Culture, Medicine, and Psychiatry

, Volume 33, Issue 1, pp 41–60

Expressed Emotion, Human Agency, and Schizophrenia: Toward a New Model for the EE-Relapse Association

  • Nicholas J. K. Breitborde
  • Steven R. López
  • Keith H. Nuechterlein
Original Paper


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.


Schizophrenia Expressed emotion Human agency Narrative 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nicholas J. K. Breitborde
    • 1
  • Steven R. López
    • 2
  • Keith H. Nuechterlein
    • 3
  1. 1.Department of PsychiatryYale UniversityNew HavenUSA
  2. 2.Department of PsychologyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Departments of Psychiatry and PsychologyUniversity of California, Los AngelesLos AngelesUSA

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