Abnormal Psychology

Understanding Psychological Disorders: The Neuropsychosocial Approach 61

include the style of interaction among family members, child maltreatment, and

parental psychological disorders. All of these factors can contribute to the emer-

gence or persistence of psychological disorders.

Family Interaction Style and Relapse

If family members exhibit hostility, voice unnecessary criticism, or are emo-

tionally overinvolved, then the family environment is characterized by high

expressed emotion. Based on what we know of the Beale women, their fam-

ily environment would likely be classifi ed as high expressed emotion. Consider

these typical comments by Big Edie to her daughter: “Well, you made a rotten

breakfast,” followed moments later by, “Everything is perfectly disgusting on ac-

count of you” (Maysles &Maysles, 1976). Big Edie and Little Edie were also

clearly overinvolved with each other: They spent virtually all their waking hours

together, participated in all aspects of each others’ lives, and responded to each

other in exaggerated ways.

British researchers found that among people with schizophrenia, those whose

families showed high expressed emotion were more likely to have the disorder re-

cur; the same association between high expressed emotion and relapse has been

found in other studies in the United States and China (Butzlaff & Hooley, 1998;

Yang et al., 2004). This may be because high expressed emo-

tion is associated with family members’ belief that the patient

has the ability to control his or her symptomatic behaviors,

which sometimes leads the family members to push the patient

to change (Miura et al., 2004). Unfortunately, these exhorta-

tions may well backfi re—instead of encouraging the patient to

change, they may produce the sort of stress that makes the dis-

order worse! When family members are educated about the

patient’s disorder and taught more productive ways of com-

municating with the patient, relapse rates generally decline

(Miklowitz, 2004).

High expressed emotion is not associated with relapse in

all cultural or ethnic groups; members of different groups in-

terpret such emotional expression differently. Among Mexican

American families, for instance, the family member with schizo-

phrenia is more likely to have a recurrence if the family style is

the less common one of being distant and aloof; high expressed emotion is not related

to recurrence (Lopez et al., 1998). And among African American families, high ex-

pressed emotion is actually associated with a better outcome (Rosenfarb, Bellack, &

Aziz, 2006). One possible explanation is that in African American families, confron-

tations are interpreted as signs of honesty (Rogan & Hammer, 1998) and may signal

love and caring.

Child Maltreatment

Child maltreatment comes in various forms—neglect, verbal abuse, physical abuse,

and sexual abuse—and is associated with a higher risk for a variety of psychologi-

cal disorders (Cicchetti & Toth, 2005), including personality disorders (Battle et al.,

2004; Bierer et al., 2003). Child maltreatment exerts its infl uence indirectly, through

the following:

• An altered bodily and neurological response to stress. For instance, children

who have been maltreated have higher baseline levels of cortisol than do chil-

dren who have not been maltreated. Such alteration of the stress response in

those who have been maltreated continues into adulthood (Tarullo & Gunnar,

2006; Watts- English et al., 2006).

• Behaviors that are learned as a consequence of the maltreatment. For instance,

maltreatment may result in a type of learned helplessness, so the children are more

likely to be victimized as adults (Renner & Slack, 2006).

High expressed emotion

A family interaction style characterized by

hostility, unnecessary criticism, or emotional

overinvolvement.

Although high expressed emotion is associated

with relapse in a European-American family

member with schizophrenia, this is not true among

Mexican Americans; the likelihood of relapse of a

patient with schizophrenia in a Mexican American

family is higher when family members are

emotionally distant. The family shown here does

not appear to be emotionally distant.

Michael Newman/Photo Edit

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