Express yourself!

Essential parental vocabulary phrase: "expressed emotion."

"a qualitative measure of the 'amount' of emotion displayed, typically in the family setting, usually by a family or care takers"

Contrary to what you may think, this is not considered a good thing.

"The three dimensions of high EE shown are hostility, emotional over-involvement and critical comments" and it is measured formally through the Camberwell Family Interview, which uses verbal and non-verbal measurements. There are also other tests.

If you appear hostile toward your (hostile) child, take too much responsibility (over-involvement) or too little (critical), you may be perceived as putting the patient at risk of relapse and poor prognosis.

Don't feel bad, though, the same judgment is made of parents of kids with other mental illnesses, and even of nurses.

For my part, I can tell you that my high EE, at times, was directly related to the attitude of the clinician and the current status of my daughter. When things were going well and we were all working well together: low EE. Perhaps EE is a measure of the clinician as much as of the family.


  1. As one who has "a complex relationship with her daughter" (to which to her enormous credit my beloved daughter simply stated "of course she does, anything else would be weird") perhaps I am too inadequate a specimen of human kind to comment here, but that isn't going to stop me is it ;-) I say to you YES! In any given interview situation (and what clinician ever interviews a parent or child in anything other than a stressful, interview type situation?) ANYONE, let alone someone faced with a life threatening illness in their child, is likely either to express emotion or clam up and seem "cold and unfeeling". In my limited experience it is the relationship between parent and clinician that it "complex".

  2. I get tired of the games they'd like us to play. Being calm when you are worried about what will happen is like swimming against the tide. Then they say that if WE keep in our emotions we are prone to heart disease. Hair can turn gray overnight with too much stress.
    I wish they'd stop observing our every little move hoping to catch us and simply offer us a hand.

  3. -Guilty as charged!

    I'm "over-involved", "worry too much", probably have nasty comments written on d's charts re my "combative" and direct tone and lack of patience for too much BS, etc.

    Here's a question though, who is helping US with all of this high level of EE when you witness clinical staff make blanket negative comments to both your child as well as yourselves as parents re this illness? When you watch Dr's, nurses, etc. fumble clumsily through your child's care and treatment for months, (in our case now 1 year), - then turn around and decide the "failure" is our fault, or reach for the "she has to choose to get well" mantra...

    For those of you who have been in the trenches long enough, how did you continually meet these trying moments in complete calm and detatchment when you weren't getting the help, support, and effective care/treatment for your child when you needed it most, and your child's health and wellbeing were played like a ping-pong ball?

    Like you point out Laura, my level of EE is very connected to the relative progress and effectiveness of our d's treatment by clinicians and especially her status- how can we as parents NOT be affected by this and express it accordingly?

    I'm much more likely to be jarred to a High-EE level when there is so much inconsistency and undermining with clinics, Dr's, therapist, dieticians, and way too many outdated and useless modes of ED treatment applications/strategies involved with our d's care vs keeping a steady, firm, but loving pace towards healing and full-health.

    I always find such irony in how the focus and studies are mostly limited to the families, when in fact the same studies and measurements need to be EQUALLY applied and published to those individuals our children, as well as ourselves, are being subjected to weekly, monthly for f/u care and treatment- they are not robots and purely objective within their practices, and some are downright worth avoiding. But where are those studies, ratings, and recommendations? Quite hypocritical and unfair, given the amount of emotion involved caring for anyone with this illness.

    I've found many times the emotions of clinicians, nurses, etc. are quite high, (even higher than ours!), as well as incredibly negative towards the patient and families, (especially in IP/OP residential programs), and how they presume this will not affect the quality of care, behavior of sufferer and their parents is really quite important to highlight as well.



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