Despite the serious nature of eating disorders, they are not well understood. In the past century, many myths have flourished; characterising eating disorders as a disease of underweight “white upper-class females” who are engaging in a “lifestyle choice” or “phase” due to vanity. Common misconceptions continue to define individuals with eating disorders are self-centred, fragile, unreliable and attention-seeking, and that these individuals “have only themselves to blame”.
Scientific evidence has been instrumental in overturning myths and generating break-throughs in prevention, health care and public policy, yet research still lags behind understanding how to reduce stigmatizing attitudes and beliefs. Recent evidence has suggested that explaining eating disorders as biologically-based psychiatric disorders is helpful for countering stigma in eating disorders, despite findings to the contrary for other mental illnesses, such as schizophrenia and other serious mental illnesses. This may be because eating disorders stigma centres on personal responsibility.
Eating disorders are plagued by “volitional” stigma; people with eating disorders are often perceived as choosing to behave as they do. Surveys respondents have indicated that people are more responsible for eating disorders than schizophrenia, depression, panic attacks, and dementia (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000).
Genetic involvement relieves the sense of responsibility for causing the disorder. It may make mental illness appear more serious and disease-like and volition less plausible by focusing on elements outside of a person’s control. In support of this hypothesis, describing anorexia nervosa in terms of genetics has been shown to elicit less blame or responsibility, as well as less perceived triviality, weakness, and selfishness (Crisafulli, Thompson-Brenner, Franko, Eddy, & Herzog, 2010).
Promoting greater awareness of the role of biogenetic factors in the development of eating disorders might also be conducive to greater recognition of the severity and public health significance of these conditions and greater acceptance by those diagnosed with an eating disorder of the need for medically oriented interventions where indicated, such as treatment from a psychiatrist and/or the use of psychotropic medication.
However, there is the risk that biological attribution would indicate that the problem is an essential, defining, and perhaps immutable characteristic of the person. This “genetic essentialism” could draw attention away from the role of developmental and/or psychosocial factors in the development of disordered eating and the need to address these factors in treatment and recovery. Furthermore, findings from a recent, qualitative study suggest that promoting biogenetic accounts of aetiology may have the effect of reducing motivation for change and, perhaps, engendering a sense of helplessness by highlighting the need for treatment that is not currently available.
For these reasons, promoting adherence to a biogenetic model of mental illness at the exclusion of other causal explanations is not the most effective way to reduce the stigma toward individuals with eating disorders.
It is important that our responses to eating disorders address the interplay between genetic and personality vulnerabilities and social and environmental triggers. An alternative approach would focus on improving awareness and understanding of the risk factors that occur at the population level and the distress and disability associated with these. A strategy of this kind has the potential to improve awareness of the public health significance of eating disordered behaviour and reduce the stigma of sufferers without encouraging fatalistic, reductionist, and self-fulfilling genetic prophecies.
Crisafulli, M. A., Thompson-Brenner, H., Franko, D. L., Eddy, K. T., & Herzog, D. B. (2010). Stigmatizing of anorexia nervosa: characteristics and response to intervention. Journal of Social and Clinical Psychology, 29(7), 756-770.
Crisp, A. H., Gelder, M. G. Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry, 177, 4-7.
Easter, M. M. (2012). "Not all my fault": Genetics, stigma, and personal responsibility for women with eating disorders. Social Science & Medicine, 75, 1408-1416.
Mond, J. (2013). Eating disorders as “brain-based mental illnesses”: An antidote to stigma? Journal of Mental Health, 22(1), 1-3.
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