Expressed Emotion in the Family: A Meta-Analytic Review of Expressed Emotion as a Mechanism of the Transgenerational Transmission of Mental Disorders

Abstract

BackgroundHigh Expressed Emotion (HEE) has been identified as a risk factor for the exacerbation and course of mental illness. EE has been investigated as a caregiver's response to an offspring's problem behavior and pathology. The present meta-analysis regards EE from a transgenerational perspective and as one mechanism that might explain the transgenerational transmission of mental disorders.MethodWe identified a total of 13 studies relying on 16 independent samples of parent-child dyads of parents with a mental illness and healthy controls; these were included in our analysis. Results were synthesized into one effect size per sample; meta-regression on additional effects of parental diagnostic category, child mental illness, and child age were also applied.ResultsParents with a mental illness are classified as HEE significantly more often. Effects were established for high criticism, albeit of small size (OR = 1.45), although they become stronger whenever offspring exhibit mental illness themselves (OR = 2.82).ConclusionThe current study highlights the dearth of studies on EE in families in which a parent has a mental illness and its effects on their children. Our findings highlight EE as a potential mechanism for attributing the transgenerational transmission of mental disorders, especially for the EE-variable criticism, indicating dysfunctional parent-child interactions.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019117609, identifier: CRD42019117609.

A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury

“…We found that adolescents’ high expressed emotion was more common in the NSSI and CC groups than in the NC group, supporting the findings that high expressed emotion is associated with psychopathology [ 20 , 27 ]. Adolescents with NSSI expressed significantly more covert criticism and critical tone toward their mothers than CC and NC adolescents.…”

“…The conceptualization of expressed emotion as a unidirectional construct from parent to child may present an incomplete picture [ 26 ]. Further, a recent review on expressed emotion within families discusses its possible role in the transgenerational transmission of mental disorders [ 27 ].…”

Non-Suicidal Self-Injuries in Adolescents: The Role of Satisfaction with Family Life

“…The primary objective of the family is to promote the full growth of its members, as well as a healthy physical condition, where each participant expresses satisfaction with their environment and the functions established in it, such as adequacy, freedom of expression, emotional development, positive affections and personal resources; aspects supported by Diener when arguing that the good or bad cognitive evaluations about their life, start from their own experiences (Serna-Arbelaez et al, 2020); (Alfaro et al, 2016). Families that present some type of dysfunctionality are characterized by unempathetic, hostile, critical, punitive parental behaviors, limiting attachment in their children (Fahrer et al, 2022) (Perquier et al, 2021) bringing as a consequence physical and emotional pain, generating the feeling that pain releases anguish and uneasiness, using self-injury as a way to channel and feel power over oneself (Fleta Zaragozano, 2017). Bronfenbrenner explains that the family system structures and directly influences the development of the human being from the moment of conception.…”

“…An inadequately expressed emotion shows how the interaction between parents and children is altered, a situation that can be transmitted from generation to generation. A negative bond within the family can generate both internalizing and externalizing symptoms in the children, who manifest indifference, low motivation, detachment, within the family group (Fahrer et al, 2022). There are imperceptible signs of distress, such as suicidal thoughts and suicidal ideation, which should not be overlooked (Raffagnato et al, 2022); (De Berardis et al, 2020).…”

“…As the main basis for development, parents play a determining role in the psychological wellbeing of their children (Carrasco Muñoz et al, 2020), fostering bonds of filiation that in the future nurture healthy affective relationships with other people (Rodríguez Mateo et al, 2018). The bonds established between parents and children are fundamental to protect or increase the risk of generating problems linked to the regulation of emotional expression, being a reflection of the family emotional climate (Fahrer et al, 2022).…”