I have a student in my class who was recently diagnosed with anorexia, and as I have never known anyone struggling with this issue, I want to make sure that I am helping do what I can.
The student is constantly ‘moving’ in an effort to burn calories. The student jogs from point to point in the classroom and school; does squats when picking up items from floor; does leg lifts while sitting at desk. If I redirect the behavior, am I causing more anxiety? If I say nothing, am I enabling unhealthy behaviors to continue? What do you recommend?
Kara Fitzpatrick, PhD responds:
As a teacher, you have identified some significant eating disordered behaviors that clearly interfere with this student’s ability to learn, but more significantly, to recover. Compulsive exercise and increased restlessness and hyperactivity are components of anorexia. Many individuals with this disorder feel that they need to move continuously to burn calories, but it is also important to understand that the brain responds to malnourishment by increasing a sense of restlessness and agitation.
As a first step, I would bring these concerns to the attention of the parents to make certain they understand the extent of these behaviors. Often family members are unaware of the extent of exercise and activity away from home and the disorder itself would make it unlikely that your student could accurately estimate their level of activity. Helping parents and others involved in the care of the student understand the behaviors you see in the classroom will assist those involved in the student’s care know where they might best make adjustments to guide your student toward recovery.
In treatment, we help teach families how to put reasonable expectations for safe and healthy behaviors in place at home and ways to enforce these to help keep anorexic behaviors “in check” until the individual can manage these on their own. Although individuals with anorexia are typically wonderfully capable, bright and motivated individuals, within the realm of food, eating and shape/weight, it is useful to think of them as regressed or unable to make appropriate decisions about their care. Often, having rules for behavior can help the anorexic individual because this allows them to respond to outside rules, not just the rules set by the eating disorder. In addition, setting rules and clear expectations for behavior can relieve some of the stress placed on the individual by the eating disorder. That said, it is important to set limits on disruptive and inappropriate behaviors in the classroom. Letting the student know that you have expectations for sitting in their seat, remaining still and walking, not running, between destinations would likely be reasonable expectations for your classroom.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.