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Vol. 47, No. 2, 2014
Issue release date: March 2014
Psychopathology 2014;47:127-132

Self-Perceived Stigmatization in Female Patients with Anorexia Nervosa - Results from an Explorative Retrospective Pilot Study of Adolescents

Maier A. · Ernst J.-P. · Müller S. · Gross D. · Zepf F.D. · Herpertz-Dahlmann B. · Hagenah U.
aInstitute of History, Theory and Ethics in Medicine, and bDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Aachen, RWTH Aachen University, Aachen, cDepartment of Psychiatry and Psychotherapy, Division of Mind and Brain Research, Charité Universitätsmedizin Berlin, Berlin, dInstitute for Neuroscience and Medicine, Jülich Research Centre, Jülich, and eJARA Translational Brain Medicine, Aachen and Jülich, Germany

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Background: The stigma of mental illness has been identified as an important barrier to treatment and recovery. Previous research reported the stigmatization of individuals with eating disorders by both health professionals and the general public. The aim of this pilot study was to empirically assess the previous stigmatization and discrimination experiences of young female patients with anorexia nervosa (AN) using a retrospective explorative approach. Methods: An in-house questionnaire that was developed to survey experiences of stigmatization was mailed to 75 former adolescent patients with AN. The mean time of assessment after discharge was 5.6 ± 1.2 years. The patients were asked to respond anonymously. The response rate was approximately 48% (n = 36). Results: Feelings that society held negative stereotypes of individuals with AN, concrete experiences of stigmatization and discrimination, and rejection by peers were reported. A remarkable degree of self-stigmatization, as indexed by high rates of agreement to stigmatizing statements, was detected. Approximately one third of the participants reported delayed initiation of treatment due to fear of stigmatization and discrimination. Conclusion: Stigmatization plays a decisive role in young patients with AN and impacts their motivation to seek professional help and engage in treatment. Clinicians should be aware of the stigmatization related to eating disorders and its burden for affected patients.

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  1. Arcelus J, Mitchell AJ, Wales J, Nielsen S: Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011;68:724-731.
  2. Nicholls D, Viner R: Eating disorders and weight problems. BMJ 2005;330:950-953.
  3. Agras WS, Brandt HA, Bulik CM, Dolan-Sewell R, Fairburn CG, Halmi KA, Herzog DB, Jimerson DC, Kaplan AS, Kaye WH, le Grange D, Lock J, Mitchell JE, Rudorfer MV, Street LL, Striegel-Moore R, Vitousek KM, Walsh BT, Wilfley DE: Report of the National Institutes of Health Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa. Int J Eat Disord 2004;35:509-521.
  4. Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Råstam M: Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry 2009;194:168-174.
  5. Corrigan PW, Rüsch N: Mental illness stereotypes and clinical care: do people avoid treatment because of stigma? Psychiatr Rehab Skills 2002;6:312-334.

    External Resources

  6. Jones E, Farina A, Hastorf A, Markus H, Miller DT, Scott R: Social Stigma: The Psychology of Marked Relationships. New York, Freeman, 1984.
  7. Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L: On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav 1997;38:177-190.
  8. Corrigan PW, Watson AC: Understanding the impact of stigma on people with mental illness. World Psychiatry 2002;1:16-20.

    External Resources

  9. Sobal J, Bursztyn M: Dating people with anorexia nervosa and bulimia nervosa: attitudes and beliefs of university students. Women Health 1998;27:73-88.
  10. Farina A, Felner R: Employment interviewer reactions to former mental patients. J Abnorm Psychol 1973;82:268-272.
  11. Link BG: Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev 1987;52:96-112.

    External Resources

  12. Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC: Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv 2001;52:1621-1626.
  13. Rüsch N, Corrigan PW, Todd AR, Bodenhausen GV: Implicit self-stigma in people with mental illness. J Nerv Ment Dis 2010;198:150-153.
  14. Sirey JA, Bruce ML, Alexopoulos GS, Perlick D, Friedman SJ, Meyers BS: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv 2001;52:1615-1620.
  15. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ: Stigmatisation of people with mental illnesses. Br J Psychiatry 2000;177:4-7.
  16. Crisp AH: Stigmatization of and discrimination against people with eating disorders including a report of two nationwide surveys. Eur Eat Disord Rev 2005;13:147-152.

    External Resources

  17. Stewart MC, Keel PK, Schiavo RS: Stigmatization of anorexia nervosa. Int J Eat Disord 2006;39:320-325.
  18. Crisafulli MA, Von Holle A, Bulik CM: Attitudes towards anorexia nervosa: the impact of framing on blame and stigma. Int J Eat Disord 2008;41:333-339.
  19. Roehrig JP, McLean CP: A comparison of stigma toward eating disorders versus depression. Int J Eat Disord 2010;43:671-674.
  20. Fleming J, Szmukler GI: Attitudes of medical professionals towards patients with eating disorders. Aust NZ J Psychiatry 1992;26:436-443.
  21. Holliday J, Wall E, Treasure J, Weinman J: Perceptions of illness in individuals with anorexia nervosa: a comparison with lay men and women. Int J Eat Disord 2005;37:50-56.
  22. Barney LJ, Griffiths KM, Jorm AF, Christensen H: Stigma about depression and its impact on help-seeking intentions. Aust NZ J Psychiatry 2006;40:51-54.
  23. Conner KO, Copeland VC, Grote NK, Koeske G, Rosen D, Reynolds CF, Brown C: Mental health treatment seeking among older adults with depression: the impact of stigma and race. Am J Geriatr Psychiatry 2010;18:531-543.
  24. Wahl OF: Mental health consumers' experience of stigma. Schizophr Bull 1999;25:467-478.

    External Resources

  25. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D: The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health 2002;17:1-16.

    External Resources

  26. Newton T, Robinson P, Hartley P: Treatment for eating disorders in the United Kingdom. II. Experiences of treatment: a survey of members of Eating Disorders Association. Eat Disord Rev 1993;1:10-21.

    External Resources

  27. Rosenvinge JH, Klusmeier AK: Treatment for eating disorders from a patient satisfaction perspective: a Norwegian replication of a British study. Eur Eat Disord Rev 2000;8:293-300.

    External Resources

  28. De la Rie S, Noordenbos G, Donker M, van Furth E: Evaluating the treatment of eating disorders from the patient's perspective. Int J Eat Disord 2006;39:667-676.
  29. Gilboa-Schechtman E, Erhard-Weiss D, Jeczemien P: Interpersonal deficits meet cognitive biases: memory for facial expressions in depressed and anxious men and women. Psychiatry Res 2002;113:279-293.
  30. Brohan E, Gauci G, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. J Affect Disord 2011;129:56-63.
  31. Brohan E, Elgie R, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010;122:232-238.
  32. Halmi KA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson SW, Kraemer HC: Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry 2005;62:776-781.
  33. Lock J, Brandt H, Woodside B, Agras S, Halmi WK, Johnson C, Kaye W, Wilfley D: Challenges in conducting a multi-site randomized clinical trial comparing treatments for adolescent anorexia nervosa. Int J Eat Disord 2012;45:202-213.

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