Journal With Question a Ire

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Knowledge about EatingDisorders in the Community

Sara Murray, B.A.(Hons.)Stephen Touyz, Ph.D.Peter Beumont, M.D.(Accepted 25 November 1988)

One -hundred and forty-nine subjects (80 females and 69 males) were asked abouttheir knowledge of anorexia and bulimia nervosa, the source of their knowledge,and the ways in which their knowledge of these disorders may have affected theirattitudes towards eating, dieting, and related behaviors. Almo st all subjects hadheard of anorexia nervosa, whereas bulimia nervosa was less well known, particu-larly among males. Knowledge of anorexia nervosa was more detailed than that forbulimia nervosa. The mass media were the major sources of subjects' informationabout these disorders. Over one-third of females reported that their knowledge con-cerning anorexia and bulimia nervosa had affected their own eating or related atti-tudes in some way. The importance of the med ia in both promoting a nd preventingeating disorders is discussed.

There is some evidence to suggest that the incidence of anorexia and bulimianervo sa ha s risen over the last two dec ade s (Crisp, Palm er, & Kalucy, 1976;Jones, Fox, Babigan, & H utto n, 1980). Certainly anorexia an d bulimia nervo sahave received increasing media attention in recent years, and the general pub-lic has access to a considerable amount of material on these disorders (Huon,Brown, & Morris, 1988).

A general finding of studies of people's knowledge about anorexia and bu-limia nervosa is that subjects are more likely to have heard of anorexia nervosathan bulimia nervosa, and that knowledge of anorexia nervosa is more detailedtha n for bulimia nervo sa (Chiod o, Stanley, & Ha rvey, 1984; Sm ith, Pru itt,M ann , & Thelen, 1986; H uo n e t al., 1988). Ch iodo et al. (1984) suggest thatsuch a difference may be explained by the popular media's greater emphasison anorexia nervosa compared with bulimia nervosa.

Sara Murray, B.A.(Hons.), is a postgraduate research student, Department of Psychiatry, University ofSydney. Stephen Touyz, Ph.D., is Head of the Department of Clinical Psychology, Westmead Hospital,Sydney, and Clinical Lecturer in Psychiatry, University of Sydney. Peter Beumont, M.D., is Professorand Head, Department of Psychiatry, University of Sydney. Requests for reprints should be sent to PeterBeum ont, Department of Psychiatry, University of Sydney, New South Wales 2006, Au stralia.International lournal of Eating Disorders, Vol. 9, No. 1, 87-93 (1990) 1990 by John Wiley & Sons, Inc. CCC 0276 -3478/90 /010087 -07$04 .00


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88 Murray, Touyz, and BeumontIn relation to the content of people's knowledge about eating disordersHuon et al. (1988) and Chiodo et al. (1984) found that the symptoms most com-monly identified by subjects were behavioral ones such as excessive dieting foranorexia nervosa and binging and vomiting for bulimia nervosa. Body imagedisturbance and psychological factors in anorexia nervosa were also mentioned

by a large percentage of subjects in both studies.Relatively few studies have examined the possible consequences of individu-als' knowledge regarding anorexia and bulimia nervosa (Branch & Eurman,1980). One likely impact of knowledge about anorexia and bulimia nervosa ison detection, reporting, and even prevention of the disorder. On the otherhand, it could be speculated that such knowledge could contribute to a "socialcontagion" effect. In support of the latter contention, Branch and Eurman(1980) found that sufferers of anorexia nervosa were admired for their appear-ance and self-control by their families and friends. In contrast, Chiodo et al.(1984) concluded that "somewhat negative" stereotypes were associated withsufferers of anorexia and bulimia nervosa. Furthermore, a significant minorityof Smith et al.'s (1986) male and female student sample held unfavorable per-ceptions of anorexics and bulimics.The aim of the present study was to investigate males' and females' knowl-edge about anorexia and bulimia nervosa; the source of subjects' knowledge,and the way(s) in which knowledge about anorexia and bulimia nervosamay have affected subjects' attitudes towards eating, dieting, and related be-haviors.

METHODSubjects

One aim of the study was to investigate knowledge in an age group believedto be most vulnerable to eating disorders. For this reason the maximum age forsubjects wa s set at 30 yea rs. The majority of subjects w ere ob tained from twolarge banking corporations (65 females and 64 males). Participation was on arandom selection, voluntary basis, and 96% of those approached agreed to par-ticipate. The final sample included a wide range of occupations and levels ofeducation. A smaller random sample of school students also participated (15females and 5 males). All students approached agreed to participate. The over-all mean age for females was 19 (SD = 3.4, range 12-28), and the mean age formales was 22.7 (SD = 4.3, range 12-30).

ProcedureEach subject was seen individually for a sem istandardized interview, a nd thefollowing open-ended questions were asked of each subject:1. Have you heard of anorexia nervosa?2. Have you heard of bulimia nervosa?3. Where did you hear or learn about anorexia and/or bulimia nervosa?4. What do you know about anorexia nervosa?


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Knowledge about Eating Disorders 895. What do you know about bulimia nervosa?a. Has your knowledge of anorexia and/or bulimia nervosa changed yourown eating habits or attitudes towards dieting, or any related issue?b. If so, in what way(s)?Responses were taped and categorized after the interview.

RESULTS A N D DISCU SSIO NAlmost al l subjects (99% of females and 97% of males) had heard of anorexianervosa . However t here was f a r g rea t e r i gnorance o f bu l imia nervosa . Therew as a high ly significant sex difference in kno w led ge , w ith only 16% (n = 11) ofmales having heard of bul imia nervosa, compared wi th 70% ( = 56) of fe-males. These f indings are similar to those of Huon et al . (1988) and Smith et al .(1984) . The extent of male ignorance i s never theless somewhat surpr i s ing g iventhe recent coverage of bul imia nervosa in popular media.The sources of subjects ' knowledge about these d isorders are g iven in Table1 . (For some quest ions subjects were able to g ive more than one response. Forth is reason percentages in Tables 1-3 do not to tal 100.) Not surpr i s ingly , themos t common sources o f i n fo rmat ion were var ious fo rms o f popu lar med ia :magaz ines , newspaper s , books , and t e l ev i s ion . Fu r ther ana lys i s r evea l ed t ha tfor 49% (n = 72) of subjec ts som e type of m ed ia ( television and /or prin te d m e-dia) was thei r only source of infonnat ion .Subjects ' knowledge of eat ing d isorders i s summarized in Table 2 . In l inewi th Chiodo et a l . ' s (1984) and Huon et a l . ' s f indings (1988) , the most com-

monly ment ioned features of anorexia nervosa were sufferers ' refusal to eat ,sufferers ' th inness and body image d is tor t ion , and the fact that anorexia ner-vosa i s psychological in nature. Twenty percent of subjects al so s tated that self-i nduced vomi t ing was a symptom o f anorex i a nervosa .Overwhelming ly , t he mos t common fea tu res men t ioned in r e l a t i on t o bu -l imia nerv osa w ere b ing ing and vo mi t ing : 38 subjects (57% of thos e wh o ha dheard o f bu l imia nervosa) men t ioned on ly b ing ing and /o r vomi t ing i n r esponseto th i s quest ion .

Table 1. Source of know ledge abou t anorexia ne rvosa/bulimianervosa (percentage frequency of responses).Fem Males Total x^{n = 79) {n = 67) {n = 146) (F v. M)

Books/magazinesTVKnow of someoneSchool/UniversityFriend had AN or BNRelative had AN or BNConversationDon't know

6846181817543

46612585286

5853211311364

6 .4"3.00.92.54.2*0. 50.40.4Note: In all tables percentages have been rounded to nearest whole num-ber.V < .05.


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Knowledge about Eating Disorders 91

The percentages in Table 2 suggest that subjects gave more detailed descrip-tions of anorexia t han bulimia n ervosa. A chi-squared. analysis was performedon the number of features of anorexia nervosa mentioned by subjects versusthe nu m be r of features th ey used to describe bulimia nerv osa . A significant dif-ference was found (p < .01). Thus not only had fewer subjects heard of bulimianervosa, but of those who had heard of it, their knowledge was not as detailedas that for anorexia nervosa.Subjects' responses to the question "Has your knowledge of anorexia and/orbulimia nervosa changed your own eating habits or attitudes towards dieting,or any related issue?" are presented in Table 3. There was a highly significantsex difference in responses, with 39% of females asserting that their attitudeshad ch ange d, com pared with only 13% of ma les.The nature of the changes perceived by subjects, summarised in Table 3,were very interesting and worthy of a detailed examination. Most of the sub-jects who perceived changes referred to their knowledge of anorexia rather

than bulimia nervosa. The majority of male and female subjects who did ac-knowledge some kind of change stated that their knowledge of these disordershad made them more cautious regarding their own dieting behavior.Many respondents held the idea that anorexia nervosa could start as the re-sult of excessive dieting or "not knowing when to stop." For some of thesesubjects forewarned was forearmed. One 21-year-old female subject remarked:"I think if I did go on a diet and lose a lot of weight I'd know when to stopbecause I've seen people in the situation where they have lost so much weightthey've become anorexic."Several females described a mild anorexia-like phase which they perceived

they had overcome because of their awareness of anorexia nervosa: "When Iwas 15 I went on a diet and didn't eat anything for 3 days. I started eatingagain because I wa s scared I'd become an orexic" (female, a ged 17 years).Over one-quarter of subjects who believed that their knowledge regardingeating disorders had changed them commented that it had made them moreTable 3. Effects of knowledge of anorexia andyor bulimia nervosa.

Percentage of Subjects Changed by Knowledge of Anorexia or Bulimia NervosaChange No Change Total

nFem ales 31 (39) 49 (61) 80 (100) 11 5Males 9 (13) 60 (87) 69 (100)Total 40 (26) 109 (73) 149 (100)

Type of Change Perceived by Subjects (Percentage Frequency of Responses)Fem Males Total x^(n = 31) (n = 9) (w = 40) (F v. M)

Made me cautious about own dieting 71 56 68 0 2Made me cautious about othe rs dieting 29 22 28 0 0Made me glad not to have AN 10 11 lo 0 3I heard abou t it, then tried it 7 0 5 o!l


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92 Murray, Touyz, and Beumontwary of other people's dieting behavior. One female commented: "If I can seethat some people are already thin and then they go on a diet I say 'Oh you'rema d, you 're thin already. You'll get anorexia' " (21 years).Not all the effects of knowledge of anorexia and bulimia nervosa were posi-tive, however. Two females stated that after hearing about these disorders theydecided to try some of the techniques they had heard about. For example: "Iread about it in 'Dolly' [a magazine for teenage girls]. And then I started takingdiet tablets and laxatives and making myself vomit, and I was losing weightrapidly. And then I woke up to myself. They're trying to be educational, butpeople abuse it. I abused it" (aged 16 years). Another female respondent indi-cated that her knowledge of anorexia nervosa has led to her adopting a verystrict diet, which she considered acceptable because it did not conform to herdefinition of the disorder.

CONCLUSIONSThe results of the present study indicate that anorexia nervosa is widelyknown, whereas bulimia nervosa is less well known, particularly amongmales. Subjects' knowledge about anorexia and bulimia nervosa was similar tothat displayed by subjects in past studies, with the majority of subjects identi-fying the major behavioral features of these disorders. The most interestingfindings concerned the effects of knowledge about anorexia and bulimia ner-vosa on peoples' attitudes and behavior. A significant percentage of femalesperceived that their knowledge of these disorders had affected them in some

way. Although most of the reported effects were positive, that is, in the direc-tion of prevention of eating disorders, the findings were certainly not clear cut.Some subjects reported being adversely affected by their knowledge.Clearly, the media were the major source of people's knowledge about thesedisorders. A further impo rtant issue for examination is the que stion of whe thercertain types of information, or methods of presentation, are more likely toserve a preventative role than others. However, the role of the media in pre-vention of eating disorders is clearly not confined to dissemination of informa-tion regarding those disorders. A point which has been made often elsewhereis that the media may actually contribute to the incidence of eating disorders

through their emphasis on dieting and thin "ideal" figures (e.g., Silverstein,Perdue, Peterson, & Kelly, 1986; Garner, Garfinkel, Schwartz, & Thompson,1980). Indeed 8% of subjects in the present study spontaneously commentedthat they believed that the mass media were responsible for the incidence ofeating disorders. The data from the present study indicate that the role of themedia in both promoting and preventing eating disorders is an issue deservingof further exploration.

REFERENCESBranch, C. H., & Eurman, L. J. (1980). Social attitudes towards patients with anorexia nervosa.


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Knowledge abou t Eating Disorders 93Chiodo, J., Stanley, M., & Harvey, J. H. (1984). Attributions about anorexia nervosa and bulimia.Journal of Social and Clinical Psychology, 2, 280-285.Crisp, A. H ., Palm er, R. L., & Kalucy, R. S. (1976). How comm on is anorexia nervosa? British Jour-nal of Psychiatry, 128, 549-554.Gam er, D . M., Garfinkel, P. E ., Schwartz, D., & Thomp son, M. (1980). Cultural expectations ofthinness in women. Psychological Reports, 47, 483-491.Hu on, G. F., Brown, L. B., & Morris, S. E. (1988). Lay beliefs about disordered eating. IntematiormlJournal of Eating Disorders, 7, 239-253.Jones, D. J., Fox, M. M., Babigan, H. M., & Hutton, H. E. (1980). Epidemiology of anorexia ner-vosa in Monroe County, New York: 1960-1976. Psychosomatic Medicine, 42, 551-558.SUverstein, B., Perdue, L., Peterson, B., & Kelly, E. (1986). The role of the mass media in promot-ing a thin standard of bodily attractiveness for women. Sex Roles, 14, 519-532.Smith, M. C , Pruitt, J. A., Mann , L. M., & Thelen, M. H. (1986). Attitudes and knowledge regard-ing bulimia and anorexia nervosa. International journal of Eating Disorders, 5, 545-553.


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