BY: Christine Peat, PhD
DATE: January 13, 2017
Despite decades of research that have significantly enhanced our understanding of the etiology and treatment of eating disorders, many individuals with these life-threatening illnesses continue to struggle without help or even recognition of their disorder. The eating disorder community (i.e., patients, caregivers, advocates, providers) are well-versed in the physical and psychological dangers conferred by these illnesses and continue to work tirelessly to help ensure that those affected receive the necessary treatment. However, many individuals with eating disorders report feeling unprepared or afraid of reaching out for help. With the many myths and stigma that exist about eating disorders, it is little wonder that those with these disorders feel reluctant to seek help. In fact, a recent systematic review conducted by Ali and colleagues (2017) sought to shed light on the perceived barriers to treatment and, importantly, identifying key factors that help facilitate help-seeking.
The authors of this systematic review searched databases for studies that examined barriers and/or facilitators of help-seeking for eating disorders. Their search revealed 3,493 abstracts, of which 3,349 were dually reviewed to determine which met the predetermined inclusion/exclusion criteria (144 were removed from the initial search as they were duplicates). Only 47 abstracts were found to meet the criteria for inclusion and these full manuscripts were dully reviewed for a more detailed review of their data. Thirty-five studies were excluded after full review, most commonly because the study did not examine perceived barriers or facilitators for help-seeking in eating disorders. After identifying an additional study in the review process, a total of 13 studies were included in the systematic review (see PRISMA diagram here). Risk of bias ratings (an evaluation of the methodological quality of each of the included studies) were dually conducted according to established criteria and any disagreements about these ratings were resolved by discussion.
Thus, the results of this systematic review were based on eight qualitative, three quantitative, and two mixed-methods studies (N=13) that were included in the review. Most of the studies were conducted in the United States and primarily included adult women with eating disorder diagnoses across the spectrum (e.g., anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified). Barriers and facilitators reported in each study were extracted and coded into subthemes such that the authors identified 15 key barriers and 10 key facilitators to help-seeking. Among the barriers identified were: stigma and shame, denial/lack of awareness, cost/transportation/inconvenience factors, and a lack of encouragement from others. Facilitators of help-seeking included: other mental health problems, health problems, and encouragement from friends and family (for an exhaustive list of the prominent barriers and facilitators, please refer to Ali et al., 2017).
Results from this systematic review highlight areas that prevention and education programs can target to help reduce help-seeking barriers. In fact, the authors suggest that awareness and prevention programs should focus on reducing shame and stigma around eating disorders, and educating people about these disorders, their impact, and available resources. Thankfully, there are some great existing resources like those from the National Eating Disorders Association and Project Heal that aim to do just that. Similarly, those local to the Chapel Hill area are encouraged to attend an Embody Carolina training – a peer-to-peer training designed to help train individuals to become allies for those with eating disorders. Finally, you can learn more about the truths about eating disorders (rather than the myths) to help reduce stigma and educate yourself about these illnesses. Collectively, these evidence-based efforts have the potential to help make a meaningful impact on those struggling with eating disorders who might be otherwise hesitant to reach out for crucial treatment.
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