This document summarizes a seminar about mental illness and relationships. It discusses how mental illnesses like bipolar disorder can impact relationships. Key points include that bipolar disorder is associated with higher divorce and unemployment rates due to deficits in social cognition. Relationships are affected by mood states, communication styles, and comorbid issues like anxiety, substance abuse, and impulse control problems. Families with high "expressed emotion" like criticism see worse outcomes. Treatments discussed include psychoeducation, DBT, and ensuring low expressed emotion from families. Health professionals are urged to help with relationship assessments, education, and treatments.

1. Mental illness and relationships
Dr. Nick Stafford, Consultant Psychiatrist
NHS & Private Practice
clinical-partners.co.uk
Seminar & discussion with
RELATE Leicester July 2013

2. Disclosures
Pharmaceuticals
Astra Zeneca Ltd
Otsuka Ltd
Bristol Myers Squibb Ltd
Glaxo Smith Kline Ltd
Pfizer Ltd
Eli Lilly Ltd
Lundbeck Ltd
Servier Laboratories Ltd
GW Pharma Ltd
Private Practice
Clinical Partners Ltd
Nuffield Health
BMI Healthcare
Clinics in:
London, Leicester, Sutton Coldfield
Previously Vice Chair Bipolar UK

3. Contents of talk
• Fundamentals
– Self, Attachment, Development, Social cognition
• Personality & disorder
• Bipolar disorder as a model
• Families
• Services and health care professionals
• Film examples

4. Summary – systemic model
Individuals
Illness
Response to stress
Treatment
Education / Knowledge

5. The brain is our lens of the world

6. Perception determines relation

7. Mental illness / Relationship System
Mental
illness
Relationship
Protective factors
Individual style
Attachment style
Communication
Expressed emotion
Nature
Degree
Treatments
Impairments
Personality

8. What makes the self?
Self
Others
World
Bio
Psycho
Past

9. Relationships
Spouse
Children
Friends
Colleagues
Neighborhood
BRIEF ENDURING

10. Social sciences
Psychology Social Work
Sociology Anthropology
Doctor

11. Insight

12. Regulations
Law Custom
Agreement Groups
Society

13. Attachment
Me
ATTACHMENT
Mummy
The
World
Self
Development
AdultLife

14. Attachment style (childhood)
Attachment
styles
Secure
Insecure
Anxious
avoidant
Ambivalent
Disorganised

15. Theory of mind

16. Development
Acquaintance
Build Up
Continuation
Deterioration
Termination
BEGINNING
ENDING

17. Adult attachment
Secure
Anxious-
preoccupied
Dismissive-
avoidant
Fearful-
avoidant
Some forms of psychological maladjustment and clinical disorders are
attributable in part to the effects of insecure working models and attachment styles.

18. Security based strategy
of affect regulation
Secure
Anxious-
preoccupied
Dismissive-
avoidant
Fearful-
avoidant
Self-esteem thoughts about the self
Sociabilitythoughtsaboutothers
Positive Negative
Positive
Negative

19. Security based strategy

20. Attachment avoidance strategy

21. Hyper-activation strategy

22. BIPOLAR DISORDER
An example mental disorder

23. Relationships in bipolar
• Key relationships
– Divorce is twice as common
– Loss of employment is twice as common
• Deficits in social cognition underpin these disabilities
• Treatments for these principal deficits
– Psychoeducation
– Functional remediation
– DBT
• Things that don’t work
– CBT
– Counselling

24. Bipolar disorder comorbidities
• Anxiety disorders
• Eating disorders
• Alcohol and substance misuse disorders
• Impulse control disorders
• Behavioural addictions
• Personality disorders (esp. Cluster B)
• Medical problems – CVS, CVA, Cancer, etc.
• Psychosocial problems

25. COGNITION

26. Social cognition - Bandura

27. Social mirroring neurons

28. The Root – Cognitive deficits

29. PERSONALITY

30. Personality (the study of)
• Changes
• Development
• Disorder
• Genetics
• Pathology
• Psychology
• Style
• Systematics
• Tests
• Type
• Traits
• Measuring

31. Personality types & disorder
Personality type
• Hippocrates four
temperaments
– Yellow bile, Black bile
– Phlegm, Blood
• Eysenck
– Extraversion / Neuroticism
• Myers-Briggs
– Extraversion / Introversion
– Sensing / Intuition
– Thinking / Feeling
– Judging / Perception
Personality disorder (Type A,B,C)
• Paranoid
• Schizoid
• Schizotypal
• Antisocial
• Borderline
• Histrionic
• Narcissistic
• Avoidant
• Dependent
• Obsessive-Compulsive

32. Paul Abbott

33. COMMUNICATION

34. Communication styles
Passive
Aggressive
Passive-
aggressive
Assertive

35. Communication
• How is this impacted on by the illness?
• Bipolar
– Mood state affects style of communication
• Depression predominates – Passive
• Mania disinhibited – Aggressive & Passive aggressive
– Thinking style can be different (social cognition)
– Relating styles affected by cognitive deficits (facial
emotional recognition …)

36. MOOD AND EMOTION

37. Emotions
• What are they?
• Why have they evolved?
• How can they be
helpful?
• How can they be
unhelpful?

38. Moods – Depression

39. Why do people with bipolar have
relationship problems?
• The impact of mania and depression
• Subsyndromal symptoms
– Irritability
– Depression
• Comorbid axis I disorders
• Personality traits and disorders
• Sleep disorders
• Treatments

40. Moods – Mania

41. Irritability
• Negatively affects ability to moderate emotions
during social interaction
• Easily argumentative
• Evokes negative emotions in others
• Difficult for sufferer to distinguish their own
irritableness
• Unpleasant to be around
• This is a predominant mood state in
mania, depression and sub-syndromal states

42. OTHER PROBLEMS

43. Social anxiety disorder
• More than 80% of bipolars suffer with this
• Disabling anxiety in the context of mixing with
others
• Avoidance of social contact leads to increased
social anxiety

44. Alcohol and substance misuse
• 60% of bipolars suffer alcohol dependence at
some point in their lives
– Worsens illness prognosis
– Increases other comorbidities
– Reduces interpersonal functioning
– Reduces occupational functioning
– Cost
– Domestic violence

45. Impulse control disorders
• Varied and can be pervasive
• Impulsive behaviour causes the person to lack
judgment
• Consequential damage to self, others and
relationships

46. Behavioural addictions
• Sex
– Could be a problem even if kept within a faithful
relationship
• Gambling
– Amounts of money wasted can be staggering
• Spending
– Typically when high but also when low

47. Medication impact on a relationship?
• Overall improvements due to the treatment
and improvement of the illness
• Side effects
– Impact on communication (sedation)
– Libido, impotence, delayed ejaculation

48. FAMILY FACTORS

49. Families - High expressed emotion
FAMILY
PATIENT
HOSTILITY
EMOTIONAL OVER-
INVOLVEMENT
CRITICAL COMMENTS
STRESS
ILLNESS

50. Families - Low expressed emotion
FAMILY
PATIENT
MORE EDUCATED
FAMILY DON’T HAVE
TO PUT UP WITH THE
ILLNESS
FEEL PATIENT DOES
NOT HAVE CONTROL
OVER ILLNESS
MORE RESERVED
WITH CRITICISM
STRESS
ILLNESS

51. TREATMENTS, SERVICES, RESOURCE
S

52. DBT
• Dialectical behavioural
therapy
• Training yourself to
become more aware of
your emotions and how
they impact on you
• Form of psychotherapy
• Marsha M. Linehan
• Original use EUPD
• Mindfulness
• Distress tolerance
• Emotion regulation
• Interpersonal
effectiveness

53. Services for Relationships
• Generic psychiatric services
• GP counselling
• Rethink (carers)
• Relate (couples)
• All services to some degree assist
• Community institutions

54. Impact of health professionals
• All health care professionals should play a key
role in a patient’s relationships
– Assessment and identification
– Education
– Treatment
– Therapy
• ‘Negative’ impact of HCPs on relationships
– Changes lead to relationship revaluations
– Discovery of abuse

55. Summary – systemic model
Individuals
Illness
Response to stress
Treatment
Education / Knowledge

56. Overcoming

57. Resources

58. Resources

59. THANK YOU