An Australian study showed that stigma was not the main reason people avoided treatment.
Stigma is one reason eating disorders patients avoid seeking help. Stigma comes in many forms, including teasing and bullying, criticism, and comments from family members and others thinking that individuals with eating disorders are responsible for and can control their own symptoms. Even today some consider eating disorders a lifestyle choice rather than an illness (J Nerv Ment Dis. 2013. 201:281). Patients report being embarrassed about their symptoms and, as a result, the rate of help-seeking for eating disorder symptoms is low and has remained unchanged over the last decade.
Although stigma is an important barrier to getting help, it’s not the main reason that individuals with eating disorders avoid seeking care, according to the results of a recent Australian study (J Eat Disord. 2024.12:126). Dr. Prudence L. Wall of the University of the Sunshine Coast and colleagues at Flinders University recruited study participants from first-year psychology students, the community, and various Australian universities through advertisements on Facebook. The study was promoted as “Body-image and eating disorder” research.
A total of 453 participants completed the online survey between July and November 2023.The final sample included 333 participants: 243 females (73%), 78 males (23.4%), and 4 binary individuals. Eight participants (2.4%) preferred not to report their gender. The participants ranged from 17 to 57 years of age (mean age: 28 years), and most self-reported as Caucasian (89.5%), Asian/Indian (7.2%), Aboriginal/Torres Strait Islander (0.3%), and Other (3.0%). More than half reported that they were currently studying at Flinders University. These students received course credit for their participation, while students from other Australian universities and other participants were eligible for a raffle to win a $50 voucher.
Measures
The participants completed a number of online questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q). Eating disorder impairment was measured using the Clinical Impairment Assessment (CIA), a 16-item self-report measure designed to be completed after completing the EDQ. The Actual Help-Seeking Questionnaire (AHSQ) was used to measure help-seeking behavior. Overall attitudes and willingness to seek help were assessed via the Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF), a 10-item self-report questionnaire.
Participants were asked if they had sought help for eating disorder symptoms in the past. If so, they were offered various help-seeking sources from the AHSQ, including informal sources (friends and family) and formal sources (mental health professionals and family physicians). Finally, participants were asked if they had sought help through digital means, including telephone and internet helplines.
Results
Almost 75% of the community sample reported having eating disorder symptoms that caused significant functional impairment. Stigma and shame were found to moderately predict help-seeking in this group, although only a single perceived stigma, ‘Being concerned that other people believe eating disorders are not real illnesses,’ was significant in this group.
The average scores on the EDE-Q shape and weight concern subscales exceeded the clinical cut-off, while the scores on the restraint and eating concern subscales, as well as the global scores, were substantially greater than the community norm. Participants also reported substantial clinical impairment due to their eating disorder symptoms. Global eating disorder symptoms and psychosocial impairment due to eating disorder symptoms were strongly correlated.
More than 65% of participants reported that they had sought some form of help for eating, weight, and/or shape concerns. However, fewer than 43% had sought formal help from either a mental health professional ( psychologist, psychiatrist, social worker, counselor) or their primary care physician.
An important finding
Self-stigma and shame were not significantly associated with help-seeking behavior. While the variable, ‘feeling ashamed of my problems,’ was highly endorsed among participants and showed a trend toward significance, its actual relationship with help-seeking proved to be different. To the authors, this implied that individuals who are ashamed of their disordered eating problems may even be encouraged to reach out for help.
These findings have several implications, according to the authors. First, the elevated levels of eating disorder symptoms they uncovered in their study has important implications for stigma. The greater the prevalence of eating disorder symptoms in the community, the more normalized they might become, and the less likely they may be perceived as unusual or disordered.
What can clinicians do?
The authors believe that healthcare professionals have a crucial role to play in reducing the stigma of having an eating disorder (i.e., that eating disorders are not ‘lifestyle choices,’ or ‘easy to overcome ‘or ‘just a phase’). Reducing stigma may be best achieved through public health campaigns whereby healthcare professionals acknowledge concern for what others think as a common barrier to seeking treatment, while also describing eating disorders as serious illnesses.
The authors point out that their findings reflect those of other recent studies suggesting that stigma is not necessarily the greatest barrier to accessing care for an eating disorder. Awareness campaigns by Australia’s eating disorders organizations may have at least slowed the effect of stigma about seeking help. Studies in the US and United Kingdom have also shown weak associations between stigma and help-seeking in individuals with significant eating disorder pathology.
Additionally, the authors encourage clinicians to be mindful of the perceived stigma that prospective help-seeking individuals may face, and to assist in educating the community about the seriousness of eating disorders.
Janice Goldschmidt
Has worked with individuals with IDD for the last decade, and written and presented her work in a range of professional formats. She received her Master’s degree in Nutrition from the University of Maryland-College Park, where she initially developed her program for development of food preparation skills, Active Engagement. As Director of Nutrition Services at Community Support Services, Inc. (Gaithersburg, MD), she has continued to build on Active Engagement, which now includes many differing contexts for guiding individuals with IDD and autism to independent cooking skills. She has also worked on the identification, classification, and treatment of eating disorders for this population.