Special Education
Teaching Students with Mental Health Disorders:
Resources for Teachers: Volume 1 - Eating Disorders
Anorexia Nervosa
Anorexia nervosa is the best known of the three disorders. By definition, anorexia nervosa is the inability to maintain body weight at or above the minimum of the normal weight range for height and body build. People suffering from this disorder are chronically underweight, yet harbour deep anxieties about becoming fat. They are not simply victims of a diet gone bad, they have an intense and irrational fear of being overweight, or even of being a normal weight. No amount of argument or logic can change this mind set. In anorexia, the destructiveness of the eating disorder is denied. Starving is seen as essential to maintaining competence and self-esteem.
The prevalence of anorexia nervosa is not known because many people with the disorder are not aware they have a problem. It is estimated that between half a percent and one percent of females in North America suffer from the disorder. While people with anorexia come from all cultures and socioeconomic backgrounds, the majority of reported cases are females from white, middle-class backgrounds. Adolescent girls are the highest-risk group for becoming anorexic, and females in general are the more susceptible. Males, however, are not immune to the problem. It is believed that five to 10 percent of people with anorexia are male.
Anorexia nervosa has serious consequences. In adults, it has one of the highest mortality rates of any psychiatric disorder. One in ten patients will either commit suicide or die as a result of malnutrition. Even those less affected can face serious health concerns, in part, because the disorder usually surfaces during adolescence when the body’s nutritional demands are high. Adolescents with anorexia frequently encounter problems with menstruation, a weakened immune system, stomach and heart problems, and chemical imbalances in the brain which can increase depression and anxiety levels.
Approximately half of all people with anorexia nervosa also engage in some “bulimic” behaviours.
Indicators
A student with anorexia nervosa may exhibit some or many of the following indicators.
Behavioural:
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Eats very little, and usually only from a narrow selection of food considered “safe.”
- Eats a restrictive diet, even when underweight.
- Shops for groceries and prepare food for others, but avoids eating.
- Pays a lot of attention to creating and maintaining records like meal plans and calorie journals.
- Continually weighs and measures food.
- Hoards food. For example, hides food in a locker or knapsack.
- Exhibits significant weight loss in the absence of any related illness.
- Wears layers of loose fitting clothing to hide the body.
- Withdraws from social activities and becomes immersed in highly physical, repetitive activities such as working out, running, cycling or roller-blading.
- Sets unrealistically high goals and constantly strives for perfection.
- Demonstrates an unwillingness or inability to eat which becomes a consistent focus of attention from family and friends.
- Demonstrates changes in behaviour, such as increased activity levels, that appear incongruent with the student’s personality.
Cognitive:
- Preoccupied with food. Conversations, school projects, artwork, etc. may revolve around food themes.
- Has difficulty concentrating.
- Appears indecisive or, conversely, exhibits rigid “black-and-white” thinking.
- Makes comments about being overweight or expresses a belief that thinness equates to happiness.
- Considers self “fat,” but does not appear to be so.
- Places a premium on self-control.
Affective:
- Appears anxious, depressed, angry, irritable, defiant, stubborn or displays intense mood swings.
- Expresses feelings of inadequacy, worthlessness, anxiety and loneliness.
- Demonstrates feelings of low self-esteem through radical change in attire, body language or social relations.
- Tends to be withdrawn and appears isolated.
- Demonstrates inflexibility and resists changes to routines.
- Expresses a fear of weight gain.
- Expresses feelings of failure with less than perfect school grades/marks.
- Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic.
- Denies anything is wrong. Becomes sullen, angry or defensive when concern is expressed.
Physical:
- Weight loss is noticeable, often over a short period of time.
- Appears unusually thin, with little muscle or fat.
- Complains of ongoing stomach problems, muscle cramps or tremors.
- Skin is unusually dry or scaly, and yellow or grey in colour.
- Fine hair growth on face or body.
- Dull, brittle or thinning hair.
- Engages in binge eating, eating large quantities of food over short periods of time.
- Appears chronically tired.
- Constantly complains of feeling cold.
- Suffers unusually severe dental problems.
- Experiences loss of menstrual periods. Younger females may experience a delay in the onset of menses.
Distinguishing Characteristics of a Student with Anorexia Nervosa
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