Individual barriers include shame, fear of stigma, cultural perceptions, minimizing the seriousness of the problem, unfamiliarity with mental health services, and a lack of trust in mental health professionals. Systemic barriers include language differences, financial limitations, lack of insurance coverage, inaccessible health care facilities, time conflicts, long waits, lack of transportation, and lack of child care. These barriers may be particularly exacerbated for those who identify outside of the skinny, white, affluent girl stereotype that dominates in the field of eating disorders, such that those who do not identify with this stereotype are much less likely to seek treatment.Conditions during the COVID-19 pandemic may increase the difficulties experienced by those with eating disorders, and the risk that otherwise healthy individuals may develop eating disorders. The pandemic has been a stressful life event for everyone, increasing anxiety and isolation, disrupting normal routines, creating economic strain and food insecurity, and making it more difficult and stressful to obtain needed resources including food and medical treatment. The COVID-19 pandemic in England exposed a dramatic rise in demand for eating disorder services which the English NHS struggled to meet. The National Institute for Health and Care Excellence and NHS England both advised that services should not impose thresholds using body mass index or duration of illness to determine whether treatment for eating disorders should be offered, but there were continuing reports that these recommendations were not followed.In terms of access to treatment, therapy sessions have generally switched from in-person to video calls.
This may actually help people who previously had difficulty finding a therapist with experience in treating eating disorders, for example, those who live in rural areas. Studies suggest that virtual (telehealth) CBT can be as effective as face-to-face CBT for bulimia and other mental illnesses. To help patients cope with conditions during the pandemic, therapists may have to particularly emphasize strategies to create structure where little is present, build interpersonal connections, and identify and avoid triggers. Medication
Orlistat is used in obesity treatment. Olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated.Two pharmaceuticals, Prozac and Vyvanse, have been approved by the FDA to treat bulimia nervosa and binge-eating disorder, respectively. Olanzapine has also been used off-label to treat anorexia nervosa. Studies are also underway to explore psychedelic and psychedelic-adjacent medicines such as MDMA, psilocybin and ketamine for anorexia nervosa and binge-eating disorder. Outcomes
For anorexia nervosa, bulimia nervosa, and binge eating disorder, there is a general agreement that full recovery rates range between 50% to 85%, with larger proportions of people experiencing at least partial remission. It can be a lifelong struggle or it can be overcome within months. Miscarriages: Pregnant women with a binge eating disorder have shown to have a greater chance of having a miscarriage compared to pregnant women with any other eating disorders.