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Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN\u2010R] versus binge\/purge [AN\u2010BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Adolescent patients (<jats:italic>N<\/jats:italic>\u00a0=\u00a0203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination\u2010Questionnaire) and depression (Patient Health Questionnaire\u20109) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No differences in caregiver EE were found between patients with AN\u2010R versus AN\u2010BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Public significance statement<\/jats:title><jats:p>High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step\u2010down to outpatient treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23890","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T18:36:37Z","timestamp":1672425397000},"page":"628-636","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Expressed emotion and treatment outcome in higher levels of care for eating disorders"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0423-7403","authenticated-orcid":false,"given":"Renee D.","family":"Rienecke","sequence":"first","affiliation":[{"name":"Eating Recovery Center\/Pathlight Mood &amp; Anxiety Center  Denver Colorado USA"},{"name":"Department of Psychiatry and Behavioral Sciences Northwestern University  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8861-8547","authenticated-orcid":false,"given":"Sasha","family":"Gorrell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California, San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madelyn","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California, San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Duffy","sequence":"additional","affiliation":[{"name":"Eating Recovery Center\/Pathlight Mood &amp; Anxiety Center  Denver Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip S.","family":"Mehler","sequence":"additional","affiliation":[{"name":"Eating Recovery Center\/Pathlight Mood &amp; Anxiety Center  Denver Colorado USA"},{"name":"ACUTE Center for Eating Disorders at Denver Health  Denver Colorado USA"},{"name":"University of Colorado School of Medicine  Denver Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7293-9496","authenticated-orcid":false,"given":"Daniel","family":"Le Grange","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California, San Francisco  San Francisco California USA"},{"name":"Department of Psychiatry &amp; Behavioral Neuroscience The University of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2564"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.21971"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20931"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22922"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.121.3.241"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/001872676601900301"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2254"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718003768"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199411)16:3<211::AID-EAT2260160302>3.0.CO;2-X"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2678"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2007.01726.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2787"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#"},{"key":"e_1_2_9_16_1","first-page":"309","volume-title":"Cognitive behavior therapy and eating disorders","author":"Fairburn C. 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