Schizophrenia: Dysfunctional Family Explanations

- Psychoanalysts suggest family relationships could act as a catalyst for development of schizophrenia. - Double bind theory & expressed emotion; notes link these explanations with psychodynamic approach.

- Symptoms result from communication difficulties within families; child receives contradictory messages & cannot ignore or respond to them adequately. - Verbal & non-verbal cues do not align -> cancel each other out; child cannot respond appropriately to conflicting messages. - Dependent on parents -> unable to comment on contradictory messages. Meta-communication = communicating about the communication itself; here commenting on the contradiction. - Specified double binds as a risk factor; not the cause of schizophrenia.

- 156 men with schizophrenia after discharge; prescribed chlorpromazine while inpatients. - Relapse strongly related to type of home: men discharged to parents / wives had higher relapse rates than those discharged to lodgings / siblings. - Relationship between relapse rate & amount of expressed emotion (EE).

- Negative remarks about behaviour of person with schizophrenia & their efforts around house. - Unmanaged anger; irritation & rejection. - Especially shown by parents; excessive self-sacrifice & extreme / stifling overprotection. - Smiling & empathy; generally demonstrated in most EE caregivers. - Number of reinforcing statements made by caregiver.

- 1. Form alliance with carers. 2. Lower emotional intra-family climate by reducing stress. 3. Increase relatives' capacity to solve problems. - 4. Reduce expressions of anger & guilt. 5. Maintain reasonable expectations. 6. Encourage relatives to set appropriate limits / boundaries. 7. Promote desirable changes in relatives' behaviours & belief systems. - Reviewed 53 randomised controlled trials -> family intervention decreased relapse frequency & reduced hospital admissions.

- Research produces conflicting conclusions. Not all studies find significant differences in quality of communication between families with & without a member with schizophrenia. - Communication-task instructions from parents of 11 sons with schizophrenia were no more disordered than those from parents of 11 sons without schizophrenia. - May reflect parents adapting to already abnormal communication styles of children with schizophrenia -> communication difficulties may be an effect rather than primary cause of disorder. - Double bind communications could arise from incidental variations during family disruption or act as a symptom of parent's own pathology. - Theory lacks a solid foundation concerning true origins of communication patterns. Association between family communication & schizophrenia cannot straightforwardly establish that double binds cause illness.

- Research support exists but role as a universal predictor is inconsistent. - Within 9 months; 53% of individuals with schizophrenia living with high-EE relatives relapsed vs 12% living with low-EE relatives. - Failed to find higher subsequent 6-to-12-month relapse rates among individuals living in high-EE homes. - High expressed emotion may contribute to relapse but is not sole / exclusive factor determining whether relapse occurs. Limits its use as a universal predictor.

- Communication difficulties & high EE occur within shared family unit; family relationships may act as psychosocial triggers rather than underlying cause of schizophrenia. - Schizophrenia Working Group of the Psychiatric Genomics Consortium (SWGPC; 2014) identified 108 genetic loci associated with schizophrenia. - Individuals may already carry a genetic predisposition. Family dysfunction then serves as environmental stressor triggering onset -> equally plausible alternative to family dysfunction as underlying cause.