Expressed emotion as an adaptation to loss: Prospective study in first-episode psychosis
Open accessAbstract
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 maybe understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.
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Carers experience a great sense of loss comparable to levels recorded in physical bereavement.
“Carers also experience a great sense of loss, comparable to levels recorded in physical bereavement.13”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [13]
Emotional overinvolvement has strong positive links with feelings of loss, self-blame and guilt about being responsible for the person's illness.
“Emotional overinvolvement has strong positive links with feelings of loss, 13 self-blame and guilt about being responsible for the person's illness.[63][64][65]”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [13]
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- Authors
- Patterson, P., Birchwood, M., & Cochrane, R.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- Patterson, Paul
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2005-08
- Volume
- 187
- Issue
- S48
- Pages
- s59-s64
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2080672979
- Cited by
- 106
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 5 · 2019: 3 · 2018: 7 · 2017: 11 · 2016: 7 · 2015: 5 · 2014: 11 · 2013: 9 · 2012: 7
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- expressed emotion, emotional overinvolvement, caregiver burden, first-episode psychosis, attachment theory, family intervention, duration of untreated psychosis, family relationships
- MeSH terms
- Adaptation, Psychological, Adult, Family Health, Female, Humans, Interpersonal Relations, Male, Middle Aged, Prospective Studies, Psychotic Disorders, Caregivers, Cost of Illness, Expressed Emotion
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