•Cathy Wright, Head of Key Stage 3, New College Worcester
•Gill Richards, Senior Counsellor, Wiltshire College
•Jennifer Beer, Public Health Practitioner, Buckinghamshire County Council
•Jo Finnett, Maths Teacher, North Halifax Grammar School
•Joe Hayman, CEO, PSHE Association
•Laura, Youth Worker
•Laura Sturdee, Deputy Housemistress, Cranleigh School, Surrey
•Nick Bolton, Personal Development Education Adviser, Wiltshire Council
•Paula Spencer, School Counsellor, Greig City Academy, Haringey
•Rachel Monahan, Form Tutor, Latymer Upper School
•Sam Beal, Partnership Adviser: Health and Wellbeing, Brighton & Hove City Council
•Shirley Shears, Senior Tutor, Clitheroe Royal Grammar School
•Siobain Chase, Inclusion Manager, Ferndale Community Primary School, Swindon.
Thank you also to my colleagues at the PSHE Association who have taught me a huge amount and provided a great forum for exploring new ideas.
Finally, thank you to my daughters Lyra and Ellie who fill me with pride and inspiration each and every day, and to my husband Tom whose unwavering support and sense of fun ensures that I continue to teach others about supporting self-harm and eating disorders without ever feeling the need to revisit these unhelpful behaviours myself.
Preface
This book is designed as a practical guide for anyone working within a school or a similar setting who wants to improve their knowledge, skills and confidence in supporting young people suffering from self-harm or eating disorders. It is drawn largely from research conducted during the course of my PhD and many training sessions and workshops I have run on this topic for school staff, parents and students.
It does not take the place of face-to-face training, but the reality is that such training can be hard to access as there are very few people specializing in this field – I would urge you to attend training where it is possible and, where it is not, I would suggest that you explore the ideas shared within this book with your colleagues. Please treat this book as a starting point and springboard rather than a definitive set of answers.
I am UK-based, so whilst I have made every effort to make the content suitable for an international audience, care will need to be taken when adapting the ideas herein for your school or college if you work outside the UK. Parents are referred to throughout – this should be taken to mean the person who provides care to a child. The words ‘student’ and ‘child’ are also used throughout as these are words that I felt would most resonate with an international audience. Much of the content of this book can be adapted to suit working with a range of ages, from very young children right through to college-aged students and beyond. Finally, I refer several times to Child and Adolescent Mental Health Services (CAMHS); if this is not a term that is applicable to your setting, please take it to mean an external agency that is able to provide support and care to children suffering with mental health and emotional wellbeing issues.
If you require further support, you will find a wide range of free resources on my website (www.inourhands.com), including some resources designed to directly complement the contents of this book. Up-to-date lists of further sources of support are also included on my website. These change so rapidly that including them in print seemed likely to prove unhelpful.
I welcome your feedback on the contents of this book and am always more than happy to be contacted should you wish to share ideas or seek advice. I also always welcome the opportunity to share good practice through the delivery of presentations, training sessions or workshops on the topics touched upon in this book as well as related topics.
Dr Pooky Knightsmith
www.inourhands.com [email protected] @PookyH
CHAPTER 1
Introduction to Eating
Disorders and Self-Harm
This chapter will enable you to:
•define the three major eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder
•understand the range of eating difficulties commonly seen in children under 11
•define self-harm and learn about the most common types
•differentiate between self-harming behaviours and behaviours with suicidal intent.
Eating disorders explained
There are three major types of eating disorder: anorexia nervosa, bulimia nervosa and binge eating disorder. We’ll go on to explore each of these in more depth later in the chapter. What all three of these eating disorders have in common is that the sufferer is using their food intake, their weight or their shape as a way of coping with their life day to day. On the outside, eating disorders look very different: some sufferers become so emaciated that they are prescribed complete bed rest, others become so morbidly obese that they are unable to leave their homes, but weight loss, gain or fluctuation is simply an eating disorder symptom. The thoughts, feelings and psychological makeup which accompany the different eating disorders are very similar.
Over the next few pages I’ve outlined the typical symptoms and characteristics we might expect to see in young people with anorexia nervosa, bulimia nervosa and binge eating disorder. Please note that whilst I think it’s helpful to understand the diagnostic criteria of major eating disorders, I also think that we must take care not to dismiss our concerns about young people who are not suffering with a diagnosable eating disorder. Many young people may either present with an atypical pattern of symptoms, or may be in the early stages of developing an eating disorder and not yet have reached diagnostic levels. In either instance, we should be offering the young person concerned appropriate support regardless of how well they fit with the diagnostic categories presented over the next few pages.
Anorexia nervosa
Anorexia nervosa, commonly referred to simply as ‘anorexia’, is the most fatal of all mental health disorders with up to 10 per cent of sufferers dying either as a result of suicide or, more commonly, due to complicating factors arising from low weight, such as organ failure or heart attack.
The most apparent symptom of anorexia is low weight – people with anorexia are usually keenly aware of the minimum weight recommendation for their height and will work very hard to keep below this weight. Despite their low weight, many people with anorexia will try to lose more weight by restricting their diet and/or exercising or will be very reluctant to gain weight even if they understand that their weight is abnormally low and putting them in medical danger. Additionally, they tend to have a completely distorted view of their body and genuinely believe they are fat or even obese. The easiest way to try to understand it is that it is like looking in a fairground mirror that distorts your shape. People with anorexia will be looking in the ‘fat mirror’ by default and have a constantly distorted view of their shape. Additionally, whilst they might be dangerously underweight, people with anorexia tend to be terrified of eating and gaining weight, even if this won’t bring them close to the normal weight category for their height and age.
‘The thinner I got, the fatter I felt. The pounds were dropping off, but each time I looked in the mirror I could see another roll of fat forming.’
Historically, cessation of menstrual periods in girls was a diagnostic criterion for anorexia. This is no longer the case but it is still worth being aware that where weight loss is extreme girls may have very irregular periods and may cease to have periods altogether unless they are taking the contraceptive pill. Younger girls will generally not start to menstruate if their weight