Illness perceptions and eating disorders

Eating disorders (EDs) are characterized by severely disordered eating
behaviour that mainly affect young women and generally start during puberty or
early adulthood. EDs can have a serious impact on various life domains of those
inflicted and may lead to physical, mental and social impairment (Maj, et al,
2003). ED patients generally report a poor quality of life (De la Rie et al
2005). Nevertheless a low readiness to enter treatment and ambivalence about
treatment are often found in ED patients (Geller, J, et al, 2005). Furthermore
when ED patients enter treatment, less than half of the patients fully recover
after treatment. In a summary of outcome studies on both anorexia nervosa (AN)
as well as bulimia nervosa (BN) Steinhausen et al (1999,2002) found that 46-47
% of ED patients recover from the disorder, 26-33 % recover partially, and as
many as 20-26 % will develop a chronic disorder. Approximately 5 % of AN
patients eventually die from suicide or physical consequences of the ED.
Chronicity and mortality of patients with an ED is among the highest of all
psychiatric illnesses. To improve the outcome of treatment of EDs studies on
the effectiveness of different treatment methods are warranted. Furthermore it
seems important to investigate how to enhance the readiness to enter treatment
and treatment adherence, which in turn may affect outcome.

Illness perceptions and eating disorders
Leventhal et al (2003) presumed that attributes of an illness representation
shape the procedures for coping or controlling illness and play an important
role in appraising coping outcomes. They developed a self-regulatory model to
conceptualize treatment adherence process. In this model, health beliefs can be
characterized along five dimensions: identity of the illness (label and
symptoms), causal explanations of the illness, perceived illness
controllability, perceived course of the illness, and the consequences of the
illness for the person's life. Studies on depression and psychotic illnesses,
have shown that health beliefs contribute to treatment seeking, treatment
adherence, and clinical outcomes (e.g., Brown et al., 2001; Sullivan et al.,
2003; Fortune et al 2004; Lobban et al., 2005). It seems that investigating
illness perceptions of patients with a mental disorder may enable the
development of interventions to enhance readiness to enter treatment and
treatment adherence.
Few research on the illness perceptions of ED patients has been conducted. In a
small study by Holliday et al (2005) on the illness perceptions of AN patients,
it was shown that participants had fairly negative perceptions about
controllability and curability of the disorder. In our study on the evaluation
of treatment of EDs from the patient*s perspective (de la Rie et al, 2006) the
evaluation of treatment was not strongly predicted by patient characteristics
or treatment characteristics. We then concluded that other factors are
important in explaining the evaluation of treatment and presumed that the
illness perceptions of ED patients at different stages of the illness
trajectory may affect the expectations of treatment, the readiness to enter
treatment and the evaluation of treatment. We want to further examine these
hypotheses and investigate the illness perceptions of ED patients.
When investigating the illness perceptions of ED patients it is important to
clarify the relationship of illness perceptions and the stage of change
(Prochaska and DiClemente, 1983, Geller, et al 2005) and prior treatment
experiences. Furthermore those factors that are known to affect coping with
illness, such as self efficacy and social support (Bandura, 2002, Bloks et al
2004), are important to take into account. Relatives or caregivers may in fact
affect treatment progress in several ways. Treasure et al (2003) suggested that
the carers and patients may not have a shared model of illness which hinders
treatment progress. In a study on the illness perceptions of carers of
schizophrenia patients, Barrowclough et al 2001 found that cognitive
representations of the illness may have important implications for both carer
and patients in schizophrenia.

In the current study we want to investigate the illness perceptions of ED
patients, to compare their perceptions with the illness perceptions of their
family caregivers and therapists and to compare the illness perceptions of ED
patients to a comparison group. Furthermore we want to investigate to what
extent the illness perceptions are related to stages of changes, self efficacy,
mastery, self esteem, social support and quality of life.

The study is a cross sectional study. All consecutive patients with a diagnosis
for an eating disorder (AN and BN) as identified by a clinician at the Centre
for Eating Disorders Ursula, will be invited to participate in the first stage
of the study. They will be asked to fill out a questionnaire. At the end they
are asked to mention one relative and therapist who will be asked to fill out a
questionnaire. At another department of Rivierduinen patients with an anxiety
disorder or PTSD will be invited in the second stage of the study.

It takes one and a half hour to fill out the questionnaire. The benefits of the
study when data are collected are enhanced insight in illness perceptions of
eating disorder patients and information that will enable the development of
interventions to enhance readiness to engage in treatment