Interpersonal factors like the intense emotional responses of close others may be a causal maintaining factor of anorexia nervosa, especially for patients with high levels of contact with their relatives. Expressed emotions (EE) measure criticism, hostility, and emotional over-involvement toward psychiatric patients from relatives, and high EE predicts relapse across numerous psychiatric illness. In cases of conflict with family members, anorexia nervosa patients may feel empowered by thwarting caregivers' attempts to intervene. This feeling of victory over logic and parental authority may reinforce beliefs and behaviors of anorexia nervosa by creating feelings of self-esteem derived from food restriction. On the other hand, excessive reassurance and support by caregivers may also reinforce the disorder by demonstrating that it elicits sympathy, care, and kindness, and may contribute to resentment toward the patient by other family members. High EE is thus correlated with distress among family members as they are unsure how to help and may have difficulty meeting other responsibilities outside of supporting the patient. For patients, having high EE relatives is associated with poorer outcomes, but these outcomes can be modified with family-based interventions. Some traits associated with anorexia nervosa are inherited, such as obsessive-compulsive traits and social impairment which can lead caregivers and family members to be excessively controlling or withdrawn toward the patient, contributing to inflexibility and miscommunication that can worsen the disorder. Instead, caregivers should focus on educating themselves about the nuances of anorexia nervosa's impacts on social cognition and communication, learning skills to support behavioral changes, and modeling a calm, compassionate, and collaborative environment.