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

• E-mail
• Print
• Link

Psychological warning signs of eating disorders may include perfectionism, competitiveness, a sense of overresponsibility, emotional distress, criticism of self and others, conformity, external locus of control and low self-esteem, mood swings, complaining of "feeling fat," an inability to express emotions, and demonstration of "black-and-white" thinking (Andersen, 2001; Kaye, Klump, Frank, & Strober, 2000; Rogers & Petrie, 2001; Vitousek et al., 1998).

Social warning signs may include isolation or withdrawal from friends and family because of excess work or preoccupation with exercise, avoidance of social or recreational activities due to a compulsive need to maintain exercise and dieting schedules, and a desire to hide one's compulsive behaviors from family and friends (Vitousek et al., 1998).

Once an at-risk individual has been identified, it is important to intervene as soon as possible.

Early Intervention

When a child's health is at risk, early intervention is crucial to recovery. There is a greater chance for an individual to recover completely from an eating disorder if significant others intervene to combat the illness as early as possible (Lask & Bryant-Waugh, 1999; Peterson & Mitchell, 1999; Powers & Johnson, 1999; Vitousek et al., 1998). Early intervention efforts attempt to identify individuals at the beginning stages of developing an eating disorder and are intended to prevent the development of more serious symptomatology (Russell & Ryder, 2001a).

Difficulties arise when the problem has been hidden for a long period of time and obsessive behavior is mistaken for "dedication and strong character" (Thompson & Sherman, 1993, p. 17). Individuals with eating disorders have a strong tendency to deny that there is a problem, to resist treatment efforts, and to insist that their behavior is legitimate and necessary (Vitousek et al., 1998). The more resistant the individual and the stronger the individual circumstances meet the criteria relative to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision), the more likely that intervention is required (American Psychiatric Association, 2000b). Significant others need to take the responsibility for treatment away from individuals under the age of 18 because the effects of starvation may render them unable to make decisions concerning their health and well-being (Lask & Bryant-Waugh, 1999; Vitousek et al., 1998). This responsibility may begin with a school based resource person.

Establishing a school-based resource person. The presence of a school-based resource person alleviates difficulties of not knowing what to do when a student seems to be on the verge of an eating disorder. Smolak, Harris, Levine, and Shisslak (2001) posit that every school will likely have at least one person interested in eating disorders, negative body image, and dieting, and that this person may be willing to dedicate extra effort to addressing these problems in school. A school-based resource person would have an understanding of how to confront the at-risk individual, discuss concerns with parents, and make a referral to an appropriate professional source (Smolak et al.).