Genetic susceptibility and family dysfunction in bipolar disorder

¶ … bipolar condition, serious as it can be in disrupting a person's normal living patterns, and the patterns of those living with the person with a bipolar condition, is seen in only about one percent of the U.S. population (Zai, et al., 2012). As to whether there is linkage to family genetics -- that indicate the possibility or probability that a family member is a candidate for a bipolar condition -- studies have "…not provided consistent findings of susceptibility regions" (Zai, 1). That said, a combined analysis of "original data from 11 previous linkage studies," using 1,067 families with bipolar disorder revealed "…significant findings in chromosomal regions 6q for bipolar 1…" (Zai, 1). Also, in the research of those 1,067 bipolar families, it was learned that there were "suggested findings at chromosomal regions 9p and 20p for bipolar 1" (Zai, 1).

Moreover, some studies which will be included in this paper do show that in certain environments individuals identified as bipolar can negatively affect those family members living with them. This paper reviews patterns that can be identified in the literature relating to individuals living with bipolar sufferers and the resulting circumstances.

Children of Bipolar Parents

In a brief article published in the peer-reviewed Brown University Child and Adolescent Behavior Letter, the authors report on a pilot study that delved into the "initial course of psychiatric illness" in the adolescent offspring of parents who have the bipolar disorder (Duffy, et al., 1998). The findings in this research: the children of bipolar parents that were "lithium-responsive" -- children that were experiencing psychiatric illness themselves -- tended to have "affective disorders that remitted and followed a recurrent course" (Duffy, p. 4). But psychiatrically ill children whose bipolar parents were "nonresponsive" to lithium showed a "broad range of psychopathology" and had elevated rates of "comorbid illnesses" (Duffy, p. 4).

The conclusion that the authors reached from this research -- after interviewing the children of bipolar parents that met "Research Diagnostic Criteria" for bipolar -- was that family history and the "course of illness" are pivotal factors in the process of diagnosing and treating affective disorders (Duffy, p. 4).

Another Study -- Families With vs. Without Bipolar Disorder

In the peer-reviewed journal Bipolar Disorders the authors basically investigated the same issue as the authors in the previous section of this paper -- only in this research article the subject was parents with bipolar disorder vs. parents without bipolar disorder. Using the Family Environment Scale again (FES), the authors involved 24 families with at least one parent with bipolar disorder and 27 families with both parents reported to be healthy. Following their investigations, the authors found that "…Seventeen (71%) of the 24 bipolar families had at least one child with a mood disorder," but only one child among the 27 healthy families was reported to have a mood disorder (DelBello, et al., 2005, 617).

The findings reflect that there could be trouble with communication between parents and children in the bipolar parent family; hence, the authors propose that "…interventions aimed at improving" communication between family members in these instances may well benefit to the patients and the children as well (DelBello, 617).

The authors also point out that children whose parents have bipolar disorder "…are at a higher risk of developing bipolar disorder (BPD) and other mood disorders than the general population" (DelBello, 617). Reporting on a recent meta-analysis conducted -- that zeroed in on the offspring of parents with BPD -- the authors explain that 52% of those children "…had a psychiatric disorder compared with 29% of offspring of parents without any psychiatric disorder" (DelBello, 617). What this data suggests is that there is nearly a "two-fold increase" in risk for the children of BPD parents to develop some form of mental illness, DelBello continues on page 617.

Moreover, the children whose parents are bipolar have a "higher risk of developing psychopathology" above and beyond mood disorders (DelBello, 617). This article points out that while there may be a parent-to-child genetic link (which is viewed as uncertain and not wholly proven in earlier references in this paper), it is clear from the empirical research presented throughout this paper that "…environmental factors also play a role in the development of psychopathology in patients with familiar risk of BPD"(DelBello, 618).

In the same context as the previous research article -- by Belardinelli, et al. -- the authors in this piece assert that children "…exposed to low maternal warmth were four times more likely to relapse after recovery," when contrasted with children that received a substantial amount of maternal warmth. In a way this piece mirrors the previous piece, but DelBello goes a bit deeper into the kind of situation where lower cohesion results due to the fact that one parent is bipolar. Cohesion reflects "…the degree of commitment, help, and support family members provide for one another," and as reported, when a parent is bipolar the result is a lower level of cohesion for the family (DelBello, 620).

DelBello discusses "expressiveness" in the sense that healthy families have the ability to express their feelings, which creates a positive environment; and so a cohesive family can help to promote "cognitive and emotional development," and knowing this, those with the skill and knowledge to intervene should pay heed to these environmental factors within families (620).

Survey of Parents with Bipolar Disorder

A survey of 266 parents with bipolar disorder -- who have at least one child (30 years of age or younger) -- was published in the peer-reviewed journal BMC Psychiatry (Peay, et al., 2013). This was a web-based survey asking the 266 parents about the "perceived risk," the "perceived etiology of BPD," the perceived "illness severity," and the ability of their children to cope, to express optimism, and to adapt to their bipolar parents. The results show that 87% of the 266 bipolar parents were willing to say there was either a "somewhat greater" or a "much greater" risk for mood disorders among their children than among children without a family history of BPD (Peay, 2).

Moreover, there are important implications for interventions and "holistic treatment approach" in the findings from these 266 bipolar parents, Peay explains (11). It is clear from the research that "regardless of the state of management of their own BPD," these parents are "aware of the risk to their children." Moreover the researchers noticed very little evidence that any of the parents tried to be in denial -- nor did they minimize -- their bipolar problems (Peay, 11).