STIGMA RESISTANCE IN EATING DISORDERS

#1 Stigma is commonly experienced among people with eating disorders

#2 More frequent stigmatization is associated with adverse outcomes

#3 Males and individuals with bulimia face unique forms of stigma

Eating disorders are (still) stigmatized

#1 Destigmatization initiatives mostly target public perceptions of eating disorders

#2 … how achievable is this goal?

#3 Can we foster an ability to process and deconstruct stigma?

Can we fix stigma by changing public perceptions?

#1 Refers to an ability to counteract or resist the stigma associated with eating disorders

#2 Studied in schizophrenia, depression and bipolar disorder, but not in eating disorders

#3 An intervention designed to build stigma resistance would target the stigmatized

Stigma resistance

Stigma resistance – the measure

› Ritsher, Otilingham & Grajales (2003)

› Internalized Stigma of Mental Illness (ISMI) scale

› Stigma Resistance; one of five subscales

#1 Greater stigma resistance among the currently diagnosed will be associated with positive outcomes

#2 Stigma resistance will discriminate the currently diagnosed from the recovered

Hypotheses

› Anorexia nervosa slightly overrpresented among the recovered

› Recovered much more likely to not currently be in treatment

› Recovered more likely to be in a relationship

Sample

Anorexia nervosa

Bulimia nervosa

EDNOS Total

Currently diagnosed 168 69 88 325Recovered 82 17 28 127

Comparison of EDE-Q global scores

Group0

1

2

3

4

5

6

Clinical norm(Welch et al. 2011)

Community norm(Mond et al. 2006)

Currently diagnosed

Recovered

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)

#1 Very large differences (Cohen’s d > 1.0) between diagnosed and recovered groups for EDE-Q global score and all four subscale

#2 Significantly fewer eating disorder behaviours for the recovered group

#3 Median of zero for frequency of eating disorder behaviours for the recovered group

#4 For anorexia nervosa, a significantly higher BMI for recovered versus currently diagnosed›Currently diagnosed mean BMI = 17.78›Recovered mean BMI = 21.95

How do you know they’re recovered?

Levels of stigma resistance

Low (6%)

Moderate (54%)

Currently diagnosed Recovered

Minimal (3%)

Low (20%) High (23%)

Moderate (37%)

High (57%)

Co-variate adjusted comparison of stigma resistance

Group1

2

3

4

Schizophrenia(Brohan et al. 2010)

Currently diagnosed

Recovered

Depression & bipolar(Brohan et al. 2010)

p = .006

Associations with stigma resistance

Variable Currently diagnosed

Recovered

r p r pEating disorder symptoms -.26 < .001 -.11 .205Depression symptoms -.36 < .001 -.29 < .001

Self-esteem .36 < .001 .35 < .001

Self-stigma of seeking help -.29 < .001 -.24 .008Internalized stigma -.40 < .001

#1 Stigma resistance may have benefits, including aiding in recovery from eating disorders

#2 Could we augment current destigmatization interventions that currently target public perceptions of eating disorders?

#3 Create a stigma resistance scale specific to eating disorders

Discussion

#1 Diagnoses and recovery status were self-reported

#2 Cross-sectional design

#3 Internal consistency of the Stigma Resistance subscale needs improvement

Limitations

GRIFFITHS, S., MOND, J. M., MURRAY, S. B., THORNTON, C., & TOUYZ, S. (IN PRESS). STIGMA RESISTANCE IN EATING DISORDERS. SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY