Expressed emotion
Encyclopedia
Expressed emotion is a qualitative measure of the 'amount' of emotion displayed, typically in the family setting, usually by a family or care takers.
Theoretically, a high level of EE in the home can worsen the prognosis
in patients with mental illness
, (Brown et al., 1962, 1972) or act as a potential risk factor
for the development of psychiatric disease. Typically it is determined whether a person or family has high expressed emotion or low expressed emotion through a taped interview known as the Camberwell Family Interview (CFI). Answers to questions and non-verbal
cues are used to determine if some one has high expressed emotion. There is another measurement that is taken from the view of the patient. It rates the patient's perception of how his family feels about him and the disorder. If the patient feels that the parents are too protective or not caring the patient feels that his parents don't care of his independence or trust his judgement. This attitude may cause the patient to relapse and patients that rate their parents poorly in this test have a harder time coping with their illness if too much time is spent with the parent.
An alternative measures 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.
in the family. The family believes that the cause of many of the family’s problems is the patient’s mental illness, whether they are or not.
Family members with high expressed emotion are hostile, very critical and not tolerant of the patient. They feel like they are helping by having this attitude. They not only criticize behaviors relating to the disorder but also other behaviors that are unique to the personality of the patient. High expressed emotion is more likely to cause a relapse than low expressed emotion.
The attitudes of family members with high expressed emotion are too strong for the patient and the patient now has to deal with the mental illness and the criticism from those that they need support from in their time of recovery.
High or low expressed emotion makes the patient feel trapped, out of control and dependent upon others. The patient may feel like an outsider because of the excessive attention received. In bipolar patients relapse from manic to depressed can be triggered by a family member's comments. Expressed emotion affects everyone in the home, raising the stress level for everyone. This is bad for the patient's recovery and for the family as a whole. The behavior of everyone around the patient influences the patient to relapse or progress with their illness. Criticism of the patient is hard to stop once it has started.
The stress from high expressed emotion may cause the patient to relapse. The patient falls into a cycle of rehabilitation and relapse because the stress builds up too much so the only escape is relapse and then the disorder is unsustainable and rehabilitation is required. The only way to escape this cycle is for the family to go through therapy together. This will greatly lower family conflicts and the stress level of the household.
, and illness length.
There is also literature that links EE to the course and outcome of numerous major childhood psychiatric disorders. One study showed that one component, high parental dimensions of criticism (CRIT), can be used as an index of problematic parent–child interactions, and emotional overinvolvement (EOI) was not a useful indicator of problems.
The article "Expressed Emotion and Relapse of Psychopathology" details expressed emotion (EE) as a construct, the link between expressed emotion and relapse, evidence of causality, attributions and EE, and more information regarding the theory of EE.
Theoretically, a high level of EE in the home can worsen the prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
in patients with mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
, (Brown et al., 1962, 1972) or act as a potential risk factor
Risk factor
In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
for the development of psychiatric disease. Typically it is determined whether a person or family has high expressed emotion or low expressed emotion through a taped interview known as the Camberwell Family Interview (CFI). Answers to questions and non-verbal
Nonverbal communication
Nonverbal communication is usually understood as the process of communication through sending and receiving wordless messages. Messages can be communicated through gestures and touch , by body language or posture, by facial expression and eye contact...
cues are used to determine if some one has high expressed emotion. There is another measurement that is taken from the view of the patient. It rates the patient's perception of how his family feels about him and the disorder. If the patient feels that the parents are too protective or not caring the patient feels that his parents don't care of his independence or trust his judgement. This attitude may cause the patient to relapse and patients that rate their parents poorly in this test have a harder time coping with their illness if too much time is spent with the parent.
An alternative measures 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.
High Expressed Emotion
The three dimensions of high EE shown are hostility, emotional over-involvement and critical comments.Hostility
Hostility is a negative attitude directed at the patient because the family feels that the disorder is controllable and that the patient is choosing not to get better. Problems in the family are often blamed on the patient and the patient has trouble problem solvingProblem solving
Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Consideredthe most complex of all intellectual functions, problem solving has been defined as higher-order cognitive process that requires the modulation and control of...
in the family. The family believes that the cause of many of the family’s problems is the patient’s mental illness, whether they are or not.
Emotional Over-involvement
It is termed emotional over-involvement when the family members blame themselves for the mental illness. This is commonly found in females. These family members feel that any negative occurrence is their fault and not the disorders. The family member shows a lot of concern for the patient and the disorder. This is the opposite of a hostile attitude and a show that the family member is open minded about the illness, but still has the same negative effect on the patient. The pity from the relative causes too much stress and the patient relapses to cope with the pity.Critical Comments
Critical attitudes are combinations of hostile and emotional over-involvement. It shows an openness that the disorder is not entirely in the patients control but there is still negative criticism. Critical parents influence the patient’s siblings to be the same way.Family members with high expressed emotion are hostile, very critical and not tolerant of the patient. They feel like they are helping by having this attitude. They not only criticize behaviors relating to the disorder but also other behaviors that are unique to the personality of the patient. High expressed emotion is more likely to cause a relapse than low expressed emotion.
Low Expressed Emotion
Low expressed emotion is when the family members are more reserved with their criticism. The family members feel that the patient doesn't have control over the disorder. When the family is more educated and doesn't have to 'put up' with the patient and his/her disorder they are more likely to have low expressed emotion. Low expressed emotion causes a different stress and it is directed at the patient less.The attitudes of family members with high expressed emotion are too strong for the patient and the patient now has to deal with the mental illness and the criticism from those that they need support from in their time of recovery.
High or low expressed emotion makes the patient feel trapped, out of control and dependent upon others. The patient may feel like an outsider because of the excessive attention received. In bipolar patients relapse from manic to depressed can be triggered by a family member's comments. Expressed emotion affects everyone in the home, raising the stress level for everyone. This is bad for the patient's recovery and for the family as a whole. The behavior of everyone around the patient influences the patient to relapse or progress with their illness. Criticism of the patient is hard to stop once it has started.
The stress from high expressed emotion may cause the patient to relapse. The patient falls into a cycle of rehabilitation and relapse because the stress builds up too much so the only escape is relapse and then the disorder is unsustainable and rehabilitation is required. The only way to escape this cycle is for the family to go through therapy together. This will greatly lower family conflicts and the stress level of the household.
Validity
Some studies show that there is no link between expressed emotion and first episode psychosis and illness severity, age of onsetAge of onset
The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder...
, and illness length.
There is also literature that links EE to the course and outcome of numerous major childhood psychiatric disorders. One study showed that one component, high parental dimensions of criticism (CRIT), can be used as an index of problematic parent–child interactions, and emotional overinvolvement (EOI) was not a useful indicator of problems.
The article "Expressed Emotion and Relapse of Psychopathology" details expressed emotion (EE) as a construct, the link between expressed emotion and relapse, evidence of causality, attributions and EE, and more information regarding the theory of EE.
External links
- http://www.personalityresearch.org/papers/mcdonagh.html