Predictive factors for outcome in adolescents with anorexia nervosa: To what extent does parental Expressed Emotion play a role?

Abstract

In studies on family therapy in Anorexia Nervosa, family relationships, as assessed by Expressed Emotion, have been associated with outcome. Our aim was to explore the contribution of Expressed Emotion as a predictor of 18-month outcome, above and beyond the usual predictive factors. Sixty adolescent girls suffering from Anorexia Nervosa and their parents were assessed at baseline and 18 months later. Levels of Expressed Emotion were evaluated in both parents with the Five-Minute Speech Sample. After controlling for treatment group and initial clinical status, high maternal Emotional Over-Involvement at baseline was significantly associated with better clinical state. More precisely, high maternal Emotional Over-Involvement was associated with higher nutritional status, lower eating disorder severity and fewer re-hospitalizations 18 months later. No associations were found with paternal levels of Expressed Emotion. Therefore, our study confirmed the importance of taking into account both maternal and paternal Expressed Emotion. Our results also underlined that high maternal Emotional Over-Involvement plays a positive role in the outcome of Anorexia Nervosa and needs to be explored further.

Group family psychotherapy during relapse. Case report of a novel intervention for severe and enduring anorexia nervosa

“…In relation to this, it has been described the influence of the relatives, as well as the type of close interpersonal interaction -crystallized through the expressed emotion (EE) construct-, affecting the adherence to treatment and outcome of the AN. It also has been shown there is an interaction between the level of EE and the type of family intervention, so families with higher levels of EE have a better outcome with separate family therapy (the subject with AN and the parents are treated apart), compared to cojoint family therapy (Allan, Le Grange, Sawyer, McLean, & Hughes, 2018;Duclos et al, 2018;Eisler et al, 2000;Le Grange, Hoste, Lock, & Bryson, 2011;Moskovich, Timko, Honeycutt, Zucker, & Merwin, 2017;Schmidt & Treasure, 2006;Uehara, Kawashima, Goto, Tasaki, & Someya, 2001).…”

Transgender fathering: children’s psychological and family outcomes

“…Regarding Expressed Emotions investigated with the FMSS, discussion should be cautious. Key aspects for interpreting Expressed Emotions in families are the need (i) to distinguish fathers and mothers, (ii) to distinguish the type of condition as it is well known that chronic and severe conditions may impact family functioning [27, 44-46], and (iii) to compare the same condition with the same instruments [47]. In our case, the current study is the first to explore parenting in the context of DSI.…”

“…Once you start speaking, I prefer not to answer any questions before the end of the 5 minutes ”. The critical dimension is based on the initial statement, the expressed relationship and the blame or the dissatisfaction supported, whereas the emotional over-involvement includes emotional displays, statements of attitude (e.g., extreme loving), self-sacrificing and overprotection or a lack objectivity, an excess of detail about the past, and more than five positive remarks regarding the child [27]. For each child we recorded separately one session with the mother and one session with the father.…”

Transgender fathering: Children’s psychological and family outcomes

“…Rating requires a specific training and each expressed emotion is rated low, intermediate or high. The critical dimension is based on the initial statement, the expressed relationship and the blame or the dissatisfaction supported, whereas the emotional over-involvement includes emotional displays, statements of attitude (e.g., extreme loving), self-sacrificing and overprotection or a lack objectivity, an excess of detail about the past, and more than five positive remarks regarding the child [ 28 ]. The number of occurrences of expressed emotions for each category is recorded and produces a percentage.…”

“…This analysis was limited to two groups. We used a permutation test based on a modified version of Fisher’s lady tasting tea procedure [ 28 , 30 , 33 ]. It is noticeable that since the raters know that half of the records belong to “cases” and the other half to “controls”, the ratings cannot be considered as independent realizations of a random variable, such that a traditional Student t-test or Mann-Whitney test should not be used.…”