Communication patterns and expressed emotion in families of persons with mental disorders.

Interaction in 40 families of persons with bipolar disorders or schizophrenia was analyzed as a stochastic process to examine communication patterns between patients and parents relative to parents' level of expressed emotion (EE). Interaction sequences were coded with the Relational Control Coding System, and Markov process characteristics of order (degree of sequential dependency), stationarity, and role homogeneity were assessed with log-linear analysis. Communication patterns in high-EE families with both disorders showed more serial dependence--were more "tightly joined"--than low-EE families. However, both low- and high-EE families of persons with bipolar disorders competed for control, while there were marked differences in control patterns in low- and high-EE families of persons with schizophrenia, with low-EE families not at all competitive and high-EE families highly competitive. Difference in both responsiveness and competition for control were much stronger in dual-parent families. It was concluded that high-EE families have a family system that combines over-responsiveness with conflict about "who's in charge".