Complex Considerations for Parents of a College Student With an Eating Disorder
by Susan Beightol, APRN-CNS, Claire Gish, MS, RD/LD & Rosanne McDaniel, EdS, LPC, LADC, of Laureate Eating Disorders Program
Attending college can be an exciting and stressful time for young adults learning to balance fun, studies, meeting new people, and exploring new interests. College requires young adults to recalibrate and manage the demands of balancing newfound freedom and responsibility. In addition, they must learn to feed and care for themselves independently. This can also be an exciting and challenging time
for the parents of college students—particularly if they have a loved one who struggles with an eating disorder. The following are important considerations from a specialized eating disorder treatment team for parents of college students who have an eating disorder.
Contributed by Susan Beightol, APRN-CNS
Transitioning from high school to college is often a very stressful time for young adults. Add eating disorder recovery management to the situation and the transition can become very overwhelming. Below are some helpful thoughts for a successful transition to college.
If your child has struggled to maintain recovery in high school or during summer break, things are not likely to improve once he or she enters college. People often believe that college will give a fresh start and symptoms will automatically improve with a new environment. Experience has shown that this is not the case. Even if stressors college students believed triggered their eating disorder were removed, they would not be likely to utilize new recovery behaviors that had not previously been practiced consistently. In addition, the stress of a new environment, new friends, new teachers, new freedoms, and recovery becomes very difficult, and they will likely revert back to poor coping skills. For these reasons, if your child has struggled to maintain recovery, it would be best to delay college to spend more time focusing on recovery. During this time, your child can consider a part-time job or taking one or two online classes.
If your child has been practicing recovery, but the skill set is still very new, it might be a good idea for him or her to start college by living at home and/or taking a reduced course load. By doing so, your child will be better able to ease into the new schedule while still maintaining visits with the home treatment team for accountability and guidance. Once he or she has a successful semester completed, more classes can be added, and eventually your child can change living environments.
Once your child has achieved a period of recovery and practiced recovery independently, and the treatment team is supporting a transition to college away from home, please consider incorporating the following for continued medical care.
- Student Health: Make certain Student Health is aware of your child’s diagnosis and plan of care. Have your home physician send a summary of your child’s eating disorder history, current medication record, and a plan of care for helping to maintain stabilization and recovery in college.
- Routine Weight and Vital Sign Monitoring: Identify Student Health or another local care provider to monitor weight, orthostatic vital signs, and possibly lab values. Your home treatment team can advise you how often this should happen, but make it frequently (once or twice a week) during the first semester. Once stability has been established, the check-ins can become less frequent.
- Release of Information: Have a “release of information” signed prior to school starting that will allow the school, parents, and treatment team to communicate with one another. This will help keep everyone informed should the student start to struggle. Keep in mind that college is a time to practice independence, and students with eating disorders should have that opportunity, as well. The release of information is for the purposes of communicating concern and a decline in medical status.
- Contract for Weight Maintenance: It might be helpful for the student to have a contract in place prior to school starting that identifies his or her weight range and what will happen if the minimum weight goal is not met. The contract may discuss strategies and time periods for getting back into the weight range. It may also define the point at which reducing the course load or withdrawing from school may be necessary to receive additional support and possibly more intensive treatment. This contract needs to be agreed upon by the student, parents, and home treatment team prior to the student entering college.
- Resources: A helpful reference guide to consider is the Society for Adolescent Health and Medicine’s “The Healthy Student: A Parent’s Guide to Preparing Teens for the College Years” by Lawrence Neinstein, MD, and Helen Johnson (adolescenthealth.org/Clinical-Care-Resources/Healthy-Student-Brochure.aspx).
Contributed by Claire Gish, MS, RD/LD
College is typically the first time in one’s life that 100% of meals and snacks are unsupervised. Prior to college, it is common that most families see each other on a daily basis and eat together for at least one meal per day. This allows parents or caregivers to observe the eating patterns of their child and to address any concerns in the moment. Once the child is in college, this will not be the case, and increased anxiety may arise. Finding a balance with support is a delicate dance—that is, allowing your child to have some autonomy while also keeping tabs to ensure he or she is managing recovery and eating skills healthfully. Some ideas to assist with this concern include picking a day and time at the frequency of your choice to meet for a meal and catch up. Technology can also assist with this via FaceTime or Skype if meeting in person is not an option. Also, having a monthly check-in (in person or over the phone) with your child’s treatment team at school is highly recommended—this will allow for everyone to be on the same page and create open communication where concerns can be addressed with a professional present. This ensures that the parent is not playing the role of “Food Police.”
At the beginning of each semester, it could be helpful to explore all of the options on campus in correlation to class schedule—what is nearby in order to get needs met throughout the busy school day. Being thoughtful about timing of classes is essential. Reviewing your child’s class schedule before the semester starts is an important part of ensuring that class time does not interfere directly with meal and snack times. This also allows your student to plan ahead with his or her registered dietitian if there are no other options available and class/lab time does cross into meal or snack times. Another important consideration is what types of meal plan options are available through the university. Make sure the plan you select for your child allows access to the places, as well as the funds, to purchase the food he or she requires to meet his or her needs. It could also be helpful to have access to view this account balance online to keep an eye on whether it is being used too infrequently or too frequently, as this could help you monitor if your child is struggling.
Most college campuses have 24/7 access to a gym or workout facility that can be cause for concern if your loved one struggles with an overexercise component with his or her eating disorder. In addition, it is not uncommon to walk to and from class on a daily basis. It will be important for your child to have a clear understanding of what the activity recommendations are from the treatment team and what that means while at college. Options to assist with this include having access to the gym blocked for your child through the university and looking into public transportation and bus routes on campus. This could be a very useful resource, as well as help conserve energy and not feed the drive to be more active or misuse the situation.
Contributed by Rosanne McDaniel, EdS, LPC, LADC
College provides an environment that allows for a lot of identity exploration that is essential to developing a sense of self. A young adult going to college may question many areas, including values, religion, political beliefs, interests, occupations, friendships, and relationships. As young adults explore their beliefs, it can be a difficult time for families to navigate. When a young adult has an eating disorder, it compounds the difficulty of identity development. This can make it hard for parents to differentiate between natural development into adulthood and what might be eating-disordered. It will be helpful for the student to work with a therapist who can help him or her navigate between what is natural identity development and what might be influenced by the eating disorder. Participating in family therapy, or at least having a release of information for the provider, can help communicate information about healthy individuation and/or concerns as they arise.
As a parent, it may be difficult to balance respecting your child’s autonomy and independence but also desiring to make sure your student’s needs are met. Again, most families with a child in college will navigate this, but having a college student with an eating disorder can complicate the process. It will likely require parents to stay more involved than they would be if their child didn’t have an eating disorder. The American Academy of Child and Adolescent Psychiatry recommends in its “Facts for Families” that parents gradually increase independence in health care management to include scheduling/keeping appointments, taking/storing/refilling medications safely, and talking about health history with providers. As Susan mentioned, it is important that releases of information are in place with providers so they can communicate with parents if the need arises. Having a specific relapse prevention plan can also help set expectations for the college student and identify limits if he or she were to need to take a leave of absence from school.
Eating disorders frequently share features with and often co-occur with anxiety. College presents many anxiety-producing situations, including both positive (eustress) and negative (distress) stressors. While eustress is sometimes classified as a motivating type of stress, our bodies seem to respond to it the same way they respond to distress, so it is important to take both into consideration. Anxiety may come from any number of demands a college student might face, such as increased responsibility, worries about schoolwork/grades, meeting new people, being away from home, and change in general. When someone with an eating disorder experiences these stressors, even the positive ones, urges to use behaviors may increase as an effort to manage anxiety. A treatment team can help your child sort through these anxieties and practice healthier ways of coping, and offer medication management if needed.
The social environment on college campuses can be one of those stressors and can have a significant impact on a young adult with an eating disorder. As young adults are working to differentiate from their parents and develop a sense of self, they have the potential to be highly influenced by peers. This occurs in many areas, such as alcohol/drug use and relationships/sex, and, as Claire mentioned, can certainly include food/exercise. I often tell patients our society doesn’t teach us how to lose much other than weight. We tend to be focused on doing, achieving, or acquiring more unless the topic comes to weight. The focus on losing, or at least not gaining, weight can be prevalent on college campuses. It will likely be difficult to go to the dining hall and complete a meal plan if peers are participating in restrictive-type eating or talking frequently about the newest diet fad. Similarly, it would also be difficult to refrain from exercise or stay within recommended guidelines for activity if friends are often at the gym or talking frequently about the amount of exercise they are doing. Just as someone might struggle with social pressures of acceptance, isolating can also be a concern for a young adult with an eating disorder. Even on a small campus, it might be easy to disappear in a sense. With no parents present, there is no one making sure that student is completing meals, refraining from overactivity, or even attending class, so struggles may easily go unnoticed. If a young adult with an eating disorder is able to develop relationships and reach out honestly to peers, these peers do have the potential to provide a support network. Families can help by staying involved with open communication both with their child and the professional team. There also may be organized support groups available on or near campus that could help provide this support.
- You may find many areas where medical, dietary, and therapeutic considerations overlap, which speaks to the importance of comprehensive care for a college student with an eating disorder.
- Often we don’t deal in “right” or “wrong” decisions, but attempt to make the most informed decision.
- Though some warning signs might be easier to spot, others may be hidden. Proper planning and open communication can help increase a young adult’s healthy transition to college.
- Working closely with a team (therapist, physician, and registered dietitian) trained to treat eating disorders is essential in providing the support your child needs while at college.
- Look into local area organized support groups for yourself, and encourage your child to look at organized support groups available at his or her college campus for additional support, if needed.
About the authors –
Susan Beightol, APRN-CNS, is a Board Certified Advanced Practice Nurse in pediatric medicine. She received her Bachelor’s degree from the University of Tennessee and Master’s of Science in nursing from Vanderbilt University School of Nursing. She worked at Vanderbilt Children’s Hospital as a Clinical Nurse Specialist in Pediatric and Adolescent medicine with a focus on the medical stabilization of eating disorders patients. Susan joined Laureate Eating Disorders Program in 2005 where she continues her focus on the medical complications of eating disorders. She is a member of the Academy for Eating Disorders.
Claire Gish, MS, RD/LD, has been an adult program dietitian for the Laureate Adult Eating Disorders Program and Magnolia House since 2011. She earned both a Bachelor of Science and Master of Science degree in nutritional sciences and dietetics from Oklahoma State University. Claire enjoys working with patients in both the in-patient and out-patient setting on nutritional goal setting and application of skill sets to effectively treat and manage the individual’s eating disorder throughout the recovery process. Claire uses an “All Foods Fit” approach to meal planning, which legalizes all food groups, and allows for flexibility and trust.
Rosanne McDaniel, EdS, LPC, LADC is a therapist in the adult program for the Laureate Eating Disorders Program. She graduated with a Bachelor of Arts degree in Psychology with a minor in Art from Austin College in Sherman, Texas. She graduated with a Master of Arts and an Education Specialty Degree in Counseling from Seton Hall University. Rosanne is both a licensed professional counselor and licensed alcohol and drug counselor. She began working with acute psychiatric patients at Laureate in 2010 and transferred to work with the eating disorders program in 2013. Prior to working at Laureate, Rosanne worked at a rehabilitation facility addressing co-occurring mental health and substance abuse disorders.
Derenne, J.L. (MD). Successfully Launching Adolescents with Eating Disorders to College: The Child and Adolescent Psychiatrist’s Perspective. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 559-561. June 2013.
“Starting College with a Psychiatric Illness.” Facts for Families. American Academy of Child and Adolescent Psychiatry, June 2014. Web.
“Transitioning from High School to College with a Psychiatric Illness: Preparation.” Facts for Families. American Academy of Child and Adolescent Psychiatry, March 2014. Web.