ABSTRACT
Although caregivers’ level of expressed emotion (EE) has long been linked to treatment outcomes for eating disorders and other forms of psychopathology, the mechanism of action underlying this relationship remains elusive. This chapter summarizes the extant literature on factors associated with high EE versus low EE in caregivers, with an emphasis on eating disorders. First, illness-related factors such as the patient’s symptom severity, duration of illness, and diagnosis are considered. There is some evidence to suggest that illness-related behaviors that are perceived as difficult to control by parents are associated with higher levels of EE, especially when these behaviors persist, sometimes for many years. The relationship between the patient’s own level of EE and that of their parents is also discussed. Next, parent characteristics, including their perceived burden of care, level of psychological distress, coping mechanisms, attributional style, and gender, are reviewed. Finally, aspects of the broader family context, including family structure and functioning, are also considered. From a clinical perspective, parents with a high perceived burden of care or high levels of psychological distress, and children with a high EE attitude toward their parents warrant extra attention in therapy.
