Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA.
Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA.
Int J Eat Disord. 2023 Mar;56(3):628-636. doi: 10.1002/eat.23890. Epub 2022 Dec 30.
Expressed emotion (EE) among caregivers toward the affected offspring is a negative prognostic indicator for adolescent patients with eating disorders (EDs) in outpatient treatment. Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN-R] versus binge/purge [AN-BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge.
Adolescent patients (N = 203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire-9) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline.
No differences in caregiver EE were found between patients with AN-R versus AN-BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge.
The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment.
High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step-down to outpatient treatment.
照顾者对受影响子女的情绪表达（EE）是门诊治疗中青少年饮食障碍（ED）患者的负面预后指标。研究较少关注其对接受更高水平护理（HLOC）的青少年的影响。本研究根据神经性厌食症（AN）的亚型（限制型[AN-R]与暴食/清除型[AN-BP]）和护理水平（LOC），检查了照顾者 EE 的差异。我们还检查了基线时照顾者 EE（情感过度卷入[EOI]或批评）、AN 亚型及其相互作用对出院时饮食病理学和抑郁的主要影响。
在 HLOC 接受治疗的青少年患者（N=203）在基线和出院时完成了 ED 病理（饮食障碍检查问卷）和抑郁（患者健康问卷-9）的测量，每位患者的一位照顾者在基线时完成了 EE 测量（家庭问卷）。
AN-R 患者与 AN-BP 患者之间，或相对于 LOC，照顾者 EE 无差异。照顾者 EE 不能预测出院时 ED 症状或抑郁的结果。
与门诊护理相比，HLOC 中高照顾者 EE 的影响可能不那么显著，因为照顾者在 HLOC 中较少参与治疗。需要进一步研究以确定高照顾者 EOI 是否会导致青少年治疗结果不佳，就像它对成年人一样，或者对于需要 HLOC 治疗的病情足够严重的患者来说，这是否是一种适当的护理表达。
在 HLOC 中，高照顾者 EE 并未预测饮食障碍青少年的治疗结果，这可能是由于照顾者在 HLOC 中参与有限。然而，患者会下降到门诊治疗，在那里高照顾者 EE 会对结果产生重大负面影响。HLOC 应在预期下降到门诊治疗时，努力减少高照顾者 EE。
