Eating disorders are psychiatric diagnoses that involve a significant disturbance in the perception of body shape and weight which leads to an abnormal or obsessive relationship with food, exercise, and self-image. Behaviors may include restricting; binge eating; self-induced vomiting; misuse of laxatives, diuretics, and enemas; fasting; and/or excessive exercise. Behaviors may also include obsessive thoughts about body size and shape. This is often manifested by frequent weighing, measuring or other forms of body checking such as body critiquing in the mirror. The most common sign of an eating disorder is that there is a preoccupation with body, food, and comparisons with others. This results in a reduced ability to focus on other aspects of life.
Eating disorders of every kind affect all sizes, ethnicities, genders, and ages. No one can determine the type of eating disorder someone may have based on his/her size. Restricting behaviors are characterized by the refusal of or significant difficulty to regularly eat an adequate amount of food to support the body’s ongoing needs. Rigid counting of calories, measuring food, or cutting out certain types of food are typical patterns of an eating disorder. Binge eating is characterized by the consumption of large volumes of food in a short amount of time. Deprivation due to restricting types of or amounts of food leads to ravenous hunger and is a common trigger for a binge. It is common for all individuals with eating disorders to experience an intense focus on weight loss and fear of gaining weight; a denial of the seriousness of the eating disorder; and a dismissal of a number of physical symptoms of malnutrition. Disordered eating in all forms can affect all areas of a person’s life. Disordered eating includes psychological restriction of food (i.e. eating a certain type/amount of food without giving oneself psychological permission to eat, thus feeling intense guilt or shame after eating) or a scarcity mindset around food (i.e. “This is the last time I’m going to eat this food”).
Depression, anxiety, perfectionism, obsessive compulsive disorder, a high need for control, substance abuse, and a history trauma often accompany these disorders. An individual with an eating disorder often struggles with emotional regulation and uses eating disorder behaviors to cope with emotions or to numb. In addition, significant physical complications often occur. If a student is unable to make changes to improve their physical and emotional health on an outpatient basis, the student may need to leave school and enter intensive treatment.
Some of the symptoms associated with eating disorders are chest pain or heart pounding; bloating, diarrhea, gas, or constipation; an irregular or absent menstrual cycle; temperature regulation problems; thinning or dry hair; dry skin; sensitive teeth; muscle cramps/weakness; headaches; dizziness; tingling in the extremities; the inability to concentrate; poor memory; chronic fatigue; decreased strength of immune system and susceptibility to illness; bruising easily; poor wound healing; an ongoing preoccupation with food and/or body shape and size that dominates the student’s life; extreme moodiness; excessive vulnerability to stress; tendency to socially withdraw; repetitive injuries and pain from compulsive/excessive exercise; and extreme rigidity.
When you suspect a student may have an eating disorder:
DO1. When possible, speak to the student in private.
2. Be supportive and express your concern about the student’s emotional and physical health. Provide specific examples of behaviors or symptoms that are of concern.
3. Accept that your concerns may be met with some denial and defensiveness, especially if the student is not yet ready to change or give up the eating disorder as a way of coping.
4. Refer the student to Counseling and Psychological Services (801.422.3035) for consultation and information about individual counseling, and the eating disorder and body concerns treatment groups; and refer the student to Women’s Services and Resources for information about the New C.H.A.P.T.E.R. (Change, Hope, and Peace Through Eating Recovery) Support Group.
5. Consult with Counseling and Psychological Services (801.422.3035) if you want advice on how or when to intervene with a student.
6. Consider encouraging the student to meet with a physician, dietitian and therapist who specialize in eating disorders.
7. Refer the student to an eating disorder clinic.
DON’T1. Reassure a student that his/her obsessions are normal and therefore nothing to worry about.
2. Scare the student into changing or getting help. With eating disorders, fear seldom motivates change.
3. Encourage dieting, calorie counting or measuring food, as individuals with eating disorders typically hyper focus on numbers and benefit from getting away from numbers.
4. Make positive or negative comments about body size or shape or changes in a student’s weight. Since a number of factors influence weight shifts, you cannot determine someone’s health based on what their weight is doing. If you suspect an eating disorder, express concerns by focusing on what you have noticed about emotions or eating or exercise behaviors--not weight, as these comments (positive or negative) may escalate disordered thinking or behavior, or encourage a hidden disorder.
5. Comment on food habits directly if you notice binge eating. This can further drive a student into shame and secrecy about their eating habits. Instead, focus on asking how they are doing emotionally and how they feel about themselves. If they bring up frustrations with body size or food habits, you can gently ask if they have considered seeking professional help to work on their emotional relationship with food and body.
6. Compare body sizes.
7. Act as the food police, since this can further drive someone into eating disorder behaviors.
8. Make comments about diets or moral statements about food (i.e. “good” or “bad” foods, “junk” or “clean” foods, “healthy” or “unhealthy” foods).
9. Make jokes about eating disorders or about fat people to students.
Other Resources/Suggested Reading:
National Eating Disorders Association https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf
Intuitive Eating 4th edition, Evelyn Tribole, MS, RDN and Elyse Resch, MS, RDN
Intuitive Eating Workbook, Evelyn Tribole, MS, RDN and Elyse Resch, MS, RDN
The Body Image Workbook, Thomas Cash, PhD
Mindful Eating, Jan Chozen Bays, MD
Anti-Diet, Christy Harrison, MPH, RD