Early research by Julian Leff at the Institute of Psychiatry and David Goldberg at UCLA on schizophrenia focused on the role of “expressed emotion” in families. They coined this term to essentially describe a negative and critical communication style that appeared to characterize many of the families who had members suffering from schizophrenia.
The results from their early studies were indeed impressive. Patients who lived with family members who were overly critical of them and had a negative communication style relapsed more often and quicker.
These results have been replicated across almost all major mental disorders (except one)*, and of course bipolar disorder. Patients with bipolar disorder actually have the highest sensitivity levels to expressed emotion/criticism.
Interestingly enough, other research by Elizabeth Kuipers at the Institute of Psychiatry has indicated that the levels of expressed emotion are best predicted by the degree of “perceived responsibility” of the person who is most critical. In other words, people who may care most about you may also be the people who will cause the most pain.
More research by David Miklowitz at UCLA has also indicated that at least in bipolar disorder it’s not just the presence of expressed emotion that is most harmful, but the lack of positive communication. In other words, you may be mean to each other, but if you try to have some positive interactions, things may not be as harmful to you.
Of course the burden one experiences and also their own levels of anxiety and depression are the culprits here, but at the same time developing an overly critical communication style is a learned process that can be changed with psychotherapy.
What’s your experience of expressed emotion and criticism in your family and relationship?
How do you handle this?
What helps and what makes things worse?
* there is one disorder that research has indicated that high levels of expressed emotion may even have a protective role and another disorder that research has found that high levels of expressed emotion may lead to marital infidelity. If you find any of the two disorders we will be happy to offer to you a free Mood-pulse session!
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Last reviewed: 6 Jun 2012