Expressed Emotions and Vulnerability to Relapse in Schizophrenia: The Role of Family Representations

Abstract

These Expressed emotions (EE), which primarily refer to criticism, hostility, and emotional overinvolvement, constitute a relational indicator associated with the course of schizophrenia. This narrative review examines meta-analyses regarding their prognostic value, the outcomes of family interventions, and the scope of illness representations in various sociocultural contexts, with a particular focus on Morocco. The meta-analysis by Ma et al. (2021), based on 33 prospective cohorts and 2,284 participants, reports a stronger association with relapses occurring within the first twelve months (OR = 4.87; 95% CI: 3.22–7.36) than with subsequent relapses (OR = 2.13; 95% CI: 1.36–3.35). Cross-cultural studies suggest the need to interpret expressions of closeness, criticism, and warmth in light of local relational norms. In Morocco, studies conducted in Casablanca and Fez document stigma, etiological beliefs, and expressed emotions, but do not allow for inferring a longitudinal risk of relapse at the national level. The data supports a transactional, non-blaming approach to family relationships, incorporating support for family members, psychoeducation, and a contextualized assessment of needs. Multicenter cohorts and studies on the adaptation of assessment tools are needed.

Key words: expressed emotions, family, relapses, illness conceptions, schizophreni

Received Date: September 17, 2026

Accepted Date: October 09, 2026

Published Date: November 01, 2026

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/1038