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Study: How Symptom Severity and Weight Impact Perceptions of Bulimia Nervosa

July 23, 2019

Perceptions of people who have bulimia nervosa differ depending on the patient’s weight, according to a new Yale study published in the International Journal of Eating Disorders.

Participants in the study, which used vignettes to examine perceptions of a fictitious patient with bulimia nervosa, found that people viewed the eating disorder as a serious psychiatric condition when the patient was underweight. That perception changed in patients with overweight, as those patients were viewed as having a weight problem, not necessarily a mental health condition.

When asked to imagine they were the patient’s health care provider, study participants were most likely to recommend weight-loss strategies in overweight rather than healthy weight or underweight portrayals of patients with bulimia nervosa.

“On the other hand, participants were more likely to recommend mental health treatment and psychiatric medication for bulimia nervosa in the underweight than overweight conditions,” the authors wrote. “This coincides with the stronger belief in the underweight than in the overweight condition that the patient with bulimia nervosa was ‘experiencing a mental illness.'"

Bulimia nervosa is a serious mental illness with associated physical health problems and impaired psychosocial functioning. It can occur at any weight, but most patients have either a healthy weight or overweight when diagnosed.

People with a body mass index in the overweight or normal weight range often are not diagnosed or fail to receive treatment bulimia nervosa, and the study suggests that people’s perceptions of the eating disorder may contribute to barriers to receiving treatment.

The study's first author was Katharine Galbraith, BS, a 2016 Yale College graduate who wrote the paper for her undergraduate thesis. Janet Lydecker, PhD, Assistant Professor of Psychiatry, was senior author. Co-authors were JoAnn Elmquist, PhD; Marney White, PhD, MS; and Carlos Grilo, PhD. The study was supported, in part, by a grant from the National Institutes of Health.

Submitted by Christopher Gardner on July 23, 2019