Examining Patients’ Perceptions of their Relatives’ Expressed Emotion

  • Martha C. Tompson
  • Amy G. Weisman


Numerous studies have demonstrated that critical or emotionally overinvolved attitudes on the part of family members can be a significant stressor for mentally ill patients (for review, see Butzlaff and Hooley, 1998). High levels of these attitudes, referred to as Expressed Emotion (EE), have been shown to predict both the development of schizophrenia (Goldstein, 1987) and a poorer course of illness in a variety of psychiatric disorders, including schizophrenia (Brown, Birley and Wing, 1972; Vaughn and Leff, 1976a; Vaughn, Snyder and Jones et al., 1984), bipolar disorders (Miklowitz et al., 1988), substance abuse (0’ Farrell, Hooley, Fals-Stewart, and Cutter, 1998), unipolar depression (Hooley, Orley and Teasdale, 1986; Vaughn and Leff, 1976a), and eating disorders (LeGrange, Eisler, Dare, and Hodes, 1992; Van Furth et al., 1996). While relatives’ attitudes may be viewed as a potential stressor for patients with psychiatric illnesses, the mechanism by which they exert their influence is still unclear. Measures of EE have traditionally been made by counting the number of criticisms and making ratings of emotional overinvolvement (EOI) based on the Camberwell Family Interview (Vaughn and Leff, 1976b), or more recently, by the Five Minute Speech Sample (Magana et al., 1986).


Eating Disorder Brief Psychiatric Rate Scale Express Emotion Parental Bonding Instrument High Express Emotion 
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  1. Asarnow, J.R., Goldstein, M.J., Tompson, M.C., and Guthrie, D. (1993): One-year outcomes of depressive disorders in child psychiatric inpatients: Evaluation of the prognostic power of a brief measure of expressed emotion. Journal of Child Psychology and Psychiatry 34(2): 129–137PubMedCrossRefGoogle Scholar
  2. Asarnow, J.R., Tompson, M.C., Hamilton, E., Goldstein, M.J., and Guthrie, D. (1994): Family expressed emotion, childhood onset-depression, and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression? Journal of Abnormal Child Psychology 22(2): 129–146PubMedCrossRefGoogle Scholar
  3. Beck, A.T., Rush, A.J., Shaw, B.F., and Emery, G. (1979): Cognitive therapy of depression. New York: Guilford PressGoogle Scholar
  4. Brown, G.W., Birley, J.L.T., and Wing, J.K (1972): Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry 121: 241–258PubMedCrossRefGoogle Scholar
  5. Butzlaff, R.L. and Hooley, J.M. (1998): Expressed emotion and psychiatric relapse. Archives of General Psychiatry 55(6): 547–552PubMedCrossRefGoogle Scholar
  6. Cramer, P., Weegman, M., and O’Neil, M. (1989): Schizophrenia and the perception of emotions: How accurately do schizophrenics judge the emotional states of others? British Journal of Psychiatry 155: 225–228PubMedCrossRefGoogle Scholar
  7. Dobson, K.S. (1989): Real and perceived interpersonal responses to subclinically anxious and depressed targets. Cognitive Therapy and Research 13(1): 37–47CrossRefGoogle Scholar
  8. Glynn, S.M., Randolph, E.T., Eth, S., Paz, G.G., Leong, G.B., Shaner, A.L., and Strachan, A (1990): Patient psychopathology and expressed emotion in schizophrenia. British Journal of Psychiatry 157: 877–880PubMedCrossRefGoogle Scholar
  9. Goldstein, M.J. (1987): Family interaction patterns that antedate the onset of schizophrenia and related disorders: A further analysis of data from a longitudinal prospective study; In: Understanding major mental disorders: The contribution of family interaction research (Halweg, K and Goldstein, M.J., eds.). New York: Family Process PressGoogle Scholar
  10. Goldstein, M.J., Rosenfarb, L, Woo, S., and Nuechterlein, K. (1997): Transactional processes which can function as risk or protective factors in the family treatment of schizophrenia. In: Towards a comprehensive therapy for schizophrenia (Brenner, H.D., Boeker, W., and Genner, R., eds.), pp. 147–157. Göttingen: Hogrefe and Huber PublishersGoogle Scholar
  11. Hooley, J.M. (1998): Expressed emotion and psychiatric illness: From empirical data to clinical practice. Behavior Therapy 29: 631–646CrossRefGoogle Scholar
  12. Hooley, J.M. (1987): The nature and origins of expressed emotion. In: Understanding Major Mental Disorder: The Contribution of Family Interaction Research (Hahlweg, K. and Goldstein, M., eds.), pp. 176–194. New York: Family Process.Google Scholar
  13. Hooley, J.J.M., Orley, J., and Teasdale, J.D. (1986): Levels of expressed emotion and relapse in depressed patients. British Journal of Psychiatry 148: 642–647PubMedCrossRefGoogle Scholar
  14. Kavanagh, D.J. (1992): Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry 160: 601–620PubMedCrossRefGoogle Scholar
  15. Lebell, M.B., Marder, S.R, Mintz, J., Mintz, L.I., Tompson, M.C., Wirshing, W., Johnston-Cronk, K., and McKenzie, J. (1993): Patients’ perceptions of family emotional climate and outcome in schizophrenia. British Journal of Psychiatry 162: 751–754PubMedCrossRefGoogle Scholar
  16. LeGrange, D., Eisler, I., Dare, C., and Hodes, M. (1992): Family criticism and self-starvation: A study of expressed emotion. Journal of Family Therapy 14(2): 177–192CrossRefGoogle Scholar
  17. Lukoff, D., Nuechterleih, K.H., and Ventura, J. (1986): Manual for the Expanded Brief Psychiatric Rating Scale. Schizophrenia Bulletin 12: 594–602Google Scholar
  18. Magana, A.B., Goldstein, M.J., Karno, M., Miklowitz, D.J., Jenkins, J., and Falloon, I.R.H. (1986): A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Research 17: 203–212PubMedCrossRefGoogle Scholar
  19. Miklowitz, D.J., Goldstein, M.J., Falloon, I.R.H., and Doane, J.A. (1984): Interactional correlates of expressed emotion in the families of schizophrenics. British Journal of Psychiatry 144: 482–487PubMedCrossRefGoogle Scholar
  20. Miklowitz, D.J., Goldstein, M.J., Nuechterlein, K.H., Snyder, K.S., and Mintz, J. (1988): Family factors and the course of bipolar affective disorder. Archives of General Psychiatry 45: 225–231PubMedCrossRefGoogle Scholar
  21. Moos, R.H., and Moos, B.S. (1981): Family Environment Scale Manual. Palo Alto, CA: Consulting Psychologist’s PressGoogle Scholar
  22. O’Farrell, T.J., Hooley, J., Fals-Stewart, W., and Cutter, H.S.G. (1998): Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology 66: 744–752CrossRefGoogle Scholar
  23. Parker, G., Tupling, H., and Brown, L.B. (1979): A parental bonding instrument. British Journal of Medical Psychology 52: 1–10CrossRefGoogle Scholar
  24. Rosenfarb, I.S., Goldstein, M.J., Mintz, J., and Nuechterlein, K.H. (1995): Expressed emotion and subclinical psychopathology observable within the transactions between schizophrenic patients and their family members. Journal of Abnormal Psychology 104(2): 259–267PubMedCrossRefGoogle Scholar
  25. Scott, R.D., Fagin, L., and Winter, D. (1993): The importance of the role of the patient in the outcome of schizophrenia. British Journal of Psychiatry 163: 62–68PubMedCrossRefGoogle Scholar
  26. Strachan, A.M., Leff, J.P., Goldstein, M.J., Doane, J.A., and Burtt, C. (1986): Emotional attitudes and direct communication in the families of schizophrenics: A cross-national replication. British Journal of Psychiatry 149: 279–287PubMedCrossRefGoogle Scholar
  27. Sturgeon, D., Kuipers, L., Berkowitz, R, Turpin, G., and Leff, J.P. (1981): Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives. British Journal of Psychiatry 138: 40–45PubMedCrossRefGoogle Scholar
  28. Tarrier, N., Barrowclough, C., Porceddu, K., and Watts, S. (1988): The assessment of psychophysiological reactivity to the expressed emotion of the relatives of schizophrenic patients. British Journal of Psychiatry 152: 618–624PubMedCrossRefGoogle Scholar
  29. Tarrier, N., Vaughn, C., Lader, M.H., and Leff, J.P. (1979): Bodily reactions to people and events in schizophrenics. Archives of General Psychiatry 36: 311–315PubMedCrossRefGoogle Scholar
  30. Tompson, M.C., Goldstein, M.J., Lebell, M.B., Mintz, L.L., Marder, S.R., and Mintz, J. (1995): Schizophrenic patients’ perceptions of their relatives’ attitudes. Psychiatry Research 57: 155–167PubMedCrossRefGoogle Scholar
  31. Vaughn, C.E., and Leff, J.P. (1976a): The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry 129: 125–137CrossRefGoogle Scholar
  32. Vaughn, C., and Leff, J. (1976b): The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social Psychology 15: 157–165CrossRefGoogle Scholar
  33. Vaughn, C.E., Snyder, K., Jones, S.J., Freeman, W.B., and Falloon, L.R.H. (1984): Family factors in schizophrenic relapse. Archives of General Psychiatry 41: 1169–1177PubMedCrossRefGoogle Scholar
  34. Van Furth, E.F., Van Strien, D.C., Martina, L.M.L., Van Son, M.J.M., Hendricks, J.J.P., and Van Engeland, H. (1996): Expressed emotion and the prediction of outcome in adolescent eating disorders. International Journal of Eating Disorders 20(1): 19–31PubMedCrossRefGoogle Scholar
  35. Ventura, J., Green, M.F. Shaner, A., and Liberman, R. (1993): Training and quality assurance with the brief psychiatric rating scale ‘The drift busters.’ International Journal of Methods in Psychiatric Research 3: 221–244Google Scholar
  36. Warner, R. and Atkinson, M. (1988): The relationship between schizophrenic patients’ perceptions of their parents and the course of their illness. British Journal of Psychiatry 153: 344–353PubMedCrossRefGoogle Scholar
  37. Woo, S.M., Goldstein, M.J. and Nuechterlein, K.H. (1997): Relatives’ expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients. British Journal of Psychiatry 170: 58–61PubMedCrossRefGoogle Scholar

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© Springer-Verlag Wien 2002

Authors and Affiliations

  • Martha C. Tompson
  • Amy G. Weisman

There are no affiliations available

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