The barriers and facilitators to accessing eating disorder treatment for individuals with bulimia nervosa and binge eating disorder: a systematic review and meta-synthesis

This systematic review aimed to synthesise qualitative literature on the barriers and facilitators to accessing eating disorder (ED) treatment for individuals with Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Searches were performed on PsychINFO, EMBASE, MEDLINE, Scopus, ASSIA and CINAHL. Included studies were appraised using the CASP qualitative checklist, and thematic synthesis was used to analyse the data. GRADE CERQual was utilised to assess confidence in the findings. Twelve studies were identified and were considered to be adequate. The synthesis produced five main themes: 'Invisibility and Illegitimacy of (Some) EDs', 'Treatment Ambivalence', 'Stigma and Shame', 'Systemic and Structural Barriers', and 'Conditions that Facilitate Access to Treatment'. Findings were rated from moderate to high confidence. Improving treatment access requires stigma-informed care, enhanced clinician training, inclusive public health messaging, and services tailored to diverse needs. A consistent barrier was low problem recognition and symptom minimisation underpinned by cultural and societal misconceptions about EDs.