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Eating Disorders

Eating disorders are a mental health and physical illness that affects many areas relating to eating and body image. People with an eating disorder show an unhealthy focus on eating, exercise, and body weight or shape. Eating disorders typically first develop in the preteen and teen years and can last years without treatment. People from all backgrounds and with different body sizes can be affected by an eating disorder.

Variations in eating practices can exist, but it becomes a disorder when thoughts, feelings, and behaviors effect a person’s quality of life and cause severe or life-threatening medical problems. A variety of treatment options exist to support a person with an eating disorder, and these can provide positive outcomes for a happy, healthy and productive life.

Eating Disorder Support

Community, State, and National Agencies

School Support

Although the Bellevue School District does not provide specific counseling for students with eating disorders, school staff are able to collaborate with students, parents, and outside providers. School professionals such as counselors, psychologists, and MHAT counselors can assist with creating school-based plans to support the mental health needs of students with eating disorders. The supports may look like helping students identify triggers for behaviors, providing support for emotion regulation, creating support and accommodation plans, and working with a student’s support team.

Basic Definitions

Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age and stature; and, in many individuals, distorted body image.

Bulimia Nervosa

Bulimia nervosa is characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Binge Eating Disorder

Binge eating disorder, the most common eating disorder in the United States, is characterized by recurrent episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not regularly using unhealthy compensatory measures to counter the binge eating.

Other Specific Eating Disorders

  • Orthorexia: Orthorexia was coined in 1998 to describe an obsession with proper or ‘healthful’ eating.

  • Other Specified Feeding or Eating Disorder (OSFED): OSFED, known as Eating Disorder Not Otherwise Specified (EDNOS) in previous editions of the DSM, was developed to encompass individuals who do not meet strict criteria for anorexia or bulimia but still have a significant eating disorder.

  • Avoidant Restrictive Food Intake Disorder (ARFID): ARFID, previously referred to as “selective eating disorder,” involves limitations in the amount and/or types of food consumed but does not involve any distress about body shape or size, or fears of fatness.

  • Pica: Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt and paint chips.

  • Rumination Disorder: Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed or spit out.

  • Unspecified Feeding or Eating Disorder (UFED): Unspecified feeding or eating disorder (UFED) applies to presentations where symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

  • Laxative Abuse: Laxative abuse is serious and dangerous, and involves the repeated, frequent use of laxatives to eliminate unwanted calories, lose weight, “feel thin” or “feel empty.”

  • Compulsive Exercise: Compulsive exercise is extreme, excessive exercise that significantly interferes with areas of one’s life. Many people struggle with symptoms associated with this term.

Common Symptoms, Behaviors, Risk Factors

Below are some common symptoms associated with eating disorders.

Emotional and Behavioral:

  • In general, behaviors and attitudes that indicate that weight loss, dieting and control of food are becoming primary concerns

  • Preoccupation with weight, food, calories, carbohydrates, fat grams and dieting

  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

  • Appears uncomfortable eating around others

  • Food rituals (e.g., eats only a particular food or food group [e.g., condiments], excessive chewing, doesn’t allow foods to touch)

  • Skipping meals or taking small portions of food at regular meals

  • Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

  • Withdrawal from usual friends and activities

  • Frequent dieting

  • Extreme concern with body size and shape

  • Frequent checking in the mirror for perceived flaws in appearance

  • Extreme mood swings


  • Noticeable fluctuations in weight, both up and down

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

  • Difficulties concentrating

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)

  • Dizziness, especially upon standing

  • Fainting/syncope

  • Feeling cold all the time

  • Sleep problems

  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)

  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity

  • Dry skin and hair, and brittle nails

  • Swelling around area of salivary glands

  • Fine hair on body (lanugo)

  • Cavities, or discoloration of teeth, from vomiting

  • Muscle weakness

  • Yellow skin (in context of eating large amounts of carrots)

  • Cold, mottled hands and feet or swelling of feet

  • Poor wound healing

  • Impaired immune functioning

Identification Process

The Bellevue School District school district does not currently offer screenings for eating disorders. Concerns around students with suspected eating disorders require a comprehensive psychological and medical evaluation that the Bellevue School District cannot provide. However, the district does currently provide mental health screening around issues with anxiety and depression. These conditions often co-occur with eating disorders and students with an eating disorder may be identified through these questions.