Research on family expressed emotion and schizophrenia: Convergent and discordant theoretical and clinical aspects

Studies on expressed emotion in schizophrenia, which started over thirty years ago, have been widely replicated in various socio-cultural contexts, and the majority of the results have confirmed the predictive power of this assessment. Patients belonging to high-EE families were three to four times more likely to relapse than were patients returning to low-EE homes. Results that have proved to be in disagreement with the ones that have prevalently emerged in this vast field of research have given rise to controversies of both an experimental and a theoretical nature. Starting from an analysis of the discordant results, we proceed to a critical examination of the variables that might represent limits to the predictive value of expressed emotion. The evaluation of the meaning and working of EE components is considered in order to define a model of clinical interpretation of EE which will be able to promote developments in experimental research in this field and strengthen the psychiatrist's alliance with the family and with the patient suffering from schizophrenia.