Trainee Clinical Psychologists' Attitudes and Clinical Judgements in Relation to Client Weight in Eating Disorder Presentations

Abstract

Aims: Weight stigma remains an acceptable form of prejudice within society (Puhl & Heuer, 2009) and its prevalence in those who specialise in eating disorder care (Puhl et al., 2014) is deeply concerning. Despite the evidence indicating that higher weight individuals are more at risk of developing eating disorders (Neumark-Sztainer et al., 2006; Darby et al., 2007), and often have more severe levels of impairment (Forney et al., 2017), they are often mistreated and misdiagnosed by eating disorder healthcare professionals (Harrop, 2019; Lebow et al., 2015; Sim et al., 2013; Veillette et al., 2018). Clinical psychologists play a central role in eating disorder care, making it essential to understand how weight bias manifests and influences practice of trainees who will soon be entering the workforce. To date, there is only one US based study that explores weight stigma in mental health professionals and how it impacts on the conceptualisation and treatment of restrictive eating disorders like Anorexia Nervosa (AN) (Veillette et al., 2018). The current research aimed to replicate this study in a UK sample of Trainee Clinical Psychologists (TCPs) to assess how anti-fat attitudes may impact eating disorder treatment for higher-weight individuals, specifically those who present with Atypical Anorexia Nervosa (AAN). Method: The current study adopted a quantitative approach, recruiting 283 TCPs, who responded to questions regarding their attitudes and clinical treatment decisions for a client presenting with AAN. The data collected was statistically analysed to evaluate trainees’ anti-fat attitudes and treatment recommendations for either an AAN clients or AN client, allowing for a comparison of how these attitudes differed based on the client weight. Findings: The study revealed that TCPs are not immune to negative attitudes towards weight. Trainees were found to report more weight-based stereotypes. They were also found to be less likely to diagnose the AAN client appropriately, offer less treatment sessions, and rate some important treatment goals as less important for the AAN client. Clinical Implications: These weight biases may negatively influence clinical practice for higher weight clients with atypical eating disorders, manifesting in reduced access to appropriate treatment opportunities, inefficient treatment protocols and overall substandard care from providers and clinicians. Clinical recommendations, as well suggestions to improve and expand on future research in this area, are discussed.