Mental health literacy and eating disorders: What do women with bulimic eating disorders think and know about bulimia nervosa and its treatment?

Weight stereotypes in eating disorder recognition

OBJECTIVE

We investigated weight stereotypes in the recognition and referral of eating disorders (EDs) by assessing if recognition, health care referral, perceived acceptability, perceived distress, and perceived prevalence of an ED differ depending on the weight of the subject in the vignette.

METHOD

Community participants (N = 180, age = 19-74) read three different vignettes describing three females with different EDs [anorexia nervosa/atypical anorexia nervosa (AN/AAN), bulimia nervosa (BN), binge eating disorder (BED)] and were randomized to three different experimental conditions concerning an individual with a different weight (overweight, normal, and underweight).

RESULTS

Across EDs, participants were more likely to recognize a problem, refer for treatment, and rate a higher perceived level of distress in the vignettes of overweight individuals than in the vignettes of normal weight individuals. For BED, a larger proportion of participants in the overweight condition classified the issue described in the vignette as a form of eating pathology compared to the normal weight condition.

DISCUSSION

These results highlight several weight stereotypes that exist in the recognition and health care referral of EDs. Future ED education and awareness programs should emphasize that EDs can occur in any individual, regardless of their weight.

Gender stereotypes in eating disorder recognition

PURPOSE

Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED.

METHODS

276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups.

RESULTS

There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men.

CONCLUSION

These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification.

LEVEL OF EVIDENCE

Level I, experimental study with randomization.

Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample

BACKGROUND

Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population.

METHODS

Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence.

RESULTS

OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting.

CONCLUSIONS

The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.

A vignette study of mental health literacy for binge-eating disorder in a self-selected community sample

BACKGROUND

Mental health literacy has implications for mental disorder recognition, help-seeking, and stigma reduction. Research on binge-eating disorder mental health literacy (BED MHL) is limited. To address this gap, our study examined BED MHL in a community sample.

METHOD

Two hundred and thirty-five participants completed an online survey. Participants read a vignette depicting a female character with BED then completed a questionnaire to assess five components of BED MHL (problem recognition, perceived causes, beliefs about treatment, expected helpfulness of interventions, and expected prognosis).

RESULTS

About half of participants correctly identified BED as the character's main problem (58.7%). The most frequently selected cause of the problem was psychological factors (46.8%) and a majority indicated that the character should seek professional help (91.9%). When provided a list of possible interventions, participants endorsed psychologist the most (77.9%).

CONCLUSIONS

Compared to previous studies, our findings suggest that current BED MHL among members of the public is better, but further improvements are needed. Initiatives to increase knowledge and awareness about the symptoms, causes, and treatments for BED may improve symptom recognition, help-seeking, and reduce stigma.

Evaluation of a decision aid for the treatment of depression among college students

Objective: Depression, and its treatment, is a concern among college students. Research indicates decision aids (DA) improve patients' treatment knowledge, decision making, and decisional conflict; however, it is unknown whether they are helpful for disseminating depression treatment information to college students. This study evaluated a DA for depression and its impact on college students' knowledge and treatment decision making. Methods: College students (N = 144) completed questionnaires pre-, post-, and at 1-month follow-up after reviewing an evidence-based DA for depression. Results: Participants rated the DA as highly acceptable and useful, and their knowledge increased at post-treatment and follow-up. However, treatment option presentation order influenced decision making. Conclusions: This DA is a useful and acceptable decision-making tool, and increased knowledge of depression and its treatment among college students. This study proposes a novel tool for educating college students about depression treatment, furthering our understanding of factors influencing treatment preferences.

Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends

PURPOSE

To investigate the prevalence of overvaluation across sociodemographic features and weight status over time.

METHODS

The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed.

RESULTS

Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001).

CONCLUSIONS

Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016.

EVIDENCE-BASED MEDICINE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

Break Binge Eating: Reach, engagement, and user profile of an Internet-based psychoeducational and self-help platform for eating disorders

OBJECTIVES

Internet-based psychoeducational and self-help platforms hold promise for alleviating existing help-seeking barriers and addressing the unmet needs of people with eating disorders (EDs). In this paper, we report data related to the reach, engagement, and visitor profile of Break Binge Eating, an online platform designed to provide evidence-based information and self-help strategies for people at all stages of an ED.

METHOD

Two sources of data were presented: (a) usage data from platform visitors generated through Google Analytics; and (b) characteristics of a sample of platform visitors (n = 786).

RESULTS

In 13 months, approximately 46,311 unique users worldwide have accessed this platform, with usage rates rapidly increasing each month. Most visitors came from organic searches (when ED-related information is directly searched in a browser). Self-help content was the most accessed material, and 81% of the sample stated that their reason for accessing the platform was to get help. Sample visitors were highly symptomatic; 52% met criteria resembling a threshold ED and 87% engaged in at least one ED behavior in the past month. Across different symptomatic subgroups, ∼50% were unsure whether they needed help, ∼80% were not receiving any help, and ∼75% were highly concerned with their symptoms.

CONCLUSION

This online platform has broad reach and is engaging its intended audience. It is an aim of this platform to improve mental health literacy, facilitate symptom recognition and improvement, and alleviate help-seeking barriers. Evaluating whether this platform is achieving its intended aims in a randomized controlled trial is the next step.

Perceived need for treatment associated with orthorexia nervosa symptoms

Orthorexia Nervosa is characterised by a pathological fixation on food purity and nutrition, coupled with a severely restricted diet and avoidance of food believed to be unhealthy. Little is known about the risk factors associated with the condition or if the condition should be treated in a similar way to other eating disorders or whether distinct interventions are required. This study aimed to identify (1) putative variables of the need for treatment in those with orthorexia symptomology and (2) assess whether comorbid psychological symptomologies were associated with orthorexia nervosa. An online cross-sectional self-report survey was developed and the data of 130 participants analysed using regression analyses. As predicted, individuals with higher levels of orthorexic symptomology, eating disorder symptomology and those who identified their healthy eating as problematic were significantly more likely to have a perceived need for treatment, however those who self-identified as having a current or past eating disorder were not. Orthorexic symptomatology was significantly correlated with eating disorder symptomatology, obsessive-compulsive symptoms, anxiety, and depression, however in the regression analysis, eating disorder symptomatology was the only significant variable. These findings highlight the need to consider orthorexic symptoms in people with eating disorders and that this inter-relationship and the ego-syntonicity of symptoms may reduce help-seeking.

Bypassing the waitlist: examining barriers and facilitators of help-line utilization among college students with depression symptoms

BACKGROUND

A large number of U.S. college students suffer from depression symptoms, yet existing resources cannot match the demand.

AIMS

This study identified the psychological determinants of utilizing a help-line and examined potential barriers in order to inform effective help-line promotion.

PARTICIPANTS

Four hundred and six undergraduate students (18-29 years) completed a survey at a large Southern United States university between January and May 2018.

METHODS

The survey assessed depression symptoms (PHQ9), whether students were aware of the help-line they had access to, stigma beliefs about depression/suicide, stigma of seeking help (SSOSH), predictors of intention to utilize the help-line (RAT) and behavioral approach and avoidance motivation (BIS/BAS).

RESULTS

Students showed mild symptoms of depression (M = 6.60, SD = 5.13) and knew about the help-line (74.8%), but expressed low intentions to use it (M = 1.5, SD = 0.97; 7-pt scale). Depression symptoms influenced the strength of association between determinants and intentions to use a help-line (β = 0.25, p < 0.001). Participants with depression symptoms were also more likely to endorse adverse beliefs about depression/suicide (β = 0.11, p = 0.025).

CONCLUSION

Help-lines should be promoted by activating and reinforcing positive outcome expectations. Health campaigns should also address adverse beliefs in this population.

Eating disorders "mental health literacy": a scoping review

Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear.Aims: A scoping review was conducted to inform the current state of knowledge in this field.Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings.Results: The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available.Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.

Can the Perceived Barriers to Psychological Treatment Scale be used to investigate treatment barriers among females with disordered and non-disordered eating behaviours?

There is a lack of psychometrically sound instruments to assess treatment barriers among individuals with disordered eating behaviours. This study examined the factor structure and psychometric properties of the Perceived Barriers to Psychological Treatment scale (PBPT; Mohr et al., 2010) among a sample of individuals with disordered eating behaviours. Participants were 708 females aged 14 years and older who completed an online survey. The sample was randomly divided in two for the conduct of exploratory (EFA) and confirmatory (CFA) factor analyses. EFA suggested a seven-factor structure retaining 24 of the original 27 items (variance explained = 60%, α = 0.91). Factors were stigma, participation restrictions, negative evaluation of treatment, lack of motivation, emotional concerns, access restrictions, and time constraints. To assess clinical sensitivity, we conducted a secondary EFA utilising only clinical cases from this sample, which supported the solution but suggested retaining 25 of the original 27 items (variance explained = 58%, α = 0.89). The 25-item, seven-factor solution was further supported by CFA with an independent sample. Construct validity was also supported. The study suggests that the instrument will provide clinicians and researchers with a valid and reliable method of assessing treatment barriers in disordered eating samples.

Assessing treatment barriers in eating disorders: A systematic review

This systematic review evaluated methods used to assess treatment barriers among individuals with eating disorders or disordered eating. A total of 11 studies were identified and evaluated according to attributes considered important in the accurate assessment of treatment barriers. The majority of studies used qualitative methods, with five studies utilizing either a checklist or scale-based instrument. Adequate psychometric investigation was lacking. This review highlights the paucity of research examining barriers to accessing and/or receiving treatment in disordered eating populations. There is a need for development of psychometrically sound instruments that assess the range and relative interference of specific barriers experienced in this population.

Poor self-recognition of disordered eating among girls with bulimic-type eating disorders: cause for concern?

AIM

Bulimic-type eating disorders are common among young women and associated with high levels of distress and disability and low uptake of mental health care. We examined self-recognition of disordered eating and factors associated with this among female adolescents with bulimic-type eating disorders (n = 139) recruited from a large, population-based sample.

METHODS

A vignette of a fictional character with bulimia nervosa was presented, followed by a series of questions addressing the nature and treatment of the problem described. One of these questions required participants to indicate whether they currently had a problem such as the one described. Self-report measures of eating disorder symptoms, general psychological distress and quality of life were also completed.

RESULTS

More than half of participants (58%) did not believe that they currently had a problem with their eating. In multivariable analysis, impairment in emotional well-being and self-induced vomiting were the only variables independently associated with self-recognition. Participants who recognized a problem with their eating were more likely to have sought treatment for an eating problem than those who did not.

CONCLUSIONS

Recognition of disordered eating among adolescents with bulimic-type eating disorders may be poor and this may be a factor in low uptake of mental health care. Health promotion efforts may need to address the misconception that only bulimic-type disorders involving self-induced vomiting are pathological.

Variables influencing presenting symptoms of patients with eating disorders at psychiatric outpatient clinics

Eating disorders (EDs) have been underdiagnosed in many clinical settings. This study investigates the influence of clinical characteristics on presenting symptoms of patients with EDs. Psychiatric outpatients, aged 18-45, were enrolled sequentially and received a two-phase survey for EDs in August 2010-January 2013. Their primary reasons for seeking psychiatric help were obtained at their first encounter with outpatient psychiatrists. Patients' clinical and demographic characteristics were compared according to presenting symptoms with or without eating/weight problems. Of 2140 patients, 348 (16.3%) were diagnosed with an ED (22.6% of women and 6.3% of men). The three most common reasons for seeking psychiatric help were eating/weight problems (46.0%), emotional problems (41.3%), and sleep disturbances (19.3%). The multivariate analyses suggest that when patients with EDs presented symptoms that were less related to eating/weight problems, they were significantly more likely to be those having diagnoses other than anorexia nervosa or bulimia nervosa and less severe degree of binge-eating. Further, patients with EDs who demonstrated more impulsive behaviors and poorer functioning were less likely to report their eating problems when visiting psychiatric clinics. Thus, ED should be assessed routinely in patients with complex psychopathology to facilitate comprehensive treatment.

Cross-cultural examination of beliefs about the causes of bulimia nervosa among Australian and Japanese females

OBJECTIVE

To identify similarities and differences in beliefs about the causes of Bulimia Nervosa (BN) held by Asian (Japanese) women and Western (Australian) women, and hence, to examine the applicability of belief models of eating disorders (ED) across different cultures.

METHOD

Four hundred three Japanese and 256 Australian female university students (aged 17-35 years) completed a questionnaire that gauged beliefs about the causes of BN.

RESULTS

Among the Australian women, the four-component structure of perceived causes (dieting and eating practices, family dynamics, socio-cultural pressure, and psychological vulnerability) found in Dryer et al. (2012) was replicated. Among the Japanese women, however, a three-component structure (without the psychological vulnerability component) was obtained. The groups also differed in the causal component they most strongly endorsed, that being socio-cultural pressure for the Australian women, and dieting and eating practices for the Japanese women.

DISCUSSION

The Japanese participants were found to endorse three out of the four Western-based causal explanations for BN, but the relative importance they placed on those explanations differed from that of the Australian participants. Further research is needed, particularly to establish whether Japanese women simply fail to see psychological vulnerability as a viable cause of BN, or there are in fact cultural differences in the extent to which such vulnerability causes BN.

The changing demographic profile of eating disorder behaviors in the community

BACKGROUND

The perception that eating disorders occur predominantly in young white upper-class women has been challenged. This study examined temporal differences to the demographic correlates of eating disorder behaviors over a 10-year period.

METHODS

Data from cross-sectional general population surveys in 1998 (n = 3010) and 2008 (n = 3034) were collected on demographics (sex, age, income, residency), current eating disorder behaviors (binge eating, extreme dieting, purging), and health-related quality of life (SF-36).

RESULTS

Below-median annual household income was associated with increased prevalence rates from 1998 to 2008 in binge eating, extreme dieting, and purging. Male sex was associated with increased prevalence rates in extreme dieting and purging. Age over 45 years was associated with increased prevalence rates in purging. In 2008 versus 1998, binge eating was associated with greater mental health-related quality of life impairment in males but not females; and greater physical health-related quality of life impairment in regional but not metropolitan areas. Extreme dieting was also associated with greater physical health-related quality of life impairment in 2008 versus 1998 in the lower but not the higher socioeconomic sector.

CONCLUSIONS

Findings suggest the 'democratization' of disordered eating, with greatest levels of associated impairment being within marginalized demographic sectors. Implications include the need for broader intervention programs and recruitment of demographically representative samples in eating disorder research.

The association of "food addiction" with disordered eating and body mass index

INTRODUCTION

The contribution of an addictive process to elevated body mass index (BMI) and disordered eating is an area of growing interest. Yet, little is known about how "food addiction" may be related to disordered eating and obesity. The ability of addictive-like eating to account for eating pathology not captured by traditional eating disorders is unknown. No prior research has examined the association of "food addiction" with bulimia nervosa (BN). Finally, little is understood about the association of "food addiction" with patterns of dieting and weight gain. The current study was conducted to address these gaps in the literature.

MATERIAL AND METHODS

Participants (N=815) were recruited from online advertisements nationwide and completed measures related to "food addiction", BMI, weight history, and disordered eating.

RESULTS

Addictive-like eating was associated with elevated current and lifetime highest BMI, weight cycling, and eating pathology. The prevalence of "food addiction" was higher in participants with BN than in those with binge eating disorder (BED). "Food addiction" continued to be related to clinically relevant variables, especially elevated BMI, even when participants did not meet criteria for BED or BN. The co-occurrence of "food addiction" with eating disorders appears to be associated with a more severe variant of eating pathology.

DISCUSSION

An addictive-type response to highly palatable food may be contributing to eating-related problems, including obesity and eating disorders. BN relative to BED appears to be more strongly associated with "food addiction." Additionally, the concept of "food addiction" appears to capture clinically relevant information in participants who do not meet criteria for either BN or BED. Further examination of "food addiction" may be important in understanding the mechanisms underlying certain types of problematic eating behavior.

Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample

OBJECTIVE

Stigmatizing attitudes towards eating disorders negatively impacts treatment seeking. To determine the effect of interventions to reduce stigma, a measure of stigma that is simple to implement is required. This study aimed to develop a measure of stigmatizing attitudes and beliefs towards bulimia nervosa (SAB-BN) and evaluate the distribution of beliefs across gender, age, education, and income groups.

METHOD

Participants were 1828 community adults (890 men; 938 women) aged 18-65 sampled from the Australian Electoral Roll responded to a mailed questionnaire. Participants provided demographic information and completed the SAB-BN questionnaire.

RESULTS

Five components of stigmatizing attitudes and beliefs were identified; advantages of BN, minimization/low seriousness, unreliability, social distance, and personal responsibility. Stigma was low except on social distance and personal responsibility sub-scales, which indicated negative attitudes toward people with bulimia. Men compared with women and lower compared with higher education and income groups held significantly higher stigmatizing attitudes and beliefs. There were few differences between age groups in stigma. Differences between demographic groups provides evidence for known-groups validity.

DISCUSSION

The SAB-BN questionnaire provides a potentially useful tool for evaluating stigma in relation to BN. Results provide insight into components of stigma and the demographic groups to whom interventions should be targeted.

Eating-disordered behavior in adolescent boys: eating disorder examination questionnaire norms

OBJECTIVE

We sought to provide normative data for the Eating Disorder Examination Questionnaire (EDE-Q) for adolescent boys.

METHOD

The EDE-Q was completed by 531 boys aged 12-18 years recruited from a number of schools in the Australian Capital Territory (ACT) region of Australia. Data for 1,135 female adolescents, recruited as part of the same research project, are provided for comparative purposes.

RESULTS

Scores on each the EDE-Q subscales and, with the exception of excessive exercise, the prevalence of each of the eating disorder behaviors assessed, were substantially higher among girls than among boys. Still, 6.0% of boys reported regular episodes of objective binge eating, 8.3% reported regular episodes of loss of control eating, 5.3% reported regular excessive exercise and 4.9% reported overvaluation of weight or shape. Eating-disordered behavior was more common among older adolescents than among younger adolescents and this was the case for both boys and girls. Reliability coefficients for the EDE-Q subscales were marginally lower in boys (0.70-0.94) than in girls (0.84-0.97).

CONCLUSIONS

The EDE-Q appears to be suitable for use in adolescent boys, with the qualification that eating and weight/shape control behaviors that are largely confined to males may not be adequately assessed. The lack of assessment of subjective binge eating episodes may also be problematic. There is a need for research addressing whether and to what extent different features are associated with distress and disability in boys as well as the validity of the EDE-Q assessment of these features when compared with interview assessment.

'My teacher saved my life' versus 'Teachers don't have a clue': an online survey of pupils' experiences of eating disorders

BACKGROUND

Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known about pupils' experiences of ED within a school setting.

METHOD

Five hundred and eleven 11- to 19-year-old school pupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male). Responses were analysed using content analysis principles.

RESULTS

Of the participants, 38% had a current or past ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise ED awareness. Only 7% would confide in a teacher about an ED.

CONCLUSIONS

Efforts are needed to break down barriers to disclosure and support teachers to play an effective role in the detection and early intervention for ED.

Improving eating disorders mental health literacy: a preliminary evaluation of the "Should I say something?" workshop

A repeated measures, uncontrolled, preliminary evaluation of a single 3-hour workshop-"Should I Say Something?"-aimed at improving eating disorders mental health literacy, was conducted in a sample of 177 university undergraduates. Following participation in the workshop, significant increases in eating disorder recognition and knowledge, and significant decreases in stigmatizing attitudes, were reported by participants. Moreover, 85% of participants reported that they provided assistance to someone whom they suspected had a mental health condition, including an eating disorder, during the 3-month follow-up period. This study provides preliminary evidence that "Should I Say Something?" may be effective in improving the mental health literacy of young people.

Self-recognition of eating-disordered behavior in college women: further evidence of poor eating disorders "mental health literacy"?

Self-recognition of eating-disordered behavior was examined among female college students (n = 94) with a high level of bulimic-type eating disorder symptoms. A vignette was presented describing a fictional young woman with bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described, while also completing self-report measures of eating disorder symptoms, general psychological distress, and functional impairment. Less than half (47.9%) of participants believed that they currently had a problem with their eating. In both bivariate and multivariable analysis, the variables most strongly associated with self-recognition were overall levels of eating disorder psychopathology, prior treatment for an eating problem, and the use of self-induced vomiting as a means of controlling weight or shape. No other eating disorder behaviors were independently associated with self-recognition. The findings support the hypothesis that young women with eating disorder symptoms may be unlikely, or at least less likely, to recognize a problem with their eating behavior when that behavior does not entail self-induced vomiting. Health promotion and early intervention programs for eating disorders may need to address the perception that, among young women of normal or above-average body weight, only problems with eating that involve self-induced vomiting are pathological.

Quality of life impairment in a community sample of women with eating disorders

OBJECTIVE

Studies of quality of life among individuals with eating disorders have relied almost exclusively on clinical samples. We examined impairment in quality of life in a community sample of women with eating disorders recruited as part of an epidemiological study.

METHODS

Measures of health-related quality of life (Medical Outcomes Study 12-item Short-Form Physical and Mental Component Summary scales) and subjective well-being (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by women with eating disorders (n = 159), primarily variants of bulimia nervosa and binge eating disorder, and a comparison group of healthy women (n = 232).

RESULTS

When compared with healthy women, women with eating disorders reported substantial impairment in aspects of quality of life relating to mental health, although item-level analysis indicated considerable variation in the extent to which specific aspects of emotional well-being were affected. Impairment in social relationship and in physical health was less pronounced and due, at least in part, to between-group differences in age, body weight and demographic characteristics. Impairment in certain aspects of perceived physical health was, however, apparent among women with eating disorders, even after controlling for between-group differences in body weight.

CONCLUSIONS

Community cases of women with eating disorders experience marked impairment in quality of life as this relates to mental health functioning and at least some impairment in physical health functioning. Personality characteristics and ego-syntonic aspects of eating-disordered behaviour may complicate the interpretation of findings relating to impairment in specific aspects of quality of life.

Illness perception in bulimia nervosa

The study was designed to extend our understanding of illness perceptions in patients with bulimia nervosa (BN). Seventy-eight participants with BN or BN-type Eating Disorder Not Otherwise Specified (EDNOS-BN) completed the Revised Illness Perception Questionnaire (IPQ-R) ( Moss-Morris et al., 2002 ). Clinical variables were also assessed. Participants experienced their ED as chronic, with serious consequences and high associated levels of anxiety and depression. The disorder was attributed primarily to psychological causes. The results indicate the perceived severity of BN, and high level of associated distress. These findings highlight the potential for targeting illness perceptions in treatment.

Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey

Few with eating disorders (EDs) access evidence-based treatments. We conducted a prospective exploration of help-seeking by 57 community women with bulimic-type EDs using the Framework approach of familiarization, identifying themes, indexing, charting and mapping and interpretation. The mean age of the sample was 33 years. Results found women sought help for concerns regarding perceived (over) weight rather than for eating, although many women would have welcomed questions from professionals regarding eating behaviours. Empathy, providing information and hope were considered important features of health professionals to provide a positive experience of help-seeking. Specific personal barriers to treatment included low motivation, fear of stigma, and cost. Greater clinician and community awareness of and action on these issues would likely help close "the gap" for effective help-seeking by those with EDs.

The recognition of mental health disorders and its association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors: an investigation using the overclaiming technique

The present study examined the general public's ability to recognise mental health disorders and this ability's association with psychiatric scepticism, knowledge of psychiatry, and the Big Five personality factors. A total of 477 members of the British general public completed an overclaiming scale, in which they were asked to rate the degree to which they believed 20 mental health disorders (of which five were foils designed to resemble real disorders) were real or fake. Participants also completed a novel scale measuring psychiatric scepticism, a single-item measure of knowledge of psychiatry, and a measure of the Big Five personality factors. Results showed that participants were significantly more likely to rate foils as fake disorders than real disorders. In addition, the difference between real and foil ratings was significantly predicted by knowledge of psychiatry, psychiatric scepticism, and the Big Five personality factors of agreeableness and openness to experience. These results are discussed in relation to the overclaiming technique as a novel method to study mental health literacy.

Gender differences in perceptions of the severity and prevalence of eating disorders

AIM

Gender differences in perceptions of the severity and prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) were examined in young men (n=113) and women (n=289) recruited from a regional university campus in north-east Australia.

METHODS

Participants viewed vignettes of fictional (female) sufferers of AN and BN and responded to the same series of questions in relation to each vignette.

RESULTS

For both vignettes, a substantial minority of male, but not female, participants indicated that they would be a little or not at all sympathetic to someone with the problem described, that the problem described would be a little or not at all difficult to treat, and that having the problem described would be moderately or a little distressing. Men were also more likely than women to consider BN to be primarily a problem of 'lack of will-power/self-control'. Perceptions of the prevalence of AN (modal response = 'very few women/10% or less') and BN ('10% to 30%') did not differ by gender and both male and female participants considered AN to be more severe and less common than BN.

CONCLUSIONS

The findings suggest that there may be a need to target the attitudes and beliefs of young men in particular in the prevention and early intervention initiatives for eating disorders.

A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers

OBJECTIVE

The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample.

METHOD

We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment (n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined by ethnic minority and non-minority participants. We then examined the influence of key social barriers-including stigma and social stereotypes-on perceived impact on care.

RESULTS

The majority of respondents (78%) endorsed at least one social barrier to care for an eating or weight concern. Perceived stigma (or shame) and social stereotyping-identified both within social networks and among clinicians-had adversely impacted care for 59% and 19% of respondents, respectively.

DISCUSSION

Social barriers to care for eating and weight related concerns may be prevalent in the U.S. and impact both ethnic minority and non-minority health care consumers.

Eating disorders "mental health literacy" in low risk, high risk and symptomatic women: implications for health promotion programs

Attitudes and beliefs concerning the nature and treatment of bulimia nervosa (BN) were compared among young adult women at low risk of an eating disorder (n = 332), at high risk (n = 83), or already showing symptoms (n = 94). Participants completed a self-report questionnaire that included a measure of eating disorder symptoms. A vignette of a fictional person suffering from BN was presented, followed by a series of questions addressing the nature and treatment of the problem described. High-risk and symptomatic participants were more likely than low-risk participants to report that they would not approach anyone for advice or help, were they to have BN or a similar problem, because they would not want anyone to know. Symptomatic participants were more likely to believe that someone with BN would be discriminated against, more likely to consider bulimic behaviors to be acceptable, and more likely to view BN as being common among women in the community, than low-risk participants, participants in the high-risk group being intermediate on each of these questions. The findings suggest that the attitudes and beliefs of individuals with eating disorder symptoms differ systematically from those of individuals at high risk, but who do not yet have symptoms, and from those at low risk. They also indicate specific attitudes and beliefs that may need to be addressed in prevention and early intervention programs. The potential benefits of assessing individuals' attitudes and beliefs concerning the nature and treatment of eating-disordered behaviour and tailoring program content accordingly may be worthy of investigation.

Prior use of extreme weight-control behaviors in a community sample of women with binge eating disorder or subthreshold binge eating disorder: a descriptive study

OBJECTIVE AND METHOD

The prior occurrence of regular extreme weight-control behaviors was examined in a community sample of women (n = 27) with binge eating disorder (BED) or subthreshold BED.

RESULTS

Approximately two thirds of participants (65.4%) reported the prior use of either purging at least weekly or nonpurging behaviors three or more times per week, for a period of 3 months or more, whereas 38.5% of participants reported either purging at least twice weekly or nonpurging behaviors five or more times per week. Comparatively few participants (11.1%) had ever met formal diagnostic criteria for BN.

DISCUSSION

Considerable overlap between disorders characterized by binge eating in the absence of extreme weight-control behaviors and those characterized by extreme weight-control behaviors in the absence of binge eating may be apparent when a longitudinal perspective is taken. Caution needs to be exercised in drawing conclusions concerning the extent of this overlap based on any one operational definition of the term "regular extreme weight-control behaviors".

Bulimic eating disorders in primary care: hidden morbidity still?

The current study examined the features of women with bulimic-type eating disorders (n = 24) attending primary care in two smaller urban regions of the USA. The assessment included measures of eating disorder psychopathology, medical comorbidity, impairment in role functioning, potential barriers to treatment and actual use of health services. Eating disorders, primarily variants of bulimia nervosa and binge eating disorder not meeting formal diagnostic criteria, were associated with marked impairment in psychosocial functioning. Although two-thirds of participants recognized a problem with their eating, less than 40% had ever sought treatment from a health professional for an eating or weight problem and only one in ten had sought such treatment from a mental health specialist. Only one-third had ever been asked about problems with eating by a primary care practitioner or other health professional. However, more than 80% had sought treatment from a health professional for symptoms of anxiety or depression. Most reported some degree of discomfort in discussing eating problems with others, and half reported that they would not be truthful about such problems if asked. Having an eating disorder was associated with several chronic medical conditions, including joint pain, gastrointestinal problems and fatigue. Although the small sample size limits any firm conclusions, the findings suggest that the health burden of bulimic-type eating disorders is substantial but remains largely hidden. Efforts may be needed to improve the eating disorders "mental health literacy" of both patients and primary care practitioners in order to facilitate early, appropriate intervention.

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

Eating disorders mental health literacy in Singapore: beliefs of young adult women concerning treatment and outcome of bulimia nervosa

AIM

We examined the eating disorders 'mental health literacy' of young adult women in Singapore.

METHODS

A self-report questionnaire was completed by 255 women recruited from three university campuses. A vignette of a fictional (female) person exhibiting the characteristic features of bulimia nervosa was presented, followed by a series of questions concerning the treatment and outcome of the problem described. A measure of eating disorder symptoms was included in the questionnaire.

RESULTS

Consulting a primary care practitioner, counsellor or psychologist; seeking the advice of a (female) family member or friend; getting advice about diet and nutrition; and taking vitamins and minerals were the interventions most often considered helpful. Participants were less positive about the benefits of psychiatristsand were ambivalent about the use of psychotropic medication. Participants' mothers were most often considered helpful as they are an initial source of help. Among participants with a high level of eating disorder symptoms, recognition of an eating problem was poor. A minority of participants believed that treatment would result in full recovery.

CONCLUSIONS

Aspects of the eating disorders mental health literacy of young Singaporean women may be conducive to low or inappropriate treatment seeking. Health promotion programmes need to target not only at-risk individuals, but also their family members and social circle.

Use of extreme weight-control behaviors in the absence of binge eating with and without subjective bulimic episodes: a community-based study

BACKGROUND AND METHODS

In a community sample of women who reported the use of extreme weight-control behaviors in the absence of binge eating, subgroups of participants who reported (n = 23) and who did not report (n = 42) recurrent subjective bulimic episodes (SBEs) were compared on a range of outcomes, including current levels of eating disorder and comorbid psychopathology.

RESULTS

Participants who reported SBEs had higher levels of eating disorder psychopathology, impairment in role functioning, and general psychological distress, than those who did not. Scores on these measures among participants who reported SBEs were similar to those of eating disorder patients receiving specialist treatment, whereas those of participants who did not have recurrent SBEs tended to be intermediate between eating disorder patients and healthy women.

DISCUSSION

The findings are consistent with the hypothesis that it is the combination of SBEs and extreme weight-control behaviors, rather than extreme weight-control behaviors per se, that indicates clinical significance.