Most parents don't like to watch their children suffer. When parents encounter a suffering son or daughter they become solution-oriented, looking for the quickest means of alleviating the problem. Parents who have a child with an eating disorder are the same. Unfortunately, the problem in using this tactic with a child who suffers with an eating disorder is that the sufferer develops complicated and often distorted thought processes. As a result, what appears to be the logical and quick solution to a problem may produce the opposite effect in an individual with an eating disorder. In fact, an individual with an eating disorder can twist perfectly normal and loving statements into negative affirmations of self that trigger greater entrenchment into the eating disorder. Thought distortion in an eating disorder sufferer affects every aspect of their life, especially behavior and achievement in the socially intensive environment of school. One of the ways parents unknowingly promote increased entrenchment in their child's eating disorder is to encourage their continued and even enhanced involvement in school with hopes that it will eliminate the problem when, at the same time, the child is actively distorting the messages they receive because of the eating disorder.
THE PROFILE OF A TYPICAL EATING DISORDER SUFFERER
An eating disorder sufferer is a contradiction in behaviors. An individual who is deeply entrenched in a disorder displays a set of characteristics diametrically opposed to their behavior when not suffering with the disorder. They become listless, withdrawn, emotionally numb, unexpressive, disinterested in activities, anti-social, and incapable of concentrating. Once they work through their distorted thinking they revert back to their real selves - sensitive, intelligent, outgoing, involved in many activities that reveal their many talents, able to focus on multiple projects, and very giving and loving.
Amy is a beautiful and gifted senior in high school. She is a cheerleader, the English Sterling Scholar from her school, writes beautiful poetry and stories, and is very active in school affairs. Amy has rebounded from an eating disorder that completely disrupted her life. She writes,
"Eating disorders are born, raised, and sustained by negativity; it is the bitterness I experienced with my eating disorder that allows me to appreciate and savor sweetness much more than I did before... Like any addict or substance abuser...I refused to think I had a problem. Not until I had been hospitalized for nearly three months...did I realize the horrific consequences brought about by my eating disorder. It had made me into the person I strived NEVER to become: I fought with my parents, I said things I will forever regret, I lied, I stole, I slipped in my studies, I isolated myself, twice I was tempted with suicide....ultimately, everything I had worked for and wanted was either gone or going as a result of my eating disorder. I lived in a grey haze which never cleared and allowed the little light left in my life to wane systematically."
The contrast between ED behaviors and healthy behaviors are drastic and frightening. Parents who witness this transformation in their child's behavior, from a bright, energetic, and out going person to the opposite, react with a swift desire to alter the trend. Unfortunately, very often the tried and tested methods of eliminating suffering and changing undesirable behaviors are the very things that make the disorder worse. Telling a daughter, "You are beautiful and don't worry!" usually is interpreted as, "She feels she needs to say that because I am so ugly," and the command, "Eat all the food on your plate!" may be interpreted as, "My parents want me to be fat and unpopular at school."
THE SCHOOL ENVIRONMENT
One of the most obvious evidences of something going wrong in the sufferer's life is the impact the disorder has on school achievement. The sufferer's normally very good grades start to slip. They begin to withdraw from activities and become more antisocial. They lose interest in school subjects and extracurricular activities. They lose their ability to focus on important projects, papers, and tests. They become much more sensitive to what is going on around them and what others may be thinking about them.
"I could not stay focused on my school studies. My concentration level was terrible and I could never read book assignments without my thoughts wandering. I was always too tired to stay awake, and more often than not my head was on the desk top sleeping. All of my energy went towards my eating disorder. It was first priority." - 19-year old woman
"My concentration level decreased, I skipped classes, isolated myself from friends, and didn't care about grades. I went from A's and B's to D's and F's." - High School Junior
School is a quick-paced, unrelenting, socially competitive, and demanding environment. When you combine this with the changes that are taking place in the lives and bodies of young men and women, it becomes a potentially threatening and frightening place. If an individual starts to wonder and worry about their social and intellectual status, the school environment can become a very intimidating place. For an individual suffering from an ED the school environment is filled with messages that can be twisted and confused. The whole experience can become too overwhelming to bear.
"My anorexia destroyed my concentration, my drive, my love of school, and my performance in classes. Education no longer played a vital role in my life. My anorexia preoccupied and consumed all of my time, leaving little time for school and studies. Anxiety-producing stress only exacerbated my anorexia, which, in turn hindered my performance." - College Freshman
Parents looking for the quickest and most logical means to alleviate the disruption of anorexia or bulimia causes in the family encourage their eating disordered child to become more involved and to work harder to display their natural talents and abilities in their school settings - Talents they know their children have because they have observed them for years. The child unable to cope with the negativity they sense all around them in school, reacts in the opposite manner and starts to withdraw and shut down even more. They know what they feel and are confused about their inability to cope with the seemingly simple solutions their parents offer. They very naturally start to believe that something is wrong with them, i.e., that they are a social outcast, unable to fit in, and undeserving of good things.
"My eating disorder destroyed school for me. I hate school and I sleep through anything. My focus isn't on anything but my eating disorder and so school is a waste of time." - 21-year-old woman
Over the last year approximately 4000 junior and senior high school students in Utah County and Las Vegas Nevada have filled out an eating survey designed to assess ED behaviors. The results of the survey suggest that approximately 6% to 13% have already developed a diagnosable eating disorder; 30% to 35% have attitudes and beliefs about food and weight that fall into the abnormal ranges and that put them at risk for eventually developing an eating disorder. These findings document that there is a great need for effective education and prevention programs.
A TEACHER'S DILEMMA
It is important for teachers to understand the impact of anorexia and bulimia so they can pick up on the signs and consequences among their students. Since most students with anorexia and bulimia are very bright and talented it can be difficult for teachers to pick up student's subtle changes in feelings and attitudes before their academic performance suffers. Consequently, knowing that 2 out of 10 girls in their classes are at risk for developing an ED presents a dilemma about when to raise concerns about anorexia and bulimia. Thus, it is helpful to raise the subject matter at different times throughout the year in general fashion. Doing this will encourage students struggling silently with the pressures and stresses of life and school to talk to you or a school counselor in private before they develop eating disorder behaviors that disrupt academic performance. The fact that a teacher is willing to broach this subject in an open and general fashion can be perceived as a safe invitation for students afraid of negative consequences of an eating disorder to do something for themselves.
Another dilemma for teachers is often in how to approach a student about a suspected eating disorder that is disrupting personal and academic performance. Most girls with a disorder will deny, minimize, or lie about the problem when confronted directly. They often feel ashamed of who they are and their behaviors. It is important to not make direct accusations about concerns, but rather, gently talk about what you are seeing as a teacher and encourage them to talk to you, or someone else, when they feel more ready to do so. Raising the concern in their presence and then giving them room to come back to you, whether they are struggling with an eating disorder, depression or some other personal problem, will let them know that you have noticed, cared, and have offered a kind invitation to do something about it.
For the student more entrenched in the ED, another dilemma for a teacher is whether to tell other school personnel or the parents about their concerns. Sometimes parents are the last to see the eating disorder because they want to believe their daughter's responses to their questions. It is important to first talk to the student in private. Explain that you need to do something to help them rather than ignore or avoid the problem. Then give them some time to get back with you about who they are willing to let you talk to about the problem. For many girls with eating disorders it was the persistence and honesty of a significant other that led to their decision to seek treatment. For those girls who are too afraid or angry to admit to or address the eating disorder, it is very important to make more people aware of their problem including the parents so that teachers do not become silent collaborators of the disorder. The student may not be ready to change but they will know the secret is out.
POSITIVE STRATEGIES FOR TEACHERS
There are a number of things teachers can do to help their students:
Encourage counselors in schools to start support groups for those who struggle with eating problems and body image concerns. Develop working relationships with counselors who can do one-on-one work with students and who can refer to outside professionals. Encourage the school to have assemblies or combined classes where outside professionals and recovered eating disorder sufferers can do presentations for the students. Provide materials and information that students could review on their own. Conduct a school-wide awareness program during national eating disorder awareness week in February. Be sensitive to the reality that eating disorders are about psychological and emotional pain and conflict and not about food and weight. Actively give invitations and encouragement to students to get help to overcome their eating fears or disorders. Talk to other teachers informally to develop a network who can identify at-risk students and offer support to those identified students.
POSITIVE STRATEGIES FOR PARENTS
Parents can help their daughters by doing the following: Do not treat this problem as just an academic issue, but rather recognize the emotional roots of anorexia and bulimia. Be open to feedback from teachers, counselors and others who can help. Educate yourself on the causes, impacts, and treatments of eating disorders through literature, books, seminars, and the Internet. Talk to your daughter about what's underneath the disordered eating behavior, don't just focus on the eating patterns. Recognize the need for proper assessment, dietary counseling, medical consultation and outpatient and inpatient therapy treatment. Get involved in a parent support group. Talk about the issues and possible solutions to eating disorders with the whole family. Don't be fooled by a daughter's attempts to minimize and ignore the real problem, be firm about the need for recovery while being sensitive to not forcing the issues. Be a good role model around food, take care of yourself, don't blame yourself, and be patient. Recognize that recovery takes time and don't place unrealistic demands for a quick fix for your daughter's eating disorder.