title: Expressed emotion and the prediction of outcome in adolescent eating disorders.
abstract: OBJECTIVE
  This study examines whether parental Expressed Emotion (EE) ratings, based on the Camberwell Family Interview (CFI), are predictive of the course of illness in a sample of Dutch families with an adolescent eating disorder patient. Levels of EE at first assessment and at the termination of treatment are reported.
  
  
  METHODS
  The study was designed as a prospective follow-up study and involved 49 adolescent eating disorder patients (DSM-III-R) and their parents. Patient and family assessments were conducted at intake (T1), at the termination of treatment (T2), and at follow-up (T3) 1 year later. The Morgan-Russell Outcome Assessment Schedule, which was adjusted to accommodate bulimics, yielded the average outcome score (AOS) which served as our outcome measure.
  
  
  RESULTS
  The levels of parental EE at first assessment were low. During the treatment period the levels decreased further. We used a stepwise multiple regression analysis, with the parental EE variables as independent variables, to predict the AOS at T2 and T3. This way we showed that the mothers' Critical Comments (CC) rating explained 28 to 34% of the outcome variance. The mothers' CC rating was also the best predictor of outcome when compared to other possible predictor variables.
  
  
  CONCLUSIONS
  The results underscore the importance of involving the family in the treatment of adolescent eating disorders. Specific attention should be given to the mother's thoughts, feelings, and behavior concerning her ill daughter. Helping the mother and daughter to differentiate and separate through a constructive noncritical approach to the presenting problems may be a crucial factor in breaking through the perpetuating cycle of criticism and illness.
authors.affiliation: Robert-Fleury Foundation, Eating Disorder Unit, Leidschendam, The Netherlands.
authors.forename: E F
authors.initials: EF
authors.lastname: van Furth
authors.forename: D C
authors.initials: DC
authors.lastname: van Strien
authors.forename: L M
authors.initials: LM
authors.lastname: Martina
authors.forename: M J
authors.initials: MJ
authors.lastname: van Son
authors.forename: J J
authors.initials: JJ
authors.lastname: Hendrickx
authors.forename: H
authors.initials: H
authors.lastname: van Engeland
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D002032:Bulimia / Q000523:psychology / Q000628:therapy*; D019260:Expressed Emotion; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D009034:Mother-Child Relations; D010352:Patient Dropouts / Q000523:psychology; D010552:Personality Assessment; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome