Introduction. My name is Elizabeth Swords. I work as a volunteer with Bodywhys, the National Association for Eating Disorders (ED’s). This resource is a starting point for teachers to access basic information to support students with ED’s. It is also intended to help develop an awareness , to help identify warning signs andto assist in developing a school strategy for supporting students with eating disorders. Today I hope to give a brief overview of causes, triggers, symptoms, support and interventions.
It is important to stress that males get eating disorders also. It is not as common as in females and as a result can sometimes go undiagnosed. Not least because boys are more likely to engage in an extreme exercise regime which may also be a symptom of anorexia. Exercise provides enormous benefits to physical and mental health but when taken to excess it can have an addictive quality.
There are persistent myths concerning eating disorders. Education is the best way to dispel them from the school environment.
Here are some facts about ED’s to begin with:
The presentation will outline the four key areas necessary to effectively support those with ED’s in school.The first 3 relate directly to the school while interventions take placeoutsideof the school with the school providing key support. The school plays such a large part in students’ lives so there is a significant preventative role.
Schools cannot of themselves prevent students from eating disorders but they do play a supportive role in equipping students with the skills and resilience to cope with life’s adversities. The link Mental Health Matters, a mental health resource pack for 14 – 18 year olds can be delivered as part of a SPHE programme. It address the issue of mental health in a realistic, relevant and age appropriate manner.
The list here gives an idea of some of the spontaneous benefits of an effective mental health strategy. This is not an exhaustive list. The rewards benefit the whole school body and not just those affected by mental health issues.
The signs are often difficult to recognise as students affected by ED’s are often model students, hardworking, helpful and anxious to please.
A number of factors are indicated including genetics, family relationships, trauma and individual cognitive styles together with some developmental triggers. Sometimes depression and low self-esteem pre-exist the ED and this is then connected to issues related to body image. Each case is unique. Issues of perfectionism, modelling and social and cultural influences may also arise. ED’s are essentially a control issue. In many cases it is an attempt to reassert control on life when everything seems out of control. Sometimes this is done to extremes and sometimes there is a complete breakdown of control. It becomes a way of coping and a crutch which is very difficult to let go. Because the dynamics of ED’s are so complex it is not helpful in the school setting to try to identify a cause.
Seventy percent of mental illness commences in adolesence. Developmentally it is a time of huge change. Also socially and emotionally adolescents are challenged and are struggling to form their own sense of identity. Many theorists have identified the different challenges from Erikson (1950), Piaget to Havinghurst’s developmental tasks (1972). This is more apparent in school than elsewhere and provides a great challenge for school and teachers.
Adapted from DSM IV criteria for AN diagnosis.
Anorexia Nervosa (AN) is a self-perpetuating illness maintained by positive and negative reinforcement, skewed thinking and distorted perception. Newer treatments are coming from a maintenance model approach (Maudsley), ie concentrating on factors that are maintaining the behaviours, such as the reinforcers, the visibility of the illness and the impact of that on self and others.
Sometimes symptoms are difficult to cope with and they can leave those supporting the person affected frustrated, confused, upset and even angry. It is important when supporting someone to begin by separating the person from the anorexia.
It sometimes takes a long time for the physical effects to be apparent.
As people suffering from AN can sometimes be hardworking, anxious to please, and perfectionistic other difficulties may be inadvertently overlooked. However people with AN exhibit signs of having a strong need for control and some behaviours are quite ritualistic. It is helpful to notice such behaviours, without watching!
DSM IV criteria for diagnosis
Like AN Bulimia Nervosa (BN) can cause serious health issues particularly if left untreated.
As with AN, the psychological effects of BN can be difficult for those around them. Teachers may not have first hand experience of this a lot of the time. However peers may be in close contact with friends with these symptoms. Their ability to cope with a friend affected will vary. This again highlights the importance of a whole-school mental health education and support strategy.
BN is not always apparent as it is not as visible as AN and weight loss is often not significant.Rawness of the fingers, particularly around the knuckle area, is often the easiest symptom to recognise in school.
Keep notes of observations. An extreme reaction may aggravate the situation as may any comments or reaction to weight or appearance. If the student with AN comes to you, advise the school counsellor but it is important to tell the student that you are doing this.
As mentioned earlier awareness is key when managing issues regarding ED’s in a school environment. Awareness includes understanding ED’s, appreciating triggers and recognising symtoms, as discussed earlier. Support comes by way of an, empathic, understanding and encouraging environment and by being supportive and accommodating to those with ED’s which enables the healing process. Effective communication is vital between teachers, guidance counsellor and parents. Sign-posting: referring a student to the counsellor and through the parents/guardian to the GP.
ED’s are a multifaceted mental health issue and require professional treatment and therapies. Nonetheless the school plays an important supportive role. Therefore it is important, particularly for the guidance counsellor, to be aware of the range of services offered to those affected at a school-going age. This facilitates the capacity to be supportive and empathic.
Equally it is useful to know what services are available for adolescents. A GP visit is a very important first step for an initial assessment, for a preliminary health check and to refer the patient on for appropriate treatment where necessary. Support, listening and advice services are available for those affected and for the for friends and family by organisations such as Bodywhys. Bodywhys is a voluntary organisation supported by the HSE. The Child and Adolescent Mental Health Service run by the HSE provides a multi-disciplinary approach for people under 16 and needs a doctors referral. Sometimes a hospital admission is required. Attending a psychologist or counsellor or other professionals may be required for a period of time.
The role of the school is a vital one in providing a supportive enriching environment that will nourish the first shoots of recovery through the sometimes difficult and turbulent path to full recovery.
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EATING DISORDERS – A RESOURCE FORTEACHERS This is a resource to support teachers who work with adolescents some of whom may be affected by an eating disorder Image: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FORTEACHERS Jamie is 17. He is lonely and scared. He is suffering from anorexia. For a long time he felt in control of his body, his food intake and his hunger. Now his eating disorder controls him. Yes he likes being thin but he yearns to be better. Now he can‟t stop. He arranges his life around every morsel he eats. He must eat alone and anyway its difficult to be with people so he avoids every social situation. His psychologist thinks its because he was bullied in primary school. “I hate that fat child”.
EATING DISORDERS – A RESOURCE FOR TEACHERS Eating Disorders are • Not a form of dieting • Not “all about food” • Not a phase • Not a choice (http://www.bodywhys.ie) Image: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS Eating Disorders • Are a very serious and complex mental disorder : • Can be fatal • Effect males and females • Are about unmanageable feelings • Are a coping strategy • Begin mostly in adolescence Image: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS • BUILIDING RESILIENCE • DETECTIONEating Disorders at School • SUPPORT • INTERVENTIONS Image: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS Dynamic mental health policy Mental Health Programme integrated into curriculumFosteringresilience Fostering positive mental health attitudes and behaviours Modelling inclusiveness Promoting self-awareness, resilience and autonomy http://www.mentalhealthireland.ie/mental-health-matters-othermenu-58 Image: istockphoto.com Hands holding Seedling (00433167.jpg
EATING DISORDERS – A RESOURCE FOR TEACHERS An Effective Mental Health Strategy : • Promotes positive caring relationships • Promotes students emotional development fostering tolerance and resilience • Improves ability to cope with adversity • Creates a positive school environment socially and educationally • Increases learning achievements and expectations (Buckley et al 2009)Image: Ian Kahn / FreeDigitalPhotos.net With Friends
EATING DISORDERS – A RESOURCE FOR TEACHERS Being informed Detectin g the An awareness of potential triggers signs Understanding symptoms and signsImage: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERSCauses aremultifactori Geneticsal and Familial personality factors Social and Cultural Eating Disorders
EATING DISORDERS – A RESOURCE FOR TEACHERSTRIGGERSDURING CHALLENGESADOLESENC exams,E relationships LIFE TRANSITIONS TRAUMAS social, emotional bereavement and developmental family break-up, bullying, abuse EATING DISORDERS
EATING DISORDERS – A RESOURCE FOR TEACHERS ANOREXIA Skewed relationship with food NERVOSA Refusal to maintain body weightcharacteristics Body starved of vital nutrients Irrational appraisal of body shape and food intake Distorted thinking
EATING DISORDERS – A RESOURCE FORTEACHERS Food Restriction Feeling of control Weight Loss – Distorted body Reinforces image worsens behaviour Anorexia Cycle of Self-Abuse Malnutrition Stomach sustains shrinks and fixated beliefs protrudes Fear of fatness Distortions reinforced
EATING DISORDERS – A RESOURCE FOR TEACHERS • Low blood pressure/poor circulation – heart failure • Dry thinning hair/skin Physical effects of • Lanugo hair on face and body Anorexia • Fatigue/restlessness • Loss of fertility • Osteoporosis • Cognitive dysfunctionImage: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS • Weight loss • Avoidance of eating with others • Breaking food into small pieces and other Anorexia – signs in rituals school • Using bathroom after eating • Social isolation • Not performing to potentialImage: istockphoto.com Hands holding Seedling (00433167.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS BULIMIA Recurrent episodes of binge eating NERVOSA A sense of lack of control while bingingcharacteristics Compensatory vomiting, laxatives, exercise, fasting etc Distorted thinking Self-worth influenced by weight
EATING DISORDERS – A RESOURCE FOR TEACHERS • Tiredness, insomnia • Calluses on fingers Physical effects of • Husky voice, mouth ulcers, Bulimia tooth erosion, gum disease • Irregular periods, fertility problems • Osteoporosis • Depletion of electrolytes – potential heart failureImage: istockphoto.com Hands holding Seedling (00433167.jpg
EATING DISORDERS – A RESOURCE FOR TEACHERS • Preoccupied with dieting • Constantly concerned with Psychological Effects weight, shape, size of Bulimia • Volatile, irritable • Self-loathing, guilt, shame • Feelings of being „out of control‟ • DepressionImage: istockphoto.com Hands holding Seedling (00433167.jpg
EATING DISORDERS – A RESOURCE FOR TEACHERS • Low mood / low energy • Decreased concentration • Calluses on fingers / tooth decay Bulimia – signs • Alternating dieting / over-in school eating • Use of bathroom directly after eating • Preoccupation with foodImage: istockphoto.com Hands holding Seedling (00433167.jpg
EATING DISORDERS – A RESOURCE FOR TEACHERS SUPPORT • Observe signs, note concerns • Don‟t overact or alarm studentWhat to • Advise counsellordo? • Be supportive, empathic, and caring • Avoid judgement/blame • Avoid comments related to appearance Image: Microsoft (00422532.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS SUPPORT• Effective communication Helping the student with• Supportive/safe an Eating environment Disorder• Facilitate needs eg. need to eat alone, avoid canteen etc• Tolerance of symptoms• Limit opportunities for bulimic behaviours Image: iCLIPART Blank Signposts (00449057.jp)g
EATING DISORDERS – A RESOURCE FOR TEACHERSTreatments • Re-feeding to healthy BMI • Family Therapy, Systemic approach • Counselling • CBT, Gestalt, Behavioural Image: istockphoto.com Tree in Meadow (00442826.jpg
EATING DISORDERS – A RESOURCE FOR TEACHERS Teacher/School Counsellor can recommend GP Visit Treatme GP will assess and can nt recommend and/or provide referral to: Services Support Services eg Bodywhys CAMHS Hospital Admission Counsellor/PsychologistImage: istockphoto.com Tree in Meadow (00442826.jpg)
EATING DISORDERS – A RESOURCE FOR TEACHERS Post Primary Resource only. Contains guidelines andresources and runs courses on mental health for teachers MentalHealth Matters, a mental health resource pack for 14 – 18 year olds aims to whichcan be delivered as part of a SPHE programme.Bodywhys works with teachers and students to provide an understanding of eatingdisorders, as well as promoting positive body image amongst young peoplethrough the‘Be Body Positive’ schools programme delivered to class groups.Image: istockphoto.com Tree in Meadow (00442826.jpgImage: istockphoto.com Hands holding Seedling (00433167.jpg)Image: Microsoft (00422532.jpg)Images Other: Authors Own