Examining Patients’ Perceptions of their Relatives’ Expressed Emotion

Abstract

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).