Characteristics of Japanese families with adlescents suffering from eating disorders determined by evaluating expressed emotion *
Expressed Emotion (EE) is a psychiatric measurement conceptualizing affective styles of other family members toward the patient in a family disrupted by the patient's symptoms of mental disorder. This study investigated the characteristics of Japanese families with adolescents having eating disorders by evaluating EE utilizing the Camberwell Family Interview (CFI) . (Subjects and Method) Twenty-five mothers of eating disorder (ED) patients (16 patients with anorexia nervosa (AN) and 9 with bulimia nervosa (BN)) were the subjects of this study. All of them had been referred to the Department of Psychiatry, Kawasaki Medical School Hospital between April 1998 and March 2000. Each mother was interviewed individually within two weeks of the first referral, using the CFI with the addition of features for anorexic and bulimic symptoms. (Results) 1. Eleven of the 25 mothers were evaluated as high-EE, and they all showed high "emotional over-involvement" (EOI). There were no differences in the scores of "critical comment" (CC) and "EOI" between the mothers of AN patients and those of BN patients. 2. Compared with the families of schizophrenic patients and mood disorder patients in Japan, those of ED patients showed low CC scores and high EOI scores. 3. A comparison of the EE subscales of the mothers of ED patients in the United Kingdom, the Netherlands and Japan showed the mean CC scores of Japanese mothers to be lower than those of mothers in the United Kingdom and the Netherlands. (Discussion) Among the subjects of this study, the characteristics of mothers with a high EOI coincided with the familial characteristics of ED patients that some theorists have mentioned. Based on a comparison of the findings in the subjects of this study and those of the families of the patients with other mental disorders, it is suggested that there are several reasons for the low CC and high EOI socores in our samples. One possibility is that the emerging physical symptoms of the patients, such as their emaciation, caused the mother to suppress critical comments and conduct, and evoked the mother overprotective behavior and exaggerated emotional in their response as a result of their worry and concern. And, from the point of view of the life cycle, most of the patients were adolescents and mothers tend to be overprotective during the adolescent period. A comparison of the mothers in the three countries specifically from a cultural standpoint led the author to consider that the low CC of the Japanese mothers could be related to the characteristics of Japanese childrearing practices. Finally, it is suggested that the factor of a mother with a high EOI score should be considered more seriously in clinical intervention into the family of cases being treated for eating disorders in Japan. (Accepted on September 3, 2001) Kawasaki Igakkaishi 27( 3 ) : 219 - 230, 2001
