Barriers to Care
The number of people with an eating disorder who access treatment in a year is considerably less (19-36%) than people with other types of mental health disorders, such as depression [1-3]. Of these individuals who do receive treatment, only 35-40% will received targeted treatment for their eating disorder [4, 5]. Further, it is estimated that treatment for an eating disorder is sought an average of 5-15 years after the onset of the disorder [6, 7].
Research demonstrates that delays to accessing treatment differs by eating disorder diagnosis with people experiencing bulimia nervosa or binge eating disorder experiencing a significantly longer delay from the onset of symptoms to accessing eating disorder-specific treatment, when compared with anorexia nervosa .
Multiple factors contribute to these low rates of accessing appropriate eating disorder treatment. These factors are outlined below and include: stigma, access to care, mental health literacy and personal factors; and knowledge and skills of health professionals.
It should be noted that there has been limited investigation into barriers to accessing eating disorder treatment for people from diverse groups such as LGBTIQA+ people, Aboriginal and Torres Strait Islander peoples and other minority populations. It is likely that people from these populations may face similar, but also unique barriers when seeking treatment.
Research has consistently demonstrated that stigma is the most impactful barrier to people accessing eating disorder-specific treatment [3, 7]. People may experience stigma, feelings of shame and fear of judgement from family members/friends/health professionals regarding experiencing eating disorder symptoms or behaviours, thus presenting a challenge to help-seeking.
Access to care
Access to care represents a significant barrier to engaging in treatment for an eating disorder. Practical barriers limiting access include: the extremely limited availability of services in regional and remote areas; the economic burden of services; available transportation to services; and lack of time available to people in order to attend appointments.
Additionally, service related constraints including long waitlists and people being ineligible to access a service due to strict entry criteria (such as requiring a specific diagnosis or BMI; belonging to a particular age group) present major barriers to accessing care.
The availability of care for diverse age groups and specific populations (e.g. transgender clients), eating disorder diagnoses and specific treatment interventions can often reflect clinician interest and expertise rather than coordinated planning, individual treatment needs and holistic care which is required for each eating disorder presentation.
Mental health literacy and personal factors
For early intervention to occur, people and those in their circle of support need to be able to recognise and respond to various signs and indicators that present early in the development of an eating disorder. To understand the warning signs of an eating disorder, click here.
Unfortunately, even if eating disorder symptoms are recognised, people with eating disorders and those caring for them often do not have a clear understanding of how and when to access help. A GP is a good ‘first base’ to seek support and access eating disorders treatment. To find help in your local area go to NEDC Support and Services. Additionally, call the Butterfly National Helpline (1800 33 4673) for support from trained counsellors and more information on available services.
Personal factors may also impact a person’s ability to seek and engage in treatments. For example, people may have low motivation to engage in treatment due to: negative past treatment experiences; a perception that treatment will not be effective; or feelings of hopelessness and misperception that recovery is not possible. Ambivalence about treatment and recovery is a common experience for many people experiencing eating disorders. However, it is important to note that recovery from an eating disorder is always possible.
Knowledge and skills of health professionals
When people do seek help, health professionals must be able to recognise symptoms of an eating disorder. Often, this does not occur due to a lack of knowledge or inaccurate beliefs about eating disorders, such as holding stereotypical (but incorrect) beliefs about what a person presenting with an eating disorder ‘should’ look like. It is imperative for all health professionals, but especially those in primary care, such as GPs, to be able to identify the warning signs, symptoms and risk factors of eating disorders.
Professionals should be aware that people experiencing eating disorders are more likely to present for help for weight loss than an eating disorder .
If an eating disorder is identified by a health professional, they need to be knowledgeable about the appropriate treatment options and have an awareness the services available for each person. Click to find out more information about the stepped system of care for eating disorders and availability of eating disorder-specific services across Australia.
1. Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clinical psychology review. 2011;31(5):727-35.
2. Vanheusden K, Mulder CL, van der Ende J, van Lenthe FJ, Mackenbach JP, Verhulst FC. Young adults face major barriers to seeking help from mental health services. Patient education and counseling. 2008;73(1):97-104.
3. Cachelin FM, Striegel‐Moore RH. Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. International Journal of Eating Disorders. 2006;39(2):154-61.
4. Mond JM, Hay PJ, Rodgers B, Owen C. Health service utilization for eating disorders: Findings from a community‐based study. International Journal of Eating Disorders. 2007;40(5):399-408.
5. Noordenbos G, Oldenhave A, Muschter J, Terpstra N. Characteristics and treatment of patients with chronic eating disorders. Eating disorders. 2002;10(1):15-29.
6. Oakley Browne MA, Elisabeth Wells J, Mcgee MA, Team NZMHSR. Twelve-month and lifetime health service use in te Rau Hinengaro: the New Zealand mental health survey. Australian & New Zealand Journal of Psychiatry. 2006;40(10):855-64.
7. Hamilton A, Mitchison D, Basten C, Byrne S, Goldstein M, Hay P, et al. Understanding treatment delay: perceived barriers preventing treatment-seeking for eating disorders. Australian & New Zealand Journal of Psychiatry. 2022;56(3):248-59.