Anorexia nervosa (AN) is a serious illness that, if left untreated, can lead to severe medical complications or even death. While long-term outcomes of AN are highly variable, studies show that roughly 10 percent of AN patients will die from the illness , and approximately 20 percent will remain chronically ill , . The good news is, research shows that early intervention and treatment for anorexia nervosa can significantly improve these treatment outcomes and help prevent severe medical complications, chronic courses, and death , 
The Barriers to Early Treatment for Anorexia
Though early treatment for AN plays such a critical role in long-term outcomes, numerous studies reveal many people with AN are left untreated for years (or even decades) after the onset of their illness ,. As mentioned previously, this delay in treatment can lead to various medical complications, poor treatment outcomes, severe and chronic courses, or even death .
Despite the importance of early AN treatment, very little is known about the barriers keeping individuals with AN from seeking early intervention and treatment. To address this gap in knowledge and help improve early treatment rates for anorexia nervosa, a recent study was conducted on female AN patients, their carers, and health care professionals . The study’s goal was to uncover the common barriers and facilitators to AN treatment from the perspective of patients, carers, and referring professionals to improve AN treatment initiation.
Participants included 10 female AN patients (all of whom were within the first three months of their first psychotherapeutic AN treatment), seven carers (mothers, fathers, friends), and five referring health care professionals (general practitioners and psychotherapists). Participants were first asked to describe the process of starting AN treatment (from the onset of first symptoms to the beginning of treatment). They were next asked specific questions on what facilitated or hindered the process of seeking and starting AN treatment. For example, “‘What made it easier/harder for you/your daughter/your friend/your patient to start treatment?’ […]” .
The results revealed that, on average, the patients did not begin treatment until 3.06 years after illness onset, with some not receiving treatment for as long as 25 years after their illness began . The most prevalent barrier to treatment (especially among adolescent patients) was identified as the failure of close others (parents, friends, doctors, etc.) to recognize and address AN as a severe illness that needed treatment. For example, during the early stages of the illness, some participants were told to “just eat normally again.” In contrast, for others, the illness was brushed aside by doctors and carers as “a phase that will naturally go away” .
Other prominent barriers to early treatment included long waiting times and limited availability among AN treatment programs, failure to be recommended and referred to treatment programs/specialists by health care professionals, prior negative experiences with health care practitioners, and encounters with health care professionals who were ill-equipped to deal with mental disorders.
Another prevalent barrier to AN treatment was the negative influence of the thin media ideal. One participant said it this way: “I have to say social media is a big factor [ …] where you are influenced by the body sizes of models and then you think, maybe I look similar to them now, but then why should I be sick?” . In other words, constantly being exposed to thin images in the media kept some patients from acknowledging that they had a problem and needed help, which, subsequently, kept them from seeking early treatment for AN.
Facilitators of Early Anorexia Nervosa Treatment
On the flip side, participants identified numerous factors that encouraged them to seek treatment. The most essential facilitators to successful early treatment included:
- Positive role models for treatment (e.g., pro-recovery content on social media or personal stories from successfully treated former AN patients)
- Calm, judgment-free support and concern of carers (parents, doctors, teachers, friends)
- Encouragement and reminders from carers to seek treatment
- Judgment-free education about eating disorders via school health classes, doctors, online resources, etc.
- Timely referrals to treatment programs
- Clear and explicitly stated diagnoses of AN by doctors
- Ongoing support, encouragement, and motivation from carers during the treatment process
These findings reveal the important role carers, health care professionals, and societal factors play in the early treatment of anorexia nervosa. Though more research is needed, this study strongly suggests early AN intervention should not only target patients and health care professionals, but should also include carers such as family members, friends, and schools. By prioritizing eating disorder educational programs, support groups for carers, and the sharing of personal recovery stories, early treatment rates for anorexia nervosa may improve, resulting in more positive treatment outcomes among AN patients.
References: Insel, T. (2012, February 24). Post by Former NIMH Director Thomas Insel: Spotlight on Eating Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2012/spotlight-on-eating-disorders.shtml#:~:text=What%20is%20the%20most%20fatal,rate%20of%20around%2010%20percent.  Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159(8):1284–93.  Fichter MM, et al. Long-term outcome of anorexia nervosa: results from a large clinical longitudinal study. Int J Eat Disord. 2017;50(9):1018–30.  House J, et al. Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders. Int J Eat Disord. 2012;45(8):949–56.  Treasure J, Russell G. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry. 2011;199(1):5–7.  Schlegl S, et al. Pathways to Care and Duration of Untreated Illness of Inpatients with Anorexia and Bulimia nervosa. Psychiatr Prax. 2019;46(6):342–8.  Weigel A, et al. Duration of untreated illness and predictors of late treatment initiation in anorexia nervosa. J Public Health. 2014;22:519–27.  Treasure J, Russell G. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry. 2011;199(1):5–7.  Kästner, D., Weigel, A., Buchholz, I. et al. Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers, and professionals. J Eat Disord 9, 28 (2021). https://doi.org/10.1186/s40337-021-00381-0  ibid.  ibid.  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published April 28, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 28, 2021, by Jacquelyn Ekern MS, LPC