Eating Disorders at School: A Support Guide for Educators, Parents, and Students
Featuring contributions from:
Lisa Alizadeh, Licensed Professional Counselor
Casey Lozier, in recovery from an eating disorder
Q&A with Caroline Ewing
An eating disorder is a complex mental health condition defined by severe disturbances in a person’s eating behavior. Students with an eating disorder may be preoccupied by food and weight loss. They may also exhibit compulsive behaviors such as overeating, refraining from eating, and binging.
A 2007 study, which is the most recent study published on the topic, found that 30 million people suffer from an eating disorder in the United States. These disorders have a long-term impact on mental and physical health and can result in death when left untreated.
This guide provides information and resources to help parents, students, and education professionals provide students with the support they need to overcome an eating disorder and excel at school and in life.
What Causes Eating Disorders?
The exact cause of eating disorders is unknown, but most professionals believe they develop through a combination of environmental, psychological, and biological factors. Specifically, these factors may include:
Several genetic studies suggest that having a family member with an eating disorder (ED) can increase a person’s risk of developing one.
Between 55 and 97% of people with an eating disorder are diagnosed with at least one other psychiatric disorder, including major depressive disorder, social anxiety, post-traumatic stress disorder (PTSD), substance abuse disorder, and self-harm and suicide ideation.
Pressure from family or participation in activities that promote a lean body, such as ballet or long-distance running, can increase a student’s risk of developing an eating disorder.
Lack of Control and Stress
Stress at school, home, or work can leave students feeling out of control. They may develop an eating disorder in an attempt to gain control over their life.
Types of Eating Disorders
There are several different types of eating disorders. The most updated edition of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) (PDF) includes:
These and several other eating disorders are described below.
Common Eating Disorders
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 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.
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 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 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 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.
Effects of Eating Disorders on Academic Performance
Eating disorders can have a profound impact on the physical and mental health of a student, including their academic performance and the performance of the students around them.
For example, eating disorders may:
On the other hand, some people who suffer from eating disorders may actually be high academic achievers.
Casey Lozier, an editor for EducationDegree.com, is in recovery from an eating disorder she struggled with in high school and college. According to Casey, “my academic performance was actually unaffected by my ED. In fact, I was an absolute perfectionist when it came to school. Receiving anything less than an “A” devastated me.
“Because of my experience and the experiences of some of my friends who are in recovery, I suggest teachers pay careful attention to their best students. If they seem to have perfectionist tendencies and get very worked up over grades, they may be more suspectable to developing an ED.”
Identifying Students With Eating Disorders
Eating disorders can present in a variety of ways. Many people with an eating disorder will go to significant lengths to conceal their behavior, which can make it more difficult for their teachers, friends, or family to recognize the signs.
Signs you can look for:
Parent / Guardian
However, it’s important to try to catch eating disorders early. According to Lisa Alizadeh, a licensed professional counselor with over a decade of experience providing mental health counseling to children and families in schools, hospitals, and outpatient settings, “Often treatment of an eating disorder can be more effective when the individual starts the process earlier in the progression of their eating disorder, so identifying warning signs and ensuring the appropriate resources and treatment can be provided to this student as soon as possible is imperative.”
This section will review the different ways teachers, friends, and parents can identify at-risk students. In later sections we discuss specific ways for helping a student with an eating disorder.
How Teachers Can Help Identify At-Risk Students
Teachers are in a prime position to recognize the signs of eating disorders among school-aged children and college-aged adults. You should watch for signs such as:
How Friends Can Help Identify At-Risk Students
It’s not always easy to determine whether a friend has an eating disorder. It can be tough to distinguish healthy behavior, such as choosing a salad at lunch, and problematic behavior, such as only eating salads. Here are some things you can watch for.
How Parents or Guardians Can Help Identify At-Risk Children
There are several behaviors parents can watch out for. Remember that young people with this disorder may hide their behavior, which can make it easy to miss the signs.
Signs of an eating disorder may include:
How to Support Students with Eating Disorders
I Need Help
Middle School Students
High School Students
I Want to Offer Help
Parents / Guardians
Want to Talk?
Contact NEDA’s trained volunteers for support, resources, and treatment options
Advice for Middle and High School Students Who Have an Eating Disorder
Many eating disorders begin onset in the teen years. This means middle and high school students are at a higher risk of developing these disorders. Getting treatment early can impact the success of treatment options. The following resources can help support middle and high school students.
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.
Advice for College Students Affected by Eating Disorders
The transition from living at home to living independently and the stress of a new school can serve as a trigger for college age students.
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.
Look for groups or meetups with other people in recovery. You can use this site to find meetings for Eating Disorders Anonymous.
Advice for BIPOC Students with an Eating Disorder
People of all shapes, sizes, and colors can suffer from eating disorders. However, many resources and treatment options cater to the stereotypical idea of an eating disorder patient. Here are tips and resources specifically aimed at BIPOC folx.
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.
Advice for Male Students with an Eating Disorder
The stereotypical person with an eating disorder is a female who is anorexic or bulimic. This stereotype is dangerous and may result in men hiding their symptoms or failing to seek treatment. In fact, males can and do suffer from eating disorders.
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.
Advice for LGBTQ+ Students with an Eating Disorder
A recent survey found as many as 75% of LGBTQA+ students may suffer from an eating disorder. Finding the right treatments and resources can be crucial to helping to overcome disordered eating.
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.
Support Advice for Teachers
You can change a student’s life by knowing the signs of an eating disorder and taking action.
Tips for Teachers
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.
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.
Advice for Parents or Guardians of a Child With an Eating Disorder
Many parents are unsure how to best support their child with an eating disorder. The tips and resources below will help navigate this difficult situation.
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.
Advice on Picking a School for Students with a History of Eating Disorders
Attending school can be difficult for those with eating disorders, particularly at the college level. New friends and experiences can result in exposure to triggers, and higher levels of stress may result in falling back into old patterns. Students should look for a school that offers some or all the following services:
The NEDA has created a list of colleges with programs and resources dedicated to students with eating disorders.
Expert Q&A with Caroline Ewing
Caroline Ewing is a teacher in Kansas. She is about to begin her ninth year of teaching in the Shawnee Mission School District at Shawnee Mission South High School. She teaches video production and creative writing and coaches the varsity girls’ soccer team. She has worked on and off as a consultant and Residential Life Specialist at Camp Wicosuta for girls since 2010.
She played soccer and received her undergraduate degree from Emporia State University. She went on to earn her master’s in school leadership from Baker University.
In her spare time she enjoys travelling around the world, reading, and listening with an open mind. She also likes to play board games with friends, taking her dog to the dog park, and recreational sports of any kind.
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.