Relatives' expressed emotion and the course of inflammatory bowel disease

Thirty-one relatives of inflammatory bowel disease (IBD) patients referred to a specialist unit were assessed with the Camberwell Family Interview, and ratings of expressed emotion (EE) were made. These relatives were significantly less critical than relatives of psychiatric patients in previous studies (p<0.001). Outcome was assessed over a 12-month follow-up period by a clinician blinded to the EE ratings. Most patients in this study had a poor outcome, and 11 (38%) needed surgery. A significantly higher proportion of patients with low EE relatives were in the surgery outcome group (p = 0.02). Excluding the surgery group, there was a nonsignificant trend for patients with high EE relatives to have a worse outcome. Patterns of response suggested better tolerance by relatives of the more ill patients. In the group overall there was no relationship between psychiatric status and physical health, either initially or at follow-up. There was considerable agreement among relatives as to the "typical" IBD personality. A number of key findings concerning the IBD patient, patterns of relatives' EE, and how they relate to the course of the illness remain to be verified by more systematic assessment.