Self-stigma of seeking help and being male predict an increased likelihood of having an undiagnosed eating disorder (2015) (original) (raw)
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The Prevalence and Adverse Associations of Stigmatization in People with Eating Disorders (2014)
International Journal of Eating Disorders
Objective. To date, studies of stigma relating to eating disorders have been largely confined to surveys of the public. We sought to examine the prevalence and correlates of stigma as reported by individuals with eating disorders. Method. An online survey designed to assess frequency of exposure to potentially stigmatizing attitudes and beliefs as well as the perceived impact of this on health and well-being was completed by a cross-national sample of 317 individuals with anorexia nervosa (n = 165), bulimia nervosa (n = 66), or Eating Disorder Not Otherwise Specified (EDNOS; n = 86). Results. Participants rated two beliefs as both particularly common and particularly damaging, namely “I should be able to just pull myself together” and “I am personally responsible for my condition”. Participants with bulimia nervosa more commonly experienced the belief that they had "no self-control" and male participants more commonly experienced the belief that they were “less of a man". More frequent stigmatization was associated with higher levels of eating disorder psychopathology, a longer duration of disorder, lower self-esteem, and more self-stigma of seeking psychological help. Discussion. Stigma towards individuals with eating disorders, as experienced by sufferers, is common and associated with numerous adverse outcomes. The perceptions that eating disorders are trivial and self-inflicted should be a focus of destigmatization interventions. Efforts to reduce stigma towards individuals with bulimia nervosa may need to focus on perceptions of self-control, whereas efforts to reduce stigma towards males with eating disorders may need to focus on perceptions of masculinity/manhood.
Eating disorders stigma: Towards a more comprehensive understanding
Eating disorders are debilitating psychological illnesses for which sufferers often face stigmatisation. This stigma has consequences for wellbeing, treatment outcomes, and help-seeking. Men with eating disorders may be particularly vulnerable to stigmatisation. Relatively understudied, there is growing recognition that the “male experience” of eating disorders is not confined to thinness-oriented eating problems, including anorexia nervosa, but also muscularity-oriented eating problems, namely, muscle dysmorphia. This thesis constitutes four peer-reviewed and published studies examining stigma toward males with eating disorders and eating disorders stigma more broadly. Two additional manuscripts, also published, provide context for the aforementioned studies, and are provided in this thesis. The core research of four studies examined a) stigmatising attitudes and beliefs about men and women with anorexia nervosa and muscle dysmorphia, b) the prevalence and adverse associations of stigmatisation among men and women with eating disorders, c) the contribution of self-stigma of seeking treatment to rates of eating disorder diagnosis among male and female sufferers, and d) stigma resistance among men and women with eating disorders. Results showed that women with anorexia nervosa may be particularly susceptible to stigmatisation from males, that stigmatisation of males with anorexia nervosa and muscle dysmorphia may be strongly tied to perceptions of masculinity, that more frequent stigma among eating disorder sufferers is associated with a more severe eating disorder and longer duration of illness, that the key sex difference in stigmatisation as reported by eating disorder sufferers is that males report more frequently being stigmatised as “less of a man”, that the self-stigma of seeking psychological help is a stronger predictor of an eating disorder sufferer being undiagnosed if the sufferer is male compared to female, and that stigma resistance may offer some protection against the internalization of mental illness and eating disorders stigma. Taken together, these findings have considerably broadened our understanding of eating disorders stigma, particularly toward males. The findings should be used inform the development of early intervention and destigmatisation initiatives aimed at eating disorders, and offer promising directions for future research on eating disorders stigma.
Objective: Eating disorders stigmatization is common and is associated with greater eating disorders symptom severity. This study sought to elucidate stigma internalization as a potential mechanism underlying this association. Two central aspects of stigma internalization were focused on: alienation and social withdrawal. Method: A cross-national sample of individuals with self-reported eating disorders (N = 260) completed measures of eating disorders stigmatization, symptom severity, alienation, and social withdrawal. Results: The model evidenced excellent fit. Eating disorders stigmatization directly predicted both alienation and social withdrawal, which, in turn, directly predicted symptom severity. Indirect effect analyses indicated that greater eating disorders stigmatization ultimately predicted greater symptom severity via alienation and social withdrawal. Moreover, social withdrawal mediated the association of alienation with symptom severity. Fitting a direct pathway from eating disorder stigmatization to symptom severity did not improve model fit. Discussion: Our model provides a potentially useful account of the mechanisms by which eating disorders stigmatization might worsen eating disorder symptom severity. Specifically, the stigma internalization processes of alienation and social withdrawal may be important factors linking stigmatization with symptom severity. The findings have implications for clinicians attempting to help individuals with eating disorders to monitor and modify their responses to eating disorders stigmatization.
Previous research has shown that men are more stigmatizing than women toward individuals with eating disorders, including anorexia nervosa and muscle dysmorphia. We hypothesized that previously observed sex differences in eating disorders’ stigmatization are driven by sex differences in individuals’ levels of conformity to masculine and feminine gender norms. Young adults (N = 545) completed validated measures of conformity to masculine and feminine norms and were then randomly assigned to read a character description of a male or female individual with anorexia or muscle dysmorphia. Subsequently, participants’ stigmatizing attitudes toward the characters were assessed. Multivariate analyses indicated that participants’ conformity to masculine and feminine norms were superior predictors of stigmatization relative to biological sex (male/female). Further, participants’ conformity to masculine norms, but not feminine norms, was significantly predictive of stigmatization. Specific masculine norms predictive of eating disorders’ stigmatization included selfreliance and heterosexual self-presentation. Our findings argue against the notion that men are intrinsically more stigmatizing of eating disorders than women; rather, sex differences in socialization to masculine gender norms may drive stigmatization. Importantly, our study highlights masculine gender norm conformity as a target for researchers involved in the development of prevention programs for eating disorders’ stigmatization.
Stigma internalisation in people with eating disorders is an area of increasing scientific interest. To date, however, no measure of stigma internalisation has been validated for use in people with eating disorders, which may help explain the paucity of research investigating stigma in this population. We conducted a confirmatory factor analysis of the 29-item Internalised Stigma of Mental Illness Scale (ISMI) in a sample of 331 individuals with various eating disorders, and further examined its concurrent predictive validity and convergent validity. The original factor structure of the ISMI indicated poor fit. Five modifications were made; one item was excluded, three items had their factor loadings moved to a different subscale, and the co-variance between two items was modelled. The modified ISMI indicated good fit and exhibited evidence of concurrent predictive validity and convergent validity. The ISMI is valid for use in people with eating disorders with minimal changes to subscale scoring. Although relatively few changes to the ISMI were proposed, the capacity to compare ISMI scores across patient populations should be weighed against obtaining empirically and theoretically defensible factor structures that may be population-specific.
Stigma Resistance in Eating Disorders (2014)
Social Psychiatry and Psychiatric Epidemiology
"Purpose: Stigma resistance, described as the capacity to counteract or remain unaffected by the stigma of mental illness, may play a crucial role in the fight against stigma. Little is known, however, about stigma resistance and its correlates in people with eating disorders. This study investigated stigma resistance in people currently diagnosed (n = 325) and recovered (n = 127) from anorexia nervosa, bulimia nervosa, and EDNOS. Methods: Participants completed an Internet survey that included the Stigma Resistance subscale of the Internalized Stigma of Mental Illness Scale together with a battery of psychosocial and psychiatric measures. Results: Greater stigma resistance among the currently diagnosed was associated with less marked eating disorder and depression symptoms, higher self-esteem, more positive attitudes about seeking psychological treatment, and lower internalized stigma. Stigma resistance was significantly greater among the recovered than the currently diagnosed (Cohen’s d = 0.25), even after controlling for differences in eating disorder and depression symptoms, attitudes about seeking psychological help, self-esteem, years between symptom onset and diagnosis, and years since diagnosis. A minimal-to-low level of stigma resistance was exhibited by 26.5% of currently diagnosed participants compared to just 5.5% of recovered participants. Conclusions: Stigma resistance is a promising concept that warrants further study. Researchers should consider designing interventions that specifically cultivate stigma resistance in people with eating disorders as a complement to current interventions that target public perceptions of eating disorders. Clinicians may consider incorporating the concept into their practice to help patients rebuff the adverse effects of mental illness stigmatization."
Stigmatizing Attitudes Differ Across Mental Health Disorders
The Journal of Nervous and Mental Disease, 2013
The aim of the current article was to compare stigmatizing attitudes toward eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), with stigma toward another weight-related condition (obesity) and a nonYweight-related mental disorder (major depressive disorder [MDD]). Participants (N = 447) read five vignettes describing a woman with AN, BN, BED, obesity, or MDD and responded to questionnaires examining stigmatizing attitudes. The targets with EDs were blamed more for their condition than the targets with MDD, whereas persons with obesity were held more responsible for their condition than any other target. On the other hand, the target with MDD was perceived as more impaired than any other target. Lack of self-discipline was attributed more to the development of BED and obesity than to any other condition. Stigmatizing attitudes vary across mental health disorders, and future research should aim to specifically target stigmatizing beliefs to reduce and prevent discrimination toward mental health disorders and obesity.
Stigmatization of Anorexia Nervosa: Characteristics and Response to Intervention
Journal of Social and Clinical Psychology, 2010
KAMryN t. eDDy AND DAViD b. herZoG Harris Center, Massachusetts General Hospital the present study aimed to investigate the effects of different etiological explanations of anorexia nervosa (AN) on stigmatization of those with the disorder. College students (N = 173) were randomly assigned to view one of three videos describing AN as the product of either biology, culture, or an interaction of the two. in general, those who viewed the interaction video exhibited less stigma than those who viewed the sociocultural video, though more than those who viewed the biological video. these findings are consistent with attribution theory, as well as previous empirical findings, and may represent a preliminary step towards guiding those conducting campaigns to destigmatize eating disorders. Approximately one decade ago, the United States (U.S.) Surgeon General reported that stigma was a major problem facing those suffering from mental illness (U.S. Department of Health and Human Services, 1999). A large body of empirical research confirms that the general public holds numerous stigmatizing beliefs regarding men
Gender, Self-Stigma, and Public Stigma in Predicting Attitudes toward Psychological Help-Seeking
Educational Sciences Theory and Practice, 2014
Using a sample of university students (N = 362), the role of gender and both the self-stigma and public stigma associated with one's decision to seek psychological help in predicting attitudes toward psychological helpseeking were examined. Moreover, gender differences regarding both the self-stigma and the public stigma associated with psychological help-seeking were investigated. Participants completed a demographic data form, the Self-stigma of Seeking Help Scale, the Social Stigma Scale for Receiving Psychological Help, and the Attitudes toward Seeking Professional Psychological Help Scale-Short Form. The results of the hierarchical regression analyses demonstrated that although both gender and the self-stigma associated with psychological help-seeking significantly predicted attitudes toward seeking psychological help, public stigma was not a significant predictor of attitudes toward seeking psychological help. Moreover, 24% of the variance in attitudes was accounted for by the variables of gender and self-stigma in the model. In addition, the results of the current study confirmed the findings of previous research which indicated that males are more likely to experience self-stigma and public stigma associated with psychological help-seeking when compared to females. Further results and implications were discussed.
Stigma towards Eating Disorders among Attendees and Non-Attendees of Outreach Events
International Journal of Psychological Studies
Eating disorders are among the most stigmatized psychological disorders. Individuals with eating disorders are often blamed for their disorder. Stigma acts as a significant barrier to treatment. Health promotion outreach programs can successfully change knowledge, attitudes, and behaviors associated with disordered eating. The current study examined eating disorder stigma scores among attendees of Disordered Eating Awareness and Prevention week events at a public US university and compared their stigma scores to college students who did not attend the events. The study recruited 332 participants (n = 159 attendees, n = 173 non-attendees). Attendees completed a paper-and-pencil survey after each event and non-attendees participated in an online survey. The study found that participants who attended disordered eating outreach events reported lower stigma scores than those who did not attend. Furthermore, female gender and having a family member with an eating disorder was associated w...