Elsevier

Appetite

Volume 57, Issue 3, December 2011, Pages 743-748
Appetite

Research report
Dyadic view of expressed emotion, stress, and eating disorder psychopathology

https://doi.org/10.1016/j.appet.2011.08.016Get rights and content

Abstract

Prevailing models of the association between expressed emotion (EE) and relapse conceptualize EE as a form of stress for patients. In eating disorders (ED), there is no research addressed to evaluate the degree to which patients feel stress due to their relatives’ EE. It has been neither investigated how the EE and the subsequent stress relate to disordered behaviours and attitudes neither. Using a sample of 77 inpatients with ED, this study aimed to: (1) evaluate patients’ reported level of stress as it relates to their caregivers’ EE, particularly as associated with carer's criticism, emotional overinvolvement and warmth; (2) examine the associations of stress with the patients’ perceptions (self-reported) and the caregivers’ perspective (assessed by the Camberwell Family Interview) of the EE; and (3) study how the two views of EE (patients’ and caregivers’) and the stress due to EE relate to the ED symptoms. The findings indicate that patients judged their carers’ critical stance as the most stressful, followed by emotional overinvolvement. Secondly, patients’ perceptions of EE, whereas none of the interview indices focused on the caregivers’ perspective, were associated to the stress and to the ED symptomatology. Additionally, the patients’ stress due to criticism was positively related to the ED symptoms, while the stress associated with emotional overinvolvement and warmth was not. Clinical and research implications are discussed. Findings suggest attention to the ED patients’ view of their family environment and support the utility of assessing their appraisals of EE.

Highlights

► We studied expressed emotion from a dyadic view, stress, and eating psychopathology. ► The most stressful emotion for the patients was criticism. ► Stress due to criticism was also the only linked to symptoms. ► Patients’ perspective of expressed emotion was related to stress and symptoms. ► Relatives’ perspective of expressed emotion was not related to stress or symptoms.

Section snippets

Participants

Seventy-seven patients with diagnosis of ED according to DSM-IV-TR (American Psychiatric Association, 2002) and their key relatives were consecutively recruited at the time of admission to an inpatient ED specialist centre (Eating Disorders Institute, Barcelona, Spain). Patient's inclusion criteria were a primary ED diagnosis by clinicians, and having a key relative who was both accessible and willing to participate. The key relative was defined as the person who was involved in the patient's

Results

Descriptive data of the variables of the study and results of statistical tests for comparing them by eating diagnosis are presented in Table 1. Post hoc analyses revealed that AN group perceived significantly less EOI and more warmth (with the BDSEE) than EDNOS. BN patients showed a significantly higher tendency to think and carry out behaviours related to excessive eating than EDNOS, exhibited this behaviour to a greater degree than patients with AN. The EDNOS group showed also significantly

Discussion

The aim of this paper is to describe the link between the EE of the caregiver, stress, and symptoms in people with ED. This is a study of adult patients and their relationship with their primary caregiver who in almost all cases was their mother. Following the conceptualization of EE as a form of stress for patients (Hooley and Gotlib, 2000, Hooley, 2007), our findings showed that family caregivers’ critical and emotional overinvolved attitudes are stressful for ED patients. As judged by ED

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