Interpersonal control, expressed emotion, and change in symptoms in families of persons with schizophrenia

This study examined the relationships of expressed emotion (EE), change in symptoms in schizophrenia, and interpersonal control patterns in relatives over a 2-year period. Subjects were 56 persons with schizophrenia and their relatives who participated in the NIMH Treatment Strategies in Schizophrenia (TSS) longitudinal study. The relationships among EE, interpersonal control as measured by the Relational Control Coding System (RCCS), and levels of symptoms at each assessment point were analyzed longitudinally with hierarchical linear modeling (HLM). No relationship was found between EE and symptoms, nor did control appear to contribute to symptoms. High-EE relatives reacted more strongly to symptom change than low-EE relatives and in opposite directions. EE may be an indicator of responsiveness rather than either a cause or result of symptoms. Understanding how EE attitudes impact the struggles patients and relatives have in coping with schizophrenia is crucial to knowing how clinicians can support these families most effectively.