Date of Award


Document Type

Open Access Dissertation



First Advisor

Mark D. Weist


Disordered eating has become a significant issue among children and adolescents; nearly 14% of all youth displaying disordered eating patterns. Despite the prevalence of these disorders amongst school-age students, there is a deficit of empirical literature on the integration of eating disorder support services in schools, as well as a lack of knowledge and training of school mental health (SMH) professionals regarding the appropriate interventions for this population. While eating disorders have previously been considered as outside of the school mental health domain of practice (e.g., Judge, 2001), this view has changed and there exists a significant need to provide accessible identification and intervention services for these students in schools.

The present paper is a mixed methods research study conducted to examine the perspectives of those most closely linked to eating disorder services (i.e., adolescents in recovery from eating disorders, family members, SMH professionals), and their viewpoints regarding the integration of such services within a SMH framework. Current SMH services for youth with disordered eating and perspectives on their delivery were explored using qualitative methods of individual interviews. A purposeful sample of 14 participants was recruited from an eating disorder treatment facility in the southeastern United States. Eight adolescent females who received treatment for disordered eating while in primary or secondary schools and 6 of their respective mothers completed interviews. In addition, a quantitative survey was used to measure SMH professionals’ knowledge and training in disordered eating identification and intervention. The perspectives of these professionals on service provision and barriers to service delivery were explored. A national sample of 720 SMH professionals completed the survey, with 561 of those useable.

Qualitative and quantitative data were collected concurrently and analyzed separately, prior to converging the data strands to better understand SMH services for disordered eating. Qualitative analyses of interview data revealed the following themes regarding experiences of the adolescents and families that hindered or helped recovery: Isolation, Perfectionism, Difficulties with Self-Acceptance and Comparison to Others, Uncertainty, Teacher Identification, Support in Recovery. Half of the sample (N = 4) received school support while being treated for disordered eating, but school support was unrelated to disordered eating. Themes surrounding the benefits of including SMH services for this population included: Increased Awareness, Support in Recovery, Family Involvement, and Linking to Resources. The costs of including these services cited in interviews were: Time Away from Academics, Need for Trained Professionals, and Not Enough Time for Training.

Quantitative results suggested that the majority of SMH professionals have not received training in the identification and/or intervention of disordered eating. Conversely, most professionals demonstrated adequate knowledge of symptoms and risk factors of disordered eating, and reported encountering and working with students who exhibited disordered eating behaviors in the last year. Professionals indicated moderate to high importance of training in this domain, as well as a belief that work with youth with disordered eating falls within the SMH domain of practice. Data suggested that lack of referrals, knowledge, skill and time impacted their ability to effectively identify and intervene.

The findings from this study provide a basis for researchers to understand the experiences of adolescents with disordered eating in the schools. This exploratory study aimed to spearhead further research on the development, evaluation and implementation of school-based intervention programs for youth with disordered eating. Implications for clinical practice and training were discussed, followed by limitations of the current study and future directions for research.


© 2016, Bryn Elizabeth Schiele