Intimate Partner Relationship Distress in the DSM‐5

• Published date: 01 March 2015
• Date: 01 March 2015
• Author: Mark A. Whisman,Heather M. Foran,Steven R. H. Beach
• DOI: http://doi.org/10.1111/famp.12122

Intimate Partner Relationship Distress in the DSM-5

HEATHER M. FORAN*

MARK A. WHISMAN

†

STEVEN R. H. BEACH

‡

To read this article in Spanish and Chinese, please see the article’s Supporting Information on Wiley

Online Library (wileyonlinelibrary.com/journal/famp).

Over the past 40 years, a large body of literature has documented intim ate partner rela-

tionship distress as a primary reason for seeking mental health services as well as an inte-

gral factor in the prognosis and treatment of a range of mental and physical health

conditions. In recognition of its relevance to clinical care, the description of intimate part-

ner relationship distress has been expanded in the DSM-5. Nonethele ss, this is irrelevant if

the DSM-5 code for intimate partner relationship distress is not reliably used in clinical

practice and research settings. Thus, with the goal of dissemination in mind, the purpose

of this paper was to provide clinicians and researchers with specific guidelines on how to

reliably assess intimate partner relationship distress and how this information can be used

to inform treatment planning. In addition to the implications for direct clinica l care, we

discuss the importance of reliable assessment and documentation of intimate partner rela-

tionship distress for future progress in epidemiology, etiology, and public health research.

Keywords: Relationshi p Distress; Marital Satisfaction; DSM-5; Classification; Mental

Health

Fam Proc 54:48–63, 2015

There is an emerging consensus that it is necessary to include provisions for describing

problems in intimate relationships (i.e., intimate partner relationship distress) to

empower clinicians to better work with patients experiencing mental health problem s.

Thankfully, this consensus is reflected in the increased attention afforded to the descrip-

tion of intimate partner relationship distress in the DSM-5 (American Psychiatric Associa-

tion, 2013). In part, the consensus reflects an acknowledgment that a satisfying marri age,

or similar long-term pair bond, is one of the most important goals in life (Roberts &

Robins, 2000). Consequently, intimate partner relationship distress may have negative

effects on the emotional and physical well-being of both partners. Indeed, in treatment

seeking samples, the most frequently cited causes of acute emotional distress are problems

in intimate relationships, including divorce, separation, and other marital strains

(Swindle, Heller, Pescosolido, & Kikuzawa, 2000). Other studies indicate that problems in

intimate relationships are common among individuals seeking mental health services,

regardless of whether they report relationship distress as their primary complaint (Lin,

Goering, Offord, Campbell, & Boyle, 1996). Further, the association between problems in

intimate relationships and mental health has been observed in many different countri es

*Institute for Psychology, University of Braunschweig, Braunschweig, Germany.

†

Department of Psychology and Neuroscience, University of Colorado, Boulder, CO.

‡

Department of Psychology, Institute for Behavioral Research, University of Georgia, Athens, GA.

Correspondence concerning this article should be addressed to Heather M. Foran, University of Braun-

schweig, Humboldtstr. 33, Braunschweig 38106, Germany. E-mail: heatherforan@gmail.com.

Preparation of this article was supported by a grant from the German ResearchFoundation (FO788/1-2).

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Family Process, Vol. 54, No. 1, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12122

and cultures (e.g., Foran, Hahlweg, Kliem, & O’Leary, 2013; Greenstein & Davis, 2006;

Hollist, Miller, Falceto, & Fernandes, 2007; Miller et al., 2013; Overbeek et al., 2006).

PREVALENCE OF INTIMATE PARTNER RELATIONSHIP DISTRESS

Relationship researchers and demographers often cite relationship dissolution rates as

a proxy for the prevalence of relationship distress. However, relationship quality is only

one factor that influences the probability of relationship dissolution. Therefore, research-

ers have sought other means for defining and estimating the prevalence of intimate part-

ner relationship distress.

Taxometric methods make it possible to evaluate empirically whether dimensional

scales are derived from an underlying entity or taxon (Waller & Meehl, 1998). Taxometric

procedures examine covariation among indicators, seeking patterns that are diagnostic of

either latent categories (i.e., taxa) or dimensions. Two studies have found evidence for the

presence of an intimate partner relationship distress taxon (Beach, Fincham, Amir, &

Leonard, 2005; Whisman, Beach, & Snyder, 2008). Both studies estimated the prevalence

of the taxon, yielding estimates of .20 for newlyweds (Beach et al., 2005) and .32 across all

couples (Whisman et al., 2008).

INTIMATE PARTNER RELATIONSHIP DISTRESS AND INDIVIDUAL FUNCTIONING

Intimate Partner Relationship Distress and Mental Health Problems

There is a sizable literature linking relationship distress with a broad range of psychia t-

ric disorders in community samples. For example, in a population-based community sam-

ple from Ontario, 24.5% of people with a 12-month psychiatric disorder reported troubled

relationships with their spouse compared to 8.9% of people without a psychiatric disor der

(Goering, Lin, Campbell, Boyle, & Offord, 1996). In a reanalysis of these data, it was found

that in comparison to troubled relationships with relatives or friends, not getting along

with one’s spouse was more strongly associated with psychiatric disorders (Whisman,

Sheldon, & Goering, 2000).

The stress generation model (Hammen, 1991) provides an overarching heuristic model

illustrating the way in which relationship distress can become connected to various men-

tal health problems, with the potential to produce vicious cycles. As a consequence, mental

health symptoms can contribute to relationship distress, which in turn, may lead to an

accumulation of additional stress and ultimately to the maintenance and/or exacerbation

of symptoms.

Interpersonal stress, such as intimate partner relationship distress, is particularly

important in extending and amplifying the stress generation process because it has the

potential to produce greater subjective distress than noninterpersonal stressors (Frans,

Rimmo, Aberg, & Fredrikson, 2005). Given the effect of stress on mental health (e.g., Mon-

roe, 2008), it is not surprising that stress generation effects involving relationship distress

may play an important role in the etiology of mental health problems as well as in predict-

ing future recurrence and relapse. In the following sections, we elaborate aspects of this

circular process by providing a selective review of research studies on the association

between relationship distress and several common forms of psychopathology. In addition,

we would like to note that relationship quality is also associated with positive well-being.

For example, one meta-analysis found that marital satisfaction was strongly related to life

satisfaction, with an average correlation of .42 across 13 studies, and that it was more

strongly associated with life satisfaction than was satisfaction in other domains, such as

satisfaction with one’s job or health (Heller, Watson, & Ilies, 2004). Furthermore, longitu-

Fam. Proc., Vol. 54, March, 2015

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