2. EATING DISORDERS â A RESOURCE FOR
TEACHERS
This is a resource to support
teachers who work with adolescents
some of whom may be affected by an
eating disorder
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3. EATING DISORDERS â A RESOURCE FOR
TEACHERS
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 canât 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. âI hate that fat
childâ.
4. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Eating Disorders are
⢠Not a form of dieting
⢠Not âall about foodâ
⢠Not a phase
⢠Not a choice
(http://www.bodywhys.ie)
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5. EATING DISORDERS â 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
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6. EATING DISORDERS â A RESOURCE FOR
TEACHERS
⢠BUILIDING RESILIENCE
⢠DETECTION
Eating Disorders at School ⢠SUPPORT
⢠INTERVENTIONS
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7. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Dynamic mental health policy
Mental Health Programme integrated into
curriculum
Fostering
resilience Fostering positive mental health
attitudes and behaviours
Modelling inclusiveness
Promoting self-awareness, resilience and
autonomy
http://www.mentalhealthireland.ie/mental-health-matters-othermenu-58
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8. EATING DISORDERS â 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)
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9. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Being informed
Detectin
g the An awareness of potential triggers
signs
Understanding symptoms and signs
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10. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Causes are
multifactori Genetics
al and
Familial personality
factors
Social
and
Cultural
Eating Disorders
11. EATING DISORDERS â A RESOURCE FOR
TEACHERS
TRIGGERS
DURING CHALLENGES
ADOLESENC exams,
E relationships
LIFE
TRANSITIONS TRAUMAS
social, emotional bereavement
and developmental family break-up,
bullying, abuse
EATING
DISORDERS
12. EATING DISORDERS â A RESOURCE FOR
TEACHERS
ANOREXIA Skewed relationship with food
NERVOSA
Refusal to maintain body weight
characteristi
cs
Body starved of vital nutrients
Irrational appraisal of body shape and food intake
Distorted thinking
13. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Food
Restriction
Feeling of
control
Weight Loss â
Distorted body
Reinforces
image worsens
behaviour
Anorexia
Cycle of
Self-Abuse
Malnutrition Stomach
sustains shrinks and
fixated beliefs protrudes
Fear of fatness
Distortions
reinforced
15. EATING DISORDERS â A RESOURCE FOR
TEACHERS
⢠Low blood pressure/poor
circulation â heart failure
⢠Dry thinning hair/skin
Physical effects of ⢠Lanugo hair on face and body
Anorexia ⢠Fatigue/restlessness
⢠Loss of fertility
⢠Osteoporosis
⢠Cognitive dysfunction
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16. EATING DISORDERS â A RESOURCE FOR
TEACHERS
⢠Weight loss
⢠Avoidance of eating
with others
⢠Breaking food into
small pieces and other
Anorexia â signs in rituals
school ⢠Using bathroom after
eating
⢠Social isolation
⢠Not performing to
potential
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17. EATING DISORDERS â A RESOURCE FOR
TEACHERS
BULIMIA Recurrent episodes of binge eating
NERVOSA
A sense of lack of control while binging
characteristi
cs
Compensatory vomiting, laxatives, exercise, fasting etc
Distorted thinking
Self-worth influenced by weight
18. EATING DISORDERS â 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 â
potential heart failure
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19. EATING DISORDERS â 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 âout of
controlâ
⢠Depression
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20. EATING DISORDERS â A RESOURCE FOR
TEACHERS
⢠Low mood / low energy
⢠Decreased concentration
⢠Calluses on fingers / tooth
decay
Bulimia â signs ⢠Alternating dieting / over-
in school eating
⢠Use of bathroom directly
after eating
⢠Preoccupation with food
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21. EATING DISORDERS â A RESOURCE FOR
TEACHERS
SUPPORT
⢠Observe signs, note
concerns
⢠Donât overact or alarm
student
What to ⢠Advise counsellor
do?
⢠Be supportive, empathic,
and caring
⢠Avoid judgement/blame
⢠Avoid comments related
to appearance
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22. EATING DISORDERS â 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
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23. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Treatment
s ⢠Re-feeding to healthy
BMI
⢠Family Therapy,
Systemic approach
⢠Counselling
⢠CBT, Gestalt,
Behavioural
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24. EATING DISORDERS â 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/Psychologist
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25.
26. EATING DISORDERS â A RESOURCE FOR
TEACHERS
Post Primary Resource only. Contains guidelines and
resources and runs courses on mental health for teachers
Mental
Health Matters, a mental health resource pack for 14 â 18 year olds aims to which
can be delivered as part of a SPHE programme.
Bodywhys works with teachers and students to provide an understanding of eating
disorders, as well as promoting positive body image amongst young people
through theâBe Body Positiveâ schools programme delivered to class groups.
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Images Other: Authors Own
Hinweis der Redaktion
Introduction. My name is Elizabeth Swords. I work as a volunteer with Bodywhys, the National Association for Eating Disorders (EDâs). This resource is a starting point for teachers to access basic information to support students with EDâs. 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 EDâs to begin with:
The presentation will outline the four key areas necessary to effectively support those with EDâs 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 studentsâ 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 lifeâs adversities. The link Mental Health Matters, a mental health resource pack for 14 â 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 EDâs 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. EDâs 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 EDâs 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 Havinghurstâs 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 EDâs in a school environment. Awareness includes understanding EDâs, 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 EDâs 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.
EDâs 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.