•The family shows exaggerated involvement in the life of the patient (including needless self-sacrifice), control, verbal criticism of the patient (occasionally including violence) and hostility towards the patient (including anger and rejection)•Leads to excessive stress beyond impaired coping mechanisms.•This triggers relapse in patients with schizophrenia and may trigger the onset in a person who is already vulnerable due to their genetic make-up (diathesis-stress model)