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. 2025 Nov;58(11):2147-2156.
doi: 10.1002/eat.24515. Epub 2025 Aug 12.

Why Young People With Eating Disorder Symptoms Do Not Seek Help-Exploring Barriers to Help-Seeking

Johanna Stadler  1   2 , Markus Moessner  2 , Katja Becker  3 , Alisa Hiery  3 , Silke Diestelkamp  4 , Heike Eschenbeck  5 , Vera Gillé  5 , Michael Kaess  6   7 , Julian Koenig  8 , Christine Rummel-Kluge  9 , Elisabeth Kohls  9 , Rainer Thomasius  10 , Stephanie Bauer  1   2   11 ; ProHEAD Consortium
Collaborators, Affiliations

Why Young People With Eating Disorder Symptoms Do Not Seek Help-Exploring Barriers to Help-Seeking

Johanna Stadler et al. Int J Eat Disord. 2025 Nov.

Abstract

Objective: Rates of help-seeking and treatment uptake are low in eating disorders. Delayed initiation of treatment has a negative impact on prognosis and treatment outcome and leads to a higher burden on the healthcare system. The aim of this study was to explore factors associated with help-seeking and their interactions in a large sample of adolescents and young adults with current symptoms of an eating disorder.

Methods: Based on the Classification and Regression Trees (CART) algorithm, the data collected within the German school-based project ProHEAD (N = 9796; age: 12-25 years) were used to estimate a decision tree to classify students into help-seekers and non-help-seekers for a mental health issue.

Results: Of those screened, 13% reported substantial current eating disorder symptoms (N = 1273). Out of those, 77.3% reported that they did not seek formal help (i.e., from a mental health professional). The absence of suicidal ideation and emotional problems, as well as a low level of education and openness to mental health issues, was characteristic of those who did not seek help for a mental health problem. Emotional problems, suicidality, and depressive symptoms were identified as the most important factors associated with general help-seeking.

Discussion: In line with previous research, our findings indicate that individuals with eating disorder symptoms are more likely to seek help when other mental health issues are present. Public health efforts should aim to promote awareness and increase knowledge of eating disorders.

Keywords: Classification and Regression Trees; adolescents; decision tree; eating disorders; help‐seeking; youth.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Decision tree model for the prediction of help‐seeking using CART. Note. Boxes represent nodes displaying the number of participants assigned to that node and the percentage of participants classified as “no help‐seeking.” aBMI percentiles were categorized as follows: Extreme underweight (< 5th percentile), underweight (< 10th percentile), healthy weight, overweight (> 85th percentile), and extreme overweight (> 95th percentile).
FIGURE 2
FIGURE 2
Relative importance of included predictor variables.
See this image and copyright information in PMC

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