Binge eating disorder: general practitioners' constructs of an ambiguous pathology

Abstract

Eating disorders are amongst the most commonly encountered psychiatric disorders experienced by young women. Binge eating disorder (BED) has received some support as a distinct pathology, but is hard to disentangle from other kinds of behaviours. This qualitative study explored awareness and knowledge of BED amongst a group of 18 inner-city general practitioners in NW England. Thematic coding of their accounts suggested a dichotomous tension. (1) Subjects were largely unaware of the existence of BED, and found it dif cult to conceptualize its diagnosis and management in primary care. (2) Subjects framed BED as a 'disorder' that was rmly within the sphere of patients' personal responsibility, and recognized that psychological distress would be an important causal factor in its aetiology. Subjects were reluctant to consider BED as a diagnosis for obese patients because of the absence of services for onward referral, and because of uncertainties about effective treatment.

A rational model for assessing and evaluating complex interventions in health care

“…Theoretical sampling [ 48 ] of specific data items from the range of studies identified above was undertaken on the basis of their reference to the social organization of clinical work in primary care. Unpublished data was also sampled from an evaluation of a salaried general practitioners scheme [ 49 ] and already analyzed data was reconsidered from interview studies of doctors' perceptions of the boundaries of work in general practice [ 50 ]; complementary medicine in general practice [ 51 ]; the management of eating disorders [ 52 ]; reasoning in primary care consultations [ 53 , 54 ]; and constructions of the changing status of therapeutic relationships [ 55 , 56 ]. (Because of the limitations of a commissioned article, no supporting data was presented in the paper itself.)…”