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Tschan T, Pfeiffer S, Gutzweiler R, In-Albon T. A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury. Child Adolesc Psychiatry Ment Health 2022; 16:64. [PMID: 35941688 PMCID: PMC9361609 DOI: 10.1186/s13034-022-00500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers. METHOD We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS). RESULTS Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10). CONCLUSION The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.
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Affiliation(s)
- Taru Tschan
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Simone Pfeiffer
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Raphael Gutzweiler
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829, Landau, Germany.
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2
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Homan KJ, Crowley SL, Rienecke RD. Predictors of improvement in a family-based partial hospitalization/intensive outpatient program for eating disorders. Eat Disord 2021; 29:644-660. [PMID: 32174240 DOI: 10.1080/10640266.2020.1734410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.
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Affiliation(s)
- Kendra J Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L Crowley
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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3
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Gramaglia C, Gattoni E, Vecchi C, Di Tullio E, Biroli G, D'Andrea F, Riso S, Gualano MR, Marchetti M, Sarchiapone M, Siliquini R, Zeppegno P. No correlation among expressed emotion, anxiety, stress and weight loss in patients with overweight and obesity. Food Nutr Res 2019; 63:3522. [PMID: 31645850 PMCID: PMC6787637 DOI: 10.29219/fnr.v63.3522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background The onset of some types of obesity may correlate with specific familial relational patterns, and expressed emotion (EE), the family life's 'emotional temperature', may play a role in obesity treatment compliance and outcome. Objective The aim of this study is to address the current gap in the literature about EE and obesity, assessing EE in a sample of patients with overweight or obesity and their relatives. A further objective is to assess patients' weight loss, patients' and relatives' anxiety, perceived stress and their possible correlation with EE and diet compliance. Design A total of 220 patients with overweight or obesity and 126 relatives were recruited; their socio-demographic and clinical features were collected; and Level of Expressed Emotion Scale (LEE), State-Trait Anxiety Inventory 1 and 2 (STAI-Y1 and STAI-Y2) and Paykel Scale of Stressful Life Events were administered. Results Patients' baseline body mass index (BMI) was negatively correlated with educational level, but we failed to find any correlation between BMI and the other variables assessed. We found a positive correlation between EE median and stressful life events, as well as between median EE and state and trait anxiety. Conclusions Our results seem to suggest that other factors than the psychological ones we investigated may play a role in treatment adherence and outcome in patients with overweight and obesity.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Camilla Vecchi
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Elisa Di Tullio
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Giampaolo Biroli
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Federico D'Andrea
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Sergio Riso
- S.C. Dietetica e Nutrizione, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Marco Marchetti
- Department of Bioscience and Territory, University of Molise, Campobasso, Italy
| | - Marco Sarchiapone
- Department of Medical and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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4
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Didericksen KW, Berge JM, Hannan PJ, Harris SM, MacLehose RF, Neumark-Sztainer D. Mother-father-adolescent triadic concordance and discordance on home environment factors and adolescent disordered eating behaviors. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:338-346. [PMID: 29389146 PMCID: PMC6070425 DOI: 10.1037/fsh0000325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION This study utilizes triadic data to examine the association between mother-father-adolescent concordance (agreement) and discordance (disagreement) on home environment factors (i.e., parental encouragement of dieting, family functioning) and adolescent unhealthy weight control behaviors and binge eating. METHOD A subsample of adolescent-mother-father triads (n = 833; adolescents ages 10-22) from two coordinated population-based studies (EAT 2010 and F-EAT) were used. Poisson regression analysis was used to estimate the relative risks of each eating disordered behavior. RESULTS Triads were more concordant (range 9-42%) than discordant (range 4-24%). Triadic agreement that parents did not encourage dieting was associated with a lower risk of adolescent eating disordered behaviors in some triadic combinations. Additionally, triadic concordance on high family functioning was also associated with a lower risk of adolescent eating disordered behaviors among some triadic combinations. DISCUSSION Results suggest that triadic concordance on healthy home environment factors is associated with fewer adolescent disordered eating behaviors in some triads. Family based interventions may want to consider focusing on strategies to help move mother-father-adolescent triads closer on seeing the home environment more similarly. Future research is needed on triadic concordance/discordance and disordered eating behaviors to confirm study results and to inform the development of family based interventions. (PsycINFO Database Record
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Affiliation(s)
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Peter J Hannan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Steven M Harris
- Family Social Science, College of Education and Human Development, University of Minnesota
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
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Darrow SM, Accurso EC, Nauman ER, Goldschmidt AB, Le Grange D. Exploring Types of Family Environments in Youth with Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:389-396. [PMID: 28675592 DOI: 10.1002/erv.2531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/08/2017] [Accepted: 05/27/2017] [Indexed: 11/10/2022]
Abstract
While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control-Oriented; (2) System Maintenance-Oriented; and (3) Conflict-Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sabrina M Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Emily R Nauman
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrea B Goldschmidt
- Weight Control and Diabetes Research Center, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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6
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Rienecke RD, Sim L, Lock J, Le Grange D. Patterns of expressed emotion in adolescent eating disorders. J Child Psychol Psychiatry 2016; 57:1407-1413. [PMID: 27377705 PMCID: PMC5115973 DOI: 10.1111/jcpp.12594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND This goal of this study was to understand the patterns of expressed emotions (EEs) in adolescent eating disorders. As such, this study compared EE among families of adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and a psychiatric control group, major depressive disorder (MDD). This study also examined the influence of family status (intact vs. nonintact) and the presence of siblings on EE. METHODS Two-hundred and fifteen adolescents (ages 12-19) and their families were recruited for this study including 121 adolescents with AN, 54 adolescents with BN, and 40 adolescents with MDD. Adolescents with at least one parent completed the Standardized Clinical Family Interview. Adolescents completed structured diagnostic interviews to assess eligibility for the study, as well as a standardized questionnaire to assess depression. RESULTS Analyses revealed that fathers showed higher levels of critical comments to adolescents with BN or MDD than those with AN, whereas mothers made more critical comments toward patients with BN. Mothers made the least number of positive remarks toward patients with MDD. In terms of the influence of family status, fathers from intact families showed more expressions of warmth and were less critical than fathers from nonintact families, whereas mothers from intact families were less critical but also made fewer positive remarks than mothers from nonintact families. The presence of siblings appeared to reduce mothers' expression of warmth and emotional overinvolvement. CONCLUSIONS Unique patterns of EE were found to characterize AN, BN, and MDD. Family status and the presence of siblings exert an influence on EE that should be taken into consideration in future research.
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Affiliation(s)
- Renee D. Rienecke
- Department of Pediatrics at Medical University of South Carolina, Charleston, SC,Department of Psychiatry at the University of Michigan, Ann Arbor, MI
| | - Leslie Sim
- Department of Psychiatry and Psychology at the Mayo Clinic, Rochester, MN
| | - James Lock
- Department of Psychiatry & Behavioral Sciences at Stanford University, Stanford, CA
| | - Daniel Le Grange
- Department of Psychiatry at the University of California, San Francisco, San Francisco, CA, USA
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Munsch S, Dremmel D, Kurz S, De Albuquerque J, Meyer AH, Hilbert A. Influence of Parental Expressed Emotions on Children's Emotional Eating via Children's Negative Urgency. EUROPEAN EATING DISORDERS REVIEW 2016; 25:36-43. [PMID: 27790790 DOI: 10.1002/erv.2489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 01/10/2023]
Abstract
We investigated whether parental expressed emotion (criticism and emotional overinvolvement) is related to children's emotional eating and whether this relationship is mediated by children's negative urgency. One hundred children, aged 8 to 13 years, either healthy or have binge-eating disorder and/or attention-deficit/hyperactivity disorder, completed the questionnaires, along with their parents. Parental criticism and, to a lesser extent, parental emotional overinvolvement were both positively related to children's emotional eating, and this relationship was mediated by children's negative urgency. Further exploratory analyses revealed that the mediating role of children's negative urgency in the relationship between parental criticism and children's emotional eating was pronounced in the clinical group of children with binge-eating disorder and attention-deficit/hyperactivity disorder but almost absent in the healthy control group. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Simone Munsch
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Daniela Dremmel
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Susanne Kurz
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | | | - Andrea H Meyer
- Integrated Research and Treatment Center of Adiposity Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.,Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
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8
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Rienecke RD, Lebow J, Lock J, Le Grange D. Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:428-436. [PMID: 25945418 DOI: 10.1080/15374416.2015.1030755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.
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Affiliation(s)
| | - Jocelyn Lebow
- b Department of Psychiatry & Behavioral Sciences , University of Miami.,c Department of Psychiatry and Psychology , Mayo Clinic
| | - James Lock
- d Department of Psychiatry & Behavioral Sciences , Stanford University
| | - Daniel Le Grange
- e Department of Psychiatry , University of California , San Francisco
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9
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Anderson LK, Murray SB, Ramirez AL, Rockwell R, Le Grange D, Kaye WH. The Integration of Family-Based Treatment and Dialectical Behavior Therapy for Adolescent Bulimia Nervosa: Philosophical and Practical Considerations. Eat Disord 2015; 23:325-35. [PMID: 26009868 DOI: 10.1080/10640266.2015.1042319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dialectical behavior therapy (DBT) and family-based treatment (FBT) are two evidence-based interventions that have been applied in the treatment of bulimia nervosa (BN) in adolescents. While DBT focuses on providing skills for coping with emotion dysregulation that often co-occurs with BN, FBT targets the normalization of eating patterns. The purpose of the current article is to introduce an integration of both treatments to provide a more comprehensive approach that targets the full scope of the disorder. We provide a review of the conceptual similarities and differences between FBT-BN and DBT along with strategies to guide a blended treatment approach. Given the strengths and limitations of either independent treatment, DBT and FBT-BN complement one another and together can address the range of symptoms and behaviors typically seen in adolescent BN.
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Affiliation(s)
- Leslie K Anderson
- a Department of Psychiatry , University of California, San Diego , San Diego , California , USA
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