Expressed Emotion, Family Functioning, and Treatment Outcome for Adolescents with Anorexia Nervosa

Abstract

The current study examined the relation between parental expressed emotion (EE) and treatment outcome among adolescents participating in a treatment study for adolescent anorexia nervosa, as well as its impact on family functioning. One hundred and twenty-one families were assigned to family-based treatment or adolescent-focused therapy. Paternal criticism predicted lesser improvement in eating disorder psychopathology at end of treatment. There was also a significant interaction between maternal hostility and treatment, indicating that adolescents whose mothers displayed hostility had greater increases in percent of expected body weight in adolescent-focused therapy than family-based treatment. In addition, maternal hostility predicted less improvement in general family functioning and family communication at the end of treatment. Findings suggest that maternal and paternal EE may differentially impact treatment outcome and should be directly attended to in clinical settings. Future research is needed to further explore ways in which parental EE can be effectively modified in treatment.

Family-based treatment of eating disorders in adolescents: current insights

“…Parents must know that their child is not in control of the disorder, and just as they did not choose to develop the disorder, they cannot choose to stop the eating-disordered behavior. Externalization serves several purposes, one of which is to reduce parental criticism, which has been shown to have a negative impact on treatment outcome 22–26…”

Heterogeneous weight restoration trajectories during partial hospitalization treatment for anorexia nervosa

“…Thus, an important transdiagnostic clinical factor is expressed emotion, a measure of a relative's attitudes and behaviors toward an ill family member that consists of five constructs: critical comments, emotional overinvolvement, hostility, warmth, and positive remarks (Brown, Birley, & Wing, 1972). Higher levels of expressed emotion are associated with poor response to treatment, premature treatment dropout, or posttreatment relapse for a number of psychiatric disorders (Butzlaff & Hooley, 1998;Hooley, 2007;Le Grange, Eisler, Dare, & Hodes, 1992;Rienecke, Accurso, Lock, & Le Grange, 2016;Szmukler, Eisler, Russell, & Dare, 1985;van Furth et al, 1996). In a study comparing FBT delivered to the patient with the family present versus separately, high levels of maternal criticism were associated with worse outcome when patients were seen together with family at end of treatment and five-year follow-up (Eisler et al, 2000(Eisler et al, , 2007.…”

Identifying predictors associated with the severity of eating concerns in females with eating disorders

“…Comparing women diagnosed with ED to healthy controls and a psychiatric patients group (diagnosed with anxiety or depressive disorders), negative perception of the father's parenting style and a low quality of relationship have been found relevant to understand the ED onset and maintenance (Horesh, Sommerfeld, Wolf, Zubery, & Zalsman, 2015). Similarly, paternal (but not maternal) criticism predicted less psychological improvement in eating disorder psychopathology at the end of treatment (Rienecke, Accurso, Lock, & Le Grange, 2016). Overall, eating disorders might affect, in turn, the family relationships and home environment in a way that allow symptom maintenance (Loeb, Lock, Le Grange, & Greif, 2012).…”