East Kootenay Eating Disorder Program
Cranbrook Mental Health & Substance Use
20-23rd Ave. S. Cranbrook, BC V1C 5V1
ph.(250) 420-2210 email. Jennifer.cooper@interiorhealth.ca
Program Clinician: Jennifer Cooper
What is Anorexia Nervosa?
Anorexia is a word coined by Dr. Gull and Dr. Laseque in 1870, meaning “nervous lack of
appetite”. This is a misnomer because seldom is there a lack of appetite except in the final
stages of the disorder. Instead, we find extreme control of ones’ thoughts over physical needs
such as hunger and a constant preoccupation with food, eating and fear of becoming fat. Food
intake is severely reduced and exercise is compulsively over done. This may occur gradually,
making it difficult to recognize someone who is struggling with this disorder until their emaciated
appearance becomes apparent.
Significant weight loss leading to a semi-starvation state, sets into motion a variety of
psychological consequences including distortion in ones’ body image, inaccuracy in identifying
sensations of hunger and fullness, a sense of ineffectiveness, interpersonal distrust, a drive
toward perfection, and feelings of hopelessness and depression.
A number of physiological responses also develop as the body tries to protect and maintain its
primary life giving functions.
More Facts re: Anorexia Nervosa
 Low prevalence disorder, with a prolonged course and with serious physical and
psychiatric manifestations.
 AN has the highest mortality rate of any psychiatric disorder.
 People with AN are more than 30 times more likely to die as a result of suicide than the
general population.
 There is increasing evidence that the age of onset is widening with more cases being
reported in prepubertal children and older people.
Anorexia Nervosa Facts: Diagnostic Features
 A refusal to maintain body weight over a minimum normal weight for age and height.
 Weight loss of 15% or more of one’s original body weight.
 An intense fear of gaining weight or becoming fat.
 Fear that weight gain is out of one’s control.
 Distorted body image.
 Amenorrhea in women (loss of menstrual periods).
Anorexia Nervosa Facts: Warning Signs
 Dissatisfaction with body shape and appearance.
 Significantly reduced food intake.
 Excuses for not eating such as: “eaten earlier”, “not hungry”, “do not like that food”.
 Talks about food and enjoys cooking for others.
 Unusual eating habits such as: cutting food into small pieces; eating alone; avoids eating
out in public; taking a long time to eat; and, pushing their food around on plate.
 Expresses feeling fat in spite of weight loss and increasing thinness.
 Exercises excessively such as walking or running and appear restless and may have
repetitive body movements.
 They look unwell, face pale, hair limp and thinning, and glands may be swollen.
 They are always cold and wear layers of clothing.
 They are irritable, deny that anything is wrong, see themselves as fat.
 They may seem angry, sad, irritable, cry easily and want to be alone.
 May have trouble concentrating, may experience fainting spells, weakness or blackouts.
 Perfectionist tendencies.
Physical Signs due to Semi-Starvation
 Loss of body fat and muscle, emaciated appearance.
 Dry, pasty, pale skin.
 Stringy, dull, thinning hair.
 Brittle nails.
 Constipation.
 Lowered body metabolism, decreased temperature, decreased heart rate.
 Heart problems, palpitations.
 Dizziness, weakness, fatigue.
 Difficulty sleeping.
 Loss of menstruation in women.
 Growth of fine downy hair on face and back.
 Swelling or puffiness in face, fingers and ankles.
 Brittleness of bones increase stress fractures.
 Slow, slurred speech, decreased concentration.
What is Bulimia Nervosa?
Bulimia is a term derived from the Greek word meaning “ox hunger” and is characterized by
binge eating or continually consuming large amounts of high caloric foods.
These binges are usually interrupted by a social contact or physical discomfort and are followed
by guilt and some kind of attempt to “purge” or rid oneself of the food. Usually this takes the
form of self-induced vomiting, excessive use of laxatives, excessive exercise or a combination
of these.
Individuals with this disorder feel shame and guilt over their binge/purge cycle and their inability
to stop it. They sometimes lead secretive lives, sneaking around, hiding food for later
consumption, disguising their purging efforts, lying to friends and family and deceiving those
who try to help. They may even steal food and/or money to support their habit. This may be in
direct contrast to other parts of their life where they may abhor lying or stealing of any kind.
More Facts re: Bulimia Nervosa
 Bulimia Nervosa is a clearly defined psychiatric disorder of moderate severity and with
higher prevalence rates than Anorexia Nervosa.
 There is also a bias towards females although not as marked as AN.
 Adolescent girls and young women are especially vulnerable but males and older
females are also affected.
 It is associated with other co-morbid psychiatric complications such as depression,
impulsiveness, dangerous behaviour and substance misuse.
Bulimia Nervosa Facts: Diagnostic Criteria
 Episodes of binge eating (rapid consumption of a large amount of food in a short period
of time), with sense of lack of control over eating.
 A feeling of lack of control over eating behaviour.
 Self-induced vomiting and/or
 Use of laxatives, diuretics or “diet drugs” and/or
 Dieting, fasting or strict excessive exercise to prevent weight gain.
 Persistent over concern with body shape and weight.
Bulimia Nervosa Facts: Warning Signs
 Consumption of large amounts of food with little weight gain or extreme weight
fluctuations. Food restriction when eating in public.
 Frequent trips to the bathroom, especially after meals.
 Evidence of vomiting or laxative abuse.
 Food disappears from fridge or cupboard for hoarding of food.
 Frequent conversations about weight, shape and calories.
 Hoarse sounding voice and complaints of sore throats.
 The person may appear angry, sad, irritable, cries easily and wants to be alone.
 Excessive exercise.
 Guilt and shame about eating, highly self-critical attitude.
 Substance abuse and/or impulsivity (spending, decision making, relationships).
 Denial of problems, hypersensitive.
 Looks physically unwell with lack of energy and general deterioration of health.
Physical Complications due to Bulimic Behaviour
 Swollen glands in neck, puffiness of cheeks or broken blood vessels under eyes.
 Dermatitis around mouth and complaints of sore throat.
 Abdominal pain, bloating, constipation.
 Electrolyte imbalances due to sodium and potassium depletion causing headaches and
irregular heartbeat.
 Dental erosion due to acid from stomach.
 Rectal bleeding or prolapsed and/or uncontrollable diarrhea due to laxative abuse.
 Dehydration, which may result in kidney damage.
 Irregular menses.
 Chest pains, muscle cramps, fatigue.
 A continuous cycle of bingeing and purging slows down the body’s metabolism. During a
binge, the body absorbs fat and calories, thereby increasing the possibility of gaining
weight.
Subclinical Eating Disorders
This category includes:
 disordered eating,
 restrained eating,
 binge eating,
 fear of fatness,
 purging, and
 distortion of body image.
The above are all common among young people, affecting 45-55% of this population.
 Internalization of the “thin ideal” begins in primary school at as early as six years old.
 Secondary school aged girls report feeling overwhelmed by body image and weight
issues.
 They describe a constant worry of fat content in food and of their shape and weight –
what is worse is that they consider this to be “normal”.
 Subclinical eating disorders increase the risk of the development of a clinical eating
disorder such as Anorexia Nervosa, Bulimia Nervosa, or Eating Disorder NOS.
Binge Eating or Compulsive Overeating
 It is characterized by recurrent episodes of binge eating WITHOUT any compensatory
behaviour – meaning they neither purge, nor fast or excessively exercise.
 Intense feelings of “emptiness” that cannot be satisfied even with food.
 Intense feelings of guilt and shame.
How Can Teachers, School Counselors and Parents Help?
Helping Children Grow Up Healthy
 Don’t make comments about anyone’s, including your own, size or weight, especially as
a “joke”.
 Make sure that the young person knows that you accept and appreciate them regardless
of their size or weight.
 Treat all children/adolescence equally well.
 Build self-confidence and self-esteem through a range of activities, both physical and
non-physical.
 Build good self-esteem in all children/adolescence for who they are and what they do,
not how they look.
 Feel proud of your child, regardless of their size or weight.
 Be creative and assertive in finding the right clothing and equipment for your child or
student.
 Encourage healthy eating and physical activity for the entire family, classroom, school.
 Seek out help to work through personal feelings of guilt and shame related to your size,
shape, appearance, in order to avoid transference of these issues onto your
child/student.
Parents and Prevention
As teachers you can help parents by encouraging the following. This becomes especially
important if you hear or see students engaging in dieting behaviours or you are
concerned about the conversations you are hearing amongst students.
 Promote frequent, balanced meals and snacks.
 Encourage a trusting feeding relationship.
 Ensure healthy attitudes about food at an early stage.
 Encourage self reflection about attitudes, language and behaviours.
Promoting Positive Body Image – A Guide for Schools
Creating a Body Positive Environment in Schools
 Emphasize self-esteem, critical thinking, self-assertion, and communication skills – these
skills will inoculate children against pressures they experience to change or harm their
bodies.
 Understand and think critically about your own values and attitudes toward weight,
dieting and body image – Consider how your values may affect the students you are in
contact with.
 Be critical of some common practices, being aware of the hidden impact they may have
on students.
 Shift the focus in schools from weight concerns, ie. Childhood obesity to a focus on
wellness and balance.
 Be a healthy example to others by taking people seriously and listening to what they say,
feel and do, rather than for how they look.
 Have a zero tolerance of jokes or teasing based on how a person looks – consider this in
the same light that you would consider sexual harassment. Remember eating disorders
can arise from a variety of potential causes but it is acknowledged that teasing or being
ridiculed about ones size and shape can contribute to the development of an eating
disorder.
What Coaches and PE Teachers can do to Promote Positive Body Image
 Do not weigh your athletes – this is an obsolete practice with no real benefits. It
perpetuates the idea that weight is the most effective way to gain a desirable form both
aesthetic and athletic.
 Educate yourself on unhealthy practices/behaviours – many athletes resort to dangerous
weight control methods in order to gain an edge over competitors. Sports where
thinness/weight are particularly emphasized include gymnastics, synchronized
swimming, diving, equestrian sports, weight lifting, wrestling, boxing, running and ballet
(dance).
 Recognize that excessive exercise can be part of an eating disorder. It is difficult for
both the general public and the person over exercising to understand that this behaviour
could pose any harm because our society views exercise as such a virtuous activity. Be
curious when you notice students excessively exercising and question whether or not
there are “thin motives” behind the behaviour.
 Create an overall climate of size and shape acceptance in your classes. Make sure that
uniforms are suitable for a variety of sizes and shapes and ensure that teams are
selected in such a way that any type of discrimination is discouraged
Resources
When Girls Feel Fat: Helping Girls Through Adolescence
Sandra Susan Friedman
Brave Girl Eating: A Family’s Struggle with Anorexia
Harriet Brown
Help Your Teenager Beat an Eating Disorder
James Lock & Daniel Le Grange
National Eating Disorder Information Centre www.nedic.ca
Kelty Mental Health Resource Centre http://www.bcmhas.ca/SupportCentre/Kelty/default.htm
Looking Glass Foundation http://www.lookingglassbc.com/