Perceptions of Anorexia Nervosa Among Patients and Healthy Lay Persons

How an individual views a given illness is important not only for explaining variations in behavior related to the illness but also for designing interventions to improve outcome. According to a team of British researchers, many of these factors are especially pertinent in relation to anorexia nervosa (AN) (Int J Eat Disord 2005; 37:50).

Many AN patients reject the idea that they are ill, and are reluctant to undergo treatment. At the same time, individuals with AN commonly report the devastating effects of the illness upon their lives.

Two study groups

Dr. Janet Treasure and her colleagues compared perceptions of AN among two groups, a group of individuals with AN and a group of healthy men and women. Past and current AN patients selected from a hospital register were sent a questionnaire and invited to participate in the study if they considered themselves to have a current eating disorder. After completing the Eating Disorders Examination Questionnaire (EDE-Q), 95 patients fulfilled the criteria for AN (53 with the restricting subtype and 42 with the binge eating/purge subtype).

Lay participants were recruited from university students, university staff, and members of the general public in Bristol and London. Eighty healthy adults with no history of eating disorders (44 women and 36 men) were included in the study.

In addition to the EDE-Q, the group with AN completed the Illness Perception Questionnaire, Revised (IPQ-R). This three-part questionnaire examines illness identification, beliefs regarding a timeline, personal control, consequences, and understanding of the illness, personal control, consequences, and understanding of the illness, and finally causal beliefs about the illness. (Note: The IPQ-R questionnaire can be found online at www.uib.no/ipq.)

The healthy men and women were asked to provide brief demographic information about themselves and also completed a version of the IPQ-R specifically adapted to elicit lay beliefs about anorexia nervosa. A typical question was, “What do you understand by the term anorexia nervosa?”

Patients with AN had more negative perceptions about recovery

Overall, those in the patient group perceived their disorder as a chronic condition associated with strongly negative consequences and a high degree of emotional distress. Patients also associated a large number of physical symptoms with their illness, and had negative views about their potential for recovery. Just as in earlier studies, women with AN perceived many therapies as helping just a little. According to the authors, patients’ uncertainty about the efficacy of treatment may contribute to the high dropout rates and ambivalence about many therapies that are commonly reported among AN patients.

In contrast to the patients, the lay group was considerably more optimistic about the ability to control and cure AN. In response to the open-ended question about their understanding of the term anorexia nervosa, the lay group had responses similar to those found in an earlier study (Huon et al, 1988), which suggested that overall public conceptualization of AN has not changed. Almost all the lay respondents endorsed the emotional state as a prime cause of AN. Although more than 90% of those in the lay group selected several psychological causes for AN, fewer patients with AN endorsed these items, suggesting that not all persons with AN perceive the disorder to be psychologically driven.

Lay persons also implicated diet and eating habits as a cause of AN far more often than patients did. Interestingly, women in the lay group believed that family problems and overwork were particularly important causes of AN.

The authors pointed out that one shortcoming of the study is the fact that comorbid depression among those in the AN sample may have influenced perceptions of the illness. Feelings of hopelessness and helpfulness may amplify the severity of the individual’s experience with the illness, according to Dr. Treasure and colleagues.