Anorexia : The Disappearing Student

1. Anorexia: The Disappearing Student Presenters: Sally, Jennifer, Farisha, Cindy

2. Eating disorders have been defined as “behavioural solutions to psychological conflicts that produce medical complications” • Shocking statistic, in B.C., 52% of teenage girls are trying to loose weight • Females focus their critical attention from the waist down • 27% of male students are trying to gain weight (reverse anorexia) • Males focus on body shape and dislike their upper bodies BCTF Research Report

3. Myth or Fact? • What media presents is a real picture of our culture. • Anybody can be slim. • Slender people are happier and more successful. • People who are overweight become and remain so because they eat excessively and lack self-control. • Being overweight is a health hazard. http://www.bced.gov.bc.ca/specialed/edi/8.htm#Reflection2

4. What is body image? • how a person feels about the way she or he lookswww.womenshealthzone.net/glossary/b/ • The way we view our physical appearance, which is based on a set of complex ideas, judgements and attitudeshttp://www.counsellingchangeslives.com/body-image.html NEGATIVE BODY IMAGE • You feel uncomfortable and awkward in your bodyhttp://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/BodyImag.pdf • You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/BodyImag.pdf

5. What is Anorexia Nervosa? • Serious emotional problem • Voluntary starvation • Excessive weight loss • Fear being “fat” • They feel “fat” despite the weight loss • Strong need for control

6. Physical expression of the underlying emotional distress…is it too late? http://www.ifashion.co.za/index.php?option=com_content&task=view&id=1209&Itemid=261 http://topnews.com.sg/content/23234-anorexia-very-prevalent-disease-even-among-middle-aged-women

7. The Distorted Self Perception of an Anorexic The reality of the situation is very different than what appears in front of the anorexic. The reflection that they see is one that disgusts the anorexic. A frail, skeleton sees an obese exaggeration standing before them. http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=12049

8. Symptoms and Characteristics • Depression, irritability, low sense of self worth • Low energy levels • Anemia • loss of 3 consecutive menstrual cycles • Thinning or loss of hair • Lanugo: growth of downy body hair • Organ damage • Dry, flakey skin • Osteoporosis

9. http://www.wellsphere.com/wellpage/causes-of-eating-disordershttp://www.wellsphere.com/wellpage/causes-of-eating-disorders

10. Causes of Anorexia Nervosa Environment Highly stressful homes Participate in highly competitive activities such as ballet Experience Sexual or other abuse Significant loss such as death Extreme dieting - Changes how the brain and metabolism work which stresses the body Genetics - Have a family history of an eating disorder, obesity or a mood disorder Personality - Certain personality traits such as low self-confidence, perfectionism, achievement- orientation http://www.healthlinkbc.ca/kb/content/major/hw46497.htmlhttp://www.bced.gov.bc.ca/specialed/edi/3.htm

11. Anorexia Nervosa Treatment • Initial treatment • Help of a team that includes a mental health professional, medical health professional, a registered dietician • Behavioural family therapy • Medical treatment • Nutritional counselling • Family therapy http://www.healthlinkbc.ca/kb/content/major/hw46497.html#aa32555

12. Anorexia Nervosa Treatment Ongoing treatment - Psychological counselling - Medical treatment - Nutritional counselling If condition worsens - Treating starvation - Nutritional rehabilitation http://www.healthlinkbc.ca/kb/content/major/hw46497.html#aa32555

13. Activity When reading the following cases, consider: • Which students do you think have potential eating disorders? • What warning signs have been observed?

14. Wendy is a quiet, mildly overweight 16-year-old who struggles to maintain passing grades. Although she does not participate in a lot of extracurricular activities, she does spend her lunch time with her steady boyfriend and a couple of close friends. Recently, she joined Weight Watchers with her mother, pledging to lose 10 pounds by the summer, and has taken up jogging with her friends at lunch. • Michelle is a quiet, hardworking 12-year-old in an enrichment class. Her parents are both working professionals who recently divorced. Although Michelle has always had a small build, she seems to be getting thinner. You have noticed that her lunch usually consists of a diet bar with some carrot or celery sticks. Michelle rarely joins the other students at lunch, preferring to stay at her desk to “get a head start” on her homework. • Dale is a quiet 14-year-old boy who is never a problem in class. He favors a “punk” hairstyle, with colours that can change from day to day. He usually wears several layers of loose fitting shirts and jackets, although he is clearly very thin underneath it all. Dale is interested in art, and often produces work depicting scenes of violence or death. You have noticed that he usually eats his lunch by himself, quietly tucking himself away in a corner somewhere to read a muscle magazine.

15. Can you tell who’s a victim of anorexia? The truth is, that this disorder is hard to detect until it’s in a critical stage

16. What anorexia looks like in the classroom • Changes in weight, or that height is not changing • Oversized clothing • Touching different parts of body • Concern over weight or shape • Multiple layers of clothing or standing around the heater

17. Change eating habits: • Skip school meals • Restrict food intake • Schedule classes or other activities during lunch • Fruits and vegetables only • Low-fat or “healthy” foods switch • Count calories http://www.yogadork.com/news/study-yoga-kicks-eating-disorders-body-obsession/

18. Complain of food allergies • Avoid food and eating in social situations • Chew gum or drink water excessively http://avitalik.deviantart.com/art/Anorexia-Nervosa-2-70806477

19. Use other means to lose weight: • Excessive exercise • Exercise when ill or injured, and appear overly competitive • Leave eating settings • Diuretics and laxatives • Dizzy or faint • Come to attention of schools first aid officer first

20. Psychological WARNING signs • Strong drive for perfection and control • Low self-opinion • Approval of others • Stubbornness • Strong work ethic • Pessimistic • Appear to be model student http://www.examstudytips.com/

21. As the eating disorder progresses… • Academic performance and work ethic declines • Decreased cognitive functioning • Difficulty dealing with stress • Moody • Socially withdrawn • Depressed, tired, distracted, fidgety, unmotivated

22. Middle and high school years are the critical ones. http://damncoolpics.blogspot.com/2008/08/horrors-of-anorexia.html

23. Videohttp://www.youtube.com/watch?v=zIFAoRU1veo • An alternate view • When we think of anorexia, we often have a bias that t only affects women, but the truth is that men are not immune from this disorder.

24. Risk factors for Males •Homosexuality and bisexuality •Involvement in weight-restricted sports • Media and its portrayal of what a man should look like http://aldhinmatters.wordpress.com/2009/09/03/anthologie-de-la-dg/

25. Activities in the Classroom • Facilitate a discussion on what it means to be ‘healthy’ and afterwards, allow the students to reflect on their definition. • Have students bring in magazines and allow them to analyze how the people in the magazine are portrayed.

26. Teaching Strategies - Suspicion • Express concern to the student and a willingness to help. • Observe, describe and document behaviours of concern across times and settings. • Consult with the school-based team regarding referral to other experienced professionals for a thorough assessment.

27. Teaching Strategies – Diagnosed • Meet with the parents, the student and the professional treatment staff to help determine how best to meet the individual needs of the student. • Examine and reflect on personal attitudes about body image, weight, and shape. Maintain zero tolerance of appearance-based jokes, taunts and harassment. • Help student with his or her transition back into the classroom by maintaining open lines of communication.

28. Meeting with the Parents/Family

29. Meeting the Parents • When approaching parents/families, always ask if it’s a convenient time to talk, and then schedule a time. • Show empathy and support. Listen to what the family member says without interrupting, judging, or making promises. • Begin by letting the parents/family know you’re concerned and offer specific, factual observations.

30. Examples “We are concerned about (student’s name) because of some behaviours we’ve noticed recently. Specifically, he/she has been keeping to himself/herself a lot and has been unfocused in class. I was wondering if you had any concerns or noticed anything recently.” “We are concerned about (student’s name) because of some comments we’ve heard him/her make about himself/herself recently. We heard a (student’s name) make a lot of comments about feeling unhappy about his/her weight, appearance, etc. I was wondering if you had concerns or noticed anything recently.”

31. “Don’ts” • Don’t oversimplify. • Don’t diagnose! • Don’t become the person’s therapist, saviour or victim. • Don’t get into an argument or a battle of wills. If the person denies having a problem calmly repeat what you have observed, repeat your concerns and leave your door open for future conversations. • Don’t imply that eating disorders are about food, weight and body size.

32. Disturbing Reality Check! • There are many websites online that can easily be accessed by young women and men that promote anorexia • These support sites give ideas to vulnerable teens on how to achieve the “perfect” body size • These sites/blogs go by the Pro-Ana • Dying to be thin, http://anaregzig.blogspot.com/

33. QUESTIONS?

34. References: BCTF Research Report:http://bctf.ca/uploadedFiles/Publications/Research_reports/report(2).pdf National Eating Disorders (NEDA) http://www.nationaleatingdisorders.org/index.php Teen Eating Disorders http://www.teeneatingdisorders.us/ Manley R, Rickson H, Standeren B. Children and Adolescents with Eating Disorders: Strategies for Teachers and School Counselors. Intervention in School and Clinic. March 2000; 35(4):228.  Available from: Education Research Complete, Ipswich, MA. http://www.bced.gov.bc.ca/specialed/edi/welcome.htm Seeing the Signs: Recognizing Eating Disorders in Your Students (Cover Story). Education Update, May 2010, Vol. 52 Iss.5, p.1-5. Understanding and Managing Eating Disorders in the School Setting. Hellings, Bride; Bowles, Terry. Australian Journal of Guidance & Counselling. Jul 2007, Vol 17 Iss.1, p.60-67. Bulimia Hope http://www.bulimiahope.com/bulimia-treatment/swollen-glands-bulimia/ http://t1.gstatic.com/images?q=tbn:ANd9GcSF-B0rrznLYCGJ39_btGYevzHVsqZlrUwBE6IC1VbqP8PDJA&t=1&usg=__fwylUlNmQ52NaFWvwWi8jpzfqO8= http://t2.gstatic.com/images?q=tbn:ANd9GcTE9fyyyaaFtp_Hre649rG22ZIVigsA8kwTISvhGWw42gcsEj4&t=1&usg=__RFtCE5xnqVTjfKjPRy-JN241r1M= www.nationaleatingdisorders.org http://www.pbs.org/wgbh/nova/teachers/activities/2715_thin.html#procedure http://kidshealth.org/classroom/9to12/problems/conditions/eating_disorders.pdf