Educating Educators about

EDUCATING EDUCATORS ABOUT EATING DISORDERS

Dr. Stephanie CaseyJuly 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 VTM – will be published in 2013

- 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– Bradycardia and

hypotension– Sudden death – arrythemia– Mitrol valve prolapse

Dermatological– Dry skin– Thinning dry hair– Lanugo hair– Starvation associated

Puritis

Gastrointestinal– Constipation– Hepatitis

Endocrine/Metabolic– Amenorrhea– Infertility– Osteoporosis– Cold intolerance– Hypothyroidism– Hypoglycemia– Arrested growth

Hematologic– Pancytopenia– Decreased ESR

Neurologic– Cerebral Atrophy

Pulmonary– Respiratory Failure



MinnesotaSemi-Starvation Experiment

November 1944 – December 1945Ancel Keys



Effects of Purging on the Body

Gastrointestinal– Dental Erosions– Parotid Gland

Swelling– Esophageal Rapture– GE Reflux– Constipation– Cathartic Colon– Mallory Weiss Tear

Pulmonary– Aspiratin

pneumonitis

Cardiac– Arrthythmias and

Sudden Death– Cardiomyopathy

Endocrine– Irregular menses

Metabolic– Hypokalemia– Dehydration– Neprhropathy– 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)



What might place a child more at 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.



Questions?

Educating Educators about

Documents

Transcript of Educating Educators about