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Knowledge about Eating

Disorders in the Community

Sara Murray, B.A.(Hons.)


Stephen Touyz, Ph.D.
Peter Beumont, M.D.
(Accepted 25 November 1988)

One-hundred and forty-nine subjects (80 females and 69 males) were asked about
their knowledge of anorexia and bulimia nervosa, the source of their knowledge,
and the ways in which their knowledge of these disorders may have affected their
attitudes towards eating, dieting, and related behaviors. Almost all subjects had
heard of anorexia nervosa, whereas bulimia nervosa was less well known, particu-
larly among males. Knowledge of anorexia nervosa was more detailed than that for
bulimia nervosa. The mass media were the major sources of subjects' information
about these disorders. Over one-third of females reported that their knowledge con-
cerning anorexia and bulimia nervosa had affected their own eating or related atti-
tudes in some way. The importance of the media in both promoting and preventing
eating disorders is discussed.

There is some evidence to suggest that the incidence of anorexia and bulimia
nervosa has risen over the last two decades (Crisp, Palmer, & Kalucy, 1976;
Jones, Fox, Babigan, & Hutton, 1980). Certainly anorexia and bulimia nervosa
have received increasing media attention in recent years, and the general pub-
lic has access to a considerable amount of material on these disorders (Huon,
Brown, & Morris, 1988).
A general finding of studies of people's knowledge about anorexia and bu-
limia nervosa is that subjects are more likely to have heard of anorexia nervosa
than bulimia nervosa, and that knowledge of anorexia nervosa is more detailed
than for bulimia nervosa (Chiodo, Stanley, & Harvey, 1984; Smith, Pruitt,
Mann, & Thelen, 1986; Huon et al., 1988). Chiodo et al. (1984) suggest that
such a difference may be explained by the popular media's greater emphasis
on anorexia nervosa compared with bulimia nervosa.

Sara Murray, B.A.(Hons.), is a postgraduate research student, Department of Psychiatry, University of


Sydney. Stephen Touyz, Ph.D., is Head of the Department of Clinical Psychology, Westmead Hospital,
Sydney, and Clinical Lecturer in Psychiatry, University of Sydney. Peter Beumont, M.D., is Professor
and Head, Department of Psychiatry, University of Sydney. Requests for reprints should be sent to Peter
Beumont, Department of Psychiatry, University of Sydney, New South Wales 2006, Australia.

International lournal of Eating Disorders, Vol. 9, No. 1, 87-93 (1990)


© 1990 by John Wiley & Sons, Inc. CCC 0276-3478/90/010087-07$04.00
88 Murray, Touyz, and Beumont

In relation to the content of people's knowledge about eating disorders


Huon et al. (1988) and Chiodo et al. (1984) found that the symptoms most com-
monly identified by subjects were behavioral ones such as excessive dieting for
anorexia nervosa and binging and vomiting for bulimia nervosa. Body image
disturbance and psychological factors in anorexia nervosa were also mentioned
by a large percentage of subjects in both studies.
Relatively few studies have examined the possible consequences of individu-
als' knowledge regarding anorexia and bulimia nervosa (Branch & Eurman,
1980). One likely impact of knowledge about anorexia and bulimia nervosa is
on detection, reporting, and even prevention of the disorder. On the other
hand, it could be speculated that such knowledge could contribute to a "social
contagion" effect. In support of the latter contention, Branch and Eurman
(1980) found that sufferers of anorexia nervosa were admired for their appear-
ance and self-control by their families and friends. In contrast, Chiodo et al.
(1984) concluded that "somewhat negative" stereotypes were associated with
sufferers of anorexia and bulimia nervosa. Furthermore, a significant minority
of Smith et al.'s (1986) male and female student sample held unfavorable per-
ceptions of anorexics and bulimics.
The aim of the present study was to investigate males' and females' knowl-
edge about anorexia and bulimia nervosa; the source of subjects' knowledge,
and the way(s) in which knowledge about anorexia and bulimia nervosa
may have affected subjects' attitudes towards eating, dieting, and related be-
haviors.

METHOD

Subjects
One aim of the study was to investigate knowledge in an age group believed
to be most vulnerable to eating disorders. For this reason the maximum age for
subjects was set at 30 years. The majority of subjects were obtained from two
large banking corporations (65 females and 64 males). Participation was on a
random selection, voluntary basis, and 96% of those approached agreed to par-
ticipate. The final sample included a wide range of occupations and levels of
education. A smaller random sample of school students also participated (15
females and 5 males). All students approached agreed to participate. The over-
all mean age for females was 19 (SD = 3.4, range 12-28), and the mean age for
males was 22.7 (SD = 4.3, range 12-30).

Procedure

Each subject was seen individually for a semistandardized interview, and the
following open-ended questions were asked of each subject:
1. Have you heard of anorexia nervosa?
2. Have you heard of bulimia nervosa?
3. Where did you hear or learn about anorexia and/or bulimia nervosa?
4. What do you know about anorexia nervosa?
Knowledge about Eating Disorders 89

5. What do you know about bulimia nervosa?


a. Has your knowledge of anorexia and/or bulimia nervosa changed your
own eating habits or attitudes towards dieting, or any related issue?
b. If so, in what way(s)?
Responses were taped and categorized after the interview.

RESULTS AND DISCUSSION

Almost all subjects (99% of females and 97% of males) had heard of anorexia
nervosa. However there was far greater ignorance of bulimia nervosa. There
was a highly significant sex difference in knowledge, with only 16% (n = 11) of
males having heard of bulimia nervosa, compared with 70% (« = 56) of fe-
males. These findings are similar to those of Huon et al. (1988) and Smith et al.
(1984). The extent of male ignorance is nevertheless somewhat surprising given
the recent coverage of bulimia nervosa in popular media.
The sources of subjects' knowledge about these disorders are given in Table
1. (For some questions subjects were able to give more than one response. For
this reason percentages in Tables 1-3 do not total 100.) Not surprisingly, the
most common sources of information were various forms of popular media:
magazines, newspapers, books, and television. Further analysis revealed that
for 49% (n = 72) of subjects some type of media (television and/or printed me-
dia) was their only source of infonnation.
Subjects' knowledge of eating disorders is summarized in Table 2. In line
with Chiodo et al.'s (1984) and Huon et al.'s findings (1988), the most com-
monly mentioned features of anorexia nervosa were sufferers' refusal to eat,
sufferers' thinness and body image distortion, and the fact that anorexia ner-
vosa is psychological in nature. Twenty percent of subjects also stated that self-
induced vomiting was a symptom of anorexia nervosa.
Overwhelmingly, the most common features mentioned in relation to bu-
limia nervosa were binging and vomiting: 38 subjects (57% of those who had
heard of bulimia nervosa) mentioned only binging and/or vomiting in response
to this question.

Table 1. Source of knowledge about anorexia nervosa/bulimia


nervosa (percentage frequency of responses).
Fem Males Total x^
{n = 79) {n = 67) {n = 146) (F v. M)

Books/magazines 68 46 58 6.4"
TV 46 61 53 3.0
Know of someone 18 25 21 0.9
School/University 18 8 13 2.5
Friend had AN or BN 17 5 11 4.2*
Relative had AN or BN 5 2 3 0.5
Conversation 4 8 6 0.4
Don't know 3 6 4 0.4
Note: In all tables percentages have been rounded to nearest whole num-
ber.
V < .05.
" p < .025.
90 Murray, Touyz, and Beumont

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Knowledge about Eating Disorders 91

The percentages in Table 2 suggest that subjects gave more detailed descrip-
tions of anorexia than bulimia nervosa. A chi-squared. analysis was performed
on the number of features of anorexia nervosa mentioned by subjects versus
the number of features they used to describe bulimia nervosa. A significant dif-
ference was found (p < .01). Thus not only had fewer subjects heard of bulimia
nervosa, but of those who had heard of it, their knowledge was not as detailed
as that for anorexia nervosa.
Subjects' responses to the question "Has your knowledge of anorexia and/or
bulimia nervosa changed your own eating habits or attitudes towards dieting,
or any related issue?" are presented in Table 3. There was a highly significant
sex difference in responses, with 39% of females asserting that their attitudes
had changed, compared with only 13% of males.
The nature of the changes perceived by subjects, summarised in Table 3,
were very interesting and worthy of a detailed examination. Most of the sub-
jects who perceived changes referred to their knowledge of anorexia rather
than bulimia nervosa. The majority of male and female subjects who did ac-
knowledge some kind of change stated that their knowledge of these disorders
had made them more cautious regarding their own dieting behavior.
Many respondents held the idea that anorexia nervosa could start as the re-
sult of excessive dieting or "not knowing when to stop." For some of these
subjects forewarned was forearmed. One 21-year-old female subject remarked:
"I think if I did go on a diet and lose a lot of weight I'd know when to stop
because I've seen people in the situation where they have lost so much weight
they've become anorexic."
Several females described a mild anorexia-like phase which they perceived
they had overcome because of their awareness of anorexia nervosa: "When I
was 15 I went on a diet and didn't eat anything for 3 days. I started eating
again because I was scared I'd become anorexic" (female, aged 17 years).
Over one-quarter of subjects who believed that their knowledge regarding
eating disorders had changed them commented that it had made them more

Table 3. Effects of knowledge of anorexia andyor bulimia nervosa.


Percentage of Subjects Changed by Knowledge of Anorexia or Bulimia Nervosa

Change No Change Total

n
Females 31 (39) 49 (61) 80 (100) 11 5»
Males 9 (13) 60 (87) 69 (100)
Total 40 (26) 109 (73) 149 (100)

Type of Change Perceived by Subjects (Percentage Frequency of Responses)

Fem Males Total x^


(n = 31) (n = 9) (w = 40) (F v. M)
Made me cautious about own dieting 71 56 68 02
Made me cautious about others dieting 29 22 28 00
Made me glad not to have AN 10 11 lo 03
I heard about it, then tried it 7 0 5 o!l
*p < .001. ~ '
92 Murray, Touyz, and Beumont

wary of other people's dieting behavior. One female commented: "If I can see
that some people are already thin and then they go on a diet I say 'Oh you're
mad, you're thin already. You'll get anorexia' " (21 years).
Not all the effects of knowledge of anorexia and bulimia nervosa were posi-
tive, however. Two females stated that after hearing about these disorders they
decided to try some of the techniques they had heard about. For example: "I
read about it in 'Dolly' [a magazine for teenage girls]. And then I started taking
diet tablets and laxatives and making myself vomit, and I was losing weight
rapidly. And then I woke up to myself. They're trying to be educational, but
people abuse it. I abused it" (aged 16 years). Another female respondent indi-
cated that her knowledge of anorexia nervosa has led to her adopting a very
strict diet, which she considered acceptable because it did not conform to her
definition of the disorder.

CONCLUSIONS

The results of the present study indicate that anorexia nervosa is widely
known, whereas bulimia nervosa is less well known, particularly among
males. Subjects' knowledge about anorexia and bulimia nervosa was similar to
that displayed by subjects in past studies, with the majority of subjects identi-
fying the major behavioral features of these disorders. The most interesting
findings concerned the effects of knowledge about anorexia and bulimia ner-
vosa on peoples' attitudes and behavior. A significant percentage of females
perceived that their knowledge of these disorders had affected them in some
way. Although most of the reported effects were positive, that is, in the direc-
tion of prevention of eating disorders, the findings were certainly not clear cut.
Some subjects reported being adversely affected by their knowledge.
Clearly, the media were the major source of people's knowledge about these
disorders. A further important issue for examination is the question of whether
certain types of information, or methods of presentation, are more likely to
serve a preventative role than others. However, the role of the media in pre-
vention of eating disorders is clearly not confined to dissemination of informa-
tion regarding those disorders. A point which has been made often elsewhere
is that the media may actually contribute to the incidence of eating disorders
through their emphasis on dieting and thin "ideal" figures (e.g., Silverstein,
Perdue, Peterson, & Kelly, 1986; Garner, Garfinkel, Schwartz, & Thompson,
1980). Indeed 8% of subjects in the present study spontaneously commented
that they believed that the mass media were responsible for the incidence of
eating disorders. The data from the present study indicate that the role of the
media in both promoting and preventing eating disorders is an issue deserving
of further exploration.

REFERENCES
Branch, C. H., & Eurman, L. J. (1980). Social attitudes towards patients with anorexia nervosa.
American Journal of Psychiatry, 137, 631-632.
Knowledge about Eating Disorders 93

Chiodo, J., Stanley, M., & Harvey, J. H. (1984). Attributions about anorexia nervosa and bulimia.
Journal of Social and Clinical Psychology, 2, 280-285.
Crisp, A. H., Palmer, R. L., & Kalucy, R. S. (1976). How common is anorexia nervosa? British Jour-
nal of Psychiatry, 128, 549-554.
Gamer, D. M., Garfinkel, P. E., Schwartz, D., & Thompson, M. (1980). Cultural expectations of
thinness in women. Psychological Reports, 47, 483-491.
Huon, G. F., Brown, L. B., & Morris, S. E. (1988). Lay beliefs about disordered eating. Intematiorml
Journal of Eating Disorders, 7, 239-253.
Jones, D. J., Fox, M. M., Babigan, H. M., & Hutton, H. E. (1980). Epidemiology of anorexia ner-
vosa in Monroe County, New York: 1960-1976. Psychosomatic Medicine, 42, 551-558.
SUverstein, B., Perdue, L., Peterson, B., & Kelly, E. (1986). The role of the mass media in promot-
ing a thin standard of bodily attractiveness for women. Sex Roles, 14, 519-532.
Smith, M. C , Pruitt, J. A., Mann, L. M., & Thelen, M. H. (1986). Attitudes and knowledge regard-
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