Educating Educators on Eating Disorders

EDUCATING EDUCATORS
ABOUT EATING
DISORDERS

Dr. Stephanie Casey
July 2012
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health

Eating Disorders are
serious mental illnesses
with devastating
psychological and
physical consequences.


Goals for Today

1. Achieve a realistic awareness of eating
disorders.
2. Identify early warning signs.
3. Discuss strategies to support students
with eating disorders and their families.


Why is it so important to
properly assess and
diagnose eating
disorders?


• 3rd most common chronic illness in
adolescent females
• Incidence of up to 5% - 1% AN, 4% BN
• 80% onset before age 20
• Rate dramatically increasing over past 3
decades
• Highest mortality rate of any psychiatric
disorder, either by medical complications
or suicide
• Now estimated that 10-20 % occur in males
and the rate appears to be increasing.


ANOREXIA

BULIMIA


Diagnostic and Statistical Manual of Mental Disorders
CLASSIFICATION SYSTEM
(published by American Psychiatric Association)

DSM ITM – 1952 – initial emphasis was to
gather statistical information for research
purposes.
60 disorders – 1 E.D. – Anorexia Nervosa

DSM IVTM – 1994 – 200 disorders – Anorexia
Nervosa, Bulemia Nervosa, Eating Disorder
Not Otherwise Specified (B.N. only
determined to be a mental illness in 1979)


Current Edition – 2000 – DSM-IV-TRTM
(text revision)
Binge Eating Disorder is a provisional disorder

DSM V – will be published in 2013
TM

- still evolving


Anorexia Nervosa (AN)
• A refusal to maintain body weight above
85% of that expected.
• Intense fear of gaining weight.
• Disturbance of the experience of one’s
body weight or shape.
• Amenorrhea, or the absence of three
consecutive menstrual cycles.


Anorexia Nervosa (AN)
Subtypes
• Restricting Type – Person has not regularly
engaged in binge eating or purging
behaviour (ie. Self-induced vomiting or
misuse of laxatives, diuretics).
• Binge Eating/ Purging Type – Person has
regularly engaged in binge eating or purging
behaviour.


Bulimia Nervosa (BN)
• Recurrent episodes of binge eating
• Large amount of food
• Loss of control
• Compensatory behaviour
• Twice a week for three months
• Evaluate self by body image


Bulimia Nervosa (BN)
Subtypes
• Purging Type – Regularly engages in self-
induced vomiting or the misuse of
laxatives/ diuretics.
• Non-purging Type – Uses other
inappropriate compensatory behaviours
such as fasting or excessive exercise.


Eating Disorder Not Otherwise
Specified (EDNOS)

Disorders of eating that do not meet the
criteria for any specific Eating Disorder


85% of patients assessed in specialty
clinics (including IWK Health Centre)
are diagnosed with ED NOS


Being diagnosed ED NOS does
not mean you are less ill than
patients diagnosed with AN or
BN!


Assessment

Most of the signs and symptoms
seen in eating disorders are the
effects of severe starvation,
chaotic eating or purging on the
brain and body.


Effects of Starvation on the
Brain

• Low mood
• Decreased motivation, decreased energy, lethargy
• Isolating, lack of interest in others
• Irritability
• Obsessive, stuck thinking
• Constant thinking about food
• Decreased memory and decreased concentration
• Behaviours such as cutting food into tiny pieces,
small bite sizes, binging behaviours


Effects of Starvation on the Body
Cardiovascular Endocrine/Metabolic
– Bradycardia and hypotension – Amenorrhea
– Sudden death – arrythemia – Infertility
– Mitrol valve prolapse – Osteoporosis
Dermatological – Cold intolerance
– Dry skin – Hypothyroidism
– Thinning dry hair – Hypoglycemia
– Lanugo hair – Arrested growth
– Starvation associated Puritis Hematologic
– Pancytopenia
Gastrointestinal – Decreased ESR
– Constipation Neurologic
– Hepatitis – Cerebral Atrophy
Pulmonary
– Respiratory Failure


Minnesota
Semi-Starvation Experiment

November 1944 – December 1945
Ancel Keys


Effects of Purging on the Body
Gastrointestinal Cardiac
– Dental Erosions – Arrthythmias and
– Parotid Gland Sudden Death
Swelling – Cardiomyopathy
– Esophageal Rapture Endocrine
– GE Reflux – Irregular menses
– Constipation Metabolic
– Cathartic Colon – Hypokalemia
– Mallory Weiss Tear – Dehydration
Pulmonary – Neprhropathy
– Aspiratin pneumonitis – Metabolic alkalosis


WHAT CAUSES AN EATING DISORDER?

WE DON’T KNOW.


We do know 75-80% start with a diet to lose
weight.


What might place a child more at
risk of developing an Eating
Disorder?

GENETIC VULNERBILITY
(the Emma story)


risk of developing and Eating
Disorder?

Individual characteristics, i.e.:
- gender
- anxious or obsessive temperament
- using any unhealthy weight control
measures
- low self-esteem


Disorder?

Family Influence
– encouragement of dieting
– over-focus on physical appearance
– negative attitudes about others who are
overweight
– few structured meals


Disorder?

Peer Influence:
– friends who are dieting
– weight teasing
– competition with friends


Sport and School Influence

Teachers’ and coaches’ attitudes and beliefs
can have a huge influence on students.


Media


Media Literacy

Media images and advertising help to create
and perpetuate social and cultural
definitions of beauty and attractiveness
which provide the context in which we
learn to place value on appearance and the
size and shape of our body.


Teaching our Youth to Become
Media Literate
1. Become a critical consumer of advertising and media
messages. Pay attention to images, messages or attitudes
that give you self-doubt, or make you feel bad about your
body.
2. Voice your opinion and protest the negative images and
messages you see by writing letters to advertisers,
television stations and movie studios.
3. Encourage the media and advertisers to present more
diverse and real images of people that promote positive
messages of beauty, health and self-esteem.
4. Remember that the primary goal of the fashion, cosmetic,
diet, fitness and plastic surgery industries is to make
money, not to help you to reach your fullest potential and
be the best person that you can possibly be.


5. Remind yourself that the print ads you see in magazines are
all photographed with special lighting and then digitally
retouched and enhances in a way that supposedly makes the
products being sold more appealing. When we spend money
trying to make ourselves look like their images, they keep on
making money.
6. Question the motives of these companies and their
advertisers, and make sure the hard-earned money you
spend reflects the person you are, not the person that the
media and advertisers want you to be.
7. Be a role-model to yourself and others. Develop your own
style and celebrate who you are. Break free from the way
our society and culture expects you to look.


Helpful things to remember when talking to
youth suffering with an eating disorder.


The patient views herself and all things
food and exercise related thru a lens
tainted by the eating disorder. When it
comes to food, eating, and weight you are
not dealing with a patient that is rational.


COGNITIVE DISTORTIONS

1. Patient feels good about refusing to eat
because she does it well despite the fact
significant weight loss can be life
threatening.

2. To us it’s a deadly disease, to her it’s a
perfectly healthy diet.


3. The patient views the parents and the
treatment team as the enemy, even though
we are trying to help them fight their
disease. We are forcing them to do the
one thing they are trying to avoid,
eating.


4. No matter how emaciated the patient
becomes, she looks in the mirror and sees
“FAT”.


HEALTHY = FAT


AVOID GETTING
CAUGHT UP IN AN
“ANOREXIC DEBATE”


Remember the patient has an inner critic
with “rules” (as many as 220) and our job is
to help them fight to challenge the eating
disorder rule.


10 THINGS NOT TO SAY
1. You don’t look so bad to me.

2. Wow, you look so healthy.

3. You look like a refugee, AIDS patient, cancer
sufferer.

4. You’re just doing this for attention.

5. But you’re such a pretty girl, you don’t need to do
this.

6. I wish I could have anorexia for a day.

7. I have an eating disorder too – I eat all
the time.

8. If you think you’re fat, you must think I
am obese.

9. If you don’t eat that you’ll have to go to
the hospital and get “the tube”.

10. Why don’t you just eat!
(Let me get a pen and write that down.
I have never heard such good advice)


Don’t talk about weight or
appearance at all.

No calories, No numbers.


10 THINGS TO SAY/DO
1. What can I do to support you?

2. Listen and try to understand.

3. Be caring and concerned.

4. You are thinking so much more clearly.

5. It’s so good to see your sense of humour.

6. Your concentration has really improved.

7. I know it’s hard but “Food is your medicine”.

8. It’s so nice to see more of your personality
coming thru.

9. You think you are in control, but it’s your
eating disorder that’s fully in charge.

10. Remind the patient she is not alone.


Eating Disorder Patients…

• Use the disorder as their default mode of
coping in a maladaptive way.

• Lie about eating disorder behaviours. This
is done out of shame, guilt, and fear and is
a symptom of the disorder, not necessarily
character.


Identifying and Referring At
Risk Students

Rule of thumb:
1. Treat any warning signs seriously.
2. Early intervention may greatly improve
the prognosis.
3. Error on the side of caution.


What Should Educators Do?
1. Keep clear records. There is a good chance
students and parents will react negatively to any
suggestion there is an eating disorder. Your
notes should focus on specific observed
behaviours.
2. Consult with other professionals (i.e. other
teachers, school guidance counsellor,
administrator).
3. Do not be afraid to breech student’s
confidentiality. These illnesses can be fatal!
4. Develop ongoing support strategies.


Support Strategies

The challenge for the classroom teacher is to
provide a supportive and safe learning
environment that does not contribute to
the students’ obsessive attention to food,
weight gain or body image.


Build a Support Network at
Your School

“Case Manager”

- Communicate regularly with the youths
medical treatment team.
- Communicate with parents.
- Ensure restrictions, supports needed are
communicated to appropriate staff.


A Word of Prevention

The research shows that providing presentations to
students about eating disorders – presentations
that inform them about the behaviours, signs,
symptoms, health consequences, etc. are
ineffective in preventing eating disorders and may
actually backfire by glamorizing eating disorders
and teaching students harmful weight loss “tricks”
such as purging and severely restricting food
intake, which they may I turn eperiment with.


It is useful to provide some education about eating
disorders, but it is unnecessary (and potentially
harmful) to go into great detail. The goal in
teaching/presenting on eating disorders should
be to PREVENT eating disorders. To prevent
eating disorders, eating disorders curriculum
should focus on some of the following:
1. Teach children the health hazards of
dieting. Dieting is a risk factor for the
development of an eating disorder, therefore
preventing students from dieting is key in
preventing eating disorders.

2. Teach children respect and tolerance for diversity of
body sizes. Establish a zero tolerance policy on teasing
about body size.
3. Help children identify the conditions in their lives that
contribute to their eating and body image struggles and
assist them in finding their own solutions.
4. Teach children to listen to their bodies; to eat when
they are hungry, stop when they are full, and to eat the
foods that nourish them and give them energy.
5. Teach children to be critical viewers of the media so
that they are better able to resist harmful media messages.
6. Teach children to respect and honor their bodies by not
using diet pills, steroids, or metabolife and teach them why
these substances are harmful.


One last note:
Having someone who has had an eating disorder come
and speak can be very powerful. However it is
important that the speaker not talk about their
behaviours (as they might teach the students
weight loss “tricks”), numbers, calories, their
weight(s), etc. (as some students might fixate on
the numbers and adopt them as their goal
weight/calorie intake, etc.). The speaker should
instead focus on feelings, the experiences that
lead up to the development of the disorder and
the consequences.

Educating Educators on Eating Disorders

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