Abstract
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.
Highlights
Expressed emotion (EE) is a concept that describes a set of attitudes and behaviors of relatives towards an ill person
Intervention, another 50 caregivers—to the SUCCEAT–ONL intervention, and 49 caregivers were included in the comparison group (COMP) group
Our study confirms that high EE is common in caregivers of adolescent patients with anorexia nervosa (AN)
Summary
Expressed emotion (EE) is a concept that describes a set of attitudes and behaviors (e.g., criticism, hostility, warmth, emotional involvement) of relatives towards an ill person. High levels of EE have further consistently been associated with treatment outcome, relapse, and treatment dropout in several other psychiatric disorders, including depression, bipolar disorder, anxiety disorders, and eating disorders (EDs) [1,2,3]. Caregivers often show extreme patterns of emotional reactions [6] They might respond too intensely and too emotional, be too directive, negative and hostile, and blame the patient (CC), or they can be overprotective, overinvolved, and take over control (EOI). The level of perceived EE from the patients’ point of view was independent from age, contact time, and duration of treatment [11]. Considering EE of caregivers in the patients’ treatment seems to be highly relevant
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