Stigmatising attitudes – damaging mental health
It is an undisputed fact that individuals who experience mental health issues are often faced with stigma. Stigma is a broad term which is used to describe the negative thoughts, attitudes and feelings about people on the basis of the traits of a person. When a person is labelled by their illness, they are often seen as part of a stereotyped group. Negative community attitudes can lead to prejudice and discrimination. This can impact on the lives of people who live with a mental illness, their families and carers, and more broadly all those who wish to live in a fair society.
Stigma brings experiences and feelings of:
- Misrepresentation in the media
- Reluctance to seek and/or accept necessary help
Research has consistently demonstrated widespread stigma toward anorexia nervosa, bulimia nervosa, and binge eating disorder. Furthermore, studies comparing individuals with eating disorders with non-eating-related mental disorders found that individuals with anorexia nervosa or bulimia nervosa were perceived as being more responsible for their disorder (than individuals with issues such as major depressive disorder or schizophrenia), suggesting that the public perceives eating disorders as more controllable than other mental disorders. Finally, a recent study by Ebneter and Latner (2013) found that individuals with binge eating disorder were blamed more for their condition, and described as being less impaired than individuals with anorexia nervosa or bulimia nervosa, indicating that the severity of binge eating disorder may be unrecognised among the public.
Obesity stigma is widespread and increasing over time. Individuals with obesity who experience stigmatisation express poor body image and psychosocial functioning and are at risk for depression and general psychiatric symptoms. On the societal side of stigma consequence, the attribution of obesity to personal responsibility leads to negative reactions including less empathy and willingness to help the affected individual (Sikorski, et al., 2011). Thus, weight bias may exist all along the weight spectrum.
Studies have also consistently documented negative weight bias among health care providers including physicians, nurses, medical students, dieticians, psychologists and fitness professionals (Puhl, Latner, King, & Luedicke, 2014). Weight-based stereotypes held by health-care professionals ultimately have important implications for the quality of care that patients receive, with some research showing that weight bias in the health-care setting serves as a barrier to health-care utilisation and increases impairment in health-related quality of life.
In addition, considerable research has demonstrated that individuals experiencing weight-bias increases their vulnerability for numerous psychological consequences, including depression, low self-esteem, anxiety, poor body image, and suicidality; as well as maladaptive eating behaviours, including binge eating, unhealthy weight control practices, increased food consumption, poorer outcomes in weight loss treatment, and eating disorder symptoms.
These findings suggest that efforts to reduce weight bias among professionals in the eating disorders field are warranted. Providing educational interventions that emphasise the complex aetiology of eating disorders and obesity (e.g. information on biological and genetic contributors) and challenging common weight-based stereotypes can effectively reduce weight bias. It is possible that some professionals may exhibit resistance in response to stigma reduction efforts that involve confronting one’s own personal attitudes and assumptions about eating disorders and obesity. However, a better understanding of the nature and correlates of weight bias in professionals will help to guide targeted interventions to improve therapeutic relationships and client outcomes as well as reduce stigma in training and clinical practice.
“For me stigma means fear, resulting in a lack of confidence. Stigma is loss, resulting in unresolved mourning issues. Stigma is not having access to resources… Stigma is being invisible or being reviled, resulting in conflict. Stigma is lowered family esteem and intense shame, resulting in decreased self-worth. Stigma is secrecy… Stigma is anger, resulting in distance. Most importantly, stigma is hopelessness, resulting in helplessness.”
Gullekson (in Fink & Tasman, 1992)
Ebneter, D. S., & Latner, J. D. (2013). Stigmatizing attitudes differ across mental health disorders: a comparison of stigma across eating disorders, obesity, and major depressive disorder. The Journal of Nervous and Mental Disease, 201(4), 281-285.
Fink, P. J. & Tasman, A. (1992) Stigma and Mental Illness. Washington, DC: American Psychiatric Press.
Puhl, R. M., Latner, J. D., King, K. M., & Luedicke, J. (2014). Weight bias among professionals treating eating disorders: Attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders, 47(1), 65-75.
Sikorski, C., Luppa, M., Kaiser, M., Glaesmer, H., Schomerus, G., Konig, H.-H., & Riedel-Heller, S. (2011). The stigma of obesity in the general public and its implications for public health - a systematic review. BMC Public Health, 11(1), 661.
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