An online survey of pupils’ experiences of eating disorders - journal article

‘My teacher saved my life’ versus ‘Teachers don’thave a clue’: an online survey of pupils’ experiencesof eating disorders

Pooky Knightsmith, Helen Sharpe, Olivia Breen, Janet Treasure & Ulrike Schmidt

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, London SE5 8AF, UK. E-mail:[email protected]

Background: Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known aboutpupils’ experiences of ED within a school setting. Method: Five hundred and eleven 11- to 19-year-old schoolpupils completed an online questionnaire exploring their experiences of ED (72% female, 28% male).Responses were analysed using content analysis principles. Results: Of the participants, 38% had a current orpast ED, 49% of these had never received a formal diagnosis. Of the respondents, 59% saw a need to raise EDawareness. Only 7% would confide in a teacher about an ED. Conclusions: Efforts are needed to break downbarriers to disclosure and support teachers to play an effective role in the detection and early intervention forED.

Key Practitioner Message

• Eating disorders are at their most prevalent amongst young people of secondary school age

• Early recognition and intervention lead to far more successful outcomes both short term and long term

• Teachers are in an excellent position to spot eating disorder warning signs but currently do not do so consis-tently

• Whilst pupils feel confident in spotting eating disorder warning signs, they are reluctant to report concerns to ateacher due to fears around confidentiality, inappropriate reactions and perceived stigma

• Teachers and peers can play an important role in eating disorder recognition and recovery; improved educationand training is needed for both school staff and students in order for this potential to be realised

Keywords: Anorexia; bulimia; binge-eating disorder; eating disorders; teacher; school

Introduction

Eating disorders (ED) affect a significant proportion ofthe school population; they are most likely to strikebetween the ages of 10 and 19 (Currin, Schmidt, Trea-sure, & Jick, 2005). A recent study found the medianages at onset of anorexia nervosa (AN), bulimia nervosa(BN) and binge-eating disorder (BED), were 12.3, 12.4and 12.6 years, respectively, with lifetime prevalenceestimates AN .3%, BN .9% and BED 1.6%, respectively(Swanson, Crow, Le Grange, Swendsen, & Merikangas,2011). Up to a further 2.37% of 12- to 23-year-oldfemales maymeet the criteria for ED not otherwise speci-fied (Machado, Machado, Gonc�alves, & Hoek, 2007).

Early recognition of ED is key in ensuring successfullong-term outcomes (Treasure, Claudino, & Zucker,2010), and poor mental health literacy regarding the effi-cacy of treatments has been presented as a barrier totreatment seeking (Mond, Hay, Rodgers, & Owen, 2008).As such, schools potentially have an important role toplay in ED detection and early intervention. Pupils andteachers are in an excellent position to notice the physi-cal and behavioural changes that accompany the early

stages of ED (McVey, Lieberman, Voorberg, Wardrope, &Blackmore, 2003; Neumark-Sztainer, 1996; Shaw,Stice, & Becker, 2009). Unfortunately, ED mental healthliteracy in adolescents may be low (Mond et al., 2007),and the knowledge and confidence of school staff,regarding ED recognition and support is a cause for con-cern (Price, Desmond, Price, & Mossing, 1990; Yager &O’Dea, 2005). Many staff would welcome more trainingin this area (Neumark-Sztainer, Story, & Coller, 1999;Piran, 2004).

There has been little research reported into pupilexperiences of ED, although some studies have exploredpupil experiences of weight-related issues (Haines, Neu-mark-Sztainer, & Thiel, 2007) and the precursors of ED(Sharpe, Damazer, Treasure, & Schmidt, in press). Thisstudy aimed to evaluate pupil understanding of ED, todetermine the common course of action for a pupil whobelieved a friend was suffering and to understand theschool’s role in working with sufferers from a pupil’spoint of view. Finally, we aimed to generate recommen-dations from pupils about how schools could improvethe support they offer to pupils’ suffering or recoveringfrom ED.

© 2013 The Authors. Child and Adolescent Mental Health. © 2013 Association for Child and Adolescent Mental Health.Published by John Wiley & Sons, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA

Child and Adolescent Mental Health Volume **, No. *, 2013, pp. **–** doi:10.1111/camh.12027

Methods

DesignThe study consisted of an anonymous online question-naire aimed at adolescents in UK secondary schools. Aconvenience sample of 23 institutions was recruited andpupils within those institutions were invited to partici-pate.

Institutional Review Board approval and informedconsent proceduresEthical approval was obtained from King’s College Lon-don Research Ethics Committee (Ref PNM/09/10-110).Opt-in written informed consent was obtained from stu-dents’ parents. For those students with parental con-sent, verbal informed assent was also obtained.

Survey contentThe survey explored student experiences of ED in schooland their perceptions of how their school could supportstudents with ED, and finally what ideas they had abouthow schools could becomemore supportive to sufferers.

Development and pretestingThe online questionnaire was developed following con-sultation with teachers and pupils. An initial versionwas piloted with 25 pupils. No technical problems or dif-ficulties in comprehension were reported.

Recruitment processTwenty-three Mainstream Secondary Schools and Fur-ther Education Colleges from throughout the UnitedKingdom were approached. Twenty-one institutions par-ticipated in the study, including state, private, singlesex, co-educational, high achieving and low achievingschools. Participating schools advertised the onlinequestionnaires to their students.

Pupils were eligible for inclusion if they were agedbetween 11 and 19 and they currently attended a partici-pating institution. A total of 511 pupils took part in thestudy.

Survey administrationThe study consisted of an anonymous self-report onlinequestionnaire, which took between 10 and 30 min tocomplete. Participation was voluntary and no incentiveswere offered for participation. The data were collectedbetween February and April 2010.

The questionnaires were hosted on a nonpasswordprotected survey website. Computers were prepared inadvance of students’ arriving at their school’s IT rooms.The questionnaires consisted of the information sheetand 13 questionnaire items which appeared on separatescreens. Only questions relating to the participant’s ageand gender were compulsory. There was no randomisa-tion of items.

There was no technical method of preventing multipleentries from students but multiple entries would havebeen unlikely as students completed the questionnairesunder supervision and were not provided with the webaddress.

AnalysisThe questionnaire generated both quantitative and qual-itative data. The quantitative data were responses to

multiple choice questions. These data were summed andthe raw number of responses calculated for each itemwas recorded as well as a percentage. When not all par-ticipants recorded a response to a question, the percent-ages were calculated according to the number ofrespondents to the specific question.

Much of the data the questionnaire generated were inthe form of free text. These data were analysed usingcontent analysis, a process by which the ‘many words oftexts are classified into much fewer categories’ enablinganalysis, examination and verification (Flick, 1998; May-ring, 2004; Weber, 1990).

A comprehensive coding system was developed byanalysing responses and classifying them into catego-ries. A second researcher independently coded the datausing the coding system, blind to the original codingdecisions with an inter-rater reliability of 94% (1185 of1261 coding decision were identical). Where there wasdiscrepancy between the two coders (n = 74), this wasgenerally the result of one researcher placing a responsein more categories than the other researcher. The eightinstances where the researchers did not agree on the pri-mary category for a response were easily resolved.

Results

Demographic informationA total of 511 pupils aged 11–19 years (M = 15.4 years,SD = 2.3) have participated. Participants came fromstate schools (n = 420), independent schools (n = 74)and home schools (n = 17). Independent schools wereslightly over-represented and female students were sub-stantially over-represented (see Table 1). An estimated1300 pupils were invited to participate in the study witha response rate of 39%.

A large proportion of participants [38% (n = 195)]endorsed either currently having an ED or having recov-ered from one, 49% (n = 96) of these had never received adiagnosis. Of the participants, 53% (n = 269) had afriend who had suffered from an ED. Of the participants,23% (n = 115) had not had an ED themselves and didnot have a friend who had ever suffered from one.

Pupils’ experiences and recommendationsResults from the closed questions are summarised inTable 2, and free text responses are summarised inTable 3. In this section, the two forms of data are drawntogether under the general themes that were identified.

Three themes emerged from the content analysis ofthe free text responses. These were as follows:

1Picking up the signs: improving education for staff andstudents.

2Encouraging disclosure and providing support.

3Management and integration: promoting recovery inschool.

Picking up the signs: improving education for staffand studentsMost pupils in this sample [79% (n = 361)] were confi-dent that they would recognise ED symptoms, 56%(n = 257) had recognised the signs in the past. Of the30% of pupils who had been taught about ED at school,82% (n = 124) felt the training could have been

© 2013 The Authors. Child and Adolescent Mental Health © 2013 Association for Child and Adolescent Mental Health.

2 Pooky Knightsmith et al. Child Adolesc Ment Health 2013; *(*): **–**

improved. The most common recommendation frompupils was that both staff and pupils would benefit fromimproved ED education. Of the pupils, 16% (n = 46)made some reference to staff having little or no knowl-edge about ED.

Teachers don’t have a clue about stuff like eating disorders.(Male, 14)

Of the respondents, 59% (n = 185) suggested thatraising pupil awareness of ED would be helpful, both interms of reducing the associated stigma and in givingyoung people the confidence to pick up warning signs infriends and to respond appropriately.

People would bully less if they really understood. (Female, 12)

How do I know if my friend’s got an eating disorder, and whatshould I do if she has? (Female, 14)

Encouraging disclosures and providing supportOnly 7% (n = 33) of pupils said they would talk to a tea-cher if they were concerned a friend might have an ED.By far, the most prevalent reasons for not talking to a

teacher were that teachers either would not take it seri-ously, over-react or fail to treat thematter in confidence.

They’d probably just laugh or say I was making it up for atten-tion or something. (Female, 12)

There was also concern about the perceived stigmaassociated with ED both from teachers:

My friend would go crazy if I told a teacher, cos once theyknow they treat you like a right freak. (Female 12)

and peers:

What if I told a teacher, and they blabbed and everyone foundout? No one would want to talk to her and she’d get bullied.(Female, 13)

The thing that most concerned pupils was the issue ofconfidentiality. Of the pupils, 55% (n = 278) mentionedtrust or confidentiality as an issue, most often sayingthat they would ‘not share concerns with a teacherbecause they were worried that a teacher would informparents’.

Teachers go blabbing to parents before you can blink. (Male,15)

Table 1. Demographics of current study vs national school averages

Independent school pupils State school pupils Girls Boys

National average 9% (n = 3,504,665) 91% (n = 3,182,130) 50% (n = 1,735,865) 50% (n = 1,735,865)This study 15% (n = 74) 85% (n = 420) 72% (n = 370) 28% (n = 141)

Figures from Clarke (2012).

Table 2. Summary of pupil responses to eating disorders (ED) experience survey – closed questions

Are you able to spot thesigns of an ED

Yes – I have inthe past

Yes – I know thesigns

Unsure No

458 respondents 257 (56%) 104 (23%) 64 (14%) 33 (7%)Has your school evertaught you about EDand was it helpful?

Taught –helpful

Taught – nothelpful

Not taught Unsure

499 respondents 27 (5%) 124 (25%) 332 (67%) 16 (3%)If you were worried that afriendmight besuffering from an ED,what would you do?

Try to help ifmy friendapproachedme

Approachmyfriend andoffer help

Talk to ateacher

Let a teacherknowanonymously

Talk to an adultout of school

Wait and see

505 respondents 137 (27%) 263 (52%) 33 (7%) 15 (3%) 29 (6%) 28 (6%)If you told a teacher thatyou were concernedabout a friend, whatwould you want them to do?

Talk tomy friend

Help me helpmy friend

Tell myfriend’sparents

Get helpfrom acounsellor ordoctor

Listen

479 respondents 122 (25%) 216 (45%) 11 (2%) 78 (16%) 52 (11%)If you told a teacher thatyou were concernedabout a friend, what doyou think they wouldactually do?

Talk tomy friend

Help me helpmy friend

Tell myfriend’sparents

Get helpfrom acounselloror doctor

Listen

474 respondents 106 (22%) 24 (5%) 229 (48%) 50 (11%) 65 (14%)Howwould youmost liketo raise concerns about afriend with a teacher?

Face to face On the phone Text/SMS/IM Email/inwriting

461 respondents 337 (73%) 5 (1%) 17 (4%) 102 (22%)If you were sufferingfrom an ED do you thinkyour school would be asafe and supportiveplace to recover?

Strongly agree Agree Neutral Disagree Stronglydisagree

504 respondents 12 (2%) 41 (8%) 81 (16%) 133 (26%) 237 (47%)


doi:10.1111/camh.12027 My teacher saved my life 3

Reports suggested that communication with parentswas not always handled well:

Her Mum came storming in saying I’d been spreadingrumours about her. They could at least of warned me theywere gonna ring her. (Female, 16)

In well managed situations, parental involvementproved very positive:

We agreed what to tell her mum and she came straight toschool. Within an hour of me telling my teacher, we were allsitting down together. We all cried. It was kind of weird but bythe end of the meeting I was really glad I’d said something.(Male, 15)

If they were to tell a teacher, 73% (n = 337) of pupilswould prefer to discuss ED concerns face to face, farexceeding the number of pupils who would prefer tocommunicate in writing/email (22%; n = 102), on thephone, or by text (5%; n = 22). Being able to raise con-cerns about friends is also important:

We thought she was going to die andmaybe it was our fault. Ifsomeone had talked to us then we might have known how tosupport our friend. (Female, 16)

The ability to receive support from nonteaching schoolstaff, such as counsellors was perceived as helpful:

Someone who we could talk to would be good. Not a teacher –you don’t want to go and learn maths off someone who you’vejust been talking to about all your deepest worries. A counsel-lor would be better. (Male, 14)

Several examples of good practice were reported bystudents:

You can make an appointment to see a teacher. No one knowsyou’re going [it was a secure online appointment booking sys-tem] and you know it’s just your time with them. (Female, 14).

Every half term, we all get a ten minute private meeting withour form tutor. Normally I didn’t have much to say but thistime I did and I was glad I could say it in private to my formtutor. (Male, 15)

Forty-nine pupils outlined highly positive situations,which demonstrated the important role school staff canplay in supporting pupils with ED.

I had an amazing teacher who really cared and noticed thesigns. She helpedme through a lot. (Female, 16)

Four pupils stated that they did not think they wouldbe alive today if it had not been for the support of specificteachers.

She knew I needed help and she offered it. I was in a really badplace. I don’t think it’s going too far if I say that my teachersavedmy life. (Female, 16)

Management and integration: promoting recoveryin schoolWhereas the first three themes focused more clearly onpicking up signs and symptoms of ED, pupils also raisedissues of managing those with ED in the school setting,particularly for those who had had to take some timeaway because of the illness.

Only 1 in 10 (n = 53) pupils considered their schoolwould provide a supportive environment for someonerecovering from an ED. Difficulties arose in bullying fromother students as well as staff being unsure as how bestto manage the return to school.T

able

3.Su

mmary

ofpupilresponsesto

eatingdisorders(ED)exp

erience

survey–freetext

How

schoolcould

help

students

understandED

Educate

peers

Better

services

inschool

Increase

openness

aboutED

Educate

teach

ers

Beless

judgemental

Teach

erstake

more

caring

approach

Schoolcannot

help

Improve

access

toservicesin

school

Betterresources

351respondents

185(59%)

68(22%)

22(7%)

19(14%)

18(7%)

16(6%)

10(4%)

9(3%)

4(1%)

How

schoolcould

bettersupport

duringreco

very

Reduce

stigma

Tailored

support

Accessto

professional

support

Nothing

Supportgroups

Confidentiality

Peermentors

Promote

school

services

342respondents

133(43%)

72(23%)

46(15%)

27(9%)

25(8%)

20(6%)

12(4%)

7(2%)

How

schoolh

as

helped

Referralto

professional

Supportive

staff

Contacted

parents

Flexible

schooling

On-goingsupport

169respondents

67(22%)

63(20%)

19(6%)

10(3%)

10(3%)

Negative

school

exp

eriences

Staffdid

not

notice

Punishment

Failedto

consult

student

Pooraccessto

professional

help

Broke

confidentiality

Judgemental

Lack

of

knowledge

Problemswith

theservices

Negative

exp

erience

notexp

andedupon

321respondents

89(27%)

31(10%)

31(10%)

27(8%)

21(6%)

12(4%)

10(3%)

8(2%)

92(28%)



If you’re different in any way you get bullied and that includesthe anorexics. (Female, 12)

They were trying to be nice but I was being treated like a freakand a weirdo. (Female, 13)

Just let me forget. Give me detentions and too much home-work. I just want to be a normal kid now. (Male, 16)

One incident in which a pupil committed suicide fol-lowing a failed attempt at reintegration into school fol-lowing a period of absence due to an EDwas outlined.

Maybe he was always going to kill himself, but I think that ifsomeone at school had done more, maybe he’d still be here.(Male, 19)

In contrast, several pupils who had recovered from EDoutlined how important their school was in providing asupportive environment.

My school was great. Our home would always be the placewhere I’d been ill, but school wasn’t like that. I could startagain as the newme, it was like an escape. (Female, 17)

The most often used words to describe the idealapproach from teachers were honest (n = 71), open(n = 19), nonjudgemental (n = 23) and approachable(n = 29).

Discussion

This study is the first to investigate pupils’ experiencesof ED in UK schools. Pupils shared a wide range of expe-riences and many constructive recommendations abouthow schools could offer better support in future. A nota-ble strength of this study was the inclusion of male par-ticipants, as previous research in this area has beenlargely confined to females (Mond & Arrighi, 2011). Alimitation of this study is that it exclusively includedpupil responses. Future studies which include schoolstaff or parent responses could further our understand-ing.

Participant characteristics and data qualityThe prevalence of self-reported ED in this study was high(38%) and females were over-represented. This preva-lence is similar to other studies with self-selecting sam-ples: Mond et al. (2007) report 29% with past or currentBN. Most likely these figures demonstrate a samplingbias towards eating disordered participants and/or atendency for participants to overstate their levels of EDpsychopathology. Teachers, parents and pupils wereaware that the aim of the research was to gain a betterunderstanding of pupils’ experiences of ED, meaningthat those with particular experiences may have beenespecially drawn to participating.

Whilst the sample is unlikely to be representative ofthe general UK school population where ED prevalenceis estimated at less than 3% (Machado et al., 2007), theself-selected sample was in a particularly strong positionto share insight into the experiences of pupils with ED.The responses generated were relevant, specific andincluded detailed descriptions of personal experiencesacross a range of scenarios.

Pupil experiencesED education. Less than a third of participants hadbeen taught about ED. The majority of pupils said they

would like to learn more about ED but felt that theirteachers needed to be trained as well. Given the limitedknowledge about ED demonstrated by some teachers inexisting studies (O’Dea & Abraham, 2001), these con-cerns are likely to reflect genuine training needs of sec-ondary school staff. Pupils felt that training for bothpupils and teachers should focus on raising awarenessof ED, reducing the stigma associated with them andmaking sure that pupils were aware of what serviceswere available to help them if they or a friend had an ED.

The perceived lack of knowledge and awareness aboutED is in line with previous study showing that adoles-cents have poor mental health literacy in this area (Mondet al., 2007). In principle, proposed benefits of improvedmental health literacy could be: (a) prevention, (b) inter-vention and (c) detection or improved help-seeking forED. Expected benefits of psycho-education for the pre-vention of ED have not been found (Stice, Shaw, &Marti,2007). There are also mixed findings regarding the effi-cacy of mental health literacy interventions for adultwomen with ED in improving symptoms and help-seek-ing (Hay et al., 2007, 2011). The fact that those with EDreport especially poor knowledge about the most helpfulavenues for treatment (Mond et al., 2010) underlines theimportance of improving mental health literacy in thosein a position to detect problems early in schools – peersand teachers – and to give them the tools to provide accu-rate support and advice to those students who are show-ing signs of a problem.

Further study needs to go into identifying exactly whata successful ED education programme for staff andpupils should look like, and study will need to be per-formed to ensure that teachers have a thorough under-standing of ED and are able to answer pupils’ questionsand foster an environment of mutual respect betweenpupils, including those with ED. Althoughmany psycho-education programmes have demonstrated significantimprovements in pupil and staff knowledge about ED(Franko et al., 2005; Killen et al., 1993; McVey, Gusella,Tweed, & Ferrari, 2008), it is not known whether thesechanges translate into greater student help-seeking andimproved perceptions of the supportiveness of the schoolenvironment. Previous reports on the role of school staffin the identification of ED in schools have highlightedthe importance of staff training in this area as well asaddressing teachers’ own attitudes towards weight,shape and eating that may influence their ability to bepositive role models within the classroom (Paxton,Schutz, Wertheim, &Muir, 1999; Piran, 2004).

Barriers to disclosure. Pupils were highly concernedabout the issue of confidentiality. Many said that theywould not talk to a teacher about ED concerns becausethey were worried that a teacher would break their confi-dence and inform parents. This is in line with previousresearch reporting that only 2% adolescents would con-sider approaching a teacher in the first instance whenconcerned about an individual with bulimia (Mondet al., 2007).

This is a very difficult issue to address, as teachers arenot legally allowed to keep matters confidential if achild’s welfare is at risk. Added to that is the fact that aminor cannot easily be referred for treatment withoutparental consent. Serious thought needs to be given tohow this situation can best be managed so the contact



between pupils, parents and school is more positive.Good communication appears to be central to this issue,both in terms of pupils understanding why parentalinvolvement is essential, and so that staff and parentscan work together with students and their friends to finda solution.

There were several examples of good practice whereparental contact was undertaken collaboratively. Whereparents are to be informed, this should be discussedwith the pupil concerned first. Where possible, their con-sent should be sought and the pupil and teacher shouldbe in agreement about what the parent will be told. Ide-ally, the pupil, parent and teacher should then meet assoon as possible so that they can work together as ateam.

Another reason why pupils would not share ED con-cerns was the logistical problem of being able to speakprivately to a teacher. Some schools used strategies forgetting around this common problem such as allowingpupils to book private appointments with a teacher orscheduling regular one to ones with form tutors for allpupils. Pupils spoke positively of these initiatives, whichcould be adapted for use in other schools.

A further barrier to disclosure was the perceivedstigma surrounding ED – both from teachers and stu-dents. This concern is likely to be valid as stigma associ-ated with eating disordered behaviour has beendemonstrated in previous studies (Bowers, Manion, Pa-padopoulos, & Gauvreau, 2012; Crisafulli, Thompson-Brenner, Franko, Eddy, & Herzog, 2010; Mond, Robert-son-Smith, & Vitere, 2006) and suggests a need forimproved mental health literacy of both students andstaff.

Creating a supportive environment. A supportive envi-ronment can result in a far better long-term prognosisfor young people with an ED (Wade, Wilksch, & Lee,2012) and the school can play an important role in work-ing with families to support young people receiving/whohave received treatment. Whilst some pupils felt stronglythat their school provided a supportive environment forpupils recovering from an ED, the majority did not. Thekey issue highlighted by pupils was that ED led to bully-ing, teasing or being treated differently both by pupilsand staff. This is in line with previous research suggest-ing that although 69% of teachers reported noticingweight-related teasing in the classroom, only 32% hadattempted to address the issue (Piran, 2004). It is vitalthat teachers are aware that weight-related teasing isnot benign, and that ED sufferers may be particularlyvulnerable to these forms of teasing. Ideally, schoolsshould employ zero tolerance policies – both for pupilsand teachers and attempt to eradicate any teasing orbullying on the basis of shape or weight.

That said, it is worth bearing in mind that pupils alsohighlighted their dislike of being treated with kid glovesduring recovery. The overriding feeling was one of want-ing to get back to normal. This is something that shouldbe discussed with each individual recovering from an EDbut the assumption should not be that pupils need out-wardly special treatment. Improvements in both staffand student knowledge about ED should be helpful inbuilding confidence to support those recovering fromthese conditions without being overly protective and

inadvertently acting as a barrier to integration into nor-mal school life.

Implications and core recommendationsPupils can be an excellent source of early disclosuresabout ED in their peers, and schools have the potentialto provide a supportive environment for those recover-ing. This study indicates that in neither instance is thispotential consistently being realised. Improved educa-tion and training about ED for both teachers and pupilswas implicated as the key means by which progress maybe made. This training could draw on the best practiceand positive experiences outlined during the currentresearch. Training for teachers, in addition to focusingon recognition of ED in pupils, needs to include develop-ment of skills on how to communicate concerns and howto manage difficult situations around ED as they arise.Much progress has been made in recent years in under-standing the needs of parents of young people with ED(Murphy et al., 2004; Perkins, Winn, Murray, Murphy,& Schmidt, 2004; Kyriacou, Treasure, & Schmidt,2008a, 2008b; Winn et al., 2007) and internet-, DVD-and book-based interventions have been developedtraining parents with relevant skills for supporting theirchild with an ED effectively on their journey to recovery(Goddard et al., 2011; Grover et al., 2011). Training forteachers could be developed along similar lines and suchwork is currently in progress (Eating Disorders Pocket-book, Knightsmith, 2013).

Acknowledgements

The authors would like to thank the young people who partici-pated in the study, and the school staff and parents who sup-ported.

This study was supported by the National Institute for HealthResearch (NIHR) under its Programme Grants for AppliedResearch Scheme (RP-PG-0606-1043). Ulrike Schmidt receivessalary support from the NIHR [Mental Health BiomedicalResearch Centre] at South London and Maudsley NHS Founda-tion Trust and King’s College London. The views expressedherein are not necessarily those of the NHS, the NIHR or Depart-ment of Health.

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Accepted for publication: 7 February 2013



An online survey of pupils’ experiences of eating disorders - journal article

Education

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