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Expressed emotion as an adaptation to loss^*

Prospective study in first-episode psychosis

School of Psychology, University of Birmingham and Early Intervention Service

RAY COCHRANE, DSc

School of Psychology, University of Birmingham, UK

Correspondence: Dr Paul Patterson, ED:IT, Early Intervention Service, 97 Church Lane, Aston, Birmingham B6 5UG. E-mail: patterpj{at}bham.ac.uk

Declaration of interest None.

^* Paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Background The factors influencing the development of expressed emotion (EE) are still unclear. Understanding the carer and patient appraisals operating during the initial adaptation to psychosis may help to clarify the early ontogenesis of EE.

Method Fifty patients and key carers were followed-up over 9 months and their appraisals of loss and burden were measured in relation to the evolution of high emotional overinvolvement (EOI) and critical (CC) relationships.

Results The appraisal of loss was linked to high EOI but not high CC relationships at baseline. Loss reduced by 9-month follow-up in those changing from high EOI to high CC or low EE. Subjective burden of carers was linked to loss but not to EE status. Patients’ and relatives’ appraisals of loss were strongly correlated, particularly in high EOI relationships. Longer duration of untreated psychosis was associated with high CC.

Conclusions The results are consistent with Bowlby’s attachment theory, where EOI and coercive criticism may be understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.