Expressed Emotion (Component of Expressed Emotion)
Expressed emotion (EE) refers to care giver's attitude towards a person with a mental disorder as reflected by comments about the patient made to an interviewer. The empirical data show that EE is one of the major psychosocial stressor and it has direct association with recurrence of illness.
A 1956 study of readmissions of schizophrenia patients in London by George Brown found that patients discharged to live with their parents or wives were more frequently readmitted than those discharged to live with siblings or non-family in lodging houses. It also found that those that lived with their mothers were more likely to be readmitted if the mothers did not work outside the home, suggesting that the duration of exposure to certain family members was related to relapse. Brown devised the five dimensions of expressed emotion to quantify the interpersonal environmental exposures of patients
George Brown explained five components of expressed emotion which includes critical comments, hostility, EOI, positive remarks, and warmth.
The construct of high expressed emotion comprises of the following factors: Criticism, hostility, and emotional overinvolvement. The low expressed emotion components are warmth and positive regard.
The presence of High Expressed Emotion within the family context may in itself constitute a traumatic experience and may exacerbate or even trigger an episode of psychosis in a susceptible individual. Expressions of emotion which might not affect other individuals may adversely affect people suffering from or susceptible to psychosis. The good news is that by being aware of this, families and carers can adapt their behaviour in a way that benefits the mental health of their loved one.
Families often feel criticised and held to blame when incidence of High Expressed Emotion in the home is discussed. Supporting a loved one with a mental illness can be extremely challenging. It is completely understandable that emotions sometimes run high in the home under such circumstances. Understanding the effect that High Expressed Emotion can have on an individual suffering from or susceptible to psychosis however, and adapting behaviour to lower the levels of ‘high expressed emotion’ in the home can improve the mental health of the individual and in turn reduce stress experienced by family and carers.
Family therapy can be really useful in identifying incidence of High Expressed Emotion in the home and formulating different, more helpful ways of interacting as a family. Understanding the symptoms of psychosis will also better enable family and carers to see behaviour as a manifestation of illness rather than as an intrinsic aspect of their loved one. Understanding can reduce feelings of hostility, frustration, anger, anxiety, sadness and blame which sometimes arise in response to symptoms.
Caring for a person with schizophrenia is highly challenging and it might result in negative emotional atmosphere in the patient's family. This emotional atmosphere means the quality of caregiver's attitudes and relationships toward the patients is a robust variable which can negatively affect both the patients and caregivers. Moreover, this negative family atmosphere causes not only relapse of symptoms and re-hospitalization, but it has significant effect on the course of the illness.