Perceived clinician stigma and its impact on eating disorder treatment experiences: a systematic review of the lived experience literature

ObjectiveThis systematic review examines the literature regarding perceived clinician stigma and treatment experiences of adult patients with eating disorders, emphasising lived experience perspectives.MethodA systematic search was conducted across MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials [CENTRAL] to identify studies published from 1 January 2000 until 24 March 2024 that explored patient experiences of clinician attitudes and behaviours in eating disorder treatment. Eligible studies included those reporting on perceived clinician stigma and impacts on treatment outcomes.ResultsThere were 11 studies that met the eligibility criteria. The studies encompassed various diagnoses, locations, and healthcare settings, reflecting a broad spectrum of experiences and contexts within treatment of eating disorders. Four key themes emerged across the studies: treatment engagement, where perceived clinician stigma led to reduced patient involvement; therapeutic alliances, with stigma compromising relationships between patients and healthcare providers; barriers to treatment and care, where stigma heightened obstacles to accessing support; and weight stigma.DiscussionDespite the overall scarcity of evidence, these qualitative studies provide evidence of impacts of perceived clinician stigma on patient experiences in eating disorder treatment. These findings provide an initial understanding of negative effects of clinician attitudes such as dismissiveness and invalidation, which may hinder treatment adherence and therapeutic outcomes. Beyond addressing stigma, future research should explore how clinician behaviours can foster positive treatment experiences, such as patients feeling heard, respected, and understood. Clinicians' reflective practices should focus on improving therapeutic alliances and fostering more inclusive, patient-centred care. Future studies should prioritise mixed-methods approaches to investigate how clinician stigma and positive care experiences influence treatment engagement, recovery trajectories, and long-term outcomes. This review examines how adults with eating disorders perceive their treatment from doctors and other healthcare providers, focusing on feelings of stigma or negative judgment. We identified 11 relevant studies that discuss patient experiences with clinician attitudes in eating disorder treatment, covering various eating disorder diagnoses and treatment settings. The key findings indicate that patients frequently reported perceived negative attitudes from clinicians, such as judgment or dismissiveness, which adversely affected their treatment experiences. This perceived stigma resulted in reduced engagement in treatment, weaker therapeutic relationships, increased barriers to accessing care, and reinforcement of harmful weight-related beliefs. Patient narratives in these studies illustrate how perceived clinician stigma can contribute to, and perpetuate, feelings of shame, frustration, and isolation. Although research on this topic is limited, the studies reviewed help us start to understand the impact of perceived clinician stigma on patient experiences. In addition to reducing stigma, future research should focus on how clinician behaviours can positively shape eating disorder treatment experiences. Specifically, healthcare providers should focus on making patients feel heard, respected, and understood to improve treatment outcomes and foster a more supportive environment for recovery.