Home Page

List of Topics




An aspect of the Center for Children and Families

Topic: Anorexia Nervosa
Researched and written byShannon E. McQuillan
                                                I attest that the following report is a product of my own original work.

Full Report
Related Websites



Author: McQuillan, Shannon

Year:                2004


Title:                 Anorexia Nervosa and its effects on the classroom

<>Abstract:          Eating disorders have become increasingly prevalent throughout the past                         few decades. Eating disorders have serious social, psychological, and
                        physical consequences. These disorders primarily affect adolescents, but
                        adults as well. Anorexia Nervosa affects the 7 to 26 age range. Children
                        <>have lower levels of body fat and their bodies crave nutrition therefore;                         they can suffer from starvation more quickly than an adult with Anorexia.                          this paper will discuss the prevalence, characteristics, classroom issues,                          and possible treatments of anorexia nervosa.


<>Subject:            Anorexia Nervosa
                         Overview/definition of the disorder
                        Statistics on how many are affected and if gender/ethnicity based
<>                       <> Characteristics of the disorder
                        Classroom issues: How the disorder impacts the classroom and its students
                        <>Treatment issue as they relate to the classroom

Full Report

Anorexia Nervosa and its effects on the classroom


            Eating disorders have become increasingly prevalent throughout the past few decades. Eating disorders have serious social, psychological, and physical consequences. These disorders primarily affect adolescents, but adults are affected as well. Anorexia affects the 7 to 26 age range. Children have lower levels of body fat and their bodies crave nutrition therefore, they can suffer from starvation more quickly than an adult with this disorder. This paper will discuss the prevalence, characteristics, classroom issues, and possible treatments of anorexia nervosa.

What is Anorexia Nervosa? An overview/definition of this disorder:

            Anorexia Nervosa is a psychological disorder usually occurring in young women that is characterized by an abnormal fear of becoming obese, a distorted self-image, a persistent unwillingness to eat, and severe weight loss. It is often accompanied by self-induced vomiting, excessive exercise, malnutrition, amenorrhea, and other physiological changes (

Diagnostic Criteria for Anorexia Nervosa:


 <>1. Refusal to maintain weight at or above a minimally normal weight for age and height (e.g.,weight loss leading to maintenance of body weight less than 85% of t hat expected; or failure to make expected weight gain during period of growth, eating to body weight less than 85% of that expected).

 2. Intense fear of gaining weight of becoming fat, even though underweight.

 3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of      body weight or shape on self-evaluation, or denial of the seriousness of the current low  body               weight.

 4. In postmenarcheal females, amenorrhea, i.e., the absence of at lease three consecutive menstrual cycle. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration) (DSM-IV criteria).

<>                                                                                                                                                Specify type:

            Restrictive type: During the current episode of anorexia nervosa, the person has         not regularly engaged in binge-eating or purging behaviors (i.e., self-induced       vomiting or the misuse of laxative, diuretics, or enemas).

            Binge-eating/purging type: During the current episode of anorexia nervosa, the person has regularly engaged in bing-eating or purging behaviors (i.e., self-induced vomiting or the misuse of laxative, diuretics or enemas).

(Kaplan, 2004)


Who are mostly affected by eating disorders? Statistics:

Sex Ratio <> 
           It is not a new concept that eating disorders occur during childhood. It has been reported that eating disorders occur just before puberty in both sexes. Many studies of adolescents with A.N. have shown that females make up for 90-95% of all patients. It has been reported that the overall sex ratio of girls to boys is 9.5 to 1 (Watkins, 2002). It has been found that 85% of women who have developed A.N. range from the ages of 13 to 20. This disorder primarily affects adolescents from age 7 to over 26 years old (Phelps, 1991).


            For the past few decades A.N. has been considered a disorder of the Western culture. It has also been confined to white, middle-class women. This is because of the Western ideas of slimness and beauty that are portrayed in the media and then reflected throughout society. This is being blamed on the change in the way women perceive their bodies. Women today strive to be thin.

            The idea that only Western cultures suffer from A.N. is no longer valid. Studies done on non-Western culture, have found evidence of A.N. throughout Hong Kong, Taiwan, China, Malaysia, India, and Singapore. There has also been research done which concluded that A.N. has also been evident in Scotland, and Switzerland, and there has been an increasing number of A.N. cases reported amongst black women, a variety of ethnic groups, and those of different socioeconomic classes (Simpson, 2002).

Some characteristic of Anorexia Nervosa

            Anorexia Nervosa is a condition that can be characterized by the denial of food, rapid and significant weight loss and amenorrhea, and is commonly found in young women (Simpson, 2002). There are signs that you can look for from a person suffering from A.N. These signs are not part of diagnosis, but characteristics that identify signs of A.N. to help you detect early on-set aid in seeking treatment:    

Ÿ         Food refusal is the number one sign to look for in someone with Anorexia Nervosa.

Ÿ    «    The person can refuse to maintain normal body weight for their age and height. This means that there will be minimal to no growth during the expected period of growth.

Ÿ       « The person will fear weight gain because they believe it will lead to becoming fat even though severely underweight.

Ÿ       «When females deprive themselves of food, there is an absence of monthly periods this is referred to as amenorrhea.

Ÿ        « Sign if an out of control personality. Starving oneself gives them a sense of control over one aspect of their life.

Ÿ         «Some physical symptoms to look for; Dry skin, constipation, weak finger and toe nails, swelling of the hands and feet (edema), and possibility of yellow skin (Phelps, 1991).

Ÿ        «Possible; hair loss, skin abnormalities, lethargy, and teeth discoloration (Omizo, 1992).

                                                                                                                                                           Sometimes the person(s) experiencing anorexia can show signs that are the complete opposite. For example, they can be an overachiever, outgoing, a perfectionist, very well behaved, and compliant. This is not always the case, but it is a possibility. A person experiencing this disorder begins to lose interest in normal daily activities that once were enjoyable. The new focus is on heavy exercise, schoolwork, and strict ‘dieting’. Since A.N. has an effect on one’s nutrition, they are not receiving enough energy to maintain good health. As a result of all the heavy activity and overload in schoolwork, there is a lower level of academic achievement from lack of energy (Phelps, 1991).

How does this disorder impact the classroom?

            In the classroom, a student suffering from A.N. feels as if he or she is in complete control of completely out of control. The empowerment of control or being out of control tend to lead the adolescent to be a hard working, overachieving perfectionist, introverted, and compliant. Because the student does not show signs of distress in an educational setting makes it difficult for teachers to recognize treatment issues. This is typically why A.N. and other eating disorders go unnoticed in the school setting. It could be apparent that the student is showing physical characteristics if A.N., but he or she shows no signs of distress and is not disruptive. This student is trying to be the stereotypically perfect student. This is not suggesting that every good student has A.N. It is simply stating that a student with A.N. is trying to stay in complete control and by focusing on schoolwork distracts the student as well as teachers (Phelps, 1991).

            Eventually these students become withdrawn socially, and lose interest in once important activities. When individuals starve themselves, they do not have the right nutrition or energy level to complete everyday tasks. Therefore, they begin to show signs of impaired concentration and alertness. This eventually results in a lower level of academic achievement.

            In the classroom, there are some other signs/mood fluctuations in which the teacher should look for:

Ÿ     ¯   Excessive anxiety

Ÿ       ¯ Hypersensitivity

Ÿ        ¯ Depression

Ÿ       ¯ Obsessive-Compulsive thinking

Ÿ        ¯ Self-Isolation

(Phelps, 1991)

Treatment issues as they relate to the classroom

The School Counselors Role:

            The treatment of Anorexia Nervosa involves many aspects. Medical management, personal management, behavioral management, and family therapy (Halmi, 1982). These are the important multidimensional aspects, which are mostly affected by Anorexia Nervosa.

            There are new current treatment procedures that can prove to benefit the school psychologist. The first approach is aimed at targeting specific attitudes towards ones weight, body shape, starvation, and eating habits. The school counselor has a responsibility to recognize and identify the symptoms of Anorexia in a school setting. The counselor needs to assess the situation and determine whether assistance will be successful in a school setting. This is because the counselor deals with not only that one student but other students as well. He or she needs to determine if they have the needed amount of time and attention to assist the anorexic through recovery. IF the counselor deems it possible, their next objective is to help the student/anorexic understand their potentially life threatening behavior (Omizo, 1992). Then the counselor is going to help the individual steer towards rehabilitating their bodies back to a healthy nutritional state. This will aid the anorexic in becoming more nutritionally balanced and hopefully lead to long-term recovery. The school psychologist will receive positive results by enforcing positive reinforcement (Phelps, 1991).

            Once the anorexic and the school counselor receive a desirable outcome during the recovery process, support group participation complements individual counseling. In addition to the support group meetings, it could be crucial for others support groups as well. For example, the anorexic should have a support group of anorexics, peers, and family members. Peers and family members help to create a loving support system for these patients. The child with anorexia craves love, affection, and attention while going through recovery. Therefore, by having a strong support group with love from the school counselor, family, and peers, the child has a greater chance for full recovery (Omizo, 1992).

Family Therapy/Treatment for the Anorexic:

            Family therapy and family treatment are two completely different approaches. Family therapies target families as the problem. It finds that family as the source of the problem for the anorexic. On the other hand, family treatment provides techniques in which the family makes changes and provides support necessary to assist their child in the recovery process. Family treatment does not find the family as the source of the problems. It is the most important once the anorexic achieves weight gain. This occurs because once the anorexic begins eating properly; the family has less stress and their mood changes. Families even begin various strategies to test the child by allowing them to prepare their own food, eat snacks without observation, and even make their own food choices. Once the adolescent can manage his/her own meals, the family will enter the last phase of family treatment. This phase focuses on how A.N. has affected the adolescent’s development. This includes development physically, mentally, socially, and sexually. This helps all involved to reorganize their lives back to normal. Yes, the parents should help the adolescent to maintain recovery, but keeping anorexia as the focus is not healthy for the families well being. This phase helps the family to set new boundaries around the focus of recovery (Lock, 2002).


            It is widely known and accepted that Anorexia Nervosa occurs in adolescents. A.N. characteristics in children are similar to those in adults. The differences between the two are important to recognize because children have lower levels of body fat, and tend to suffer from starvation drastically quicker than adults. Therefore, identifying characteristics for early detection in adolescents is more crucial. To aid in the diagnosis of A.N., teachers must always be aware that A.N. can go undetected without proper observations. By showing awareness, this possibly fatal illness can be reversed at an early age. There is more research/studies being done to help in the understanding and taken into account. This included the physical, psychological, social, and family aspects of treatment (Watkins, 2002).

            I hope that you now have a better understanding of this chronic illness. Understanding and recognizing the severity of this illness is the key to helping those struggling with A.N.




Eisler, I (2000). Family therapy for adolescent anorexia nervosa: The results of a controlled                               comparison of two family interventions. Journal of Child Psychology      &                                         Psychiatry, 41(6), 727-736.

<>Halmi, K.A (1982). Pragmatic information on eating disorders. Psychiatric clinics of North               
            America,5(2), 371-377.

Kaplan, S.M.E (2004). Nutrition and eating disorders in adolescents. Mount Sinai Journal of                        Medicine, 71(3), 155-161.

Kerwin, M.E (1996). Feeding and eating disorder: ingestive problems of infancy,  childhood, and               adolescents. The School Psychology Review, 25(3), 316-328.

Levitt, D.H (2001). Anorexia nervosa: treatment in the family context. The Family  Journal:                           Counseling and Therapy, 9(2), 159-163.

  <>Lock, J (2002). Treating adolescents with eating disorders in the family context, 11(2), 331-342.

Omizo, S.A. & Omizo, M.M (1992). Eating disorders: the school counselor’s role. US:  American
School Counselor Association, 39 (3), 217. 

Phelps, L (1991). Eating disorders of the adolescent: current issues in etiology, assessment, and
treatment. School Psychology Review, 20(1), 9-14.      

<>Simpson, K.J (2002). Anorexia nervosa and culture. Journal of Psychiatric & Mental Health       
              Nursing, 9(1),65-71.

Watkins, B (2002). Eating disorders in school-aged children. Child & Adolescent Psychiatric
Clinics of North Amercia, (2), 185-199.        

This website is a service learning project by the students of "Psychology of the Exceptional Child" at Frostburg State University.  Manager of web page and project: Dr. Megan E. Bradley