Family dysfunction | AQA A-Level Psychology Revision

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 60 minutes

Family dysfunction explanations propose that stressful patterns of communication and emotional interaction within families may contribute to schizophrenia. These Family dysfunction A-Level Psychology revision notes examine the schizophrenogenic mother, double-bind theory and expressed emotion.

The explanations differ in whether they attempt to explain the original development of schizophrenia or the maintenance and relapse of existing symptoms. They also raise important questions about cause and effect, environmental determinism and the ethics of blaming relatives. Family dysfunction is one of the psychological explanations explicitly required by the AQA specification.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

• Explain family dysfunction as a psychological explanation of schizophrenia.

• Describe the schizophrenogenic-mother explanation.

• Explain double-bind theory.

• Explain high expressed emotion.

• Apply each explanation to an unfamiliar family scenario.

• Evaluate family-based explanations using evidence, methodological issues and alternative explanations.

Revision Notes 📚

Family dysfunction overview

Family dysfunction refers to unhealthy or stressful patterns of communication, emotion and relationships within a family.

The explanation proposes that experiences such as:

• Hostility.

• Rejection.

• Contradictory communication.

• Persistent criticism.

• Emotional over-involvement.

• High levels of conflict.

• Controlling behaviour.

may create psychological stress and confusion.

This stress may contribute to:

• The original development of schizophrenia.

• The expression of an existing vulnerability.

• The severity of symptoms.

• Relapse following treatment or recovery.

AQA mark schemes identify three major family-dysfunction explanations:

1. The schizophrenogenic mother.

2. Double-bind theory.

3. Expressed emotion.

The general family-dysfunction pathway

A simplified explanation is:

dysfunctional family interaction → stress, confusion or insecurity → dysfunctional thinking and emotional distress → increased risk or worsening of schizophrenia symptoms

This is an environmental explanation because it focuses on experiences within the person’s social environment.

It contrasts with:

• inherited biological vulnerability [Genetic explanations]

• dopamine and brain functioning [Neural correlates and the dopamine hypothesis]

• dysfunctional information processing [Cognitive explanations]

These explanations do not have to be treated as mutually exclusive.

A person may possess genetic vulnerability and then experience stressful family communication.

Family dysfunction as a psychological explanation

The role of family relationships

Family-based explanations argue that the emotional environment in which a person develops or lives can affect their psychological functioning.

Family interaction may influence:

• Trust.

• Self-esteem.

• Interpretation of other people.

• Emotional regulation.

• The ability to communicate clearly.

• Stress levels.

• The meaning attached to unusual experiences.

For example, repeatedly receiving affection followed by rejection might make another person’s intentions appear unpredictable.

Persistent criticism may also increase stress in someone already vulnerable to symptoms.

Development, maintenance and relapse

It is important to distinguish three possible roles.

Role	Meaning
Development	Family dysfunction contributes to the initial emergence of schizophrenia
Maintenance	Family interaction helps symptoms continue
Relapse	Family stress contributes to symptoms returning after improvement

The schizophrenogenic-mother and double-bind explanations were originally presented mainly as accounts of development.

Expressed emotion has been particularly important in explaining relapse.

📌 Exam tip: Do not automatically write that every form of family dysfunction causes the original condition. High expressed emotion is more securely associated with the course and relapse of schizophrenia.

The schizophrenogenic mother

What does schizophrenogenic mean?

The word schizophrenogenic means “schizophrenia-producing”.

The concept was proposed by Fromm-Reichmann within a psychodynamic tradition.

She suggested that the behaviour of a particular type of mother could contribute to schizophrenia in her child.

AQA’s 2024 mark scheme describes the proposed mother as:

• Cold.

• Rejecting.

• Controlling.

Characteristics of the proposed mother

The schizophrenogenic mother was described as:

• Emotionally cold.

• Distant.

• Rejecting.

• Controlling.

• Dominating.

• Unresponsive to the child’s emotional needs.

The child may experience the relationship as:

• Unpredictable.

• Unloving.

• Unsafe.

• Difficult to understand.

Proposed effect on the child

The explanation suggests that the child may develop:

• Insecurity.

• Low self-worth.

• Distrust.

• Confusion about relationships.

• Suspiciousness towards other people.

These experiences might contribute to symptoms such as:

• Paranoid delusions.

• Social withdrawal.

• Distorted interpretations of other people’s intentions.

A possible pathway is:

cold and rejecting parenting → insecurity and distrust → suspicious interpretation of relationships → increased risk of paranoid thinking

Applying the explanation

A parent closely controls every part of their child’s life but rarely displays warmth. The child reports feeling rejected and says that nobody can be trusted.

A schizophrenogenic-mother explanation would suggest that:

• The parent is emotionally cold and controlling.

• The child experiences rejection rather than secure affection.

• This may create distrust and insecurity.

• These patterns could contribute to paranoid interpretations.

Problems with the term

The term is now regarded as problematic because it:

• Places responsibility primarily on mothers.

• Uses highly blaming language.

• Reflects historical gender expectations.

• Suggests a direct causal relationship that has not been established.

• Overlooks fathers, siblings and wider social influences.

• Ignores biological vulnerability.

It should be described as a historical psychological explanation, not as an established fact about the families of people with schizophrenia.

Gender bias

The schizophrenogenic-mother account may be gender biased because it focuses blame specifically on women.

Mothers were treated as principally responsible for:

• The child’s emotional development.

• Family relationships.

• The later psychological condition.

The father’s role was often given much less attention.

This reflects gender bias in psychological explanations [Gender bias].

Double-bind theory

What is a double bind?

Double-bind theory was proposed by Bateson and colleagues.

A double bind occurs when a person receives two conflicting messages at different levels of communication.

For example:

• The verbal message appears loving.

• The non-verbal behaviour communicates rejection.

Whichever message the child responds to, the response may be treated as wrong.

The person is placed in a no-win situation.

AQA describes the theory as involving contradictory verbal and non-verbal messages, such as communicating affection while simultaneously pushing the child away.

Verbal and non-verbal communication

Communication includes both words and behaviour.

Verbal message

What is said aloud.

For example:

“Of course I want you to spend time with me.”

Non-verbal message

Information communicated through:

• Tone of voice.

• Facial expression.

• Body position.

• Physical contact.

• Withdrawal.

• Behaviour.

The parent might say the affectionate words while:

• Turning away.

• Sounding irritated.

• Pulling away physically.

• Showing visible disapproval.

The no-win situation

The child cannot respond successfully.

Suppose a parent says:

“You know you can always talk to me.”

but repeatedly criticises the child whenever they express a feeling.

The child faces two options.

Option 1: Speak openly

The child follows the verbal message but is criticised.

Option 2: Remain silent

The child follows the non-verbal message but may be accused of being distant.

Neither response is accepted.

Repeated communication

An occasional mixed message is not enough to explain schizophrenia.

Double-bind theory concerns a repeated communication pattern within an important relationship.

The child may be unable to:

• Leave the relationship.

• Identify which message is genuine.

• Discuss the contradiction safely.

• Develop a consistent understanding of communication.

Proposed effect on cognition

Repeated double binds may teach the child that:

• Communication is unreliable.

• Surface meanings cannot be trusted.

• Other people’s intentions are hidden.

• Contradictory ideas must be accepted simultaneously.

The child may develop difficulty:

• Interpreting social communication.

• Distinguishing internal and external information.

• Constructing a coherent understanding of reality.

• Trusting their own judgement.

This could contribute to:

• Disorganised thinking.

• Paranoid delusions.

• Confused communication.

• Social withdrawal.

Double-bind pathway

A simplified sequence is:

repeated contradictory messages → confusion and stress → difficulty interpreting communication → disordered thinking or suspiciousness → schizophrenia symptoms

Example

A father tells his daughter that she should be independent. Whenever she makes her own decision, he criticises her for being inconsiderate. When she asks what he expects, he says that she should already know.

This could illustrate a double bind because:

• Independence is verbally encouraged.

• Independent action is punished.

• The daughter cannot identify a successful response.

• The contradiction cannot be discussed or resolved.

Applying double-bind theory accurately

A strong application identifies both messages.

For example:

“The parent says that Ravi is loved, which is a positive verbal message, but repeatedly pushes him away and criticises him, creating a contradictory non-verbal message. Ravi is placed in a no-win situation because responding to either message may lead to rejection.”

A weak application would say only:

“The parents send mixed messages.”

The examiner needs to see:

1. What the two messages are.

2. How they contradict each other.

3. Why the person cannot respond successfully.

Double bind versus an ordinary disagreement

Not every disagreement is a double bind.

Ordinary disagreement	Double bind
Two people openly express different opinions	One person communicates contradictory messages
The disagreement can be discussed	The contradiction cannot be safely challenged
A successful response may be possible	Every response appears wrong
May happen occasionally	Usually described as a repeated pattern
Does not necessarily undermine reality testing	May create persistent confusion

For example:

One parent says the child should go out, while the other says they should stay home.

This is disagreement between two parents.

It is not automatically a double bind from one communicator.

Expressed emotion

What is expressed emotion?

Expressed emotion, abbreviated to EE, refers to the emotional climate communicated by family members towards a person with schizophrenia.

High expressed emotion involves:

• Critical comments.

• Hostility.

• Emotional over-involvement.

These responses may increase the person’s stress and make symptoms more difficult to manage.

AQA’s mark scheme identifies criticism, disapproval, hostility and emotional over-involvement as the central elements of high EE.

Critical comments

Criticism may focus repeatedly on the person’s:

• Behaviour.

• Motivation.

• Symptoms.

• Dependence.

• Ability to work.

• Self-care.

• Social activity.

Examples include:

• “You never make any effort.”

• “You are ruining everything.”

• “Why can’t you just behave normally?”

• “You are too dependent.”

Persistent criticism may create:

• Shame.

• Anxiety.

• Conflict.

• Pressure.

• A sense of failure.

Hostility

Hostility involves a more general negative attitude towards the person.

Rather than criticising one behaviour, the family member may reject the individual as a whole.

For example:

“You are selfish and impossible to live with.”

Hostility may include:

• Anger.

• Resentment.

• Rejection.

• Blame.

• Disapproval.

Emotional over-involvement

Emotional over-involvement occurs when relatives become excessively involved in the person’s life.

It may involve:

• Overprotectiveness.

• Constant monitoring.

• Intrusion into decisions.

• Sacrificing all other activities.

• Treating the person as incapable.

• Excessive worry.

For example:

A parent repeatedly checks where their adult child is, speaks on their behalf and refuses to allow them to complete ordinary activities independently.

Support versus over-involvement

Support is not automatically high EE.

Support may involve:

• Listening.

• Encouraging independence.

• Helping when requested.

• Communicating calmly.

• Respecting the person’s choices.

Over-involvement involves excessive control or intrusion that may increase pressure and dependence.

High EE and relapse

High EE is particularly important as an explanation of relapse.

A person may:

1. Receive treatment.

2. Experience reduced symptoms.

3. Return to a highly critical, hostile or over-involved home.

4. Experience increased stress.

5. Show a return or worsening of symptoms.

The proposed pathway is:

high expressed emotion → increased stress and arousal → reduced ability to cope → relapse

Nomura’s research, cited in AQA’s 2024 mark scheme, found a higher rate of relapse in families showing high expressed emotion.

Expressed emotion does not necessarily cause the original condition

Evidence that high EE predicts relapse does not prove that it caused the person to develop schizophrenia initially.

It may be better understood as:

• A trigger for vulnerable individuals.

• A factor maintaining symptoms.

• An influence on relapse.

• Part of a reciprocal family process.

Applying expressed emotion

Since returning from hospital, Dominic’s family continually criticise his lack of activity, argue with him and monitor everything he does.

A developed application would state:

• The criticism and hostility demonstrate high expressed emotion.

• Constant monitoring suggests emotional over-involvement.

• This may increase Dominic’s stress.

• Increased stress could worsen symptoms or raise the likelihood of relapse.

The three components of expressed emotion

Component	Meaning	Scenario clue
Criticism	Repeated negative comments about behaviour	“You make no effort”
Hostility	General rejection or anger towards the person	“You are the problem”
Emotional over-involvement	Excessive concern, control or intrusion	Constantly watching and speaking for the person

A scenario may contain more than one component.

For example:

“Your family watches you constantly, complains that you are dependent and becomes angry whenever you make a mistake.”

This includes:

• Monitoring, emotional over-involvement.

• Complaints, criticism.

• Anger, hostility.

Family schism and skew

Previous AQA mark schemes have also accepted schism and skew as family-dysfunction concepts.

Family schism

A family schism occurs when conflict between parents divides the family.

Features may include:

• Persistent disagreement.

• Competition between parents.

• Each parent seeking support from the child.

• Lack of a cooperative family structure.

The child may experience:

• Conflicting loyalties.

• Unpredictable expectations.

• Chronic stress.

Family skew

A family skew occurs when one parent dominates the family while the other accepts a passive role.

The dominant parent may impose an unusual or distorted view of reality.

Other family members adapt to this view rather than challenging it.

Exam priority

The three clearest explanations for current examination preparation are:

• Schizophrenogenic mother.

• Double bind.

• Expressed emotion.

Schism and skew can provide additional detail where relevant, but they should not replace secure knowledge of the three main accounts highlighted in the 2024 assessment.

Comparing the family explanations

Explanation	Main family feature	Proposed effect	Most relevant outcome
Schizophrenogenic mother	Cold, rejecting and controlling parenting	Insecurity and distrust	Development of paranoid thinking
Double bind	Repeated contradictory messages	Confusion about communication and reality	Development of disordered thought
Expressed emotion	Criticism, hostility and over-involvement	Increased stress	Maintenance or relapse
Schism	Persistent parental conflict	Divided loyalties and stress	Vulnerability or symptom worsening
Skew	One dominating parent	Distorted family reality	Dysfunctional interpretation

Applying family dysfunction to schizophrenia

Application example 1

A parent tells Rae that they care deeply about her but regularly complains that she is too dependent and rejects her attempts to talk.

This may demonstrate double-bind communication because:

• The verbal message expresses affection.

• The behaviour communicates rejection and criticism.

• Rae cannot identify whether closeness or distance is expected.

• The resulting confusion may contribute to dysfunctional thinking.

Application example 2

Tariq’s relatives repeatedly accuse him of being lazy, become angry when he withdraws and monitor all of his daily activities.

This demonstrates high EE because:

• Accusations are critical comments.

• Anger suggests hostility.

• Monitoring suggests emotional over-involvement.

• The emotional climate may raise stress and contribute to relapse.

Application example 3

A person describes their parent as distant, controlling and unable to show warmth. They report feeling unloved and suspicious of close relationships.

This can be linked with the historical schizophrenogenic-mother account because:

• The parent is described as cold.

• The behaviour is rejecting and controlling.

• The person develops insecurity and distrust.

A balanced answer should add that the explanation is controversial and cannot establish that the parent caused schizophrenia.

Applying the 2024 Jade scenario

AQA’s June 2024 question described a person whose parents communicated care while criticising dependence, watched her closely, argued about her treatment and included a mother experienced as cold and unloving. The mark scheme allowed these details to be connected with double binds, high expressed emotion and the schizophrenogenic-mother explanation.

Caring while criticising

This may represent a double bind:

• “We care about you” communicates affection.

• Complaining about dependence communicates rejection or disapproval.

Watching closely

This suggests:

• Emotional over-involvement.

• Controlling behaviour.

Criticism

This is a direct component of high expressed emotion.

Arguments about treatment

This indicates:

• Negative family communication.

• Conflict.

• Possible family schism.

Feeling unloved by the mother

This can be linked with the schizophrenogenic-mother concept because the mother is experienced as:

• Cold.

• Rejecting.

• Emotionally distant.

📌 Application rule: Do not label the entire scenario once. Link each separate detail to the most relevant concept.

Evaluating family-based explanations

Evidence supporting double-bind theory

Bateson developed the theory partly from observations and case material involving families of people diagnosed with schizophrenia.

The communication patterns appeared to include:

• Contradictory messages.

• Difficulty discussing the contradiction.

• Confusing emotional relationships.

AQA recognises Bateson’s case-study observations as relevant evidence for the explanation.

Limitation of Bateson’s evidence

Case observations cannot establish that double binds caused schizophrenia.

Possible problems include:

• Small or unusual samples.

• Subjective interpretation.

• Retrospective accounts.

• Lack of a suitable control group.

• Families being observed after schizophrenia had developed.

The communication difficulty may have developed in response to the person’s symptoms.

Evidence supporting expressed emotion

Nomura found higher relapse rates among people returning to families with high expressed emotion.

This supports the claim that:

• Criticism.

• Hostility.

• Emotional over-involvement.

can increase stress and worsen the course of schizophrenia.

What the EE evidence supports

This evidence supports an explanation of:

• Relapse.

• Maintenance.

• Symptom severity.

It provides weaker evidence that high EE originally caused schizophrenia.

A careful conclusion is:

High expressed emotion appears to influence the course of schizophrenia, particularly among people who already possess vulnerability.

Evidence from difficult childhood relationships

Read and colleagues reported that many people with schizophrenia described difficult or abusive childhood family relationships.

This is consistent with the idea that severe family stress may contribute to psychological vulnerability. AQA accepts this work as evidence relevant to family dysfunction.

Limitation of retrospective evidence

Adults reporting childhood experiences may be affected by:

• Forgetting.

• Reconstruction.

• Current distress.

• Knowledge of their diagnosis.

• A desire to explain their symptoms.

This is retrospective evidence because people report events after the condition has developed.

A relationship between childhood adversity and later diagnosis does not prove that family dysfunction caused the condition.

Cause and effect

The major problem is deciding which variable came first.

The family-dysfunction explanation proposes:

dysfunctional family interaction → schizophrenia

An alternative direction is:

schizophrenia symptoms → family stress and dysfunctional interaction

For example:

• Avolition may be interpreted as laziness, leading to criticism.

• Delusions may produce conflict and distrust.

• Unpredictable behaviour may make relatives overprotective.

• Repeated crises may increase anger and frustration.

The relationship may be reciprocal:

symptoms increase family stress → family stress worsens symptoms → symptoms create further stress

AQA repeatedly recognises the difficulty of establishing whether family dysfunction is a cause or consequence of schizophrenia.

The direction-of-causality problem

Family dysfunction as cause

Possible pathway:

criticism and contradictory communication → stress and confusion → symptoms

Family dysfunction as effect

Possible pathway:

symptoms → stress and uncertainty among relatives → criticism or over-involvement

Bidirectional relationship

Most realistically:

family interaction affects symptoms, and symptoms affect family interaction

This reciprocal account is more complex than a simple one-way explanation.

Family therapy as practical support

Family therapy aims to:

• Reduce expressed emotion.

• Improve communication.

• Increase understanding.

• Develop realistic expectations.

• Reduce family stress.

• Support the person with schizophrenia.

The practical success of reducing dysfunctional family interactions [Family therapy] is consistent with the claim that family climate affects symptoms.

AQA’s 2025 mark scheme identifies reducing expressed emotion, improving communication and increasing tolerance as central aims of family therapy.

Treatment effectiveness does not prove original cause

Family therapy may reduce relapse even if family dysfunction did not originally cause schizophrenia.

For example:

Physiotherapy may improve recovery from an injury without proving that a lack of physiotherapy caused the injury.

Similarly:

Improving communication may reduce stress without showing that poor communication created the original condition.

Family therapy supports the view that family environment affects the course of schizophrenia, not necessarily that relatives caused it.

Ethical issue: blaming families

Parent blaming

The explanations may imply that parents are responsible for their child’s condition.

This is particularly severe in the schizophrenogenic-mother explanation, which directly presents the mother as “schizophrenia-causing”.

Possible consequences include:

• Guilt.

• Shame.

• Family conflict.

• Stigma.

• Reluctance to seek support.

• Damage to the relationship between relatives and professionals.

Families may already be under pressure

Relatives may already experience:

• Worry.

• Financial strain.

• Interrupted employment.

• Fear during crises.

• Responsibility for care.

• Uncertainty about symptoms.

Blaming them may add distress without improving treatment.

Family behaviour may be understandable

Over-involvement may arise because relatives are trying to protect someone.

Criticism may develop through:

• Exhaustion.

• Lack of information.

• Frustration.

• Fear.

• Limited professional support.

This does not make harmful communication unimportant, but it provides a more compassionate explanation.

Distinguishing responsibility from influence

It is possible to state that family communication influences symptoms without claiming that families deliberately caused schizophrenia.

A responsible conclusion is:

Family interactions may alter stress and relapse risk, but responsibility cannot be assigned simplistically to parents.

The 2024 examiner report identified ethical family blame as one of the strongest discussion points used in high-quality answers.

Social sensitivity

Family-dysfunction research is socially sensitive because it can affect:

• People with schizophrenia.

• Parents.

• Siblings.

• Family relationships.

• Public attitudes.

Careless interpretations might suggest:

• Mothers cause severe mental illness.

• Every family of a person with schizophrenia is dysfunctional.

• Relatives are responsible for relapse.

• Biological vulnerability is unimportant.

None of these conclusions is justified.

Researchers should:

• Use cautious language.

• Avoid universal claims.

• Distinguish correlation from causation.

• Recognise pressures experienced by relatives.

• Involve families constructively in treatment.

Environmental determinism

Family dysfunction is an environmentally deterministic explanation.

It suggests that behaviour and symptoms are shaped by external experiences such as:

• Parenting.

• Communication.

• Criticism.

• Emotional climate.

A strongly deterministic account may imply that the child has little control over development.

Strength of determinism

Deterministic explanations allow psychologists to:

• Search for predictable relationships.

• Identify risk factors.

• Develop treatments.

• Test whether reducing stress lowers relapse.

Limitation of determinism

A hard deterministic version overlooks:

• Individual resilience.

• Different interpretations of the same family environment.

• Biological vulnerability.

• Supportive relationships outside the family.

• The person’s coping strategies.

Not everyone exposed to contradictory or critical communication develops schizophrenia.

This weakens any claim that family dysfunction is sufficient by itself.

The issue links with environmental determinism and personal agency [Free will and determinism].

Environmental reductionism

Family explanations may be environmentally reductionist because they reduce schizophrenia to a limited number of family processes.

For example:

• One parent’s coldness.

• Contradictory messages.

• Critical comments.

Schizophrenia is a complex condition involving possible influences from:

• Genes.

• Neurotransmitters.

• Brain development.

• Cognitive processing.

• Trauma.

• Wider social adversity.

Focusing only on the family may oversimplify the condition.

Value of a social-psychological level

Family explanations nevertheless add something that biological explanations may miss.

They consider:

• Relationships.

• Communication.

• Emotional meaning.

• Everyday stress.

• The social context of relapse.

AQA has contrasted family dysfunction and expressed emotion at a social-psychological level with dopamine action at a lower biological level.

This links with different levels of psychological explanation [Holism and reductionism].

Comparison with biological explanations

Family dysfunction	Biological explanations
Psychological and social level	Biological level
Focuses on family communication and emotion	Focuses on genes, brain regions and neurotransmitters
Emphasises nurture	Emphasises nature
Family plays an active environmental role	Family may transmit vulnerability genetically
Leads towards family therapy	Leads towards drug treatment
Environmentally deterministic	Biologically deterministic
Risks blaming parents	May reduce blame but increase biological stigma
Often based on observations and correlations	Often based on twin, genetic and scanning evidence

AQA’s November 2020 mark scheme emphasised that biological explanations involve the family passively through heredity, whereas family dysfunction gives relatives a more active causal role through communication, conflict and expressed emotion.

Both face causality problems

Biological differences may be consequences rather than causes of schizophrenia.

Family dysfunction may also be a consequence rather than a cause.

Neither explanation gains automatic causal status simply because an association is found.

Both have practical applications

• Biological explanations support medication.

• Family explanations support family therapy.

The existence of two useful treatments suggests that schizophrenia can be approached at several levels.

An interactionist explanation

The family environment may be most convincing when combined with biological vulnerability.

A person might inherit genetic vulnerability to schizophrenia [Genetic explanations].

High family stress may then act as a trigger.

A possible sequence is:

genetic or neural vulnerability + double binds, criticism or hostility → increased stress → symptoms or relapse

This avoids claiming that:

• Genes alone are sufficient.

• Family behaviour alone is sufficient.

The interaction is covered fully in biological vulnerability and environmental stress [Interactionist explanations and treatments].

Family dysfunction as stress

Within a diathesis-stress approach:

• Genetic or neural factors form the diathesis.

• Family dysfunction acts as environmental stress.

• The combination increases risk.

High expressed emotion may also trigger relapse after the condition has developed.

Individual differences

People may respond differently to the same family environment.

Possible protective factors include:

• Supportive friendships.

• Effective coping skills.

• Access to treatment.

• Financial security.

• A trusted family member.

• Reduced biological vulnerability.

Possible risk factors include:

• Genetic loading.

• Other life stress.

• Social isolation.

• Substance use.

• Previous episodes.

This shows why family dysfunction is better viewed as a risk factor than as an inevitable cause.

Cultural considerations

Family communication differs across cultures.

For example, close involvement in an adult child’s life might be viewed as:

• Intrusive in one cultural setting.

• Ordinary family responsibility in another.

The meaning of emotional involvement therefore depends partly on context.

However, this does not mean that criticism and hostility are harmless whenever they occur within a cultural tradition.

Researchers must examine:

• How behaviour is experienced by the person.

• Whether it increases distress.

• Whether it predicts symptom worsening.

• Whether the measurement of high EE is culturally appropriate.

Methodological issues in family research

Correlational evidence

Researchers cannot ethically allocate children to:

• Cold parenting.

• Double-bind communication.

• High hostility.

Family research therefore usually observes naturally occurring relationships.

This means that:

• Variables cannot be controlled fully.

• Third variables may explain the association.

• Causal conclusions are limited.

Third variables

Possible third variables include:

• Genetic vulnerability shared by family members.

• Poverty or financial pressure.

• Trauma.

• Parental mental health.

• Social isolation.

• Substance use.

• Limited access to professional support.

For example, parental mental-health difficulties might contribute both to:

• Dysfunctional communication.

• Genetic vulnerability in the child.

The apparent environmental relationship could partly involve genetic transmission.

Retrospective reports

People may be asked to describe childhood relationships after developing schizophrenia.

Retrospective reports may be affected by:

• Memory distortion.

• Current emotional state.

• Reconstruction.

• Diagnosis-related expectations.

Observer judgement

Researchers may need to classify communication as:

• Critical.

• Hostile.

• Over-involved.

• Contradictory.

This can involve subjective judgement.

Objectivity may be improved by:

• Clear coding criteria.

• Several independent observers.

• Observer training.

• Inter-rater reliability checks.

• Keeping coders unaware of relapse outcomes.

Prospective research

A prospective study measures family interaction before observing later outcomes.

For example:

1. Researchers assess expressed emotion after discharge.

2. Participants are followed for a year.

3. Relapse rates are recorded.

This establishes that high EE occurred before relapse.

It improves temporal ordering but still does not establish that EE was the only cause.

Ethical difficulties

Researchers studying families should avoid:

• Increasing blame.

• Provoking conflict.

• Revealing private information carelessly.

• Labelling one relative as responsible.

• Pressuring the person with schizophrenia to participate.

Confidentiality and sensitivity are especially important.

Applying family dysfunction in examinations

Step 1: Identify the family behaviour

Look for:

• Coldness.

• Rejection.

• Control.

• Contradictory messages.

• Criticism.

• Hostility.

• Over-involvement.

• Conflict.

Step 2: Select the relevant explanation

Scenario detail	Most likely concept
Cold, rejecting and controlling parent	Schizophrenogenic mother
Affectionate words combined with rejection	Double bind
Repeated negative comments	Critical component of EE
General anger and rejection	Hostility component of EE
Constant monitoring and protection	Emotional over-involvement
Parents divided by conflict	Schism
One parent dominates the family	Skew

Step 3: Explain the psychological mechanism

Do not stop after naming the concept.

Explain how it may produce:

• Confusion.

• Distrust.

• Stress.

• Insecurity.

• Relapse.

Step 4: Use cautious language

Use:

• “May contribute.”

• “Could increase stress.”

• “Is consistent with.”

• “May raise relapse risk.”

Avoid:

• “Definitely caused.”

• “The parent gave the child schizophrenia.”

• “Every critical family creates schizophrenia.”

Application sentence structure

Use:

scenario detail → family concept → psychological effect → possible symptom outcome

For example:

“The parents repeatedly tell Lena that they care while criticising every attempt she makes to become independent. This creates a double bind because the verbal message of affection conflicts with rejection of her behaviour. Repeated no-win communication may increase confusion and difficulty interpreting other people’s intentions.”

Structuring a 16-mark application essay

The June 2024 family-dysfunction question allocated:

• AO1: 6 marks

• AO2: 4 marks

• AO3: 6 marks 

A useful structure is:

Paragraph 1: Brief overview

Define family dysfunction and explain the general role of stress and communication.

Paragraph 2: Double bind and application

• Explain contradictory messages.

• Identify both messages in the scenario.

• Explain the no-win situation.

Paragraph 3: Expressed emotion and application

• Explain criticism, hostility and over-involvement.

• Apply each available detail.

Paragraph 4: Schizophrenogenic mother and application

• Explain coldness, rejection and control.

• Link with insecurity or distrust.

• Acknowledge the historical and controversial nature of the theory.

Paragraph 5: Evidence and causality

• Use Bateson, Nomura or Read.

• Explain what the finding supports.

• Discuss reverse causality.

Paragraph 6: Ethics and alternatives

• Discuss family blame.

• Compare with biological vulnerability.

• Reach an interactionist conclusion.

Overall conclusion

Family-dysfunction explanations identify three major ways in which family experience may contribute to schizophrenia.

• The schizophrenogenic-mother explanation focuses on cold, rejecting and controlling parenting.

• Double-bind theory focuses on repeated contradictory messages that place the child in a no-win situation.

• Expressed emotion focuses on criticism, hostility and emotional over-involvement, especially as predictors of relapse.

Evidence suggests that difficult family relationships and high expressed emotion are associated with schizophrenia and relapse.

However:

• Most evidence is correlational.

• Symptoms may produce family dysfunction.

• Retrospective reports may be unreliable.

• The explanations risk blaming parents, particularly mothers.

• Biological vulnerability is overlooked by a family-only account.

The strongest conclusion is that family interaction can affect stress and the course of schizophrenia, but it is more convincing as part of an interactionist explanation than as a single sufficient cause.

Key Words 🔑

Key word	Student-friendly definition	How it may be used in an exam
Family dysfunction	Unhealthy or stressful patterns of family communication and relationships	Introduce the psychological explanation
Psychological explanation	An account based on mental processes, behaviour or social experience	Distinguish the explanation from biological accounts
Schizophrenogenic mother	Historical proposal that a cold, rejecting and controlling mother contributes to schizophrenia	Apply maternal coldness or control
Fromm-Reichmann	Psychologist associated with the schizophrenogenic-mother explanation	Identify the origin of the concept
Double bind	A no-win situation created by contradictory messages	Apply verbal and non-verbal inconsistency
Bateson	Psychologist associated with double-bind theory	Describe the communication explanation
Verbal communication	Information expressed in spoken or written words	Identify one side of a double bind
Non-verbal communication	Information expressed through behaviour, expression, posture or tone	Identify the contradictory message
No-win situation	A situation in which every available response is treated as wrong	Explain the effect of a double bind
Expressed emotion	The emotional climate communicated by relatives towards a person	Explain maintenance and relapse
EE	Abbreviation for expressed emotion	Use specialist terminology efficiently
Critical comments	Repeated negative judgements about the person’s behaviour	Identify one component of high EE
Hostility	General anger, rejection or dislike directed towards the person	Identify one component of high EE
Emotional over-involvement	Excessive concern, control or intrusion into the person’s life	Apply constant monitoring
Relapse	Return or worsening of symptoms after improvement	Explain the main outcome linked with high EE
Maintenance	Continuation of symptoms over time	Explain how family stress may sustain difficulties
Schism	Persistent division or conflict between parents	Apply a divided family structure
Skew	Family structure in which one parent dominates and another is passive	Explain a distorted family balance
Stress	Psychological and physiological pressure produced by demands	Explain the mechanism linking family climate with symptoms
Retrospective evidence	Information collected about events that happened in the past	Evaluate reports of childhood relationships
Direction of causality	The question of which associated variable caused the other	Evaluate family dysfunction research
Reverse causality	The possibility that schizophrenia causes family dysfunction	Present an alternative explanation
Bidirectional relationship	A relationship in which family interaction and symptoms affect each other	Give a balanced causal conclusion
Environmental determinism	The view that behaviour is controlled by external experiences	Evaluate family explanations
Environmental reductionism	Explaining complex behaviour through a small number of environmental factors	Evaluate explanatory completeness
Parent blaming	Holding parents responsible for a child’s psychological condition	Discuss ethical implications
Social sensitivity	Potential for research findings to affect individuals or groups	Evaluate stigma and family blame
Family therapy	Treatment aiming to improve communication and reduce stress within the family	Explain a practical application
Diathesis-stress model	Explanation combining vulnerability with environmental stress	Present an interactionist alternative
Inter-rater reliability	Agreement between observers coding the same family interaction	Evaluate observational family research

Hints from the Examiner Reports 💡

Examiner hint: Cover explanations in enough depth. In June 2024, many students described all three main accounts, but some reduced each to only a couple of sentences. This breadth-without-depth approach restricted access to the highest level.

For each explanation, include:

1. The family behaviour.

2. Its psychological effect.

3. How it may contribute to symptoms.

4. An application or evaluation.

Examiner hint: Apply every available part of the scenario. The June 2024 stem contained separate clues for:

• Double binds.

• Maternal coldness.

• Control.

• Criticism.

• Emotional over-involvement.

• Negative family communication.

Examiner hint: State both sides of a double bind. Writing “the parents send mixed messages” is usually too vague.

Examiner hint: Do not use double bind and expressed emotion as interchangeable terms.

• Double bind concerns contradictory communication.

• Expressed emotion concerns criticism, hostility and over-involvement.

Examiner hint: Link expressed emotion with stress and relapse. Avoid claiming that it necessarily caused the original development of schizophrenia.

Examiner hint: Develop evidence. Do not merely write:

“Nomura supports expressed emotion.”

Explain that higher relapse in high-EE families supports the proposed relationship between family emotional climate and symptom return.

Examiner hint: Cause and effect was one of the strongest evaluation points in the 2024 responses. Explain specifically how hallucinations, delusions or avolition could produce criticism or overprotectiveness from relatives.

Examiner hint: Ethical discussion needs a consequence. Explain how blaming relatives may create guilt, stigma or reluctance to take part in treatment.

Examiner hint: Practical application to family therapy was used effectively by stronger students. Remember that successful therapy supports a role for family stress but does not prove that families caused schizophrenia.

Examiner hint: When comparing family dysfunction with a biological account, compare directly:

“Family dysfunction treats the family as an active environmental influence, whereas genetic explanations involve the family passively through inherited DNA.”

Common Mistakes ⚠️

Mistake: Saying family dysfunction means every family argument causes schizophrenia

Why this is incorrect:

The explanation concerns persistent and stressful patterns of interaction, not ordinary occasional conflict.

How to improve:

Refer to repeated criticism, contradictory communication or emotional over-involvement.

Mistake: Saying family dysfunction is a biological explanation

Why this is incorrect:

It is a psychological and environmental explanation.

How to improve:

Contrast it with genes and neural correlates.

Mistake: Treating the schizophrenogenic mother as established fact

Why this is incorrect:

It is a historical and controversial proposal without proof of simple causation.

How to improve:

Use language such as “Fromm-Reichmann proposed”.

Mistake: Saying schizophrenogenic means the mother has schizophrenia

Why this is incorrect:

The term means “schizophrenia-producing”.

How to improve:

Explain the proposed cold, rejecting and controlling behaviour.

Mistake: Blaming all mothers of people with schizophrenia

Why this is inaccurate and unethical:

Families vary, and the explanation has serious evidential and gender-bias problems.

How to improve:

Discuss it critically and avoid universal claims.

Mistake: Defining a double bind as two parents disagreeing

Why this is incomplete:

A double bind usually involves contradictory messages received by the same person in a no-win situation.

How to improve:

Identify the conflicting verbal and non-verbal messages.

Mistake: Giving only one message in a double bind

Why this is incomplete:

The contradiction is the central feature.

How to improve:

State what is communicated at both levels.

Mistake: Saying one mixed message causes schizophrenia

Why this is incorrect:

Bateson referred to a repeated pattern within an important relationship.

How to improve:

Explain chronic confusion and stress.

Mistake: Defining expressed emotion as expressing any emotion

Why this is incorrect:

High EE has specific components.

How to improve:

Name criticism, hostility and emotional over-involvement.

Mistake: Treating emotional involvement as automatically harmful

Why this is incorrect:

Support and care can be helpful.

How to improve:

Explain that the involvement becomes excessive, controlling or intrusive.

Mistake: Saying EE only explains the initial development of schizophrenia

Why this is inaccurate:

It is particularly associated with relapse and maintenance.

How to improve:

Link high EE with stress following treatment or discharge.

Mistake: Saying evidence of relapse proves initial causation

Why this is incorrect:

Relapse occurs after the condition has already developed.

How to improve:

State precisely which stage of schizophrenia the evidence supports.

Mistake: Ignoring reverse causality

Why this weakens evaluation:

Symptoms can alter family behaviour.

How to improve:

Explain how withdrawal or delusions might trigger criticism or overprotectiveness.

Mistake: Naming a study without its implication

Why this is incomplete:

A name alone does not provide evaluation.

How to improve:

State the finding and explain whether it supports development, maintenance or relapse.

Mistake: Saying effective family therapy proves families caused schizophrenia

Why this is incorrect:

Treatment can reduce symptoms without identifying the original cause.

How to improve:

Use family therapy as evidence that family stress affects the course of the condition.

Mistake: Describing family therapy instead of family dysfunction

Why this loses focus:

One is an explanation and the other is a treatment.

How to improve:

Use therapy briefly as evaluation, then return to the explanatory claim.

Mistake: Comparing explanations in separate paragraphs

Why this may weaken comparison:

Two descriptions do not automatically form a comparison.

How to improve:

Use linked language such as “whereas”, “both” and “in contrast”.

Exam-Style Questions ✍️

Questions

1. What is meant by family dysfunction as an explanation for schizophrenia?[2 marks]

2. Outline the schizophrenogenic-mother explanation of schizophrenia.[3 marks]

3. Explain what Bateson meant by a double bind.[4 marks]

4. Explain high expressed emotion as an explanation for relapse in schizophrenia.[4 marks]

5. A parent tells Morgan, “You can always come to me for support.” Whenever Morgan asks for help, the parent becomes irritated and says that Morgan is too dependent.

Explain this interaction using double-bind theory.[4 marks]

6. Since returning home after treatment, Aisha’s relatives criticise her lack of activity, frequently become angry with her and monitor everything she does.

Explain Aisha’s family environment using expressed emotion.[6 marks]

7. Explain one difference between double-bind theory and expressed emotion.[4 marks]

8. Researchers assess expressed emotion in 80 families after a relative is discharged from hospital. One year later, they record the following results:

Family environment	Number who relapsed	Number followed
High expressed emotion	24	40
Low expressed emotion	10	40

a) Calculate the percentage of participants who relapsed in the high-EE group.[2 marks]

b) Calculate the percentage who relapsed in the low-EE group.[2 marks]

c) Explain one conclusion and one limitation of these findings.[4 marks]

9. Explain one strength and one limitation of family-based explanations of schizophrenia.[6 marks]

10. Compare family dysfunction with genetic explanations of schizophrenia.[8 marks]

11. Discuss family dysfunction as an explanation for schizophrenia. Refer to the following scenario in your answer.

A person’s parents repeatedly state that they want them to become independent but criticise every independent decision. One parent is emotionally distant, while both parents closely monitor the person’s activities and frequently express anger about their symptoms.

[16 marks]

Answers and Mark Scheme

Question 1

Award up to two marks:

• Family dysfunction refers to unhealthy or stressful patterns of communication and emotional interaction within a family.

• These patterns are proposed to contribute to the development, maintenance or relapse of schizophrenia.

Question 2

Award up to three marks:

• Fromm-Reichmann proposed the concept of the schizophrenogenic mother.

• The mother was described as cold, rejecting and controlling.

• This relationship was thought to create insecurity and distrust.

• These experiences might contribute to suspicious or paranoid thinking.

Answers should make clear that this is a proposed historical explanation.

Question 3

Award up to four marks:

• A double bind involves two contradictory messages.

• The contradiction may occur between verbal and non-verbal communication.

• Responding to either message leads to an unwanted outcome.

• The person is placed in a no-win situation.

• Repeated double binds may create confusion about communication and reality, contributing to disordered thought.

Question 4

Award up to four marks:

• High expressed emotion involves criticism, hostility and emotional over-involvement.

• These family interactions increase stress for the person with schizophrenia.

• Increased stress may reduce coping and worsen symptoms.

• The person may therefore be more likely to relapse after treatment.

• EE is more directly an explanation of maintenance or relapse than proof of initial causation.

Question 5

Award up to four marks:

• The parent’s statement that support is always available is a positive verbal message.

• Irritation and criticism when Morgan seeks help communicate rejection.

• The two messages contradict each other.

• Morgan cannot respond successfully because seeking help and not seeking help may both be criticised.

• This repeated no-win communication may create stress and confusion.

Question 6

Award up to six marks:

• Criticising Aisha’s inactivity is the critical-comments component of high EE.

• Frequent anger demonstrates hostility.

• Monitoring everything she does demonstrates emotional over-involvement.

• The family environment may place Aisha under considerable psychological stress.

• This stress may increase symptom severity or the risk of relapse.

• The scenario does not establish that the family originally caused schizophrenia.

Question 7

Award up to four marks:

• Double-bind theory concerns contradictory messages within communication.

• It proposes that the person is placed in a no-win situation and becomes confused.

• Expressed emotion concerns criticism, hostility and emotional over-involvement.

• High EE is associated particularly with stress and relapse.

• Double bind was proposed mainly as a developmental explanation, whereas EE is often used to explain maintenance or recurrence.

Question 8a

4024​×100=60%

Award one mark for suitable working and one mark for:

60%

Question 8b

4010​×100=25%

Award one mark for suitable working and one mark for:

25%

Question 8c

Award up to four marks.

Possible conclusion:

• Relapse was more frequent in the high-EE group.

• The difference was 35 percentage points.

• This is consistent with high expressed emotion increasing stress and relapse risk.

Possible limitation:

• The study is correlational and does not establish that high EE caused relapse.

• More severe symptoms could have produced greater criticism and involvement.

• Medication adherence, initial symptom severity or another variable may differ between groups.

• Statistical significance cannot be claimed without an inferential test.

Question 9

Award up to three marks for a developed strength and three for a developed limitation.

Possible strength:

Research has found higher relapse rates among people living in families with high expressed emotion. This supports the proposal that criticism, hostility and over-involvement increase stress and influence the course of schizophrenia.

Possible limitation:

The direction of causality is uncertain. Relatives may become critical or overprotective because they are responding to avolition, delusions or repeated crises, so family dysfunction may be a consequence rather than the original cause.

Alternative creditworthy points include:

• Evidence from difficult childhood relationships.

• Practical application to family therapy.

• Retrospective evidence.

• Family blame.

• Environmental reductionism.

• Alternative biological explanations.

• Interactionist accounts.

Question 10

A strong comparison may include:

• Family dysfunction is a psychological and environmental explanation.

• Genetics is a biological explanation.

• Family dysfunction emphasises nurture, while genetics emphasises nature.

• Family dysfunction gives relatives an active role through communication.

• Genetics gives biological relatives a passive role through DNA transmission.

• Family explanations include double binds and high expressed emotion.

• Genetic explanations include risk alleles and polygenic vulnerability.

• Family dysfunction may lead to parent blaming.

• Genetic explanations may reduce blame but increase biological fatalism.

• Both can be deterministic.

• Both rely heavily on naturally occurring correlational evidence.

• Both face cause-and-effect problems.

• Family dysfunction leads towards family therapy.

• Genetics contributes to biological treatment and early-risk research.

• The explanations may interact within a diathesis-stress model.

Higher marks require direct comparison throughout.

Question 11

A strong response should include:

Knowledge and understanding

• Family dysfunction as stressful family communication or emotional interaction.

• The schizophrenogenic-mother explanation.

• Cold, rejecting and controlling behaviour.

• Insecurity and distrust.

• Double-bind theory.

• Contradictory verbal and non-verbal messages.

• No-win communication.

• Repeated confusion contributing to disordered thought.

• Expressed emotion.

• Criticism.

• Hostility.

• Emotional over-involvement.

• Stress and relapse.

• Possible reference to schism or skew.

Application

• Encouraging independence while criticising independent decisions is a double bind.

• The person receives incompatible expectations and cannot respond successfully.

• The emotionally distant parent may be linked with the schizophrenogenic-mother account.

• Close monitoring demonstrates emotional over-involvement.

• Anger demonstrates hostility.

• Criticism of symptoms adds to high EE.

• The family climate may increase stress and relapse risk.

Evaluation

• Bateson’s observations provide some support for double-bind communication.

• Case observations cannot demonstrate causation.

• Nomura’s relapse evidence supports high EE.

• Relapse evidence does not establish original development.

• Read’s evidence links difficult childhood relationships with schizophrenia.

• Retrospective reports may be affected by memory and current distress.

• Symptoms may cause family dysfunction.

• The relationship may be bidirectional.

• Effective family therapy supports a role for family stress.

• Treatment success does not prove original cause.

• The explanation risks blaming parents, particularly mothers.

• The schizophrenogenic-mother account is gender biased.

• Family explanations may be environmentally deterministic.

• They may reduce a complex condition to a few family processes.

• Biological evidence provides an alternative explanation.

• Family stress may interact with genetic or neural vulnerability.

• An interactionist account is more complete than family dysfunction alone.

Higher-level responses will apply separate details of the scenario to separate family concepts, develop evidence rather than merely naming researchers and distinguish factors affecting relapse from claims about the original cause.