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Cult Med Psychiatry. 2009 Mar;33(1):41-60. doi: 10.1007/s11013-008-9119-x.

Expressed emotion, human agency, and schizophrenia: toward a new model for the EE-relapse association.

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  • 1Department of Psychiatry, Yale University, New Haven, CT 06519, USA. nicholas.breitborde@yale.edu


Although there is a clear statistical association between expressed emotion (EE) and schizophrenic relapse, our understanding of the mechanisms underlying this relationship is underdeveloped. This study tested a theoretical model in which caregivers' perceptions of their ill relative's agency underlie the EE-relapse association. To evaluate this model, we completed qualitative and quantitative analyses of narratives provided by individuals caring for a relative with schizophrenia. The results indicate that high-EE caregivers perceive the expression of symptoms as stemming from their ill relative's agency more frequently than low-EE caregivers. This was true for both high-EE-criticism and high-EE-emotional overinvolvement caregivers. High-EE and low-EE caregivers did not differ in their perceptions of the role of their ill relative's agency with regard to the control of symptoms. The findings suggest that EE may be a proxy risk factor for caregivers' perceptions of their ill relative's agency.

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