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Q: Anorexia nervousa and bulimia ( Answered 5 out of 5 stars,   0 Comments )
Subject: Anorexia nervousa and bulimia
Category: Health > Conditions and Diseases
Asked by: fredirvine-ga
List Price: $100.00
Posted: 18 Feb 2005 08:22 PST
Expires: 20 Mar 2005 08:22 PST
Question ID: 476572
Hi, I am researching into ' what attitudes student and health
professionals hold (particularly occupational therapists) regarding
anorexia nervosa and bulimia'. I need lit on attitudes in general and
how they might influence care given to patients, and articles/journals
on studies similar to mine. I would appreciate any help you can give
Thank you
Amy Irvine
Occupational therapy student

Request for Question Clarification by livioflores-ga on 18 Feb 2005 18:12 PST
Are looking an answer regarding to some specific place or country, for
example USA or UK or Sudafrica?

Clarification of Question by fredirvine-ga on 21 Feb 2005 05:50 PST
Hi, thank you for responding. I need journal articles exploring health
professionals attitudes to anorexia and bulimia. for example what
health professionals think. Some professionals may have stereotypical
views e.g 'the condicion can only effect women'. If you can find an
article looking at what student health professionals think that would
also be useful.

What I mean by health professionals in, Occupational therpaists,
physios, nurses, and other therpaists.

I hope this clarifys things, if not please get back to me.

thank you for your help

Amy Irvine

Clarification of Question by fredirvine-ga on 21 Feb 2005 08:48 PST
Hi again, I am looking for info from the uk mostly however, other
countries may also be useful e.g america

Amy Irvine
Subject: Re: Anorexia nervousa and bulimia
Answered By: welte-ga on 12 Mar 2005 13:37 PST
Rated:5 out of 5 stars
Dear Amy,

Thanks for your interesting question.  As you may already be aware,
there isn?t a lot of information out there on the topic you?re
interested in.  I?ve done multiple searches since you first posted
your question and, due to the minimal amount of articles, etc.,
available, I will include everything I could find without strict
regard to whether the information came from the UK, etc., as some of
the information will likely still be relevant to you.

First off, searching through the medical literature via (PubMed / Ovid
databases) including the Cochrane, Cumulative Index of Nursing and
Allied Health Literature, PsychInfo, and other evidence based medicine
databases came up with the following articles, arranged roughly from
most to least relevant:

This article looks specifically at entry-level occupational therapists
and their attitudes toward individuals with a range of disabilities by
sending a survey to 402 recently graduated occupational therapists. 
The paper attempts to determine what factors play a role in the
formation of OT?s attitudes.

Eberhardt K, Mayberry W.
Factors influencing entry-level occupational therapists' attitudes
toward persons with disabilities.  Am J Occup Ther. 1995
PMID: 7573333
Here is the abstract for the above article:

?Negative attitudes exhibited by rehabilitation professionals could
have adverse consequences for persons with disabilities in their
achievement of desired outcomes. Because occupational therapists are
in a position to exert considerable influence in the therapeutic
relationship, this study explored entry-level occupational therapy
practitioners' equal status contact with and attitudes toward persons
with disabilities. METHOD. Questionnaires were sent to 402 entry-level
occupational therapists. These questionnaires consisted of: a
demographic scale, the Disability Social Distance Scale, the Contact
With Disabled Persons Scale, and a Similarity Scale (constructed for
this study to evaluate the concept of equal status). Data analysis
explored the relationship between 172 respondents' equal status
perception and contact with persons with disabilities and their
attitudes toward persons with disabilities. RESULTS. Respondents
exhibited generally positive attitudes toward persons with
disabilities. Perceived equality, personal and professional contact,
and the majority of demographic factors were not significantly
correlated with their attitudes toward persons with disabilities.
Respondents who specified working with persons without disabilities in
the wellness capacity exhibited more positive attitudes than those
working with persons with biomechanical and neurological disabilities.
In addition, respondents who had a greater frequency of professional
contact with persons with disabilities also appeared to experience
more personal contact with persons with disabilities. CONCLUSION.
Entry-level occupational therapists' attitudes toward persons with
disabilities may not only be influenced by parameters of the contact
variable but also by the profession's holistic philosophy, the
occupational therapy educational curricula, and the personal
characteristics of those who choose to pursue a career in occupational


Blum RW. Bearinger LH. Knowledge and attitudes of health professionals
toward adolescent health care. [Journal Article] Journal of Adolescent
Health Care. 11(4):289-94, 1990 Jul.
UI: 2365602

Here is the abstract of the above article for convenience:

?The rising concern over the competency of health care professionals
in the United States to meet the health needs of adolescents was the
impetus for a national survey of 3066 physicians, nurses, social
workers, nutritionists, and psychologists. The survey explored
perceptions of training and competency regarding 16 dimensions of
adolescent health care. Major deficits were noted for each discipline.
For physicians, self-perceived limitations were in the areas of eating
disorders, learning disabilities, chronic illness, and delinquent
behavior. The same limitations were also mentioned by nurses. Over
half of the psychologists reported deficits related to the
psychological sequelae of sexual concerns, sexual orientation
conflict, eating disorders, and chronic illness. Many of the same
concerns reflected the perceived competencies of social workers.
Nearly half of all nutritionists surveyed acknowledged deficits in
almost all adolescent food-related concerns. The impact of these low
levels of perceived competency is discussed in terms of implications
for clinical service.?


Surgenor, Lois J. Treatment coercion: Listening carefully to client
and clinician experiences. [Peer Reviewed Journal] International
Journal of Law & Psychiatry. Vol 26(6) Nov-Dec 2003, 709-712.

Here is the abstract:

?No clinician is likely to feel comfortable with the business of
treatment compulsion. Early in professional careers, clinicians are
exhorted to build "a trusting, honest, genuine relationship that is
collaborative in nature and where there is agreement on commonly
shared goals". To find one's self sometimes acting at odds with the
pleas of those we treat can be deeply disquieting. Added to this,
there are many issues in the area of eating disorders that make
grappling with compulsory treatment, or indeed the therapeutic
relationship itself, a more fraught business than in most other areas
of mental health. Specifically, this paper comments on three
problematic issues: the inevitability of control contestability,
attitudes and practices of health professionals, and the diverse
meaning of eating disorders for clients. Power and control issues are
argued by many to lie at the heart of anorexia nervosa and the
interface between client and therapist. Contrary to the concepts of
agreement and collaboration therefore, explicit or often implicit
power battles are expected in treatment, and therapists are counseled
on how best to manage these. Despite our best efforts, therefore,
clients may still hold a deep vulnerability to being "taken over" by
the reality or force of others.?

This article also cites other valuable references.  Here is the
bibliography from the above paper:

Anonymous. (1995). Which option would you take? British Medical
Journal, 311, 635-636.

 Beumont, P. J. V., & Vandereycken, W. (1998). Challenges and risks
for health care professionals. In P. Beumont, & W. Vandereycken
(Eds.), Treating eating disorders (pp. 1-29). London: Athlone.

 Brach, H. (1978). The golden cage: The enigma of anorexia nervosa.
Cambridge, MA: Harvard University Press.

 Brotman, A. W., Stern, T. A., & Herzog, D. B. (1984). Emotional
reactions of house officers to patients with anorexia nervosa,
diabetes, and obesity. The International Journal of Eating Disorders,
3, 71-77.  PsycInfo

 Bruch, H. (1974). Perils of behavior modification in treatment of
anorexia nervosa. Journal of the American Medical Association, 230,

 Carroll, L. (1970). Alice's adventures in Wonderland, In M. Gardner
(Ed.), The annotated Alice (pp. 25-164). New York: Penguin Books.

 Claude-Pierre, P. (1998). The secret language of eating disorders.
London: Doubleday.

 Crisp, A. H. (1995). Anorexia nervosa: Let me be. Hove: Erlbaum. 

 Fairburn, C. G., Shafran, R., & Cooper, Z. (1999). A cognitive
behavioural theory of anorexia nervosa. Behaviour Research & Therapy,
37, 1-13.  PsycInfo

Gowers, S. G., & Shore, A. (1999). The stigma of eating disorders.
International Journal of Clinical Practice, 53, 386-388.

 Jarman, M., Smith, J. A., & Walsh, S. (1997). The psychological
battle for control: A qualitative study of health professionals'
understandings of the treatment of anorexia nervosa. Journal of
Community and Applied Social Psychology, 7, 137-152.

 Kaplan, A. S., & Garfinkel, P. E. (1999). Difficulties in treating
patients with eating disorders: A review of patient and clinician
variables. Canadian Journal of Psychiatry (Revue Canadienne de
Psychiatrie), 44, 665-670.

 Katzman, M. A., & Waller, G. (1998). Gender of the therapist: Daring
to ask the questions. In W. Vandereycken, & P. J. V. Beumont (Eds.),
Treating eating disorders: Ethical, legal, and personal issues (pp.
56-79). London: Athlone Press.

 Palmer, R. (2001). Rotten apples and prodigal sons. European Eating
Disorders Review, 9, 284-285.

 Rathner, G. (1998). A plea against compulsory treatment of anorexia
nervosa patients. In W. Vandereycken, & P. J. V. Beumont (Eds.),
Treating eating disorders: Ethical, legal and personal issues (pp.
179-215). New York: New York University Press.

 Surgenor, L. J., Horn, J., Plumridge, E. W., & Hudson, S. M. (2002).
Anorexia nervosa and psychological control: A reexamination of
selected theoretical accounts. European Eating Disorders Review, 10,
85-101.  PsycInfo

Surgenor, L. J., Plumridge, E. W., & Horn, J. (2003). 'Knowing one's
self anorexic: Implications for therapeutic practice. The
International Journal of Eating Disorders, 33, 22-32.  PsycInfo

Tozzi, F., Sullivan, P. F., Fear, J. L., McKenzie, J. M., & Bulik, C.
M. (2003). Causes of recovery in anorexia nervosa: The patient's
perspective. The International Journal of Eating Disorders, 33,
143-154.  PsycInfo

Vandereycken, W. (1993). Naughty girls and angry doctors: Eating
disorder patients and their therapists. The International Journal of
Eating Disorders, 5, 13-18.

 Zerbe, K. J. (1998). Knowable secrets: Transference and
counter-transference manifestations in eating disordered patients. In
W. Vandereycken, & P. J. V. Beumont (Eds.), Treating eating disorders
(pp. 30-55). London: Athlone.


The following articles may provide some starting point for exploring
the attitudes of allied health practitioners toward people with eating
disorders.  Several of them deal with the experience of patients with
their health care providers, which may hint at these providers?
attitudes.  Others deal with the attitudes of therapists (generally
meaning cognitive behavioral therapists) toward their patients, which
may in some cases be generalizable to other members of the therapy
team including occupational therapists:

Breden AK. Occupational therapy and the treatment of eating disorders.
[Journal Article, Case Study] Occupational Therapy in Health Care.
1992; 8(2-3): 49-68. (25 ref)

Here is the abstract:

?The occupational therapist is vital to providing a complete
assessment and thorough treatment of the population with eating
disorders. Symptoms and etiology that effect the occupational
therapist's reasoning are explored followed by the theoretical
frameworks used and specific group intervention at the Sheppard and
Enoch Pratt Hospital. Two case studies conclude the article.?


McMaster R. Beale B. Hillege S. Nagy S. The parent experience of
eating disorders: interactions with health professionals. [Journal
Article] International Journal of Mental Health Nursing. 13(1):67-73,
2004 Mar.
UI: 15009381

Beale B, Cole R, Hillege S, McMaster R, Nagy S.  Impact of in-depth
interviews on the interviewer: roller coaster ride.  Nurs Health Sci.
2004 Jun;6(2):141-7.
PMID: 15130100

Winn S, Perkins S, Murray J, Murphy R, Schmidt U.
A qualitative study of the experience of caring for a person with
bulimia nervosa. Part 2: Carers' needs and experiences of services and
other support.  Int J Eat Disord. 2004 Nov;36(3):269-79.
PMID: 15478136

Lee, Sing. How lay is lay? Chinese students' perceptions of anorexia
nervosa in Hong Kong. [Peer Reviewed Journal] Social Science &
Medicine. Vol 44(4) Feb 1997, 491-502. Elsevier Science, Netherlands

The above article looked at the attitudes of non-medical students in
China regarding eating disorders, and may give you some information
useful for comparing either cultural differences or differences
between public and professional attitudes.


Burket RC, Schramm LL.
Therapists' attitudes about treating patients with eating disorders. 
South Med J. 1995 Aug;88(8):813-8.
PMID: 7631205

?The attitudes of 90 therapists toward patients with an eating
disorder were explored by questionnaire. Topics included therapist's
treatment desires, countertransference, treatment approaches, and
prognosis. Twenty-eight respondents (31%) desired not to treat such
patients. Analysis of those who did not desire to treat these patients
showed that (1) more of them were male, (2) individual therapy as the
sole treatment method was more common, (3) feelings of empathy were
less common, and (4) more of them believed the prognosis for anorexia
nervosa with bulimia to be poor. Overall, therapists considered
cognitive behavioral therapy to be the preferred treatment method,
though subjects who desired to treat these individuals tended to use
more diverse (dynamic, supportive, interpersonal, eclectic)
approaches. Twenty-nine percent of both groups believed female
therapists were preferred. Therapist frustration, treatment
resistance, and comorbid conditions were found problematic. This study
revealed several factors that distinguish therapists by desire to
treat individuals with eating disorders.?


The following article looked at the attitudes of Ob/Gyn physicians and
may provide a somewhat different perspective than the other articles
dealing with cognitive behavioral therapists.

Morgan JF.  Eating disorders and gynecology: knowledge and attitudes
among clinicians.  Acta Obstet Gynecol Scand. 1999 Mar;78(3):233-9.
PMID: 10078586


Finally, the following article looks at attitudes of nurses who enter
the field of eating disorders.  This is not a peer-reviewed article
and is therefore more subjective than most of the articles above, but
may give you some other avenues to pursue.

Wright S. Eating disorders: why do nurses choose this field?
Nurs Times. 2001 Nov 15-21;97(46):37-8. 
PMID: 11966048


Although it doesn?t seem to contain much information on the attitudes
of OT?s, you may still find this book useful:

Eating Disorders, Food and Occupational Therapy
by  Joan E. Martin

You can search within the book from the Amazon web site to see if it
might be worth purchasing.

Also of potential interest is this article on eating disorders in the
UK from the Guardian:,6903,528869,00.html


I hope this information was useful.  Best of luck with your article. 
Please feel free to ask for clarification.

fredirvine-ga rated this answer:5 out of 5 stars
This was extreamly useful, a difficult area to research so thanks very
much. Highly recomended!

There are no comments at this time.

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