Almost a month after Princess Diana confirmed that she had suffered from bulimia, and decades after anorexia nervosa first became a dinner party talking point, some schools are still failing to educate their pupils adequately about eating disorders.

Penelope Penney, the outgoing president of the Girls’ Schools Association, provoked a flurry of interest when she mentioned anorexia in a recent speech. But public fascination with disordered eating has not brought with it knowledge of how to avert it.

“We really don’t have much of a problem with that kind of thing,” was not an untypical response when The TES contacted some independent girls’ schools. The facts are that 1 to 2 per cent of schoolgirls still develop anorexia; as many as 10 per cent of adult women have a bulimic episode at some stage in their lives; eating disorders can affect boys and men, but they are nevertheless 90 per cent a female problem. Why?

“There are certain acceptable outlets for women’s anxieties and frustrations, and others that are taboo,” says Micheal Gallagher, a clinical psychologist at Hull University. “As a society we take a very firm line with women who are drunk, or aggressive, but young women are also told not to do drugs, or be promiscuous or smoke. I see bulimia as far more prevalent than people realise. ”

Bulimia means “ox hunger”. The hunger is brought on by severe dieting - the binge eating is the body’s response to starvation. The mind then reasserts control so the bulimic person purges herself by self-induced vomiting.

Some sufferers binge and vomit infrequently; in the worst cases, the bulimic may be making herself sick several times a day, and consuming hundreds of pounds worth of food. Some people with bulimia have had anorexia, some sufferers veer between the two conditions, but there is no intrinsic connection between anorexia nervosa and bulimia nervosa.

The cycle of gorging and vomiting that Princess Diana delicately described as beginning with “jumping into the fridge” rarely develops before the age of 13, and typically affects young women from the mid-teens onwards. One of its great dangers is that it tends to be invisible. Sufferers usually remain within 10 per cent of normal body weight and, because of the huge shame they feel, go to enormous lengths to keep the condition secret.

“Bulimics are much harder to treat than ordinary anorexics,” says Eleanor Wigglesworth of the Child Psychotherapy Trust. “They tend to have a capacity for being very, very secretive. Children with anorexia are on the whole much easier to make truthful contact with.”

What are schools doing in the face of this dangerous and distressing condition? Not enough, according to specialists trying to help young people with eating disorders. “In some schools it is still denied,” says Eleanor Wigglesworth. They say ‘it doesn’t happen here’, like they used to say ‘bullying doesn’t happen here’.”

Not only are some schools still ignoring anorexia and bulimia, many are giving children harmful nutritional advice, says Dr Dee Dawson, medical director of the Rhodes Farm Clinic in London, whichspecialises in the treatment of eating disorders. According to Dr Dawson, up to 10 per cent of people with bulimia eventually commit suicide.

“Schools are making our job much, much harder,” she says. “People doing personal and social education seem to get most of their information from women’s magazines. They tell children they shouldn’t eat meat or fats and ought to eat bran. Before you know it, you’ve got a whole lot of vegetarian children, exercising like mad and having no fat at all in their diets.”

Opinion is divided on whether or not eating disorders are getting worse. Awareness has certainly grown, and with it the numbers of young people being treated. heads questioned by The TES reported a small, fairly constant number of pupils developing eating disorders over the past 15 or 20 years. But children are developing eating disorders younger, and there are more anorexic girls in their early teens. Nobody reported a decreasing number of pupils with eating disorders.

Huntercombe Manor is a private psychiatric hospital specialising in adolescents. With Great Ormond Street Children’s Hospital and Rhodes Farm, Huntercombe Manor is one of the few institutions to have developed expertise in treating eating disorders. The hospital treats young people with anorexia and bulimia both as in-patients and out-patients, and Robert Munro, its clinical specialist in eating disorders, visits schools to lecture staff and pupils on anorexia and bulimia. What should schools be doing to help pupils?

“Eating disorders need to be de-glamorised,” he says. “I describe exactly what they are, and how they get hold of you.” He says that schools should keep an eye on what pupils eat. “Basic stuff is often forgotten. I go into schools and find 14 or 15-year-olds who are not eating anything but cucumber. Staff don’t know what the kids are eating.” He, too, is critical of the standard nutritional advice given to children. “You have to be very careful, especially with young women, of giving the message that fats are bad,” he says.

Apart from the obvious sign, with anorexia, of dramatic weight loss, other signs of an eating disorder in an early stage might be loss of concentration or depression, says Mr Munro. “Teachers should be more conscious of the possibilities for a child being unhappy. Often, no one has sat the kid down and tried to talk to them. Then once the idea of ‘eating disorder’ has been introduced, teachers feel completely deskilled.”

Some girls’ schools feel confident enough about how they manage eating disorders to talk about it. “It’s been a problem in schools almost forever, ” says Rosanne Musgrave, head of Blackheath High School, an independent girls’ school with more than 600 pupils.

“We are pro-active about this because it’s important. We have it as part of the personal, health and social education programme, and we encourage as much openness as possible. Staff have gone on training courses and conferences and cascaded what they have learnt down to other staff, so there’s a heightened awareness among both male and female staff of eating disorders as an issue. ”

The days of pupils sitting grimly in front of unwanted food are, thankfully, long gone. But at Blackheath School they try to encourage the social side of eating. Lunch in school is compulsory for pupils up to the fourth year, and pupils are only allowed to diet with a doctor’s letter. Sixth-formers have their own microwave and toaster, and are only allowed out at lunchtime in groups. “There’s a culture of having something to eat at lunchtime,” says the head.

Most important, believes Miss Musgrave, is a climate where difficult subjects can be discussed.

“Openness is the name of the game,” she says. “Girls are hungry for information about themselves, their bodies and the world. If they ask a question, we’ll give them all the information we possibly can, so they can have an informed discussion. The less of a mystery something is, the less exciting it is.”

She concedes that social and academic pressures on pupils are fierce. But, she says, “We try to minimise pressure by teaching them good study habits and giving them good support. If we can help them feel in control of their work and their lives, they don’t have to control their eating to such an extent that they lose control of their bodies.”

Other heads believe that discussion of eating disorders is not so important. “I can’t remember a year without a girl who’s either developing anorexia or has it or is recovering from it,” says Ann Williamson, recently appointed head of West Heath, Princess Diana’s old school. “But I don’t think you can cause it or stop it by talking about it. The most common cause of anorexia is low self-esteem, and comments made about being fat. But with counselling and help from friends, you can stop it getting out of control.”

For heads with boarding pupils, the responsibility is particularly heavy. “With boarders we monitor very closely what they are eating,” says Carol Sibson, head of The Royal School, a small, mixed boarding and day school in Hampstead, north London. “We’re in loco parentis at the end of the day. I have a weekly meeting with the cook to hear what children are doing. If there was a girl really not eating I’d ask myself if this was some sort of attention-seeking thing, or faddiness. We’re a small school, we have a resident nurse, and we know what’s going on. Still, I cannot swear we won’t get a problem tomorrow.” The Boarding Schools Association, which has 500 members, has extended its training activities on eating disorders over the last couple of years, says its secretary Frank Bickerstaff. “It’s a very important aspect and one which we are fully aware of,” he says. “We have tried to make sure that members are fully aware of symptoms and all the support that is needed for children and their families.”

Education on eating disorders is vital, say those who try to treat them, because the earlier the conditions are spotted the better the chances of a full recovery. Normally, close friends are the first to become aware that a girl is scraping her uneaten lunch into the bin every day, or regularly vomiting in the lavatory, or gulping laxatives. They are more likely to tell an adult if they understand the implications.

Will Princess Diana’s admission of bulimia help schools to warn pupils? “I do believe in openness, so I suppose it is a good thing,” says Margaret Rudland, head of Godolphin and Latymer School in west London. “But she is one of the most attractive young women of the age, so young people may think it is something attractive to do. But it is no bad thing for a public figure to speak out.”

Anorexia, at least, is still not unfashionable among schoolchildren. “Talking to girls at school, if you said you were a compulsive shoplifter or a psychopath, they would turn away from you. But anorexia somehow is identified with the supermodel waif. It doesn’t have that untouchable feel that many mental illnesses do,” says Dr Gillian Harris of the School of Psychology at the University of Birmingham. “And the thing that is absolutely unacceptable to them is to be obese.”

Dr Harris’s recent research has monitored children’s preference for different body images, and the way their taste changes through the primary years. By the end of primary school, she says, children have already begun to show a preference for being thinner than they are. “Given a range of shapes, the one they choose is gaunt and skeletal. They choose that over the much healthier slightly plump one.”

Like Dr Dawson, Dr Harris is critical of some of the “healthy eating” messages children receive in schools. “If you start dividing into ‘good’ foods, and ‘bad’ foods,” she says, “there is the beginning of a dissonant split. Children are told they shouldn’t have certain foods, but they still like them and want them.”

Her research shows that even in primary school the ‘naughty but nice’ ethos had been grasped by children. “They tended to want whatever they thought they shouldn’t have,” she says. “Which immediately brings you into the binge cycle where you stick to vegetables all week then walk past a sweet shop feeling a bit low and have three chocolate bars.”

The Eating Disorders Association, Sackville Place, 44-48 Magdalen Street, Norwich, Norfolk NR3 1JU. Tel: 01603 621414. Youth helpline for 18-year-olds and under: 01603 765050, 4pm-6pm, Monday to Wednesday.

Dr Dee Dawson is the author of Eating Disorders: A Quick Guide, Pounds 8 plus Pounds 1.50 pp, from Daniels Publishing, 38 Cambridge Place, Cambridge CB2 1NS. Tel: 01223 467144.