نمایش دوتایی ابراز احساسات، استرس، و آسیب شناسی روانی اختلال خوردن

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.

The family emotional climate, as assessed by the construct Expressed Emotion (EE) (Hodes and Le Grange, 1993 and Hooley, 2007), is associated with the course of serious mental illness including eating disorders (ED). EE refers to the emotional nature of the relationship between the patient and a significant other and is comprised of five indices: criticism, hostility, emotional overinvolvement (EOI), warmth, and positive remarks (Leff & Vaughn, 1985). Patients with different chronic illnesses living in a high-EE environment (high in criticism, hostility and/or EOI) have significantly more risk of relapse than do patients in a low-EE environment (low in criticism, hostility and EOI; Wearden, Tarrier, & Barrowclough, 2000). The amount of time the patient and caregiver spent together also predict the relapse rate (Bebbington & Kuipers, 1994). A meta-analysis of EE and relapse studies reported a medium (large) effect size (φ = .51) among a handful of studies of ED ( Butzlaff & Hooley, 1998). Moreover, family-based treatments that reduce EE have also improved ED symptomatology ( Le Grange and Eisler, 2009 and Sepúlveda et al., 2008).