were assessed using the Five Minute Speech Sample. Offspring of high- and low-EE parents were compared on scores obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia, Mania and Depression Rating Scales. Results. There were no differences among highand low-EE parents in their personal history of psychopathology, nor were there differences in levels of family loading of affective disorders. Secondary analyses revealed that high-EE/critical and critical/emotionally overinvolved (EOI) parents had a significantly greater personal history of anxiety than low-EE parents and parents who were EOI only. There were no differences between bipolar patients in high-EE and low-EE families in symptom severity. Discussion. Sensitivity and specificity of the family history interview may be compromised due to the difficulty of assessing the psychiatric histories of multiple subjects based on second-hand accounts. The findings should thus be viewed with caution. However, EE attitudes do not appear to be related to parental psychopathology or family history of affective disorders. However, anxiety may make parents particularly vulnerable to expressions of criticism during the open-ended FMSS. The EE/psychopathology relationship should be studied longitudinally using the FMSS and more rigorous genetic measures than those employed in the present study.