By Andrew Walen, LCSW-C, LICSW, CEDS
Eating disorders kill. Let’s be really clear on this. It’s the deadliest mental health diagnosis in the United States and affects approximately 30 million individuals. The majority of them are young, with the average age of onset in the early teenage years. This means teachers, health educators, and coaches – the adults who work with these children the most – are on the front lines of prevention, intervention, and treatment.
First off, you can’t tell if someone has an eating disorder simply by looking at them. Let’s examine common signs of an eating disorder beyond a change in body size as described by the National Eating Disorder Association (NEDA):
- Intense fear of fat or gaining weight
- Negative or distorted body image
- Frequent checking in the mirror for perceived flaws
- Self-worth and self-esteem being negatively influenced by weight and shape
- Fear of eating in public or with others
- Constantly or frequently thinking about food; fixating on cooking shows and collecting recipes
- Cooking extravagant meals for others, but choosing not to eat
- Hoarding food
- Only eating “safe” or “healthy” foods
- Eating strange combinations of foods
- Elaborate food rituals
- Making excuses not to eat
- Increased irritability
- Self-harm such as cutting or burning
- Substance abuse (alcohol, marijuana, cocaine, heroin, methamphetamines)
- Inflexibility regarding behavioral routines, and extreme anxiety resulting from interruption
- Withdrawing from previously enjoyed social activities
- Wearing baggy or layered clothing
- Showing a lack of emotion; alternately, extreme mood swings
The physical signs we most associate with restriction and anorexia, such as extreme emaciation, are actually the least common form of an eating disorder. Typically, we see adolescents with some mixed presentation of restriction, binge eating, purging, compulsive exercise, and an obsessive fixation on “healthy” eating termed orthorexia.
In addition, most assume that only females develop eating disorders. The National Association for Males with Eating Disorders (NAMED) states males make up 1 in 3 cases in adolescents. That number may be much higher if you take into consideration the diagnosis of muscle dysmorphia – the unhealthy fixation on leanness and muscle definition which often has significant disordered eating behaviors attached to it.
Coaches may see some very specific signs of eating disorders in their athletes as well.
- Becoming exhausted more quickly
- Lag time in recovery after workouts or competition
- Lower body temperature and increased sensitivity to cold
- Increased occurrences of severe muscle strain, sprains, or fractures
- Bradycardia, or reduced heart rate, along with low blood pressure
- GI distress such as nausea, constipation, abdominal pain, and feeling full all the time
- Trouble with concentration, energy, coordination, and speed
- Becoming light-headed and dizzy
- Decrease in performance
- Unnecessary additional training above and beyond what is required for sports (e.g. extra sit-ups, extra miles on the track, etc.)
- Struggling to get along with coaches and teammates
- Increased perfectionism
- Edgy and irritable mood
- Avoiding others
- Difficulty with taking days off and tapering
- Not staying hydrated or consuming too much
- Obsession with food, especially fixation on “health” values of food
- Preoccupation with how and what others eat
- Ritualistic eating, such as balling foods into tiny bites, or eating in a certain sequence repeatedly
- Avoidance of certain foods for reasons other than preference (i.e. “I don’t like olives.”)
- Excessive concern with how their body looks in athletics rather than performs
- Teammates becoming concerned about an individual
So now you have an idea of what to look for. What do you do next? How do you help? First job is to involve the family as soon as possible when appropriate. Help the family see how important treatment and early intervention is. An adolescent with an eating disorder is 12 times more likely to die from cardiac arrest and suicide than their peers. With the family on board, help connect the athlete to a doctor, eating disorder professional, or a program for a thorough mental and physical health evaluation.
It takes a treatment team to help the family and the adolescent recover, and typically involves psychotherapy, nutrition counseling, medical management, and psychiatric management as necessary. Be prepared for denial, anger, and anxiety (and not just from the adolescent). This is to be expected and will take some time to overcome with the help of treatment professionals. Be patient, kind, and firm. Don’t let the eating disorder win. Treatment is not optional.
The role of teachers, health educators, and coaches in prevention is invaluable. Educate your colleagues, students, athletes, and families on the signs and symptoms of an eating disorder. Know what resources are available in your community. You are in the position to save a life.
If you or someone you care about is struggling with an eating disorder, please contact The Body Image Therapy Center at firstname.lastname@example.org or 877-674-2843 x 0.