The Role of Criticism in Expressed Emotion Among Psychoactive Substance Users: an Experimental Vignette Study

Expressed emotion (EE) is a rating of criticism, hostility, and emotional over-involvement from a carer towards a person experiencing mental distress. High EE denotes family stress and is associated with greater severity of substance use. Little is known about how EE is perceived by patients with a history of substance use disorder (SUD). The aim of the present study was to investigate perceived EE among substance users and its association with substance use, schizotypy, and depression. Ratings of arousal and relevance of auditory criticism and praise depicting EE, and self-report measures of schizotypy and depression were measured in patients with a recent history of SUD, patients with a recent history of SUD co-occurring with mental disorders (SUD + CMD), and non-clinical healthy control subjects. Group differences in ratings of criticism and praise were tested. The ratings were correlated against schizotypy and depression. Prediction of sensitivity to criticisms by a history of substance use was explored in the SUD groups. Compared to control subjects, individuals with a history of SUD rated criticism as less arousing and those with SUD + CMD rated criticism as more self-relevant. The rating of criticism was positively correlated with schizotypy and depression in the SUD group. Age of onset of substance use was a significant predictor of the arousal of criticism. History of SUD may affect perception of negative audio comments depicting family stress. This effect may be enhanced by high schizotypy traits and negative mental health status, and early age of onset of substance use.