Amy Bannatyne

Educating Medical Students About Anorexia Nervosa: A Potential Method for Reducing the Volitional Stigma Associated With the Disorder

It is frequently reported that clinicians across a range of professional disciplines experience strong negative reactions toward patients with anorexia nervosa (AN). The present study aimed to develop, evaluate, and compare the effectiveness of two different educational programs, based on an etiological framing model. Participants were medical students (N = 41) from an Australian University, who were randomly assigned to one of three conditions (biogenetic intervention vs. multifactorial intervention vs. control). Outcome attitudinal/stigma data were collected pre- and post-intervention, and at 8 weeks follow-up. Results indicated intervention participations exhibited significantly lower volitional stigma scores compared to the control group, who exhibited no change in attitudes or stigma. Specifically, intervention participants had significantly lower total ED stigma scores, levels of blame, perceptions of AN as a selfish/vain illness, and viewed sufferers as less responsible for their illness at post-intervention. These reductions were maintained at follow-up. Overall, the study provides preliminary evidence that brief targeted interventions can assist in reducing levels of volitional stigma toward AN.

Body Image Avoidance, Body Dissatisfaction, and Eating Pathology Is There a Difference Between Male Gym Users and Non–Gym Users?

With research highlighting the increasing prevalence and severity of body image and eating disturbances in males, particularly athletes and regular gymnasium users, the current study examined body image and eating disturbances in a sample of male gym users and non–gym users (N = 180). Based on previous research, it was predicted that male gym users would report greater body image disturbance (e.g., body image avoidance and body dissatisfaction) and eating pathology, compared with non–gym users. Results of the study partially supported hypotheses, revealing body dissatisfaction and eating pathology were significantly increased in male gym users. However, no significant differences were observed in body image avoidance behaviors, though this is likely because of methodological limitations associated with psychometric measures selected. The study provides preliminary evidence that male gym users do experience subclinical eating and body image concerns, with some also experiencing clinically significant symptoms that could be precursors to the later development of an eating disorder. Results of the current study highlight the importance of educating key stakeholders within health and fitness centers, through community-based interventions, to increase awareness regarding male body image and eating disturbances.

Implementation of psychiatric-focused lifestyle medicine programs in Asia

Lifestyle‐focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle‐focused health programs to enhance mental and physical health are considered to include the evidence‐based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal‐setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures.

Eating Disorder Patient Experiences of Volitional Stigma Within the Healthcare System and Views on Biogenetic Framing: A Qualitative Perspective: Eating disorders, stigma, and health care

Objective Research has consistently indicated that fear of stigma is a pertinent factor when understanding the poor prevalence of treatment seeking among individuals with mental illness, particularly eating disorders (EDs). The purpose of this study was to investigate the treatment experiences of ED sufferers within an Australian context, in addition to exploring patient views on framing EDs as biogenetic conditions, given the increased understanding and presentation of EDs as biologically based conditions. Methods Semi‐structured online data collection was conducted with 35 Australian women with a history of an ED (54.3% in treatment, 45.7% in “recovery” or “recovered”). The data were evaluated using a three‐phased coding system, allowing findings to emerge from significant themes inherent within the raw data (thematic analysis). Results Treatment was perceived as traumatic, punitive, blaming, lacking in understanding/education, and overemphasised the physical dimensions of the illness. The experience of volitional stigma in the healthcare system was frequent and expected, and for many sufferers had adverse effects. Biogenetic framing was perceived to be more likely to reduce (rather than exacerbate) stigma, particularly perceptions of volition and personal responsibility. Although reductions in blame and responsibility were welcomed, there was concern that biogenetic explanations could negatively impact recovery by endorsing genetic fatalism and encouraging self‐fulfilling prophecies via genetic essentialism. Conclusions Overall, findings highlight that attention to volitional stigma within the health system is required (particularly education) and that aetiological framing (with caution and sensitivity) is perceived to be a feasible stigma reduction method by ED sufferers.

Consensus on the assessment of disordered eating in pregnancy: an international Delphi study

This study aimed to assess and develop consensus on the assessment of disordered eating in pregnancy. A three-round modified Delphi approach was used. Participants were international clinicians and researchers (N = 26) with extensive knowledge on and/or clinical experience with eating disorders, particularly in relation to pregnancy and/or women’s health. Clear consensus among the panel, defined as 75% agreement, was reached regarding the assessment of disordered eating in pregnancy, in addition to potential assessment methods. Antenatal assessment of disordered eating was perceived to be crucial and ideally occur in a routine manner. Despite agreement that various assessment methods would be relevant in assessing disordered eating in pregnancy, psychometrically sound brief screening instruments were perceived to be most feasible for practitioners and women accessing antenatal care; however, these instruments must be pregnancy-specific and delivered in an authentic and caring manner to be beneficial.

Twelve tips for teaching brief motivational interviewing to medical students

Abstract Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training. Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy. Methods: Tips were drawn from the literature and authors’ own experiences. Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate. Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum.

Eating disorder patient experiences of volitional stigma within the healthcare system and views on biogenetic framing: A qualitative perspective

Objective Research has consistently indicated that fear of stigma is a pertinent factor when understanding the poor prevalence of treatment seeking among individuals with mental illness, particularly eating disorders (EDs). The purpose of this study was to investigate the treatment experiences of ED sufferers within an Australian context, in addition to exploring patient views on framing EDs as biogenetic conditions, given the increased understanding and presentation of EDs as biologically based conditions. Methods Semi‐structured online data collection was conducted with 35 Australian women with a history of an ED (54.3% in treatment, 45.7% in “recovery” or “recovered”). The data were evaluated using a three‐phased coding system, allowing findings to emerge from significant themes inherent within the raw data (thematic analysis). Results Treatment was perceived as traumatic, punitive, blaming, lacking in understanding/education, and overemphasised the physical dimensions of the illness. The experience of volitional stigma in the healthcare system was frequent and expected, and for many sufferers had adverse effects. Biogenetic framing was perceived to be more likely to reduce (rather than exacerbate) stigma, particularly perceptions of volition and personal responsibility. Although reductions in blame and responsibility were welcomed, there was concern that biogenetic explanations could negatively impact recovery by endorsing genetic fatalism and encouraging self‐fulfilling prophecies via genetic essentialism. Conclusions Overall, findings highlight that attention to volitional stigma within the health system is required (particularly education) and that aetiological framing (with caution and sensitivity) is perceived to be a feasible stigma reduction method by ED sufferers.

The effectiveness of educational interventions in reducing negative attitudes and stigmatisation toward patients with anorexia nervosa

It is frequently reported that clinicians across a range of professional disciplines experience strong negative reactions toward patients with eating disorders, particularly anorexia nervosa (AN). As research consistently demonstrates fear of stigma is the most frequently cited reason explaining why individuals with mental illness do not seek treatment, the current study aimed to develop, evaluate and compare the effectiveness of two differing educational interventions, based on an etiological framing model, against a wait-list control. Participants were fourth-year medicine students randomly assigned to one of three conditions. A three-hour educational workshop was delivered to participants at the beginning of an eight-week clinical rotation. Outcome attitudinal data were collected pre-intervention, post-intervention, and at an eight-week follow-up period. It was hypothesised that both intervention groups would result in more positive attitudes toward AN, compared to the wait-list control, with the biologically-framed intervention resulting in the greatest stigma-reduction effect, consistent with Attribution Theory. Preliminary findings will be discussed. This abstract was presented in the Prevention stream of the 2013 ANZAED Conference.

Signs and symptoms of disordered eating in pregnancy: a Delphi consensus study

BackgroundThis study aimed to establish consensus on the expression and distinction of disordered eating in pregnancy to improve awareness across various health professions and inform the development of a pregnancy-specific assessment instrument.MethodsA three-round modified Delphi method was used with two independent panels. International clinicians and researchers with extensive knowledge on and/or clinical experience with eating disorders formed the first panel and were recruited using structured selection criteria. Women who identified with a lived experience of disordered eating in pregnancy formed the second panel and were recruited via expressions of interest from study advertising on pregnancy forums and social media platforms. A systematic search of academic and grey literature produced 200 sources which were used to pre-populate the Round I questionnaire. Additional items were included in Round II based on panel feedback in Round I. Consensus was defined as 75% agreement on an item.ResultsOf the 102 items presented to the 26 professional panel members and 15 consumer panel members, 75 reached consensus across both panels. Both panels clearly identified signs and symptoms of disordered eating in pregnancy and endorsed a number of clinical features practitioners should consider when delineating disordered eating symptomatically from normative pregnancy experiences.ConclusionA list of signs and symptoms in consensus was identified. The areas of collective agreement may be used to guide clinicians in clinical practice, aid the development of psychometric tools to detect/assess pregnancy-specific disordered eating, in addition to serving as starting point for the development of a core outcome set to measure disordered eating in pregnancy.

Attitudes towards anorexia nervosa: Volitional stigma differences in a sample of pre-clinical medicine and psychology students

Abstract Background: Anorexia nervosa (AN) is a highly stigmatised condition, with treatment often involving multidisciplinary care. As such, understanding and comparing the attitudes of emerging mental health and medical professionals towards AN, within the content of sex-based differences, is pertinent to facilitate the development of targeted stigma interventions. Aims: Examine the volitional stigmatisation of AN in emerging medical and mental health professionals. Method: Participants (N = 126) were medical (n = 41) and psychology students (n = 85) who completed a range of attitudinal outcome measures (e.g. Causal Attributions Scale, Eating Disorder Stigma Scale, Opinions Scale, Characteristics Scale and Affective Reaction Scale). Results: Across both disciplines, men were found to exhibit significantly higher eating disorder (ED) stigma, considered AN to be a more trivial and weak illness, and attributed greater levels of blame and responsibility to AN sufferers. Men also had significantly lower biogenetic causal attributions. Compared with psychology students, medicine students exhibited slightly greater anticipation of negative reactions in response to AN, obtained higher selfish/vain scores and considered sociocultural factors to contribute “a lot” in the development and maintenance of AN. Conclusions: Overall, results indicate interventions aimed at improving ED mental health literacy are needed, specifically targeting males and potentially medical students.