10 Things to Know About Eating Disorders and College Life
The college years are a time of great growth and development for most students. It is a time when people explore and define who they are, and to what they wish to devote their life’s time and energy. While this is exciting, it can also be challenging, especially for those who feel less comfortable or confident about these tasks.
1. The college and graduate school years are a time when people are at the high risk for struggling with an eating disorder. According to the National Institute of Mental Health, the mean age of onset of Anorexia is 19, of Bulimia is 20, and of Binge Eating Disorder is 25. Because we live in a culture which defines much of who we are by how we look, and which has very unrealistic ideas about how we “should” look, it is not surprising that the challenges of finding your place in a broader world might lead some to become over-focused on body and appearance, which is a significant risk factor for developing an eating problem.
2. Most students who go away to college do not gain 15 pounds. The common fear of gaining weight at college may also lead students to become overly focused on eating or weight. However, research shows that while first year college students do tend to gain some weight, it is usually much less than 15 pounds (typically, it is less than 5 pounds). And, over time, they lose much of the weight gained (Karasu, S. The gravity of weight. Psychology Today 9/10/13).
3. But, how and what they eat does become different for many when they first go to college. For most students, there are significant changes in how they eat when they go to college. For many, eating in a dining hall, or in one’s own apartment, puts them, usually for the first time, solely in charge of what they eat when. For some this can be difficult, and can result in either overeating (because there is access to so many choices at each meal) or undereating (because of fear of the quantity of food or of not knowing how it is prepared). If students then get overly concerned about minor weight changes, they may be unable to resume regular eating from a range of foods, and move to developing either disordered eating, or an eating disorder (Karasu, S. 2013).
4. The stress of transition to college may increase vulnerability to relapse. Students who have experienced, but recovered from, an eating problem may find that the challenges of college life leads them to want to control their eating or weight more again (as a way of feeling more “in control” emotionally). In fact, some of the students who developed an eating problem earlier in life may still be struggling with symptoms, either because they never sought therapy (they may have never even told anyone, but carried this burden on their own), or because they have continued to struggle while in treatment. It’s important to remember that eating symptoms begin as a way to cope, and may return when a student’s stress levels increase (as they do for all of us at major life transitions, even ones to which we are very much looking forward). It’s important for all who care about those with eating concerns (including the students themselves!) to track their focus on eating, weight and bodies and reach out for help, or to express concern, if they notice these increasing.
5. It’s important to remember that eating and body image problems can impact students of any gender, race or ethnicity. Sadly, no group is immune from the multiple factors (of individual, cultural, and familial origin) that contribute to the risk for eating problems. (Levine M. and Smolak, L. in Agras, W. S., Ed. (2010), The Oxford Handbook of Eating Disorders.)
6. There are resources to support recovery on campus. The range of services available in campus health centers is quite wide. Most colleges have experience with assessing disordered eating issues and working with students or referring for appropriate treatment. Some health centers have a multidisciplinary team, typically including medical staff, psychiatrists, counselors, dietitians, and sometimes an athletic trainer. Each member of the team has a distinct role: the medical staff is responsible for assessing medical risk and monitoring medical conditions; the psychiatrist would evaluate and monitor any use of psychiatric medications; counselors provide individual or group therapy; the dietician focuses on meal planning, establishing healthy eating behavior and can be especially helpful in negotiating the challenges unique to the campus lifestyle; the athletic trainer is primarily involved in working with student athletes and may consult on the role of exercise in maintaining health and balance. If the health center does not have a team, they may have individuals who are responsible for working with students who present with eating concerns and can refer students off campus for more specialized care.
It would be prudent to call the health service before arriving on campus to learn about available services. If the student is currently in treatment, these providers are often in a good position to make recommendations about what is needed to support recovery and prevent relapse. When a consent to release information is given, treatment providers can discuss recommendations with health center staff to ensure continuity of care. Some students chose to continue with home providers via phone therapy and meeting over breaks while at the same time using some of the services on campus such as group therapy or intermittent individual therapy. It is a good idea to have a contact on campus in the health center.
7. The level of treatment provided on different campuses varies. Most health centers will provide an evaluation. After the evaluation, a determination is made about providing services on or off campus. Some centers offer short-term treatment on campus and referrals to off campus providers for longer-term treatment. Individual counseling and groups are often offered at counseling centers. Although students may initially be hesitant about groups, groups are typically popular. Being a part of a group breaks the sense of isolation that often comes with eating issues and offers a safe place to talk openly about daily struggles. Students find that groups help them feel more comfortable with themselves and their peers. Groups may focus on eating disorder recovery, healthy body image, life-skills training or other topics related to health and healing.
8. When longer-term therapy is anticipated, it may be beneficial to seek services off campus. While on campus services may be offered at no cost to students, services are often time-limited and constrained by the academic calendar. Seeing a provider off campus allows for unlimited sessions, as well as flexible and consistent scheduling. There are commonly off campus providers who specialize in working with students and eating issues near campus, in some cases, walking distance. It would be wise to meet with a counselor to explore different options and the counseling center could provide referrals to off campus services.
9. Concerned parents may contact the health center and inquire about services. Launching off to college is often an exciting and scary time for both students and their parents. While all services at health centers abide by the guidelines of confidentiality, there are ways parents may be involved. Parents can learn about resources and services available and request to meet with providers and the student to discuss plans for treatment. Parental support of treatment and attention to both progress and relapse plays an essential role in the recovery process. Another resource for parents may be a campus-life staff. There is often a dean, staff member or resident advisor directly involved in dormitory living that can listen to concerns, address the needs of the student and access resources.
10. Recovery while in college is possible. Although disordered eating can be a part of college life, recovery also happens. The college years are a time of challenge, self-discovery, growth and transformation. With the proper encouragement, support and treatment, students can establish a healthy relationship to food and eating, develop a sense of confidence, cultivate effective habits of living and thrive. There is a web of support on campus committed to working flexibly and creatively to ensure that students get all they need to be healthy, engaged and successful in their college experience. For parents and students, it is critical to be aware of the risks inherent at this time of change and to be proactive in identifying resources and bringing the right supports together early in the process.
Robin Boudette, Ph.D. is a clinical psychologist with 20 years of experience treating eating disorders. She has been the Coordinator of the Eating Disorders Team at Princeton University Counseling and Psychological Services for the past 12 years. She maintains a private practice in Princeton.
Anne M. Slocum McEneaney, Ph.D, ABPP, CGP is a Clinical Psychologist in New York City. She maintains a private practice in Manhattan. She has worked in the treatment of eating disorders on college campuses for more than 25 years, at Columbia University, Rutgers University and is currently the Eating Disorders Team Leader at New York University. She has lectured and led workshops in this area throughout the United States, as well as in Brazil, China, Greece and South Africa.