Disappearing Act: Interventions for Students Who Are Dying to be Thin Judy Ordogne, MA, LPC Stacy Hall, MEd, LPC-I 4840 W Panther Creek Dr., Suite 212 The Woodlands, Texas 77381 281-465-9229
Prevalence An estimated 5-10 million girls and women have some type of eating disorder and approximately 1 million boys and men are affected. -National Eating Disorders Association
School Counselors can be first line of defense Earlier Diagnosis = Better Prognosis
Anorexia Nervosa Inability to maintain normal body weight Intense fear of weight gain Body image distortion, self evaluation based on weight, or denial Amenorrhea Subtypes Restricting type: no regular bingeing/purging Binge Eating/Purging type: regular episodes of bingeing and purging
Warning Signs of Anorexia Obsessive dieting Loss of menstrual cycle Preoccupation with food, calories, and nutrition Preparing food for others but not self Hiding and collecting food Denial of hunger Excessive exercising
Warning Signs of Anorexia Frequent weighing Strange behaviors around food and eating Isolation from family and peers Sleep difficulties Feeling bloated after eating small amounts of food Feeling fat when not overweight Measuring worth in terms of weight and shape
Physical Signs and Symptoms Constipation Cold intolerance Fatigue or hyperactivity Low body temperature Dry, pale skin Lanugo Slow heart rate Amenorrhea Low blood pressure Anemia Dental problems Brittle nails and hair loss Early morning awakening Abd i l i
Mortality Rate Up to 20% Highest of any psychiatric disorder
Bulimia Nervosa Regular episodes of binge eating Compensatory behavior Feelings of loss of control Self evaluation over reliant on weight Purging type: regular use of self-induced vomiting, laxatives, diuretics, emetics Nonpurging type: use of excessive exercise, fasting
Warning Signs of Bulimia Obsessive dieting followed by bingeing Rapid weight fluctuations Frequent weighing Over concern with weight, size, and shape Trips to the bathroom after eating Secretive eating Guilt about eating
Warning Signs of Bulimia Disappearance of large quantities of food Hiding and collecting food Excessive exercise Swollen glands beneath jaw Evidence of vomiting or laxative-induced diarrhea Abdominal pain Use of laxatives, diuretics, and/or diet pills
Physical Signs and Symptoms Dental problems Swollen salivary glands Calluses or scars on hands Menstrual irregularities Edema Diarrhea Constipation Dizziness or weakness Broken blood vessels in the eyes Dry skin Dry, brittle hair Weight fluctuations Abdominal pain Heartburn Hypokalemia
Life Threatening Consequences Arrhythmias Cardiac Arrest Gastric Rupture
Binge Eating Disorder Recurrent binge eating No regular, compensatory behavior Feelings of guilt, shame, embarrassment, or depression following a binge 30% prevalence in weight loss patients 8% prevalence in community
Development of Eating Disorders Genetic predisposition Societal messages Media images Fitness and the perfect body Westernization of cultures Definitions of successful women Changing roles of women
Sexualization of Girls is Linked to Common Mental Health Problems in Girls and Women - Eating Disorders, Low Self-Esteem, and Depression. APA TASK FORCE, 2007
Development of Eating Disorders Individual personality characteristics Perfectionism Need for control Low self-esteem Family characteristics Separation/individuation problems Communication difficulties Boundary issues
An eating disorder is an imagined physical solution to coping with underlying psychological issues and a disturbance in identity.
How Is An Eating Disorder Treated?
Multidisciplinary Treatment of Eating Disorders
Individual Psychotherapy To resolve the underlying psychological problems of growing up and forming an independent sense of self and identity.
Nutritional Counseling To address the overt symptoms of food and weight issues.
Family Therapy To identify and address family issues that have contributed to the development and maintenance of the eating disorder.
Medical Management To assess and treat any medical complications as well as support the mental health professionals.
Eating Disorders Prevention
Be A Good Role Model
Protective Factors Self-esteem Focus on appreciation, respect, and development of inner qualities Build self-confidence in self, school, hobbies, interests Create a sense of belonging Healthy relationships/interpersonal skills Promote acceptance of diversity in self and others for both inner qualities and appearance Teach and model good interpersonal skills
Protective Factors Problem solving and decision making skills Talk about how to counteract negative messages about food, size, shape Encourage, teach, and model how to problem-solve and make decisions Critical thinking skills Critique media messages about gender, size, and shape
Protective Factors Coping skills Allow natural consequences and failure Encourage independence Teach and model healthy coping Feelings and communication Teach and model identification and expression of feelings
Protective Factors Normal developmental stages Educate yourself and your child Discuss stages, feelings, and concerns Pubertal changes Physical (height, weight, shape) Emotional Secondary sex characteristics
How Educators Can Facilitate Treatment Intervention Approach the student privately in a caring manner Allow a sufficient amount of time Explain your observations and concerns Enlist the assistance of the school counselor Brief counselor before meeting Have meeting with counselor and student Plan a meeting with parents
How Educators Can Facilitate Treatment Have a plan in place Impart seriousness of situation Ease anxiety Include an evaluation as part of the plan Be prepared for denial, minimization, and/or resistance from student and/or family Repeat observations, concerns, recommendations Focus on health, effective functioning
How Educators Can Facilitate Treatment Be prepared for anger, pleading, bargaining from student and/or family If reach impasse, consult school policy, officials If reach impasse, consult with a professional Plan a follow-up meeting Be a part of the treatment team Counselors, teachers, coaches
How Educators Can Facilitate Treatment Be available for student Communicate with therapist Progress Concerns Observations
Conclusions The earlier the eating disorder diagnosis is made and treatment is initiated, the better the prognosis. The best chance of successful treatment is through the cooperative and integrated efforts of a multidisciplinary team of professionals. Full recovery is possible with comprehensive treatment and a motivated patient.
Conclusions Primary prevention efforts are needed to stop the negative attitudes, beliefs, and images presented to children and teens regarding their appearance and roles in society to decrease body dissatisfaction, dieting, and eating disorders.
Resources Academy for Eating Disorders www.aedweb.org American Dietetic Association www.eatright.org Deborah M. Michel, PhD www.treateatingdisorders.com National Eating Disorders Association www.nationaleatingdisorders.org ****TOOLKIT FOR EDUCATORS****