Information on Eating Disorders
Striving for the Perfect Body by Edward J. Cumella, Ph.D.
At some time during their youth, approximately half of high school and college age girls and 10 percent of boys will have an eating-related problem. 20 percent of girls may develop a diagnosable eating disorder such as anorexia, bulimia or binge-eating disorder, and an additional 30 percent suffer from nondiagnosable but distressing eating/body image problems. Eating disorders among adolescent girls have increased by 300 percent since 1960. Rates appear to be increasing among boys, and more cases of eating disorders are occurring in children ages 8 to 11.
Eating disorders can strike people from all walks of life. However, young people genetically prone to perfectionism and low self-esteem may be most at risk, according to research. And media images ñ often equating thinness with beauty, peer acceptance, sexual and financial success, self-esteem, morality and health also contribute. Cultural pressures for young people to obtain and maintain super-thin bodies are therefore extreme. In this environment, the imagined antidote to adolescentsí common problems, such as low self-esteem, feelings of victimization, relationship or identity problems, becomes the perfect body.
Other eating disorder risk factors for adolescents include female gender, Western cultural background, urban lifestyle and a history of dieting. Ethnicity and socioeconomic status bear no clear relationship to eating disorder risk.
A number of signs may suggest someone has an eating disorder, especially when several occur together:
• Weight loss: extreme thinness or loss of 15 or more lbs in two-three months; exhilarated by weight loss
• Intense fear of being overweight: preoccupied with thinness; wants to be thinner than peers; complains of being overweight when not; obsessed with clothing size, scales, mirrors and weighing
• Preoccupation with dieting and food: uses diet products; talks constantly about food, calories, fat grams; reads a lot about nutrition, dieting and exercise
• Eating little: skips meals; eats very little; is finicky about food; appears to eat when not, e.g., pushes food around on a plate but mostly does not eat it
• Unusual eating habits: eats one thing at a time; eats the same thing every day; cuts food into tiny pieces; fears touching certain foods; sudden vegetarianism; refuses to eat with others; evidence of binge eating
• Bathroom breaks: disappears into the bathroom during or after meals, which may suggest vomiting to purge calories
• Taking up smoking: especially for someone who would not be expected to smoke, intended to suppress appetite and promote weight loss
• Caffeine use: excessive drinking of diet caffeinated beverages or regular coffee without sugar
• Onset of hyperactivity: constantly fidgets; lots of exercise
• Loss of menstrual period: irregular, minimal or absent menses
• Intolerance of cold: shivering; bluish skin or fingers; cold extremities
• Baggy or full-covering clothes: wears baggy clothes or long sleeves, pants and coats during summer months, used to hide excessive thinness and may indicate serious body image problems
• Skin/hair problems: sallow, dry skin; thin, dry hair; hair loss; fine hair growth on the face and arms
• Swollen salivary glands: distended, "chipmunk cheeks"
• Mood change: anxiety, depression, irritability, increased obsessions and compulsions
• Social withdrawal: isolates from peers and family; unwilling to eat with other people
• Perfectionism and low self-esteem: expects too much of self and sees self as not good enough
Ways to Help
Eating disorders are complex. They often involve medical, nutritional, emotional, cognitive, interpersonal and spiritual disruptions, as well as co-occurring depression and anxiety. Therefore, eating disorders usually cannot be treated by one provider. A treatment team is typically needed, consisting of at least a counselor, dietitian and primary care physician experienced in treating eating disorders. In short, the frequency, intensity and specialization needed to treat eating disorders effectively make it difficult to address these problems within the context and confines of typical school-based counseling.
Unless a school counselor is convinced that a studentís eating disorder is very mild and of recent origin or the school counselor has specific training and experience in working with eating disorders, outside professional referral is strongly urged.
However, school counselors play a pivotal role in identifying students who may have eating disorders, particularly since patients with eating disorders are often secretive about their behavior. Along with teachers and peers, school counselors are often the first individuals to notice a studentís eating disorder. Counselors therefore have the opportunity to intervene early. Early intervention is among the best predictors of treatment success and recovery from eating disorders. Simply put, time matters.
Before speaking to a student you suspect has an eating disorder, make sure you know the warning signs of anorexia and bulimia so you act on clear information rather than uninformed suspicion. Learn the medical and psychological consequences of eating disorders, and learn what community and healthcare resources are available for students with eating disorders. Finally, examine your own potential prejudices about weight, body shape and exercise, so your efforts to help ring with integrity.
Next, pick a non-stressful time to discuss the problem with the student. Describe your concern to the student and state what you have observed. Be compassionate and listen. The affected students will need someone to understand things from their perspective. People with eating disorders often make decisions based on feelings rather than facts and logic. Express your concerns about the personís health and functioning, not just their weight, and let them know you think a professional should evaluate their situation. Explain how you can help, either with a referral, information or emotional support. Involve the student's parents in seeking professional assistance.
In situations such as this, youíll need to be ready to end conversation if it is going nowhere or the student becomes upset. If possible, leave the door open for further conversations. If you are forced to end the conversation, try again later, explaining that you are coming back because you think the situation is serious. If you still get nowhere, contact an eating disorder specialist for assistance. If, however, you learn that the student is throwing up several times per day, passing out, complaining of chest pain or talking about suicide, get help for them immediately.
There are also some actions to avoid and to counsel studentsí parents to avoid. These actions could lead the students to feel as though they aren't being heard and to reject help:
• Don't oversimplify. Avoid platitudes such as, "Eating disorders are an addiction like alcoholism," or "All you have to do is accept yourself as you are."
• Don't appear judgmental; don't say that what the person is doing is sick, stupid or self-destructive.
• Don't get into an argument or battle of wills.
• Don't give advice about weight loss, exercise or appearance.
• Don't say, "I know how you feel." Instead, demonstrate you understand by paraphrasing what the student says.
• Don't feel obliged to agree with the studentís perspective or beliefs, even though you endeavor to understand them.
• Don't bring a group of people to confront the student.
Students with eating disorders may be quite needy of emotional support and often seek dependent relationships. Therefore, remember that good boundaries will help protect your well-being as well as the studentís. Don't make promises you can't keep, and don't promise to keep the person's behavior a secret. And don't get over-involved. Know your limits.
Helping Those in Denial
If the student insists nothing is wrong, a therapeutic assessment is advised. This is best done by a counselor and dietitian who specialize in eating disorders. In such cases, it is necessary to involve the studentís parents and to educate them about the potential urgency of the situation and the need for them to seek professional assessment for their child. Having ready resources to which you can refer parents is an obvious benefit. To find professionals across the country who specialize in eating disorders, visit www.edreferral.com or www.nationaleatingdisorders.org.
If assessment reveals a full-blown eating disorder, the student must start working with a treatment team on a regular basis, and the parents may need to place restrictions on some of the student's activities, including athletics. The school should do everything it can to support the studentís regular attendance at therapy sessions and needed behavioral monitoring, including involving and educating coaches and teachers so they can properly support the student's recovery.
If the school counselor believes it is warranted – and often it is for families with an eating disorder child – the school counselor may recommend the parents consider marital or family therapy. This sends a positive signal to their child about the value of therapy. It shows how much the parents care about their child and how far they will go to help. It indicates they donít blame their child exclusively for the eating disorder.
Although all interventions will obviously convey genuine concern and warmth, there must never be ambiguity regarding the seriousness of the situation. The student must understand that if outpatient therapy proves ineffective, a higher level of care will be sought. Knowing this may help the student to take the outpatient therapies more seriously.
An Ounce of Prevention
Because of eating disorders' complexity, prevention programs fail when they oversimplify the causes or issues or focus exclusively on one aspect of eating disorders.
Prevention efforts will fail or even encourage disordered eating if they concentrate solely on warnings about the signs, symptoms and dangers of eating disorders. Effective prevention programs also address:
• The U.S. cultural obsession with thinness as a physical, psychological and moral issue.
• The roles of men and women in society.
• The development of student self-esteem and self-respect in areas that stretch beyond physical appearance, such as school, work, community service, personality attributes, interpersonal skills and hobbies.
School prevention programs should include an opportunity for participants to speak confidentially with a trained professional who has expertise in eating disorders and, when appropriate, to receive treatment referrals. And don't forget the boys; they have eating disorders too. Males also play an important role in prevention of girlsí eating disorders. Males' objectification, cruel teasing, harassment and other forms of mistreatment of girls contribute directly to girls' eating disorders.
By addressing eating disorders head on and putting prevention programs into place, school counselors can help students deal with eating disorders and the associated issues.
Edward J. Cumella, Ph.D., is director of research & education, Remuda Ranch Center for Anorexia and Bulimia Inc. For more information, vist www.remuda-ranch.com.
