Clinician Reactions to Patients With Eating Disorders: A Review of the Literature
Abstract
OBJECTIVE: The delivery of psychiatric services may be affected by clinicians' negative reactions to treatment-resistant or stigmatized patient groups. Some research has found that clinicians across professional disciplines react negatively to patients with eating disorders, but empirical data related to this topic have not been systematically reviewed. The authors sought to review all published empirical studies of clinician reactions to patients with eating disorders in order to characterize negative reactions to these patients and identify patient or clinical factors associated with negative reactions. METHODS: The authors conducted a comprehensive online search for all published studies of clinician reactions in regard to patients with eating disorders. The reference lists of articles found in the literature search were examined to identify additional studies. RESULTS: Twenty studies, published between 1984 and 2010, were found. Clinician negative reactions in regard to patients with eating disorders typically reflected frustration, hopelessness, lack of competence, and worry. Inexperienced clinicians appeared to hold more negative attitudes toward patients with eating disorders than toward other patient groups, but experienced psychotherapists did not experience strong negative reactions to patients with eating disorders. Medical practitioners consistently reported strong feelings of lack of competence in treating eating disorders. Negative reactions to patients with eating disorders were associated with patients' lack of improvement and personality pathology and with clinicians' stigmatizing beliefs, inexperience, and gender. CONCLUSIONS: Research about the impact of negative clinician attitudes toward patients with eating disorders on psychiatric service delivery, including multivariate analyses using larger samples, comparison groups, validated instruments, and experimental methods, is much needed.
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These feelings may be intensely felt when patients struggle to receive compassion and help, do not respond to treatment, and their suffering becomes chronic.
“These feelings may be intensely felt when we struggle to receive their compassion and help, do not respond to treatment, and our suffering becomes chronic [186].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [186]
Feelings of frustration, anger and helplessness toward AN patients may be mediated by clinicians' years of experience working with ED patients and caseload, indicating possible effects of stress and burnout.
“Feelings of frustration, anger and helplessness toward AN patients may be mediated by clinicians’ years of experience working with ED patients and caseload, indicating possible effects of stress and burnout [185, 186].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [186]
Intense countertransferential feelings may be evoked when working with chronically ill, medically unstable AN patients at risk of death due to EDs, which clinicians may perceive as an unwillingness to recover.
“Intense countertransferential feelings may be evoked when working with chronically ill, medically unstable AN patients who are at risk of death due to the impact of our EDs, which clinicians may perceive as an unwillingness to recover [181, 186, 188].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [186]
Strong negative feelings of revulsion and disgust for ED behaviours may also be experienced by clinicians.
“Strong negative feelings of revulsion and disgust for ED behaviours may also be experienced [181, 186, 188].”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [186]
Cites
(2020) · Journal of Medical Education · doi:10.5812/jme · Cited by 3,505 · see citing works
Stigmatisation of people with mental illnesses
Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.1.4 · Cited by 1,457 · see citing works
Risk factors for eating disorders.
Striegel-Moore, R. H., & Bulik, C. M. (2007) · American Psychologist · doi:10.1037/0003-066x.62.3.181 · Cited by 999 · see citing works
Mortality in anorexia nervosa.
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.7.1073 · Cited by 974 · see citing works
Personality and eating disorders: A decade in review
Cassin, S. E., & von Ranson, K. M. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.012 · Cited by 832 · see citing works
Schulze, B., & Angermeyer, M. C. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00028-x · Cited by 749 · see citing works
Enhancing motivation for change in treatment-resistant eating disorders
Vitousek, K. M., Watson, S., & Wilson, G. T. (1998) · Clinical Psychology Review · doi:10.1016/s0272-7358(98)00012-9 · Cited by 721 · see citing works
Barriers to diabetes management: patient and provider factors
Nam, S., Chesla, C., Stotts, N. A., Kroon, L., & Janson, S. L. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.02.002 · Cited by 680 · see citing works
The mortality rate from anorexia nervosa
Birmingham, C. L., Su, J. C., Hlynsky, J., Goldner, E. M., & Gao, M. (2005) · International Journal of Eating Disorders · doi:10.1002/eat.20164 · Cited by 374 · see citing works
Crisp, A. H., Gelder, M., Goddard, E., & Meltzer, H. (2005) · PubMed Central · Cited by 357 · see citing works
What about psychiatrists' attitude to mentally ill people?
Lauber, C., Anthony, M., Ajdacic‐Gross, V., & Wulf Rössler, A. (2004) · European Psychiatry · doi:10.1016/j.eurpsy.2004.06.019 · Cited by 209 · see citing works
Gray, A. (2002) · Journal of the Royal Society of Medicine · doi:10.1258/jrsm.95.2.72 · Cited by 209 · see citing works
Loeb, K. L., Wilson, G. T., Labouvie, E. W., Pratt, E. M., Hayaki, J., Walsh, B. T., Agras, W. S., & Fairburn, C. G. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.6.1097 · Cited by 139 · see citing works
Managing the chronic, treatment-resistant patient with anorexia nervosa
Strober, M. (2004) · International Journal of Eating Disorders · doi:10.1002/eat.20054 · Cited by 137 · see citing works
Role of therapeutic alliance in family therapy for adolescent anorexia nervosa
Pereira, T., Lock, J., & Oggins, J. (2006) · International Journal of Eating Disorders · doi:10.1002/eat.20303 · Cited by 137 · see citing works
Attitudes towards anorexia nervosa: The impact of framing on blame and stigma
Crisafulli, M. A., Holle, A. F. V., & Bulik, C. M. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20507 · Cited by 120 · see citing works
Long-Term Menstrual and Reproductive Function in Patients With Bulimia Nervosa
Crow, S. J., THURAS, P. D., Keel, P. K., et al. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.6.1048 · Cited by 114 · see citing works
Currin, L. G., Waller, G., & Schmidt, U. H. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20636 · Cited by 112 · see citing works
The effects of therapist experience and patient diagnosis on countertransference.
Brody, E. M., & Farber, B. A. (1996) · Psychotherapy · doi:10.1037/0033-3204.33.3.372 · Cited by 107 · see citing works
Attitudes of Medical Professionals towards Patients with Eating Disorders
Fleming, J., & SZMUKLER, G. I. (1992) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048679209072067 · Cited by 106 · see citing works
Knowledge and attitudes of health professionals toward adolescent health care
Blum, R. W., & Bearinger, L. H. (1990) · Journal of Adolescent Health Care · doi:10.1016/0197-0070(90)90037-3 · Cited by 101 · see citing works
A Multidimensional Meta-Analysis of Psychotherapy for Bulimia Nervosa
Thompson‐Brenner, H., Glass, S. J., & Westen, D. (2003) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.bpg024 · Cited by 99 · see citing works
Self-citationSatir, D. A., Thompson‐Brenner, H., Boisseau, C. L., & Crisafulli, M. A. (2009) · International Journal of Eating Disorders · doi:10.1002/eat.20650 · Cited by 79 · see citing works
Self-citationPhysiciansʼ assessment of deficiencies and desire for training in adolescent care
Blum, R. W. (1987) · Academic Medicine · doi:10.1097/00001888-198705000-00005 · Cited by 77 · see citing works
Medical Providers' Screening, Training and Intervention Practices for Eating Disorders
Linville, D. C., Benton, A., O'Neil, M. E., & Sturm, K. (2010) · Eating Disorders · doi:10.1080/10640260903585532 · Cited by 73 · see citing works
Stereotypes, prejudice and discrimination of women with anorexia nervosa
Stewart, M., Schiavo, R. S., Herzog, D. B., & Franko, D. L. (2008) · European Eating Disorders Review · doi:10.1002/erv.849 · Cited by 64 · see citing works
Self-citationA Naturalistic Study of Psychotherapy for Bulimia Nervosa, Part 1
Thompson‐Brenner, H., & Westen, D. (2005) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000178843.81100.eb · Cited by 62 · see citing works
Self-citationSights, J. R., & Richards, H. C. (1984) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198422)3:4 · Cited by 57 · see citing works
Stigmatization of Anorexia Nervosa: Characteristics and Response to Intervention
Crisafulli, M. A., Thompson‐Brenner, H., Franko, D. L., Eddy, K. T., & Herzog, D. B. (2010) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2010.29.7.756 · Cited by 54 · see citing works
Self-citationTreating Patients with Eating Disorders: An Examination of Treatment Providers' Experiences
Warren, C. S., Crowley, M. E. J., Olivardia, R., & Schoen, A. (2008) · Eating Disorders · doi:10.1080/10640260802570098 · Cited by 53 · see citing works
Reid, M., Williams, S. J., & Burr, J. A. (2010) · European Eating Disorders Review · doi:10.1002/erv.976 · Cited by 53 · see citing works
Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care
Anthony, J. S., Baik, S.-Y., Bowers, B. J., Tidjani, B., Jacobson, J. C., & Susman, J. L. (2010) · Rehabilitation Nursing · doi:10.1002/j.2048-7940.2010.tb00286.x · Cited by 53 · see citing works
An eating disorder curriculum for primary care providers
Gurney, V. W., & Halmi, K. A. (2001) · International Journal of Eating Disorders · doi:10.1002/eat.1074 · Cited by 50 · see citing works
Bulimia and borderline personality disorder
Cooper, J. L., Morrison, T. L., Bigman, O. L., Abramowitz, S. I., Blunden, D., Nassi, A. J., & Krener, P. G. (1988) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198801)7:1 · Cited by 48 · see citing works
Eating disorders and gynecology, knowledge and attitudes among clinicians
MORGAN, J. F. (1999) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1034/j.1600-0412.1999.780311.x · Cited by 41 · see citing works
Countertransference in the Treatment of Patients with Eating Disorders
Franko, D. L., & Rolfe, S. (1996) · Psychiatry · doi:10.1080/00332747.1996.11024753 · Cited by 38 · see citing works
Self-citationPatients with eating disorders. How well are family physicians managing them?
Boulé, C. J., & McSherry, J. (2002) · PubMed · Cited by 33 · see citing works
Therapistsʼ Attitudes About Treating Patients With Eating Disorders
Burket, R. C., & Schramm, L. L. (1995) · Southern Medical Journal · doi:10.1097/00007611-199508000-00004 · Cited by 33 · see citing works
Ego functioning in eating disorders: Description and relation to diagnostic classification
Norring, C. E. A., Sohlberg, S., Rosmark, B., Humble, K., Holmgren, S., & Nordqvist, C. (1989) · International Journal of Eating Disorders · doi:10.1002/1098-108x(198911)8:6 · Cited by 29 · see citing works
Dialysis Practices That Distinguish Facilities with Below- versus Above-Expected Mortality
Spiegel, B. M. R., Bolus, R. R., Desai, A. A., et al. (2010) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.01620210 · Cited by 26 · see citing works
Myers, J. J., Rose, C. D., Shade, S. B., et al. (2007) · AIDS and Behavior · doi:10.1007/s10461-007-9269-9 · Cited by 24 · see citing works
Eating disorders and gynecology, knowledge and attitudes among clinicians
Jf, M. (1999) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/j.1600-0412.1999.780311.x · Cited by 21 · see citing works
Substance Abuse Treatment Clinician Opinions and Infectious Disease Service Delivery
Tracy, K., Brown, L. S., Kritz, S., et al. (2009) · Journal of Addictive Diseases · doi:10.1080/10550880802544625 · Cited by 14 · see citing works
Managing medical complications
Birmingham, C. L., & Treasure, J. L. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9781139150040.018 · Cited by 9 · see citing works
Winston, A. P., Baxter, H. A., & Rogers, D. (2007) · Eating Disorders · doi:10.1080/10640260701190683 · Cited by 5 · see citing works
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An overview of trauma-informed care and practice for eating disorders
Brewerton, T. D. (2019) · Journal of Aggression, Maltreatment & Trauma · doi:10.1080/10926771.2018.1532940 · Cited by 111 · see citing works
Brelet, L., Flaudias, V., Désert, M., Guillaume, S., Llorca, P.-M., & Boirie, Y. (2021) · Nutrients · doi:10.3390/nu13082834 · Cited by 94 · see citing works
Elwyn, R. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-022-00729-0 · Cited by 61 · see citing works
Downs, J., Ayton, A., Collins, L., Baker, S., Missen, H., & Ibrahim, A. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00400-x · Cited by 51 · see citing works
Brewerton, T. D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1149433 · Cited by 46 · see citing works
- Authors
- Thompson-Brenner, H., Satir, D. A., Franko, D. L., & Herzog, D. B.
- Affiliations
- Dr. Thompson-Brenner is affiliated with the Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon St., Boston, MA 02215 (e-mail: ).
- Boston University (US)
- ORCID
- Franko, Debra L.
- Venue
- Psychiatric Services
- Published
- 2012-01
- Volume
- 63
- Issue
- 1
- Pages
- 73-78
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W1987603103
- Cited by
- 136
- References
- 45
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 15 · 2023: 15 · 2022: 1 · 2021: 11 · 2020: 4 · 2019: 10 · 2018: 10 · 2017: 8 · 2016: 8 · 2015: 11 · 2014: 5 · 2013: 5 · 2012: 2
- FWCI
- 8.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (K23MH071641)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- eating disorders, clinician attitudes, stigma, treatment-resistant patients, clinician competence, clinician experience, personality pathology, gender differences
- MeSH terms
- Adolescent, Feeding and Eating Disorders, Attitude of Health Personnel, Clinical Competence, Emotions, Factor Analysis, Statistical, Female, Humans, Male, Personality Disorders, Professional-Patient Relations, Sex Factors, Comorbidity, Treatment Refusal, Treatment Outcome, Social Stigma
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