What do you consider appropriate?  As a teacher, you will have students with all kinds of bodies.  Will body image affect your interaction with students?

Anorexia nervosa has the highest death rate of any mental illness.

USEFUL WEBSITES
Definitions of less well known eating disorders:  http://www.anred.com/defslesser.html
What are the symptoms of an eating disorder?  University of Maryland Medical Center
Website on Eating Disorders www.something-fishy.org This is an excellent site.

Anorexia Nervosa and Related Eating Disorders, Inc. www.anred.com/

Gurze Books www.gurze.com This is a site for educational resources.

National Eating Disorders Association www.nationaleatingdisorders.org

Mirror - Mirror www.mirror-mirror.org

ANAD – National Association of Anorexia Nervosa and Associated Disorders www.anad.org

Residential Treatment Sites:

www.newlifecenters.org (this is where I went)

www.remuda-ranch.com

www.renfrew.org

www.renfrewcenter.com

Hospitals sometimes have Eating Disorder Units too.  University of Iowa has one, Methodist Hospital in Minneapolis, Research Medical Center in Kansas City, Radar Programs, and others 

St. Louis Psychologists and Counseling Information and Referral about Anorexia Nervosa: What is an appropriate diagnosis? http://www.psychtreatment.com/anorexia_nervosa_diagnosis.htm

BOOKS

• “The Secret Language of Eating Disorders” by Peggy Claude-Pierre
• “Life Without ED” by Jenni Schaefer
• “Wasted” by Marya Hornbacher (This book is a story of this girl’s eating disorder.  It is a double edged sword in a sense because it is very triggering to someone with an eating disorder, yet at the same time it is very helpful because someone can realize that isn’t what they want to be.  For someone without and ED, this book is great because it gives you a brutally honest look into exactly what someone with an ED is really thinking.  A lot of times for people who have absolutely no interest in recovery, this book is referred to as the “ana bible”—sick)
• “Intuitive Eating” by Evelyn Tribole and Elise Resch
• "The Overcoming Bulimia Workbook: Your Comprehensive, Step-by-step
  Guide to Recovery, by R. E.
  Mccabe, T. L. Mcfarlane, & M. P. Olmsted
  Through their cutting-edge research at the Toronto Hospital Eating Disorders Program, the authors of The Overcoming Bulimia Workbook have developed a proven, step-by-step program for recovery. The authors empower bulimia suffers to take control of their lives, not only by providing information and advice, but by giving them a personalized format with which they can put these new behavior changes into practice, a process that is critically important for lasting recovery. This comprehensive guide covers everything from bulimia's symptoms, causes, and risks to how to normalize eating, shift eating-disordered thoughts, build on personal strengths, improve self-esteem, deal with underlying issues, prevent relapse, and understand what medications can help. With many real-life examples, this book also helps readers learn through the experiences of other sufferers how to overcome their disorder and live a happier, more fulfilled life.  (Review from Adolescence, Spring,2006, Vol. 41, Issue 161
• 
   

MEASURES

We have no idea if this online measure is reliable or valid, but it may be thought-provoking.  http://www.anred.com/slf_tst.html You can find discussion about reliable/valid measures used in these studies:

Cooper, M., Rose, K., & Turner, H. (2005). Core beliefs and the presence or absence of eating disorder symptoms and depressive symptoms in adolescent girls. International Journal of Eating Disorders, 38(1), 60-64. Study was to compare two measures:  The Young Schema Questionnaire and the Negative Self-Beliefs subscale of the Eating Disorder Belief Questionnaire (EDBQ). Both measures seem useful, but the EDBQ seemed to yield more information. 

Eklund, K., Paavonen, E., & Almqvist, F. (2005). Factor structure of the Eating Disorder Inventory-C. International Journal of Eating Disorders, 37(4), 330-341.  The Eating Disorder Inventory-C (EDI-C) is a multidimensional self-report questionnaire for children and adolescents used to characterize differences in the symptoms of eating disorders. When the EDI-C is used with children, the reliability of the original 11 factors may be low. A modified subscale structure with five factors is proposed. 

Favaro, A., Zanetti, T., Huon, G., & Santonastaso, P. (2005). Engaging teachers in an eating disorder preventive intervention. International Journal of Eating Disorders, 38(1), 73-77.  This study evaluated the effectiveness at 1-year follow-up of a psychoeducational eating disorders preventive intervention implemented by specifically trained teachers. Teachers participated in a 5-week training program. One hundred forty-one female students attending nine classes at a vocational training school in Mestre (Venice) were assessed via a structured clinical interview (Structured Clinical Interview for DSM-IV Axis I disorders) and via the 40-item Eating Attitudes Test (EAT-40). Three classes were randomly selected to participate in a 6-week prevention program conducted by the trained teachers. Results: Our data show that a disturbing number of the girls who were asymptomatic at baseline had developed a full or partial eating disorder 1 year later. Findings suggest that students can benefit from participation in a preventive intervention program conducted by teachers, and the benefits appear to be particularly pronounced for bulimic symptoms.

Toro, J., Castro, J., Gila, A., & Pombo, C. (2005).  Assessment of sociocultural influences on the body shape model in adolescent males with anorexia nervosa. European Eating Disorders Review, 13(5), 351-359. To produce a questionnaire for the assessment of sociocultural influences on the male body shape model; to study the role of sociocultural influences in the development of anorexia nervosa in adolescent males; to compare the results obtained with those from a similar study conducted in adolescent females. In anorexic boys, the influence of conversations, magazine articles and advertisements may be greater than in anorexic girls. Anorexic boys present a contradiction: A desire for thinness on the one hand and for a muscular build on the other.

PEER-REVIEWED ARTICLES

Agranat-Meged, A., Deitcher, C., Goldzweig, G., Leibenson, L., Stein, M., & Galili-Weisstub, E. (2005). Childhood obesity and attention deficit/hyperactivity disorder: A newly described comorbidity in obese hospitalized children. International Journal of Eating Disorders, 37(4), 357-359.

The current study described a subgroup of children presenting with obesity and comorbid attention deficit/hyperactivitiy disorder (AD/HD) and assessed a possible casual relationship. Method: School-aged children hospitalized for obesity (body mass index [BMI] >85%) in a tertiary referral center underwent extensive evaluations and were prospectively assessed for comorbid AD/HD. Results: :During a 4-year period, 32 obese school-aged children were hospitalized and 26 were included in the current study. We found that over one half (57.7%) suffered from comorbid AD/HD. Discussion:  AD/HD shows a high comorbidity among obese hospitalized children. The characteristic difficulty in regulation found in AD/HD may be a risk factor for the development of abnormal eating behaviors leading to obesity. We suggest that obese children should be screened routinely for AD/HD.

Ali, A., & Maharajh, H. (2004). Anorexia nervosa and religious ambivalence in a developing country. Internet Journal of Mental Health, 2(1), 1-9.

It is argued that there exists many connections between the religious ascetic and the anorexic, and that there are many psychopathological features common to both. While empirical evidence for religious themes in anorexia is not strong, in the family therapy literature there are indications of ethical codes of sacrifice, loyalty and sexual denial. Anorexia and asceticism are considered to be connected conceptually in the process of idealization.

Binford, R., & le Grange, D. (2005). Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only. International Journal of Eating Disorders, 38(2), 157-161.

The purpose of the study was to better understand the phenomenology of bulimic symptomatology in an adolescent clinic sample. Subjects with bulimic episodes and bulimia nervosa were equivalent in terms of age and weight, but were less likely to have intact families. Nearly one half of bulimic episodes subjects purged exclusively outside of eating episodes in which they experienced a sense of loss of control. Although still at clinically significant levels, bulimic episodes subjects reported less concerns regarding weight, shape, and eating relative to bulimia nervosa. Groups were not significantly different on psychiatric comorbidity, but differed on self-esteem.

Bornholt, L., Brake, N. Thomas, S., Russell, L, Madden, S., Anderson, G., et al.  (2005).  Understanding affective and cognitive self-evaluations about the body for adolescent girls. British Journal of Health Psychology, 10(4), 485 – 503. 

The aim of this study was to understand relations between cognitive and affective self-evaluations about the body for adolescent girls in the context of their diverse experiences of the body. The study analyzed self-concepts about the body, movement and appearance, and feeling OK, guilt, worry, disgust, and anger about the body. Self-concepts and feelings were not correlated with body weight, and were sensitive and specific for girls with anorexia nervosa versus low-weight schoolgirls. Relations among self-concepts and feelings about the body vary with the context. In particular, self-concepts and feelings about the body were incongruent for anorexia nervosa girls with acute experiences of making self-evaluations of their bodies.  It is clear that self-evaluations by adolescent girls do not necessarily reflect actual body weight. Findings suggest that associations between thoughts and feelings about the body vary with diverse experiences of the body.

Faer, L., Hendriks, A., Abed, R., & Figueredo, A. (2005). The evolutionary psychology of eating disorders: Female competition for mates or for status?. Psychology & Psychotherapy: Theory, Research & Practice, 78(3), 397-417. 

The relationship between eating disorders and female intrasexual competition was studied.  Contrary to initial expectations, the results supported a mostly spurious causal relationship between Female competition for status and anorexia, with the only indirect causal effect being through the influence of perfectionism, which was uniquely on anorexia and not on bulimia. The role of perceived personal and Ideal partner mate value was also explored. Although they were strongly positively related to each other, these were shown to have nearly equal and opposite effects on body dissatisfaction.

Gerner, B., & Wilson, P. (2005). The relationship between friendship factors and adolescent girls' body image concern, body dissatisfaction, and restrained eating. International Journal of Eating Disorders, 37(4), 313-320. 

This study examined whether poorer friendship relations predict weight concerns and dietary restraint in adolescent girls. Whereas heavier girls were more likely to believe being thinner would improve their friendships, they did not experience poorer friendships. Results suggest sociocultural risk factors for disordered eating and underline the importance of perceived peer affiliation on girls' body image concern and dieting.

Halliwell, E., & Harvey, M. (2006). Examination of a sociocultural model of disordered eating among male and female adolescents. British Journal of Health Psychology, 11(2), 235-248.  

Perceived pressure to lose weight was directly associated with eating behavior, as well as indirectly associated through social comparisons, internalization and body dissatisfaction. However, social comparisons were most strongly related to body dissatisfaction among adolescents who perceived themselves as overweight. Conclusions. The findings indicate that models of eating disordered behavior, developed for adolescent girls, are also appropriate for understanding this behavior among male adolescents.

Holtkamp, K., Müller, B., Heussen, N., Remschmidt, H., & Herpertz-Dahlmann, B. (2005). Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. European Child & Adolescent Psychiatry, 14(2), 106-110. 

Anorexia nervosa (AN) is frequently associated with symptoms of depression, anxiety, and obsessive-compulsive behavior which also develop secondary to semistarvation. It is less certain if these symptoms persist after recovery. In conclusion, depressive, anxious, and obsessive-compulsive symptoms may be personality traits in subjects with former adolescent anorexia nervosa.

Agranat-Meged, A., Deitcher, C., Goldzweig, G., Leibenson, L., Stein, M., & Galili-Weisstub, E. (2005). Childhood obesity and attention deficit/hyperactivity disorder: A newly described comorbidity in obese hospitalized children. International Journal of Eating Disorders, 37(4), 357-359. 

The current study described a subgroup of children presenting with obesity and comorbid attention deficit/hyperactivitiy disorder (AD/HD) and assessed a possible casual relationship. Method: School-aged children hospitalized for obesity (body mass index [BMI] >85%) in a tertiary referral center underwent extensive evaluations and were prospectively assessed for comorbid AD/HD. Results: During a 4-year period, 32 obese school-aged children were hospitalized and 26 were included in the current study. We found that over one half (57.7%) suffered from comorbid AD/HD. Discussion: AD/HD shows a high comorbidity among obese hospitalized children. The characteristic difficulty in regulation found in AD/HD may be a risk factor for the development of abnormal eating behaviors leading to obesity. We suggest that obese children should be screened routinely for AD/HD.
 

Epel, E., Spanakos, A., Kasl-Godley, J., & Brownell, K. (1996). Body shape ideals across gender, sexual orientation, socioeconomic status, race, and age. International Journal of Eating Disorders, 19(3), 265-273.

To assess body shape ideals across gender, sexual orientation, race, socio-economic status, and age. Women advertised body weight much less often than men, and lesbians reported body shape descriptors significantly less often than heterosexual women. Gay men and African-American men described their body shape significantly more often than did other groups. However, their reported body mass indices (BMI) were significantly different--African-American men reported a higher BMI, and gay men a lower BMI, than Euro-American heterosexual men. Ethnicity and sexual orientation may influence the importance of size of body shape ideals for men.

Graham, M., Spencer, W., & Andersen, A. (1991). Altered Religious Practice in Patients with Eating Disorders. International Journal of Eating Disorders, 10(2), 239-243.

Alteration in the religious practice of 20 patients hospitalized for treatment of an eating disorder were studied by means of a Religious Attitudes Questionnaire and by psychiatric history. The patients as a group were observant with only one (5%) claiming no religious affiliation. Two-thirds of the patients who regularly participated in communion decreased their frequency of reception (p < .01) because of fear of the calories in the Communion elements. Attendance at church or synagogue activities where food was present was significantly decreased (p < .005). In contrast, participation in fasting activities increased. We conclude that (1) religious practice is significantly altered by the presence of an eating disorder requiring hospitalization, (2) the fear of fatness pervades even the existential and spiritual life of eating disorder patients, cutting them off from a potential source of support, structure and comfort, (3) considerations of the religious activity of psychiatric patients are often neglected in history taking and treatment.

Homosexuality: A risk factor for eating disorders in men. (2002).  Eating Disorders Review, 13(6), 2.

Examines the risk of developing eating disorders among homosexual men. Information on common symptoms associated with eating disorder; Implications of greater body dissatisfaction among homosexual men; Correlation of disordered eating with depression and poor self-esteem.

Kassel, P., & Franko, D. (2000). Body Image Disturbance and Psychodynamic Psychotherapy with Gay Men. Harvard Review of Psychiatry, 8(6), 307.

Examines the psychotherapy of a young gay man with body image disturbance. Discussion of the case report; Models of attractiveness; Cognitive-behavioral therapy.

Katzman, D. (2005). Medical complications in adolescents with anorexia nervosa: A Review of the literature. International Journal of Eating Disorders, 37, 52-59.

The literature suggests that the medical complications in adolescents with AN are different from those reported in adults. The unique clinical presentation, the early onset, and the unknown impact of these complications underscore the need for early identification and treatment of AN in adolescents. Anorexia Nervosa is a serious disorder with significant and often life-threatening medical complications.

Lask, B., Bryant-Waugh, R., Wright, F., Campbell, M., Willoughby, K., & Waller, G. (2005). Family physician consultation patterns indicate high risk for early-onset anorexia nervosa. International Journal of Eating Disorders, 38(3), 269-272. 

There is often a delay in the recognition of early-onset anorexia nervosa. A single consultation about eating behavior or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.

Miljkovitch, R., Pierrehumbert, B., Karmaniola, A., Bader, M., & Halfon, O. (2005). Assessing attachment cognitions and their associations with depression in youth with eating or drug misuse disorders. Substance Use & Misuse, 40(5), 605-623. 

The study investigates associations between attachment cognitions and depression symptoms in 71 15–25-year-olds, 26 of whom have eating disorders, and 20 of whom are drug misusers. For participants with eating disorders, depressive symptomatology was related to preoccupation and parental interference. These findings help understand how attachment cognitions may participate in depressive symptomatology, namely in youth whose behavior problems may be associated with specific attachment experiences.

Neumark-Sztainer, D. (2005). Can we simultaneously work toward the prevention of obesity and eating disorders in children and adolescents?. International Journal of Eating Disorders, 38(3), 220-227. 

Because of the growing prevalence of obesity among children and adolescents, increased attention is being directed toward its prevention. An important question is: Can we simultaneously work toward the prevention of obesity and eating disorders? To address this question, we need to determine (a) if there is a need for integrated approaches; (b) if we can bridge the fields of obesity and eating disorders; (c) if we can foster the development of environments that promote healthy eating and physical activity choices and the acceptance of diverse body shapes and sizes; and (d) if we can work toward the development of interventions that have relevance to a broad spectrum of weight-related conditions and behaviors.

Neumark-Sztainer, D. (2005). Preventing the broad spectrum of weight-related problems: Working with parents to help teens achieve a healthy weight and a positive body image. Journal of Nutrition Education & Behavior, 37, S133-S139. 

A spectrum of eating-, activity-, and weight-related concerns is presented that includes 5 dimensions (weight control practices, level of physical activity, body image, eating behaviors, and weight status) and different levels of severity within each of these dimensions. Multiple interacting factors contribute to the etiology of problems within each of these dimensions in adolescents at the individual, familial, peer, school, community and societal levels. Families have an important role to play in reinforcing the positive influences at each of these levels and in filtering out the negative influences. Parents can help their children engage in more healthful eating and physical activity behavior and feel better about themselves through (1) role modeling healthful behaviors, (2) providing an environment that makes it easy for their children to make healthful choices, (3) focusing less on weight and more on behaviors and overall health, and (4) providing a supportive environment for their children to enhance communication. Families need to be proactive within our society, which works against the development of a healthy weight and a positive body image in children and adolescents. However, families cannot do it on their own and need support from the more distal environments within which they function.

Rojo-Moreno, L., Livianos-Aldana, L., Conesa-Burguet, L., & Cava, G. (2006). Dysfunctional rearing in community and clinic based populations with eating problems: Prevalence and mediating role of psychiatric morbidity. European Eating Disorders Review, 14(1), 32-42. 

Significant differences were found between eating disorders subjects and controls on the scales of emotional warmth, overprotection, and rejection. There were no rearing differences between community cases and hospitalized patients. The father's rejection is the correlate most strongly associated with eating disorders in teenage women.

Sjostrom, L., & Steiner-Adair, C. (2005). Full of ourselves: A wellness program to advance girl power, health & leadership: An eating disorders prevention program that works. Journal of Nutrition Education & Behavior, 37, S141-S144. 

The article provides information a school-based primary prevention program "Full of Ourselves: A Wellness Program to Advance Girl Power, Health and Leadership." This program sustains girls in their mental, physical, and relational health and decreases their vulnerability to developing body preoccupation and eating disorders. It reduces the risk of disordered eating by increasing self-esteem, promoting body acceptance, providing leadership opportunities, framing "weightism" as a key issue of social justice, and teaching a range of coping strategies to help girls resist the cultural forces that encourage maladaptive body preoccupation and unhealthful eating and dieting behaviors. This wellness program also reviews existing programs in the field to learn from their failures and successes. It also explores that why do so many girls struggle to claim their strengths.

Steinhausen, H., Gavez, S., & Winkler Metzke, C. (2005). Psychosocial correlates, outcome, and stability of abnormal adolescent eating behavior in community samples of young people. International Journal of Eating Disorders, 37(2), 119-126. 

The current study investigated psychosocial correlates of abnormal adolescent eating behavior at three times during adolescence and young adulthood and its association with psychiatric diagnosis in young adulthood in a community sample.  High-risk subjects were characterized by higher scores for emotional and behavioral problems, more life events including more negative impact, less active coping, lower self-esteem, and less family cohesion. Stability of abnormal eating behavior across time was very low.

Stout, E., & Frame, M. (2004). Body image disorder in adolescent males: Strategies for School Counselors. Professional School Counseling, 8(2), 176-181.

In recent decades, men have been bombarded with images in society that depict the "ideal" male: strong, muscular, lean, with perfect features. What many adolescents do not realize is that most of the male bodies that they idealize can be acquired only with the use of anabolic steroids. Thus, many adolescent boys find themselves pursuing a body type that is impossible to obtain. By the time these boys reach adulthood, many have developed an eating disorder, such as bulimia, or an image disorder, such as muscle dysmorphia. In this article, the authors describe body image disorders in adolescent males and offer intervention strategies for school counselors.

Striegel-Moore, R., Franko, D., Thompson, D., Barton, B., Schreiber, G., & Daniels, S. (2006). Caffeine intake in eating disorders. International Journal of Eating Disorders, 39(2), 162-165.

Caffeine intake increased over time between ages 9 and 19 years across all groups and this trend was not moderated by diagnostic status. For anorexia nervosa, relative to the non-eating disorder group, the proportional intake of caffeine from soda increased significantly before onset to onset to after onset and ingestion of chocolate-containing foods decreased sharply over time. Caffeine consumption in young girls with eating disorders differs from girls with no eating disorders only for anorexia nervosa, but not for bulimia nervosa.

Strumia, R. (2005). Dermatologic signs in patients with eating disorders. American Journal of Clinical Dermatology, 6(3), 165-173. 

Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the ‘hidden’ signs of these disorders in patients who tend to minimize or deny their disorder, and to avoid over-treatment of conditions which are overemphasized by patients’ distorted perception of skin appearance.

Swenne, I. (2005). Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche. International Journal of Eating Disorders, 38(4), 340-345. 

Growth may be stunted for about two years.  Catch-up growth is possible in girls with eating disorders of premenarcheal onset. Weight gain is necessary for catch-up growth and must start before the ability to grow is lost with age. Once weight gain starts, the full effect on growth in stature takes several years to evolve.

Toda, M., & Morimoto, K. (2004). Ramadan fasting -- Effect on healthy Muslims. Social Behavior & Personality: An International Journal, 32(1), 13-18. 

The purpose of this review was to ascertain the effects on healthy Muslims of fasting during Ramadan. We found some changes such as weight loss, evidence of dehydration, increase in serum uric acid, and no pharmacological improvement in lipid parameters. We also observed changes in daily lifestyles and mental-health status. Thus, observance of the Ramadan fasting has both positive and adverse effects on healthy individuals. The adverse effects, however, are unlikely to persist after Ramadan or to lead to other complications. Healthy individuals can observe Ramadan without anxiety about their health. 

Talpade, M. (2006). Food intake among African American girls and diet-related risks. North American Journal of Psychology, 8(1), 123-133.

Statistics today indicate a 45% increase in diet-related problems, especially among African American children. Evidence of obesity, diabetes, high blood pressure, and early sexual maturation among AA girls warrants an investigation of their food intake. The present study analyzed the food intake among African American girls ages 7-10 years. The expectations that the young African American girls would display unhealthy eating habits, that there would be a difference in food intake as a function of early sexual maturation, & body image satisfaction would not vary as a function of early puberty, were confirmed. These findings are important because a description of specific foods eaten by the young girls, rather than their breakdown into food elements, can be used to communicate with the population, as well as help establish support systems for these emerging child-women.

Tamney, J. (1986). Fasting and dieting:  A research note.  Review of Religious Research, 27(3), 255.

Findings suggest that fasting remains a fairly widespread activity. Although many people now fast for secular reasons, such as weight control, religious reasons remain important. The variety of motives for fasting emphasizes the need to study not just how frequently a possibly religious act is performed, but also the meaning of this act to people in a certain social context. Although for many contemporary people fasting is a secular activity, it is the multiplicity of reasons for fasting that characterizes the contemporary situation.

Wigren, M., & Hansen, S. (2005). ADHD symptoms and insistence on sameness in Prader-Willi syndrome. Journal of Intellectual Disability Research, 49(6), 449-456.

Prader-Willis syndrome is congenital problem usually associated with mental retardation where drive to eat constantly will not be denied.  The syndrome is also characterized by a distinct behavioral profile comprising maladaptive behaviors, obsessive-compulsive traits, and skin picking. In this study, indices of ADHD and excessive insistence on sameness were common. They were associated with conduct problems.