High Expressed Emotion: How Does Family Affect the Course of a Mental Disorder?

Did you know that the emotional behavior of the family influences the evolution of a mental disorder? Discover what the expressed emotion is and how it affects you.

It is common to think that the symptoms and evolution of a mental disorder depend on the person who presents it. However, the reality is that the symptoms, evolution and relapses of disorders are influenced by other factors that are not solely individual.

Throughout the 20th century, with the aim of explaining the causes of schizophrenia, it was found that solely organic factors, despite playing an important role, were insufficient to explain its appearance. In this sense, it was observed that there were patients with schizophrenia who had completed treatment, but had relapses upon returning home to their families. families From this moment on, it was found that different dimensions of the family area had an important role in certain disorders and today it is known that these dimensions not only affect the evolution of patients with schizophrenia but also influence other disorders such as, for example, bipolar disorder, depression, etc.

What is the expressed emotion?

The concept of expressed emotion (EE) emerged in the second half of the 20th century to refer to the style of emotional communication within the family unit. Specifically, the emotional behaviors that family members present towards other member(s) who have a mental disorder. Therefore, it only includes those members who have an influence on the day-to-day life of the person who has a disorder. In other words, how the family acts in response to the patient’s disorder can determine the course and relapses of the disorder, with families with high expressed emotion being the ones that have the most negative influence.

Components of expressed emotion:

The emotion expressed is made up of different components and it has been found that those that best predict a person’s relapse are the following:

1. Critical comments: The critical comments They are basically assessments that family members make about the patient’s behavior, both in terms of content (annoyance, displeasure, resentment, disapproval, etc.) and intonation. Example: “she is behaving like a slut”
2. Hostility: The hostility It is similar to the previous component, but it is more extreme since the displeasure is not towards the patient’s behavior, but rather towards the person. Therefore, the comments do not revolve around specific behaviors or situations, but rather imply a negative assessment of the person, so families that show high hostility will show rejection towards the patient. Example: “He is lazy and has no choice,” “He has always been absent-minded, he has never done anything right,” etc.
3. Emotional overinvolvement: The emotional overinvolvement It arises in families that tend to be very overprotective. Specifically, emotional overinvolvement implies excessive control of the person suffering from a mental disorder, an exaggerated emotional response, and excessive behavior. overprotective and of sacrifice. Therefore, it is an intense emotional manifestation in which one or more family members try to exercise excessive control over the behavior of the person who has a disorder. Example: A father who cries frequently when talking about his/her child and who shows hopelessness, pessimism, etc.

Expressed emotion and psychological disorders

Different investigations have been carried out to find out how the emotion expressed influenced each of them. Some of the disorders that were studied were the following:

Schizophrenia:

In various studies it has been found that critical attitudes, hostility and emotional overinvolvement on the part of family members, are related to the presence of relapses in the person diagnosed with schizophrenia. Specifically, a greater number of relapses has been observed after two years after discharge in those patients who live with members of their family and present high expressed emotion

On the other hand, regarding the symptoms, less hygiene and personal care behaviors have been found, in addition to isolation, more affected social functioning, violent behavior and irritability in patients with families who present high expressed emotion This would be explained because the high emotion expressed would cause greater stress within the family and, consequently, more intense symptoms.

Eating disorder:

Eating disorders (ED) are characterized in most cases by excessive concern about weight, figure and body image, which ends up having serious consequences on both the physical and psychological state, especially when These have an early onset. In this sense, it has been confirmed that those people who present these disorders early often present problems in the family environment and that high expressed emotion on the part of the family, is a factor that influences the maintenance of eating disorders.

Psychological disorders do not depend solely on those who suffer from them but, as we have seen, family dynamics often influence the maintenance of symptoms. It is for this reason that it is important to go to a professional to make a correct evaluation of each case and estimate whether it is appropriate to carry out a family intervention.