BACKGROUND Findings that the EE level of a relative may change over time support the idea that EE may represent the circumstances of the relationship between patient and caregiver. The present study examines to what extent EE levels in relatives are related to relatives' burden of care and their perceptions of patients' deficits in social role performance. METHODS Fifty patients recently admitted to hospital with DSM-III-R diagnoses of schizophrenia or schizophreniform disorder were assessed for positive and negative symptoms. Fifty relatives who were living or were in close contact with these patients were interviewed for the assessment of EE and burden or care, and to provide information about patients' social role performance and social and behaviour problems. RESULTS High-EE relatives had considerably higher mean scores for burden of care then low-EE relatives relatives (12.5 v. 6.8, respectively, P = 0.002), and perceived more deficits in patients' social functioning than low-EE relatives (means: 16.2 v. 6.9, respectively, P = 0.004). The employment status of relatives was the only socio-demographic characteristic of relatives and patients associated with EE levels, those who were working being less likely to be high EE. Patients' psychopathology was not associated with EE levels and burden of care. CONCLUSIONS This study shows that EE and the burden of care are related. EE and burden both measure aspects of the relationship between relatives and patients. These findings suggest that EE and burden of care are more dependent on relatives' appraisal of the patient condition than on patients' actual deficits.