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anorexia nervosa, bulimia nervosa, eating disorders, nursing student, stigma
According to the World Health Organization, eating disorders are a constantly growing public health problem in industrialized countries with an important stigmatizing impact. The study investigates stigmatizing beliefs and attitudes towards Anorexia nervosa (AN) and Bulimia nervosa (BN). Materials and Methods: From October 2018 to November 2019, an online survey was conducted for students of the Degree Courses in Nursing of 2 Italian university centres, using the Italian version of the SAB-BN-ITA, adapted for AN. Results: The sample consists of 517 nursing students, aged between 20 and 23. Male subjects presented higher scores, relative to stigma, both for BN (F =17.5, p <0.001) and for AN (F = 1 9.64, p <0.001). For the sample the main trigger factor of BN is the influence of the media (56.67), the lack of social support (53.19) and parental care (51.84). The association between the stigmatizing views was explored through Spearman’s correlation and a linear regression model between the two overall scores (coeff. 0.73; p <0.001: r-squared 0.52). The ‘self-regulation’ is the stigmatizing opinions for AN (Coeff. 0.0768; p <0.001; r-squared 0.039) and BN (Coeff 0.0684; p <0.001; r-squared 0.030), and the ‘social support’ is stigmatizing opinions for AN (coeff. -0.0713; p = 0.004; r-squared 0.016). Conclusions: The study shows that the male gender has a higher level of stigma than the female one. Moreover, a large number of students consider media influence to be the main causative factor in the onset of ADs, in addition to the lack of social support.
2. Keski-Rahkonen A, Raevuori A, Hoek HW. (2008)Epidemiology of eating disorders: an update. In: Wonderlich S, Mitchell JE, de Zwaan M, Steiger H, editors. Annual review of eating disorders. Academy for Eating Disorders. Oxon: Wiley & Sons, 59-68.
3. Deliberazione della Giunta Regionale 5 febbraio 2013, n. 7-5304. Regione Piemonte. Percorso diagnostico-terapeutico per le persone con Disturbi del Comportamento Alimentare (Anoressia Nervosa e Bulimia Nervosa). Modifica ed integrazione della D.G.R. n. 96-13749 del 29 marzo 2010. https://www.dors.it/documentazione/testo/201509/pet_dgr_2013_pdta_anoressia_bulimia.pdf
4. Keski-Rahkonen A, Mustelin L. (2016) Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current opinion in Psychiatry, 29(6), 340-345.
5. Favaro A, Caregaro L, Tenconi E, Bosello R, Santonastaso P. (2009) Time Trends in Age at Onset of Anorexia Nervosa and Bulimia Nervosa. Journal of Clinical Psychiatry February, 70, 1715-21.
6. Ministero della Salute, Italia. I disturbi dell’alimentazione sono patologie complesse che portano la persona ad avere un rapporto distorto con cibo, peso e immagine corporea. 2013. http://www.salute.gov.it/portale/salute/p1_5.jsp?id=63&area=Disturbi_psichici
7. Preti A, De Girolamo G, Vilagut G, Alonso J, De Graaf R, Bruffaerts R, et al. (2009) The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WHM project. Journal of Psychiatric Research, 43(14), 1125-32.
8. Lask B, Bryant-Waugh R. (2000) Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence. Hove: Psychology Press.
9. Gershon ES, Schreiber JL, Hamovit JR, Dibble ED, Kaye W, Nurnberger JI, Andersen AE, Ebert M. (1984) Risultati clinici in pazienti con anoressia nervosa e malattie affettive nei loro parenti. Am J Psychiatry, 141, 1419-1422
10. Nolen-Hoeksema, S.”(Ab)normal Psychology” (6th edition). McGraw Hill. 2013, p. 343
11. Crisp A, Gelder MG, Goddard E, Meltzer H. (2005) Stigmatization of people with mental illnesses: A follow –up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry, 4, 106- 113.
12. Corrigan PW, Watson AC. (2002) Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20.
13. Livingston JD, Milne T, Fang ML, Amari E. (2012) The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction, 107(1), 39-50. doi: 10.1111/j.1360- 0443.2011.03601.x.
14. Jorm, A. F. (2012) Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243. Doi: 10.1037/a0025957.
15. McLean SA, Paxton SJ, Massey R, Hay PJ, Mond JM, Rodgers B. (2014) Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample. Int J Eat Disord, 47(4), 353-61. doi: 10.1002/eat.22227.
16. Ebneter DS, Latner JD, O’Brien KS. (2011) Just world beliefs, causal beliefs, and acquaintance: associations with stigma toward eating disorders and obesity. Personal Individ Differ, 51(5), 618–22.
17. Stewart MC, Keel PK, Schiavo RS. (2006) Stigmatization of anorexia nervosa. Int J Eat Disord, 39, 320-325.
18. Stewart MC, Schiavo RS, Herzog DB, et al: (2008) Stereotypes, prejudice, and discrimination of women with anorexia nervosa. European Eating Disorders Review, 16, 311-318
19. Caslini M, Crocamo C, Dakanalis A, Tremolada M, Clerici M, Carrà G. (2016) Stigmatizing attitudes and beliefs about Anorexia and Bulimia Nervosa among italian undergraduates, 204(12), 916-924.
20. Angermeyer MC, Matschinger H, Schomerus G. (2013). Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry, 203, 146-151.
21. Scheff TJ. Shame in the labeling of mental illness. In: Gilbert, P., and Andrews, B., eds. Shame (1998) Interpersonal Behavior, Psychopathology, and Culture. New York, NY: Oxford, 191-205.
22. Ebneter DS, Latner JD. (2013) Stigmatizing attitudes differ across mental health disorders: a comparison of stigma across eating disorders, obesity, and major depressive disorder. J Nerv Ment Dis, 201(4), 281-5. doi: 10.1097/NMD.0b013e318288e23f
23. Von dem Knesebeck O, Mnich E, Kofahl C, Makowski AC, Lambert M, Karow A, et al. (2013) Estimated prevalence of mental disorders and the desire for social distance - results from population surveys in two large German cities. Psychiatry Res, 209(3), 670–4.
24. Mason TB., Maduro RS., Derlega VJ, Hacker DS, Winstead BA, Haywood JE. (2016) Individual differences in the impact of vicarious racism: African American students react to the George Zimmerman trial.
25. Crisafulli MA, Thompson-Brenner H, Franko DL, Eddy KT, Herzog DB. (2010) Stigmatization of anorexia nervosa: Characteristics and response to intervention. J Soc Clin, Psycho.; 29:756-770. doi:10.1521/jscp.2010.29.7.756.
26. Griffiths S, Mond JM, Murray SB, Touyz S. (2014) Young peoples’ stigmatizing attitudes and beliefs about anorexia nervosa and muscle dysmorphia. Int J Eat Disord, 47, 189-195.
27. Zwickert K, Rieger E. (2013) Stigmatizing attitudes towards individuals with anorexia nervosa: an investigation of attribution theory. J Eat Disord, 1, 5. doi: 10.1186/2050-2974-1-5
28. Truening EL, Perlick DA, Link BG, Hellman F, Herman D, Sirey JA. (2001) Stigma as a barrier to recovery: the extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv, 52(12), 1633-1638.
29. Devine PG. (1989) Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol, 56, 5–18.
30. Hilton J. von Hippel W. (1996) Stereotypes. Annu Rev Psychol, 47:237–271.
31. Krueger J. (1996) Personal beliefs and cultural stereotypes about racial characteristics. J Pers Soc Psychol, 71, 536–548.