Issue 27 | Disclosure, Help Seeking and Online Support
About this resource
Number 27 | December 2014
Welcome to the twenty-seventh edition of the NEDC e-Bulletin. As the year winds down we've taken this opportunity to explore issues surrounding help seeking for eating disorders and other mental illnesses as well as access to online support.
If you are interested in getting more involved in the NEDC we encourage you to join the collaboration and become an NEDC member. We want to thank you all for your support in 2014 and we hope you have a happy and healthy holiday period.
The Importance of Disclosure, Eating Disorders and Early Help Seeking
Help seeking early in the course of an illness is one of the most critical pathways for those with disordered eating problems. Evidence has shown that the earlier help seeking and treatment occurs, the better chance an individual has of achieving recovery and shortening the duration of psychiatric morbidity (Räisänen & Hunt, 2014).
This month, we take a look at some of the behaviours around eating disorder disclosure and seeking help, and in particular how these two pathways can affect access to treatment.
A recent study (Gilbert et al., 2012) of females with eating disorders and their behaviours showed that a period of 3 years and 3 months lapsed between the onset of a concern over eating and access to treatment. Overall, 12.4 months lapsed before the onset of concern and the first disclosure to another individual, while disclosure to a GP took another 10.7 months after this (with a further 14.9 months lapsing before treatment was provided).
Mothers and friends of younger participants were also shown to be much more involved in the first disclosure than other figures (e.g. fathers); this involvement was followed closely by teachers, bosses and coaches. Older participants, on the other hand, were more likely to disclose to a mental health professional and these patients were also shown to access specialist services much more quickly.
Disclosure prompted by another individual (e.g. a parent) also took less time than disclosure volunteered by the participant and those that received positive appraisal also resulted in faster access to help. “Other-initiated” disclosures were also more common in younger patients (particularly in those first disclosing to a parent), while older patients demonstrated more a more voluntary, self-initiated disclosure.
The study further revealed that the period from disclosing to a GP to accessing treatment showed the longest delay, indicating that services are lacking and that both patient and clinician-based barriers need to be addressed. This also emphasises the need for GPs to familiarise themselves with disordered eating and to ask relevant questions (e.g. SCOFF) that can reveal the presence of an eating disorder.
This experience in the clinical health setting was similarly demonstrated by Räisänen & Hunt (2014) in their research into males with eating disorders.
In males, gendered, cultural representations of eating disorders as primarily a young “female” illness contributed to the delay in recognition of symptoms and behaviours as indicative of an eating disorder. This low level of literacy was also reported by the participants in relation to their friends, family and teachers at school none of whom recognised the signs of disordered eating in males (for example, one patient was treated for gastric issues, with no suggestion that psychological factors were involved).
Delays in disclosure for men were also attributed to: fears that they would not be taken seriously when approaching a professional, fears that they could not survive if they broke away from their disordered eating routines, and a lack of knowledge about where to go for help. A similar study also showed that men aged 16-60 years have a much lower rate of engagement than women with primary care professionals in general (Wang et al., 2013).
As a result of both delayed recognition and delayed help seeking, many males with eating problems presented late in the trajectory of their illness, thereby mitigating the chances of early intervention and treatment.
Once help seeking was achieved, research also showed that the first experience with a GP or professional could ultimately determine how willing patients would be to engage with treatment. While some positive experiences were outlined, most males in the study stated that they had to undertake multiple GP visits before they were taken seriously or adequately referred. Misdiagnoses were also common and were often attributed to depression, teenage ‘fads’ or general weaknesses, which simply required the patient to “man up.”
GPs and other clinicians play a significant role in improving disclosure and help seeking experiences and have a responsibility to be able to recognise symptoms in both women and men.
Promoting positive disclosure experiences that are empathetic and non-judgemental and that give patients hope (Evans et al., 2011) are also essential in prompting better treatment engagement and higher rates of recovery.
For more information about eating disorders identification, referral and management, see: NEDC REsource for GPS.
If you are concerned about yourself or someone you know, you can get help now on 1800 ED HOPE.
Gilbert, N., Arcelus, J., Cashmore, R., Thompson, B., Langham, C., Meyer, C.
Should I Ask About Eating? Patients’ Disclosure of Eating Disorder
Symptoms and Help‐seeking Behaviour Eur. Eat. Disorders Rev. 20 (2012) 80-85
Wang, Y., Hunt, K., Nazareth, I., Freemantle, N., Petersen, I. Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open 2013;3: e003320. doi:10.1136/bmjopen-2013-003320
Evans, E.J., Hay, P.J., Mond, J., Paxton, S.J., Quirk F., Rodgers, B., Jhajj, A.K., Sawoniewska, M.A. (2011). Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey. Eating Disorders: The Journal of Treatment & Prevention, 19(3), 270-285
Accessing Online Support
E-mental health involves the delivery of mental health services by phone and online applications that utilise technology to extend the reach of mental health service support. Services are able to deliver confidential, flexible, individually tailored mental health support that may not be achievable in the same time frame via other treatment modalities.
In recent years there has been an increase in individuals accessing help and support via e-Mental Health platforms, attributable in part to advancements in technology and their widespread uptake.
These services offer opportunities to address the common barriers experienced by those needing treatment for an eating disorder, particularly in relation to:
- Isolation from services; Individuals do not always have access to specialised treatment or experienced practitioners are not available to in their area
- emotional barriers such as fear, shame and guilt
- Stigma and societal pressures
- Financial barriers.
Individuals accessing an e-service often have the ability to remain anonymous, which creates feelings of safety for those who may have had a negative or disempowering experience to engage in seeking help and support (Christensen & Hickie, 2010).
Accessing services via these platforms can also help individuals feel more empowered as they take responsibility for the central role in managing their own health (Christensen & Hickie, 2010).
This often results in individuals feeling more confident in taking the first steps to access help, and supports them in moving towards a traditional person-based setting if needed.
E-mental health services offer:
- less threatening or difficult modes of contact which can occur at a pace set by the consumer
- flexible access to services through preferred methods of contact
- Immediacy of access regardless of geographic location and proximity to traditional forms of support
- Access at low cost and in flexible, non-stigmatising ways.
Evidence shows that access to information, counselling and online self-help programs plays an important role in suicide prevention, crisis advice and treatment of mental health issues. E-mental health services can be an important tool in early intervention for the treatment of eating disorders as well as act as an adjunct to therapy. Access to services as soon as they are needed can reduce the severity, duration and impact of the illness (NEDC, 2012).
Butterfly Foundation's ED Hope Service
Under its Teleweb (Telephone Counselling, Self Help and Web-based support) measure the federal Department of Health funds Butterfly Foundation’s National Support Line and Web Counselling Service, ED HOPE. The service provides free, confidential support for anyone with a question about eating disorders or negative body image, including sufferers, carers, family and friends, teachers, employers and more.
ED HOPE is open Monday to Friday 8am to 9pm AEST daylight savings adjusted (except national public holidays).
Phone: 1800 ED HOPE / 1800 33 4673
In addition to this federally funded service, several other organisations also provide online support.
Eating Disorders Victoria Recovery Chatroom, Eating Disorders Victoria
Eating Disorders Victoria (EDV) provides online support through The Eating Disorders Victoria Recovery Chatroom. The service provides an opportunity for people living with an eating disorder (16 years & over) to communicate with others and give and receive the mutual understanding and support that is vital to promote a full recovery. The Recovery Chatroom is moderated by trained volunteers who ensure it remains a safe and supportive environment. The Recovery Chatroom is intended as a means of support and communication; it does not provide any form of counselling and is not intended to be a substitute for professional/medical advice.
Christensen, H, Griffiths, K.M and Evans, K (2002), e-Mental Health in Australia: Implications of the Internet Related Technologies for Policy. ISC Discussion Paper No. 3 Canberra: Commonwealth Department of Health and Ageing. Cited in Jorm, A. F, Morgan, A. J and Malhi, G. S. The future of e-mental health. Australian & New Zealand Journal of Psychiatry, 2013, Vol.47(2), pp.104-106
Find more services and support organisations
New Resource: Eating Disorders 101
NEDC are very excited to launch a new video “Eating Disorders 101”. This ninety second animated video highlights some core facts about eating disorders, dispels misconceptions and encourages help seeking.
Greater understanding of the facts about mental health and eating disorders leads not only to a more aware and accepting community, but also improves prevention, early identification and help-seeking. Unfortunately research indicates that there are generally low levels of mental health literacy in the community in relation to eating disorders.
This video has been developed for use online, particularly through social media, to target the general public. It is hoped that in reaching a broad audience we will encourage interaction with evidence-based information on the NEDC website and contribute to the improvement of eating disorders awareness and understanding in Australia.
Research Roundup: Help Seeking
The National Eating Disorders Collaboration collects and provides the latest evidence based research and information available on eating disorders from Australia and around the world. The topics included in our Knowledge Hub are wide ranging and recognise the physical, social and emotional aspects and the broad spectrum of eating disorders. This month in the e-Bulletin we are highlighting content in our Knowledge Hub relating to help seeking.
Help-seeking intentions in college students: An exploration of eating disorder specific help-seeking and general psychological help-seeking.
This study investigated help-seeking intentions for eating disorders and general psychological problems in college students. Participants reported that they would be more likely to seek help for a friend with an eating disorder than for themselves if they were experiencing an eating disorder.
Participation and outcome in manualized self-help for bulimia nervosa and binge eating disorder — A systematic review and metaregression analysis.
There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. This study conducted a systematic literature review using electronic databases and hand searches of relevant journals.
A Retrospective Look at the Internal Help-Seeking Process in Young Women With Eating Disorders.
This qualitative study retrospectively explored the help-seeking process in women with eating disorders. Participants described a gradual shift from denial to increased awareness of self and the impact of the illness.
Find more research in the NEDC Research & Resources
Save the Date - NEDC Regional Forums
NEDC are running a series of FREE information and professional development forums held in regional centres across Australia.
Targeted at those providing services to people with or at risk of eating disorders attendees can expect to engage with evidence based knowledge and practice and professional networking and support. This is also an excellent opportunity to discuss and workshop the unique service and workforce needs of your local community. The program for each forum will be adapted to meet the needs of the local community.
Previous areas visited include Townsville, Bunbury, Wagga Wagga, Broken Hill, Darwin, Canberra, Mount Gambier, Launceston and Bendigo.
Dates and locations for a series of forums in regional NSW have been confirmed. NEDC will be running the following information and professional development sessions in February:
- 24th February - Kempsey
- 25th February - Port Macquarie
- 26th February - Coffs Harbour
- 3rd-4th March - Lismore
More information and registration for these session will be made available early next year. Dates and locations for upcoming eating disorders forums across 2015 will also be made available soon.
More information and professional development events held in Australia can be found in Professional Development section.
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