Eating Behavior Disorders And Expressed Emotion In Family Members

Eating disorders (ED) are defined as disturbances or alterations of behavior related to eating, and therefore to its ingestion, that are maintained in the long term and that entail a wear and tear on the physical health of the person, as well as a deterioration of their psychological, social and very possibly family environment.

Despite being a psychopathological disorder of great social and health interest due to its prevalence in the population, and more specifically due to its incidence in adolescents – it is estimated that up to 4% of adolescent women and young adults present this pathology in the Western world -, studies on relatives of people with Eating Disorders are still very scarce.

This becomes an inescapable and pressing challenge, since given the huge percentage of adolescents who are at risk of suffering from ED, it is a problem that can be transferred to the family environment and have fierce repercussions within it. It is in turn very relevant since family members can also have an exhaustive influence on the course of the disorder.

Precipitating and Maintaining Factors of Eating Disorders

Numerous studies have tried to look for not only the precipitating factors of EDs, but also the maintenance factors. Models such as the multifactorial of Vohs, Bardone, Joiner, Abramson and Heatherton (1999) already showed the role of perfectionism in the development of the symptoms of anorexia nervosa. 

This perfectionism in more recent studies such as the one carried out by the National Autonomous University of Mexico in 2010 is defined as an extreme preoccupation with making mistakes or as indecision for action.

Body dissatisfaction and negative self-concept,  the beginning of a strict diet, weight gain, family conflicts or constant criticism of weight and figure are also highlighted as risk factors for the development of an eating disorder.

Regarding the factors of maintenance of the pathology, there are dietary restriction, purgative behaviors and a very reduced social environment, in which the attitudes of family members are collected.

What is the emotion expressed in relatives of people with eating disorders?

Expressed emotion (EE) is defined as the emotional communication style within the family and is also postulated as a maintenance factor for eating disorders. EE is a construct that began to take shape in the 1950s at the Institute of Social Psychiatry in London. In a first study, it was observed how most of the relapses of people with schizophrenia took place in those who, after having been admitted for a season, returned to family breasts in which their parents or partners were included.

As a result of this, investigations were carried out to elucidate which elements of the family bosom were that had something to do with the relapses of those people who returned to their homes. Brown, Birley, and Wing found t

• Hostility.
• Emotional Over-involvement.
• Critical Comments.

Other authors, such as Muela and Godoy, also include warmth and positive comments. In family members of people with ED, the EE construct presents aspects similar to those found in previous research on schizophrenia.

Components of expressed emotion

• Critical comments : negative evaluation by a family member of the behavior of the person with ED (the content not only denotes criticism, but also the intonation).

• Hostility : rejection by a family member of the person with ED. It is not just a criticism of something he does, it is in general of his person.
• Emotional over-involvement : intense emotional response by family members in an attempt to control the behavior of the person with eating disorders. The emotional response can range from constant sobbing and crying due to the situation, to self-sacrifice due to the demands of the pathology or excessive overprotection.
• Heat : adequate emotional response from family members that involves empathy, affection, interest.
• Positive comments: verbal comments of affection to the person.

All these components seem to play an essential role in the course of the pathology of the person or family member with ED. When there are high levels of, for example, critical comments, hostility, and emotional over-involvement, the family context of the person with the disorder is a more coercive, more guarded, and much less flexible context.

Longitudinal studies of the area show that there are differences between EDs that lasted less than those that became chronic. It is observed that only 6% of the relatives of those people who recovered quickly from an eating disorder showed high levels of Expressed Emotion (EE).

Numerous authors have also studied the relationship of the emotion expressed in relatives and the development of the pathology, not only the maintenance once it has developed. The results showed that between 55-60% of the relatives of people with eating disorders had a high EE.

The relevance of family members in eating disorders

For all the above, it is insisted on the need to include in the psychological treatment of eating disorders (anorexia nervosa, bulimia nervosa and binge eating disorders) a part of psychoeducation, and if necessary, intervention in the relatives of the person with the disorder .

Family involvement is extremely important, even more so when most of those affected by an eating disorder are adolescents. It is not to be expected, however, that they know how to handle an eating disorder and therefore the idea of including family members throughout the treatment is emphasized , since not only the EE will be the object of intervention.

Thus, it will surely become necessary to exonerate family members, who learn to de-label the person with an ED, who learn to reinforce alternative behaviors and improvements of the person with ED, or instill calm and patience in the face of a pathology that can be prolonged in the time.