Perceived expressed emotion in the siblings and parents of hospitalized patients with anorexia nervosa

Abstract

Objective: The present study investigated the relationship between the level of perceived Expressed Emotion (EE) of the siblings and parents of patients hospitalized with anorexia nervosa and its effect on weight gain and psychological functioning. Method: The Level of Expressed Emotion (LEE) Scale was administered on admission to 19 patients with anorexia nervosa who completed the LEE three times so as to identify their perceptions of their relationship with their closest age sibling, mother, and father. They were also required to complete the Eating Disorder Inventory 2 (EDI-2). Patients' closest age sibling completed the Family Attitude Scale (FAS). The patients' body mass index (BMI) was calculated 6 weeks later, and the EDI-2 readministered. Results: Perceived EE was not predictive of BMI change after 6 weeks of hospitalization. A composite perceived family EE score was a significant predictor of change on the Interpersonal Distrust, Maturity Fears, and Perfectionism subscales of the EDI-2. Discussion: These findings suggest that patients' perceptions of their relationships with their closest aged sibling, mother, and father are poor predictors of weight gain and improvement in psychological functioning following 6 weeks of inpatient treatment.

Expressed Emotion in Families of Patients with Eating Disorders: A Review of the Literature

“…Only parental W was associated with a better weight outcome [35]. In addition, higher Final Composite perceived EE scores in a sample of 19 AN subjects were predictive of a greater improvement in Bulimia symptoms and maturity fears (defined by the EDI-2) [60].…”

“…Even if comparisons were not easy due to methodological disparities in EE assessment, higher EE levels or more marked parental criticism are generally associated with poorer patient outcome, whether global outcome or psychological functioning [32,33,35,[37][38][39]60]. EE is also reliable in predicting implication in and compliance with treatment (dropout from treatment, involvement of parents by patients) in AN and in BN.…”

“…Ten studies determined the predictive value of EE in ED: 6/10 concerned AN outcome [29,35,[37][38][39][40]60], 1/10 BN outcome [33] and 3/10 outcome in a mixed sample of ED [32,47,61]. …”

“…Eisler et al [40] indicates that initial high levels of maternal criticism were predictive of poorer patient outcome (defined by the OAS score) in AN (N=40). A higher composite perceived EE score was a significant predictor of smaller improvement in psychological functioning (Interpersonal Distrust and Perfectionism) defined by the EDI-2 [62] in a sample of AN (N=19) after a 6-week inpatient treatment [60].…”

My Sister Myself: A Controlled Study of the Relationship Between Women with a Lifetime Diagnosis of Anorexia Nervosa and Their Sisters

“…These authors took an invaluable look at the role of unaffected brothers and sisters in protecting their affected siblings and helping them to recovery (Vandereycken & Van Vreckem, ). Other researchers have also drawn attention to this lack of systematic research on the siblings of eating‐disordered individuals (Bachner‐Melman, ; Moulds et al, ). In a qualitative study of sibling relationships of women with AN, Bachner‐Melman () found that AN sisters reported on non‐relationships, on very negative or adversarial relationships, on ongoing feuds and years of non‐communication between siblings.…”