Self-stigma of seeking help and being male predict an increased likelihood of having an undiagnosed eating disorder

Griffiths, S., Mond., J. M., Li, Z., Gunatilake, S., Murray, S. B., Sheffield, J., & Touyz, S. (2015). International Journal of Eating Disorders.

#1 Approximately 75% of eating disorders are undiagnosed (Hart et al., 2011)

#2 Diagnosis is important because it facilitates access to appropriate and effective treatment (Striegel-Moore et al., 2000)

Introduction

#3 Self-stigma of seeking psychological help may contribute to undiagnosed eating disorders (Griffiths et al., 2014)

#4 Males may suffer disproportionately from self-stigma of seeking psychological help due to masculinity (Griffiths et al., 2015; Smiler, 2006)

Introduction

Methods - procedure

An online survey requested participants who: a. were currently diagnosed with an eating disorder; b. had recovered from an eating disorder; orc. thought they might have an eating disorder

Q1 “Have you ever been diagnosed with an eating disorder by a health professional, such as a general practitioner or psychologist?” YES = Diagnosed group, NO = Question 2

Q2 “Do you think you might have an eating disorder?YES = Undiagnosed group, NO = Excluded

Methods - procedure

485 persons with eating disorders360 diagnosed125 undiagnosed

~50% of diagnosed group in treatment0% of undiagnosed group in treatment

YES = Undiagnosed group, NO = Excluded

Methods - participants

Comparison of EDE-Q global scores

0

1

2

3

4

5

6

Clinical norm(Welch et al. 2011)

Community norm(Mond et al. 2006)

Diagnosed

Undiagnosed

EDE-Q Global score

Comparison of EDE-Q subscale scores

Restraint Eating Concern Shape Concern Weight Concern

0

1

2

3

4

5

6

Clinical norms(Welch et al. 2011)

Community norms(Mond et al. 2006)

Dietary Restraint

Eating Concern

Shape Concern

Weight concern

Diagnosed

Undiagnosed

Methods – statistical analyses

#1 Hierarchical binary logistic regression

#2 Outcome: Undiagnosed vs. diagnosed

#3 Predictors: Demographic variables (sex, employment, etc.), psychiatric variables (eating disorder symptoms, duration of illness, etc.), psychosocial variables (self-stigma of seeking help, self-esteem, etc.)

#1 Men were four times more likely to be undiagnosed than womenOR = 4.04 (95% CI: 1.43, 11.43), p = .009

#2 Self-stigma of seeking psychological help predicted a greater probability of being undiagnosedOR = 1.57 (95% CI: 1.07, 2.30), p = .022

Results

#3 Significant interaction between sex and self-stigma of seeking psychological helpOR = 6.81 (95% CI: 1.39, 33.25), p = .018

Results

Females

1No

self-stigma of treatment

5Maximum

self-stigmaof treatment

Pred

icte

d pr

obab

ility

of b

eing

un

diag

nose

d

0%

20%

40%

60%

80%

100%

1No

self-stigma of treatment

5Maximum

self-stigmaof treatment

Pred

icte

d pr

obab

ility

of b

eing

un

diag

nose

d

0%

20%

40%

60%

80%

100%

Males

Females

1No

self-stigma of treatment

5Maximum

self-stigmaof treatment

Pred

icte

d pr

obab

ility

of b

eing

un

diag

nose

d

0%

20%

40%

60%

80%

100%

Males

Females

1No

self-stigma of treatment

5Maximum

self-stigmaof treatment

Pred

icte

d pr

obab

ility

of b

eing

un

diag

nose

d

0%

20%

40%

60%

80%

100%

Males

R2 = .59

R2 = .11

#1 Findings consistent with the view that males with eating disorders are more reluctant to seek treatment and more likely to be undiagnosed

#2 Self-stigma of seeking psychological help may be responsible, to some extent, for this reluctance

Discussion

#3 Conflict between traditional masculine gender roles and the act of reaching out for help may explain why self-stigma of seeking psychological help has a stronger influence on males

#4 Addressing males’ negative beliefs about seeking treatment is important for early intervention initiatives

Discussion

#1 Cross-sectional design

#2 The experience of treatment may reduce self-stigma about seeking treatment

#3 Relatively few males recruited

Discussion - limitations

#4 Certain subgroups of sufferers may have been underrepresented

#5 Factors likely to have influenced diagnosis, such as access to services, were not examined

#6 Eating disorders were self-reported and not confirmed with interview assessments

#4 Addressing males’ negative beliefs about seeking treatment is important for early intervention initiatives

Discussion - limitations

Investigate men with muscle dysmorphia and men who use steroids

Muscle dysmorphia sufferers tend to be more traditionally ‘masculine’ than men with anorexia nervosa and ‘healthy’ control men (Kanayama et al., 2006; Murray et al., 2013)

Discussion – future research

#1 Self-stigma of seeking psychological help may be a salient barrier to eating disorder diagnosis and treatment, particularly for males

Conclusion

Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (2014). The prevalence and adverse associations of stigmatization in people with eating disorders. International Journal of Eating Disorders. http://doi.org/10.1002/eat.22353

Griffiths, S., Murray, S. B., & Touyz, S. (2015). Extending the masculinity hypothesis: An investigation of gender role conformity, body dissatisfaction, and disordered eating in young heterosexual men. Psychology of Men & Masculinity. http://doi.org/10.1037/a0035958

Hart, L. M., Granillo, M. T., Jorm, A. F., & Paxton, S. J. (2011). Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases. Clinical Psychology Review, 31(5), 727–735. http://doi.org/10.1016/j.cpr.2011.03.004

Kanayama, G., Barry, S., Hudson, J. I., & Pope, H. G. (2006). Body Image and Attitudes Toward Male Roles in Anabolic-Androgenic Steroid Users. American Journal of Psychiatry, 163(4), 697–703. http://doi.org/10.1176/appi.ajp.163.4.697

Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating Disorder Examination Questionnaire (EDE-Q): Norms for young adult women. Behaviour Research and Therapy, 44, 53–62.

Murray, S. B., Rieger, E., Karlov, L., & Touyz, S. W. (2013). Masculinity and femininity in the divergence of male body image concerns. The Journal of Eating Disorders, 1(11), 1–8. http://doi.org/10.1186/2050-2974-1-11

Striegel-Moore, R. H., Leslie, D., Petrill, S. A., Garvin, V., & Rosenheck, R. A. (2000). One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. International Journal of Eating Disorders, 27(4), 381–389.

Welch, E., Birgegård, A., Parling, T., & Ghaderi, A. (2011). Eating disorder examination questionnaire and clinical impairment assessment questionnaire: General population and clinical norms for young adult women in Sweden. Behaviour Research and Therapy, 49(2), 85–91. http://doi.org/10.1016/j.brat.2010.10.010

References

Griffiths, S., Mond., J. M., Li, Z., Gunatilake, S., Murray, S. B., Sheffield, J., & Touyz, S. (2015). Self-stigma of seeking help and being male predict an increased likelihood of having an undiagnosed eating disorder. International Journal of Eating Disorders.

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