Assessment of Relational Disorders
The Global Assessment of Relational Functioning Scale (GARF) (Group for Advancement of Psychiatry, 1996) included in DSM-IV-TR is a 1 to 100 scale of overall relationship functioning, akin to the Global Assessment Scale for individuals. Recent studies have indicated that the GARF is reliable in clinical settings and that changes in GARF scores are positively associated with both patient and therapist-reported change in treatment and with treat-ment satisfaction.
The raw frequency of relational disorders (broadly defined) in the general population is unknown. No epidemiological stud-ies have been done, in part because of the absence of accepted diagnostic criteria for these disorders. There are rather vague “proxies” of relational disorders that are useful in making esti-mations of their prevalence, such as the approximate frequencies of divorce in the general populus (40–50% of all couples) or of marital violence (12–33% of couples). Factors such as divorce or violence, however, are best thought of as relational events rather than relational disorders. A single incident of marital violence does not necessarily signal the presence of a family relational disorder (in the absence of confirmatory information), nor is a diagnosable relational disorder in a spousal couple necessarily associated with divorce.
A further difficulty in making these estimations in the normal population is that certain of the constructs conveyed, such as expressed emotion (EE) assume the presence of a psy-chiatric disorder in an index family member. Also, the goal of EE and other family psychopathological studies has been to examine family attribute–outcome relationships on a within-group basis in psychiatric disorders rather than to making com-parisons between families of psychiatric patients and nonpsychi-atric control subjects. Thus, data are lacking on the frequencies of high-EE attitudes or other family attributes in normal control groups.
The paucity of studies on the frequency of family rela-tional disorders points to the need to develop strict operational criteria for these disorders and to conduct epidemiological studies using random sampling techniques, much as is done for individual disorders. The availability of epidemiological data would allow us to determine not only the need for treatment of specific relational disorders, but also their comorbidity with in-dividual or other relational disorders, their associated features, and the social conditions under which they are most likely to arise.