مدل های ذهنی دانش آموزان کالج برای تشخیص بی اشتهایی و پرخوری عصبی(بولیمیا)

Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge.

Consider the following scenario: Becky, a college sophomore, recently has noticed unusual behavior in her roommate, Molly, who has become more reserved and secretive. Although she sometimes goes to meals, she never seems to eat much. She also complains about being cold and tired. Becky is concerned that there is something wrong with Molly, but she is not sure exactly what the problem is or what to do about it. Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) affect millions of individuals (Becker, Grinspoon, Klibanski, & Herzog, 1999). They can lead to serious physical and psychological outcomes, including bone damage, cardiac problems, infertility, malnutrition, depression, and death (Fairburn & Harrison, 2003; Sullivan, 1995; Treasure & Szmukler, 1995). It therefore is critical that individuals with AN and BN are appropriately diagnosed and treated. Peers and family members may play an important role in recognizing disordered eating and suggesting that an individual needs professional care (Campbell & Roland, 1996; Price & Desmond, 1990; Pritts & Susman, 2003; Suls, Martin, & Leventhal, 1997; Tsogia, Copello, & Orford, 2001). However, the ability of lay people to recognize potential eating disorders depends on their knowledge of the behavioral, physical, and psychological characteristics associated with AN and BN. For example, how Becky responds to her roommate depends on whether she knows that minimal eating, coldness, and fatigue are potential indicators of AN. Thus, to understand, and ultimately improve, help-seeking for eating disorders, it is necessary to assess what lay people know about AN and BN. In this paper, we provide detailed data about knowledge and beliefs about AN and BN in a group that is particularly likely to encounter it, college students. We first discuss the role of lay people in eating disorder referrals as well as previous research about lay people's knowledge of AN and BN. We then describe a study that comprehensively assesses college students’ mental models of AN and BN. Finally, we discuss the implications of the research for understanding lay recognition of AN and BN and for increasing lay referrals. The importance of lay referrals for AN and BN Over the lifespan, AN is diagnosed in approximately 0.5–1% of the population and BN is diagnosed in approximately 1–4% of the population (American Psychiatric Association [APA], 2000; Fairburn, Hay, & Welch, 1993; Hsu, 1996; Wakeling, 1996). According to the DSM-IV-TR (APA, 2000), there are four diagnostic criteria for AN: (1) failure to sustain a minimally normal weight, (2) extreme fear of weight gain, (3) distorted body image or excessive emphasis on weight in self-evaluation, and (4) amenorrhea (i.e., absence of menstruation). BN has five criteria: (1) repeated occurrences of binge eating, (2) repeated instances of compensatory behaviors (e.g., purging, laxative abuse) to prevent weight gain, (3) episodes of binge eating and compensatory behaviors at least twice per week for 3 months, (4) excessive emphasis on weight in self-evaluation, and (5) disordered eating behaviors that occur separately from periods of AN. Epidemiological research indicates that a much larger portion of the population regularly engages in disordered eating behaviors, such as intentional starvation and purging (French, Perry, Leon, & Fulkerson, 1995; Heatherton, Nichols, Mahamedi, & Keel, 1995; Serdula et al., 1993; Story, French, Resnick, & Blum, 1995). For example, approximately 12% of teenagers report chronic dieting or purging to lose weight (Ackard, Neumark-Sztainer, Hannan, French, & Story, 2001; Story et al., 1995). Although many individuals who report dysfunctional eating may not have full-blown eating disorders, they still may require medical and/or psychological intervention to restore healthy eating and bodily functioning (Pritts & Susman, 2003). Notably, eating disorders often go undetected (Hay, Marley, & Lemar, 1998; King, 1989; Whitehouse, Cooper, Vize, Hill, & Vogel, 1992) due to factors such as lack of familiarity among physicians, the ambiguity of related symptoms (e.g., fatigue), and the presence of comorbid conditions (Blumenthal, Gokhale, Campbell, & Weissman, 2001; Pritts & Susman, 2003). A key factor may involve the unwillingness of many individuals with AN and BN to seek treatment (Becker et al., 1999; Pritts & Susman, 2003), thus requiring another lay person, such as a friend or family member, to intervene (Campbell & Roland, 1996; Suls et al., 1997; Tsogia et al., 2001). School counselors have reported that students with eating disorders often come to their attention through referrals by other students, teachers, or parents (Price & Desmond, 1990). Likewise, interviews with family members may constitute an important source of information for physicians to diagnose eating disorders (Pritts & Susman, 2003). However, for such lay referral to occur, people need to be well-informed about the physical, psychological, and behavioral indicators of eating disorders. Lay knowledge about eating disorders Research from different disciplines indicates that people form cognitive representations of their knowledge about specific health problems. One framework asserts that mental models of illness contain information about several dimensions of a condition, including its (1) identity or nature (i.e., symptoms), (2) causes, (3) short- and long-term consequences, (4) duration, and (5) cure ( Lau & Hartman, 1983; Leventhal, Nerenz, & Steele, 1984). Another framework, mental health literacy ( Jorm, 2000), posits that cognitive representations of illnesses include this information as well as the ability to recognize a condition, attitudes about seeking treatment, and knowledge about how to obtain additional information. Despite minor differences, both frameworks assert that illness representations serve several functions, including organizing information about health problems, helping individuals plan and implement treatment strategies, and serving as schemas to guide the recognition and interpretation of new information ( Jorm, 2000; Leventhal et al., 1984). As a result, they may influence whether people notice health-relevant information (e.g., low body weight), interpret it as indicative of a health problem (e.g., connect it with AN), and respond to it in an appropriate manner (e.g., encourage a friend to see a doctor). 1 To date, eight studies have assessed some aspect of lay people's mental models of eating disorders (Butler, Slade, & Newton, 1990; Chiodo, Stanley, & Harvey, 1984; Furnham & Hume-Wright, 1992; Huon, Brown, & Morris, 1988; Lee, 1997; Mond, Hay, Rodgers, Owen, & Beumont (2004a), Mond, Hay, Rodgers, Owen, & Beumont (2004b) and Mond, Hay, Rodgers, Owen, & Beumont (2004c); Murray, Touyz, & Beumont, 1990; Smith, Pruitt, Mann, & Thelen, 1986). Typically, these studies have measured people's ability to recognize accurate information about AN or BN, for example, by labeling statements as true or false. Results indicate that the majority of lay people believe that excessive dieting is the primary characteristic of AN, and binge eating and purging is the primary characteristic of BN (Huon et al., 1988; Murray et al., 1990; Smith et al., 1986). They also believe that psychological factors (e.g., emotional problems), and social factors (e.g., pressure to be slim) can lead to eating disorders (Chiodo et al., 1984; Furnham & Hume-Wright, 1992; Huon et al., 1988; Lee, 1997; Mond et al., 2004b, Smith et al., 1986). They think BN can be treated by counselors, general practitioners, self-help groups, and better nutrition. Finally, lay people appear to be more knowledgeable about AN than BN, but few report detailed knowledge about either disorder (Chiodo et al., 1984; Huon et al., 1988; Murray et al., 1990; Smith et al., 1986). Together, these findings suggest that lay people have some basic information about eating disorders and may be able to recognize them if they see dysfunctional eating (e.g., bingeing and purging); however, they may lack the knowledge to recognize less obvious indicators of AN and BN (e.g., dental erosion). In addition, mental models of eating disorders may contain beliefs about the groups of people who are likely to experience them. Specifically, lay people commonly believe AN occurs more frequently in women and adolescents than in men and people of other ages (Furnham & Hume-Wright, 1992; Lee, 1997; Mond et al., 2004b, Root, 1990). These beliefs may play an important role in lay referral. Because people may be more likely to attribute symptoms to a health problem when an individual belongs to an associated group (Martin, Gordon, & Lounsbury, 1998; Wrobel, 1993), they may be more likely to recognize eating disorders when the symptomatic individuals are young, upper-class, White women. In fact, two studies have shown that, holding symptoms constant, minimal eating is more likely to be seen as an indicator of an eating disorder when performed by a White woman than in an African-American or Latina woman (Gordon, Perez, & Joiner, 2002; Hunt & Rothman, 2004). Thus, a systematic assessment of lay people's knowledge about eating disorders needs to address beliefs about which groups of people are most likely to develop them. Current research Although some research has investigated lay people's knowledge about AN and BN, those studies have several important limitations. First, previous research was not designed to provide a comprehensive assessment of all of the components of mental models. Second, prior studies typically have measured the ability to recognize rather than generate information about eating disorders. Because lay referral depends on the ability to identify possible symptoms in everyday contexts, it is necessary to assess knowledge that is salient and can be freely generated by lay people. Third, research has not systematically assessed beliefs about the occurrence of eating disorders in different gender and race groups, which may play an important role in lay referral. The current study systematically examines knowledge about AN and BN in a group that may be especially likely to encounter them: college students. To address the limitations of previous research, the present study includes questions about all components of mental models, uses qualitative measures to determine what information about AN and BN is most salient to lay people, and systematically assesses associations between eating disorders, gender, and race. Because lay beliefs often differ from professional knowledge (Jorm et al., 1997), we also compare participants’ descriptions of AN and BN to clinical diagnostic criteria (APA, 2000). We hypothesized that most college students would possess basic knowledge about AN and BN's identity, causes, consequences, duration, and cures; however, substantially fewer students would have detailed knowledge (e.g., information about specific physiological consequences). Consistent with prior research, we predicted that students would know more about AN than BN (Chiodo et al., 1984, Huon et al., 1988; Lee, 1997; Murray et al., 1990; Smith et al., 1986), and women would know more about both eating disorders than would men (Lee, 1997; Smith et al., 1986). Finally, we hypothesized that students would believe that young White women are more likely than other grou