Classification in Couples andFamilies

The relevance of intimate partner and family relationships

for overall well-being, mental health,

and physical health has been established with

numerous studies (e.g., Lissau and Sorensen

1994; Smith et al. 2012; Gouin et al. 2010;

Whisman 2007). Early research documented the

effects of emotional neglect and attachment processes

on children’s development (e.g., Beckett

et al. 2006; Manly et al. 2001) and the link

between intimate partner relationship distress

and mental health (e.g., Hammen 1991; Whisman

2001). More recent studies have documented

some of the biological and behavioral

mechanisms through which family

relationships and maltreatment can impact lifelong

health (e.g., Boeck et al. 2017; Kiecolt-

Glaser and Wilson 2017; Thomas et al. 2008).

Based on this accumulated literature and the prevalence

of these problems, family problems and

family maltreatment are considered important

public health problems.

An important first step in addressing public

health problems is proper detection and assessment

of the problems in the international classification

systems – the International Classification of

Diseases (ICD) and the Diagnostic and Statistical

Manual for Mental Disorders (DSM). Family

problems and maltreatment have not been fully

included with reliable definitions in these classifications

systems in the past (DSM-IV, ICD-10).

However, some progress has been made in the

DSM-5 and revisions are underway for the

ICD-11.

Four main types of relational problems have

been the focus of the DSM-5 and ICD-11 revisions

and will be reviewed here: intimate partner

violence, caregiver-child relational problems, intimate

partner relationship distress, and child maltreatment.

These four types of relationship

problems are prevalent, are associated with negative

public health impacts, and have definitions

with operationalized criteria and assessment tools

to support their inclusion in the DSM-5 and ICD-

11. Further, identification of these four types of

relational problems has clear implications for

improving communication between health care

providers and in improving treatment planning.