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Anorexia nervosa: Restricting food intake, excessive exercising, or vomiting to reduce body weight. Those who suffer from anorexia are concerned about gaining weight, think they are overweight and are underweight (Morrison, 2014).

Bulimia nervosa: Similar to anorexia but the person is at a normal body weight or sometimes obese. Those who have bulimia consume large amounts of food (also known as binge eating) in response to depression or stress. Due to shame, people with bulimia will vomit everything they eat because they care about how they look. Purging behavior is not limited to vomiting; laxatives, excessive exercise, and fasting are also used (Morrison, 2014).

Binge-eating disorder: Overeating even though the person is not actually hungry. There is shame in their behavior, but it does not result in the person to engage in vomiting, reducing food intake, or any of the behaviors found in anorexia or bulimia (Morrison, 2014).

Pica: Typically found in children or in pregnant women. This is when a person eats things that are not food. Examples include dirt, paper, and soap (Morrison, 2014).

Rumination Disorder: A person who regurgitates food (Morrison, 2014).

Avoidant/restrictive food intake disorder: A person who eats too little to get the nutrients they need or to gain weight. There is no issue with self-image in this situation. Tube feeding or extra nourishment are needed (Morrison, 2014).

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Anorexia: Body is thin, person is on a diet even though they do not need to be, negative body image and tying body image to value, loss of hair, obsession with food and dieting, and excessive exercise (Breeden & Marchesani, 2013).

Bulimia: Binge eating, overeating, fluctuations in weight, vomiting, use of laxatives or excessive exercise, self-esteem is tied to weight, and callused hands (Breeden & Marchesani, 2013).

Binge-eating disorder: Eating fast and a lot of food even when not hungry, uses food to cope with stress and depression, eats alone due to shame, high blood pressure, and eating until uncomfortably full (Breeden & Marchesani, 2013).

Pica: Upset stomach, stomach pain, blood in the stool, constipation or diarrhea (Family Doctor, 2018).

Rumination disorder: Stomach issues, dental issues, weight loss, chapped lips, vomiting or re-chewing food (Cleveland Clinic, 2019).

Avoidant/restrictive food intake disorder: Extremely particular in food choices, elimination of food through vomiting without replacing the food, nutritional deficiencies, no weight gain (Center for Discovery, 2019).

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In all ages, the following are signs of a possible eating disorder: weight loss, avoiding PE or the locker room due to undressing, exercising a lot, not participating in lunch, wearing extra layers, less time spent with friends, lack of focus and desire to be perfect (Alexander, 2013).
Cafeteria staff: Be aware of students who do not get much to eat each day and are losing weight. Also students who throw away the majority of their food or avoid the lunch room entirely.
Coaches: It is necessary to monitor exercise while with student athletes. Coaches could be the first to notice excessive exercise and weight loss, especially in high school students.
Teachers: Discussions among students in class about food and body image should be monitored. Be on the lookout for students discussing their dislike of their body or thinking they are overweight when they are not.
Custodians: If custodians notice students vomiting in the bathroom consistently, this must be reported.

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Present an open line of communication. Let the student know that you care, and you are someone they can talk to. This is a delicate situation because the student may get defensive or deny any form of disorder if the conversation is too aggressive.

Notify a school counselor immediately and follow school policy when it comes to the chain of who to notify. This can be in person, via phone, or via email. Follow the counselors or crisis teams’ instructions on what to do.

Avoid discussing food or body image with the student.

Do not wait; if you notice something, say something early so intervention can begin quickly.

Keep it confidential and be professional (National Eating Disorders Collaboration, 2016, p. 28-29).

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School counselors should start prevention programs geared towards healthy eating and positive body image. Educational material for parents have been helpful in prevention as well (Busar, 2012).

School counselors should be trained to notice early warning signs and symptoms. They often observe students in variety of settings including the classroom, cafeteria, and before and after school programs (Busar, 2012).

School counselors should understand when they need to send the student to an outside referral for proper treatment. Students with eating disorders often need either inpatient or outpatient treatment and to need to be monitored by a doctor (Busar, 2012).

School counselors should work with students, therapist, and parents if a student is placed into a treatment program.

School counselors should understand the school districts confidentially protocols when informing parents when a student discloses some type of eating disorder.

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NAMI, National Alliance and Mental Illness, is a nationally mental health organization to help families and individuals of mental health disorders.

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When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Without treatment, eating disorders can take over a person's life and lead to serious, potentially fatal medical complications. Eating disorders can affect people of any age or gender, but rates are higher among women. Symptoms commonly appear in adolescence and young adulthood.

Symptoms

Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.

Anorexia Nervosa. People with anorexia will deny themselves food to the point of self-starvation as they obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as they attempts to limit, eliminate or "burn" calories.

The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person's diet, out of fear of being "fat".

Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.

Bulimia Nervosa. People living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person's life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.

The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.

Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body's electrolytes and leads to cardiac arrhythmias, heart failure and even death.

Binge Eating Disorder (BED). A person with BED losses control over their eating and eats a very large amount of food in a short period of time. They may also eat large amounts of food even when he isn't hungry or after he is uncomfortably full. This causes them to feel embarrassed, disgusted, depressed or guilty about their behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.

Causes

Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person's physical and emotional health, self-esteem and sense of control.

Factors that may be involved in developing an eating disorder include:

Genetics. People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.

Environment. Cultural pressures that idealize a particular body type place undue pressure on people to achieve unrealistic standards. Popular culture and media images often tie thinness (for women) or muscularity (for men) to popularity, success, beauty and happiness.

Peer Pressure. With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.

Emotional Health. Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person's self-esteem and make them vulnerable to developing eating disorders.

Eating disorders affect all types of people. However there are certain risk factors that put some people at greater risk for developing an eating disorder.

Age. Eating disorders are much more common during teens and early 20s.

Gender. Women and girls are more likely to have a diagnosed eating disorder. However, it is important to recognize that men and boys may be under-diagnosed due to differences in seeking treatment.

Family history. Having a parent or sibling with an eating disorder increases the risk.

Dieting. Dieting taken too far can become an eating disorder.

Changes. Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.

Vocations and activities. Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.

Diagnosis

A person with an eating disorder will have the best recovery outcome if they receive an early diagnosis. If an eating disorder is believed to an issue, a doctor will usually perform a physical examination, conduct an interview and order lab tests. These will help form the diagnosis and check for related medical issues and complications.

In addition, a mental health professional will conduct a psychological evaluation. They may ask questions about eating habits, behaviors and beliefs. There may be questions about a patient's history of dieting, exercise, bingeing and purging.

Symptoms must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to warrant a diagnosis. Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is involved. It is not necessary to have all the criteria for a disorder to benefit from working with a mental health professional on food and eating issues.

Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identified and address all conditions at the same time. This gives a person comprehensive treatment support that helps insure a lasting recovery.

Treatment

Eating disorders are managed using a variety of techniques. Treatments will vary depending on the type of disorder, but will generally include the following.

Psychotherapy, such as talk therapy or behavioral therapy.

Medicine, such as antidepressants and anti-anxiety drugs. Many people living with an eating disorder often have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that these medicines help with underlying issues.

Nutritional counseling and weight restoration monitoring are also crucial. Family-based treatment is especially important for families with children and adolescents because it enlists the families' help to better insure healthy eating patterns, and increases awareness and support.

Related Conditions

People with eating disorders often have additional illnesses:

Treating these illnesses can help make treating an eating disorder easier. Some of the symptoms of eating disorders may be caused by another ilnesss.

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When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Without treatment, eating disorders can take over a person's life and lead to serious, potentially fatal medical complications.

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When staff are eating in front of students,  staff should refrain from sensitive topics regarding weight, calories, throwing up, etc.

Staff should focus on exercise and health eating rather than appearance (Educator Toolkit, n.d.).

Staff should limit eating treats and junk food in front of students but should encourage drinking lots of water (Action For Health Kids, 2019).

When food is needed for a school event, healthy food should be encouraged and limit junk food.

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This is a great resource for all school professionals.

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Pawley, C. (2017, February 24).

After anorexia: Life's too short to weigh your cornflakes. [Video]. YouTube. https://www.youtube.com/watch?v=gZpcTVqpaPw

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After anorexia: Life's too short to weigh your cornflakes | Catherine Pawley | TEDxLeamingtonSpa

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Renzoni, C. (2019). Eating disorders facts and statistics. The Recovery Village. https://www.therecoveryvillage.com/mental-health/eating-disorders/related/eating-disorder-statistics/

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Alexander, J. (2013). A lesson for teachers in addressing the eating disorder bully. National Eating Disorders Association Blog. https://www.nationaleatingdisorders.org/blog/lesson-teachers-addressing-eating-disorder-bully

Breeden, L. & Marchesani, A. (2013). Eating disorders 101. Florida School Counselor. https://renfrewcenter.com/sites/default/files/media_article_pdfs/Eating%20Disorders%20101.pdf

Busar, J. (2012).  The School counselor’s role in addressing eating disorder symptomatology among adolescents. American Counseling Association. https://blackboard.angelo.edu/bbcswebdav/pid-2699674-dt-content-rid-25653748_2/courses/11451.202110/17.SUM1.EDG6327DM1.lcasarez1_ImportedContent_20170518094448/the-school-counselor-s-role-in-addressing-eating-disorder.pdf

Center for Discovery. (2019). ARFID signs and symptoms. Center for Discovery. https://centerfordiscovery.com/conditions/arfid/

Cleveland Clinic. (2019). Rumination Syndrome. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17981-rumination-syndrome

Educator Toolkit. (n.d.) National Eating Disorder Association. https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/EducatorToolkit.pdf

Family Doctor. (2018). Pica. American Academy of Family Physicians. https://familydoctor.org/condition/pica/

Morrison, J. (2014). DSM-5® Made Easy: The Clinician’s Guide to Diagnosis. The Guilford Press.

National Eating Disorders Collaboration (NEDC). (2016). Eating disorders in schools: Prevention, early identification, and response. National Eating Disorders Collaboration. https://www.nedc.com.au/assets/NEDC-Resources/NEDC-Resource-Schools.pdf

Staff as health role models. (2019). Action for Heathy Kids. https://www.actionforhealthykids.org/activity/staff-as-healthy-role-models/