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Feldhege J, Bilic S, Ali K, Fassnacht DB, Moessner M, Farrer LM, Griffiths KM, Bauer S. Knowledge and Myths about Eating Disorders in a German Adolescent Sample: A Preliminary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116861. [PMID: 35682445 PMCID: PMC9180431 DOI: 10.3390/ijerph19116861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022]
Abstract
Eating disorder mental health literacy (ED-MHL) refers to knowledge about the symptoms, causes, and treatment of eating disorders (EDs) and is an important factor in people’s attitudes towards individuals with EDs and help-seeking for EDs. Associations between ED-MHL, stigma, ED symptomatology, and gender were investigated in a sample of N = 194 German high school students. Knowledge and myths about EDs were assessed with 18 factual statements about EDs and agreement/disagreement with common myths about ED. Students also completed the Universal Stigma Scale (USS), the Weight Concerns Scale (WCS), and demographic items. Students judged M = 8.39 (SD = 3.40) statements correctly, while the average agreement with all ED myths was low (M = 0.19, SD = 0.14). Greater ED-MHL was associated with lower stigmatization of EDs. Male participants were less knowledgeable and more likely to agree with the ED myths. Participants displayed moderate ED-MHL; however, certain aspects such as ED risk factors or symptoms of specific disorders such as anorexia nervosa and bulimia nervosa were less well known. These results can inform the design of future MHL interventions for adolescents.
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Affiliation(s)
- Johannes Feldhege
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
- Correspondence:
| | - Sally Bilic
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Kathina Ali
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Daniel B. Fassnacht
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Louise M. Farrer
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia;
| | - Kathleen M. Griffiths
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
- College of Health & Medicine, Australian National University, Canberra 2601, Australia
| | - Stephanie Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
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Feldhege JM, Gulec H, Moessner M, Stieler C, van Stipelen J, Bauer S. Stigmatization and attitudes toward eating disorders: a comparison between native German adolescents, Turkish immigrant adolescents in Germany, and native Turkish adolescents. J Ment Health 2021; 31:99-108. [PMID: 34569396 DOI: 10.1080/09638237.2021.1979484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS The purpose of this study was to investigate the attitudes toward eating disorders in native German adolescents (Germans), adolescents with Turkish migration background in Germany (Immigrants), and native Turkish adolescents (Turks). METHOD A total of 507 adolescents (N = 139 Germans; N = 126 Immigrants; N = 242 Turks) read a vignette describing a 16-year-old female with bulimic symptoms. Participants completed questionnaires on mental health literacy, stigmatization, desirability of eating disorder-related behaviors and acquaintance with bulimic symptoms. RESULTS Adolescents living in Germany were more likely to recognize the vignette as an eating disorder than Turks. Immigrants were more similar to Germans in mental health literacy of eating disorders than Turks. However, in terms of stigmatizing attitudes, immigrants blamed more than Germans, Turks being intermediate on this variable. In Turks, higher desirability of eating disorder-related behaviors was associated with an increased acquaintance with bulimic symptoms and decreased evaluations of impairment. Higher mental health literacy was associated with less blame in Germans. CONCLUSIONS Migration background was associated with increased mental health literacy of eating disorders but did not result in reduced stigma. Differences in attitudes toward eating disorders indicate the need for differential interventions across the groups.
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Affiliation(s)
| | - Hayriye Gulec
- Department of Psychology, Bursa Uludag University, Bursa, Turkey
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Christiane Stieler
- Klinik für Suchttherapie und Entwöhnung, Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | - Jhana van Stipelen
- Refugio Villingen-Schwenningen e. V., Psychosoziales Zentrum für traumatisierte Flüchtlinge, Villingen-Schwenningen, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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Brelet L, Flaudias V, Désert M, Guillaume S, Llorca PM, Boirie Y. Stigmatization toward People with Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder: A Scoping Review. Nutrients 2021; 13:nu13082834. [PMID: 34444994 PMCID: PMC8400545 DOI: 10.3390/nu13082834] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
Research about stigmatization in eating disorders (EDs) has highlighted stereotypes, prejudices, and discrimination against people with EDs, as well as their harmful effects on them, including self-stigma and a difficult recovery process. Whereas a recent review focused on the consequences of ED stigma, our work aimed to provide a broader synthesis of ED stigma, including its consequences, but also its content and distribution. More precisely, we focused on three EDs-namely, anorexia nervosa, bulimia nervosa, and binge eating disorder. Based on a systematic search of four major databases in psychology, the present scoping review includes 46 studies published between 2004 and 2021. We did not conduct any quality assessment of the studies included, because our aim was to provide a wide-ranging overview of these topics instead of an appraisal of evidence answering a precise research question. The review confirmed the existence of a common ED stigma: all individuals affected by EDs reviewed here were perceived as responsible for their situation, and elicited negative emotions and social distance. However, our review also depicted a specific stigma content associated with each ED. In addition, the demographic characteristics of the stigmatizing individuals had a notable influence on the extent of ED stigma: men, young adults, and low-income individuals appeared to be the most stigmatizing toward individuals with EDs. It is important to note that ED stigma had a negative effect on individuals' eating disorders, psychological wellbeing, and treatment-seeking behavior. There is an urgent need for further research on the adverse effects of ED stigma and its prevention.
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Affiliation(s)
- Lisa Brelet
- Pôle R&D Santé, Jeolis Solutions, 63000 Clermont-Ferrand, France
- Correspondence:
| | - Valentin Flaudias
- Pôle Psychiatrie B, CHU Gabriel Montpied, 63003 Clermont-Ferrand, France;
- EA 780 NPsy-Sydo, Université Clermont Auvergne, 63001 Clermont-Ferrand, France
| | - Michel Désert
- Laboratoire de Psychologie Sociale et Cognitive (LAPSCO), Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63003 Clermont-Ferrand, France;
| | - Sébastien Guillaume
- Département des Urgences Psychiatriques, Hôpital Lapeyronie, CHRU Montpellier, 34295 Montpellier, France;
- Institut de Génomique Fonctionnelle (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Montpellier, 34094 Montpellier, France
| | - Pierre-Michel Llorca
- CMP-B CHU, Clermont Auvergne INP, Institut Pascal, Centre National de la Recherche Scientifique (CNRS), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Yves Boirie
- Centre Troubles des Conduites Alimentaires (TCA), Service de Nutrition Clinique, Unité de Nutrition Humaine, CHU Gabriel Montpied, CRNH, Université Clermont Auvergne, 63003 Clermont-Ferrand, France;
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Dryer R, Tyson GA, Kiernan MJ. Bulimia Nervosa: Professional and Lay People's Beliefs About the Causes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00077.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Holtzhausen N, Mannan H, Foroughi N, Hay P. Effects associated with the use of healthcare for eating disorders by women in the community: a longitudinal cohort study. BMJ Open 2020; 10:e033986. [PMID: 32859658 PMCID: PMC7454177 DOI: 10.1136/bmjopen-2019-033986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examined formal and informal healthcare use (HCU) in community women with disordered eating, and associations of HCU with mental health-related quality of life (MHRQoL), psychological distress, mental health literacy (MHL) and eating disorder (ED) symptoms over time. HYPOTHESIS We hypothesised that HCU would lead to improvement in ED symptom severity, MHRQoL, MHL and psychological distress. DESIGN, SETTING, PARTICIPANTS Data were from years 2, 4 and 9 of a longitudinal cohort of 443 community women (mean age 30.6, SE 0.4 years) with a range of ED symptoms, randomly recruited from the Australian Capital Territory electoral role or via convenience sampling from tertiary education centres. Data were collected using posted/emailed self-report questionnaires; inclusion criteria were completion of the HCU questionnaire at time point of 2 years (baseline for this study). HCU was measured using a multiple-choice question on help seeking for an eating problem. To test the effect of HCU over time on MHRQoL (Short Form-12 score), psychological distress (Kessler Psychological Distress Scale score), ED symptom severity (Eating Disorder Examination Questionnaire score) and ED-MHL, linear or logistic mixed-effects regression analyses were used. RESULTS 20% of participants sought ED-specific help at baseline; more than half of participants sought help that was not evidence based. HCU at baseline was significantly associated with improved MHRQoL and ED symptom severity and decreased psychological distress over time (Cohen's d all >0.3, ie, small). HCU was not significantly associated with MHL over time. The predictive ability of the fitted models ranged from 32.18% to 42.42% for psychological distress and MHL treatment, respectively. CONCLUSIONS Formal and informal HCU were associated with small improvements in ED symptoms, MHRQoL and psychological distress but not with improved MHL. Informal services in ED management should be investigated further along with efforts to improve ED-MHL.
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Affiliation(s)
- Nicol Holtzhausen
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Nasim Foroughi
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
- Campbelltown Hospital Mental Health, South West Sydney Local Health District, Campbelltown, New South Wales, Australia
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Brown CE, Nicholson Perry K. Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity? J Eat Disord 2018; 6:19. [PMID: 30186605 PMCID: PMC6119328 DOI: 10.1186/s40337-018-0208-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder. METHOD A survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism. RESULTS Results demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity. CONCLUSION These findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.
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Affiliation(s)
- C E Brown
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
| | - K Nicholson Perry
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
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Stigmatizing attitudes and beliefs toward bulimia nervosa: the importance of knowledge and eating disorder symptoms. J Nerv Ment Dis 2015; 203:259-63. [PMID: 25751709 DOI: 10.1097/nmd.0000000000000275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Widely held stigmatizing attitudes and beliefs toward bulimic eating disorders may lead to self-blame and reduced treatment seeking. Knowledge and familiarity with mental disorders may help decrease associated stigma. However, these relationships are not well understood in bulimia nervosa (BN). A community sample of 1828 adults aged 18 to 70 years completed a survey assessing stigmatizing attitudes and beliefs toward BN, knowledge and familiarity with the disorder, as well as levels of eating disorder symptoms. Knowledge of BN was negatively associated with three dimensions of stigmatization, personal responsibility (ρ = -0.28), unreliability (ρ = -0.19), and advantages of BN (ρ = -0.23). Familiarity revealed no association with stigmatization. Both men and women with high levels of eating disorder symptoms perceived BN as less serious than the participants with low levels of symptoms. Increasing community knowledge about bulimia may help mitigate stigmatization and perceived barriers to treatment.
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Dryer R, Uesaka Y, Manalo E, Tyson G. Cross-cultural examination of beliefs about the causes of bulimia nervosa among Australian and Japanese females. Int J Eat Disord 2015; 48:176-86. [PMID: 24599823 DOI: 10.1002/eat.22269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/22/2014] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Rachel Dryer
- School of Psychology, Charles Sturt University, Bathurst, Australia
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Blodgett Salafia EH, Jones ME, Haugen EC, Schaefer MK. Perceptions of the causes of eating disorders: a comparison of individuals with and without eating disorders. J Eat Disord 2015; 3:32. [PMID: 26380085 PMCID: PMC4570226 DOI: 10.1186/s40337-015-0069-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/04/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In this study, we examined perceptions regarding the causes of eating disorders, both among those with eating disorders as well as those without. By understanding the differences in perceived causes between the two groups, better educational programs for lay people and those suffering from eating disorders can be developed. METHOD This study used open-ended questions to assess the beliefs of 57 individuals with self-reported eating disorders and 220 without. Participants responded to the questions, "What do you think was (were) the cause(s) of your eating disorder?" and "What do you think is (are) the cause(s) of eating disorders?". RESULTS A list of possible codes for the causes of eating disorders was created based on a thorough review of the literature. A manually-generated set of eight codes was then created from individuals' actual responses. Frequencies and chi square analyses demonstrated differences in rates of endorsement between those with eating disorders and those without. Participants with eating disorders most frequently endorsed psychological/emotional and social problems, with genetics/biology and media/culture ideals least endorsed. Participants without eating disorders most frequently endorsed psychological/emotional problems and media/culture ideals, with traumatic life events and sports/health least endorsed. There was a difference between groups in the endorsement of the media as a cause of eating disorders, suggesting that those without eating disorders may overly attribute the media as the main cause while those with eating disorders may not be fully aware of the media's impact. Additionally, while both groups highly endorsed psychological/emotional problems, there was a noticeable stigma about eating disorders among those without eating disorders. CONCLUSIONS There were noteworthy differences between samples; such differences suggest that there is a need for more education on the topic of eating disorders. Furthermore, despite empirical support for the effects of genetics, sports, and family factors, these were infrequently endorsed as causes of eating disorders by both groups. Our results suggest that there is a need for more education regarding the factors associated with eating disorders, in order to reduce the stigma surrounding these disorders and to potentially aid the treatment process.
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Affiliation(s)
- Elizabeth H Blodgett Salafia
- Department of Human Development and Family Science, North Dakota State University, 283-H EML Hall, #2615, P.O. Box 6050, Fargo, North Dakota 58108 USA
| | - Maegan E Jones
- Department of Human Development and Family Science, North Dakota State University, 283-H EML Hall, #2615, P.O. Box 6050, Fargo, North Dakota 58108 USA
| | - Emily C Haugen
- Department of Human Development and Family Science, North Dakota State University, 283-H EML Hall, #2615, P.O. Box 6050, Fargo, North Dakota 58108 USA
| | - Mallary K Schaefer
- Department of Human Development and Family Science, North Dakota State University, 283-H EML Hall, #2615, P.O. Box 6050, Fargo, North Dakota 58108 USA
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McLean SA, Paxton SJ, Massey R, Hay PJ, Mond JM, Rodgers B. Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample. Int J Eat Disord 2014; 47:353-61. [PMID: 24277701 DOI: 10.1002/eat.22227] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Siân A McLean
- School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
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Sandberg K, Erford BT. Choosing Assessment Instruments for Bulimia Practice and Outcome Research. JOURNAL OF COUNSELING AND DEVELOPMENT 2013. [DOI: 10.1002/j.1556-6676.2013.00107.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katie Sandberg
- Department of Education Specialties; Loyola University Maryland
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Swami V, Knowles V. Mental health literacy of negative body image: symptom recognition and beliefs about body image in a British community sample. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/17542863.2013.769611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kroon Van Diest AM, Perez M. Exploring the integration of thin-ideal internalization and self-objectification in the prevention of eating disorders. Body Image 2013. [PMID: 23182310 DOI: 10.1016/j.bodyim.2012.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n=177), post-intervention (n=169), 5-month (n=159), and 1-year follow-up (n=105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.
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Affiliation(s)
- Ashley M Kroon Van Diest
- Department of Psychology, Texas A&M University, 230 Psychology Building, College Station, TX 77843-4235, USA.
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Hart LM, Jorm AF, Paxton SJ. Mental health first aid for eating disorders: pilot evaluation of a training program for the public. BMC Psychiatry 2012; 12:98. [PMID: 22856517 PMCID: PMC3549729 DOI: 10.1186/1471-244x-12-98] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/14/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Eating disorders cause significant burden that may be reduced by early and appropriate help-seeking. However, despite the availability of effective treatments, very few individuals with eating disorders seek treatment. Training in mental health first aid is known to be effective in increasing mental health literacy and supportive behaviours, in the social networks of individuals with mental health problems. Increases in these domains are thought to improve the likelihood that effective help is sought. However, the efficacy of mental health first aid for eating disorders has not been evaluated. The aim of this research was to examine whether specific training in mental health first aid for eating disorders was effective in changing knowledge, attitudes and behaviours towards people with eating disorders. METHODS A repeated measures, uncontrolled trial was conducted to establish proof of concept and provide guidance on the future design of a randomised controlled trial. Self-report questionnaires, administered at baseline, post-training and 6-month follow-up, assessed the effectiveness of the 4-hour, single session, mental health first aid training. RESULTS 73 participants completed the training and all questionnaires. The training intervention was associated with statistically significant increases in problem recognition and knowledge of appropriate mental health first aid strategies, which were maintained at 6-month follow-up. Sustained significant changes in attitudes and behaviours were less clear. 20 participants reported providing assistance to someone with a suspected eating disorder, seven of whom sought professional help as a result of the first aid interaction. Results provided no evidence of a negative impact on participants or the individuals they provided assistance to. CONCLUSIONS This research provides preliminary evidence for the use of training in mental health first aid as a suitable intervention for increasing community knowledge of and support for people with eating disorders to seek appropriate help. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12611001181998.
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Affiliation(s)
- Laura M Hart
- Melbourne School of Population Health, University of Melbourne, Parkville, VIC, Australia.
| | - Anthony F Jorm
- Melbourne School of Population Health, University of Melbourne, Parkville, VIC, Australia
| | - Susan J Paxton
- School of Psychological Science, La Trobe University, Bundoora, VIC, Australia
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Rousseau A, Callahan S, Chabrol H. Representations and beliefs about eating disorders in a sample of French adolescents. Int J Eat Disord 2012; 45:247-51. [PMID: 21448972 DOI: 10.1002/eat.20887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Body dissatisfaction and psychological problems are cited as the major cause of anorexia nervosa (AN) and bulimia nervosa (BN). Behavioral characteristics most often associated with AN and BN are food restriction, vomiting, and excessive exercise. The objective of this study was to examine representations and beliefs about AN and BN in a sample of French adolescents. METHOD The sample was composed of 942 adolescents (16.4 years ± 1.2; 59.1% girls and 40.9% boys). RESULTS Excessive thinness and health problems were the physical characteristics most often associated with eating disorders (ED). A majority of the adolescents believe that ED most often manifest in adolescent females and were conscious of the gravity and chronic nature of ED; thinness was appropriately associated with AN, but many had erroneous beliefs regarding BN. DISCUSSION The results of this study provide insight into what young people in France believe and understand about the two major ED and advocate for more available information concerning BN for this population.
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Darby AM, Hay PJ, Mond JM, Quirk F. Community recognition and beliefs about anorexia nervosa and its treatment. Int J Eat Disord 2012; 45:120-4. [PMID: 22170023 DOI: 10.1002/eat.20886] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Mental Health Literacy (MHL), namely recognition, and beliefs about treatment concerning Anorexia Nervosa (AN) were examined in a community sample of male and female (n = 983) aged 15-94 years. METHOD A vignette describing a women suffering from the symptoms of AN was presented, followed by a respondent-based structured interview concerning recognition of the problem and treatment beliefs. RESULTS The majority of participants could identify the problem as that of an eating disorder, although only 16.1% could specifically identify it as AN. Many also believed the problem was primarily one of low self-esteem (32.5%). General practitioners and psychiatrists or psychologists were considered the most helpful treatment providers, while obtaining information about the problem and available services, followed by family therapy, were considered the most helpful treatments. Less than one-third of participants believed complete recovery was possible. Better AN MHL was found in younger, higher educated, and metropolitan domiciled females. DISCUSSION This study offers encouraging results in regard to AN MHL. In particular, there was moderate regard for the use of mental health specialists in the treatment of the disorder. However, there appears to be a misconception that AN is largely the manifestation of low self-esteem and confusion concerning the distinction between AN and bulimia nervosa. AN MHL was poorer in males and those with higher social and health disadvantage.
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Affiliation(s)
- Anita M Darby
- School of Medicine, James Cook University, Townsville, Australia
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Levinson CA, Rodebaugh TL. Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears. Eat Behav 2012; 13:27-35. [PMID: 22177392 PMCID: PMC3244677 DOI: 10.1016/j.eatbeh.2011.11.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 08/23/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with disordered eating. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation, and social appearance anxiety. Results indicated that social appearance anxiety predicted body dissatisfaction, bulimic symptoms, shape concern, weight concern, and eating concern over and above fear of scrutiny, social interaction anxiety, and fear of positive evaluation. Fear of negative evaluation uniquely predicted drive for thinness and restraint. Structural equation modeling supported a model in which social appearance anxiety and fear of negative evaluation are vulnerabilities for both social anxiety and eating disorder symptoms. Interventions that target these negative social evaluation fears may help prevent development of eating disorders.
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Abstract
BACKGROUND Twenty years ago, Price published a survey identifying knowledge deficits of school counselors regarding eating disorders. Our study surveys current school counselors to determine whether knowledge has increased and determine the availability of school-based prevention programming. METHODS School counselors from a single metropolitan area were surveyed prior to a mandatory in-service on eating disorders. RESULTS Of the 109 respondents, 55% felt eating disorders were a problem in their school. Very few felt "very competent" identifying (6%) or helping (2%) students with eating disorders. Today's school counselors were more likely to know a symptom of anorexia nervosa (AN) is missing at least three consecutive menstrual cycles and malnutrition is not a common cause of death for bulimia nervosa (BN). CONCLUSIONS While knowledge of AN and BN appear to have increased, school counselors still lack some basic understanding and report very low confidence in identifying and helping students with eating disorders.
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Mond JM, Hay PJ, Paxton SJ, Rodgers B, Darby A, Nillson J, Quirk F, Owen C. Eating disorders "mental health literacy" in low risk, high risk and symptomatic women: implications for health promotion programs. Eat Disord 2010; 18:267-85. [PMID: 20603729 DOI: 10.1080/10640266.2010.490115] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Jonathan M Mond
- School of Biomedical and Health Sciences, University of Western Sydney, Campbelltown, New South Wales, Australia
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Wilson GT, Perrin NA, Rosselli F, Striegel-Moore RH, Debar LL, Kraemer HC. Beliefs about eating and eating disorders. Eat Behav 2009; 10:157-60. [PMID: 19665098 DOI: 10.1016/j.eatbeh.2009.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 03/20/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
Abstract
Beliefs about foods and binge eating may influence the development and maintenance of eating disorders and the likelihood that people will seek treatment. We found that the majority of a random sample of members of a large health maintenance organization considered binge eating a problem for which there are effective treatments. Self-reported binge eaters, however, were significantly less likely to agree that there are effective treatments. Two thirds of the sample reported that certain foods are addictive and also believed that strict dieting is an effective means of reducing binge eating. Therapeutic implications of these attitudes are discussed.
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Affiliation(s)
- G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ 08854-8020, United States.
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Mond JM, Robertson-Smith G, Vetere A. Stigma and eating disorders: Is there evidence of negative attitudes towards anorexia nervosa among women in the community? J Ment Health 2009. [DOI: 10.1080/09638230600902559] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mond JM, Hay P, Rodgers B, Owen C. Mental health literacy and eating disorders: What do women with bulimic eating disorders think and know about bulimia nervosa and its treatment? J Ment Health 2009. [DOI: 10.1080/09638230701677787] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE Attitudes and beliefs concerning a binge eating problem were examined in a community sample of men and women (n = 1031) aged 15 to 94 years. METHOD A vignette describing a fictional 32-year-old female obese binge eater was presented, followed by a series of questions concerning the nature and treatment of the problem described. RESULTS Most participants believed that binge eating is primarily a problem of low self-esteem or depression. Behavioral weight loss treatment and self-help interventions were the treatments considered most helpful, whereas few participants believed that psychotherapy would be helpful. General practitioners and dieticians were the treatment providers considered most helpful. Most participants were ambivalent about prognosis given treatment and pessimistic about outcome in the absence of treatment. CONCLUSION The fact that binge eating is viewed primarily as a problem of negative affect, and that specific psychotherapy is not highly regarded as a treatment, may go some way to explaining why most individuals with binge eating-type disorders do not receive appropriate treatment. The benefits of specific psychotherapy in stabilizing eating behavior and improving quality of life for obese binge eaters need to be communicated to sufferers and to the health professionals they are likely to contact.
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Affiliation(s)
- Jonathan M Mond
- School of Psychological Science, LaTrobe University, Bundoora, Victoria, Australia.
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Mond J, Marks P. Beliefs of adolescent girls concerning the severity and prevalence of bulimia nervosa. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2007. [DOI: 10.1080/00049530601148413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jonathan Mond
- Discipline of Psychiatry, School of Medicine, James Cook University, Townsville, Queensland
| | - Peta Marks
- NSW Centre for Eating and Dieting Disorders, Central Sydney Area Health Service, Sydney, New South Wales, Australia
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Hunt JS, Rothman AJ. College students’ mental models for recognizing anorexia and bulimia nervosa. Appetite 2007; 48:289-300. [PMID: 17241690 DOI: 10.1016/j.appet.2006.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 05/01/2006] [Accepted: 05/19/2006] [Indexed: 11/18/2022]
Abstract
Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge.
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Affiliation(s)
- Jennifer S Hunt
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308, USA.
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Abstract
OBJECTIVE The aim of this study was to examine, using Mental Health Literacy, acceptability and correlates of acceptability of three treatment interventions for bulimia nervosa; medication, psychological therapy and self-change/lifestyle therapies. METHOD A self-report questionnaire to ascertain correlates of attitudes towards the three interventions was used. Respondents (n = 177) were females aged 18-53 years. RESULTS Psychological therapy was rated the most acceptable treatment to participants as well as the most acceptable to others, and to have most advantages and fewest disadvantages, followed by self-change/lifestyle therapies, and then medication. Social Pressures to be Thin was the most strongly endorsed cause of bulimia, followed by Low Self-Esteem, Eating Behaviour, Relationship and Family Environment, and lastly, Biology. Correlates with acceptability of different treatment approaches were identified. CONCLUSIONS Although no causal link can be assumed from this design, findings suggest that women appear to have a mixed understanding of the different mechanisms that each treatment intervention adopts to treat the causes and symptoms of bulimia, particularly self-change/lifestyle therapies. This may help to explain poor adherence to interventions.
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Affiliation(s)
- Natasha S Hepworth
- School of Psychological Science, La Trobe University, Bundoora, Vic. 3086, Australia
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Mond J, Hay P, Rodgers B, Owen C. Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study. Int J Eat Disord 2006; 39:747-53. [PMID: 16941624 DOI: 10.1002/eat.20306] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Self-recognition of eating-disordered behavior was examined in a community sample of young adult women (n = 158) with bulimic eating disorders. METHOD A vignette was presented describing a fictional person meeting diagnostic criteria for bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described. Scores on measures of eating disorder psychopathology, functional impairment and general psychological distress were compared between participants who recognized a problem with their eating and those who did not. RESULTS Participants who recognized a problem with their eating (n = 86, 51.9%) had higher levels of eating disorder psychopathology and general psychological distress, were more likely to engage in self-induced vomiting, and tended to be heavier, than those who did not (n = 72, 48.1%). In addition, participants who recognized a problem were more likely to have received treatment for an eating or weight problem. In multivariate analysis, the occurrence of self-induced vomiting and higher body weight were the only variables significantly associated with recognition. CONCLUSION Poor recognition of eating-disordered behavior may be conducive to low or inappropriate treatment seeking among individuals with bulimic- type eating disorders. The perception that only disorders involving self-induced vomiting are pathological may need to be addressed in prevention programs.
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Affiliation(s)
- Jonathan Mond
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA.
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