BACKGROUND: The aim of this study was to assess barriers and facilitators in the pathways toward specialist care for eating disorders (EDs). METHODS: Eleven ED services located in seven European countries recruited patients with an ED. Clinicians administered an adapted version of the World Health Organization "Encounter Form," a standardized tool to assess the pathways to care. The unadjusted overall time needed to access the ED unit was described using the Kaplan-Meier curve. RESULTS: Four-hundred-nine patients were recruited. The median time between the onset of the current ED episode and the access to a specialized ED care was 2 years. Most of the participants did not directly access the specialist ED unit: primary "points of access" to care were mental health professionals and general practitioners. The involvement of different health professionals in the pathway, seeking help for general psychiatric symptoms, and lack of support from family members were associated with delayed access to ED units. CONCLUSIONS: Educational programs aiming to promote early diagnosis and treatment for EDs should pay particular attention to general practitioners, in addition to mental health professionals, and family members to increase awareness of these illnesses and of their treatment initiation process.

1st Medical Faculty of Charles University and General University Hospital Prague Prague Czech Republic

Clinical Psychology Unit Bellvitge University Hospital IDIBELL and CIBERobn ISCIII Barcelona Spain

Clinical Sciences Department School of Medicine and Health Sciences University of Barcelona Spain

Department of Emergency Psychiatry and Acute Care CHU Montpellier and University of Montpellier Montpellier France

Department of Medical and Surgical Sciences University Magna Graecia of Catanzaro Catanzaro Italy

Department of Medicine Surgery and Dentistry 'Scuola Medica Salernitana' University of Salerno Salerno Italy

Department of Psychiatry and Psychotherapy University Hospital Munich Munich Germany

Department of Psychiatry Poznan University of Medical Sciences Poznan Poland

Department of Psychiatry University of Campania L Vanvitelli Naples Italy

Eating Disorder Unit Hospital Clínico San Carlos Universidad Complutense Cibersam Madrid Spain

Eating Disorders Center for Treatment and Research Department of Neuroscience University of Turin Turin Italy

GHU Paris Psychiatrie et Neurosciences Paris France

INSERM U1266 Paris France

King's College London Department of Psychological Medicine Institute of Psychiatry Psychology and Neuroscience London UK

Neurosciences Department University of Padua Padua Italy

Psychiatry Unit Department of Health Sciences University of Florence Florence Italy

Schoen Clinic Roseneck Prien am Chiemsee Germany

Section of Clinical Psychiatry Department of Clinical Neurosciences DIMSC Università Politecnica delle Marche Ancona Italy

Servei de Psiquiatría Hospital de Sant Pau Barcelone Spain

South London and Maudsley NHS Foundation Trust London UK

Université Paris Cité Paris France

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