Weissman et al., (2016) released a paper highlighting the problematic language surrounding eating disorders (ED) in scientific literature. The researchers emphasise the need to reconsider the use of improper language in clinical environments and in public, as well as in scholarly articles. Refraining from using negative ED language could help to bridge the gap for individuals seeking support from clinical practices. This article aims to provide an overview of Weissman’s publication by discussing the detriments of problematic and stigmatising ED language and to define potential remedies for each term.
What is the issue?
Stigma and negative societal attitudes are detrimental to the mental health and wellbeing of many individuals who are suffering from an ED. Stigmatising language may serve as a barrier to accessing support, prolongs ED recovery, as well as increases the likelihood of a relapse. Elaborating further, the literature suggests that individuals with an ED are less likely to seek support through fear of judgement and being perceived as ‘attention-seeking’ (O’Connor et al., 2016). However, research has also identified an association between experiences of stigmatisation and ED psychopathology (Griffiths et al., 2015).
Furthermore, stigmatising ED language could be inaccurate or misleading in describing the adversities these individuals face on a day-to-day basis. For instance, previous literature has identified that, among the general public as well as medical staff, individuals with a diagnosis of anorexia nervosa were perceived as being the blame for their disorder as well as being perceived by others to have control over their disordered behaviours (Zwickert and Rieger, 2013). Similar findings were identified in a more recent study by O’Connor et al., (2016) who found that adolescent participants perceived individuals with an ED (particularly those diagnosed with a binge-eating disorder) to be personally responsible for their diagnosis and to lack self-discipline when compared to individuals with depression or type 1 diabetes. Moreover, the literature argues that there is a lack of research pertaining to stigma surrounding EDs when compared to other psychiatric diagnoses such as schizophrenia or depression.
These findings suggest that EDs are stigmatised at disproportionately higher rates than other mental or physical health conditions, which further highlights the importance of understanding ED-related stigma, and how to overcome it to promote wellbeing and recovery in individuals with an ED.
Time to rethink the terms we use
Labelling someone with an ED using shorthand terms, such as anorexic, bulimic, or binge-eater, implies that the individual is defined by their diagnosis. Using such adjectives is arguably harmful because the individual does not ‘become’ their diagnosis. An appropriate alternative would be: ‘individuals with anorexia nervosa/ bulimia nervosa/ binge-eating disorder’ because it is more respectful to the person as well as scientifically accurate. Furthermore, when referring to a diagnosis of an ED, anorexia (without nervosa) or bulimia (without nervosa) can come across as ambiguous. This is because the words anorexia and bulimia have connotations to appetite loss and abnormal food cravings. Therefore, it is recommended that using the full diagnostic definition (anorexia nervosa/ bulimia nervosa) is more scientifically accurate when describing specific eating disorders.
Taking language accuracy into consideration, ‘binge-eating episode’ is more accurate compared to ‘bulimic episode’ when describing episodes of binge-eating. ‘Binge-eating episode’ captures the loss of control experienced during episodes of binge eating, whereas the term ‘bulimic episode’ implies both binge-eating and compensatory behaviours (e.g. self-induced vomiting, misuse of laxatives or excessive exercise). Furthermore, the term ‘binging’ or ‘bingeing’ is linked to other forms of behavioural disinhibition within psychiatric literature (e.g. binge drinking), so using the full term ‘binge-eating’ is more accurate when describing the experiences of an individual with binge-eating disorder.
The terms ‘sufferer’ and ‘struggling with an eating disorder’ may be perceived as derogatory towards the individual with an ED. That is not to diminish their experiences or suggest that they do not suffer because of their ED, but rather suggest that it would be more beneficial to use less emotionally charged language within clinical or public environments. The suggested alternatives are: ‘treatment-seeking individuals’ or ‘exhibiting an eating disorder or related symptoms’.
A final note
Weissman et al., (2016) note that their paper is not an exhaustive list, and more focus needs to be placed on aspects of ED language and stigmatising attitudes. It is hoped that, by making small changes on the words used to reflect ED experiences, stigma surrounding ED will diminish as societal attitudes change.
GRIFFITHS, S., MOND, J.M., MURRAY, S.B., and TOUYZ, S., 2015. The prevalence and adverse associations of stigmatization in people with eating disorders. International Journal of Eating Disorders. 48 (6), pp. 767–774.
O’CONNOR, C., MCNAMARA, N., O’HARA, L., and MCNICHOLAS, F., 2016. Eating disorder literacy and stigmatising attitudes towards anorexia, bulimia and binge eating disorder among adolescents. Advances in Eating Disorders[online]. 4 (2), pp. 125–140. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=uedi20
WEISSMAN, R.S., BECKER, A.E., BULIK, C.M., FRANK, G.K.W., KLUMP, K.L., STEIGER, H., STROBER, M., THOMAS, J., WALLER, G., and WALSH, B.T., 2016. Speaking of That: Terms to Avoid or Reconsider in the Eating Disorders Field. International Journal of Eating Disorders [online]. 49 (4), pp. 349–353. Available from: http://doi.wiley.com/10.1002/eat.22528
ZWICKERT, K. and RIEGER, E., 2013. Stigmatizing attitudes towards individuals with anorexia nervosa: An investigation of attribution theory. Journal of Eating Disorders [online]. 1 (1), p. 5. Available from: https://jeatdisord.biomedcentral.com/articles/10.1186/2050-2974-1-5
This article was written by Ellie Tkocz who is one of our volunteers here at S.E.E.D