Eating Disorders at School: A Support Guide for Educators, Parents, and Students

Lisa Alizadeh, Licensed Professional Counselor

Casey Lozier, in recovery from an eating disorder

Q&A with Caroline Ewing

Anorexia Nervosa

Anorexia nervosa is characterized by a distorted image of the body, which causes patients to view themselves as overweight even as they continue to lose weight. Students with anorexia nervosa may restrict their calorie count to a dangerous level and refuse food they view as “unhealthy.”

Anorexia is the deadliest of all eating disorders.

Bulimia Nervosa

Bulimia Nervosa is an eating disorder characterized by a distorted body image, which results in patients binge eating and then purging, often through vomiting. Bulimia patients may also exercise excessively, take laxatives, or fast after binging.

Binge Eating Disorder

Binge eating disorder (BED) is an eating disorder characterized by recurrent episodes of eating large quantities of food. People who have it may feel out of control and experience shame and embarrassment after binging. Binge eaters do not use purging or exercise to compensate for the binges.

Unspecified Feeding or Eating Disorder (UFED)

UFED, previously known as Eating Disorder Not Otherwise Specified (EDNOS), is a catch all classification for eating disorders that do not specifically match the criteria for other eating disorders. This may include combinations of other eating disorders.

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFRID, previously referred to as Selective Eating Disorder, is characterized by an avoidance of food based on sensory characteristics, which results in an extremely limited diet. Unlike anorexia, ARFID sufferers are not distressed about their body shape or size.  Rather, ARFRID sufferers dislike so many foods they are unable to get the nutrition they need.

Pica

People who suffer from pica struggle with cravings for non-food items. A few examples are dirt, clay, paper, and chalk. Pica is the only eating disorder that can be diagnosed simultaneously with another eating disorder.

Rumination Disorder (RD)

Those with Rumination Disorder regurgitate their food. Some patients with RD seem to have a physical cause for it, while others do it to “taste” food without the calories.

Other Specified Feeding or Eating Disorder (OSFED)

This diagnosis is given to patients who have irregular eating patterns or an unhealthy relationship with food, but do not meet the diagnosis for any other eating disorder.

Orthorexia

Orthorexia is characterized by an obsession with eating healthy. Unlike anorexia, which focuses on restricting food, patients with orthorexia often focus on the quality of the food they consume, not the quantity.

Currently, the American Psychiatric Association does not recognize orthorexia as an eating disorder. However, orthorexia can present similarly to anorexia and bulimia.

Muscle Dysmorphia

Muscle dysmorphia is an obsessive-compulsive disorder characterized by a perceived small body type. Individuals with muscle dysmorphia may workout and lift weights excessively to develop muscle mass. They may also take steroids or other drugs in an attempt to build muscles.

Diabulimia

Diabulimia is characterized by underusage of insulin dosages by diabetics in an effort to control and lose weight. This causes a rise in blood sugar and increases the risk of diabetic ketoacidosis, retinopathy, and neuropathy.

Tips for Middle and High School Students

Foster Healthy Coping Skills
Eating disorders are often accompanied by anxiety. By learning healthy coping mechanism for stress, such as deep breathing, meditation, taking anti-anxiety medicine, going for a walk, etc., the intensity of cravings for disordered eating may subside.

Look for Resources
There are dozens of resources available to help you better understand the challenges you are facing. We’ve included a list in the section below.

Tell Someone You Trust
Talk to a friend, school nurse, family member, or other trusted adult. Therapy, medication, and nutrition education may help those who suffer from an ED regain control in their life.

Resources

• Paperweight by Meg Haston: This book details a teenager’s struggles to navigate an inpatient eating disorder treatment center and deal with feelings of loss, suicide, and the mistakes of her past. It may help people who struggle with an ED feel less alone.
• The Healthy Teen Project: About Eating Disorders: This judgment-free guide provides education about eating disorders and dispels common myths.

Tips for College Students

Look for On-Campus Resources
Many colleges must offer mental health services by law. You may be able to receive treatment for little or no cost.

Have a Plan for Triggers
Being in college can expose you to exciting new experiences – but it may also present triggers in unexpected ways. Have a plan for how you will react. This is best accomplished with the help of a mental health counselor.

Find Support
Look for groups or meetups with other people in recovery. You can use this site to find meetings for Eating Disorders Anonymous.

Resources

• Emancipated Love Junkie: Liberating Myself from Anorexia: A first-person account of surviving anorexia that provides insights into overcoming anorexia.
• How Eating Disorders Can Affect Anyone | NPR: An episode from NPR’s Morning Edition that explores how EDs can impact people of all shapes, sizes, and backgrounds.
• The Eating Disorder Recovery Podcast: A podcast about recovering from a range of eating disorders. Includes episodes with celebrities, clinical psychologists, and other medical professionals.
• How to Tell Someone You Have an Eating Disorder: A guide for talking to a friend or family member about your eating disorder so you can get the support you need.
• Eating Disorder Hotline: A helpline provided by the National Eating Disorder Association. Support provided by chat, phone, or text.

Tips for BIPOC Students

You Are Not Alone
The stereotype of an eating disorder patient as a skinny white girl is dangerous. According to the NEDA, Black teens are 50% more likely to exhibit bulimic behaviors, such as binging and purging.

Help Is Available
EDs will not go away on their own. If you think you might have an eating disorder, reach out to a friend, trusted adult, call a hotline, or join an online support group.

Understand That Eating Disorders Go Beyond Anorexia
Many people assume you must be thin to have an eating disorder, but some eating disorders are related to weight gain or muscle mass.

Learn to Manage Your Triggers
Recovery from an eating disorder requires facing situations that make you uncomfortable. Work with your treatment team to find ways to manage your triggers.

Resources

• Not All Black Girls Know How to Eat by Stephanie Covington Armstrong: A first-person narrative from a Black woman growing up in foster care detailing how she overcame bulimia.
• Food Is Not Bae – Podcast Hosted by Dr. Ebony: A down-to-earth podcast about how to free yourself from societal, familial, and cultural relationships that keep you trapped in a toxic relationship with food.
• Here’s How BIPOC are Often Overlooked in Eating Disorder Treatment, and How That Can Change: An article about the challenges BIPOC folx face in getting the treatment they need.
• A Hunger So Wide and So Deep: Multiracial View of Women’s Eating Problems: An indepth look at how race, class, sexuality, and nationality can impact women’s eating problems.
• Turning a Blind Eye to Eating Disorders | Indian Country Today: An article that explores how disordered eating is often ignored in Native communities.
• Sage and Spoon: A free online eating disorder peer group specifically for BIPOC over the age of 18.

Tips for Male Students

Eating Disorders Are Not Solely a Female Challenge
Many men struggle with a wide range of eating disorders, including anorexia and bulimia. The stigma against men with eating disorders may hinder you from coming forward – but you are not alone.

Men Suffer From Anorexia, but Other Types of EDs as Well
Eating disorders in males may not focus on thinness, but rather on bulk and muscle strength.

The Risk Factors for Males Are Similar to Females
Risk factors include being overweight in childhood, dieting, and participating in sports that require leanness.

Don’t Avoid Treatment
Research shows males are just as likely to overcome an eating disorder with the right treatment plan.

Resources

• Please Eat….: A Mother’s Struggle to Free Her Teenage Son from Anorexia by Bev Mattocks: A mother’s heartbreaking story of helping her son overcome his eating disorder and rebuild his life.
• The Voices of Males with Eating Disorders | Veritas Collaborative: A blog post that explores the challenges boys and men face when seeking treatment for eating disorders.
• Men with Eating Disorders and BED | The Eating Disorder Recovery Podcast: A podcast episode that discusses common myths about binge eating and men with eating disorders.
• Patrick DeVenny’s Recovery Story | The Eating Disorder Recovery Podcast: Former Seattle Seahawks football player talks about his eating disorder recovery.
• 6 Male Celebrities Who Have Opened Up About Having Eating Disorders | Spoon University: Men with eating disorders often feel alone. This post reviews six famous men who struggled with overcoming their eating disorder.

Tips for LGBTQ+ Students

LGBTQ+ Students Face Unique Stressors That Can Impact Eating Disorders
Understanding these challenges and how they can result in unhealthy coping mechanisms may help you better manage your disorder.

Developing a Sense of Community Can Help Protect Against Eating Disorders
According to the NEMA, creating connections with others in the LGBTQ+ community is critical to preventing and overcoming an eating disorder.

Look for Treatment Programs That Make You Feel Comfortable
Treatment program that use LGBTQ+ affirming language are likely to be more sensitive to the needs and challenges of LGBTQ+ folx.

Eating Disorders Often Coexist With Other Mental Health Issues
Suicidal ideation, depression, and addiction may impact your treatment plan, so be honest with your medical team about all the challenges you face.

Resources

• Lesbian Crushes and Bulimia: A Diary on How I Acquired My Eating Disorder, by Natasha Holme: A memoir of navigating coming out and dealing with an eating disorder.
• Hunger: A Memoir of (My) Body by Roxane Gay: New York Times Best Seller about how women (especially Black and lesbian women) often have a fetishistic relationship with food.
• National Eating Disorder Association Hotline: Get help from trained volunteers by phone, chat, or text.
• Understanding Eating Disorders in LGBTQ People | Social Work Today: An article that examines the relationship between discrimination and eating disorders.
• The Eating Disorder Recovery Podcast: A podcast hosted by Dr. Megan Wilhite that explores how eating disorders work psychologically, including how recovery works.

Tips for Teachers

Be Aware
There are many different types of eating disorders, and symptoms can manifest in a variety of ways. Don’t assume every person will exhibit the stereotypical symptoms of an eating disorder.

Create Opportunities for One-On-One Time
Meeting with students one-on-one may help them open up and allow them to explain more about their circumstances.

Offer Support
High pressure tactics rarely work with any student. Let students know they can trust you if they need someone to talk to.

Model a Good Relationship With Food When Possible
Don’t label foods as good or bad, and explain how to balance food choices without being restrictive.

Connect Them With Another Trusted Adult or Resource
Look for ways to help students by giving them a referral to a school counselor or offering resources.

Resources

• National Eating Disorders Association (NEDA): This website offers support, resources, a hotline, and treatment options.
• Guidance for Teachers Who May Suspect a Student is Struggling with an Eating Disorder: This article from Eating Disorder Hope website was written by authors with experience in education and special education fields. It outlines symptoms and resources specifically for teachers.
• Addressing Eating Disorders in Middle and High Schools: In this paper, author Lauren Muhlheim, a clinical psychologist and certified eating disorder specialist, explores warning signs, treatment options, and ways to prevent eating disorders.

Tips for Parents or Guardians

Don’t Ignore the Symptoms
Eating disorders will not go away on their own. If you suspect your child has an eating disorder, seek medical care for your child.

Don’t Blame Yourself
Feeling guilty is a natural response, but eating disorders are caused by a complex mix of genetic and environmental factors. You alone did not cause your child’s eating disorder. Keep that in mind.

Keep the Lines of Communication Open
Both you and your child are navigating a new experience. Be honest about your feelings and be a judgement-free ear when they need it.

Get Support for Yourself
Navigating an eating disorder as a parent can be incredibly difficult. Look for support groups or therapy to help you navigate this challenging time.

Don’t Lose Hope
Statistics show that about 60% of patients who receive treatment for an eating disorder improve or fully recover.

Resources

• Brave Girl Eating: A Family’s Struggle with Anorexia, by Harriet Brown: A memoir from a mother chronicling their daughter’s struggle with anorexia.
• Parent Talk: Tips on How to Parent A Child Struggling with an Eating Disorder: A guide from the NEDA (National Eating Disorder Association) about having hard conversations with your child and how to help find the support they need.
• Eating Disorders: When Light is Dark | A TEDX Talk with Anastasia Broder: A talk dedicated to tackling the stigma around mental illnesses, including eating disorders.
• Eating Disorders: Advice for Parents: A simple guide from UK’s National Heath Service for parents of children with eating disorders, including mealtime tips.
• The Eating Disorder Recovery Podcast: How allowing my parents to refeed me saved my life: A woman in recovery shares how moving home with her parents for three months helped her navigate the challenges of anorexia recovery.

What are some ways you can tell a student might be suffering from an eating disorder?

I would say there are two kind of students that I encounter that are suffering from eating disorders. The first would be students who want you to know they are suffering from an eating disorder. These students will blurt out their struggles in class discussions or write about their struggles in their journal and star that entry for me to read.

Sometimes when students talk about their personal struggles it can cause an awkward classroom environment because their testimonies can seem out of place or like a complete overshare, but it’s almost like they compulsively have to put their struggle out there.

Conversely, there are the students that are struggling with eating disorders or other mental health issues in silence.

Some tangible examples I see of students struggling with eating disorder are when I teach creative writing, and students allude to a strained relationship with food in their poems. Sometimes they will wrap them up in a lot of metaphor as a form of protection, but body image and taking drastic measures to stay skinny are pretty common topics of pieces in the poetry unit I teach.

When I worked with teenagers at a summer camp on the east coast, I could tell a kid might be struggling with their relationship with food if they always appeared to be too busy during mealtimes to sit down and eat any substantial amount of food.

There are other obvious signs, like students losing a dramatic amount of weight over a short period of time or students who ask to go to the bathroom after the lunch period consistently. Sometimes students will comment on my weight or ask me what I do to stay small and that always indicates to me that there may be an issue at hand because that is a boundary that I don’t think a student would cross unless they had a serious fixation on body image and/or controlling food intake.

What do you do when you suspect one of your students is struggling with an eating disorder?

When I suspect that a student has an eating disorder, I evaluate my relationship with the student and ask myself a few questions:

• How well do I know this student?
• If this student has explicitly told me they were struggling with an eating disorder, why me?
• Would a conversation about my suspicions with the student open doors for helpful conversation or would it further push the student away?
• How would this student feel about being referred to our school social worker without me telling them I was going to refer them? Should I talk to the student before I refer them, after, or not at all?
• Is the student already seeing a therapist? If they are, does that mean I am in the clear?
• Do I think the student is in a place where they are ready to receive help?

At this point, eight years into my teaching career, my first step is to always go to the counseling center and talk about the student with their counselor or social worker. We will engage in a conversation and pool our knowledge about the student, then we game plan the best approach together. It always feels better to know that you are not the only one that knows this student is struggling, and having a specialist involved relieves a lot of the burden.

From that point, the counselor and I may decide the counselor should take over the situation from there; we may roll play a conversation between me and the student; we may ask other teachers what they have witnessed to add to our knowledge base; we may call the parents on speaker phone.

Whatever is decided upon, the important thing is that I am not alone in my efforts to help the student. When I was younger I used to think that I was the only one who could help the student because only I understood them and had gained their trust. I have come to find that that mindset is not healthy for me, nor sustainable, nor what is best for the student.

When one of your students is struggling with an eating disorder, what is the effect on their academic performance?

I have noticed that when a student is struggling with an eating disorder that it is typically not the only mental health struggle that the student is experiencing. I think an eating disorder is often a side effect or symptom of an overarching condition like depression or anxiety.

Anxious students tend to do extremely well academically. Food intake and schoolwork are elements of their life that they can control. Students who have anorexic or bulimic tendencies that are driven by anxiety tend to approach schoolwork meticulously and strive for the same perfection that they attempt to exercise over their food intake.

In my experience, students who are depressed have eating disorders that tend to manifest differently. Their depression leads to low motivation. Sometimes things like school work just seem too overwhelming for them to complete so even though they are completely capable of doing the work satisfactorily – they simply cannot begin working.

What tips do you have for new teachers on how they should handle it when they suspect one of their students has an eating disorder?

My main tip for teachers on handling students with eating disorders is to share that burden with the appropriate parties as soon as possible. Another tip is to expect students to come to you. Many new teachers are young and that youthfulness combined with authority is attractive to young people. I started teaching in my younger twenties and with the thought that I could save every child and it was my responsibility to make myself emotionally available to every troubled teenager.

That approach makes it extremely difficult to attain a healthy and balanced work and home life, which ultimately leads to early teacher burnout. I want new teachers to understand that they do not have to be a martyr to their profession, and they will ultimately help less students in the long run by taking on too much of their struggle. Refer struggling students to counselors and social workers who are professionally trained to handle these situations.