Beneath the Surface of Expressed Emotion (EE)

Abstract

Expressed emotion (EE) is a multidimensional construct that was initially investigated in the context of schizophrenia but has come to be researched across a wide spectrum of psychiatric disorders, including eating disorders. In this chapter, we argue that while EE research in eating disorders has undoubtedly made a significant contribution, it is important to think more critically about this construct. We contend that EE needs to be integrated with a wider body of evidence on the neurobiology of eating disorders, temperament, cognitive appraisal, and emotion regulation. Furthermore, to develop a more contextual understanding of EE, we need to consider factors such as age, culture and eating disorder diagnosis and history, as well as individual and family characteristics. We outline a theoretical model that integrates the different findings and offers a framework that allows EE to be used not just as a treatment predictor or moderator to inform the choice of treatment but that can also be used to shape individual treatment strategies as part of an evidence-based treatment approach. We review up-to-date key research findings on the role of EE in the process of treatment in light of these ideas before concluding with recommendations for future EE research.