The impact of patient weight on US mental health providers’ diagnosis of bulimia nervosa

This study examined how patient weight influences mental health providers' diagnosis of bulimia nervosa (BN). US mental health providers (<i>N</i> = 200) from PsychologyToday.com and professional listservs participated in an online experiment, reading vignettes about patients with major depressive disorder (MDD) and BN with the compensatory behavior of excessive exercise. For the BN vignette, participants were randomized to read about a patient whose weight status was described as "healthy weight" or "obesity." Participants reported their diagnoses, confidence, treatment recommendations, and perceived symptom severity. Only 27% of participants accurately diagnosed BN, with 38% of participants instead diagnosing binge eating disorder. There were no significant differences between weight conditions in diagnostic accuracy, confidence, or treatment recommendations for the BN vignette (<i>p</i>s > .05). However, symptoms within the BN vignette were perceived as more severe in the "obesity" condition compared to the "healthy weight" condition (<i>M</i> = 5.08 ± 0.80 vs. <i>M</i> = 4.72 ± 0.99 on a 1-7 scale, <i>p</i> = .005). Within-subjects analyses revealed that participants were more accurate and confident in diagnosing MDD than BN (<i>p</i>s < .01). These findings suggest poor detection of BN among mental health providers when patients present with healthy or higher weights. Providers may benefit from improved training for detecting BN when excessive exercise is used as the primary compensatory behavior.