Expressed emotion (EE), is a measure of the family environment that is based on how the relatives of a psychiatric patient spontaneously talk about the patient.[1] It specifically measures three to five aspects of the family environment: the most important are critical comments, hostility, emotional over-involvement, with positivity and warmth sometimes also included as indications of a low-EE environment.[2] The psychiatric measure of expressed emotion is distinct from the general notion of communicating emotion in interpersonal relationships, and from another psychological metric known as family emotional expressiveness.[3]
A high level of EE in the home can worsen the prognosis in patients with mental illness, such as schizophrenia and social anxiety disorder,[4][5] or act as a potential risk factor for the development of psychiatric disease.[6] Higher degrees of expressed emotion in the environment of a patient have been empirically found to be robust predictors of relapse of schizophrenia, eating disorder, and mood disorders.[1][2] It has also been investigated as a contributor to the progress of unipolar depression, bipolar disorder, dementia, and diabetes.[1] Interventions to improve outcomes include reducing contact with high-EE caregivers, and educating and supporting families so they can reduce high-EE behavior.[2]
Various mechanisms have been proposed to explain why high EE family environments produce worse outcomes, including that:[2]
Critical comments often misidentify certain behaviors as laziness or selfishness rather than symptoms of a mental illness.
Over-protectiveness can undermine the patient's self-reliance and ability to use their own skills to solve mental health problems.
High-EE behaviors can be a source of psychological stress, which exacerbates mental illness (the diathesis–stress model).
Typically it is determined whether a person or family has high EE or low EE through a taped interview known as the Camberwell Family Interview (CFI). Answers to questions and non-verbal cues are used to determine if someone has high expressed emotion. There is another measurement that is taken from the view of the patient, which rates the patient's perception of how their family feels about them and the disorder. An alternative measure of expressed emotion is the Five Minutes Speech Sample (FMSS), where the relatives are asked to talk about the patient for five uninterrupted minutes. Although this measure requires more training, it becomes a quicker form of assessment than the CFI.[7]
^ abcButzlaff RL, Hooley JM (June 1998). "Expressed emotion and psychiatric relapse: a meta-analysis". Arch. Gen. Psychiatry. 55 (6): 547–52. doi:10.1001/archpsyc.55.6.547. PMID 9633674.
^ abcdVenkatasubramanian, Ganesan; Amaresha, AnekalC (2012-01-01). "Expressed Emotion in Schizophrenia: An Overview". Indian Journal of Psychological Medicine. 34 (1): 12–20. doi:10.4103/0253-7176.96149. PMC 3361836. PMID 22661801.
^Family emotional expressiveness and family structure
^Brown G, Birley J, Wing J (1972). "Influence of family life on the course of schizophrenic disorder: a replication". British Journal of Psychiatry. 121 (562): 241–258. doi:10.1192/bjp.121.3.241. PMID 5073778. S2CID 40443476.
^Garcia-Lopez LJ, Muela JAE-F, Diaz-Castela MM (2009). "Exploring the relevance of expressed emotion to the treatment of social anxiety disorder in adolescence". Journal of Adolescence. 32 (6): 1371–1376. doi:10.1016/j.adolescence.2009.08.001. PMID 19762073.
^Asarnow JR, Tompson M, Woo S, Cantwell DP (December 2001). "Is expressed emotion a specific risk factor for depression or a nonspecific correlate of psychopathology?". J Abnorm Child Psychol. 29 (6): 573–83. doi:10.1023/A:1012237411007. PMID 11761289. S2CID 22980727.
^Hooley JM (2007). "Expressed emotion and relapse of psychopathology". Annu Rev Clin Psychol. 3: 329–52. doi:10.1146/annurev.clinpsy.2.022305.095236. PMID 17716059.
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