Expressed emotion in anorexia nervosa

Although the role of family dynamics in the development and possibly maintenance of anorexia nervosa has been widely acknowledged (Bruch, 1973; Selvini Palazzoli, 2006; Minuchin, 1978) for a long time, the concept of expressed emotion in this disorder has not received much attention. This is surprising, considering the concept of "anorexic family" suggested by Minuchin (1978), i.e. the entanglement between anorexia and family dynamics, especially after the onset of the eating disorder itself. The concept of expressed emotion was first developed to measure the emotional temperature of the family. With more detail, it is a marker of the intensity of the emotional response to a stressful situation like having an ill relative. At first, the focus of expressed emotion research was on schizophrenic families (Brown, 1972), according to the clinical observation that schizophrenic patients' outcome significantly correlated with the features of the social group patients returned to after inpatient or residential treatment. It was observed that sometimes it was inadvisable for patients to return to their own families, since families' expressed emotion played a relevant role as far as relapse and disease course and outcome are concerned. Our aim is to describe the concept of expressed emotion, its measures and the main findings of the current literature about this construct in anorexia nervosa.