The shaping of individuals’ mental structures and dispositions by others: Findings from research on expressed emotion

Expressed emotion (EE) is a measure of the family environment that has been demonstrated to be a reliable, cross-culturally valid psychosocial predictor of relapse in patients with schizophrenia, mood disorders, and other — also somatic — illnesses. Assessed during the Camberwell Family Interview CFI, relatives are classified as being high in EE if they make more than a specified threshold number of critical comments or show any signs of hostility or marked emotional overinvolvement. In schizophrenia, the median relapse rate for patients returning after hospital discharge to a high EE environment is 48%, compared with 21% in a low EE-environment. In this article, the history of EE research will be outlined, and the evidence for the association between family EE and the course of schizophrenia and mood disorders will be presented. Conclusions about the treatment of major mental disorders are discussed as well as the directions of future studies.