The Prevalence and Adverse Associations of Stigmatization in People with Eating Disorders

THE PREVALENCE ANDADVERSE ASSOCIATIONS OFSTIGMATIZATION IN PEOPLEWITH EATING DISORDERS

#1 Perceived as attention-seekers who are

personally responsible for their condition

#2 Current stigma-related interventions target

public perceptions about eating disorders

Eating disorders are stigmatized

#1 Is the stigma most commonly perpetrated by the public the same as that most commonly experienced by sufferers?

#2 Is the most commonly experienced stigma also the most damaging?

#3 Are anti-stigma initiatives targeting the most commonly experienced/damaging public perceptions?

#4 Are males stigmatised more than females? If so, how?

Gaps in the literature

› Young adults (mean age = 24.7 years)

› Predominantly female (95%)

› Residing in USA (33%), Aus (31%) or UK (21%)

› Students (48%) or employed (36%)

› Single (63.4%) or in a relationship (34%)

› Currently receving tx (57%), received treatment in the

past (33%), or never recevied treatment (7%)

Sample

Anorexia nervosa Bulimia nervosa EDNOS

165 66 86

Comparison of EDE-Q global scores

0

1

2

3

4

5

6

Anorexia Bulimia EDNOS

Clinical norm(Welch et al. 2011)

Community norm(Mond et al. 2006)

Q. “How frequently have you been subjected

to the following stigmatizing attitudes/beliefs

due to your eating disorder?”

Never

Rarely

Sometimes

Often

Always

Frequency of stigma

0% 25% 50% 75% 100%

Dangerous

Drug user

Dumb

Narcissist

Lazy

Bad influence on others

Loser

Weak

Less of a man/woman

Disgusting

Incompetent

"Attention seeker"

Shameful

Don't have a "real" condition

No self-control

Deceptive

Personally responsible

Able to just pull myself together

Always

Often

Sometimes

Rarely

NeverProportion of participants 0% 100%

Q. “How damaging have the following

attitudes and beliefs been to your physical or

psychological wellbeing?”

Not at all damaging

A little damaging

Moderately damaging

Very damaging

Extremely damaging

Damage due to stigma

0% 25% 50% 75% 100%

Drug user

Dangerous

Lazy

Loser

Narcissist

Less of a man/woman

Dumb

Deceptive

Weak

Bad influence on others

No self-control

Shameful

"Attention seeker"

Disgusting

Incompetent

Personally responsible

Don't have a "real" condition

Able to just pull myself together

Extremely damaging

Very damaging

Moderately damaging

A little damaging

Not at all damaging Proportion of participants 0% 100%

#1 No self-control

More frequently experienced for bulimia than

for anorexia or EDNOS

Medium/large effect: F(1, 314) = 28.8, p< .001

#2 Less of a man/less of a woman

More frequently experienced for males than

females

Medium effect: F(1 314) = 11.42, p < .001

Notable between-groups differences

What predicts changes in the

frequency of (overall) stigma?

Predictor B t(296) p Partial η2

Eating disorder symptoms 0.24 3.89 < .001 .05

Depression symptoms 0.01 0.15 .884 < .01

Duration of disorder 0.11 2.11 .036 .02

Self-esteem -0.19 -2.79 .006 .03

Self-stigma of seeking psych help 0.22 4.02 < .001 .05

BulimiaREF vs anorexia 0.07 1.38 .169 < .01

EDNOSREF vs anorexia -0.03 -0.65 .516 < .01

In treatmentREF vs not in treatment -0.01 -0.05 .960 < .01

MaleREF vs female -0.05 -0.96 .340 < .01

#1 Destigmatising eating disorders? Prioritise

the perceptions that eating disorders are trivial

and/or self-inflicted

#2 Destigmatising bulimia? Go after the

perception that sufferers have no self-control

#3 Destigmatising males? Go after the

perception that male sufferers have less

masculinity/manhood

Discussion

#1 Diagnoses were self-reported and not

confirmed through interviews

#2 Cross-sectional design

#3 Few males = limited power to detect sex

differences

#4 Self-stigma may have been a contaminant

Limitations

GRIFFITHS, S., MOND, J. M., MURRAY, S.

B., & TOUYZ, S. (IN PRESS). THE

PREVALENCE AND ADVERSE ASSOCIATIONS

OF STIGMATIZATION IN PEOPLE WITH EATING

DISORDERS. INTERNATIONAL JOURNAL OF

EATING DISORDERS

Comparison of EDE-Q subscale

scores

0

1

2

3

4

5

6

Restraint EatingConcern

ShapeConcern

WeightConcern

Clinical norms(Welch et al. 2011)

Community norms(Mond et al. 2006)

0% 25% 50% 75% 100%

Dangerous

Drug user

Dumb

Narcissist

Lazy

Bad influence on others

Loser

Weak

Less of a man/woman

Disgusting

Incompetent

"Attention seeker"

Shameful

Don't have a "real" condition

No self-control

Deceptive

Personally responsible

Able to "just pull myself together"

Always

Often

Sometimes

Rarely

NeverProportion of participants 0% 100%

0% 25% 50% 75% 100%

Drug user

Dangerous

Lazy

Loser

Narcissist

Less of a man/woman

Dumb

Deceptive

Weak

Bad influence on others

No self-control

Shameful

"Attention seeker"

Disgusting

Incompetent

Personally responsible

Don't have a "real" condition

Be able to "just pull myself together"

Extremely damaging

Very damaging

Moderately damaging

A little damaging

Not at all damaging Proportion of participants 0% 100%

#1 BMI. F(2, 298) = 25.6, p < .001

› Anorexia (17.4)

› Bulimia (23.2)

› EDNOS (23.7)

#2 Vomiting. 2(2) = 87.5, p < .001

› Anorexia (0)

› Bulimia (20)

› EDNOS (0)

Comparison of key indicators

#3 O Binge. 2(2) = 100.1, p < .001

› Anorexia (0)

› Bulimia (15)

› EDNOS (0.5)

#4 S Binge. 2(2) = 1.86, p = .395

› Anorexia (5)

› Bulimia (10)

› EDNOS 10)

#1 Should be able to just ‘pull myself together”

Experienced very often or always: 77.3%

Very damaging or extremely damaging: 83.6%

#2 Personally responsible for my condition

Experienced very often or always: 68.8%

Very damaging or extremely damaging: 74.8%

The two stigma standouts

#4 More stigma is associated with more

marked eating disorder symptoms and a

longer duration of disorder (and vice versa)

#5 More stigma is associated with more self-

stigma of seeking psychological help (and vice

versa)

Discussion