Family Issues In Behavioral And Psychological Symptoms Of Dementia: Unraveling Circular Pathways?

Family issues are at the heart of biopsychosocial and systemic approaches to the way we understand and manage dementia. Based on evidence and clinical experience, this chapter revisits the circularities involving behavioral and psychological symptoms of dementia (BPSD) and the family. Negative and positive consequences of the caregiving experience are considered within the particular context of BPSD. We then analyze some of the "appalling dangers of family life" - i.e., negative ways in which family determinants, including expressed emotion, may impact BPSD. We see that these do not overshadow the family's role as the most powerful resource throughout the disease. Although further research is needed, both directions of causality ought to be considered in clinical situations: the principle of circularity, as described by the Milan School of Family Therapy, is a heuristic assumption regarding part of the overall BPSD picture. This is discussed at the end of the chapter, together with examples of mediator or modulator variables such as personality and relationship quality, which deserve further exploration.