Chances Are What You Know About ED May Be Wrong.

Although clinicians (and medical professionals not specializing in eating disorders) often carry a lot of false beliefs about EDs, the publicis even worse. Way worse. The portrayal of eating disorders in the news contributes to the myriad of myths and misconceptions that surround EDs. O’Hara and Clegg-Smith wanted to find out how exactly newspapers “contribute to shaping public perception of EDs.” 

It is awful when doctors are dismissive and ignorant, but it is even worse when you encounter these attitudes from your friends and family. When they not only don’t get it, they don’t want to get it. As O’Hara & Clegg-Smith point out, this ignorance and “disconnect potentially prevents timely ED diagnosis and reinforces a stigma that limits treatment availability.”

While researchers and ED specialists increasingly understand that eating disorders are “caused by a combination of genetic and environmental factors” (for example, evidence from twin studies suggests that genetic factors account for >50% of the risk for developing an ED), the public does not. 

Surveys of what the public thinks about eating disorders and those struggling with them are, well, nothing short of depressing. A real failure for all parties involved, the clinicians, researchers, journalists and media outlets.

A 2005 poll commissioned by NEDA (National Eating Disorders Association) revealed that American adults think that dieting (66%), the media (64%) and family (52%) are the primary causes of eating disorders. And only 30% think there is any link between genetics and eating disorders.

Brits are no better: 35% feel that ED patients “could pull themselves together” and 33% think that they “are to blame”.

O’Hara & Clegg-Smith point out that besides the causes of eating disorders (etiology), the public also tends to have the wrong ideas about the epidemiology and severity of EDs. They highlight a few areas where the public opinions are divergent from the medical consensus.

• GENDER: Public thinks EDs are female-only disorders. Research reveals that at least 10% of ED sufferers are men (and that’s probably an underestimate).
• AGE: Public thinks ED patients are teens or adolescents. Research reveals that EDs are not uncommon in adults.
• RACE: Public thinks EDs are white-only diseases. Research suggests that ethnic minorities have comparable rates of EDs. “No study has found an absence of ED symptoms in minority populations” 
• SEVERITY: One study showed that ONLY 3% thought anorexia and bulimia had any physical consequences! Researchers have long-established that eating disorders have severe physical consequences (heart failure, bone density loss, kidney failure, dental erosion, etc.. )
• TREATMENT: Public thinks eating disorders are easy to cure. Research suggests only about 50% fully recover, 30% achieve partial recovery while 20% remain chronic.

The impact of this disconnect is huge. O’Hara and Clegg-Smith summarize the implications really well, so I’ll quote them a lot here.

SELF-PERCEPTION & EARLY DETECTION 

Families and friends who hold a particular demographic picture of EDs may fail to recognize disease among people who fall outside this stereotype, preventing early diagnosis… Gordon et al. [19] asked three groups of undergraduates to read a passage describing an adolescent girl with ED symptoms; the only difference… was the girl’s race (African American, Caucasian or Hispanic). When asked whether the girl had any ‘‘notable’’ medical problems, respondents were less likely to consider information about her ED symptoms when she was portrayed as an African American or Hispanic.

ACCESS TO TREATMENT

Becker et al. [11] reported that ‘‘eating disorders may go unrecognized in clinical settings in up to 50% of cases’’ (p. 1092)…. Anecdotally, many patients report that even when an accurate diagnosis was made, their doctors initially told them simply to ‘‘eat better’’ (NEDA President Lynn Grefe,personal communication, 7 April 2005), and a study of Australian clinicians found that ED patients were seen as self-inducing their illness, which was associated with the recommendation that patients ‘‘take self-control’’…

You can read more about how clinicians’ negative attitudes can do more harm that good when it comes to eating disorder treatment in myprevious post (I encourage you to read the comments, too).

INSURANCE COVERAGE

Currently, most health plans provide little or no coverage for EDs, limiting the provision of effective treatment after diagnosis [16]. Compared to other mental illnesses, EDs have not benefited extensively from policy efforts within the United States to expand mental health insurance coverage. Since 1991, 38 states have passed legislation mandating equal insurance parity between some mental and physical conditions [26], but in many cases these policies demonstrate a preference toward illnesses that are seen as ‘‘serious’’ or ‘‘biologically based,’’ such as schizophrenia, bipolar disorder, obsessive compulsive disorder and autism [27].

There’s also STIGMA that results from the general public misunderstanding surrounding eating disorders.

A survey of the British public reported that ED patients attract ‘‘fear, hostility and disapproval’’ rather than ‘‘compassion support and understanding’’ [14]. …most [college students, parents of teens] knew that EDs were serious illnesses, but would be ‘‘too ashamed to tell others or possibly seek help for themselves’’ if needed [16]. Physicians have also been found to stigmatize people with EDs, with a 1999 survey of British gynecologists showing 31% of respondents held ‘‘pejorative’’ attitudes toward EDs [29]. Such attitudes can isolate patients from the social and emotional support needed for recovery and stop individuals from seeking treatment for fear that others will learn of their condition [30].

To find out how eating disorders are portrayed in the media, they analysed the coverage of EDs by seven daily U.S. newspapers over the course of one year. The newspapers the authors surveyed were: The New York Times, USA Today, Baltimore Sun, Minneapolis Star Tribune, San Diego Union-Tribune, St. Louis Post-Dispatch and Pittsburgh Post-Gazette (2 national, 5 regional).  They found 252 articles but used only 210 because 30 of the articles focused on Terri Schiavo (and the connection to bulimia) and 12 on the (short-lived show) “Starved” (they excluded these for the fear that they would bias the analysis).

Table 3 summarized the breakdown of article placements.

Summary and Highlights of the Findings: 

For this, they used a sub-sample of 90 articles that “included profiles of individuals with EDs”:

Epidemiology

• 48% of articles were in the “Arts & Entertainment” section, 13% in “Health”
• 95% of individuals profiles were female
• only 18% of articles profiled older adults, and even then relatively young or those whose conditions might have started years earlier
• in the cases were race was determined, 94% of the individuals were white. Only one person was black (in an NY Times article about the growing prevalence of EDs in blacks and other minorities).

Etiology (causes)

• when mentioned, 48% attributed to parental influence (verbal/sexual abuse, nagging)
• individual struggle, low self-esteem, stress also commonly mentioned
• often frames as a simple personal decision: “At 14, she struggled with body image. She stopped eating and slipped into anorexia… [50]“
• 2 articled mentioned that “genetics” or “biology” playing a role in the etiology of EDs

Severity, treatment and recovery

• only 11% stated medical complications (often in retrospect)
• only 21% had any mention of treatment (presented as a straightforward solution)
• 8% mentioned professional help of any kind
• less than 1 in 10 articles “framed EDs as a condition worthy of or requiring medical” treatment
• often portray recovery as simple, higher rates of success than true
• “Actions and events that reportedly caused individuals to recover included ‘snap[ping] out of it’[50]; being inspired by a triathlon to eat better [51]; having a dream about life after death [52]; and ‘[making] peace with her size’ [53].”

Articles in more serious sections (heath versus entertainment), on the whole, are better at portraying the complexity of EDs. But they still suffer from all of the aforementioned problems, just not as much.

EDs are only newsworthy in the context of famous people who suffer from them. This frame essentially may serve to distance readers from any engagement with this issue beyond the voyeuristic. It may also reinforce the public perception that anorexia and bulimia are conditions with entirely socio-cultural roots……By primarily profiling women, newspapers either perpetuate or at least fail to challenge a perception that may contribute to under-diagnosis among men. 

O’Hara & Clegg-Smith urge advocates and educators to combat this: highlight the true demographics, the complexity of the disorder, the difficulties in recovery, and so on. They urge more people of “all walks of life” to speak out. It is difficult to be open, but if you feel you can, even just to those around you, it is worthwhile.

Readers, how have you been affected by the way the news media often portrays eating disorders? Has it shaped how you or those around you think about eating disorders? What would you like to see in the news media coverage of eating disorders?

O’Hara, S., & Clegg-Smith, K. (2007). Presentation of eating disorders in the news media: What are the implications for patient diagnosis and treatment? Patient Education and Counseling, 68 (1), 43-51 DOI: 10.1016/j.pec.2007.04.006