[3] A high level of EE in the home can worsen the prognosis in patients with mental illness, such as schizophrenia and social anxiety disorder,[4][5] or act as a potential risk factor for the development of psychiatric disease.
[2] Brown devised the five dimensions of expressed emotion to quantify the interpersonal environmental exposures of patients.
[2] The advantage of a low-EE environment has been cited to partly explain the success of the Belgian village of Geel, where residents have for hundreds of years welcomed unrelated people with mental illness to live with them.
Emotional over-involvement reflects a set of feelings and behavior of a family member towards the patient, indicating evidence of over-protectiveness or self-sacrifice, excessive use of praise or blame, preconceptions and statements of attitude.
On the whole, families with high EE appear to be poorer communicators with their ill relative as they might talk more and listen less effectively.
Emotional over-involvement demonstrates a different side compared to hostile and critical attitudes but is still similar with the negative affect that causes a relapse.
The relative becomes so overbearing that the patient can no longer live with this kind of stress from pity, and falls back into their illness as a way to cope.
However, it is believed that in the early stages of the illness, families should be allowed to grieve and be supported emotionally, and that behavioral interventions can actually increase relapse rates at this critical juncture.
[11] High expressed emotion, by contrast, makes the patient feel trapped, out of control and dependent upon others.
One study[14] showed that one component, high parental dimensions of criticism (CRIT), can be used as an index of problematic parent–child interactions.