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OneToughMomma

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Reply with quote  #1 
Hi, all,

As part of our professional development, my fellow teachers and I must complete student protection training each year.  It's online, necessary and relatively painless.

This year, however, I noticed something different.  I, along with all other employees of this school system, was told to look for signs of sexual abuse in students, including anorexia! 

I am horrified at the thought of poor families battling ED at the same time as suspicions of sexual abuse, and I'm going to take on 'town hall', so to speak.

Can someone please point me to some research that outlines the etiology of AN?  I remember reading it's 80% genetic.

I'd be grateful, and we might make difference next year.

Thanks, OTM

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D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
deenl

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Reply with quote  #2 
Hi OneToughMomma,

https://uncexchanges.org/2016/10/31/the-importance-of-genetics-in-eating-disorders-part-2-the-genetics-of-eating-disorders/

This is a link to Cynthia Bulik's UNC Center of Excellence for Eating Disorders and would seem like a good place to start. There they say that 40%-60% of the risk is genetic.

The remainder is, of course, related to environment. All traumas are part of the environmental picture. I do know people who have been sexually abused as children but the person I know best developed BED, not RAN, and most did not develop any eating disorder at all.

Please also remember that the majority of children abused are victims of people they know well and very often immediate/extended family members or friends/acquaintances of the family. Just because someone is abused does not automatically mean suspicion falls on the immediate family. And, let's not forget that though rare it is not unknown. The person I know with BED was a victim of incest.

I think the biggest issue to stress is that we must be aware  that we all have prejudices and stereotypes and when any child is in danger we must consider all possibilities while not jumping to unproven conclusions.  Immediate support for the person in difficulty, an open mind and the role of specialists should be emphasised. I would think it very unfair to expect teachers to do anything other than raise concerns about a child and contact the relevant experts.

Best of luck,

D

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Mother of 13yo son restricting but no body image issues; inpatient 6 wks Sept/Oct 2015 but lost weight! So emotionally destroyed they agreed to let him home to us. Stable but no progress. Medical hosp to kick start recovery for Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid. Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home.

2 years since first signs and life is good. Happy, first trip away in years, tons of variety in food, stepping back into social life. 

Swedish proverb: Love me when I least deserve it because that's when I need it most.

We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.

If the plan doesn't work, change the plan but never the goal. (but don't give up on the plan too soon, maybe it just needs a tweak or a bit more time and determination [wink] )

mjkz

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Reply with quote  #3 
Recent seminar on neurobiology of EDs from Center for Balanced Living found here.
Foodsupport_AUS

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Reply with quote  #4 
There are a number of studies found that show an increased frequency of sexual abuse in those with eating disorders. This goes along with there is an increased frequency of traumas in those with eating disorders. This was referenced to in the video that mjkz has referenced to. This paper, is a little on the old side, so does not reference binge eating disorder as it was not part of DSM, however it quotes the highest frequency of sexual abuse being in those with bulimia and substance abuse with the lowest being in those with anorexia. http://eatingdisorders.ucsd.edu/research/pub/imaging/doc/1999/deep1999role.pdf  In the video it talks of binge eating disorder as having an even higher frequency. 

Those with mental health issues surely do need more support, for any type of issue, assuming that it means there has been sexual abuse or any type of abuse is a long bow.

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
meadow

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Reply with quote  #5 
Hi OTM

Great that others have been able to provide some links to back this up.

Whilst I absolutely support training professionals to spot the indicators or abuse, suggesting that anorexia is a 'sign of sexual abuse' is jumping way too many steps and I agree that this is unhelpful and potentially very damaging to families.

It reminds me of when I once observed an intake meeting in a CAMHS team (I'm a MH practionner). I can't write details here, but a young child had been referred in with almost identical presentation to my D (i.e. restricting) and the Consultant's view was "we should keep in mind whether this is an issue of neglect".

The fear that professionals would assume that we were neglecting our 8 year-old actually made us delay our referral to CAMHS when she started to get ill. I regret that now and thankfully our team has been very supportive, but that extra few weeks did give D's illness more of a grip.

Good for you for flagging this up x
OneToughMomma

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Reply with quote  #6 
Thank you all for the links and the info.  I knew you would have answers for me!

Deenl, I didn't mean that the parents would necessarily be suspected, but that there would be suspicion of abuse to a child diagnosed with AN. So your comment about jumping to unproven conclusions is exactly where I was headed.  Only I didn't express myself well.

Also, teachers are only expected to report. For our system, we are legally required to report any concerns at a school level, and the decision about what to with that information is not ours to make. So, again you are spot on. 

Personally, we were 'lucky'.  While we had ineffectual treatment for years, at no point was I aware of anyone looking for abuse in my d's background.  At no point did I feel suspected.  Maybe that box was quietly ticked early on.  However, I have heard anecdotally of cases like meadow relates, where treatment teams have wasted time and caused undue stress doggedly looking for abuse.

I will compile all of your links and find a lucky recipient! I'll let you know how I go.

xoOTM


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D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
FaithKeepsMeGoing

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Reply with quote  #7 
Like meadow, I delayed seeking professional help for a few weeks after I realized my daughter had anorexia because I feared the potential of undeserved allegations of abuse or neglect.  Fortunately, our team was also wonderful, and we never had to deal with that.  But that fear adds a negative dimension for a lot of families dealing with this awful illness.  

It's not just eating disorders, but also other types of mental illnesses that become a red flag for trauma.  My oldest daughter has severe ocd, and when she went to a counselor a few years back to seek help with some of her questions (before we understood the importance of ERP), this well-meaning but uninformed professional started probing for the "trauma" that he was certain was at the root of her ocd.  My daughter knew full well that she'd had a pretty much ideal life, except for the mental gymnastics in her brain that she couldn't stop.  It was a reminder to me, however, that as the parents of two kids with mental health issues, some people would look at us as the problem.

Some of you have pointed out that sometimes abuse can be a trigger for an eating disorder.  But it seems that a footnote in this training program, to the effect that eating disorders are only occasionally the result of abuse, would be in order. 

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The Irish tell the story of a man who arrives at the gates of Heaven and asks to be let in.  St. Peter says, “Of course. Show us your scars.”  But the man replies, “I have no scars.”   St. Peter shakes his head and says, “What a pity. Was there nothing worth fighting for?”

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