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Early Identification and Intervention

Considering the multiple domains of influence on students' body experiences, some children and early adolescents will inevitably not only develop a negative body image but start to engage in a disordered eating pattern in an effort to alter their body shape. Counselors in community-based settings need to be aware of the high prevalence of negative body image, as well as disordered eating patterns, among children. Therefore, the initial assessment should include inquiries about such challenges among children. School-based counselors have a unique role in the early identification of the development of disordered eating patterns and can be a resource for teachers in that domain. In moving toward the goal of early identification and intervention, it is important for counselors to work against the negative stigma associated with EDs and frame negative body image and disordered eating patterns as understandable reactions to multiple pressures that exist in and outside of the school and community environment (Piran, 1999b). In the context of experienced pressures, students may view altering their body as their only way of coping.

Counselors need to make themselves accessible to youths expressing distress about body weight and shape and other body concerns. By removing the stigma of EDs, and by being accessible to students who are preoccupied with body image issues, counselors make it more likely that students will seek out help and approach them at the earlier phases of preoccupation and before disordered eating patterns (such as starvation or bingeing and purging) have become entrenched as central coping strategies in these students' lives. A longer duration of difficulties has been well established as being associated with poorer outcome (Katzman, 1999).

Students approaching the counselor themselves (rather than being mandated by a teacher or parent) is much more preferable, and it may indeed happen if the counselor becomes known as a source of support in relation to body image issues. Students can then be invited by the counselor to examine challenges they experience in their lives at that time and decide collaboratively on an action plan. Unless the counselor has had special training in treating disorders of body shape and eating, it is vital that the student be referred to a health professional for a comprehensive assessment and intervention. EDs are associated with significant medical complications and, in particular during puberty, several consequences are irreversible (such as stunted growth; Katzman, 1999).

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