Berryville School District
Berryville, Arkansas
Health Management for School Series
Web page 4:
Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Learning Activities
Etiology
Diagnosis/Treatment
Management
Main Menu
|
What is
an Eating Disorder?
An eating disorder is a psychiatric disorder involving disturbances in the
way one thinks about, feels about, and behaves around food or with regards
to eating. Three primary types of eating disorders have been
identified: anorexia nervosa, bulimia disorder, and binge eating disorder
(sometimes referred to as compulsive overeating).
This web page will be devoted to improving our understanding of two potentially
life-threatening eating disorders: anorexia nervosa and bulimia nervosa.
|
 |
|
(Back to Top) |
Anorexia
Nervosa
Individuals with anorexia nervosa literally starve
themselves. This self-starvation, or anorexic behavior, results from a
distorted body-image and an intense fear of gaining weight.
Individuals with anorexia nervosa "see" themselves as fat, even
when they
continue losing significant amounts of weight from dieting.
Physical symptoms, such as weight loss, slow pulse, dry
skin, sunken eyes, protruding bones, sensitivity to cold, and constipation,
are frequently exhibited. Menstrual cycles cease (a condition known as
amenorrhea), and a fine, downy hair grows on the face and body.
According to statistics from the National Institute of Mental Health (NIMH),
up to 3.7 % of females develop anorexia nervosa in their lifetime. Source:
Facts about eating disorders and the search for solutions (2003),
available at: http://www.nimh.nih.gov
|
|
Bulimia
Nervosa
Bulimia nervosa is characterized by recurrent episodes of
binge eating followed by purging. Purging behaviors may include self-induced vomiting,
the use of
laxatives/diuretics, excessive exercising, or fasting to counteract the
effects of binge eating. During a binge, the individual may consume
a large amount of food in a relatively short period of time. However, binge-eating
most often involves consuming an average - or even a small - portion of
food. Eating
is done in secret, and the individual feels a loss of self-control.
The symptoms of bulimia nervosa may include the following: dry, cracked skin, mouth sores, erosion
of tooth enamel, frequent sore throats, swelling of the hands, feet, and
face, broken blood vessels of the face and eyes, irregular menstrual
periods, abdominal pain, stomach tenderness, constipation or diarrhea,
gastric reflux, weakness, and fatigue.
An individual with bulimia nervosa may be of normal weight, significantly
overweight, or extremely underweight. It is estimated that up to 4.2 %
of females develop bulimia in their lifetime (NIMH, 2003).
|
(Back to Top) |
Etiology
-
Eating disorders are believed to arise from a complex interaction between
biologic, social, cultural, psychologic, and familial factors.
-
Risk factors for development of eating disorders:
-
Diagnosis of other
psychiatric disorders (depression, anxiety, substance abuse, phobias,
obsessive-compulsive disorder)
-
Identification with
groups that focus on thinness (fashion models, ballet dancers,
wrestlers, gymnasts, etc.).
-
Family history of
eating disorders
-
Obesity and chronic
dieting
-
History of sexual
abuse
-
Low self-esteem,
competitiveness, rigidity, and perfectionism.
-
Family and/or school
problems
-
Peer pressure
-
Both disorders appear to have abnormalities in the neurotransmitters in
the brain, but the precise mechanism is unclear.
(Back to Top)
Diagnosis and Treatment
The diagnosis of an eating disorder is made on the basis of clinical
manifestations and their consistency and conformity to criteria established by the American
Psychiatric Association (2000). Findings from physiologic, metabolic,
and psychologic examinations are necessary to obtain a clear
picture of problems facing the individual. Family evaluations are
important for understanding . Laboratory and diagnostic
testing may be necessary to rule out other diseases or disorders.
In anorexia nervosa, the priority goal of treatment is to treat
life-threatening complications from malnourishment. Behavior modification
and intensive individual and family therapy are begun after emergency
treatment is complete. Management of bulimia is similar to that of anorexia.
Immediate hospitalization for treatment of electrolyte imbalance,
dehydration, cardiac dysrhythmias, and esophageal damage is the
priority. And, as with anorexia nervosa, individual and family therapy
becomes an important part of treatment .
(Back to Top)
Management of Eating Disorders
Important: if you want to help a student, friend, or family member
with an eating disorder,
start by
LEARNING more about the disorder, the services available in your community,
and what you can do to help. Please remember: because these
illnesses are potentially life-threatening, they must be evaluated and
treated by a qualified professional.
Teachers,
family members, and friends often are first to suspect that a young person
they care about has an eating problem. These individuals should
NEVER attempt to act as "doctors" or "therapists." Rather, they
should serve as sources of support and information for the individual with
the suspected disorder.
It may be
necessary to confront the individual with a suspected eating disorder.
Below are some guidelines that may be helpful when confronting a student:
-
Seek out the
student with the suspected eating disorder. Use a calm,
non-confrontational (yet direct) approach. Make sure you speak to the
individual student in private (after school, in your office, etc.).
-
Explain to the
student that, based on your observations, you are concerned that she/he may
have an eating disorder. Tell the student that this type of problem needs to
be evaluated.
-
Encourage the
student to talk to a counselor, a doctor, a dietician, the school nurse, or
another health professional about eating issues and health.
-
Always provide the
student with an opportunity to respond to your concerns. If the student opts
to talk about her/his problems, use your best listening skills. Be
supportive and non-judgmental, but NEVER promise to keep the student's
eating disorder a secret.
-
Share with the
student that eating disorders are complex and difficult to overcome without
help. Emphasize that this complex and difficult-to-treat nature is NOT a sign of individual weakness or failure.
-
By providing a
student with a supportive, non-judgmental, and empathetic environment, the
student may be more open to resources available to her/him in the community.
Share your knowledge of resources available in the community.
-
Keep telephone
numbers and addresses of professional organizations and
services available. Provide the student with the telephone numbers of
professional hot-lines or the URLs
of "quality" websites.
-
Avoid having your
meeting with the student become a therapy session. You are an educator - NOT
a therapist. Don't allow the meeting to become a power struggle or a
lesson on morality.
-
If you are unable
to speak with the student yourself or you feel you do not know the student
well enough, find an adult with whom the student has rapport.
This may involve sharing your concerns with a guidance
counselor, nurse, social worker, coach, or school psychologist.
-
If the student
refuses to acknowledge that he/she has an eating problem, do not initiate a
power struggle. Never shame a student, never blame a student, and avoid
making a student feel guilty about the eating problem.
-
End your meeting
if the student becomes distraught or if the meeting hits an impasse.
-
If the student
refuses to acknowledge a problem, let him/her know that your "door is
open," should they need to talk.
-
Before the student
leaves, arrange for follow-up. Consultation with a professional
may be necessary.
-
Become a good role
model for all students. Examine your own thoughts and beliefs about
eating, weight, body image, and physical appearance.
-
Integrate
nutrition into your curriculum and incorporate self-esteem building
activities in your classroom..
-
Demonstrate an
appreciation for diversity in your students, including size and shape. Treat all your
students with unconditional respect and validate their contributions to the
classroom.
-
Encourage your
students to communicate effectively with one another. Also encourage them to
respect diversity and accept their own uniqueness.
-
Be aware of the
the signs of possible eating disorders:
-
Refusing or
skipping meals
-
Constantly talking
about food, food preparation, or weight loss
-
Wearing loose-fitting
clothing or many layers of clothing
-
Withdrawing from
relationships
-
Becoming more
irritable or depressed
-
Making frequent
comments like, "I'm so fat"
-
Visiting the
bathroom immediately after eating
Tips on what NOT
to do when dealing with students with suspected eating disorders:
-
DO NOT attempt to
diagnose your students' health problems!
-
Do NOT judge the
student. Telling the student that his/her behavior is self-destructive
will not help the situation.
-
Do NOT
oversimplify the problem (i.e., "you could get better if you just started
eating.") Eating disorders are complex.
-
Never tell a
student how to lose weight. Let the student's health care provider
determine what is best for the student, should weight control be required.
-
NEVER imply that a
certain body size or shape will lead to happiness or success in life.
-
Do NOT look the
other way. If you know that a student has stopped eating, started
self-induced
vomiting, or started using diuretics or laxatives, seek help
immediately. Your school administrator, school nurse, guidance
counselor, or school psychologist can help you.
-
Because
individuals with bulimia frequently are of "normal weight," do NOT imply
that bulimia is less serious than anorexia. Bulimia can lead to
life-threatening metabolic and physiologic disturbances.
-
Do NOT use food as
a reward or punishment in your classroom.
-
Do NOT criticize
your own shape or the size and shape of others. This implies that
shape is more important than an individual's personality or character.
(Back to Top)
References
American Psychiatric Association. (2000).
Diagnostic and statistical manual
of mental disorders (4th ed.). Text Revision. Washington, DC: Author.
DeStefano-Lewis, K., & Bear, B.J. (2002). Manual of school health (2nd
ed.). St. Louis: Saunders.
Levine, M., & Smolak, L. (2002). The
role of the educator: Faculty and student guidelines for meeting with and
referring students who may have eating disorders. Retrieved November 30,
2004, from
http://www.nationaleatingdisorders.org.
Levine, M. & Smolak, L. (2002). The
role of the educator: Some "don'ts" for educators and others concerned about a
person with an eating disorder. Retrieved November 30, 2004, from
http://www.nationaleatingdisorders.org.
Levine, P. (2002). Prevention
guidelines & strategies for everyone: 50 ways to lose the "3 Ds:" Dieting, drive
for thinness, and body dissatisfaction. Retrieved December 3, 2004, from
http://www.nationaleatingdisorders.org.
National Eating Disorders Association. (2002).
What should I say? Tips for talking to a friend who may be struggling with an
eating disorder. Retrieved November 30, 2004, from
http://www.nationaleatingdisorders.org.
National Institute of Mental
Health. (2001). Eating Disorders: Facts about eating disorders and search for
solutions (No. 01-4903). Retrieved November 30, 2004, from
http://www.nimh.nih.gov.
Written December 1, 2004
Last
update: December 10, 2004
Written by: S.
Verwey, R.N.
Graduate Student
Southwest Missouri State University
Springfield, MO
contact me
Main Menu
(Back to Top)
Disclaimer: This
web page was created for the faculty and staff of Berryville School District for
informational purposes only. Information provided on these pages should
NOT be substituted for evaluation and treatment by a qualified physician or
mental health care provider.
