Psychiatric patients living with critical relatives suffer relapse rates that are 4 - 5 times higher than the averages for patients not living in such families. Despite the consistency with which this finding has been replicated across laboratories in the United States and Europe, the criticism-relapse link -- most typically operationalized in terms of the expressed emotion (EE) construct -- is still poorly understood; it remains an important body of data in search of an explanation. Moreover, it has become increasingly clear that further demonstrations of the EE-relapse link will contribute little to our understanding of psychiatric relapse in the absence of an understanding of why the link exists. This questions forms the primary focus of this proposal. An intensive, 3 year longitudinal study is proposed to investigate the association between psychiatric relapse and family criticism in sample of 60 DSM-III diagnosed schizophrenic patients. The study focuses on characteristics of patients and relatives that have been linked empirically to high rates of relapse. Central to the investigation is a test of 3 competing explanatory models of the criticism-relapse link: (1) criticism is a more or less trait-like characteristic of certain family members that is indepentent of specific characteristics of the patient's disorder; (2) criticism from family members is engendered by specific, identifiable characteristics of patients' disorders; (3) characteristics of patient and relatives operate together in theoretically coherent ways to increase the risk of psychiatric morbidity in some patients. Based on our pilot work, we believe that relatives' attributions about patients' abilities to control their symptoms may be an important mediating variable between manifest psychopathology and family supportiveness. An attributional model of expressed emotion is proposed, and several related hypotheses are tested.
| Hooley, J M; Hiller, J B (2000) Personality and expressed emotion. J Abnorm Psychol 109:40-4 |
| Hooley, J M (1998) Expressed emotion and locus of control. J Nerv Ment Dis 186:374-8 |
