Perceived Severity Mediated Stigmatization of Anorexia Nervosa Among College Students

The mental illness stigmatization literature has largely excluded factors specific to eating disorders (ED). Studies on ED stigmatization have identified the themes of personal responsibility, weakness, and attention-seeking as the most prevalent attitudes, in addition to the belief that EDs are relatively easily resolvable (Mond, Robertson-Smith, & Vetere, 2014; Stewart, Keel, & Schiavo, 2006). Adverse outcomes of stigmatization include increased prevalence of ED symptoms, a longer illness duration, and increased levels of self-stigma (Griffiths et al., 2014). Other Specified Eating or Feeding Disorder (OSEFD) is the most common DSM-5 diagnosis among individuals with ED symptomology (Fairburn & Bohn, 2005). Since these individuals do not present as a prototypical model of anorexia, their illness is perceived as less severe, although psychopathology severity and extent of psychosocial impairment experienced by these individuals are not significantly different than those who receive an Anorexia Nervosa (AN) diagnosis (eg., Ricca et al., 2001). In the present study, one hundred participants were randomly assigned to two groups: “clinical vignette” and “sub-clinical vignette”. Both groups describe a character with the psychological and behavioral symptoms of AN. In the clinical vignette, the character has diagnosable AN due to her low weight, but the character in the sub-clinical vignette has average weight and therefore cannot be diagnosed with AN. Participants then completed measures of controllability (AQ 30), trivialization, blame, weakness, selfishness/vanity (EDSS, 2010), and willingness to help. Mediation analyses revealed significant findings to suggest trivialization mediates weight-based stigmatization. Specifically, trivialization mediates the relationship between experimental condition on assignments of controllability and weakness, but does not mediate the relationship between experimental condition and blame, selfishness/vanity, or willingness to help. Additionally, a univariate ANOVA analyses show that participants in the average weight group assigned significantly greater levels of overall stigma than did the participants who read the vignette describing the clinically underweight character. Our findings stress the importance of the implications of OSEFD and AN diagnoses in both research and clinical settings, as well as the perceptions of eating disordered individuals by peers and the public. These data suggest individuals of sub-clinical weight with behavioral and psychological symptoms of AN may be assigned higher levels of controllability, and viewed as weak. Future research should focus on average weight individuals with AN symptomology, the psychosocial and clinical implications of assigning an OSEFD diagnosis, and improving psychoeducation about EDs.