Crossed glances between patients with eating disorders and GPs: an impossible encounter?

Introduction. Eating disorders, which are common in the general population, are associated with severe psychiatric and physical comorbidities. Early detection of EDs would improve the prognosis for patients with EDs. General practitioners (GPs) are often cited as the key players in the early detection of EDs, whilst the patients concerned do not seem to discuss this during consultations. There is little data to explain this discrepancy.Objective. To compare GPs’ perceptions of their care for patients with EDs with those of patients with EDs regarding the role of their GP in their care pathway and treatment.Methods. A qualitative study using a grounded theory approach. GPs participating in the General Practice Observatory’s database were recruited; they in turn recruited patients with eating disorders whom they were treating in their practices. Individual interviews were conducted, and a constant comparative analysis contrasting GP and patient perspectives, with triangulation by three researchers, was carried out.Results. 24 GPs and 6 female patients were interviewed. The four categories identified were: 1) Eating disorders: a condi-tion rarely encountered by GPs, despite the patients’ long-standing family and personal problems; 2) The encounter bet-ween the GP and the patient with an eating disorder: the clash between the two parties and the relief brought by the dis-closure of the disorder; 3) Managing the eating disorder on a day-to-day basis: the patients’ isolation and shame, and the GPs’ initial sense of helplessness; 4) A fundamental therapeutic alliance: the GP as a trusted figure, but with the risk of emotional dependence.Discussion. An impasse was observed between GPs feeling helpless and incompetent and patients experiencing shame and isolation. GPs appeared to adopt a biopsychosocial approach to patients with eating disorders, were able to draw on specific networks within tertiary care, and needed to address their own negative perceptions. It seems important to remind GPs of the need to identify low self-esteem in adolescents as a marker for eating disorders, and to utilise emotion-focused practice groups.