Response to Eating Disorder Patients May Impact Treatment Outcome

Clinicians who treat patients with eating disorders often have negative reactions to those patients: where treatment is concerned they feel frustrated, helpless, incompetent, and worried.

“When I tell other clinicians that I specialize in eating disorders, they often express concern or dismay. They say things like, ‘It must be difficult for you to do that all day,’ because of the perception that eating disorders are so hard to treat,” explained Heather Thompson-Brenner, Ph.D., to Psychiatric News. She is director of the eating disorders program and a research assistant professor at the Center for Anxiety and Related Disorders at Boston University and lead author of a study published in the January Psychiatric Services.

“I was interested in … the often negative perception of working with this population—whether it was in fact widespread, what beliefs it was associated with, and whether there were signs that these attitudes affected clinical practice,” she said.

Thompson-Brenner and her colleagues conducted a comprehensive computerized search for all studies published through 2010 of clinician reactions to patients with eating disorders in standard electronic databases, such as Medlife and PsychINFO, as well as in online search programs for journal articles about eating disorders. Twenty such studies were located and separated into four groups by differences in methods and results. The groups consisted of studies of inexperienced clinicians and trainees, studies of specialists and highly experienced psychotherapists, general surveys of medical professionals, and studies of clinician attitudes toward themselves.

“First we found that in fact clinicians with adequate experience or training expressed stronger positive than negative reactions toward their patients with eating disorders,” said Thompson-Brenner. “Our review also indicated that several beliefs—some erroneous—explained some of the negative reactions. These included the belief that eating disorders have poor prognoses and the belief that eating disorders stem primarily from sociocultural factors and are perhaps therefore deliberately chosen behaviors. We also found that patients with personality pathology elicited more negative reactions. Therefore, we concluded that extra supervision for beginning therapists as well as special training in eating disorders and personality pathology might all be useful.”

Thompson-Brenner and colleagues pointed out that important areas of investigation remain unstudied: “No studies were found examining the possibility that the risk of medical complications of eating disorders might affect the feelings of the clinicians who work with them,” they wrote, noting that the mortality rate for anorexia nervosa—10 percent to 15 percent—is among the highest of any psychiatric illness.

“Many individuals with eating disorders can be treated successfully in private practice with basic coordination with primary care,” Thompson-Brenner told Psychiatric News. “It would benefit patients greatly if there were much wider access to good treatment in the treatment community, and given how widespread eating disorders are, it would greatly benefit clinicians to know these approaches and to integrate them into their practice.”

The study was funded by the Harris Center for Education and Advocacy in Eating Disorders and the National Institute of Mental Health.

An abstract of “Clinician Reactions to Patients With Eating Disorders: A Review of the Literature” is posted at http://psychiatryonline.org/article.aspx?articleid=181281.