होम Journal of Nervous & Mental Disease Stigmatizing Attitudes and Beliefs Toward Bulimia Nervosa

Stigmatizing Attitudes and Beliefs Toward Bulimia Nervosa

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ORIGINAL ARTICLE

Stigmatizing Attitudes and Beliefs Toward Bulimia Nervosa
The Importance of Knowledge and Eating Disorder Symptoms
Rachel Florence Rodgers, PhD,*† Susan J. Paxton, PhD,‡ Siân A. McLean, BSc (Hons),‡
Robin Massey, BA, PGDipPsych,‡ Jonathan M. Mond, PhD,§
Phillipa J. Hay, PhD,k¶ and Bryan Rodgers, PhD#
Abstract: Widely held stigmatizing attitudes and beliefs toward bulimic eating
disorders may lead to self-blame and reduced treatment seeking. Knowledge and
familiarity with mental disorders may help decrease associated stigma. However,
these relationships are not well understood in bulimia nervosa (BN). A community sample of 1828 adults aged 18 to 70 years completed a survey assessing stigmatizing attitudes and beliefs toward BN, knowledge and familiarity with the
disorder, as well as levels of eating disorder symptoms. Knowledge of BN was
negatively associated with three dimensions of stigmatization, personal responsibility (ρ = −0.28), unreliability (ρ = −0.19), and advantages of BN (ρ = −0.23).
Familiarity revealed no association with stigmatization. Both men and women
with high levels of eating disorder symptoms perceived BN as less serious than
the participants with low levels of symptoms. Increasing community knowledge about bulimia may help mitigate stigmatization and perceived barriers
to treatment.
Key Words: Stigmatization, bulimia nervosa, knowledge, eating disorder
symptoms
(J Nerv Ment Dis 2015;203: 259–263)

B

ulimia nervosa (BN) affects a substantial proportion of the population and is associated with distress and role impairment (Hay,
2003; Hay and Mond, 2005). However, only a minority of individuals
with BN seek appropriate professional treatment (Hudson et al.,
2007; Swanson et al., 2011; Wade et al., 2006). It has been proposed
that one of the main barriers to treatment seeking among individuals
with these disorders is the fear of stigma (Becker et al., 2004; Hepworth
and Paxton, 2007). Indeed, stigmatizing and negative attitudes toward
eating disorders in general seem to ; be widespread (Mond et al.,
2004b, 2004c; Stull et al., 2013). Such stigma results in the discrediting
of individuals with these disorders and individuals with eating disorders being labeled as possessing undesirable and negative characteristics, which may, in turn, lead to social rejection (Jones et al., 1984).
In relation to BN, individuals have reported fearing the judgment
of others because their behaviors are considered disgusting and shameful (Hepworth and Paxton, 2007). In addition, eating disorders have
been shown to be perceived as more under the control of the individual
and associated with more blame directed toward the individual with an

*Department of Counseling and Applied Educational Psychology, Northeastern
University, Boston, MA; †Laboratoire de Stress Traumatique, Université Paul
Sabatier, Toulouse, France; ‡School of Psychological Science, La Trobe University, Melbourne, Victoria; §Research School of Psychology, Australian National
University, Canberra, Australian Capital Territory; kCentre for Health Research,
School of Medicine, University of Western Sydney, Sydney; ¶School of Medicine,
James Cook University, Townsville; and #Australian Demographic & Social Research Institute, The Australian National University, Canberra, Australian Capital
Territory, Australia.
Send reprint requests to Rachel Florence Rodgers, PhD, 404, International
Village, Northeastern University, 360 Huntington Ave, Boston, MA 02115.
E-mail: r.rodgers@neu.edu.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0022-3018/15/20304–0259
DOI: 10.1097/NMD.0000000000000275

eating disorder than other mental health disorders (Ebneter and Latner,
2013). Furthermore, stigmatizing attitudes toward BN may affect the
self-view of individuals with the disorder (Corrigan and Watson,
2002; Rüsch et al., 2010). This form of self-stigma could then be associated with heightened shame and self-blame. Consistent with this theory, among students with high levels of disordered eating, self-stigma
predicted negative attitudes toward seeking counseling (Hackler et al.,
2010). Furthermore, feelings of shame and that one should be able to
help oneself have been identified as important barriers to treatment
seeking among individuals with significant eating problems (Cachelin
and Striegel-Moore, 2006). Individuals with high levels of eating disorder symptoms are also more likely to expect someone with BN to be
discriminated against and less likely to seek help for a similar eating
problem compared with individuals with low levels of eating disorder
symptoms (Mond et al., 2010).
The “contact hypothesis” of discrimination (Allport, 1954)
posits that increased contact and familiarity with a stigmatized group
will result in decreased discrimination. Consistent with this hypothesis,
there is some evidence that greater contact with individuals with mental
health issues decreases the stigmatization of these groups (Read and
Harré, 2001). Similarly, individuals with higher levels of contact with
those with eating disorders have reported lower levels of negative attitudes. In a study using 16 different scenarios depicting individuals presenting symptoms of either BN or anorexia nervosa, college students
who reported having previous contact with eating disorders perceived
the fictional characters as more similar to themselves compared with
participants with no previous contact with eating disorders (Wingfield
et al., 2011). In a similar study using a vignette depicting a young
woman with anorexia nervosa, among undergraduate students, previous
personal contact with an individual with anorexia nervosa was associated with greater reported comfort with interacting with the young
woman depicted in the vignette (Stewart et al., 2008). However, other
studies have found that college students acquainted with eating disorders through personal experience of knowing someone who had had
such a disorder did not report decreased stigmatizing attitudes and beliefs regarding eating disorders compared with individuals who were
not acquainted with the disorders (Ebneter et al., 2011).
Knowledge about mental health disorders, specifically their origin, course, treatment options, and dangerousness, has been pinpointed
as an important factor contributing to lower levels of stigmatizing attitudes and beliefs (Hinshaw and Stier, 2008; Jorm, 2012). In line with
this hypothesis, one previous study has suggested that increased knowledge of BN was associated with lower levels of critical attitudes toward
individuals with the disorder (Rancie, 2008). However, data regarding
the relationship between knowledge of BN as well as stigmatizing attitudes and beliefs in community samples are lacking, and further investigations of community beliefs and attitudes are warranted. Moreover,
this gap limits our understanding of the usefulness of targeting knowledge in interventions that aim to decrease stigma.
The aims of the present study were therefore twofold. The first
aim was to explore the relationships of stigmatizing attitudes and
beliefs toward BN with knowledge of and familiarity with BN. We

The Journal of Nervous and Mental Disease • Volume 203, Number 4, April 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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259

The Journal of Nervous and Mental Disease • Volume 203, Number 4, April 2015

Rodgers et al.

hypothesized that higher levels of familiarity with and knowledge of
BN would be associated with lower levels of stigmatizing attitudes toward BN. The second aim was to explore the relationships between
stigmatizing attitudes and beliefs toward BN and current self-reported
eating disorder symptoms, in particular, to assess stigmatizing attitudes
toward BN among individuals with higher levels of eating disorder
symptoms. Increased familiarity and empathy with individuals with
BN could lead to participants with high levels of eating disorder symptoms reporting lower levels of stigmatizing attitudes and beliefs. However, within a self-stigma framework, the converse would be expected,
that is, that individuals with high levels of eating disorder symptoms
would report high levels of stigmatizing attitudes toward BN. We therefore developed no specific hypothesis related to this second aim. In
view of suggestions that stigmatizing attitudes and beliefs toward individuals with eating disorders might vary according to sex and age
(Hudson et al., 2007; Mond and Arrighi, 2011; Mond et al., 2008),
we also examined our hypotheses among men and women separately
and among younger and older age groups.

METHODS
Participants and Procedure
A random sample from the Australian Electoral Roll for
Victoria, Australia, was mailed a questionnaire, resulting in a sample
of 1828 adult participants, aged 18 to 70 years (mean [SD] age, 44.63
[13.11]; response rate, 22.43%), similar to previous eating disorder
postal surveys of community adults in the United States and Australia
(Mond et al., 2004a; Striegel et al., 2009). The sample demographics
were compared with similar samples from Australia with higher response rates (Hay et al., 2008) and found to be similar. The participants
returned their completed surveys in a prepaid envelope and were compensated Aus$10 for their time. The sample was stratified according to
basic demographics including sex, age group, socioeconomic status,
and location. The distribution of participants by sex was relatively even
(51.3% women); 25.9% of the sample was aged between 18 and
34 years, 27.2% of the sample was aged between 35 and 44 years,
and 46.9% of the sample was aged between 45 and 65 years. Approximately a third of the sample (32.7%) came from rural areas; 31.9% of
the sample reported low socioeconomic status (SES), 41.1% reported
average SES, and 27% reported high SES. The majority of the sample
was born in Australia (79.4%). Approval for the study was granted by
the La Trobe University Human Ethics Committee. Study protocols
were in accordance with the 2008 Declaration of Helsinki. (An additional detailed account of the methods used in this study is provided
in McLean et al. [2014].)

A short definition of bulimia nervosa was provided to the participants to orient them to the salient features of the disorder. The definition was “Bulimia is an eating disorder (a type of mental illness) that
involves binge eating and using extreme ways to control weight. Binge
eating means eating more than normal in a short period of time and losing control of eating. Examples of extreme ways to control weight are
excessive exercise, extreme dieting, vomiting and abuse of laxatives.
People with bulimia usually have a normal body weight and do not need
to gain weight to get better. You may have heard of other eating disorders, such as anorexia nervosa where people starve themselves in order
to become very thin.”

Stigmatising Attitudes and Beliefs Towards Bulimia
Nervosa Scale
The Stigmatising Attitudes and Beliefs Towards Bulimia Nervosa
scale is a 26-item scale developed for the present study assessing
www.jonmd.com

Familiarity With BN
Familiarity with BN was assessed using a modified version of the
Level of Familiarity Questionnaire (Holmes et al., 1999; Mond et al.,
2006b). The measure includes 10 dichotomous items describing increasing familiarity with BN from “I know/knew people in my school, university, workplace or social group who have/had bulimia” to “I currently
have bulimia.” Statements were ranked in order of increasing social proximity by 10 independent experts, including 8 clinical psychologists and
2 academics in the field of eating disorders. The final ranking was developed from the mean of the rankings provided by these experts. In line
with previous coding schemes for assessing familiarity and social distance (Holmes et al., 1999), the participants were attributed the score
corresponding to the highest level of familiarity that they endorsed
(for example, participants endorsing “I currently have bulimia” were
attributed a score of 10).

Knowledge of BN

Measures

260

stigmatizing attitudes and beliefs regarding BN, which includes five subscales: advantages of BN (seven items), minimisation/low seriousness
(six items), unreliability (five items), social distance (three items), and
personal responsibility (five items). Items are scored on a 6-point scale
ranging from 1 (completely disagree) to 6 (completely agree). An example item from the advantages of BN subscale is “Bulimia is not that bad
because you can eat what you like without putting on weight,” with high
scores indicating greater perceived advantages of BN. Items from the
minimisation/low seriousness subscale are reverse scored so that higher
scores indicate a greater degree of minimization of the seriousness of
the disease. An example item is “Bulimia with deliberate vomiting is a
serious problem.” An example item from the unreliability subscale is
“People with bulimia are unreliable,” with higher scores indicating a
greater lack of trust in individuals with BN. An example item from the
social distance subscale is “Deep down, I would be ashamed of a family
member if they had bulimia,” with higher scores indicating greater levels
of social distance. An example item from the personal responsibility subscale is “People with bulimia should work on their self-control,” with
higher scores indicating higher levels of perceived personal responsibility
of the individual with BN. The subscales were identified through principal component analysis, in which an unspecified factor solution was selected. This revealed a five-factor solution, which was confirmed with
confirmatory factor analysis. Factors were correlated at small to moderate
levels, and the subscales revealed satisfactory internal consistency
(see McLean et al., 2014), with α = 0.75 for advantages of BN, α =
0.70 for minimisation/low seriousness, α = 0.86 for unreliability, α =
0.50 (mean interitem correlation, 0.25, indicating acceptable internal
consistency) for social distance, and α = 0.78 for personal responsibility.

Knowledge of BN was assessed using 10 dichotomous questions
focusing on knowledge of treatment options (5 questions) as well as etiological factors (2 questions), age of onset (1 question), treatment barriers (1 question), and outcomes (1 question). Item selection was guided
by reference to the mental health literacy framework (Jorm, 2000) and
consideration of low levels of appropriate treatment seeking found for
BN (Hart et al., 2011). Thus, a large proportion of the items assessed
treatment seeking in relation to other aspects of knowledge. An initial
pool of 15 items was obtained from previous work examining knowledge of BN among a community sample in Victoria, Australia (Rancie,
2008), as well as additional items developed by the researchers for the
purpose of the present study. The 15 items were pilot tested among a
community sample (unpublished data), and items that were judged to
be ambiguous or had a high rate of nonresponses were revised or removed, leading to 10 final items being retained. A total score was obtained from the sum of correct responses to the 10 items. An example
item is “Psychologists and psychiatrists are unhelpful for treating bulimia.”
© 2015 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

The Journal of Nervous and Mental Disease • Volume 203, Number 4, April 2015

Eating Disorder Symptoms
Eating disorder symptoms were assessed using the Eating Disorders Examination Questionnaire (EDEQ; Fairburn and Beglin, 1994),
which contains 22 items yielding 4 subscales: weight concern, shape
concern, dietary restraint, and eating concerns. Items are scored on a
7-point scale representing the frequency with which eating disorder behaviors have occurred during the past 4 weeks, with higher scores indicating higher levels of eating disorder symptoms. This questionnaire
has been shown to produce valid and reliable scores in Australian community samples, and a cutoff score of 56 on the total sum of the 22 items
has been proposed to indicate potential eating disorder cases (Mond et al.,
2004d). In the present study, the Cronbach's α values were α = 0.79 for
the weight concerns, α = 0.90 for the shape concerns, α = 0.79 for the
eating concerns, and α = 0.77 for the dietary restraint subscale.

Statistical Analyses
Descriptive statistics for the study variables were examined. Because the distributions of the stigma dimensions of minimisation/low
seriousness and advantages of BN were skewed, relationships between
stigmatizing attitudes toward BN, familiarity, knowledge, and eating
disorder symptoms were explored using Spearman's correlations. Analyses were first conducted in the total sample, then for each sex separately, and then within each sex split by age group (i.e., among six
different subgroups). In view of the large sample size, and multiple
comparisons conducted, effect sizes rather than p-values were used to
evaluate the strength of the relationships, and only correlations of
higher than ρ = 0.15 were deemed worth considering (which is slightly
on the conservative side of the commonly used benchmark for a small
effect size of r = 0.10; Ellis, 2010). The proposed cutoff score of 56
of the summed total score of the EDEQ was used to create low eating
disorder and high eating disorder symptom groups. Independent sample Mann-Whitney's U tests were conducted to compare levels of stigmatizing attitudes toward BN in the high and low eating disorder
symptom groups, with a p-value set at p = 0.025 to adjust for multiple
comparisons. The probability of superiority (PS) was used as an index
of effect size. There are no clear cutoff points for interpreting PS. However, the further away PS is from 0.5 (in either direction), the larger the
effect (Ellis, 2010).

Stigma Toward Bulimia Nervosa

was not associated with levels of stigmatizing attitudes toward BN, with
ρ values ranging between −0.06 and 0.05. However, knowledge of BN
was negatively associated with three of the dimensions of stigmatizing
attitudes toward BN, namely, personal responsibility (ρ = −0.28), unreliability (ρ = −0.19), and advantages of BN (ρ = −0.23). When the sample was split by sex, the pattern of correlations remained identical, with
slightly stronger associations among men (personal responsibility: men,
ρ = −0.29; women, ρ = −0.28; unreliability: men, ρ = −0.23; women,
ρ = −0.15; advantages of BN: men, ρ = −0.27; women, ρ = −0.20).
When the sample was further subdivided according to both sex and
age, among men, the patterns remained consistent, with one additional
relationship emerging among young men (18–34 years old) between
knowledge and social distance (ρ = −0.16). Similarly, among women,
no age variations emerged.

Stigmatizing Attitudes Toward BN Among Individuals
With Higher Levels of Disordered Eating
Results from the correlation analysis indicated no relationships
between stigmatizing attitudes and beliefs toward BN and eating disorder symptom scores. With the use of the cutoff of 56, 21% (n = 447) of
the sample reported high levels of eating disorder symptoms. Of these,
149 (33%) reported having previously sought professional help for a
problem pertaining to weight or eating. In addition, 174 of these
(39%) reported having eaten what other people would regard as an unusually large amount of food, 151 (34%) reported a sense of loss of control, 17 (4%) reported having used self-induced vomiting as a means of
controlling shape and weight, 28 (6%) reported having used laxatives,
41 (9%) reported using diet pills, and 150 (33%) reported exercising
hard to control shape or weight.
Mann-Whitney's U tests revealed no differences in levels of stigmatizing attitudes toward BN between the participants with high and
low levels of eating disorder symptoms when data from men and
women were analyzed together. The analyses were repeated in men
and women separately. In men, the high eating disorder symptoms
group reported higher scores on minimisation/low seriousness (p =
0.003, PS = 0.42). Among women, the high eating disorder symptoms
group reported higher scores on the advantages of BN subscale. However, this finding was on the threshold of significance (p = 0.025,
PS = 0.54).

RESULTS
DISCUSSION

Relationships of Stigmatizing Attitudes and Beliefs
With Knowledge of and Familiarity With BN
The means and standard deviations for the study variables are
presented in Table 1. Contrary to our hypothesis, familiarity with BN

The aims of the present study were to explore the relationships of
stigmatizing attitudes and beliefs toward BN with knowledge of and familiarity with BN as well as to explore the relationships between stigmatizing attitudes and beliefs toward BN and current self-reported

TABLE 1. Spearman's Correlations Between Stigmatizing Attitudes Toward BN and Familiarity, Knowledge, and Eating Disorder Symptoms
Eating Disorder Symptoms

Stigmatization
Personal responsibility
Minimisation/low
seriousness
Unreliability
Social distance
Advantages of BN
Mean (SD)

Mean (SD)

Familiarity

Knowledge

Weight Concerns

Shape Concerns

Eating Concerns

Dietary Restraint

2.93 (1.07)
1.83 (0.89)

−0.01
−0.05

−0.28
−0.10

−0.05
0.00

−0.04
0.01

−0.01
0.05

−0.05
−0.02

2.29 (1.01)
2.68 (.98)
1.64 (0.65)

−0.05
−0.04
−0.01
3.44 (1.91)

−0.19
0.10
−0.23
6.32 (1.42)

−0.02
0.01
0.00
1.42 (1.36)

−0.02
−0.01
0.00
1.76 (1.55)

0.04
0.05
0.05
0.56 (.91)

−0.03
0.00
−0.02
1.32 (1.36)

Correlations higher than ρ = 0.15 are in bold. High scores on the stigmatization subscales all indicate greater stigmatization of BN. High scores on the familiarity and
knowledge scales indicate high familiarity and knowledge of BN, respectively. High scores on the eating disorder symptoms subscales indicate higher eating disturbance.

© 2015 Wolters Kluwer Health, Inc. All rights reserved.
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261

Rodgers et al.

The Journal of Nervous and Mental Disease • Volume 203, Number 4, April 2015

eating disorder symptoms. Regarding the first aim, the findings revealed that greater knowledge of BN, for the purposes of this study predominantly conceptualized as knowledge of treatment of BN, was
related to lower stigmatizing attitudes and beliefs toward BN, and few
sex and age variations were found in these relationships, contrary to
the contact hypothesis and previous findings (Allport, 1954; Ebneter
et al., 2011; Wingfield et al., 2011); however, greater familiarity with
BN, such as knowing someone with BN, was not associated with lower
levels of stigmatizing attitudes and beliefs. For the second aim, our
findings revealed that stigmatizing attitudes and beliefs toward BN
were not associated with current self-reported eating disorder symptoms across the entire sample. In relation to consideration of possible
differences across sex groups, interesting findings emerged. Men with
high levels of eating disorder symptoms reported higher levels of
minimisation/low seriousness stigmatizing beliefs, whereas women
with high levels of eating disorder symptoms tended to report greater
perceptions of the advantages of BN in comparison with their counterparts with low levels of symptoms.
Consistent with previous findings (Rancie, 2008), greater knowledge of BN was associated with lower levels of stigmatizing attitudes
and beliefs, specifically lower personal responsibility, unreliability,
and advantages of BN. Although our findings are correlational, they
are consistent with the theory that greater knowledge may lead to lower
levels of stigmatizing attitudes and beliefs. As previously discussed, the
belief that the individual with BN is personally responsible for his/her
disorder and should merely pull himself/herself together to overcome
the problem is an important dimension of stigma related to eating disorders (Ebneter and Latner, 2013), and identifying potential ways to
decrease blaming of this kind is therefore important. In addition, minimization of symptoms, or the perception of potential advantages to
maintaining symptoms, has been identified as a significant barrier to
treatment seeking among women with an eating disorder (Cachelin
and Striegel-Moore, 2006). Our results suggest that increasing knowledge about BN causes and treatment in the community at large might
perhaps help reduce the tendency toward blaming people with BN for
their disorder and to limit the perception of benefits or advantages to
symptoms, which may, in turn, facilitate treatment seeking among individuals with BN.
Our findings revealed that the perception of BN behaviors as desirable or acceptable was more frequent among the participants with
high levels of eating disorder symptoms. This pattern was consistent
with previous research. For example, similar to our finding that men
with high levels of eating disorder symptoms reported perceiving BN
as less serious, previous studies have also found that individuals with
high levels of eating disorder symptoms have been more likely to rate
bulimic behaviors as acceptable (Mond et al., 2010). In the current
study, women with high levels of eating disorder symptoms tended to
be more likely to express greater perceptions of advantages to BN compared with their healthy peers, which is consistent with findings that individuals with high levels of eating disorder symptoms report that it
might not be “all that bad” to resemble the person in the vignette
depicting BN (Mond et al., 2004c). Such attitudes might seem to reflect
a certain reluctance to recognize symptoms as problematic and to imagine giving them up. Such attitudes have been documented in the literature (Fox et al., 2011) and may also serve to increase barriers to
treatment because symptoms are normalized. Lack of recognition of
eating disorder symptoms, which may stem from the normalizing of bulimic behaviors, constitutes a barrier to treatment seeking (Hepworth
and Paxton, 2007). Interestingly, however, the prevalence of bulimic behaviors, in particular purging behaviors such as self-induced vomiting
or laxative use, was relatively low among the participants in our high
eating disorder symptom group. It may therefore also be that these participants did not identify strongly with BN and thought of individuals
with this disorder as being quite different from themselves because it
has previously been shown that self-induced vomiting is a key behavior
262

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in the self-recognition of bulimic-type eating disorders (Mond et al.,
2006a). This may partly explain why no differences were found on
the personal responsibility, unreliability, or social distance subscales between the high and low eating disorder symptom groups.
Although attention has been paid to methods to reduce stigma
associated with obesity and to highlight stigma as a social justice and
primary public health issue (Puhl and Heuer, 2010; Puhl and Latner,
2007), similar efforts to reduce the stigma attached to eating disorders
are lacking. In other psychological disorders such depression, in
Australia, public health campaigns have been successful in changing attitudes and correcting widespread myths regarding the origins and treatment of the disorder (Jorm et al., 2006). Further efforts are required
both at the national and the international level to identify and correct
common misconceptions regarding BN and related disorders. Although
longitudinal studies would help clarify the directionality of the
relationships, the present findings provide preliminary evidence of
cross-sectional relationships that suggest that improving knowledge
about eating disorders, particularly in terms of origin, treatment options,
and the seriousness of the disorder, may contribute to decreasing stigmatizing attitudes and beliefs toward BN and increase treatment seeking
among affected individuals.
Limitations to the study include the characteristics of the sample,
which, although diverse in terms of sex, SES, age, and location, was not
guaranteed to be representative of the Victorian population as a result of
the low response rate, and this may limit generalizability of the findings. The low internal consistency of the social distance subscale was
also a limitation. In addition, because of the nature of the study design,
which provided the participants with a definition of BN, aspects of
knowledge of the symptoms of the disorder could not be assessed. Furthermore, the knowledge items may have failed to assess other aspects
such as the course of the disorder that have been shown to be an important aspect of mental health knowledge (Hinshaw and Stier, 2008). Nevertheless, this project represents a first attempt to develop a multifaceted
scale exploring stigmatizing attitudes and beliefs toward BN. Moreover,
our findings are based on strictly correlational data; therefore, causality
should not be inferred. Finally, although we recruited a large community sample, our study included no adolescents. In the future, it would
be interesting to extend these findings to younger members of
the community.

CONCLUSIONS
Knowledge of BN emerged as the main factor related to lower
stigmatizing attitudes and beliefs toward the disorder. Stigmatizing attitudes were also held by individuals with high levels of eating disorder
symptoms. Future research should continue to pursue this line of work
by clarifying which information is most important in counteracting stereotypes and reducing stigma and thereby identifying targets for effective public health campaigns to improve mental health literacy related to
BN and increase access to treatment.
DISCLOSURES
This research was funded by a grant from the Australian Research
Council (DP1095656) to S. J. P., P. J. H., J. M. M., and B. R.
The authors declare no conflict of interest.
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Cachelin FM, Striegel-Moore RH (2006) Help seeking and barriers to treatment in a
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© 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

The Journal of Nervous and Mental Disease • Volume 203, Number 4, April 2015

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