Complete Guide to Eating Disorders in College

An eating disorder is diagnosed when unhealthy eating habits such as food restriction, binging and purging are sustained and severe enough to impair a person’s physical and mental health. The most common eating disorders are:

• Anorexia nervosa: Anorexia is characterized by severe food restriction, a dangerously low body weight, extreme exercise and a distorted body image.
• Bulimia nervosa: Bulimia is characterized by out-of-control eating offset by purging, fasting or extreme exercise designed to maintain weight.
• Binge eating disorder: Someone with binge eating disorder regularly consumes unusually large amounts of food in short periods of time, often in secret, and feels out of control.

Young women of college age are most at risk, but men are affected too. Between 10 and 20 percent of college-aged women and 4 to 10 percent of college-aged men suffer from an eating disorder.

Eating disorders can have a severe impact on physical health, with effects ranging from tooth decay to fatal heart attacks. ED sufferers often struggle with isolation, depression and anxiety, and many also engage in self-harming behaviors such as cutting. They are also significantly more likely to attempt or commit suicide.

The National Eating Disorders Association reports that 35 percent of “normal” dieters progress to unhealthy dieting, which can include fad dieting, restricting fats, dairy or gluten, and more severe manifestations such as over-exercising, abusing laxatives, binging or purging. Of those, 20-25 percent develop eating disorders.

College can be what experts call a “perfect storm” for eating disorders. Why?

• New stressors: A major trigger point for eating disorders comes when old anxieties meet new hard-to-manage pressures. A student coming from the more supportive, familiar life she had in high school may find the challenges of college life — increased workload, less structure, a new roommate — overwhelming. If she’s struggling with pre-existing vulnerabilities such as low self-esteem, anxiety or poor body image, the need to feel control over a stressful environment can be channeled through food restriction, over-exercise and an unhealthy focus on body weight.

• Social pressures: Making new friends and living with peers instead of parents for the first time is a highly anticipated part of college life, but it can spell danger for kids who are at risk for eating disorders. If friends or roommates are obsessing over weight, or engaging in dangerous behaviors like intensive dieting or over-exercising, it can be all too easy to fall into step.

• Lack of supervision: The independence that comes with living away from home can also trigger eating issues. College is famous for midnight pizza runs, all-you-can eat dining halls and the dreaded freshman fifteen. Unhealthy eating can wreak havoc on self-esteem. Conversely, dangerous dieting behaviors that would have raised flags at home often go unnoticed in the chaos of dorm life.

Signs someone may have eating disorder:

• Serious weight loss: Losing a lot of weight, especially in a short period of time

• Obsession with body image: Constant worry about gaining weight, counting calories or avoiding food ingredients that might be “fattening”

• Body loathing: Being preoccupied with how “fat” she is, or comparing her body negatively to others’

• Perfectionism: Taking the normal desire to do well, and to look nice, to an extreme. She must have a 4.0, has to look flawless or needs to be first on the team.

• Excessive exercising: Spending hours running on the treadmill to “work off” a small snack, or insists on going jogging outside even when she’s sick or the weather’s bad.

• Food avoidance: Skipping meals or parties where eating or drinking are the main event

• Hiding and lying: Wearing baggy clothes to hide weight loss and always saying she’s had a big breakfast or is in “too much of a hurry” to eat

If someone you know is showing signs of an eating disorder, don’t stay silent. Talk about it. Having a conversation is the first step to getting help.

• Do: Try to be calm and non-judgmental.

• Don’t: Focus on her appearance. Comments like “you are too thin” or “you look terrible” can be fuel for the fire, even if you mean them in a helpful way.

• Do: Focus on health. Let her know how worried you are, and how dangerous her unhealthy behaviors have become.

• Don’t: Accuse or demand. Stay away from reproachful language such as “You need to stop,” or “You are making everyone worry,” which can make her feel guilty or defensive.

• Do: Be honest and use supportive “I” statements like “I am concerned, I hope you’ll let me help you,” or “I am worried, and I’m here for you. I want you to be safe.”

• Don’t: Back off after one talk. To be helpful you will need to be supportive and persistent.

• Do: Be prepared to listen, even if you don’t like what you’re hearing at first. People with eating disorders often deny that they have a problem, or have complicated feelings about getting better. It is important to take her feelings into account and make her feel heard.

• Do: Encourage her to get into treatment. Research what treatment options are available and what the best options are for your child.

• Don’t: Wait. Seeking treatment is the first step to recovery, and the sooner someone gets into treatment, the better the outcome.

College campuses are required by law to provide basic mental health services.

• College counseling centers: College counseling services are usually included in tuition and can be very good. They can also provide referrals for more specialized care if necessary. Some schools may also have active, student-run eating disorders support groups or other helpful programs.

• Outside professionals: While campus services can be very useful, eating disorders often require more serious treatment than college counseling centers can provide.

• College administrative services: Some students may need to take some time off to focus on treatment. If this is the case, parents and students can work with the college to discuss best options.

Online communities can be excellent support resources for individuals struggling with eating disorders and their loved ones. Finding a place to get support or participating in real world meet-ups can be a good way to bolster recovery.

The website for the National Eating Disorder Association (NEDA) offers a range of services and supports including a comprehensive guide to which colleges offer what services, as well as links to support groups nationwide, and a helpline.

Be aware of dangerous sites that promote or encourage eating disorders. Terms to avoid include:

• “Pro-Ana” (pro-anorexia)

• “Pro-Mia” (pro-bulimia)

• “Thinspiration” or “Thinspo”

• Any site that places an unhealthy influence on fitness, slimness or radical dieting

To treat serious eating disorders, comprehensive treatment teams or inpatient treatments are sometimes necessary. This kind of intensive care can be very costly and is not always covered by insurance. Should treatment become unaffordable, there are organizations that offer financial support. Founded by two women in recovery, Project Heal provides treatment scholarships on a case-by-case basis. NEDA’s site also offers treatment coverage resources, forums and advice on accessing affordable treatment options.