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. (C) 2007 by Wiley Periodicals, Inc.