15 Barriers to Eating Disorder Treatment—A Look at Mental, Emotional, Logistical & Systemic Challenges to Accessing Care

For many people living with eating disorders, receiving treatment isn’t as simple as making a phone call and getting started the next day. There is usually much more to it than this. While we often hear about the dangers of eating disorders, far less attention is given to the significant barriers that prevent people from accessing care. In fact, eating disorders are sometimes referred to as a "silent epidemic"—not only because they often go unnoticed, but because an alarming number of people never receive professional help. A recent study done by Yale’s School of Medicine found that only around 50% of people with eating disorders seek treatment, with the percentage dropping as low as 35% for those with anorexia.

This begs the question: why do so many people struggle to access the care they need?

The answer is complicated. There are different – and often multiple – answers for each person with an eating disorder. Some barriers to treatment are mental and emotional - like fear of change or not recognizing the severity of the disorder, and some are systemic and logistical - like limited access to specialized care and medical fatphobia and bias. All of them, though, can prevent someone from seeking and/or receiving the care they need. Taking time to shine a light on these barriers is an important step toward breaking them down.

6 Mental & Emotional Barriers to Eating Disorder Treatment

1. Not Recognizing (or Accepting) the Severity of the Eating Disorder

   Some people may not seek treatment because they don’t believe they are sick or sick enough. The blurred lines between “healthy habits” and some eating disorder behaviors and the normalization of some of these behaviors can make it hard for people to acknowledge that they need help. This was a barrier I struggled with myself; it was quite a challenge for me even to recognize that I was not just “being healthy” and that I might need help.

2. Fear of Weight Gain

Even if someone recognizes their need for treatment, fear that treatment might lead to weight gain (depending on the eating disorder) can be enough to prevent someone from moving toward healing. Speaking from my own experience, it can be hard to desire something (treatment ) that perceptibly disrupts a primary source of your self-worth.

3. Emotional Isolation and Shame

The isolation that often comes with an eating disorder can fuel other painful emotions, such as shame and guilt. These feelings can make it even harder to seek treatment—you may feel unworthy of help or fear being judged or rejected if you put yourself out there to seek help.

4. Attachment to the Disorder

A sense of identity in or comfort from the eating disorder itself can make someone hesitant to move toward treatment, especially if this is something you have been struggling with for a long time. The idea of detaching from something that has housed your emotions, thoughts, and habits for any length of time can be terrifying.

5. Fear of Change & Uncertainty

Even if you want to detach from your eating disorder, the idea of stepping into the unknown—leaving behind familiar thought patterns and behaviors, even if harmful—can be daunting. You may be left wondering what life even could look like without your eating disorder and, as is the case with many situations where people are comfortable with the familiarity of their situation, and when confronted with making a decision: you opt to stick with what you know. 

6. Internalized Stigma & Shame 

You may avoid seeking treatment as a result of fear of judgment from other people, particularly due to common misconceptions, like the belief that eating disorders are a choice, an attempt to ‘get attention,’ only impact white teenage girls, or are a superficial issue.

9 Logistical & Systemic Barriers to Eating Disorder Treatment

1. Not Knowing Where to Start

The treatment journey can be overwhelming, especially because there is no one clear-cut treatment path for everyone who struggles with a specific eating disorder. Without clear guidance or a trusted referral, you might feel overwhelmed at the idea of even looking into treatment options. 

If you are in Philadelphia, Virginia, Delaware, New Jersey, Massachusetts, or Florida and are in need of support or are even in the phase of considering in-person or virtual options, our team of therapists is here and ready to help. 

If you are outside of these areas, consider using this tool to look up eating disorder therapists in your area. 

2. Limited Access to Specialized Care

You may live in an area that lacks specialists or treatment centers,  forcing you to travel far if you want specialized care. For many, this is not feasible or even possible.

3. High Cost of Treatment

You may be connected to inpatient or outpatient treatment options, but there may be economic constraints, including high treatment fees and lack of insurance coverage, that make accessing treatment more challenging. 

4. Long Waitlists

Even if you are ready to start treatment, long waitlists for specialized providers, residential care, or outpatient programs can be discouraging and provide a waiting period in which you may lose the desire or motivation to start treatment. 

5. Complexity of Treatment Options

With various therapy types ( different inpatient and outpatient treatment options), understanding which option suits one’s needs is often a major hurdle to seeking out care. This paired with not being sure about wanting or needing treatment can hinder some from even exploring treatment options at all.

6. Medical Fatphobia & Bias

People in larger bodies struggling with an eating disorder are often dismissed or even encouraged to continue disordered behaviors, making treatment access even more challenging. 

7. Comorbid Mental Health Conditions

Struggles with depression, anxiety, PTSD, or OCD can make it even harder to seek or commit to treatment. For those who have co-occurring mental illnesses and seek treatment, some providers who don’t specialize in eating disorders may treat anxiety, OCD, or other mental illnesses as the “primary” illness, leaving the eating disorder untreated or in the background of a treatment plan. 

8. Minimization by Others

Loved ones or doctors might downplay the severity of the disorder, making it harder to get the care you need to start and continue your recovery journey. You may even experience praise for being “disciplined,” for “looking great,” and for “sticking to *healthy* eating” and/or an exercise plan. When you are surrounded by positive reinforcement for the behaviors that are keeping you sick, it can add to the barriers to seeking treatment.

9. Cultural and Language Barriers

In some communities, there may be fewer culturally sensitive or linguistically accessible services, which can add another layer of difficulty to accessing the high-level, personalized care you deserve when you are seeking treatment.

No Barrier Makes You Undeserving of Eating Disorder Treatment

Whether you are contemplating starting treatment, in the midst of treatment, or supporting someone who is going through treatment, it can be helpful to have heightened awareness about the barriers that could be preventing you (or someone you know) from seeking out, starting, staying in, or returning to eating disorder treatment. Some of these barriers require systemic change, and while that may not be something any one of us can do on our own, giving voice to these barriers can help us move in the direction of lowering them. For more personal barriers, please know that many of us are or have struggled with those on our path to or through treatment. Please know that experiencing any of these barriers does not make you less worthy or deserving of care, period. You are – and always will be – deserving of high-quality treatment that meets you right where you are.

By: Erika Muller, Assistant for Wildflower Therapy LLC

All images via Unsplash

How Can Eating Disorder Therapy in Philadelphia, PA Help You?

If you’re looking for someone to come alongside you to help you start or come alongside you during your eating disorder journey, our therapists in Pennsylvania are honored to help!  In fact, you can get to know a little bit more about them here and book a free consultation here.

Other Mental Health Services Provided by Wildflower Therapy, Philadelphia, PA

Life is a unique and sometimes messy journey for each of us; we all have our own individual battles to fight. Our therapists know there is no one-size-fits-all approach to any of life’s challenges and because of that, we offer many unique perspectives and approaches to help meet you where you are with our Philadelphia, PA Therapy services.

We offer services for eating disorder therapy, services for anxiety, and depression, and have practitioners who specialize in perinatal mental health , maternal mental health, therapy for college students and athletes. As well as LGBTQIA+ Affirming Therapy. As you can see, we have something to offer just about anyone in our Philadelphia, PA office. Reaching out is often the most difficult step you can take to improve your mental health. We look forward to partnering with you on this journey!