Clinical decisions on diagnosis and indication for treatment in stereotypical vs. non-stereotypical cases of eating disorders

Background Prevalence of non-stereotypical Eating Disorders (EDs; e.g., characterized by normal weight, subjective binge eating) is much higher compared with stereotypical EDs (e.g., characterized by under- or overweight, objective binge eating), but treatment rates are much lower. Despite the similar subjective burden, individuals with non-stereotypical symptom presentation are often misperceived and do not receive adequate treatment. Methods Using case vignettes, we investigate not only whether non-stereotypical cases of ED are judged differently by a sample of N = 308 psychotherapists in training than stereotypical cases. Via a quasi-randomized, controlled design, we also investigate whether a short, educational intervention improves clinical judgement. Results Data analyses via hierarchical modelling confirm that non-stereotypical vignettes are perceived as less severe than stereotypical vignettes. They are also less likely to receive an ED-diagnosis, and treatment is less likely to be seen as indicated. The intervention reduced this difference in judgement, leading to a higher perceived problem severity, a higher likelihood of ED-diagnosis, and a higher rating in treatment urgency for non-stereotypical vignettes. Conclusions The results draw attention to the problem of misjudgement of non-stereotypical cases of ED. The promising findings regarding the intervention indicate that education of healthcare professionals might contribute to higher likelihood of treatment for individuals with non-stereotypical symptom presentation. Clinical trial number Not applicable.