- When Does it Cross the Line?College Women's Perceptions of the Threshold Between Normal Eating and Eating Disorders
Clinicians rigorously study diseases and disorders so that they can formulate the best set of criteria for diagnosis. However, it is often the case, particularly on a college campus, that a friend would notice changes in physical or mental wellness long before a doctor or psychologist would. Because of this, research on the accuracy of lay diagnosis is needed. Although multiple studies have assessed the accuracy of lay diagnosis for disorders such as depression (e.g., Johnson, Mayanja, Bangirana, & Kizito, 2009), very little research has been conducted on lay diagnosis of eating disorders. With the high prevalence of eating disorders among women at college, this lack of research attention is particularly problematic.
Psychologists conceive of eating disorders as falling on a continuum that places unrestricted eating behaviors and exercise at one extreme and eating disorders, such as anorexia nervosa and bulimia nervosa, at the other. Therefore, clinical diagnoses are a matter of degree rather than of type (Tylka & Subich, 1998). The point at which one crosses the line from dieting to an eating disorder becomes extremely important to identify, because this boundary likely determines the point at which someone would seek help, or would recommend that a friend seek help. Although clinicians have the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM; American Psychiatric Association, 2000) available to guide them through diagnosis, the general public is often not well-versed in diagnostic criteria and relies on their own conceptions of, and experiences with, disorders to assess behaviors of family and friends. If their perceptions are not accurate, people with disorders may not receive the help and support they need to seek treatment.
The purpose of the present study was to introduce a new measure designed to determine how accurate college women are in their judgments about the point at which a target woman has an eating disorder, based on symptoms of being underweight, exercising excessively, limiting caloric intake, and self-induced vomiting. The present research is important because problematic behavior that is diagnosed too late might result in women delaying treatment until symptoms have progressed. With eating disorders, as with many psychological disorders, early intervention provides the best conditions for recovery, so encouraging early detection and referral is crucial.
One hundred twenty-two women (mean age = 19.6 years) from a pool of students enrolled in introductory psychology courses at a small, liberal arts college in Pennsylvania volunteered to participate. Students were able to choose from a variety of research studies or [End Page 163] complete an alternative reading assignment to receive research credit toward their classes. Of the sample, 42.6% were first-year students, 24.6% were sophomores, 9.8% were juniors, and 22.1% were seniors. The sample was predominantly White: 88.5% of participants were Caucasian, 4.1% were Hispanic, 2.5% were African American, and 1.6% were Asian American.
Identification of Diagnostic Threshold.
A new measure was created for this study, designed to examine the level at which behavior is considered to be disordered. Based on the characterization of eating disorders as existing on a continuum with normal behaviors (American Psychiatric Association, 2000; Tylka & Subich, 1998), we created four vignettes that began with a woman displaying acceptable behavior that becomes increasingly more representative of an eating disorder. The variables that were examined, in separate vignettes, were weight, exercise behavior, caloric intake, and purging habits. In each vignette, one variable was made increasingly severe. At each increasingly severe step, the participants were asked whether the woman has an eating disorder. The point at which an individual participant switched from responding "No" to responding "Yes" was the indicator of the threshold.
For example, the weight vignette began by stating, "Susan is a 19 year-old college student. She is 5'5. and weighs 140 pounds. She takes 4 classes and has an on-campus job. She exercises occasionally." The first item asked, "Given only this information, would you say that Susan has an eating disorder?" Subsequent items gradually reduced Susan's weight; item...