Eating Disorders in Childhood: Prevention and Treatment Supports
Cook-Cottone, Catherine, Childhood Education
Sarah is a sensitive child who thrives on praise. She works hard to succeed, believing that success is what truly defines a person. Her efforts are often taken for granted, however. Sarah's high-achieving, impeccably dressed parents expect achievement. They regularly attend teacher conferences. They offer continuous support of Sarah's academics and sports. Like any family, they have problems at home, but this family is exceptionally private. Thus, Sarah knows not to discuss the problems with anyone. For Sarah, failure is not an option--not in school, and not on the playing field. She believes that success depends on being what others need you to be. School, her parents, and the media have all influenced how she determines success.
On the surface, Sarah is the type of student that teachers love. She is always smiling, her homework is done perfectly, and she is an active team member across the board. However, it is what is happening inside, beneath the surface, that places Sarah at high risk for developing an eating disorder. Eating disorders (EDs) are chronic clinical mental disorders that are disruptive to the psychological and social development of children and adolescents (Hoek & van Hoeken, 2003). They can be difficult to prevent and treat and are considered among the most chronic and medically lethal of mental disorders (American Psychiatric Association [APA], 2000; Keel & Herzog, 2004). Research suggests that the incidence and prevalence of eating disorders are increasing and that the age of onset may be decreasing (e.g., Rastam, Gillberg, van Hoeken, & Hoek, 2004). Luckily for Sarah and others like her, school can provide a safe and protective environment in which to heal from an ED.
The keys to preventing and successfully treating EDs are the efficient integration of mental health and school practices in effective prevention programs, timely and efficient risk identification, and support of treatment (Cook-Cottone & Phelps, 2006). However, few education publications offer information and guidance as to how early childhood educators can be part of prevention and intervention of EDs (Haines, Neumark-Sztainer, & Thiel, 2007). To help educators support prevention and treatment of EDs, this article provides: 1) a detailed description of symptoms and risk factors associated with EDs; 2) an overview of ED definitions, prevalence rates, and treatment protocol; and 3) a review of school-based prevention practices, with explicit recommendations for childhood educators.
Eating Disorder Risk
It is important for school professionals to have a solid understanding of the risks and causes of EDs (Yager & O'Dea, 2005). The risks are complex, and the pathway to ED behavior is determined by a combination of factors. Although this pathway appears to vary from patient to patient, a combination of biological, psychological, and environmental factors affect each student's risk.
The two strongest predictors of eating-disordered behaviors are body dissatisfaction and dieting (Cook-Cottone & Phelps, 2006; Mintz, Borchers, Bledman, & Franko, 2008). Gender is a strong risk factor, with only a small proportion of documented clinical cases being male (APA, 2000). Other individual risk factors include: genetic predisposition, early pubertal onset, emotional sensitivity, perfectionism, emotional-regulation difficulties, and disordered development of self-concept (Mintz et al., 2008). A history of physical and sexual abuse also is believed to increase risk (Wonderlich et al., 2001). Family factors include low levels of parental attunement and poor communication (Wonderlich et al., 2001). Participating in activities that emphasize appearance and weight adds to the risk (Patel, Greydanus, Pratt, & Phillips, 2003); such activities include boxing, wrestling, dancing, crew, and gymnastics (Patel et al., 2003). Adding to the risk, today's children and adolescents are eating more calorie-dense foods that are void of nutritional value (i. …