Expressed emotion in eating disorders assessed via self-report: an examination of factors associated with expressed emotion in carers of people with anorexia nervosa in comparison to control families.

OBJECTIVE: High expressed emotion (EE) has been linked to outcome in anorexia nervosa (AN). Traditional interview measures of EE require considerable resources. The aim was to compare EE, measured with a self report tool, in parents of people with AN (carers; N = 151) with that of parents of healthy people (controls; N = 93), and to explore factors associated with EE.

METHOD: A cross-sectional design was used to assess EE (Family Questionnaire) and psychological distress (Hospital Anxiety and Depression Scale).

RESULTS: Over 60% (96/151) of carers showed high emotional over-involvement (EOI) compared with 3% (3/93) of controls, whereas 47% (71/151) of carers showed high criticism (CC) compared with 15% (14/93) of controls. The most significant variable related to CC was "negative/difficult behaviors," and anxiety, for EOI.

CONCLUSION: The FQ was sensitive both to CC and EOI. Interventions aimed at reducing EE may need to focus on decreasing carers' anxiety and teaching skills to moderate difficult behaviors.