Eating Disorders in College Students: What Families Need to Know
College is a high-risk period for the onset of eating disorders for a number of reasons. While the transition to college is an exciting time for young adults, full of opportunities for independence and self-discovery, it also comes with an array of stressors, challenges, and potentially troubling life events that must be navigated. Many college students experience feelings of isolation and homesickness; pressure to achieve academically; difficulty negotiating conflict with roommates; intense peer pressure; or traumatic events. Eating disorder symptoms typically develop in response to life stressors or traumatic events, serving as strategies for coping with overwhelming emotions or circumstances. Therefore, it is not at all surprising that these symptoms often develop during college (Vohs et al., 2001). While it might seem like eating disorders are about food, weight, exercise, and eating, the symptoms usually represent more complex psychological or emotional issues such as anxiety, depression, perfectionism, low self-esteem, trauma, or relational problems with friends or family members. The narrow focus on eating and weight is often seen as an avenue of managing the internal chaos that your student may be experiencing. This focus can serve to provide a sense of control when other aspects of life feel out of control and impossible to manage.
College is also the first time many students have the freedom and responsibility to make their own food choices. Dining halls offer a smorgasbord of food to choose from and no one is there to tell them what, when, or how much they should eat. This can be anxiety-provoking for many people, especially when living situations such as residence halls or sorority/fraternity houses make eating such a public event. Families differ in their food values and traditions, as well as the emphasis they place on weight, appearance, nutrition, and fitness. When students from such different backgrounds come together to share a living environment, social comparison, competition, and self-consciousness can increase. Even students with no history of dieting or weight preoccupation can start feeling insecure about their bodies and eating behaviors when they share living space with individuals who obsess about their weight or body shape.
Finally, college is also a time when appearance and image are emphasized as students seek to meet friends and dating partners. Unfortunately, societal definitions of attractiveness as portrayed in the media have become increasingly narrow and impossible to achieve for both men and women. Striving to meet such unrealistic ideals for body shape and size often leads people to engage in unhealthy eating and exercise behaviors (Lorenzen et al., 2004; Stice & Shaw, 1994).
Disordered eating arises from an interaction of social, cultural, genetic, and psychological risk factors and no one is immune to eating disorders on the basis of gender, racial/ethnic background, or sexual orientation (Smolak & Striegel-Moore, 2001; Stice, 2002). Although it is not your fault if your college student is struggling with an eating disturbance, there are many ways that you can support your student and help facilitate their recovery process.
What are eating disorders?
Eating problems fall within a broad range of eating-related feelings, attitudes, and behaviors (Scarano & Kalodner-Martin, 1994). Consider the continuum:
Body image confidence is characterized by mostly positive feelings about your body shape and size. For body confident people, all foods are seen as fitting into an overall balanced, healthy diet, and no foods are forbidden or always “bad.” People with body image confidence are flexible about what, how much, and when they eat, and they listen to their body’s needs for nutrition and health when making decisions about food.
Preoccupation with body shape/size, exercise, and eating involves frequently thinking about food, eating, and weight/shape. In this range of the continuum, people tend to be inflexible about what they allow themselves to eat and may entirely avoid some types of food. They may frequently count calories or examine nutritional content of foods and feel guilty or anxious after eating something “bad.” In general, however, these feelings do not interfere with enjoying life and engaging in situations involving food.
Distress about body shape/size, exercise, and eating indicates that the preoccupation has reached a level in which it interferes with daily activities and functioning. People in this range of the continuum think a great deal about food, appearance, and weight, and they may engage in excessive, rigid behaviors in attempts to change and control their body size/shape. For example, a person may exercise excessively, restrict their diet, fast, use laxatives or diet pills, or self-induce vomiting after eating. However, in this range of the continuum, the behaviors are usually not frequent or severe enough to result in significant weight loss.
Eating disorders — such as anorexia, bulimia, binge eating, and other eating disorders – include extreme emotions, attitudes, and behaviors related to weight, exercise, and food. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for men and women. If you think your family member is struggling with an eating disorder it is extremely important for you to consult with a mental health provider either here at the university (www.counselingcenter.illinois.edu) or some other trusted provider. For more information regarding the diagnosis of an eating disorder, please go to www.nationaleatingdisorders.org.
What to watch for:
It can be very difficult for family members to detect an eating or body image disturbance in their college student for several reasons. First, eating disorders are associated with a great deal of shame and individuals often try very hard to keep the disordered eating behaviors hidden. In fact, many people who struggle with disordered eating even deny to themselves that there is a problem. Second, when your student is no longer living at home, it can be very hard to detect changes in their daily behaviors. Nonetheless, there are some signs you can watch for.
Mood changes: Your student may become more withdrawn, down, or irritable. Fluctuations in mood can be indicative of many things, such as depression, anxiety, relationship concerns, or even stress; they do not necessarily point to an eating disorder. However, severe caloric restrictions, body dissatisfaction, and preoccupation with food are often associated with irritability, guilt, anxiety, fatigue, and depressed mood.
Weight fluctuations: Not seeing your student for extended periods of time can actually make it easier to detect significant weight gain or loss. Rapid weight loss may indicate severe food restriction and/or excessive exercise. Weight gain can be a result of frequent bingeing and/or overeating. Many students cycle between periods of intense dieting and periods of overeating which may lead to drastic fluctuations in weight. However, it is important to be aware that many individuals struggling with disordered eating do not exhibit noticeable changes in weight.
Preoccupation with food and weight: You might notice your student has started thinking and talking about food and weight constantly. They might weigh themselves repeatedly throughout the day; count calories and fat grams religiously; constantly scrutinize their bodies in the mirror or fidget with clothing; make critical comments about their body or appearance; and/or express guilt after eating.
Changes in eating behavior: During visits, you might observe that your student eats less than usual; refuses to eat certain types of food that they used to eat (e.g., desserts, pizza); or only eats low-fat or diet foods. People who are restricting their eating often have rigid and specific rules about what, when, and how much they can eat. They also tend to avoid eating in front of others and pass up social activities that will involve food—such as going out to eat. You might notice signs of distress during meals and guilt or anxiety after eating. If your student starts going to the bathroom immediately after meals or has swollen cheeks or abrasions on their knuckles, it could indicate self-induced vomiting. If they are engaging in binge eating behavior, you might find evidence of binges, such as empty packages or wrappers and food disappearing.
Changes in exercise behavior: You might become aware that your student is spending increased time at the gym and frequently exercising to the point of exhaustion. Other indicators of excessive or compulsive exercise include insisting on exercising despite exhaustion, injury, or illness, experiencing intense guilt if a workout is missed, and regularly prioritizing exercise over other important aspects of life, such as classes or spending time with friends and family.
How can you be supportive?
- Educate yourself about eating disorders and know what to look for. Understand that eating disorders are not just about food or a vain desire to “look good.” They are complex struggles that involve emotional, psychological, and physiological components. Ordering your student to “just eat” or insisting that they do not need to lose weight may be a natural reaction, but neglects the emotional and psychological struggle underlying the symptoms.
- Monitor your own verbal and nonverbal behavior. Avoid making negative comments about your own or others’ eating habits, weight, or body shape. This may only reinforce and fuel your student’s disordered eating beliefs and behaviors.
- Avoid commenting on your student’s appearance and weight when they come home to visit. Instead, show your interest in other aspects of their lives (e.g., classes, friends, volunteer work) and keep the focus on health.
- Remain non-judgmental and compassionate. Often the eating disorder symptoms feel like the only thing holding a person together. Try not to get angry or blame your student for the problem.
- Convey your concern for your student’s health and happiness.
- Strive for balance. Looking the other way and denying the existence of a problem is not going to help. At the same time, forcing your student to enter treatment and controlling all aspects of the treatment process for them can actually interfere with their recovery process.
- Consult resources and inform your student about supportive programs in the community.
The Next Step
If you have noticed several of the warning signs described above and are concerned about your student, there are a number of campus resources available. The Counseling Center offers short-term individual therapy, group therapy, and referrals to other campus and community resources. Counselors at the Counseling Center are also available to consult with family members, faculty/staff, or students who are concerned about someone and want information about how to approach the individual and encourage them to access treatment services. To speak with a counselor about your concerns and learn more about the resources and options available, please call the Counseling Center (217-333-3704) for a consultation. You can also find additional information about eating and body image concerns, types of counseling and educational services provided, and how to schedule an appointment by visiting the website: www.counselingcenter.illinois.edu.
Students who come to the Counseling Center for eating concerns might also be referred to McKinley Health center to see a nutritionist, medical provider, or exercise physiologist for further assessment.
In addition to medical assistance and nutrition counseling, the Health Education Unit at McKinley Health Center has health educators specialized in alcohol abuse, athletic injury, stress management, fitness, and wellness. Please call (217) 333-2714 or visit www.mckinley.illinois.edu for more information.
National Eating Disorders Association (NEDA)
Toll-free Information and Referral Helpline: 800-931-2237
Academy for Eating Disorders
National Institute for Mental Health (NIMH)
Books on Eating Disorders
www.bulimia.com (site for Gurze Books Publishing)
Surviving an Eating Disorder: Perspectives and Strategies for Family & Friends, Revised Edition by Michelle Siegel, Ph.D., Judith Brisman, Ph.D., Margot Weinshel, Ph.D.
Beginner’s Guide to ED Recovery by Nancy Kolodny, MSW, LCSW
Lorenzen, L., Grieve, F., & Thomas, A. (2004). Exposure to muscular male models decreases men’s body satisfaction, Sex Roles, 51, 743-748.
Scarano, G., & Kalodner-Martin, C. (1994). A description of the continuum of eating disorders: Implications for intervention and research. Journal of Counseling & Development, 72, 356-361.
Smolak, L., & Striegel-Moore, R. (2001). Challenging the myth of the golden girl: Ethnicity and eating disorders. In Eating Disorders: Innovative Directions in Research and Practice. Eds. Striegel-Moore & Smolak. Published by APA, Washington, D.C.
Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825-848.
Stice, E., & Shaw, H. E. (1994). Adverse effects of the media portrayed thin-ideal on women and linkages to bulimic symptomatology. Journal of Social and Clinical Psychology, 13, 288-308.
Vohs, K., Heatherton, T., & Herrin, M. (2001). Disordered eating and the transition to college: A longitudinal study. International Journal of Eating Disorders, 29, 280-288.