Our culture is obsessed with appearance. Many adolescents feel enormous pressure to stay slim and to emulate impossibly thin models and celebrities. In fact, many clinicians believe that the media images that bombard students provoke a fixation with food and dieting and the corresponding problems of anorexia nervosa and bulimia nervosa. If we accept that eating disorders are in part culturally driven, then the school can be an ideal place to work to prevent these potentially devastating problems.
Anorexia and Bulimia
A morbid preoccupation with food and an intense, fixated fear of gaining weight characterize anorexia nervosa. People with anorexia starve themselves, eventually suffering the effects of prolonged malnutrition. Criteria for the disorder include failure to maintain body weight at above 85 percent of the expected weight for age and height and, for girls, a stop in menstruation, their bodies too undernourished to complete their normal reproductive cycles.
Bulimia, in contrast, is a pattern of binge eating and subsequent purging of food, either by self-induced vomiting or by other means, such as the use of laxatives. Approximately one-third of those who are in treatment for bulimia have previously experienced anorexia.
Some studies suggest that up to 3 percent of women experience either anorexia or bulimia during their lifetime, with a majority first experiencing problems during their teen years. Although the problem is most prominent among adolescent girls, the number of boys with similar problems is increasing.
Devastating Effects
A cultural explanation for eating disorders is compelling, but the likely root of these problems is a complex mingling of psychological, biological, and cultural issues. Years of research have shown that a simple explanation is not adequate.
What is clear is the extent to which eating disorders remain a significant problem. They are often difficult to treat, and clinicians, teachers, and family members are often baffled and frustrated by the steadfastness of a young person's abnormal eating behavior.
Progress has been made in treating these disorders, but the complication rate remains high. People with anorexia may suffer heart irregularities, abnormally low blood pressure, cognitive slowing, permanent changes in bone density, and even sudden death.
Those with bulimia may experience dental malformations, dangerous fluctuations in body fluids and minerals, inflammation of the stomach and esophagus, and also, though more rarely, sudden death. Studies suggest that about 50 percent of those with anorexia or bulimia make a full recovery, 30 percent make a partial recovery, and 20 percent never recover.
In addition, partial syndrome disorders—conditions that do not meet the full criteria for anorexia or bulimia but clearly involve disordered eating—may occur up to twice as often as formal eating disorders. Recognizing anorexia or bulimia early provides an opportunity for intervention, thus potentially staving off some of the more devastating consequences.
Psychological, Biological, and Cultural Theories
A great deal of literature addresses the causes of eating disorders, often exploring the interplay of culture, biology, and psychology. From a biological perspective, changes in such brain chemicals as serotonin and norepinephrine have been implicated, as have abnormalities in such hormones as estrogen, testosterone, and cortisol. Leptin, a hormone secreted by fat cells and involved in fat storage, also may function abnormally. Some evidence suggests that anorexia and bulimia may be transmitted genetically.
For a psychological explanation, it is important to resist generalizations; a variety of young people may suffer from eating disorders. Nevertheless, multiple investigations have noted that sufferers are often perfectionists, with difficult and pressured family interactions, for whom issues such as control and competition are extremely important.
Eating disorders occur predominantly in developed countries and in higher socioeconomic tiers. Nonetheless, some evidence suggests the growth of eating disorders in middle-class and lower—middle-class societies. Many suggest that the pervasiveness of media in our culture is the origin for these changes in the demographics of anorexia and bulimia. In an examination of this phenomenon, psychiatrist and anthropologist Anne Beckerfound that eating disorders in Fiji mirrored the appearance of Western media in this previously isolated island nation.
Treatments
Treatments consist of a combination of medications and group and individual therapy. In addition to the problems associated with abnormal eating, people with eating disorders often suffer from such problems as depression and substance abuse. Effective treatment may depend on treating all the accompanying difficulties. A team approach is often necessary. A psychiatrist can prescribe appropriate medications, a therapist who understands eating disorders can provide individual or group psychotherapy, a nutritionist can structure an appropriate food regimen, and a primary care physician can maintain vigilance for signs of medical danger.
The physical or psychiatric problems often become so severe that sufferers need to be hospitalized. Because sufferers can appear healthy despite their increasingly dangerous medical state, vigilance and communication between the treatment team and family are often the best defense against potentially dire outcomes.
In the Classroom
Schools can be an ideal place to address the ongoing pressures about appearance that young people experience. Media endorsements are pervasive, but students pay attention to the ways in which their teachers address these messages. Teachers should discourage any ridicule of a student because of his or her weight. At the same time, positive comments about weight and appearance might give students the impression that appearance carries undue importance in the classroom.
Teachers can model for students a realistic and balanced approach to the messages that media and culture provide. A careful approach to these complex issues can go a long way toward changing students' cultural landscape.
Teachers often wonder whether a student is suffering from an eating disorder. Symptoms of abnormal eating are increasingly common, and many teenagers will probably exhibit at some point a preoccupation with food and dieting. Further, because those with anorexia and bulimia are adept at hiding the seriousness of their condition, teachers are often anxious that they will miss an opportunity to intervene in the course of a student's difficulties.
Seriously disordered eating is often difficult to identify, but teachers can be vigilant for certain signs. Any student who seems unusually cognitively slowed and tired for a prolonged period should probably be investigated. These symptoms can, of course, represent multiple problems, from a nasty flu to depression to substance abuse to difficulties with friends or family. But, if a girl is rapidly losing weight, restricting her intake of food, or making frequent bathroom requests, then extra scrutiny is in order. Instructors might speak with the school nurse or the guidance counselor about how best to talk with the student. If the teacher's relationship with the student is strong, then the teacher might gently approach the student.
One should remember, however, that the level of denial among adolescents with eating disorders can be astounding. A strong teacher is an asset to the suffering teenager, so teachers should not risk their relationship with students who deny that they have a problem. Teachers should swiftly refer their concern to the school officials who are responsible for helping with such issues. In this way, the teacher becomes a valuable member of the treatment team. Keeping the student focused on academic and social development is paramount, and the classroom is an ideal setting for this task.
