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Eating disorder intervention, prevention, and treatment: recommendations for school counselors

Professional School Counseling, Dec, 2004 by Angela D. Bardick, Kerry B. Bernes, Ariana R.M. McCulloch, Kim D. Witko, Jennifer W. Spriddle, Allison R. Roest

School counselors are in daily contact with the highest risk group for developing eating disorders--children and adolescents. School counselors are in a position to identify at-risk individuals, implement effective school-based prevention programs, make appropriate referrals, and provide support for recovering individuals. An overview of a theory of recovery for eating disorders reinforces the importance of early intervention.

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Eating disorders need to be taken seriously because they are potentially life-threatening conditions that affect an individual's physical, emotional, and behavioral growth and development, and they may lead to premature death. Eating disorders may be seen as a slow form of suicide because self-starvation is an attempt to destroy one's body. Seemingly innocent dieting, exercise, and weight control behaviors in children and adolescents may lead to dangerous disorders such as anorexia nervosa, bulimia nervosa, muscle dysmorphia, and other disordered eating or exercise behaviors.

Girls as young as 9 years of age are concerned about their weight (Cavanaugh & Lemberg, 1999). Anorexia nervosa affects approximately 2% of the North American population, and bulimia nervosa affects approximately 4%, of which 10% are males (American Psychiatric Association, 2000a). There is a significantly high mortality rate among individuals with eating disorders--more than 12 times higher than any other cause of death in females 15 to 24 years old (Cavanaugh & Lemberg).

Early intervention is crucial to the prevention and recovery of an eating disorder. There is a relatively good prognosis for childhood and adolescent eating disorders if they are treated soon after onset. However, if these disorders are not treated, they may become chronic conditions with devastating physical, emotional, and behavioral consequences (Lask & Bryant-Waugh, 1999).

Eating disorders are of particular concern for school counselors because they are in contact with the highest risk group--children and adolescents. School counselors are in a position to provide early intervention by recognizing at-risk individuals, implementing effective school-based prevention programs, making appropriate referrals, and providing support for students recovering from eating disorders.

The primary eating disorders referred to in this paper are anorexia and bulimia. This paper is divided into two sections and is structured as follows: The first section discusses the implications of eating disorder treatment and intervention for school counselors, with practical suggestions for implementing effective prevention programs in schools, identifying at-risk individuals, and making appropriate referrals. The second section provides an overview of a theory of recovery and a continuum of treatment for eating disorders, including practical suggestions for school counselors to support individuals who may be recovering from an eating disorder.

IMPLICATIONS FOR SCHOOL COUNSELORS

School counselors play a critical role in the prevention and early identification of eating disorders. They are in a unique position to detect students' changing attitudes around food, weight, and body shape; act as role models for students; positively influence a wide range of the at-risk population for developing eating disorders; and convey important messages about healthy behaviors and stress management (Powers & Johnson, 1999; Russell & Ryder, 2001a, 2001b; Smolak, Harris, Levine, & Shisslak, 2001).

An awareness of diagnostic criteria, medical complications, causes, warning signs, and risk factors is important for school counselors; however, knowing what to do when faced with an individual at-risk for developing an eating disorder is imperative. Therefore, it is necessary to discuss the school counselor's role in the prevention, identification, and intervention processes for the treatment of eating disorders.

Prevention of Eating Disorders in Schools

Prevention efforts focus on populations who are at-risk of developing eating disorders, eliminate risk factors, and seek to enhance mental health and well-being (Russell & Ryder, 2001a). However, the danger of current eating disorder prevention efforts in schools is that they may bring undue attention to the signs and symptoms of eating disorders with a limited emphasis on healthy attitudes and behaviors (Russell & Ryder; Steiner-Adair, 1994). Russell and Ryder assert that eating disorder symptomatology should not be addressed in school programs because of the high risk of teaching dangerous eating disordered behavior to impressionable youth. As well, practices such as weighing students, comparing athletic ability, and discussing caloric and fat content of food in school classes need to be eliminated to prevent the development of negative thoughts and behaviors in regard to body image and food intake.

School counselors, teachers, coaches, and parents need to explore their own values, beliefs, and practices about weight, dieting, and body image to identify, how their attitudes may inadvertently affect children (Graber, Archibald, & Brooks-Gunn, 1999; Powers & Johnson, 1999; Russell & Ryder, 2001a). Well-intentioned comments about a child's appearance or physical ability, and/or ill-considered comments about weight or laziness have the potential to cause serious damage to a child's emerging body image and self-concept. Impressionable youth may internalize such comments, which in turn may trigger harmful dieting and unhealthy, compulsive exercising (Beumont, Arthur, Russell, & Touyz, 1994). Adults who work with children are role models who can cushion the blow of negative societal messages about body image, perfectionism, and achievement as well as encourage and reinforce positive attitudes and behaviors (Russell & Ryder; Vitousek, Watson, & Wilson, 1998).

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Eating disorder intervention, prevention, and treatment: recommendations for school counselors

Professional School Counseling, Dec, 2004 by Angela D. Bardick, Kerry B. Bernes, Ariana R.M. McCulloch, Kim D. Witko, Jennifer W. Spriddle, Allison R. Roest

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