Variables that influence diagnosis and treatment of the eating disorders within primary care settings: a vignette study.
OBJECTIVE
This study examined the influence of clinical and nonclinical features of case presentation on the diagnosis and treatment of eating disorders in primary care.


METHODS
Family physicians from a defined region of the UK were provided with two vignettes, characterizing eating disorder presentations in primary care. Case gender, ethnicity, weight status, and diabetes history were experimentally manipulated. Outcome variables included the primary diagnosis and the treatment course selected for each case.


RESULTS
Female cases were more likely to receive an eating disorder diagnosis, even when their symptoms were identical to those of males. Nonclinical demographic variables also influenced treatment decisions. Weight status and physical comorbidity had a limited influence on treatment pathways.


CONCLUSIONS
Nonclinical features of case presentations are used when making eating disorder diagnoses and in selecting treatment. Decision-making in primary care does not reflect recommendations from clinical guidance, and this disparity might increase the risk of complications in the care of sub-groups of eating-disordered patients.
Currin
Laura
L
King's College London, Institute of Psychiatry, Eating Disorders Section, London, England. l.currin@iop.kcl.ac.uk
Schmidt
Ulrike
U
Waller
Glenn
G
D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D012737:Sex Factors