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Chapter: Essentials of Psychiatry: Relational Problems

Diagnosis of Relational Disorders

Five specific relational problems are noted in DSM-IV. Family relational problems and partner relational problems are delineated below.

Diagnosis of Relational Disorders


Although research on structure, expression of affect, communication and problem solving in couples and families has lead to a greater understanding of the difficulties that can afflict these relational units, specific relational problems have only been recently included as a diagnostic entity in the DSM and clear diagnostic criteria have yet to be developed. Current textual descriptions of these conditions refer to impairment in the “pattern of interaction” in these relational units, reflecting the broad range of specific difficulties subsumed under these diagnostic entities.





Five specific relational problems are noted in DSM-IV. Family relational problems and partner relational problems are delineated below. These difficulties may also afflict relational units in the presence of a mental disorder or medical condition. The phenomenology of sibling relational problems and relational problems with other individuals have not been well explored.



Partner Relational Problems


Clinical experience and the research descriptions suggest that marital (and couples) relational problems manifest in the follow-ing ways:


o     Couple does not clarify mutual requests, provide information, or accurately describe problems.


o     Spouse or spouses verbalize underlying attributions, as-sumptions and expectations that are negative (e.g., spouse is globally negatively intentioned) or exaggerated (e.g., couples should never fight).


o     Affective communication is characterized by negative affect (e.g., anger, hostility, jealousy), critical remarks, disagree-ment with spouse and nonacceptance of what the mate has communicated.


o     There is a low frequency of self-disclosure of thoughts, feel-ings and wishes.


o     Couple demonstrates inadequate problem solving character-ized by poor problem definition, lack of task focus, mutual criticism and complaint, and negative escalation.


o     Couple displays sequences of negative communication char-acterized by criticism, disagreement, negative listening and refusal to agree.


o     Couple avoids conflict by withdrawal, lack of discussion and subsequent nonresolution.


Associated features of marital communication difficulties or disorders include poor marital satisfaction, psychiatric dis-order in one or both spouses, threatened and contemplated separation and divorce, or concentration and job performance difficulties.




Family Relational Problems


Family relational problems manifest as the following:


·   Family is unable to communicate clearly, cannot communi-cate closure, or cannot share a focus of attention (CD).


·    Family communication is characterized by unidirectional hostility or frequent criticism or by bidirectional, negatively escalating cycles of pejorative or critical comments.


·   Parent–offspring relationships are characterized by over-protectiveness, overconcern, unnecessarily self-sacrificing behaviors, intrusiveness, or overdependence (emotional overinvolvement).


·   Parent–offspring interchanges are marked by negatively re-inforcing coercive cycles that tend to perpetuate antisocial or aggressive behavior in one or more family members.


·   A broad array of family problems cannot be solved because of the family’s inability to agree to try to solve, define, generate, or evaluate solutions to, or implement solutions to, existing problems.


The associated features of parent–child communication dif-ficulties or disorders include adolescent acting out and disrup-tive behavior, major psychiatric disorders in one or more family members (i.e., schizophrenia, affective disorder), poor parental morale and parenting dissatisfaction.

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