Supporting Exchange Participants with Bulimia or Anorexia

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Identifying resources and keeping an open line of communication may be all you need to support participants with Bulimia or Anorexia.

An international exchange program can involve a change in nutritional routines, causing symtoms of Bulimia and Anorexia to develop or to spin out of control. It is possible though for participants with Bulimia or Anorexia to successfully complete international exchange, whether they come into the program with a diagnosed condition or if they develop symptoms after departure. By educating program staff and participants about the symptoms and dangers of these conditions as well as creating access to support networks, these individuals can successfully complete international exchange and come out stronger as a result.

Prepare

Before anything happens, it is a good idea to start taking the necessary steps to organize networks of support in both the home office and the host country.

  • Identify staff in your counseling center who will help you locate and or develop materials for exchange participants.
  • Include information about recognizing and managing Bulimia or Anorexia as part of your orientation for all exchange participants.

It is important that all participants are educated about Bulimia or Anorexia and know how to respond, because the friends and room mates of a participant with an eating disorder can sometimes be the ones to recognize it, and facilitate effective referrals.

Identify Resources

Some countries may not recognize certain psychological disorders and may not provide the support necessary to assist a participant with an eating disorder. It is important to investigate this possibility. If the participant has disclosed and is planning to participate in an exchange program in one of these countries, it is essential to make the participant aware that they might not have the same level of support.

  • Identify options such as postponing participation in the program, choosing a country with better support, or going forward with their original choice.
  • Organize networks of support in host countries, including eating specialists, nurses, clinics, counselors and eating disorder support centers. The website under Related Links can get you started finding a support center in each of your host countries.

A support network should include an M.D. who can conduct medical tests to evaluate whether the participant's physical health has been compromised by an eating disorder. The M.D. can monitor electrolyte imbalances, signs of organ failure or other life-threatening indicators. A licensed psychologist can work through the psychological basis of the illness with the participant. In some cases it might be helpful for the participant to speak with a local nutritionist who can identify local, easily prepared foods to rebuild the participant's strength and stamina.

In addition, there are many online forums where people with Bulimia or Anorexia find support, and you can ask questions or even search topics such as studying abroad which have been discussed before. Some of these forums include Grace on the Moon, and Why Eat.

Encourage Self-Disclosure

Exchange participants who are managing Bulimia or Anorexia are most successful when the program is aware that they have it. Disclosure can enable program staff to assist the participant with predeparture planning, and identifying an on-site support network in case they need assistance while abroad.

  • Create an atmosphere where it is safe for the participant to discuss his or her concerns about food abroad and the food culture.
  • Try to normalize Bulimia or Anorexia. Directly addressing Bulimia or Anorexia and providing useful resources to turn to will send the message that it is okay to talk about it.
  • Share the material in a way that is open and provides useful resources to turn to will send a message that it is okay to talk about it and to not ignore unmanaged Bulimia or Anorexia as it can lead to serious, even life-threatening health complications.
  • Openly converse about Bulimia or Anorexia and let exchange participants know that people with Bulimia or Anorexia have successfully participated in exchange programs before.

By providing participants with a format for disclosing information about an eating disorder, it opens an opportunity to explain to them how the information they provide will be used, and what measures are in place to protect confidentiality. Some institutions provide a health form in which participants can voluntarily disclose this information, while others require them to obtain clearance from a medical professional prior to taking part in an international exchange program. Consult with your legal counsel to identify the best approach.

If a Participant Discloses

  • If you are an exchange professional on the program, meet with each participant who has disclosed an eating disorder.
  • If you have not been hired by your organization to serve as a counselor, it is important to communicate this to the participant, but to also reassure them that you can assist with arrangements to manage the disorder, and that you may be part of a support network that includes medical and counseling professionals.
  • Clarify any strategies that the participant has in place for managing the disorder. Ask how they will keep those plans operating when abroad.
  • Be forthcoming with the participant, describing different aspects of the program schedule, housing and dining options, cultural or environmental differences, and health resources, without jumping to evaluative judgments on how that may impact them.
  • Ask about challenges that they may be concerned about as you talk through the programmatic and cultural aspects, and think through solutions or contingency plans in a creative and caring manner.

Behavioral Contracts

Some programs ask the participants who have disclosed an eating disorder to enter into a behavioral contract, in which they agree to a certain set of behaviors which they will adhere to while abroad and sanctions if the participant does not follow the contract, which could include dismissal from the program.

If a Participant Develops Bulimia or Anorexia after Departure

  • Meet with the participant and in a caring and nonjudgmental way approach your concerns with the disorder. Remember not to act as a counselor unless your institution has hired you to serve this role.
  • Ask about behaviors that you observe.
  • Let them know that you are concerned and that you take the symptoms seriously.
  • Do not try to diagnose.
  • Refer the participant to a professional evaluation with a nutritionist or medical practitioner, and preferably one who is English-speaking.

It is not unusual if the participant is upset or if they are in denial. Refer to the medical practitioner for next steps. As part of a support system, it can also be helpful to ask the medical practitioner for a referral to a nutritionist abroad.

If the eating disorder continues to be unmanageable, emergency intervention and assisting the participant with returning home may be the only alternative.

Conclusion

People with Bulimia or Anorexia routinely participate in international exchange, managing their conditions while abroad. They do this with the support of a team including program staff, participants and appropriately qualified medical practitioners working with an open line of communication free of judgment.

Thanks go to Barbara Lindeman of University of Missouri, and Joanna Holvey-Bowles of Colgate University for their expert guidance on this topic.