Expressed emotion in anorexia nervosa: What is inside the “black box”?

Jeanne Duclos, Géraldine Dorard, Sylvie Berthoz, Florence Curt, Sophie Faucher, Bruno Falissard, Nathalie Godart
Comprehensive Psychiatry. 2014-01-01; 55(1): 71-79
DOI: 10.1016/j.comppsych.2013.10.002

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1. Compr Psychiatry. 2014 Jan;55(1):71-9. doi: 10.1016/j.comppsych.2013.10.002.
Epub 2013 Oct 10.

Expressed emotion in anorexia nervosa: what is inside the “black box”?

Duclos J(1), Dorard G, Berthoz S, Curt F, Faucher S, Falissard B, Godart N.

Author information:
(1)Psychiatry Unit, Institut Mutualiste Montsouris, 75014 Paris, France; INSERM
U669, 75014 Paris, France. Electronic address: .

OBJECTIVE: Expressed Emotion has been called a “black box”, since little is
known about contributing factors. The aim of this study was to examine which
parental and which patient/illness-related characteristics contribute to
maternal and paternal Expressed Emotion levels.
METHOD: Sixty adolescent girls with Anorexia Nervosa (AN) and their parents
completed instruments that evaluate characteristics of the adolescent’s illness
and patient/parental psychological characteristics (depression; anxiety;
obsession-compulsion; social anxiety and alexithymia). The following
illness-related characteristics were recorded: age at AN onset, duration of
illness, AN subtype (restrictive AN-R vs. purging type AN-B), current Body Mass
Index (BMI) (in kg/m(2)), minimum lifetime BMI and number of previous
hospitalizations, the Global Outcome Assessment Scale total score. Levels of
Expressed Emotion were assessed for the two parents using the Five-Minute Speech
RESULTS: Less than 30% of the parents in our sample expressed high levels of
Critical EE and Emotional Over-Involvement. Our main findings indicate that
maternal Criticism (Critical EE levels, Critical Comments, Dissatisfaction) and
the sub-dimensions of maternal Emotional Over-Involvement (EOI EE) (Statement of
loving Attitudes and Excessive Details about the past) were related both to the
severity of the daughters’ clinical state and to maternal psychological
functioning. Only paternal levels of anxiety explained paternal Dissatisfaction,
EOI EE and Statement of loving Attitudes.
DISCUSSION: Parental psychological functioning and the severity of the
daughters’ clinical state have an impact on the family relationships. These
elements should be targeted by individual treatment for parents where necessary,
and by psycho-educational sessions about Anorexia Nervosa for parents generally.

© 2014.

DOI: 10.1016/j.comppsych.2013.10.002
PMID: 24199888 [Indexed for MEDLINE]

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