The relationship of attributions and expressed emotion to outcome and marital satisfaction in patients with bipolar disorder

Lori Isman Greene, Fordham University


Bipolar disorder is a mental illness marked by episodes of mania or hypomania and episodes of depression. Its cyclical patterns make it likely to impact and be impacted by marital relationships. The course of this illness may be affected by cognitive factors (i.e., the causal attributions made by patients and their spouses to explain events) and family factors (i.e., spouse expressed emotion/criticality). The purpose of this study was to investigate the relationship that causal attributions have with marital distress, spouse critical comments, and symptom outcome in patients with bipolar disorder. Participants were recruited from the New York Hospital-Cornell Medical Center and included 39 couples with one individual with bipolar disorder. They completed interviews, videotaped interactions, and self-report questionnaires measuring spouse criticality, symptomology, attributions, and marital distress. Results indicated that more distressed patients with bipolar disorder made more internal attributions to their spouses for negative events. Additionally, more critical spouses made more internal attributions to the patients for negative events and less internal attributions to themselves for negative events. Finally, although patient attribution variables did not predict symptom outcome, it was found that the more internal to patient, external to self, and stable the attributions for negative events made by the spouses, the more symptoms displayed by the patients at the end of 10 months of treatment. Implications of the current research are that spousal attributions were related to patient symptom outcome and should be addressed in cognitively based marital therapy. Additional research examining the extent to which attributions can be effectively modified as a result of psychotherapy, and exactly what impact that may have on the course of illness, is required. Other directions for future research as well as limitations of the current study are discussed.

Subject Area

Psychotherapy|Social psychology|Physiological psychology|Families & family life|Personal relationships|Sociology

Recommended Citation

Greene, Lori Isman, "The relationship of attributions and expressed emotion to outcome and marital satisfaction in patients with bipolar disorder" (1998). ETD Collection for Fordham University. AAI9825849.