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Fortschr Neurol Psychiatr 2003; 71(10): 517-526
DOI: 10.1055/s-2003-42870
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Expressed Emotion im Verlauf kinder- und jugendpsychiatrischer Störungen

Expressed Emotion and the Outcome of Child and Adolescent Psychiatric DisordersB. Graf  Schimmelmann1 , H.  Meng2 , E.  Koch3 , M.  Karle4 , U.  Preuss5 , M.  Schulte-Markwort1
  • 1Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie Universitätsklinikum Hamburg-Eppendorf (Direktor: Prof. Dr. P. Riedesser)
  • 2Kinder- und Jugendpsychiatrische Universitätsklinik und -poliklinik Basel (Direktor: Prof. Dr. D. Bürgin)
  • 3Abteilung für Kinder- und Jugendpsychiatrie der Universität Heidelberg (Direktor: Prof. Dr. F. Resch)
  • 4Abteilung Psychiatrie und Psychotherapie im Kindes- und Jugendalter der Universität Tübingen (Direktor: Prof. Dr. G. Klosinski)
  • 5Universitätsklinik für Kinder- und Jugendpsychiatrie der UPD Waldau Bern (Direktor: Prof. Dr. W. Felder)
Wir danken Prof. Dr. Franz Resch und Frau Dr. Phil. Brigitte Ramsauer herzlich für die kritische Durchsicht des Manuskripts und stud. Psych. Melanie Schacht für die Erstellung des Literaturverzeichnisses
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Publication History

Publication Date:
10 October 2003 (online)

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Zusammenfassung

Einleitung: Nachdem Rutter u. Mitarb. 1975 erstmalig davon berichtet hatten, dass Feindseligkeit und fehlende Wärme der Eltern mit Verhaltensauffälligkeiten bei deren Kindern assoziiert sind, wurden seit etwa 1990 zunehmend Studien zur Bedeutung von „Expressed Emotion” (EE) für den Verlauf kinder- und jugendpsychiatrischer Störungen publiziert. In der vorliegenden Arbeit wird der aktuelle Forschungsstand diskutiert. Methode: Es wurde eine umfassende deutsch- und englischsprachige Literaturrecherche über den Zeitraum von 1960 - 2002 zu dem Begriff „Expressed Emotion” einerseits und Begriffen der Kinder- und Jugendpsychiatrie andererseits in den Datenbanken Medline, PsycINFO und PSYNDEX angefertigt. Arbeiten explizit zu „Expressed Emotion” und kinder- und jugendpsychiatrischen Störungen sowie weitere relevante Literaturzitate bilden die Grundlage dieser Arbeit. Ergebnisse: Es gibt Hinweise, dass der EE-Status eines Elternteils ein Prädiktor für den Verlauf von depressiven Störungen und Essstörungen im Kindes- und Jugendalter ist. Die prädiktive Validität im Verlauf von Verhaltensstörungen konnte bislang nicht belegt werden. Überraschend ist, dass lediglich zwei Arbeiten über den Zusammenhang des EE-Status mit dem Verlauf schizophrener Störungen im Kindes- und Jugendalter vorliegen. Studien zum Verlauf von Angststörungen fehlen. Die EE-Dimension-Kritik ist über verschiedene Störungsbilder hinweg mit Verhaltensauffälligkeiten und die EE-Dimension emotionale Überinvolviertheit mit Angststörungen assoziiert. Der EE-Status zeigt sich im Verlauf kinder- und jugendpsychiatrischer Störungen als nicht stabil. Es gibt Anzeichen dafür, dass es im Verlauf einer psychischen Erkrankung des Kindes bei Eltern eine Entwicklung des Expressed-Emotion-Status vom State-Merkmal zum Trait-Merkmal gibt. Forschungsausblick: Notwendig sind weitere Studien zur prädiktiven Validität des EE-Status im Verlauf kinder- und jugendpsychiatrischer Störungen, zu assoziierten Eltern- und Patientenvariablen sowie Studien zur Stabilität des EE-Status im Verlauf und zu den Faktoren, die der Verfestigung eines ungünstigen Hoch-EE-Status im Verlauf zugrunde liegen. Kinder und Jugendpsychiater können zur Dynamik des EE-Status von Beginn der psychischen Störung an einen wichtigen Beitrag zum gesamten Forschungsbereich liefern, dessen Ziel es ist, effektive und möglichst frühzeitig einsetzbare Familieninterventionen zu finden.

Abstract

Objective: The review discusses empirical research on the association of “Expressed Emotion” (EE) and the outcome of child and adolescent psychiatric disorders. Method: A comprehensive search in the databases Medline, PsycINFO and PSYNDEX was performed. Moreover, publications cited in the reference sections were taken into consideration. Results: Empirical data suggest that EE is a predictor of the outcome of depressive and eating disorders in childhood and adolescence, but not of behavioural disorders and ADHD. There are no studies on EE and its influence on anxiety disorders and - surprisingly - only two case studies on EE and schizophrenia in childhood and adolescence. Across psychiatric groups there is an association between behavioural disturbances of the child and parental criticism and an association of child anxiety and parental emotional over involvement. Data suggest that EE is not a stable variable. There is some evidence that a high-EE-status of parents transforms from a state into a trait variable. Conclusion: Further studies on the predictive validity of EE for the outcome of child adolescent psychiatric disorders are warranted, as well as studies on variables of the parents and their offspring, which are associated with EE and with the entrenchment of EE with the progress of the disorder. Child and adolescent psychiatrists may contribute to a large research area with studies on the early development of high-EE. The mutual goal is the development of effective early family interventions.

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Dr. Benno Graf Schimmelmann

Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie · Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

Email: bschimme@uke.uni-hamburg.de

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