Anorexia Nervosa and Stigma

Dr. David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, is an internationally respected scholar on eating disorders credited with over 280 publications.  He is board certified in pediatrics, child and adolescent psychiatry, and general psychiatry and has treated over 3,000 individuals with eating disorders such as anorexia and bulimia nervosa. He founded and directed the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital and, prior to that, the Harvard Eating Disorders Center.

Dr. David Herzog and his staff collaborated with Boston University to explore public stigma associated with eating disorders. In 2010, 173 college students were shown one of three videos describing anorexia as a product of either biology, culture, or an interaction between the two. 

Each video ran about 5 minutes and consisted of two parts. All three videos opened with the same two-minute segment, in which an average-weight actress portrays a young woman who has recovered from anorexia. She describes her descent into the disorder and the suffering she experienced while actively ill, including her self-loathing, impaired concentration, physical consequences, obsessionality, and social isolation. She also discusses her attempts to appear fine to the outside world while feeling miserable inside.

The second part of each video varied by condition, but each consisted of a three-minute segment in which a middle-aged actor portrays a doctor who is an expert on anorexia nervosa. In all conditions, the basic structure of the segment was the same, though specific content varied. First, the doctor describes the seriousness of anorexia. Next, he indicates that much debate surrounds the etiology of anorexia but that a great deal of evidence points to the role of (biological/sociocultural/both biological and sociocultural) factors in the development of the disorder. Then, he elaborates the research evidence supporting the roles of (biology/society/an interaction between biology and society) in the development of the disorder.

Finally, in each video, the expert states that anorexia can be treated but often requires a team of doctors and sometimes occurs in the context of hospitalization. He also says that "adequate insurance coverage and other supports for those with this disease are very much needed."

After watching the videos, the participants completed a questionnaire designed to measure which explanation evoked the least stigmatizing attitudes. Those who viewed the interaction video demonstrated less stigma than those who viewed the sociocultural video but more than those who viewed the biology video. The stigma against anorexia tended to be blame-based, meaning that the disorder was seen as the patient’s own doing.  Both the biological and the interaction groups showed more intention to engage in helping behavior than the sociocultural group.

The preponderance of empirical evidence points to anorexia as a product of an interaction between both biology and culture.  More research is needed to learn how to accurately portray the etiology of the disorder while, at the same time, trying to reduce stigma.