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: http://www.nedc.com.au/gp-resource.
If you are concerned about yourself or someone you know, you can get help now on 1800 ED HOPE.
Räisänen & Hunt (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study. BMJ Open 2014;4:e004342 doi:10.1136/bmjopen-2013-004342
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
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