To examine whether self-stigma of seeking psychological help and being male would be associated with an increased likelihood of having an undiagnosed eating disorder. A multi-national sample of 360 individuals with diagnosed eating disorders and 125 individuals with undiagnosed eating disorders were recruited. Logistic regression was used to identify variables affecting the likelihood of having an undiagnosed eating disorder, including sex, self-stigma of seeking psychological help, and perceived stigma of having a mental illness, controlling for a broad range of covariates. Being male and reporting greater self-stigma of seeking psychological help were independently associated with an increased likelihood of being undiagnosed. Further, the association between self-stigma of seeking psychological help and increased likelihood of being undiagnosed was significantly stronger for males than for females. Perceived stigma associated with help-seeking may be a salient barrier to treatment for eating disorders – particularly among male sufferers.

1. Self-stigma of seeking
help and being male
predict an increased
likelihood of having an
undiagnosed eating
disorder
Griffiths, S., Mond., J. M., Li, Z., Gunatilake,
S., Murray, S. B., Sheffield, J., & Touyz, S.
(2015). International Journal of Eating
Disorders.

2. #1 Approximately 75% of eating disorders
are undiagnosed (Hart et al., 2011)
#2 Diagnosis is important because it
facilitates access to appropriate and
effective treatment (Striegel-Moore et al.,
2000)
Introduction

3. #3 Self-stigma of seeking psychological
help may contribute to undiagnosed eating
disorders (Griffiths et al., 2014)
#4 Males may suffer disproportionately
from self-stigma of seeking psychological
help due to masculinity (Griffiths et al.,
2015; Smiler, 2006)
Introduction

4. Methods - procedure
An online survey requested participants who:
a. were currently diagnosed with an eating disorder;
b. had recovered from an eating disorder; or
c. thought they might have an eating disorder

5. Q1 “Have you ever been diagnosed with
an eating disorder by a health
professional, such as a general
practitioner or psychologist?”
YES = Diagnosed group, NO = Question 2
Q2 “Do you think you might have an eating
disorder?
YES = Undiagnosed group, NO = Excluded
Methods - procedure

6. 485 persons with eating disorders
360 diagnosed
125 undiagnosed
~50% of diagnosed group in treatment
0% of undiagnosed group in treatment
Methods - participants

7. Comparison of EDE-Q global scores
0
1
2
3
4
5
6
Clinical norm
(Welch et al. 2011)
Community norm
(Mond et al. 2006)
Diagnosed
Undiagnosed
EDE-Q
Global score

8. Comparison of EDE-Q subscale scores
0
1
2
3
4
5
6
Clinical norms
(Welch et al. 2011)
Community norms
(Mond et al. 2006)
Dietary
Restraint
Eating
Concern
Shape
Concern
Weight
concern
Diagnosed
Undiagnosed

9. Methods – statistical analyses
#1 Hierarchical binary logistic regression
#2 Outcome: Undiagnosed vs. diagnosed
#3 Predictors: Demographic variables
(sex, employment, etc.), psychiatric
variables (eating disorder symptoms,
duration of illness, etc.), psychosocial
variables (self-stigma of seeking help, self-
esteem, etc.)

10. #1 Men were four times more likely to be
undiagnosed than women
OR = 4.04 (95% CI: 1.43, 11.43), p = .009
#2 Self-stigma of seeking psychological
help predicted a greater probability of
being undiagnosed
OR = 1.57 (95% CI: 1.07, 2.30), p = .022
Results

11. #3 Significant interaction between sex and
self-stigma of seeking psychological help
OR = 6.81 (95% CI: 1.39, 33.25), p = .018
Results

12. Females
1
No
self-stigma of
treatment
5
Maximum
self-stigma
of treatment
Predictedprobabilityofbeing
undiagnosed
0%
20%
40%
60%
80%
100%

13. 1
No
self-stigma of
treatment
5
Maximum
self-stigma
of treatment
Predictedprobabilityofbeing
undiagnosed
0%
20%
40%
60%
80%
100%
Males

14. Females
1
No
self-stigma of
treatment
5
Maximum
self-stigma
of treatment
Predictedprobabilityofbeing
undiagnosed
0%
20%
40%
60%
80%
100%
Males

15. Females
1
No
self-stigma of
treatment
5
Maximum
self-stigma
of treatment
Predictedprobabilityofbeing
undiagnosed
0%
20%
40%
60%
80%
100%
Males
R2 = .59
R2 = .11

16. #1 Findings consistent with the view that
males with eating disorders are more
reluctant to seek treatment and more likely
to be undiagnosed
#2 Self-stigma of seeking psychological
help may be responsible, to some extent,
for this reluctance
Discussion

17. #3 Conflict between traditional masculine
gender roles and the act of reaching out
for help may explain why self-stigma of
seeking psychological help has a stronger
influence on males
#4 Addressing males’ negative beliefs
about seeking treatment is important for
early intervention initiatives
Discussion

18. #1 Cross-sectional design
#2 The experience of treatment may
reduce self-stigma about seeking
treatment
#3 Relatively few males recruited
Discussion - limitations

19. #4 Certain subgroups of sufferers may
have been underrepresented
#5 Factors likely to have influenced
diagnosis, such as access to services,
were not examined
#6 Eating disorders were self-reported and
not confirmed with interview assessments
Discussion - limitations

20. Investigate men with muscle dysmorphia
and men who use steroids
Muscle dysmorphia sufferers tend to be
more traditionally ‘masculine’ than men
with anorexia nervosa and ‘healthy’
control men (Kanayama et al., 2006;
Murray et al., 2013)
Discussion – future research

21. #1 Self-stigma of seeking psychological
help may be a salient barrier to eating
disorder diagnosis and treatment,
particularly for males
Conclusion

22. Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (2014). The prevalence and adverse associations of
stigmatization in people with eating disorders. International Journal of Eating Disorders.
http://doi.org/10.1002/eat.22353
Griffiths, S., Murray, S. B., & Touyz, S. (2015). Extending the masculinity hypothesis: An investigation of gender
role conformity, body dissatisfaction, and disordered eating in young heterosexual men. Psychology of Men
& Masculinity. http://doi.org/10.1037/a0035958
Hart, L. M., Granillo, M. T., Jorm, A. F., & Paxton, S. J. (2011). Unmet need for treatment in the eating disorders:
A systematic review of eating disorder specific treatment seeking among community cases. Clinical
Psychology Review, 31(5), 727–735. http://doi.org/10.1016/j.cpr.2011.03.004
Kanayama, G., Barry, S., Hudson, J. I., & Pope, H. G. (2006). Body Image and Attitudes Toward Male Roles in
Anabolic-Androgenic Steroid Users. American Journal of Psychiatry, 163(4), 697–703.
http://doi.org/10.1176/appi.ajp.163.4.697
Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating Disorder Examination Questionnaire (EDE-Q):
Norms for young adult women. Behaviour Research and Therapy, 44, 53–62.
Murray, S. B., Rieger, E., Karlov, L., & Touyz, S. W. (2013). Masculinity and femininity in the divergence of male
body image concerns. The Journal of Eating Disorders, 1(11), 1–8. http://doi.org/10.1186/2050-2974-1-11
Striegel-Moore, R. H., Leslie, D., Petrill, S. A., Garvin, V., & Rosenheck, R. A. (2000). One-year use and cost of
inpatient and outpatient services among female and male patients with an eating disorder: evidence from a
national database of health insurance claims. International Journal of Eating Disorders, 27(4), 381–389.
Welch, E., Birgegård, A., Parling, T., & Ghaderi, A. (2011). Eating disorder examination questionnaire and clinical
impairment assessment questionnaire: General population and clinical norms for young adult women in
Sweden. Behaviour Research and Therapy, 49(2), 85–91. http://doi.org/10.1016/j.brat.2010.10.010
References

23. Griffiths, S., Mond., J. M., Li, Z.,
Gunatilake, S., Murray, S. B., Sheffield, J.,
& Touyz, S. (2015). Self-stigma of seeking
help and being male predict an increased
likelihood of having an undiagnosed
eating disorder. International Journal of
Eating Disorders.
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