A new study has found that only a quarter of mental health providers could correctly diagnose bulimia nervosa when presented with a patient description outlining symptoms of the disorder. The research, conducted by the University of Florida College of Public Health and Health Professions, highlights critical gaps in the recognition of eating disorders among healthcare professionals. The findings were published in the journal Eating Disorders.
The study, led by doctoral student Dakota Leget and her mentor Rebecca Pearl, Ph.D., an associate professor in the Department of Clinical and Health Psychology, identified two key misconceptions that may have contributed to the misdiagnoses. One factor was the patient’s body size, as many individuals with bulimia maintain an average or higher weight. The other was the role of excessive exercise, which is often overlooked as a compensatory behavior for binge eating.
“Unfortunately, we have stereotypes that someone with an eating disorder will look ‘very lean’ or ‘sickly,’ but we know that’s not the case for a lot of eating disorders,” Leget said.
The research involved a nationwide sample of over 200 mental health providers who reviewed patient vignettes and selected a diagnosis and treatment plan. One vignette described a fictitious patient meeting all diagnostic criteria for bulimia nervosa, yet only 27% of providers correctly identified the condition. In contrast, 38% mistakenly diagnosed the patient with binge eating disorder.
In another vignette used as a control, 75% of participants correctly diagnosed a patient with major depressive disorder. Researchers assigned participants one of two versions of the second vignette: one describing the patient as having a healthy weight and the other as having obesity. Despite identical symptoms in both cases—including binge eating, strict dieting, and excessive exercise—many providers failed to recognize the patient had bulimia.
Leget emphasized the importance of correctly distinguishing between eating disorders, as misdiagnosis can lead to ineffective treatment and overlooked health risks. For example, bulimia can cause dangerously low sodium levels due to excessive exercise, a complication that requires specific medical attention.
“If you are treating the wrong eating disorder, you might not be using the best evidence-based strategy,” Leget warned.
The study underscores the need for more continuing education on eating disorders for mental health providers, particularly those without specialized training in the field.
“Many people with eating disorders will probably be seen in outpatient settings and may not be treated by someone with expertise in this area,” Leget said. “Early detection and treatment are crucial. If a community provider can identify an eating disorder, they can either treat the patient or refer them to a specialist for appropriate care.”
The findings highlight the importance of improving awareness and education about eating disorders to ensure timely and accurate diagnoses, ultimately leading to better patient outcomes.
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