Intersectionality in help-seeking for eating disorders: a systematic scoping review

Individuals with marginalised social characteristics (e.g. by race/ethnicity, gender, body weight) report experiencing eating disorder (ED) symptoms but do not proportionally access treatment. There may be unique factors experienced by individuals with multiple marginalised social characteristics which are not included in our current understanding of help-seeking for EDs. The present review sought to examine the extent of evidence exploring help-seeking and service utilisation for (EDs) by people with more than one marginalised social characteristic or identity. MAIN: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Four databases (PsycINFO, PubMED, Embase, Medline) were searched for papers explicitly examining help-seeking or service utilisation for people with more than one marginalised social characteristic or identity (e.g. race/ethnicity, sexual orientation, weight status). Included studies underwent qualitative synthesis employing an existing model of help-seeking adapted for this review. The most common ED investigated was binge eating disorder (BED) and the most frequently reported marginalised characteristics were overweight/obesity and race/ethnicity. Other intersectional characteristics identified included socioeconomic status (SES), gender, and sexual orientation. People with marginalised social identities such as race/ethnicity or gender were more likely to seek help for BED when they also experienced a higher BMI. There was consensus across studies included in this review that help-seeking rates are low for people with an ED.

Mental health literacy and cultural beliefs about help-seeking are important factors affecting the experiences of people with intersectional identities and this may impact their likelihood to seek help. Results suggest that future studies should consider the interaction between social characteristics and identities in their analyses of outcomes in EDs as this is an emerging area of research, extension of our findings is also needed. The protocol for this review is registered via PROSPERO number CRD42024525849.