Psychiatric patients living with critical relatives suffer relapse rates that are 4-5 times higher than the average 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 question forms the focus of the proposal. 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 independent 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 patients and relatives operate together in theoretically coherent ways to increase the risk of psychiatric morbidity in some patients. Preliminary findings indicate that levels of criticism in relatives are influenced by patients' functioning and decrease considerably in the three months subsequent to patients' discharge from the hospital. However, the high correlation between relatives' criticism measured during the patient's hospitalization and at 3-month follow-up demonstrates that, although mean levels of criticism change, relatives still preserve their rank order. In other words, absolute levels of criticism decrease but, relatively, levels of criticism remain fairly stable. Obtaining a better understanding of the precise meaning of these findings in terms of the EE-relapse link will be a major focus of attention in the next funding period.
| 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 |
