Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa

ABSTRACT

This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12–18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.

Disclosure statement

Financial Disclosure: Dr Bohon receives salary and stock options from Equip Health, Inc. Dr Lock receives royalties from Guilford Press for books on family-based treatment and is co-director of the Training Institute for Child and Adolescent Eating Disorders, LLC. Dr Le Grange receives royalties from Guilford Press and Routledge, is co-director of the Training Institute for Child and Adolescent Eating Disorders, LLC, and a Member of the Clinical Advisory Board of Equip Health, Inc. Dr Rienecke receives consulting fees from the Training Institute for Child and Adolescent Eating Disorders, LLC, and receives royalties from Routledge.

Data availability statement

Data are available upon request from the authors.

Additional information

Funding

Funding support for this study was provided by NIH grant R01-MH-070621 to Dr Lock and NIH grant R01-MH-070620 to Dr Le Grange.