An exploration of school factors associated with eating disorder risk and the experience of supporting a friend with an eating disorder in secondary school: a systematic review and qualitative study on help-seeking and support.

Abstract

Adolescence is well-established as the peak period for the onset of eating disorders. It is hypothesised that the biological, psychological and social changes that occur during this critical developmental period make young people particularly vulnerable to external stressors. Throughout adolescence, young people navigate increasing independence from family, and friendships appear to play a central role in shaping their identities, self-esteem, and overall well-being. Given the significant amount of time adolescents spend in school, this environment serves as a key social setting where friendships are formed and maintained. Despite the anecdotal importance of both friendships and schooling environments in relation to eating disorders, little is known about how these factors shape the experience of individuals with eating disorders, or how they intersect to do so. The aim of this thesis is to examine how school environments can influence the risk of young people developing eating disorders, and to better understand the unique experiences of adolescents who have supported friends struggling with disordered eating. By exploring both the structural factors within schools, and the social dynamics of friendships, this research seeks to deepen our understanding of how these contexts shape the experience of having an eating disorder or supporting a friend with an eating disorder.
With such aims and scope in mind, two research investigations were conducted. The first chapter presents a systematic review of 18 studies investigating the relationship between school environments and the risk of developing an eating disorder. A synthesis of these studies was conducted and suggested that factors such as all-female schooling, high academic pressure, private-schooling, and a school’s socioeconomic status may significantly contribute to the risk of developing an eating disorder. The synthesis highlights the impact of school culture, social comparisons, and performance-related stress on students' vulnerability to eating disorders. However, further intersectional analysis is needed to understand how these factors interact.
The second chapter employs a qualitative approach to examine the experiences of adolescents who maintained friendships with peers struggling with disordered eating. Semi-structured interviews with 15 participants, analysed using reflexive thematic analysis, generated key themes: (1) Barriers to help-seeking: loyalty and fear (2) A culture of normalisation (3) What could have helped? Gaps in support & missed opportunities, and (4) The emotional impact on friends. Although participant’s accounts were retrospective, potentially introducing memory biases, findings suggest that, whilst peers often play a crucial role in eating disorder identification and support, they remain largely unsupported themselves.
Taken together, these chapters underscore the importance of holistic, education-based strategies to promote early intervention and mitigate eating disorder risk factors. Suggestions are made regarding enhanced mental health education and teacher training, structured support options for individuals with eating disorders and the friends supporting them, and greater collaboration between healthcare and education systems.

More information

Identifiers

ORCID for Naomi Sarah Law: orcid.org/0009-0009-6469-9969

ORCID for Katy Sivyer: orcid.org/0000-0003-4349-0102

Catalogue record

Export record