THEME The role of the family has always been studied in relation to psychopathology, which has allowed us to advance in the definition, measurement and understanding of family factors involved in the course and evolution of serious mental disorders and chronic diseases . The Expressed Emotion (EE) (Brown, Birley and Wing, 1972; Brown and Rutter, 1966) revealed by relatives is one of the most studied factors, evidencing their influence in the course of serious mental disorders, (Anastasiadou, Medina-Pradas, Sepúlveda and Trerasure, 2014), as well as in borderline personality disorder (TPL) (Hoffman, Buteau, Hooley, Fruzzetti and Bruce, 2003). the latter the object of our study. According to Linehan (1993), the pattern of high EE found by Left and Vaughn (1985) in depressive and schizophrenic patients is very similar to the "invalidating environment" described in his BPD biosocial model. Gunderson (1984) also makes reference to this analogy, suggesting that "the hostile and sobreimplicated environment in which TPL grows reminds to EE concept". At the same time, other authors place the focus on the role of the family caregivers of a patient with severe mental illness, analyzing the stress and overload they experience, as well as the biopsychosocial consequences derived from care (González et al., 2005 ; Roig, Abengózar & Serra, 1998). GENERAL OBJECTIVE The general objective of this thesis is to analyze the emotion expressed in family members and patients diagnosed with Personality Limit Disorder and the relationship with relevant variables such as caregiver burden, dyadic adjustment and social support. SPECIFIC OBJECTIVES O1. Analysis and description of the variable Emotion expressed in relatives of patients diagnosed with Borderline Personality Disorder and its relationship with sociodemographic variables of family members and patients. O2. To analyze the relationship between emotion expressed in relatives and the course of the disease. O3. To analyze the relationship between emotion expressed in relatives and the expressed emotion perceived by the patients. O4. To analyze the relationship between Emotion expressed and caregiver burden in patient relatives. O5. Analysis and description of the variables Emotion expressed, social support and dyadic adjustment in relatives of patients diagnosed with Borderline Personality Disorder. METHODOLOGY 1. SAMPLE. A total of 134 family members (men and women) from 111 patients (men and women) diagnosed with Borderline Personality Disorder who were receiving psychological treatment at the PREVI Clinical Center at the time of the study were enrolled. The inclusion criteria of the patients: - Written consent to participate in the study. - Patients diagnosed with Borderline Personality Disorder according to DSM-5 diagnostic criteria. - Non-psychotic patients with intellectual deficit. - Patients who were receiving psychological treatment at the time of study in any of the three health care facilities: outpatient clinic, Day Center or Continued Care Center (24h). Criteria for inclusion of family members: - Written consent to participate in the study. - Not having performed a Psychoeducation group program for relatives of TP patients. - Not having a severe mental disorder or cognitive deficit. 2. EVALUATION INSTRUMENTS USED. The evaluation instruments performed by family members who participated in this study were: - "Level of Expression Emotion" (LEE-S) (Sepúlveda et al., 2012; Cole & Kazarian, 1988) in the family version. - "Family Impact Assessment Questionnaire" (IEQ) (González et al., (2012) and Schene & Wijngaarden, 1992). - "Caregiver Experience Inventory" (ECI-S) (Szmukler, Burgess, Herrman and Benson, 1996). - "Diadical Adjustment Scale" (EAD-13) (Spanier, 1976; Santos-Iglesias, Vallejo-Medina & Sierra, 2009) in the couple version and family version. - "Social Support Questionnaire" (MOS) (Sherbourne & Stewart, 1991). The evaluation instruments performed by the patients who participated in this study were: - "Level of Excited Emotion Level" or "The Level of Expressed Emotion" (LEE-S) (Sepúlveda et al., 2012; Cole & Kazarian, 1988) in the patient version. - "Diadical Adjustment Scale" (EAD-13) (Spanier, 1976; Santos-Iglesias, Vallejo-Medina & Sierra, 2009) in the family version. 3. PROCEDURE. The sample of patients and relatives was selected from the Previ Clinical Centers, who came to receive specialized treatment in Personality Disorder. Patients and families who met the inclusion criteria described above were selected. All of them had completed the evaluation phase (clinical psychologist and psychiatrist) and had received as the main diagnosis the Borderline Personality Disorder according to DSM-5 and CIE-10 criteria. Both the patients and their families were previously informed of the characteristics and objectives of this study, assuring them the confidentiality of the data. Once their participation was accepted, they all signed the consent document to participate in this study and received the instructions and set of evaluation tests selected. 4. BIBLIOGRAPHY. Almond, S., Kanapp, M., Francois, C., Toumi, M, y Brugha, T. (2004). Relapse in schizophrenia: costs. Clinical outcomes and quality of life. British Journal of Psychiatry, 184, 346-351 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. Amaresha, A. C., y Venkatasubramanian, G., (2012). Expressed emotion in Schizophrenia: An Overview. Indian Journal of Psychological Medicine, 34, 1, 12-20. Bailey, R. C. y Grenyer, B. F. S. (2014b). Supporting a person with personality disorder. A study of carer burden and well-being. Journal of Personality Disorders, 28, 136. Bailey, R. C., y Grenyer, B. F. S. (2015). The relationship between expressed emotion and wellbeing for families and carers of a relative with Borderline Personality Disorder. Personality and mental health, 9, 21-32. Barrowclough, C. y Hooley, J. M. (2003). Attributions and expressed emotion: A review. Clinical Psychology Review, 23, 849-880. Barrowclought, P., Tarrier, N. y Johnston, M. (1996). Distress, expressed emotion, and attributions in relatives of schizophrenia patients. Schizophrenia Bulletin, 22, 691-702. Belloch, A. y Fernandez-Alvarez, H. (2010). Tratado de Trastornos de la Personalidad. Madrid: Editorial Síntesis. Bodenmann, G., Pihet, S., & Kayser, K. (2006). The relationship between dyadic coping and marital quality: a 2-year longitudinal study. Journal of Family Psychology, 20(3), 485. Brown, G. W., Birley, J. L., y Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241-258. Brown, G. W., y Rutter, M. (1966). The measurement of family activities and relationships: a methodological study. Human Relation, 19, 241-263. Bullock, B. M., Bank, L. y Burraston, B. (2002). Adult sibling expressed emotion and fellow sibling deviance: A new piece of the family process puzzle. Journal of Family Psychology 16, 3, 307-317. Butzlaff, R. L. y Hooley, J. M., (1998). Expressed emotion and psychiatric relapse. A meta-analysis. Archieves of General Psychiatry, 55, 547-552. Cáceres Carrasco, J., Herrero-Fernández, D., & Iraurgi Castillo, I. (2013). Características psicométricas y aplicabilidad clínica de la "escala de ajuste diádico" en una muestra de parejas españolas. Behavioral Psychology/Psicología Conductual, 21(3). Cohen, S., Mermelstein, R., Kamarck, T. y Hoberman, H.M. (1985). Measuring the functional components of social support. En I.G. Saranson y B.R. Saranson (eds.), Social Support: Theory, research and applications (pp. 73-94). Dordrech: Martinus Nijhoff. Coid, J., Yang, M., Tyrer, P., Roberts y A., Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. The British Journal of Psychiatry, 188 (5) 423-431. Espina, A., Pumar, B., Santos, A., Gonzalez, P., García, E. y Ayerbe, A. (1999). Correlación entre la Emoción Expresada por los padres de esquizofrénicos y su percepción por los hijos. Revista de la Asociación Española de Neuropsiquiatría, 19, 71, 394-406. Espina Eizaguirre, A., Pumar González, P.B., González Peláez, P., Santos Mocoroa, A.,García Martín, E., & Ayerbe, A. (2000). Emoción expresada y características de personalidad, psicopatológicas y de ajuste diádico en padres de esquizofrénicos. Psiquis: Revista de Psiquiatría, Psicología y Psicosomática, 21(4), 23-33. Fadden S, Bebbington P, Kuipers L. The burden of care. The impact of functional psychiatric illness on the patients family. Br J. Psychiatry 1987; 150, 285-92. García-Palacios, A. (2006). La terapia dialéctico comportamental. edupsykhé, 5,2,255-271. Glenn, C. R. y Klonsky, E. D., (2009). Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders, 23, 20-28. Goodman, M. A., Patil, U., Triebwasser, J., Hoffman, P., Weistein, Z. A, New, A. (2010). Parental burden associated with borderline personality disorder in female offspring. Journal of Peronslity Disorders, 25, 1, 59-74. González, A., García-Palacios, A., Molinari, G., y del Rio, E. (2015). DSM-5: avances en la clasificación y el diagnóstico de los trastornos mentales. Agora de Salut, 1, 115-126. González, N., Bilbao, A., Padierna, A., Martín, J., Orive, M., y Quintana, J. M. (2012). Validity and reliability of the Spanish version of the Involvement Evaluation Questionnaire among caregivers of patients with eating disorders. Psychiatry research, 200, 2, 896-903. Graham, J.M., Liu, Y.J., & Jeziorski, J.L. (2006). The dyadic adjustment scale: A reliability generalization meta¬analysis. Journal of Marriage and Family, 68(3), 701-717. Gunderson (2009). Borderline Personality Disorder: Ontogeny of a Diagnosis. American Journal of Psychiatry, 166, 530-539. Hirst, M. (2005). Carer distress: a prospective, population-based study. Social Science & Medicine, 61, 697-708. Hoffman, P. D., Buteau, E., Hooley, J. M., Fruzzetti, A. E., y Bruce, M. L. (2003). Family members' knowledge about borderline personality disorder: Correspondence with their levels of depression, burden, distress, and expressed emotion. Family Process, 42, 4, 469-478. Hoffman, P. D., Frunzzetti, A. E., y Buteau, E. (2007b). Understanding and engaging families: An education, skills and support program for relatives impacted by borderline personality disorder. Journal of Mental Health, 16, 1, 69-82. Hooley, J. M. y Hoffman, P. D. (1999). Expressed Emotion and Clinical Outcome in Borderline Pesonality Disorder. The American Journal of Psychiatry, 156, 10, 1557-1562. Hooley, J. M., y Gotlib, I. H. (2000). A diathesis-stress conceptualization of expressed emotion and clinical outcome. Applied and Preventive Psychology, 9, 3, 135-151. Hooley, J. M., y Licht, D. M. (1997). Expressed emotion and causal attributions in the spouses of depressed patients. Journal of Abnormal Psychology, 106, 298-306. Kernberg, O. (1967). Borderline personality organization. Journal of the American Psychoanalytic Association, 15, 641-685. Lin, N. (1986). Conceptualising social support. En N. Lin, A. Dean y T. W. Ensel (eds.), Social support, life events and depression (pp. 103-105). Nueva York: Academic Press. Leff, J. P., y Vaughn, C. (1985). Expressed emotion in families: It´s significant for mental illnes. New York: Guilford Press. Lee, G., Barrowclough, C. y Lobban, F. (2014). Positive affect in the family environment protects against relapse in first-episode psychosis. Social Psychiatry and Psychiatric Epidemiology, 49, 3, 367-76. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Miller C.J., Miller S.R., Newcorn J.H., Halperin J.M. (2008). Personality characteristics associated with persistent ADHD in late adolescence. Journal of Abnormal Children Psychology, 36, 2, 165-73. Pérez-Pareja, B., Quiles, Y., Romero, C., Pamies-Aubalat, L., y Quiles, M. J. (2014). Malestar psicológico y emoción expresada en cuidadores de pacientes con un trastorno de la conducta alimentaria. Anales de psicología, 30, 1, 37-45. Pritchard, J. C. (1835). A treatise on insanity and other disorders affecting the mind. London: Sherwood, Gilbert & Piper. Rosenthal, R., Muran, J., Pinsker, H., Hellerstein D. y Winston, A. (1999). Interpersonal change in brief supportive psychotherapy. Journal of Psychotherapy Practice Research, 8, 55-63. Samuels, J., Eaton, W. W., Bienvenu, O. J., Brown, C. H., Costa, P. T. y Nestadt, G. (2002). Prevalence and correlates of personality disorders in a community simple. The British Journal of Psychiatry, 180, 6, 536-542. Scheirs, J. G. M. y Bok, S. (2007) Psychological Distress in Caretakers or Relatives of Patients With Borderline Personality Disorder. International Journal of Social Psychiatry, 53, 3, 195-203. Sepúlveda, A. R., Anastasiadou, D., del Río, A. M., y Graell, M. (2012). The Spanish Validation of Level of Expressed Emotion Scale for Relatives of People with Eating Disorders. The Spanish journal of psychology, 15, 2, 825-839. Spanier, G.B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 15-28. Stern, A. (1938), Psychoanalytic investigation and therapy in the borderline group of neuroses. Psychoanalytic Quarterly, 7, 467-489. Struening, E. L., Stueve, A., Vine, P., Kreisman, D. E., Link, B. G., & Herman, D. B. (1995). Factors associated with grief and depressive symptoms in caregivers of people with serious mental illness. Research in Community and Mental Health, 8, 91–124. Torgersen, S. (2009). The nature (and nurture) of personality disorders. Scandinavian Journal of Psychology, 50, 624-632. Torgensen, S., Kringlen, E. y Cramer, V. (2001), The prevalence of personality disorders in a community simple. Achieves of General Psychiatry, 58, 590-596. Tyrer, P., Gunderson, J., Lyons M., y Tohen, M. (1997). Extent of comorbidity between mental state and personality disorders. Journal of Personality Disorders. 11, 242–259. Van Wijngaarden, B., Schene, A. H., Koeter, M., Vázquez-Barquero, J. L., Knudsen, H. C., Lasalvia, A., y McCrone, P. (2000). Caregiving in schizophrenia: development, internal consiconsistency and reliability of the Involvement Evaluation Questionnaire-European Version EPSILON Study 4. The British Journal of Psychiatry, 177, 39, 21-27. Widiger, T. A. (2012). The Oxford Handbook of Personality Disorders. New York: Oxford University Press.TEMA El papel de la familia ha sido siempre objeto de estudio en relación a la psicopatología, lo que nos ha permitido avanzar en la definición, medición y entendimiento de los factores familiares implicados en el curso y evolución de los trastornos mentales graves y enfermedades de curso crónico. La Emoción Expresada (EE) (Brown, Birley y Wing, 1972; Brown y Rutter, 1966) que manifiestan los familiares es uno de los factores más estudiados, evidenciando su influencia en el curso de trastornos mentales graves, tales como, Trastornos afectivos (Ellis et al., 2014), Trastornos alimentarios (Anastasiadou, Medina-Pradas, Sepúlveda y Trerasure; 2014), así como, en Trastorno de personalidad límite (TPL) (Hoffman, Buteau, Hooley, Fruzzetti y Bruce, 2003), siendo este último el objeto de nuestro estudio. Según Linehan (1993), el patrón de alta EE encontrado por Left y Vaughn (1985) en pacientes depresivos y esquizofrénicos es muy similar al “ambiente invalidante” descrito en su Modelo biosocial del TPL. Gunderson (1984) también hace mención a esta analogía, sugiriendo que “el ambiente hostil y sobreimplicado en el que crecen los TPL recuerda al concepto de EE”. Paralelamente, otros autores sitúan el foco de atención en el papel de los familiares cuidadores de un paciente con patología mental grave, analizando la situación de estrés y sobrecarga que experimentan, así como, las consecuencias biopsicosociales derivadas del cuidado (González et al.,2005; Roig, Abengózar & Serra, 1998). ABSTRACT The role of the family has always been studied in relation to psychopathology, which has allowed us to advance in the definition, measurement and understanding of family factors involved in the course and evolution of serious mental disorders and chronic diseases . The Expressed Emotion (EE) (Brown, Birley and Wing, 1972; Brown and Rutter, 1966) reported by relatives is one of the most studied factors, evidencing their influence in the course of serious mental disorders, such as affective disorders (Ellis et al (Hoffman, Buteau, Hooley, Fruzzetti and Bruce, 2003), as well as in borderline personality disorder (TPL) (Hoffman, Buteau, Hooley, Fruzzetti and Bruce, 2003). object of our study. According to Linehan (1993), the pattern of high EE found by Left and Vaughn (1985) in depressive and schizophrenic patients is very similar to the "invalidating environment" described in his BPD biosocial model. Gunderson (1984) also makes reference to this analogy, suggesting that "the hostile and sobreimplicated environment in which TPL grows reminds to EE concept". At the same time, other authors place the focus on the role of the family caregivers of a patient with severe mental illness, analyzing the stress and overload they experience, as well as the biopsychosocial consequences derived from care (González et al., 2005 ; Roig, Abengózar & Serra,1998). OBJETIVO GENERAL El objetivo general de esta tesis es analizar la emoción expresada en familiares y pacientes diagnosticados de Trastorno de la Personalidad límite y la relación con variables relevantes como la carga del cuidador, ajuste diádico y apoyo social. OBJETIVOS ESPECÍFICOS O1. Análisis y descripción de la variable Emoción expresada en familiares de pacientes diagnosticados de Trastorno de la personalidad límite y su relación con las variables sociodemográficas de los familiares y pacientes. O2. Analizar la relación entre Emoción expresada en familiares y el curso de la enfermedad. O3. Analizar la relación entre Emoción expresada en familiares y la Emoción expresada percibida por los pacientes. O4. Analizar la relación entre Emoción expresada y carga del cuidador en familiares de pacientes. O5. Análisis y descripción de las variables Emoción expresada, apoyo social y ajuste diádico en familiares de los pacientes diagnosticados de Trastorno de la Personalidad límite METODOLOGÍA 1. MUESTRA. Participaron un total de 134 familiares (hombres y mujeres) de 111 pacientes (hombres y mujeres) diagnosticados de Trastorno de Personalidad límite que estaban recibiendo tratamiento psicológico en el Centro Clínico PREVI en el momento en el que se realizó este estudio. Los criterios de inclusión de los pacientes: - Consentimiento escrito para participar en el estudio. - Pacientes diagnosticados de Trastorno de la personalidad límite según criterios diagnósticos del DSM-5. - Pacientes no psicóticos ni con déficit de capacidad intelectual. - Pacientes que estuvieran recibiendo tratamiento psicológico en el momento del estudio en cualquiera de los tres dispositivos asistenciales: ambulatorio, Centro de día o Centro de atención continuada (24h). Los criterios de inclusión de los familiares: - Consentimiento escrito para participar en el estudio. - No haber realizado programa grupal de Psicoeducación para familiares de pacientes TP. - No tener presentar un trastorno mental grave o déficit cognitivo. 2. INSTRUMENTOS DE EVALUACIÓN UTILIZADOS. Los instrumentos de evaluación que realizaron los familiares que participaron en este estudio fueron: - “Escala del Nivel de Emoción Expresada” o “The Level of Expressed Emotion” (LEE-S) (Sepúlveda et al., 2012; Cole & Kazarian, 1988) en la versión familiar. - “Cuestionario de evaluación de la repercusión familiar” (IEQ) (González & cols., (2012) y Schene & Wijngaarden, 1992). - “Inventario de la Experiencia del Cuidador” (ECI-S) (Szmukler, Burgess, Herrman y Benson, 1996). - “Escala de Ajuste Diádico” (EAD-13) (Spanier, 1976; Santos-Iglesias, Vallejo-Medina & Sierra, 2009) en la versión pareja y versión familiar. - “Cuestionario de Apoyo Social” (MOS) (Sherbourne & Stewart, 1991). Los instrumentos de evaluación que realizaron los pacientes que participaron en este estudio fueron: - “Escala del Nivel de Emoción Expresada” o “The Level of Expressed Emotion” (LEE-S) (Sepúlveda et al.,2012; Cole & Kazarian, 1988) en la versión paciente. - “Escala de Ajuste Diádico” (EAD-13) (Spanier, 1976; Santos-Iglesias, Vallejo-Medina & Sierra, 2009) en la versión familiar. 3. PROCEDIMIENTO. La muestra de pacientes y familiares fue seleccionada de los Centros Clínicos Previ, que acudieron para recibir tratamiento especializado en TP. Se seleccionaron los pacientes y familiares que cumplían los criterios de inclusión anteriormente descritos. Todos ellos habían finalizado la fase de evaluación (psicólogo clínico y psiquiatra) y habían recibido como diagnóstico principal el de Trastorno de la Personalidad Límite siguiendo criterios del DSM-5 y CIE-10. Tanto los pacientes como los familiares fueron informados previamente de las características y objetivos de este estudio asegurándoles la confidencialidad de los datos. Una vez aceptada su participación, firmaron todos ellos el documento de consentimiento de participación en este estudio y recibieron las instrucciones y conjunto de pruebas de evaluación seleccionadas. 4. BIBLIOGRAFÍA. Almond, S., Kanapp, M., Francois, C., Toumi, M, y Brugha, T. (2004). Relapse in schizophrenia: costs. Clinical outcomes and quality of life. British Journal of Psychiatry, 184, 346-351 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. Amaresha, A. C., y Venkatasubramanian, G., (2012). Expressed emotion in Schizophrenia: An Overview. Indian Journal of Psychological Medicine, 34, 1, 12-20. Bailey, R. C. y Grenyer, B. F. S. (2014b). Supporting a person with personality disorder. A study of carer burden and well-being. Journal of Personality Disorders, 28, 136. Bailey, R. C., y Grenyer, B. F. S. (2015). The relationship between expressed emotion and wellbeing for families and carers of a relative with Borderline Personality Disorder. Personality and mental health, 9, 21-32. Barrowclough, C. y Hooley, J. M. (2003). Attributions and expressed emotion: A review. Clinical Psychology Review, 23, 849-880. Barrowclought, P., Tarrier, N. y Johnston, M. (1996). Distress, expressed emotion, and attributions in relatives of schizophrenia patients. Schizophrenia Bulletin, 22, 691-702. Belloch, A. y Fernandez-Alvarez, H. (2010). Tratado de Trastornos de la Personalidad. Madrid: Editorial Síntesis. Bodenmann, G., Pihet, S., & Kayser, K. (2006). The relationship between dyadic coping and marital quality: a 2-year longitudinal study. Journal of Family Psychology, 20(3), 485. Brown, G. W., Birley, J. L., y Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241-258. Brown, G. W., y Rutter, M. (1966). The measurement of family activities and relationships: a methodological study. Human Relation, 19, 241-263. Bullock, B. M., Bank, L. y Burraston, B. (2002). Adult sibling expressed emotion and fellow sibling deviance: A new piece of the family process puzzle. Journal of Family Psychology 16, 3, 307-317. Butzlaff, R. L. y Hooley, J. M., (1998). Expressed emotion and psychiatric relapse. A meta-analysis. Archieves of General Psychiatry, 55, 547-552. Cáceres Carrasco, J., Herrero-Fernández, D., & Iraurgi Castillo, I. (2013). Características psicométricas y aplicabilidad clínica de la "escala de ajuste diádico" en una muestra de parejas españolas. Behavioral Psychology/Psicología Conductual, 21(3). Cohen, S., Mermelstein, R., Kamarck, T. y Hoberman, H.M. (1985). Measuring the functional components of social support. En I.G. Saranson y B.R. Saranson (eds.), Social Support: Theory, research and applications (pp. 73-94). Dordrech: Martinus Nijhoff. Coid, J., Yang, M., Tyrer, P., Roberts y A., Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. The British Journal of Psychiatry, 188 (5) 423-431. Espina, A., Pumar, B., Santos, A., Gonzalez, P., García, E. y Ayerbe, A. (1999). Correlación entre la Emoción Expresada por los padres de esquizofrénicos y su percepción por los hijos. Revista de la Asociación Española de Neuropsiquiatría, 19, 71, 394-406. Espina Eizaguirre, A., Pumar González, P.B., González Peláez, P., Santos Mocoroa, A.,García Martín, E., & Ayerbe, A. (2000). Emoción expresada y características de personalidad, psicopatológicas y de ajuste diádico en padres de esquizofrénicos. Psiquis: Revista de Psiquiatría, Psicología y Psicosomática, 21(4), 23-33. Fadden S, Bebbington P, Kuipers L. The burden of care. The impact of functional psychiatric illness on the patients family. Br J. Psychiatry 1987; 150, 285-92. García-Palacios, A. (2006). La terapia dialéctico comportamental. edupsykhé, 5,2,255-271. Glenn, C. R. y Klonsky, E. D., (2009). Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders, 23, 20-28. Goodman, M. A., Patil, U., Triebwasser, J., Hoffman, P., Weistein, Z. A, New, A. (2010). Parental burden associated with borderline personality disorder in female offspring. Journal of Peronslity Disorders, 25, 1, 59-74. González, A., García-Palacios, A., Molinari, G., y del Rio, E. (2015). DSM-5: avances en la clasificación y el diagnóstico de los trastornos mentales. Agora de Salut, 1, 115-126. González, N., Bilbao, A., Padierna, A., Martín, J., Orive, M., y Quintana, J. M. (2012). Validity and reliability of the Spanish version of the Involvement Evaluation Questionnaire among caregivers of patients with eating disorders. Psychiatry research, 200, 2, 896-903. Graham, J.M., Liu, Y.J., & Jeziorski, J.L. (2006). The dyadic adjustment scale: A reliability generalization meta¬analysis. Journal of Marriage and Family, 68(3), 701-717. Gunderson (2009). Borderline Personality Disorder: Ontogeny of a Diagnosis. American Journal of Psychiatry, 166, 530-539. Hirst, M. (2005). Carer distress: a prospective, population-based study. Social Science & Medicine, 61, 697-708. Hoffman, P. D., Buteau, E., Hooley, J. M., Fruzzetti, A. E., y Bruce, M. L. (2003). Family members' knowledge about borderline personality disorder: Correspondence with their levels of depression, burden, distress, and expressed emotion. Family Process, 42, 4, 469-478. Hoffman, P. D., Frunzzetti, A. E., y Buteau, E. (2007b). Understanding and engaging families: An education, skills and support program for relatives impacted by borderline personality disorder. Journal of Mental Health, 16, 1, 69-82. Hooley, J. M. y Hoffman, P. D. (1999). Expressed Emotion and Clinical Outcome in Borderline Pesonality Disorder. The American Journal of Psychiatry, 156, 10, 1557-1562. Hooley, J. M., y Gotlib, I. H. (2000). A diathesis-stress conceptualization of expressed emotion and clinical outcome. Applied and Preventive Psychology, 9, 3, 135-151. Hooley, J. M., y Licht, D. M. (1997). Expressed emotion and causal attributions in the spouses of depressed patients. Journal of Abnormal Psychology, 106, 298-306. Kernberg, O. (1967). Borderline personality organization. Journal of the American Psychoanalytic Association, 15, 641-685. Lin, N. (1986). Conceptualising social support. En N. Lin, A. Dean y T. W. Ensel (eds.), Social support, life events and depression (pp. 103-105). Nueva York: Academic Press. Leff, J. P., y Vaughn, C. (1985). Expressed emotion in families: It´s significant for mental illnes. New York: Guilford Press. Lee, G., Barrowclough, C. y Lobban, F. (2014). Positive affect in the family environment protects against relapse in first-episode psychosis. Social Psychiatry and Psychiatric Epidemiology, 49, 3, 367-76. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. Miller C.J., Miller S.R., Newcorn J.H., Halperin J.M. (2008). Personality characteristics associated with persistent ADHD in late adolescence. Journal of Abnormal Children Psychology, 36, 2, 165-73. Pérez-Pareja, B., Quiles, Y., Romero, C., Pamies-Aubalat, L., y Quiles, M. J. (2014). Malestar psicológico y emoción expresada en cuidadores de pacientes con un trastorno de la conducta alimentaria. Anales de psicología, 30, 1, 37-45. Pritchard, J. C. (1835). A treatise on insanity and other disorders affecting the mind. London: Sherwood, Gilbert & Piper. Rosenthal, R., Muran, J., Pinsker, H., Hellerstein D. y Winston, A. (1999). Interpersonal change in brief supportive psychotherapy. 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