National School Counseling Week

~ by Sina King-Smith, MS, M.Ed., RDN, LD (she/her/hers)

It’s National School Counselor Week and in honor of this week, let’s take a look at how school counselors can support students with eating disorders, common signs and symptoms of disordered eating and eating disorders, as well as resources that may help along the way.

Let’s first consider that eating disorders in adolescents are the result of several complex genetic, psychological, and social factors rather than a singular root cause. Current research has shown that the COVID-19 pandemic has further exacerbated both the development of eating disorders and the worsening of previously diagnosed eating disorders in adolescents largely due to factors such as disruption in regular routines, increased financial insecure, and overconsumption of eating disorder-promoting media to name a few (Rodgers et al., 2020). It’s important to note that secrecy and denial commonly accompany eating disorders in adolescents which is of large concern because denial and secrecy can not only exacerbate symptoms but prolong maladaptive eating behaviors and the time it takes to seek treatment (Buser, 2012).

Signs & Symptoms

School counselors can be well equipped and attuned to recognize concerning signs and symptoms in their student population most at risk for developing disordered eating and eating disorders (Buser, 2012). Social factors can play a large role in the development of eating disorders. There are several different aspects which can shape an adolescent’s social experiences and subsequent risk of eating disorder development. Weight stigma, bullying related to weight, and cultural fixation and perpetuation of the “thin ideal”—or the concept that smaller bodies are inherently better—are all incredibly prominent risk factors which increase the likelihood of an eating disorder developing. Social isolation and poor familial or social support also have a strong correlation with eating disorder risk, which may be linked to mental health disorder predisposition as well. Furthermore, the Westernization of modern media—and the subsequent onslaught of media promoting traditional Western beauty standards—is shown to have sparked an increase in eating disorder prevalence not only in America, but in countries all around the world (CEDO, 2021).

There are a variety of psychological risk factors which may place adolescents at a higher risk for the development of an eating disorder. One of the strongest psychological risk factors for the development of an eating disorder is a self-reported history of perfectionism and setting unrealistically high standards for oneself in multiple areas of life. A personal history of “behavioral inflexibility,” or an extreme need to “follow the rules” as both a child and later as a teenager is also associated with higher instances of disordered eating. Additionally, it has been found that there is a strong correlation with eating disorders and signs of anxiety disorders and obsessive-compulsive disorder even before an eating disorder manifests. This suggests that having such disorders is another psychological factor which may cause an adolescent to develop a disordered eating pattern (CEDO, 2021).

One of the most well-studied categories of eating disorder risk factors is those that are biological in nature. Several studies have suggested that certain genetic and/or physiological factors may predispose an individual to be more likely to develop an eating disorder. For example, having an immediate family member with an eating disorder or mental health condition greatly increases one’s risk for developing an eating disorder, particular in the case of both anorexia nervosa and bulimia nervosa (Mazzeo & Bulik, 2009). Having a mental health condition (such as anxiety or depression) regardless of family history also increases the likelihood of disordered eating tendencies. A history of dieting attempts and long-term negative energy balance (or chronically consuming less calories than you body needs on a daily basis) has been strongly linked with the later development of eating disorders as well (CEDO, 2021).

Other warning signs may include skipping lunch, secrecy around eating, using the bathroom immediately after eating, frequent attempts at dieting, preoccupation with weight, food and body image, preoccupation with exercise, reported fatigue or dizziness, calluses on the back of the hands and knuckles from self- induced vomiting, and reported feelings of disgust, depression and low self-esteem (CEDO, 2021).

Resources

School counselors can be an essential resource in both preventative and active interventions specific to eating disorders. Several studies have found preventative programs are beneficial to students if they are created carefully and intentionally with information that asks students to engage via homework, writing prompts that promote cognitive dissonance, and group discussion (Buser, 2012). Topics helpful to include in preventative programing include discussing the “thin-ideal,” educating students on the dangers of restriction, and skills building that assists with changing behaviors and ED related attitudes (Buser, 2012).

Students in need of active treatment and intervention can also be supported by school counselors. School counselors can support the student and their family with seeking outside professionals such as outpatient or inpatient treatment, family therapy, and individual therapy to name a few. Additionally, collaboration and consultation may be needed if a student is engaging in sub-clinical eating disorder behaviors such as dieting, restriction, weight control behaviors, body image concerns and more. Working with a multidisciplinary team of clinicians (including physicians, dietitians, etc.) is the best approach when working with students exhibiting sub-clinical eating disorder concerns (Buser, 2012).

Resources exist for school counselors to support students with disordered eating and eating disorders. Check out the following topics and links to learn more about:

– ANAD (www.anad.org) publishes school guidelines that they will make available via email.

– Maudsley Parents (www.maudsleyparents.org). This website for parents of eating-disordered children provides support and a great deal of information about Family-Based Therapy.

– Families Empowered and Supporting Treatment of Eating Disorders (FEAST) (www.feast-ed.org). FEAST is an international nonprofit organization of parents and caregivers designed to help loved ones recover from eating disorders by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders.

– Around the Dinner Table (www.aroundthedinnnertable.org) is a support forum for parents and caregivers of anorexia, bulimia and other eating disorder patients.

– Academy for Eating Disorders (www.aedweb.org). The AED is the main international scientific body for the study and prevention of eating disorders. It provides professional training to therapists as well as education and information LAUREN MUHLHEIM, PSY.D.: Addressing Eating Disorders in Middle and High Schools / page 8 about eating disorders research, prevention, and clinical treatments.

– Help Your Teenager Beat an Eating Disorder, James Lock, M.D., Ph.D. and Daniel Le Grange, Ph.D. (2005). This book for parents includes a comprehensive overview of the Maudsley (family based therapy) approach to treatment.

– Eating Disorders Guide to Medical Management, 2nd Edition. This brief set of guidelines is designed to enhance early recognition of eating disorders by front line professionals and improves the quality of the initial assessment and medical management of individuals with eating disorders.

(* These resources were compiled and published by Lauren Muhlheim, Psy.D., CEDS)

References

1. Mazzeo, S. E., & Bulik, C. M. (2009). Environmental and genetic risk factors for eating disorders: What the clinician needs to know. Child and Adolescent Psychiatric Clinics of North America, 18(1), 67–82. https://doi.org/10.1016/j.chc.2008.07.003
2. CEDO. (2021). How to know if you have an eating disorder. Retrieved from https://www.allianceforeatingdisorders.com/8-signs-you-may-have-an-eating-disorder/
3. Rodgers, R. F., Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller‐Tyszkiewicz, M., Linardon, J., Courtet, P., & Guillaume, S. (2020). The impact of the COVID‐19 pandemic on eating disorder risk and symptoms. The International Journal of Eating Disorders, 10.1002/eat.23318. https://doi.org/10.1002/eat.23318
4. Buser, J. K. (2012). The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents. VISTAS Online. Retrieved from https://www.counseling.org/docs/default-source/vistas/the-school-counselor-s-role-in-addressing-eating-disorder.pdf?sfvrsn=f1ab2b7e_14