College Students and Eating Disorders

Eating disorders can and do occur in teenagers, and even in young children. But it’s during the college years that young people, especially young women, are most at risk for developing them.

The challenges of college life, adding pressure to underlying mental health issues, create what Alison Baker, MD, calls a “perfect storm” for these disorders, the most common of which are anorexia and bulimia.

The storm occurs when the realities of college life—increased workload, less structure, and more focus on peers—collide with anxieties, learning issues, or poor self-esteem. A young person who was able to manage stress and stay afloat during high school with a lot of hard work and support from their parents might find themselves drowning in the confusing, complicated world of college.

Eating disorders develop when the need to feel control over a stressful environment is channeled through food restriction, over-exercise, and an unhealthy focus on body weight.

“College can be a time of a lot of excitement and stimulation and also a lot of stress,” explains Dr. Baker, a child and adolescent psychopharmacologist. “It asks young people who are not yet adults to act in a very adult way, especially if they’re contending with mental illness and suddenly have to begin managing it on their own.”

“The stress of a college schedule, managing a new social context, and dealing with independent living can trigger re-emergent anxiety or, in some cases a new mental illness,” explains Douglas Bunnell, PhD, clinical director of the Monte Nido treatment center in New York. “If you have a heavy dose of anxiety and you’re in a social environment, and you’re constantly exposed to the thin body ideal, that’s a perfect storm convergence of factors that can drive a vulnerable individual into an eating disorder.”

Full-blown eating disorders typically begin between 18 and 21 years of age, according to the National Eating Disorders Association (NEDA). The association estimates that between 10 and 20% of women and 4 to 10% of men in college suffer from an eating disorder, and rates are on the rise.

Kids who are at risk for anorexia or bulimia might have struggled with a need for control or perfectionism in day-to-day life before college, breaking down when homework wasn’t perfect, or feeling terrible about themselves when activities didn’t go as planned. But college life is substantially more difficult to manage.

It’s not just the increased workload and the disruption of an accustomed schedule. It’s also a whole new set of peers who are unpredictable, starting with a new roommate (and that roommate’s love of death metal, or late-night visits from their significant other).

And managing your food intake in college, famous for midnight pizza runs and all-you-can eat dining halls, is a whole new ballgame. Unscheduled, unhealthy eating can cause problems for anyone, but for students struggling with eating issues it can wreak havoc on self-control and self-esteem.

“The freedom to eat at different times, a range of eating options available whenever—it’s not a good environment for people who are at risk for ED,” says Dr. Bunnell. This is particularly risky for students who are susceptible to bulimia, he notes.

Bulimic, or binge-eating, patterns can be triggered when students try and fail to stick to unreasonably restrictive diets, something many college’s buffet dining halls and late-night Easy Mac make even more difficult. Slip-ups on a diet can lead to binges, which in turn bring on feelings of shame and guilt, and the cycle begins anew.

Bulimia and binge eating disorder, says Dr. Bunnell, are more “socially sensitive” than anorexia. “Binging and purging behaviors are highly susceptible to social factors like those you find in college,” he says. College life is hugely focused on peer-interactions and students may use others as models for dangerous behavior. If friends or roommates are engaging in intensive dieting, binging and purging, over-exercising, or using laxatives, it can be all too easy to fall into step.

When does dieting become a serious disorder?

College students are known for strange eating habits, but it’s a long trip from attempts at losing the freshman 15 to a full-blown eating disorder.

“Not everyone who goes on a diet will develop a formal disorder,” explains Dr. Bunnell. “The difference is a function of latent vulnerabilities and genetics. There’s a continuum. At the high end would be anorexia, bulimia, and binge eating disorder, and at the low end you have disordered eating.”

Disordered eating behavior ranges from fad dieting, or attempts at “clean” eating by restricting fats, dairy, or gluten, to more severe manifestations such as over-exercising, abusing laxatives, binging, or purging, which are serious, but don’t yet meet the criteria for an eating disorder.

NEDA reports that 35% of “normal” dieters progress to unhealthy dieting, and of those, 20-25% develop partial or full-syndrome eating disorders.

An eating disorder is diagnosed when these behaviors are sustained over time—becoming dangerous, all-consuming and unmanageable.

When trying to determine if habits are simply disordered eating or something more serious, Dr. Bunnell says it’s important to look at the impact they have in other areas of life. “To what extent do the eating, weight, shape, body image concerns really start to dominate? For example you decide not to go to a party because you’re too worried about your weight, or you can’t enjoy any beach activities because you won’t put on a bathing suit. If someone is starting to withdraw from normal activities because of anxieties about eating, weight, and shape that would be cause for concern.”

Eating disorders in college students are serious, and can be life-threatening in some cases. “There is a woeful lack of awareness about how serious these disorders are,” says Dr. Bunnell, citing the stereotype that eating disorders stem from an overblown sense of vanity or desire to be beautiful. “These are not just extreme diets, they are real medical illnesses.”