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FACTORS OF BARRIERS TO
EATING DISORDER
TREATMENT AMONG WOMEN
Carly Thompson
PPOL V546 Health Services Utilization
Dr. Park
Introduction
Literature Review
Gaps & Significance
Objectives
Framework
Methods
Expectations
Agenda
Introduction
 Formally recognized in the Diagnostic and
Statistical Manual of Mental Disorders, fifth
edition (DSM-5)
 Mental and physical characteristics
 Estimated 24 million people in the US
suffer from an eating disorder
 Have the highest mortality rates of any
psychiatric diagnosis
Introduction
 Only 1 in 10 people living with eating disorders
receive clinical treatment
 Only 35% of those who receive treatment
specifically designed for eating disorders
 Onset occurs for a variety of reasons
Top 3: sexual/physical abuse
death of family member/partner
major life change (moving, child, etc.)
Literature Review
Personality
 Anorexics score low on novelty seeking,
suggesting that they may avoid risk and be
reluctant to engage in new activities in which
success in not guaranteed
 Comparatively, bulimics tend to score high in
novelty seeking
 Anorexics may avoid treatment for fear of failure
and being uncomfortable in a new situation
Claes, L., Vandercycken, W., & Vertommen, H. Impulsive and compulsive traits in eating disordered patients
compared with controls. Personality and Individual Differences 2002; 32, 707-714.
Literature Review
Ethnicity-Race & Culture
 Perception of clinician sensitivity to cultural background,
including racial discrimination and stereotyping,
influences treatment seeking
 Ethnic minorities also have a lower percentage of
anorexia cases compared to Caucasians (weight issues
not as prevalent)
 This may contribute to why ethnic minorities are less
likely to be referred for treatment and also less likely to
seek treatment
Cachelin, F.M, Veisel, C., Barzegarnazari, E., Strigel-Moore, R.H. Disordered eating, acculturation, and treatment seeking in
a community sample of Hispanic, Asian, Black and White women. Psychology of Women Quarterly 2000; 24: 244-253.
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to
Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating
Disorders 2010, 43: 633-647.
Literature Review
Health Beliefs
 Those who perceive themselves relatively well-off in
comparison to others are more likely to forego seeking
treatment
 Feelings of shame and the belief that one should be able
to help herself have been identified as important barriers to
treatment
 Those with anorexia in particular tend to use avoidant
strategies designed to shield people from the reality of
their illness
Akey, J., Rintamaki, L., Kane, T. Health Belief Model deterrents of social support seeking among people coping with eating disorders. Journal of
Affective Disorders 2013, 145; 246-252.
Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to Care for Eating
Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating Disorders 2010, 43: 633-647.
Literature Review
Financial Barriers
 Inpatient treatment is about $30,000 a month on
average. Intensive outpatient costs range
demographically, average is $200-$500 per day
 Insurance requires treatment to be “medically
necessary”- problematic for bulimia and OSFED
 May not be “in-network” or appropriate facility
for eating disorders
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
National Association of Insurance Commissioners, 2015. https://eapps.naic.org/cis/.
Literature Review
Physician’s Beliefs
 Numerous reports indicate that eating disorders are
frequently unrecognized in clinical settings
 Misperceptions regarding the types of people who suffer
from eating disorders often prevent their detection, which
places non-stereotypical individuals at risk for long-term,
adverse effects from these conditions
 Found that physicians lack complete understanding of the
various physical ramifications of eating disorders
Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study.
International Journal of Eating Disorders 2007; 40: 399-408.
Becker, A.E., Thomas, J.J., Franko, D.L., Herzog, D.B. Interpretation and use of weight information in the evaluation of eating disorders:
Counselor response to weight information in a national eating disorders educational and screening program. International Journal of Eating
Disorders 2005; 37: 38-43.
Currin, L., Waller, G., Schmidt, U. Primary Care Physicians’ Knowledge of and Attitudes Toward the Eating Disorders: Do They Affect Clinical
Actions? International Journal of Eating Disorders 2009; 42:5, 452-458.
Literature Review
Social Stigma
 It has been found that many people fear losing control of
information pertaining to the onset of their eating
disorder; causing them to conceal their illness
 Bulimia has been shown to be perceived as more under
the control of the individual and associated with more
blame directed toward the individual
 Those who are from lower socioeconomic classes tend
to feel like their condition is more socially unacceptable
than those from higher socioeconomic classes
Schmidt, U.H., Tiller, J., Andrews, B., Blanchard, M. Treasure, J. Is there a specific trauma precipitating onset of anorexia nervosa? Psychological
Medicine 1997; 27, 523-530.
Ebneter, D.S., Latner, J.D. Stigmatizing attitudes differ across mental health disorders: A comparison of stigma across eating disorders, obesity,
and major depressive disorder. Journal of Nervous and Mental Disease 2013; 201: 281-285.
Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study.
International Journal of Eating Disorders 2007; 40: 399-408.
Literature Review
Distance, Work, Family
 Few treatment centers, primarily located in
metropolitan areas
 Most common length of stay 26-30 days
 Those with anorexia tend to be younger with a
mean age of 25.08; bulimia mean age of 28;
and OSFED have a mean age of 30.50
 Therefore, those with bulimia or OSFED are
more likely to have permanent job, family, kids.
National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/.
Noordenbox, G. Characteristics and Treatment of Patients with Chronic Eating Disorders. International Journal of Eating Disorders 2002, Volume
10: 15-29.
Previous studies have looked at barriers specific to
anorexia or bulimia, but no studies have been found
that explicitly compare and contrast various barriers
of eating disorder subtypes.
Information on the barriers of OSFED are also few
and not well understood.
This study will help indentify the most prevalent
barriers specific to eating disorder subtypes in order
to help address specific issues in access and
utilization to treatment.
Gaps & Significance
The purpose of this study is to identify the
most common barriers among each eating
disorder subgroup in order to address how
to increase access and utilization of
inpatient and intensive outpatient
treatment.
Objective
Framework-
Anderson’s Initial Behavior Model
Predisposing Enabling Need
Eating Disorder
Subgroup
Age
Ethnicity/Race
Education level
Health Beliefs
Family Status
Insurance Status
Income
Physician’s Beliefs
Social Stigma
Distance
Work Status
Family Status
Evaluated need is
already determined
Perceived need is
included in health
beliefs
Variables and Hypothesis
 Dependent variable: barriers to intensive
outpatient and inpatient eating disorder treatment.
 Independent variables: various factors associated
with the barriers.
 There are no control variables in this study.
 Those with bulimia will have the highest amount of
barriers collectively, followed by OSFED, with
anorexia having the lowest amount of barriers.
Methods
Physician Beliefs, Social Stigma, Health Beliefs,
Distance/Family, Work
1
No
impact at
all
5
Moderately
impactful
10
Extremely
impactful
Insurance status (including treatment center being out of network)
Out of pocket expenses (including travel and time off work)
Insurance claimed treatment was not medically necessary
Physician did not believe my ED was valid or required intensive
treatment
Physician’s lack of identifying the ED
Wanted to keep reason for onset of ED secret
Lack of ability to get time off work for treatment
Distance of treatment facility
Your health beliefs(ex: I should be able to get over this on my own)
Expected Findings
 Financial issues will be a more significant barrier for those
with bulimia and OSFED due to lack of insurance coverage.
 Those with anorexia will have a more significant guilt/shame
barrier than those with bulimia or OSFED primarily due to
their people pleasing personality trait and fear of
disappointing others.
 Those with bulimia or OSFED will have a higher prevalence
of health beliefs being a barrier to treatment primarily due to
the belief that their illness is something they should be able to
overcome.
 Those with bulimia and OSFED will have more distance,
work, and family barriers because, on average, they tend to
be older than those with anorexia.
 Culture and ethnicity barriers will be more prevalent among
those with bulimia or OSFED due to the higher rate of those
disorders among ethnic groups.

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Health Services Utilization Carly's Study Design

  • 1. FACTORS OF BARRIERS TO EATING DISORDER TREATMENT AMONG WOMEN Carly Thompson PPOL V546 Health Services Utilization Dr. Park
  • 2. Introduction Literature Review Gaps & Significance Objectives Framework Methods Expectations Agenda
  • 3. Introduction  Formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)  Mental and physical characteristics  Estimated 24 million people in the US suffer from an eating disorder  Have the highest mortality rates of any psychiatric diagnosis
  • 4. Introduction  Only 1 in 10 people living with eating disorders receive clinical treatment  Only 35% of those who receive treatment specifically designed for eating disorders  Onset occurs for a variety of reasons Top 3: sexual/physical abuse death of family member/partner major life change (moving, child, etc.)
  • 5. Literature Review Personality  Anorexics score low on novelty seeking, suggesting that they may avoid risk and be reluctant to engage in new activities in which success in not guaranteed  Comparatively, bulimics tend to score high in novelty seeking  Anorexics may avoid treatment for fear of failure and being uncomfortable in a new situation Claes, L., Vandercycken, W., & Vertommen, H. Impulsive and compulsive traits in eating disordered patients compared with controls. Personality and Individual Differences 2002; 32, 707-714.
  • 6. Literature Review Ethnicity-Race & Culture  Perception of clinician sensitivity to cultural background, including racial discrimination and stereotyping, influences treatment seeking  Ethnic minorities also have a lower percentage of anorexia cases compared to Caucasians (weight issues not as prevalent)  This may contribute to why ethnic minorities are less likely to be referred for treatment and also less likely to seek treatment Cachelin, F.M, Veisel, C., Barzegarnazari, E., Strigel-Moore, R.H. Disordered eating, acculturation, and treatment seeking in a community sample of Hispanic, Asian, Black and White women. Psychology of Women Quarterly 2000; 24: 244-253. National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/. Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating Disorders 2010, 43: 633-647.
  • 7. Literature Review Health Beliefs  Those who perceive themselves relatively well-off in comparison to others are more likely to forego seeking treatment  Feelings of shame and the belief that one should be able to help herself have been identified as important barriers to treatment  Those with anorexia in particular tend to use avoidant strategies designed to shield people from the reality of their illness Akey, J., Rintamaki, L., Kane, T. Health Belief Model deterrents of social support seeking among people coping with eating disorders. Journal of Affective Disorders 2013, 145; 246-252. Becker, A.E., Arrindell, A.H., Perloe, A., Fay, K., Striegel-Moore, R.H. A Qualitative Study of Perceived Social Barriers to Care for Eating Disorders: Perspectives from Ethnically Diverse Health Care Consumers. International Journal of Eating Disorders 2010, 43: 633-647.
  • 8. Literature Review Financial Barriers  Inpatient treatment is about $30,000 a month on average. Intensive outpatient costs range demographically, average is $200-$500 per day  Insurance requires treatment to be “medically necessary”- problematic for bulimia and OSFED  May not be “in-network” or appropriate facility for eating disorders National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/. National Association of Insurance Commissioners, 2015. https://eapps.naic.org/cis/.
  • 9. Literature Review Physician’s Beliefs  Numerous reports indicate that eating disorders are frequently unrecognized in clinical settings  Misperceptions regarding the types of people who suffer from eating disorders often prevent their detection, which places non-stereotypical individuals at risk for long-term, adverse effects from these conditions  Found that physicians lack complete understanding of the various physical ramifications of eating disorders Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study. International Journal of Eating Disorders 2007; 40: 399-408. Becker, A.E., Thomas, J.J., Franko, D.L., Herzog, D.B. Interpretation and use of weight information in the evaluation of eating disorders: Counselor response to weight information in a national eating disorders educational and screening program. International Journal of Eating Disorders 2005; 37: 38-43. Currin, L., Waller, G., Schmidt, U. Primary Care Physicians’ Knowledge of and Attitudes Toward the Eating Disorders: Do They Affect Clinical Actions? International Journal of Eating Disorders 2009; 42:5, 452-458.
  • 10. Literature Review Social Stigma  It has been found that many people fear losing control of information pertaining to the onset of their eating disorder; causing them to conceal their illness  Bulimia has been shown to be perceived as more under the control of the individual and associated with more blame directed toward the individual  Those who are from lower socioeconomic classes tend to feel like their condition is more socially unacceptable than those from higher socioeconomic classes Schmidt, U.H., Tiller, J., Andrews, B., Blanchard, M. Treasure, J. Is there a specific trauma precipitating onset of anorexia nervosa? Psychological Medicine 1997; 27, 523-530. Ebneter, D.S., Latner, J.D. Stigmatizing attitudes differ across mental health disorders: A comparison of stigma across eating disorders, obesity, and major depressive disorder. Journal of Nervous and Mental Disease 2013; 201: 281-285. Mond, J.M., Hay, P.J., Rodgers, B., Owen, C. Health service utilization for eating disorders: Findings from a community-based study. International Journal of Eating Disorders 2007; 40: 399-408.
  • 11. Literature Review Distance, Work, Family  Few treatment centers, primarily located in metropolitan areas  Most common length of stay 26-30 days  Those with anorexia tend to be younger with a mean age of 25.08; bulimia mean age of 28; and OSFED have a mean age of 30.50  Therefore, those with bulimia or OSFED are more likely to have permanent job, family, kids. National Eating Disorders Association, 2015. http://www.nationaleatingdisorders.org/. Noordenbox, G. Characteristics and Treatment of Patients with Chronic Eating Disorders. International Journal of Eating Disorders 2002, Volume 10: 15-29.
  • 12. Previous studies have looked at barriers specific to anorexia or bulimia, but no studies have been found that explicitly compare and contrast various barriers of eating disorder subtypes. Information on the barriers of OSFED are also few and not well understood. This study will help indentify the most prevalent barriers specific to eating disorder subtypes in order to help address specific issues in access and utilization to treatment. Gaps & Significance
  • 13. The purpose of this study is to identify the most common barriers among each eating disorder subgroup in order to address how to increase access and utilization of inpatient and intensive outpatient treatment. Objective
  • 14. Framework- Anderson’s Initial Behavior Model Predisposing Enabling Need Eating Disorder Subgroup Age Ethnicity/Race Education level Health Beliefs Family Status Insurance Status Income Physician’s Beliefs Social Stigma Distance Work Status Family Status Evaluated need is already determined Perceived need is included in health beliefs
  • 15. Variables and Hypothesis  Dependent variable: barriers to intensive outpatient and inpatient eating disorder treatment.  Independent variables: various factors associated with the barriers.  There are no control variables in this study.  Those with bulimia will have the highest amount of barriers collectively, followed by OSFED, with anorexia having the lowest amount of barriers.
  • 16. Methods Physician Beliefs, Social Stigma, Health Beliefs, Distance/Family, Work 1 No impact at all 5 Moderately impactful 10 Extremely impactful Insurance status (including treatment center being out of network) Out of pocket expenses (including travel and time off work) Insurance claimed treatment was not medically necessary Physician did not believe my ED was valid or required intensive treatment Physician’s lack of identifying the ED Wanted to keep reason for onset of ED secret Lack of ability to get time off work for treatment Distance of treatment facility Your health beliefs(ex: I should be able to get over this on my own)
  • 17. Expected Findings  Financial issues will be a more significant barrier for those with bulimia and OSFED due to lack of insurance coverage.  Those with anorexia will have a more significant guilt/shame barrier than those with bulimia or OSFED primarily due to their people pleasing personality trait and fear of disappointing others.  Those with bulimia or OSFED will have a higher prevalence of health beliefs being a barrier to treatment primarily due to the belief that their illness is something they should be able to overcome.  Those with bulimia and OSFED will have more distance, work, and family barriers because, on average, they tend to be older than those with anorexia.  Culture and ethnicity barriers will be more prevalent among those with bulimia or OSFED due to the higher rate of those disorders among ethnic groups.