Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: a systematic review.

The purpose of this review is to appraise the literature regarding psychological distress, burden and expressed emotion (EE) in caregivers of people with eating disorders (EDs). Electronic databases were searched up until October 2008. Selected studies contained carers of people with ED and employed one measure of burden, EE or psychological distress. Twenty studies were identified measuring psychological distress burden and EE. Most of the studies examined these features in families of anorexic patients. The majority of the studies found high levels of psychological distress, burden and EE in this population. Only few studies included a control group. Carers of people with ED presented high levels of psychological distress and burden. ED carers tend to have levels of EE resembling that found in families of depressed patients, rather than schizophrenic patients. There is some evidence (particularly for EE) that these factors can impact the outcome of ED.