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Chapter 55 HelpingStudents with Eating Disorders

DanaHeller lzvitt Preview clinicalformsofdisordered eating andbody image andtheirless Eatingdisorders preoccupalion continue to bcon therise.Professional schoclcounselors te likely presenting with suchissues from elementary tlrough high school. to seestudents This chapterprovidesa brief overviewof the symptomsand behaviorsof eating ofcounseling andprevention Anention disorden followed by discussion strategies. differences is provided, including manifestations and to developmental provides rcsources for counselors aswell asstudents, interventions. A finalsection teachers, andparents. (e.g., AnorexiaNervosa,Bulimia Nervosa,and Binge Eating Clinical eatingdisorders population. of thegeneral A greater numberof peopleare Disorders) canbe foundin about5Vo with sub-clinical whenthedefinition is expanded to includethose such included manifestations, as disordered eatingand disturbanccs in b^dy image.Disorders thal do not meet diagnostic population, with suchcases critcriacanaffcct4 to l6Vootthe general being two to tive times girls (Muscll,Binford, & Fulkerson, morecommonamongadolescent 2000). Clinical eating andhealthyeatingattinrdes disorders may be conceived on onc endof a continuum andbody imageon the other end, with differingvaluesof eachlying in between.Studentswho are ., dissati.sfied point all have lhe potentialto with their bodies, dieting,or cven at the healthiest problems. develop moreserious are Anorexia Nervosa,Bulimia The most corunon forms of chnical eating disorders and Binge EatingDisorder. Anorcxiais markedby intense desiresto lose weight, Nervosa, aboulone'sactual weight,refusello gain weight,and a body rveightthat is at misperceptions a student who should,accordingto heightand lesstlan it shouldbe (fo; example, leastl5%o weigh100pounds currentjy weighs no morethan85).Srudents with anorexia bodycomposition, fastandavoidfoodandmay or may not engage may intentionally in compensatory activities, ., vomitingafterperiods exercise or self-induced of feelingthal theyhaveeaten suchasexcessive pointof Bulimia ofpurging area defining lco muchSuchacts Nervosa, a cycleofbingeeating asealingan excessive and purging. A bingeis defined amountof food in a discrete periodof in a 2-hourperiod.This shouldbe differerrtiated tirne,suchas 2,000calories from uormative with friends suchas snacking binge.s or eatinga lot of food at a socialevent.Purging,suchas vorniting, useof la:ratives self-induced or diuretics, or excessive exercise, is usedasa means of cornpensaiing for thebingeor maysimplybea way to alleviate feelings of guilt, stress, anxiety, feelingthatis rbleased or another tluough thisactivityfollowinga binge. Similarty, BingeEating Disorderis characterized by bingeepisodes as described above, absent of the purgingcycle (Amcrican Psychiatric Association, 2000). Disordered earing(dietingor in someorherway modifyingfcod intake to lose weight) affects (Gabel sruden rsof all ages to eating disorders & Kearney, I 998;Phelps, sapia,Nathanson,


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Otherfaclorsmustalso be considered, 2000). includingthe evalualion ofbody size & Nelson, towards thebody(Pesa, Syre,& Joncs, attitude.s 2000).Body irnage andnegative dissarisfacrion as the strongest predictorof eatingdisorders (Phelpset al., 2000).Eating hasbeenreported manifestations or their sub-clinical may havelittle or nothingto do with earingor disorders theyareresponscs Some!imes to traumatic events bodyimage. or feclings of lossof control, and of eating may beonemeans of establishing manipulalion a sense of idenr.ity or pcrsonal power. and bodyperceptions (Brook & Tepper,1997;Franko Thereis a directlink beiweenself-esleem Israel& Ivanova, 2002;Loewy,1998;Pesa & Onori, 1999; er aI., 2000;phelpser al., 2000), little argumenl ard, asa result, thateatingdisorders need attention in schools.
Identilication of A t-Risk Students Eating disordersand relared issues still predominantly affect females, with gender differencesemerging ar around ages eight ro ten (Ricciardelli & Mccabc,200l). Malc body image idealsantJvalucs havc morc reccntly spuned developn)cntofsuch concerls among boys and young mcn- The prirnary concern for boys is abcut being underdevelopedor nol muscular enough, whilc girls are drawn toward thinness (Cohanc & Pope,200l). Eating parhology and appcar:lncc prcu;cupatiolr arc associatedwi[h dcprcssionand dysfunctional t]inking, both of which affect stuCents'overall self-esteem and well,being (Franko & Omori, 1999). There are numerous waming signs of eating disorders (see Table I) on any point along the continuum b e y o n dd i e t i n g ,s u c h a s w e i g h t c o n c e r n s ,d r i v e s f o r t h i n n c s s , f e e l i n g i n a d e q u a t ea , ndnegative self-evaluation. lfa student presentswith any ofthese warning signs (parricularly the physical and behavioral symptorns) it is important for the professional school counselor to ensure the studentconsultsa health care professional. Table l. Phys;cal, behavioral, and psychological warning signs of eating disorders. Physical tweight loss *hair loss teriema (swelling) *skin abnormalilies +discoloredteet} *scarring on thc backs ofhands fabnormaleatinghabits Behavioral lfreguent rips to the bathroom lavoiding snack ioods *frequent weighing tsubstance abuse +social avoidance *isolation *perfectionism Psychological *low sclf-estcem texlernal locus of control thelpiessness *depressio;: ranxiety tanger

Counseling and Prevention Slrategies The mostwidely usedtreatments for eatingdisorders in the schools areindividualand groupcounseling, .guidancc involvement of family members, and classroom programs. Professional schoolcounselors canalso implernentschool-based changes to creatca more safc andaccepting cnvironment around the issues of eating disorders, weightism, andphysical and overall self-estecm. hevention cffortsgenerally centered on bodysatisfaction andeducation maybeconceived at primary (curbdietingbehaviors, address conccms aboutweight/shape), (reduce secondary theduration ofeating disorders), andtertiarylevels(adtliess & reduce impairment ofestablished disorders)(Gabel 1998). & Kearney, Activides shouldaddress all of thesystems at playin thedevelopment ofeatingdisturbances:


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family,sociocultural, self-deficits, body imageconcerns, self-esteem, and peer and patental (O'Dca,2000). the negative involvement shouldaddress Attempts consequences of unhealthy weightcontrolaswcll asencourage (Musseller al.,2000). healthyeatingandexercise Professional counselors school and odrerpersonnel musl first cxaminetheir own beticfs and feelingsaboutweight,shape, appearancc, and self-estcem. Regardlcss of the form of interventionor age grofp to which it applies,professionalschool counsclors' work should forcmostfocus cn Promotingbody satisfaction.Counselors may lhen help studentsenhance andpersonal efficacyby recognizingpositiveaspects self-estcem of their physical appearance (Phelps, et al.,2000). Somcapproaches, particularlypcer-led,canhavenegativeeffects.Programsthat provide informationabouteatingdisorders, led by recovcredpeers,incrcasesstudents'knowledge of disorden,but alsoincreases (O'Dea,2000).Srude;,sintroducedro bclicfs, eating theirsymptoms and bchaviors preceding attitudes, eatingdisorders may hearsuggestions to toseweight and the of doingso.For younger means covengeof eatingdisorders chil&en, frequent in this manner can normaUzc thc problemandtherebycreatelonger-term difficulties. A positive approach providing information on body image can be more beneficial. whatmakes Addressing tbemsatisfied with theirbodiesandintroducingactivities anddissatisfied tlat descnsitize thcmto theevents dissatisfaction elicitingbodyimage and earingdisorders are useful tools(Gorc,VanderWal, & Thelen, 2001).Helpfulactivilics may includeguidedimagery and rclaxation, envisioning as brave and strong, and encouraging oneself pleasurable bodyrelated riding, gettinga haircut,or wearingfavoriteclothes. Individual Counseling Theprofessional schoolcounselor must bc mindful of his or her limits, and bc preparedto referstudcnls who havesevere impairmcnisto counselors in thecommuniry who can offer more conslanl and intensive care.In additionto thenpists,professional schoolcounselors should becomc familiar with otherhelpingprofessionals who canassistwith earingjisorders, such as nutritionists, dieticians, physicians, excrcisephysiologiss,and psyci'riatrists. 'Counseling theeatingdisordered studcntcanbe tricky.Educationaboutnutrition, exercise, self-acceptance, andthephysical dangers associated with eatingdisorders areessential. At r-he time,the student's same emotional distress performance andacademic needio be addressed, as well asdevelopment of identiryard appropriate copingmechanisms (Cabel& Keamey,t998; Car::er, Garfinkel,& Irvine, I 986;I-evine& Smolak,2001).Many stuJenrs with eatingdisorders maybc dcfcnsive andrcsistanl to hclpbccausc lrrcirbehavior theybelievc hasbecncffectivein wbai they want (attentionfrom peers,parentalaffection, a socially acceptablebody sizc). Othertimes,students will referthemselves theireatingdisorder because hasgottenout of control. cases, In these thesmdent's willingness lo dealwith theeatingdisorderandotherpmblems in thesrudent's life, andto seek helpin doingso,should be acknowledged (Ornizo andpraised &Onrl'2o,1992\. Garneret al. (1986),pioneers in eatingdisorder Featrnent, suggested thar thereare t\ryo tracks. The first trackinvolvesissues of weigbt,starvation, enalic eating,bingeing, vorniting, srenuous exercise, or whalever thestudent's physical manifestation of the eatingdisorder may bc. Cognitive-bchavioral approaches rnight includerestructuring thoughts,assistincewith meal planning, and challenging distorted atritudes aboutweightand shape. The secondtrack is the emotional contextthai may involle underlying developmental issues, personality, and family a-nd peerthemes. A psychodynamic approach rnight includea developmental undersranding of eating disorders asa typeoffear,iamily separation parenlal issues, inattention to the student's nceds, anda lack of self-regulation. Garneret al. suggested thateatingdisorders can be dealt with initially from eithertrack, as eachcommunicates lo the studenta desirero helb and



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commitrnent to eosuring tllatbothphys.ical andemotionalhealtl is restored. cognitive- behavioral andpsycbodynamic approaches arer}e mosl widervuseawirrr;"drd;;;;ff iadng disorders; the afectivc levershourdbe particurarryatrended io amongpre-adurt popurations. Counseling shouldmatch srudenr developmental l.".fr. m"'uJ" oijou_rt, .un U. particularlvhelpfu.l in uackingfeelingsandbehaviors. Fo, yrr;;.;;i;d;;;lt tesscognirive ,food_mood,diary capaciry, simply kecpinga may be enough.;;;i;;Jil -trigtr ,.i*r .ounr.ton working with order srudenrs in.middre ana sctroor,;y h,;;;lrtti-n'"ri.irrng o,oo comprexprocessing by examining whar was rr-.pp"ningdu;"g p";;;;i'*-,ing ro binge, purge,absrain from eating, and^so forrh.Engaging students in rtre piocess io.nrifying, theireivironm.nts is empo-wcring "i-iyJ"g, at anydeveropmentirr"rl (Lcvine


In this way srudents learnaboutadvocacy and oreforcestlratinfluencerheir feelings about their bodies, while learnirrg-trow. ro *i,l;";;;ry inreracrions *ln o*i^ Lu ,.""i"g lo'e abouttheirbodies. Theseprorecrive faciorsand oreimmediare feedback from peers in groups enables students ro be mo;epr.activein pr."rnrinf *,.,, o*n andpeers, eatingdis.rderrisks. fhcrc are dangersr'n running groups of ,Jrf ;;;;r., as rhey can ar timJs be explosive, heaviiyemorionauy laden, or diffjcul-r ,o i., r,rJ*i. io.t -" op."ry ,uo"iit lir"o"n"npr,"u,. feelings. Theprofessional schoor .ounr"tJr rt ouiJ'ii.,.r"r"* exercjse caurion antJ parience and haveappropriate supports in placefor students in rh"s"'groupr. I nvolvingFamiIy M enbe rs Few indjvidualor groupinterventions are effecti.

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Group Counseling Groupsthat focus on body imagc and lhc factors that lead to eating disor<Jers arc more likcly to occur wilhin the schoorr"tti-ng.Th"s" groups provide studen* with opportunities ro engage in activiriesandpracrjce_new behaviors ,Lh p".r, u, a time whentlrey arewrnerabre ro peerinfluences (r-evine & Smolah zmrl,st"a-""rtin ioay r,n.g. ur"*n"r. gioupsbuirdsuppon syslems andfaciritate connections wirh oneanother. I1is important fo, counsiorsreading groups to ensure tlat rheyarebeingpositive role modelsby .*;lrJ;; o-ntt ,uU;..r. stru*ured groupcounseling gives studenrsi focus"d;;;r " *ur, ;;;il;;Jiou, ,o promotepositivebody image-Severar approaches incorporale education, insight, and action. Groupscanfocuson rearisric goar.ser,i"g, rr."r,r,y u"ay rmage,assertiveness, andperfectionism over8 ro r0scssions (Rhvne-MnkJe'driuru.ra, rqsqr. c;;.r,,;*",;;;: ]il;riviries rhar encourage putting into perspective socioculnrral and media messages l-p"rlance of appearance empowerstuden* ro feel "t"'ri,ir" 300d abour rhemserv"s*tu"re .;;;;;; ro rie serf_ esreem of their peers.o.u:Ju:: may in-crud:identiirng characterisrics of aa.niieo peoplcor collectrng adverrisemenL< rhar teachstudents rrruilir is bad. Group sessions often incrude: informationon dietingandexcrcising,devetopilt a fooo tog, heartryexercise, eatingbehavion, emotions associared wirh eating, r"r-"rt."r uni uutoyry,. uooyimageand goa!setting, and

inrageand serf-esrecrn. Family mernber;r.t ;;;;;;;rc ro unhealrhy atrirudes and behaviors aboutrhc bodyrh'rughrri,xJeling.ri"ring;urjJr".r us werias cornrncnrs abour students' andorhers' "uring, appe;uances, andcriricism of rheirsr'dcnrs,changing b.dies(Goreet ar., 2001;Loewy,I998; N,taine, ?000;Mus"eti.i.i., iObOl Famitydynamics haveatsobeen implicated in tre cteveropment of eating disordor.crrr, *lro..port highlevers of eating probrems live in families marked by lesscohesion, orgunirr,ion, undexpressiveness. Famjlies ifsrudents

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in secure attachments andwarmth(Byely, disorders arealso lacking witheating more conflicrual, parentsmust bc involved in In any circumstances Archibdd, Grabcr,& Brooks-Gunn,2000). ConsuliACA andASCA codesof ethicsand local school policies for guidance on treatment. informcdconsent. family therapyis often highly rccommendedto Bccausc of the natureof eatingdisorders, anxiety, and any host of other felings of anger,conJlict,deprcssion, explorethc child's expression (Gamer et d., 1986).This is firrther by thebomeandfamily cnvironment thatmay bc intluenced to know communityresourcesand makc referrals for for profcssional schoolcounselors causc needed scrvices. hofessionalschoolcounselonwill alsoneedto work collaborativclywith the Caution: Recognizcyour limils and thenpists,andmedicaldoctorswhen applicablc. srudcnts, professional schoolcounselors Tablc2 includesactivities can engage asnecessala. makcrcfcrrals Within the school setting,professional school in to help families copwitl eatingissues. counselors can takeon a numberof rolesto prevent,identify, and provide servicesfor srudcnts with eatingdisorders. Tbble 2" How to help fandlies copewith eating disorders. abouteatingdisordersfamilies l. Educate homc. 2. Sendqrinen conespondencc abut weightandhealth. 3. Facilute familydiscussions 4, Alerl farniliesto how they might sendharmfirlmessages. 5. Setlimits andopenlydiscu:sissues. andfosterfamilyrelationships by spending eating habits mealrimes togethcr. 6. Ascertain own feelingsand prejudices about an examination of family members' 7. Facilitate weight. and mentalhealthprofessionals. to cornmuniry medical referrals 8. Makc appropriate canfostercohesive, warmrelationships, thatspending time with children 9. Emphasize protectingstudents from eatingdisorden. tkough parent-teacher association 10.Planprograrns meetings. aboutnormalpuberty families anddevelopmental I l. Educate changes. ntal Guidanc e Programs Deve lopme canbecovered asa lopicwithinseveral Eatingdisorders elective courses aswell asthc education curricula. andphysical hofessional counselors health school canencourage tcachers andself-acceptance to combine issues ofnutrition,exercise, into appropriate classes suchthat childrcnleam positivcly abouthealthyandactivelifcstyles(Gabel & Kear.ney, 1998).Srudents aboutthe negative effectsof stawation,erratic eating,and bingeing, can also be educated depression, anxiety, including: irritability, feelings of inadequacy, fatigue,preoccuparion with (Garner andsocialwithdrawal food,poorconcentration, et al., I 986). other contentto address


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wit-hstudents in classrcioms .includes body-esteem and self-esteem, locusof control,approvalseekingbehavior, body image and nutrition, cxcessiveerercise,and pcrfectionism(RhyDeWinkler& Hubbard, 1994). guidanceprograms Classroom ad&essingthesetopicscreatean environment in whicb students examine knowledgeandatdrudes aboutfood andeating,dcveloppositivcandrcalistic attitudes towards tbeirbodies, andgainaccurate information(Rhyne-Mnklcr & Hubbard,1994). Given the influenceof peers,trainingsnrdents to providepeerJedprogramsmigbt bc a uscful meansof disseninatingsuchinformationeffecrivcly.Students will bcmorc |itely t" listen ro one anothet on mosiissues. A select groupofstudentsto teach othcn aboutcatilg disorders and positivcbodyimagecan be empowering for botlr leaden antirccipiens. Suchoplxruruues can sene asprotective factors,much;;r the sameway aspeermentoringprognms oo olhcr issues, suchassubstance abuse, violenceandtransition to new schools. In oncir"h progta-, theOphelia Project(, high school girls are mentorsio mi.ldle schoolsrudcntsil ord-er to prevenlandprocess relationalaggression. Programcoordinators found tbatincreasing self-esteem in anotberrealm creates more positive body image anong parricipants. srudeDrs involvedwith tlrepro8rarnalsohadsignificantinfluences on rheschoolenviron-ent asa whole. Sys temic Sc hool-bos ed Changes hofessionaJ schoolcounselors shouldbecomeknowledgeable abouteatingdisorders and provideinformation andconsultaiion to prsonnel, parents, andsrudents lMussil er al., 2000). Discussions aboutbiases zrnrl viewscantale placewith teachers, coaches, ald administrators who address weighr (Gabel reduction & Kean:ey, l99g).1'eachen may a.lso betrained ro infuse eating disorders into curricula andlo Listen actively, provide feerJback non-judgr:entally, andro teachwithoutlecturingsuchthatthey aremore likely to identify srudenbat riJk andrefer them for help. A safeschoolenvironntent can beg;nwith the professional schoolcounselor. Trainiugfor awareness ofsigns and symptoms ofeating disorders isjusr the beginning. Table3 addresses continuinginitiatives tiat will prompt systemicchanges, andreduce&e frevalenceof caring disorders (Ryhne-MnHer & Hubbard.1994). Developmental Coruiderations ElementarySchool Startingto apPropriatcly teachstudents early abouteatingdisorders and body and selfesteem maximizes impactanddecrcases thelikelihoodof issues laterir childhood andaiolescencc (ohring et al-2002). Because youngchildren respond weil by doing, "rprrl.nriJ.o*ponenrs suchaspoetry, humor,andgames in prevention curriculaald inte-"niions hosprgven successhrl (Mussell et a1.,2000). Young children havelikely nothadexperiences witi failedo; chronic diering andmay rror undersrald theconcept of bingeing (Ricciardelti & Mccabe,2col ). For tJrose wio showearly signsofdisordered eating,gradual exposure to fearedfoodswith relaxadon training, role playin! to address social and familial probtems,and developingaltemariveways of tiinking about problems arehelpfulelements (Gorest aI.,2001). Middie School Perhaps mostimportantat this level is rhe normalization of physical changes that tale . placcin puberty(ohring cr at.,2002).Bodily changes, especially lbr siudents whom-arure earlier, areunfamilar andcreatediffereEces. Peersupportis vita.l in mid<Jle school, particularlyrelativc lo eatingdisorders. Peer-led programs, whethergroups,prevention *oikrhopr, Jr merery


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Tbble3. Initiativesto enhance slslemic change. L homote activities thai fosterhealtly attirudes about weight, shape , growth, and nutrition. 2. Monitorhowhealth andphysical activityrequiremenis arccommunicatcd to srudenrs andfamiles. 3. Creatc an atmosphcrc in whichstudents confrontnegative body, 4. Advocatcfor nutritionalfood and snackofferings. 5. Enforce purcbase oflibrary andclassroom materials with positiveimagesaboutselfesteem and body image. 6. Encouragc useofthe term 'fat'as neutraland non-derogatory. 7. Crcatea wellnessprogram. a. Focuson prevention andearlyintervention. b. Involveleachers andadministrators. c. Promote healthyanirudes andhabitslowards eating. d. Encourage self-control. e. Focuson improving sclf-esteem and autonomy. f. Prcride apprcpriate materialsin fre hallways. g. Foster discussions amongthe wholeschoolcommuniry. h. Conrinually l-ocus on theoverallwell-being of siudcntsfacilitated smallgroupdiscussions, allow srudents to promolesensirivity andposirivebo<ty talt whilelearning thattheymay seekone another(Mussell et al.,2000).As pcers areso influenrial duringmiddleschool, encouraging srudents to talk sensitively andproviding traininglbr pcer menloring andfacil.itation to teach others aboutthese issues can be empowering and a positive uscof peerinflucnce. (2000)describcd O'Dea and.Abraham a 9-weekprogram based solelyon self-esteem thal waseffecrivc in improving bodyimage andoffsetting dicting,weightloss,andeatingdisordered behavior amongfemale middleschool participants. Based on uhe principlcof student-centered Iearning, srudents workedin groups andincorporated leamwork, games, play,and dramain thjs content-fue curiculum. Theprogram itselfwasintended to fostcra positive sense of self,positive and safc studentenvironment, vicariouslearning,feedbackexchange, and a posirive antl supportive environmenl in which thesegirls felt that they could not fail. The suicessof programin nodifying body imagewithoutdirectlyaddressing thetopic demonstrates r.he benefits of self-estecm bascd programming. High School It may be imponantto targetgirls with low self-esteem as well as other earlt sisnsof eating disorders. Smallgroups areparticularly usefulin facilitaring inrimate discussions inong high schoolpeersabourthis issue(l'lussellet at., 2000).peershelp io debunk myths abour appearance andofferalternative wayscfhandlingdifflcult problems. It is also usefulto incorporare activjties that havean activisttwist, enablinsstudenrs to



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serf_e srecm), leaches high schoorers aboutmedia r*-.n.*, activism,and advocacy and simultaneousry increases serf-esteem andprevenrs eatingd.isorders ( Go GtRrJrand orrer weekrl^grgups discu.siso.iur pr.rsur"sfom rnedia,peen, andparenrs beforc movinginlo subsequent sessioDs focusingon increasing penoaar competence and deveropingan intemar rocusof - contror, reducing body dissatisfaction, and exploringappropriate weightcontrc! measures. curminaring sessions wirr youngadurrs whohavcrecovered from eadng disorders mighr arso beincruded (pberps er ar.,2ri0o), [u, rr,ourJu"a""" r;;i;;;;;;;'rr**isjon sincc srudenbareparticurarrvvurnerabre ar rrtir d;;;;;" wirh earing disorders' This is especially-rrue usttua.nrs t uu" ,".1r, T;.";;;;;H[, ,o o,1,", urtirudes abouteatingd.isordcrs. For exampre, "proanorexic"and 'proburimi";'ru.Lri,". -" extremery dangerous praceswherc peoplcwith activeeatingdisorders anemptto convince orl"rs.rrrat lhescareposirivcandadaptivc waysof copingandpromotethc ultra-thin, sicuy, emacrated appearance of anorexiastudents havegrearer access ro thesesiteswith increase'j unsup"-is.a time on the Internet, and rhe popularity of lhc chatsclions within themis high. Profcssit-rnur scht'rl counsel,rs shoultlbt awaretbatsuchpropaganda existsand that sruienr are readilyable to find, acccss, ald be subject to thedangerous content iherein. Jvlost counseling inlervenlions aredesigned for work with adulrs. Adolescents who have the abilirvro rhink abs'acrrv 1:^lir.rr roreipond well ro.such professional dr;;;;;r:;-e schoolcounselor shouldb-"ti"glrf oi ti. d"u.toprental lcvel andpressures tharrhc studenr faces.Challengingstudentsto think about tlre conirecdon hetweentheir tlroughts,probrems, fears,or pressures andthejr eatingdisordered Lrravlols .nustueaccompanied by thegeneration of alternatives that can be directly applied. Thedevelopmenral Ievelof stu<jints is animportant considerarion in detemrining t].,e course of actionfor rheprofessional school.ornr"lor. tlUi"l djfferences regarJingweight and appearancc ro, ,tJ.nt, ar tiifferenrpoinr, a.".ffibes "f Resources parrells,and Other personnel for Students,
kofessiona.r schoorcounserors have a uemendous impacr on students and the scbool community by beinginrenrionar about.herping srudenrs wirheating di."r,r;;r-;;;;rared imagc concernsInterventions at in<tiviaual, group,iumfil, andschool_wide levelscanbe challenging andrequire "l^rrno_, appropriate r.roui..r. ffr. ,.ilr.n.., rharfollow may be shared wirh students, parents, and schoorpersonne.l. prof"srionat-s.hoor counscrors shourd consurtthese andothcrresources in theirefforrsro rr.or ."ring-Jir*j"rl _ Bodywise - l_g00-62g-3g12; EatingDisorders Coalitionior Rese arch,policy & Maine, M. (20M) - Bodywars;Making peace withwomen\bodies.Carrsbad, CA: Gurze Books: Nationar EatingDisorrersAssociarion., Seattre, wA 206_382_3s87: projecr: The Ophelia, Erie,pA; and Pipher, Ivr'(1994). Reviving-ophetia: soring'ih) rrbrs of acorescent grrls.New york: Ballantine Books.

workproductively towards a sorutionto eatingdisordel, fr.epressures ro b. thjn,andthenegadve anriburions praced on fa1ry1ql1br sociery. Afrogram deveroped by ,r,. N"ri""JLurg Dsordcn Association,

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Table4. Development of differences relatedto eating and appearance, Elemenrary School At an agc whenthefocusshouldbc on makingfriendsan<J growth,boysand girrs today worry aboutappearance andfitting in. 'students asyoungas agc5 express concerns aboutbody imageand becomrng fat (Maine,2000;Shapiro, Newcomb,& t-oeb, lD7). 'Byagc6snrdentsuseadultcultura.tcriteriatojudgephysicalattractiveness(Gabel + rearney, 1998). ' studcnt! rcasc,sbamc,and avold frlcndshlpswlth pccrs who arc fat or not convcntionallyattractive pccrs. 'srudentsimirate actions.and attitudes of parents and adurts; what messages are adultssending about dietingandappearance? MituIle School During middle scboor, dissatisfaction with bodyshapeand size worsens: ' Body imagedissatisfaction increascs from 40% in third gradeto ?9% in silth grade (Ricciardelli & McCabe, 2001). 'Self-esteem is dircctlylinkedto bodysatisfaction; students with low self-esteern in othcrrealm(maybc at high risk. . The # | wishfor I I ro l7 yearold girls:lo.e weight(Mainc, 2000). High School iligh school studcnts havcthc incrcascd burdcn of bcginning t6 makc:rdultlccisions, addcd to thestress of tryingto fit in borhsociallyandphysically. ' Dscontentabout their bodiesand feelingfat has becomenormative, parti.ularly for girls (Maine,2000). '67vooifemalesand82%-ofmaresberieveappeararceinfluencesromanticappear: 72% and687o, r:spectivery, attribute happiness to appearance (o'Dea &-Abraham, 1999). ' High school studcnts havelowerphysical self-esteem and moreunlealtlryweight conrrolbehavion rhan younger srudents (cohane& pope,20cri;lsraer& i"unoua, 2002;McCabe & fucciardelli, 2001;Nyiander l). , lg1. Summaty/Conclusion Eatingdisordersand their sub-crinicar manifestations do not appearro be going awayin our sociefrProfessionai schoot counserors areon the front rine to lnterven. u,iJ or"u.n, ,h. development of eatingdisordenamongsrudents. At ar deverop..","ir*"ri ,*i'"nts need atreDtion and education abouteatingdisorders, which can be addressed throughc.lassroom guidance, individuarcounsering,.an.d parenrs groupcounsering. b" ;]";;;;uilur .r,ing disorders, "r" gf.e how to detect thern in tJreir students, andhoJhom. can be a haven or contribute to these disorders. As agcnts of changc, profcssionar schoor counsclors a;c rjkcwise cncouragcd . to educate teachers andotheradministrarive personner abour earirrg disorders, f", 0",.., andapproach students about.whom, "r";;i;:;;*',o they have.on..-i, and ways to make the schoora safe environment accepting ofall bodyshapes. It is incumbent uponprofessional schoolcounselors to attend to therealiryof eating disorders in theirschools, whether theyareoverror moresubtfe manifestalions ar4ongtheir sludentsThroughprevention, education, unj ini"iu.n,ion, professional schoolcorrnselors playanintegraliole for stutlents, their families,the school,and

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cornmunlty to appropriately theSrealer andeffectively address thisdangerous phenomenonReferences AmcricanPsycNatricAssociation. (2VJ0). Diagnosticand slaisical manualfor menral disorders (4Ded.,rexrrevision) (DSM-IV-TR). Washingron, DC: Aurbor. Brook, U-, & Tcppcr,l. (1997).High schoolsrudcnrs'aniludcs and knowlcdge of tborl consumption andbodyimage:Implicationsfor schoolbased education . PatientEtlucntiott and CounseIing, 30, 283-288. Byely, L., Archibajd,8., Graber,J., & Brooks-cunn, J. (2000).A prospecrive studyof familiat andsocialinfluences on grrls' body imageand dieringInremational Journtal of Eating Disorders,28, | 55-164. cohane,G. H., & Pope,H. G. (2001).Body imagein boys:A review of rhe lirerarure. InternstionalJournal of Eating Disorders, 29,373-3j9. Franko, D. L., & omori, M. ( 1999). Subclinical eating disorders in adolescenr women: A testof the continuilyhypothesis and its psychological correlates. Journal oJAdolescence, 22, 389-396. cabel, K. A., & Kcarncy, K. ( 1998). Promoring reasonable pcrspecrives of bodyweighr: Issucs for schoolcounselors. Professional SchoolCounseling, l. 32-35. Garner, D. M., Garfinkel, P.E., & lrvine,M. J. (1986).Integrarion andsequ;ncing of rrearmenr approaches for eaiingdisorders. Psychotherapy and psychosomatics, 46,67-'75. core, S.A-,vander wal, J. S.,& Thelen, M. H. (2001). Treatment of earing disorders in children ard adolescents. ln J. K. Thompson& L. Smolak @ds.),Body image,eoringdisorders, and obesityin youth: Assessment, prevention,and trearmenr (pp.293-3ll). washington, DC: American Psychological Associalion. Israef, A. C., & Ivanova, M. Y. (2002).Globaland dirnensional self-esreem in preadolescenl and early adolescent children who arc overweighi:Age and genderdifferences. InternationalJoumal of Eating Disorders, 31, 424429. Levine,M. P., & Smolak,L. (2001).Primary prevenrion of bcdy image disrurbarces and disordered eatingin childhoodand early adolescence. In J. K- Thompson & L. Smolal (Eds.), Bcrrl,v inuve, coringlisorders,and obesityin youth: Assessmenr, preventiorr, uni (pp.237-260). trea!Dteilt washinglon, DC: Americanpsychological Associarion. Loewy,lr!. I. (1998).Suggestions for working with fat childrenin the schools.Professiona! School Courceling, I,l8-22. Maine,M. (2ooo).Bodywars: Makingpeacewith women's bodjes. carlsbad,cA: GurzeBooks. Mccabe,M. P-,& Ricciardelli, L. A. (2001). pecr,andmedia Parenr, influences on bodyimage andstraregies to both increase anddecrease body sizeamong adolescent boysandgiris. Adolesc ence, 36, 225-240. Mussell, M- P.,Binford,R. 8., & Fulkerson, J. A. (2000).Earingdisor<lers: Summary of risk faclors, prevention programming, psychologist, andprevention research. TheCounseling *rt::;n;';rut). Thefeering of beingfat anddieting in a schoor popurarion:An epidemiorogic intervicw investigation. A cra Socio-medica Scandinavica, I, 17-26. o'Dea, J. (2000).school-based inrerventions lo preventeatingproblems: Firsr do no harm_ EaringDisonlers, 8, 123-13O. O'Dea, I' A., & Abraham, S. ( 1999). Onse! of discrdered eating attitudes andbehaviors in early adolescence: Inlerplayof pubenalsratus, gender, weight,and age. Adolescence, 34,67l6'19.



'rrJcsrrLrnal Schrrri ('ounsclror

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o'Dea,J' A., & Abraham, s. (2000). Improving bodyimage, earing arrirudes, andbehaviors of young maleand femaleadolescents: A new educational approach rhat focuseson selfesleem. InrernationalJoumal of Eating Disorders,2g, 43-57. ohring' R., Graber, J. A., & Brooks-Gunn, r. (z0oz). Girls'recurrent and concurrenr body dissatisfaction: Correlates andconsequences over8 yea;s. International Journalol Eating Disorders,3I, 4M-415. omizo, s. A., & omizo, M. M. (1992) Earingdisordcrs: The schoorcounseror'srore.The School Counselor 39,217-224. Pesa, J' A., syre, T- R., & Jones,E. (2000).psychosociar differences associared wiLh oody weightamong fcmalcadolcscents: Thc importancc of body image. Jottnn! of Adolescent Health, 26, 330-33'1. Phelps'L', sapia,J., Narhanson, D., & Nerson, L. (2000).An empiricaily supporred earing disorderpreventionprogram.Psychoto gy in the Sc hools, J7, 443-452'. Rhyne-winklcr, M. c., & Hubbard, G. T. (r994). Earingattitudes and behavior: A schoor counsclingprogram.The School Counselon 4 I , lgi-lgg. p. Ricciardelli, L. A., & Mccabe,M. (2001).children'sbody imageconcemsand earing disturbance: A reviewof rheriteraturc. Crinicalpsychology Review, 2r, 325-3u. shapiro, S.,Newcomb, M., & Loeb,T. B. (1997). Fearof fat, rJisregurared-resrrained earing, andbody-estem: Prevalence andgender differences among eight-ro ten-year-old chjldren. Joumal of Clinical Child psychology,26, 359_365.