MODULE TITLE: DISSERTATION

The Aetiology and Diagnosis of Eating Disorders in

Students, with a Particular Emphasis on the Importance
of Mental Health in Achieving Optimal Academic
Performance.

Student’s Number

G00366994

Submitted for the Award of

Bachelor of Science (Hons) in Education
(Design Graphics and Construction)
to
Galway-Mayo Institute of Technology, Letterfrack

Supervisor: Marie English

Submission Date: 25th April 2022

Plagiarism Disclaimer

Student Number: G00366994

Programme: BSc. (Hons) in Education (Design Graphics and
Construction)
Year: 4
Module: Dissertation
Lecturer: Dr. Pauline Logue
Assignment Title: Dissertation
Submission Date: 25rd April 2022

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The Aetiology and Diagnosis of Eating Disorders in Students,
with a Particular Emphasis on The Importance of Mental Health
in Achieving Optimal Academic Performance.

Abstract
This dissertation explores, reviews, and critically discusses the fundamental evidence on
eating disorders and the knowledge around this area in the educational system in
Ireland. Eating disorders are serious mental illnesses that have a negative impact on the
academic and social performance of affected adolescents. Research suggests that
gender, along with other variables such as social media, peer pressure and low self-
esteem appears to have a considerable, detrimental influence on young teenagers,
women in particular. This dissertation examines the current research on eating disorders
as well as the risk factors associated with their development. It also looks at the
negative effect on the academic performance of second-level students suffering with
these illnesses. In addition, it highlights the necessity for further research in this area in
order to identify and support affected students. Finally, this dissertation questions the
capabilities of the educational system in providing the necessary preventative
interventions and supporting students with an eating disorder in order to help them
reach their academic potential.

Keywords: Eating Disorders (ED), Adolescents, Psychosocial, Awareness, Gender,

Bulimia Nervosa (BN), Anorexia Nervosa (AN)
Introduction

The focus of this dissertation is to examine the impact of eating disorders on students’
academic performance in second-level education. An eating disorder is a health
condition that causes a serious and potentially life-threatening change in your normal
eating habits. (SpunOut, 2021) What many people may not realise is that eating
disorders do not necessarily concern the area of food – they are often a sign of
underlying worries and emotional stress. Having a negative body image can cause some
people to develop an eating disorder. Eating disorders are extremely common and all
genders experience them. According to BodyWhys (2022), eating disorders (ED) are
more common in young adults between 15 and 34 years old and are of growing concern
in Ireland. They go on to say that it is extremely difficult to find reliable statistics on the
prevalence and severity of eating disorders, due to the nature of the illness (BodyWhys,
2022). This dissertation does not set out to examine all the aspects of eating disorders
but highlights how eating disorders can impact students’ abilities in the area of
academia. Research has shown that eating disorders are profoundly serious illnesses
and can have severe consequences if left untreated. The significant impact of eating
disorders is highlighted by Welch, Ghader & Swenne (2015) who state that eating
disorders are “serious disorders that have a negative impact on both the psychological
and physiological well-being of the individual afflicted” (p. 1). Hudson, Hiripi, Pope,
Harrison & Kessler (2007) also highlight the major public health concerns associated
with eating disorders. They state that eating disorders frequently correlate with another
psychopathology and role impairments, yet are frequently undertreated. Health and
fitness have become iconic terms in today’s health-conscious society, but dieting can
become dangerous if it evolves into an eating disorder. The most common types of
eating disorders (EDs) outlined in the most recent edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) (2013), are anorexia nervosa (AN),
bulimia nervosa (BN), and binge eating disorder (BED).
The aim of this dissertation is to examine how eating disorders can impact a student’s
academic performance at second level.

The objectives of this dissertation are to:

• Define eating disorders and discuss how they are diagnosed.
• Discuss the aetiology and risk factors which may contribute to an individual’s
likelihood of developing an eating disorder.
 • Examine Erik Erikson’s theory of psychosocial development and highlight the
significant and contributing changes that occur during adolescence.
• Discuss how teachers can support a student with an eating disorder.

Eating Disorders and Diagnosis

Eating disorders are complex illnesses that have affected adolescents for many years
and appear to be possibly increasing in frequency, though gathering data is particularly
difficult and more studies are warranted. BodyWhys carried out a study and estimated
that 16 million people world-wide were diagnosed with having either anorexia nervosa
or bulimia nervosa. This translates to approximately 0.1 to 1.0% of people per country
(BodyWhys, 2022). The topic of eating disorders is broad and peoples’ understanding
of the illnesses can vary. This section will define what is meant by eating disorders and
explain the subgroups that are categorised under the term eating disorders. Bodywhys,
the Eating Disorder Association of Ireland, defines eating disorders as complex
psychological disorders that affect every aspect of a person’s functioning (BodyWhys,
2022). The Diagnostic and Statistical Manual of Mental Health Disorders fifth edition
(DSM V) outlines the four main categories of eating disorders consisting of Anorexia
Nervosa, Bulimia Nervosa, and Binge Eating Disorder. They also include the category
of ‘eating disorder not otherwise specified (EDNOS)’. This fourth category includes
those variations of eating disorders that cannot be assigned a more specific diagnosis
due to insufficient information (Hoek H. W., 2003). A major goal of the DSM-V was to
reduce the category of eating disorder not Otherwise Specified (EDNOS) which was a
category listed in DSM4. This category has been documented as being heterogeneous
and not well defined, yet it was the most common diagnosis in clinical and community
samples of adolescents, accounting for eighty percent of all eating disorders diagnosed
(Hoek H. W., 2003). This highlights the lack of information and knowledge about
eating disorders within the general population as well as with the wider medical
professional community.

Anorexia nervosa is known to be a particularly challenging strand of eating

disorders as it is associated with an elevated suicide risk of around 12 per 100,000 of the
population (American Psychiatric Association, 2013). It is characterised by the
sustained and determined pursuit of weight loss. This is achieved through severe
restriction of food intake and in many cases, adapting methods of laxative use and
induced vomiting, causing the individual to lose a significant amount of body weight.
This facilitates their isolation from society (Fairburn & Harrison, 2003). Patients who
suffer from Anorexia Nervosa are said to have high mortality rates, and reduced
recovery rates. A substantial proportion of those diagnosed with Anorexia Nervosa
remain chronically ill throughout their lifetime (Van Son G. v., 2010). Bulimia Nervosa
is associated with recurrent episodes of binge eating and inappropriate compensatory
behaviours with the aim to prevent weight gain. An individual suffering from Bulimia
Nervosa may adapt techniques of fasting or excessive exercise (DSM V, 2013).
Attempts to restrict food intake are punctuated by repeated binges of eating during
which there is an adverse sense of loss of control and can be followed by self-induced
vomiting or substance misuse (Fairburn & Harrison, 2003). This strand of eating
disorders can be difficult to detect for both non-professionals and professionals as the
person suffering may often be of average weight or in some cases overweight due to the
frequent episodes of uncontrolled overeating. In this respect, health professionals may
not initially see anything physically wrong (Fairburn & Harrison, 2003). Binge Eating
Disorder is another common strand of eating disorder. It is similar to bulimia nervosa in
the fact that it is associated with recurrent episodes of binge eating, evidence of marked
distress regarding binge eating and the occurrence of episodes of binge at least once a
week over a period of at least three months (American Psychiatric Association, 2013).
While both disorders share this similarity, they differ considerably. However, those
suffering from Binge-eating disorder will not attempt to eliminate the consumption of
an excessive number of calories from a binge episode (Fairburn & Harrison, 2003).

In sum, eating disorders have one of the highest mortality rates of all psychiatric
illnesses. Eating disorders present a challenge to clinicians due to their complex nature,
as their cause is elusive, with social, psychological and biological processes all playing
a role (Fairburn & Harrison, 2003). The prevalence of eating disorders is increasing,
and it is clear they are posing a major health risk to society due to the high mortality
rate associated with them, as well as their co-morbid nature (McDermott, 2016).
Aetiology and Risk Factors

Extant research concurs that the aetiology of eating disorders is multidimensional in

nature and relate closely to vulnerability and risk factors (Striegel-Moore & Bulik,
2007). These are commonly subsumed under the three broad categories, including
biological influences, psychological influences and social and cultural influences.
Although precise causal mechanisms have not yet been established, Polivy and Herman
(2002) posit that it may be possible to distinguish between stronger and weaker
contributory factors in the development of ED. Accordingly, the authors conceptualise
causal factors along a continuum ranging from weaker, broad level factors at one end to
stronger, individual considerations at the other. Stice, South and Shaw (2012) deduce
that the interaction of genetic, biological and temperamental vulnerabilities with
sociocultural factors increases risk of ED development. Though there are many
epidemiology’s associated with the development of an ED, this dissertation will look at
four of the main contributing risk factors under the sub headings below.

Shame and Self-Criticism

Shame is one of the central components to developing an eating disorder (Costa,

2016). Shame is a painful emotion and is linked to the perception of being judged in a
negative way and feeling unattractive and subordinate to everyone else (Costa, 2016).
People full of shame are often comparing themselves to others and fearing that are not
attractive enough, good enough, or both (Costa, 2016). Self-criticism plays a role. When
someone has an eating disorder, self-criticism can be used as a tool to cope with the
emotions of feeling less than everyone else. In turn, this self-destructive attitude may
provoke more feelings of inferiority (Costa, 2016). Several studies have examined what
happens to individuals with eating disorders and co-morbid depression and found that
they have higher levels of shame. Unfortunately, these negative thoughts and feelings
associated with depression are often geared toward the body and unhealthy eating habits
(Costa, 2016).

Social Media

While eating disorders are not a new phenomenon, there are reasons to believe
that the development of social media has worsened many of the issues surrounding such
disorders. Technology has become a normal part of everyday life for adolescents and
children (Barth, 2015). There has been a drop in watching television and reading
magazines and much of this change is attributed to teenagers and young adults (Perloff,
2014). Instead of watching television and reading, many people in this age group turn to
social media in order to find their entertainment (Perloff, 2014). Social Media in its
display of thin models and celebrities can be especially triggering to individuals who
have suffered some form of an eating disorder. Internet exposure alone is a risk factor
for developing body image disturbances, as exposure to the ‘thin ideal’ is almost
guaranteed (Tiggemann & Slater, 2013). A 2014 study found that after only 20 minutes
of Facebook use, students can be observed experiencing an increase in body shape and
weight concern (Mond, 2014). The behaviour included comparing themselves to
friends’ photos and un-tagging themselves in photos they perceived unflattering of
themselves. Additionally, the study discusses that comments on Facebook such as “you
look so thin” perpetuate the thin ideal and may contribute to eating disorder risk.
However, despite the support for this study by other researchers, it is not without
limitations. For example, the study may have been based on correlations, rather than
experimental evidence. The study does not appear to consider external influences such
as extra-curricular activities and the relationships of the students with their family and
friends. This suggests that 20 minutes of social media time may not have been enough
evidence to support the claim made by Mond (2014). Further evidence for the linkage
between the effects of social media on the increasing prevalence of eating disorders
needs to be explored. The amount of time spent on social media along with the value
placed on this and the direct impact it may have on young people’s self-esteem and
body image is presently unclear.

Peer Influence
Peer influence has also been implicated as a contributor to eating disorders
(Keel & Forney, 2013), although the relative importance of peer influence in the process
of eating disorder manifestation remains unclear (Polivy & Herman, 2002). In their
sample of Irish adolescent females, Mooney (2009) found that peers influenced body
dissatisfaction and dieting practices. Congruently, findings from longitudinal research
suggest that the development of bulimic symptoms and weight control behaviours may
be more vulnerable to peer influence (Keel & Brown, 2012; Keel & Heatherton, 2006).
However, the literature on the relative impact of peers is confined to the evaluation of
peer influence on risk of bulimic symptoms only, thus limiting external generalizability
of these findings to other ED diagnoses.

Temperament and Personality

Toward the other end of the continuum are risk factors related to the individual.
Several authors concur that such risk factors comprise both predisposition-like features
(i.e., personality traits) and adverse life events (Fairburn & Harrison, 2003). Affective
influences (i.e., stress and negative mood) are commonly reported antecedents for
eating disorders (Corstorphine, 2006). Research commonly deduces that AN and BN are
characterized by negative emotionality and perfectionism (Striegel-Moore & Bulik,
2007). Low self-esteem is further identified as a poor prognostic factor (i.e., predictive
of adverse outcomes) (Polivy & Herman, 2002). Almost all approaches to eating
disorders refer to body dissatisfaction (BD) - subjective feelings of unhappiness
involving negative thoughts and feelings associated with one’s physical appearance
(Mooney, 2009). Hilda Bruch first identified body image disturbances as an important
clinical feature of eating disorders (Bruch, 1962) and most current models of eating
disorders continue to attribute a prominent causal role to body dissatisfaction (BD)
(Keel & Brown, 2012). Research posits that body dissatisfaction peaks during
adolescence. It is predominantly observed in females and can increase the possible
incidence of eating disorder behaviours (Mooney, 2009).

Erikson and Changes in Adolescence

Erikson (1968) believed the primary psychosocial task in adolescence is the formation
of identity. Therefore, he called the developmental conflict identity versus role
confusion. There are several contributing factors to the formation of identity. The onset
of puberty during adolescence leads to newfound cognitive skills and physical abilities
(Kroger, 2004). From Erikson’s perspective, identity refers to a sense of who one is as a
person and as a contributor to society (Hoare, 2002). It is personal coherence or self-
sameness through evolving time, social change, and altered role requirements. The
formation of identity is a major event in the development of personality and could be
associated with positive or negative outcomes (Marcia, 1993). Identity provides a deep
sense of ideological commitment and encourages the individual to find his or her place
in the world (Hoare, 2002). It provides one with a sense of well-being, a sense of
mattering to those who count (Erikson, 1968). Identity is what makes one move with
direction, it is what gives one reason to be. Erikson clearly believed that having a solid
sense of identity is crucial to further development. However, not all people successfully
resolve this development task. Role confusion can lead to a variety of different human
experience. It causes the individual to seriously question one’s essential personality
characteristics, one’s view of oneself, and the perceived views of others (Bosma, 1994).
Consequently, the individual experiences extreme doubt regarding the meaning and
purpose of their existence, leading to a sense of loss and confusion. Due to changing
physical, cognitive and social factors, nearly all adolescents experience some form of
role confusion (Kroger, 2004).
Castellini concludes that “eating disorders are conditions in which the process
of self-identity construction is interfered with by a profound uneasiness toward one’s
own body” (Castellini, 2017, p. 59). In eating disorders “the external reality of the body
and the inner subjective perception do not match” (Castellini, 2017, p. 53) or a feeling
of estrangement within itself occurs as a result of the failure to establish a harmonious
relationship between the internal representation of the body and the body itself. Fairburn
(2010), states that those not suffering from an eating disorder are more inclined to
evaluate or define themselves in other domains such as work, quality of relationships,
sport, physical ability or their status, etc. Bruch suggested that the levels of
dissatisfaction with body image seen in persons with eating disorders reflect a
maladaptive “search for selfhood and a self-respecting identity” (Bruch, Eating
Disorders: Obesity, Anorexia Nervosa and the Person within, 1979).

Cognitive deficits

There is a myriad of cognitive deficits that are associated with eating disorders. Overall,
these deficits may disappear when the eating disorder is in remission. However, in
people with an active eating disorder, these impairments can be detrimental to
educational and occupational functioning. Past studies have shown that those with
Anorexia Nervosa have difficulty paying attention and remembering information. There
is evidence that those with Bulimia Nervosa also have difficulty paying attention and
focusing on assigned tasks. It is important to note that as anorexic and bulimic patients
recovered from their illnesses, their impairments in these areas improved (Bosanac, et
al., 2007). Bosanac and his co-investigators conducted a study where their patient
population was categorized into four main groups: active Anorexia Nervosa, active
Bulimia Nervosa, those who have recovered from Anorexia Nervosa, and a group of
normal controls. All patients were administered a series of neuropsychological tests to
determine the impact that cognitive deficits may have on these patient groups. The
investigators of this study confirmed that patients with active Anorexia Nervosa and
active Bulimia Nervosa had difficulty paying attention to assigned tasks. In a word
recall task, those who recovered from anorexia nervosa had difficulty remembering
words they had just heard, and those who were actively suffering from bulimia nervosa
had difficulty remembering not only words they had just heard, but also words they had
heard previously. Both groups with active bulimia nervosa and anorexia nervosa, as
well as those who had recovered from anorexia had difficulty completing a finger
tapping task (Bosanac, et al., 2007). The investigators also note that there were a small
number of participants in this study who were taking medication to reduce symptoms of
concurrent conditions, such as depression or anxiety. At the time, the impact these
medications had on cognitive functioning is not clear. It is apparent in this study, that
cognitive deficits had the greatest impact on those with active anorexia and active
bulimia. If researchers can determine the specific impact of these deficits, health care
providers can proactively treat these impairments in eating disordered patients to
minimize any negative effects to daily functioning (Bosanac, et al., 2007). Research has
shown that those who have Anorexia Nervosa may have difficulty with neurocognitive
functioning. However, the reason for this has yet to be determined. Some researchers
believe that these deficits are due to the psychological components of anorexia while
others believe that changes in brain functioning related to metabolism are the cause.
Due to this impairment, those with anorexia may have difficulty focusing on tasks or
remembering information and may be slower to process information. A study was
conducted to further examine these neurocognitive impairments through administration
of several tasks to test abilities such as motor and memory skills (Fowler, et al., 2006).
For this study, Fowler (2006) recruited women who were actively suffering from
anorexia, at low weight, and currently hospitalized. If the participants were taking
medication for their anorexia on a regular basis, the investigators asked that their dose
was administered after neurocognitive tests were completed. The patient group was
compared to a group of healthy controls who completed the same battery of tests in the
same order. The investigators found that the patients in the anorexia nervosa group did
show evidence of neurocognitive impairment when compared to the healthy control
group. The deficits the investigators noted in this study were related to spatial memory,
planning, and processing information that was presented quickly (Fowler, et al., 2006).
These types of skills are necessary to perform well at work and school.

Eating Disorder Impairments

The degree of impairment caused by an eating disorder can affect many aspects
of a student’s life. As mentioned above, anxiety, overeating in public or perceived body
image can impact personal relationships and affect cognition. A new questionnaire,
called the Clinical Impairment Assessment (CIA) was designed by Bohn and Fairburn
(2008) to examine the impact of impairment including cognitive functioning that is
specifically related to eating disorders. The CIA is intended to examine any impairment
that the patient may have subjectively experienced over the past 28 days related to
affect, social relationships, cognition, and ability to function in an occupational setting
(Bohn & Fairburn, 2008). Among the key inclusion criteria in the Bohn et al. (2008)
study was body mass index (acceptable range was 16.0- 39.9) and no evidence of co-
morbid conditions related to affect, such as depression. This may be due to the fact that
these types of disorders can influence impairment ratings on the CIA. Study participants
also needed to meet criteria for a clinically significant eating disorder, per the DSM-V.
In this study, 8 patients were diagnosed with Anorexia Nervosa, 48 were diagnosed with
Bulimia Nervosa, and 67 were diagnosed with an eating disorder not otherwise
specified. The results of this study demonstrated that the more significant the symptoms
of the eating disorder, the greater the rating of subjective impairment on the CIA (Bohn
& Fairburn, 2008)

Impact of Eating Disorders on Learning

The National Eating Disorders Association (NEDA) released an Educator
Toolkit designed to provide vital information on eating disorders to parents and
educators (2007). In this toolkit, the negative effect that eating disorders have on
cognition are discussed. This is important because malnutrition can have a profound
impact on a student’s learning. In addition, the comorbid conditions that can coexist
with eating disorders such as anxiety and depression can further distract a student from
learning (NEDA, 2007) NEDA surveyed 1,000 people with clinically diagnosed eating
disorders within their clinical practice. Their findings indicated that people with
anorexia spent most of their time thinking about food, weight, and hunger (respondents
with anorexia reported that 90-100% of awake time and additional time sleeping was
spent with these preoccupations). In addition, people with clinically diagnosed bulimia
reported 70-90% of their time was spent thinking about food and weight, and people
with disordered eating reported that 20-65% of their time was spent thinking about
food. This is in comparison to the average woman who spends 10-15% of their time
thinking about food, weight, and hunger (NEDA, 2007). This topic is also discussed in
The BodyWhy’s Eating Disorders Information Packet for Middle School Personnel,
which was created by Office on Women’s Health (United States Department of Health
and Human Services) and its third edition was released in 2005. This handbook
describes the effect that even mild under-nutrition has on learning: students who are
hungry can be distracted from learning by irritability, nausea, and a lack of energy.
They may have reduced attention spans and be less able to concentrate than their peers.
These issues are compounded by nutritional deficiencies such as iron, which impacts
memory and the ability to concentrate.

Teacher Support

As mentioned above, eating disorders manifest during adolescence and many children
may begin dieting in these early years. Teachers encounter children in this age category
on almost a daily basis, however, they may not be aware of the risk factors, signs and
symptoms or presentation of an eating disorder in their students. Awareness of statistics,
knowledge and understanding, open discussion among staff and pupils and most
importantly the development of trusting and reliable relationships between staff and
students may be a starting point in addressing this problem in a more effective manner.
This poses the question as to whether there is an onus on the department of education to
better equip their teachers with the skills and knowledge required to support their
students suffering with eating disorders. Furthermore, teachers may be in a position to
help prevent the onset of eating disorders through specific whole staff training in this
area. Increased awareness may serve to enable schools to direct their students towards
intervention services such as cognitive behaviour therapy. Researchers found that if a
person suffering with an eating disorder was treated with cognitive behavioural therapy
(CBT), there was a decrease in the subjective impairment ratings on the CIA (Bohn &
Fairburn, 2008).

Importance of early intervention

There is evidence to suggest that factors such as time constraints, stigma, and the
difficulty involved in eating disorder cases all play a part in hindering the early
identification process of eating disorders. It has been reported that an estimated four
hundred new cases of eating disorders emerge each year in Ireland, representing eighty
deaths annually. In 2016, eating disorders were the second highest child and adolescent
admission diagnosis at twelve percent of all admissions. (Department of Health and
Children., 2006). This shows the pressing concern eating disorders are posing to Irish
society and the need for early intervention and detection of an eating disorder within an
individual. However, studies have shown that there is a lack of early intervention and
identification strategies within the primary care setting and education providers. Currin
et al (2007) highlights that there may be unrealistic expectations placed upon GP’s that
might result in the deduction that treatment for eating disorder patients is outside the
primary care remits (Currin, et al., 2007). However, studies consistently show that the
most effective treatment approaches occur in the primary care setting and is also the
most cost effective for the state and society (Schoemaker, 1997). This highlights the
importance of GPs in the early intervention and identification process of eating
disorders among their patients. Previous studies have stated that early intervention is a
vital prognostic factor in the treatment of anorexia nervosa, and that a large interval
between the time of onset and first admission for treatment has a negative impact on the
outcome of effective treatment (Schoemaker, 1997). The need for early intervention in
any form of healthcare issue is important, however it has been argued that it is even
more vital in the case of eating disorders as they are associated with high mortality rates
and are susceptible to relapse cases. Previous studies have stated that GPs have
highlighted that patient's often do not present with eating disorder problems until a
crisis, such as being admitted to Accident and Emergency or hospital, has occurred
(McDermott, 2016). This further highlights the need for early intervention in the
identification process of eating disorders. Hoek and van Hoeken (2003), carried out a
review on the prevalence and incidence of eating disorders and they confirmed that
patients who suffer from anorexia nervosa have a high mortality rate, moderate recovery
rate and a substantial proportion of the patients remain chronically ill (Van Son & van
Hoeken, 2010). The benefit of early intervention is also highlighted in Schoemaker's
(1997). This study involved an extensive search in literature concerning treatment
outcomes for AN sufferer in Holland, Germany and England, specifically addressing the
prognostic value of the duration of illness (Schoemaker, 1997). This study found that
early detection and referral to specialist care means that the disorder will be treated at a
less advanced stage thus improving the chances of recovery while decreasing overall
mortality rates (Schoemaker, 1997). Within this statement another issue is presented
which GPs face, and that is their knowledge of the specialised services available to
those with eating disorders. Studies have shown that GPs who have practices in the
same area of a specialist eating disorder service have a better understanding of eating
disorders and feel more confident diagnosing a patient with an eating disorder, as they
feel there is more support available to them (Currin, et al., 2007). McDermott’s (2016)
study also highlighted the need for access to more specialist services as requested by
GPs in order to improve their own practice, as a result of 63.9% of GPs being unaware
of specialist services available for eating disorders (McDermott, 2016).While it may not
be feasible to have a broad range of specialist services throughout Ireland, there is a
need to extend the services beyond GP practices and further extend this service to
schools to raise awareness among teaching staff, to allow for more efficiency in
recognising and supporting students, who may be at risk. There appears to be a lack of
integration and coordination between the primary care setting and the specialist services
within the healthcare setting in Ireland, leading to inefficiencies in the problem of eating
disorders. Early detection and referral to specialised care means that the disorder will be
treated at a less advanced state thus improving the chances of recovery while decreasing
overall mortality rates of Anorexia Nervosa and other types of eating disorders (Van
Son & van Hoeken, 2010). It must be acknowledged that mental health providers and
medical providers roles can often be confused resulting in back-and-forth referrals
however this issue needs to be addressed to allow for better coordination and delivery of
services (Linville, 2012).

Conclusion and Recommendations

In conclusion, eating disorders are abnormal eating habits that are either caused by, can
lead to or can exacerbate psychological problems. Due to the many risk factors
discussed in this dissertation, students in their adolescent stages of life may develop an
eating disorder. Eating disorders distract students from both academic work and social
relationships, acting as a barrier to them reaching their full potential in their school
lives. Eating disorders make up a small subsection of a much larger issue when it comes
to mental health in adolescence. However, up to date research needs to be conducted
particularly in the area of teacher awareness and education. Teacher and general
awareness of neurodivergence has greatly improved in recent years, with most teachers
being aware that on average, 1:10 people are dyslexic (Dyslexia Association of Ireland,
2022) and that 1:65 are autistic (NCSE, 2016). This has led to a broader understanding,
an ability and willingness to accommodate children and create an inclusive environment
where children are treated with equity to ensure their learning needs are developed. The
question is therefore raised, as to whether it would be beneficial for educators to have
an increased awareness of the incidence of people who suffer from ED’s. This holistic
approach to the development of the student can only be achieved by the teacher and
student fostering a connection. Staff getting to know their students through class
surveys, having discussions on sensitive issues such as body image and social media
influences and most importantly, being approachable. This study has highlighted the
cognitive deficits associated with eating disorders and the learning problems which can
co-occur. It looked at the natural physiological and psychosocial changes which occur
during a student's time in second level education and how those changes can actually
contribute to the development of an eating disorder. Conclusive evidence has not yet
been found to confirm whether optimal academic performance can co-exist with poor
mental health in the form of an eating disorder. Not enough is known about the effects
of eating disorders on the academic potential and performance of the adolescent. It is
unclear whether the physical changes in the brain and body or the emotional burden of
an eating disorder, or indeed both, play the more significant role in affecting the
student's education. What is clear, is that eating disorders have been hidden, disguised,
ignored for many years in society. This should not be the case as it serves only to
further shame and suppress the individual whose increasing needs are pushed further to
the background. Eating disorders cause concentration difficulties due to the obsession
with the relationship with food, sleep deprivation, anxiety, dysfunctional coping
methods, increased emotional stress, mood imbalance, inability to focus and attend.
Malnutrition and poor nutrition results in long term neural issues in the brain. All these
facts are important for educators to be aware of in order to understand why a student
may not be achieving to the best of their academic abilities and support networks should
be put in place.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders. Washington, DC: American Psychiatric Publishing.

Association, A. P. (2013). DSM V. Arlington, VA: American Psychiatric Association

Publishing .

Barth, F. D. (2015). Social media and adolescent development: Hazards, pitfalls and

opportunities for growth. Journal of Clinical Social Work, 43, 201-208.

BodyWhys. (2022). BodyWhys. Retrieved April 14, 2022, from The Eating Disorder

Association of Ireland: https://www.bodywhys.ie/understanding-eating-

disorders/

Bohn, K., & Fairburn, G. C. (2008). The measurement of impairment due to eating

disorder psychopathology. Behaviour Research and Therapy, 1105 – 1110.

Bosanac, P., Kurlender, S., Stojanovska, L., Hallam, K., Norman, T., McGrath, C., . . .

Olver, J. (2007). Neuropsychological study of underweight and "Weight-

recovered" anorexia nervosa compared with bulimia nervosa and normal

controls. INTERNATIONAL JOURNAL OF EATING DISORDERS, 40(7), pp.

613-621.

Bosma, H. A. (1994). Identity and Development: An Interdisciplinary Approach.

Thousand Oaks: SAGE Publications, Inc; 1st edition.

Bruch, H. (1962). Perceptual and conceptual disturbances in anorexia nervosa.

Obstetrical & Gynecological Survey, 17(5), 730-732.

Bruch, H. (1979). Eating Disorders: Obesity, Anorexia Nervosa and the Person within.

Houston: Basic Books.

Castellini, G. (2017). The body and the other: a crisis of the self-representation in the

disorders of post-modernity. In G. Castellini, Dialogues in philosophy, mental

and neuro sciences (p. 59). Rome: Associazione Crossing Dialogues,.

Christopher G. Fairburn. (2010). Cognitive Behavioral Therapy for Eating Disorders.

The Psychiatric Clinics of North America, 33(3): 611–627.

Corstorphine, E. (2006). Cognitive-emotional-behavioural therapy for the eating

disorders: Working with beliefs about emotions. European Eating Disorders,

14, 448-461.

Costa, J. M. (2016). Shame, Self-Criticism, Perfectionistic Self-Presentation and

Depression in Eating Disorders. International, 3, 315-328.

Currin, L., Waller, G., Treasure, J., Nodder, J., Stone, C., & Yeomans, M. a. (2007).

The use of guidelines for dissemination of “best practice” in primary care of

patients with eating disorders. International Journal of Eating Disorders, 476-

479.

Department of Health and Children. (2006). A Vision for Change: report of the expert

group on mental health policy. Dublin: stationery office.

Erikson, E. H. (1968). Identity Youth and Crisis. New York: W.W. Norton & Company.

Fairburn, C. G., & Harrison, P. J. (2003). Eating Disorders . The Lancet, pp.407-416.

Fowler, L., Blackwell, A., Jaffa, A., A, P., Robbins, J., Sahakian, B., & Dowson, J.

(2006). Profile of neurocognitive impairments associated with female inpatients

with anorexia nervosa. Psychological Medicine, 36, 517-527.

Hoare, C. H. (2002). Erikson on Development in Adulthood: New Insights from the

Unpublished Papers. New York: Oxford University Press.

Hoek, H. a. (2003). Review of the prevalence and incidence of eating disorders.

International Journal of eating disorders, 383-396.

Hoek, H. W. (2003). Review of the prevalence and incidence of eating disorders.

International Journal of eating disorders, 34(4), pp.383-396.

Hudson, J. I. (2007). The prevalence and correlated of eating disorders in the national

comorbidity survey replication. Biological psychiatry, 348-358.

Ireland, D. A. (2022). Dyslexia Association of Ireland. Retrieved from Supporting

Children and Adults with Dyslexia: https://dyslexia.ie/

Keel, P. K., & Brown, T. A. (2012). Empirical Classification of eating disorders.

Annual Review of Clinical Psychology, 8, 381-404.

Keel, P. K., & Forney, K. J. (2013). Psychosocial risk factors for eating. International

Journal of Eating Disorders, 46(5), 433-439.

Keel, P. K., & Heatherton, T. F. (2006). Point prevalence of bulimia nervosa in 1982,

1992, and 2002. Psychological Medicine, 36(01), 119-127.

Kroger, J. (2004). The Future of Identity :Centennial Reflections on the Legacy of Erik

Erikson. Lanham: Lexington Books.

Linville, D. B. (2012). Medical providers' self-perceived knowledge and skills for

working with eating disorders. A national survey. Eating disorders, 1-13.

Marcia, J. E. (1993). The Status of the Statuses: Research Review. In: Ego Identity. New

York, NY.: Springer, New York, NY.

McDermott, H. (2016). An exploration of General Practitioner’s knowledge of eating.

Mond, J. H. (2014). Validity of the Eating Disorder Examination Questionaire (EDE-Q)

in screening for eating disorders in. Behaviour Research and Therapy, 42(5),

551-67.

Mooney, E. F. (2009). A qualitative investigation into the ions of adolescent females

regarding their body image concerns and dieting. Appetite, 52(2), 485-491.
NCSE. (2016). National Council for Special Education Annual Report. Meath: National

Council for Special Education.

NEDA. (2007). NATIONAL EATING DISORDERS ASSOCIATION. Retrieved from

NEDA: https://www.nationaleatingdisorders.org/

Perloff, R. M. (2014). Social media effects on young women’s body image concerns.

Journal of Sex Roles , 71, pages363–377.

Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. nnual Review of, 53,

187-213.

Polivy, J., & Herman, C. P. (2002). Causes of eating disorders Psychology. Annual

Review of, 53, 187-213.

Schoemaker, C. (1997). Does early intervention improve the prognosis in anorexia

nervosa? A systematic review of the treatment‐outcome literature. International

Journal of Eating Disorders, 1-15.

SpunOut. (2021). What is an eating disorder? Retrieved from SpunOut:

https://spunout.ie/mental-health/eating-disorders/eating-

disorders#:~:text=What%20are%20eating%20disorders%3F%20Eating%20diso

rders%20are%20complex,can%20put%20your%20life%20and%20health%20at

%20risk.

Stice, E. S. (2012). Future directions in etiologic, prevention, and. Journal of Clinical

Child and Adolescent, 41(6), 845-855.

Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders.

American Psychologist, 181-198.

Tiggemann, M., & Slater, A. (2013). NetGirls: the Internet, Facebook, and body image

concern in adolescent girls. . International Journal of Eating Disorders, 46, 630-

633.
Van Son, G. v. (2010). Course and outcome of eating disorders in a primary care‐based

cohort. International Journal of Eating Disorders, 43(2), pp.130-138.

Van Son, G., & van Hoeken, D. v. (2010). Course and outcome of eating disorders in a

primary care‐based cohort. International Journal of Eating Disorders, 130-138.

Welch, E. G. (2015). A comparison of clinical characteristics between adolescent males

and females with eating disorders’ . BCM psychiatry, 1-7.

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