Expressed emotion

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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. 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. 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. A high level of EE in the home can worsen the prognosis in patients with mental illness, such as schizophrenia and social anxiety disorder, or act as a potential risk factor for the development of psychiatric disease. 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. It has also been investigated as a contributor to the progress of unipolar depression, bipolar disorder, dementia, and diabetes. Interventions to improve outcomes include reducing contact with high-EE caregivers, and educating and supporting families so they can reduce high-EE behavior. Various mechanisms have been proposed to explain why high EE family environments produce worse outcomes, including that: 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...