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Back to Campus: Understanding Eating Disorders at Colleges and Universities

When autumn arrives, young adults across the country gear up to head back to college. Every September brings new classes, new friends, new dorms or apartments – and new pressures. From brand new first-year students to returning juniors and seniors, readjusting to campus life can be fraught with psychological tension as they strive to manage their studies, social life, and activities. This increases the risk of mental health conditions, and eating disorders are no exception.

As the CEO of the National Eating Disorder Association (NEDA), Claire Mysko, said in an interview, “College is a period of development in which disordered eating is likely to arise, resurface, or worsen for many young men and women.”

Why is the return to campus so fraught with risk factors for students to develop or resume disordered eating behaviors? It’s a combination of several life situations that are unique to this particular era in a person’s life. Here, we’ll go over some of them, and outline what students can do to prepare for a healthy return to school.

Why College Students Are at Higher Risk for Eating Disorders

First and foremost, college-age students, 17 – 23, fall squarely in the prime onset years of most eating disorders. Well-known disorders like anorexia nervosa and bulimia nervosa generally first begin between the ages of 12 – 25. Other forms of eating disorders like binge eating disorder and ARFID may begin later or earlier, respectively, but young adults are still at the highest risk. In many cases, young adults who have already begun to show signs of disordered eating patterns and received treatment experience triggers that cause them to resume those behaviors as well. In addition to the biological reasons for eating disorder development at this age, there are several factors that college students experience that can exacerbate this tendency:

  1. Newfound Independence

Especially for first-year students, the new independence and responsibilities that come with it are liberating – and overwhelming. For the first time, every decision about meals, all the cooking, and other household activities are all on the student. Even returning students may have gotten reacclimated to living at home again over the summer. When there is no one immediately available to help meal planning or maintain motivation for keeping up with recovery, it’s easier to fall back into disordered eating.

  1. Campus Meal Plans and Food Availability

Most colleges and universities provide some form of meal plans for their students, especially in dormitories. However, for students dealing with hectic schedules, the pressures of homework and after-class projects, and perhaps part-time jobs, the chance to indulge in the cafeteria can be rare. The meal plans may not be foods the student likes, either. Especially in ARFID and orthorexia cases, they may also regularly contain the student’s “fear foods,” food their disorder makes them strenuously avoid. Many students also find themselves consisting of junk foods bought from the campus store or a convenience store as well. While people with eating disorders are encouraged to eat intuitively, i.e. to eat what they like and when they like in order to feel satiated. However, eating sporadically and with less nutritious food can promote binge eating episodes and subsequent purging in the case of bulimia nervosa. Those infamous late-night cram sessions can be a trigger for disordered eating behaviors.

  1. Athletics

Many Division I college athletics programs provide help from nutritionists for their athletes, but this is certainly not a hard and fast rule. Aside from the major sports that might be seen on TV, such as basketball or tennis, many other sports receive less acclaim (and less funding). Intramural sports are also quite popular on campus. While athletics are generally a positive endeavor for students, many people with eating disorders are prone to excessive exercise. Over-exercising is a method to lose weight that can become akin to addiction; the athlete will often continue to work out despite injuries or medical conditions caused by the exercise or let their social life and relationships suffer.

Athletes may also face other stressors related to their sport. The intense pressures of high-level athletics can cause people to resort to disordered eating as a coping mechanism – although unhealthy, many disordered behaviors provide a sense of control. Some sports, like wrestling or gymnastic, have weight classes that inadvertently encourage food restriction and over-exercise to reach those goals – especially dangerous in athletes who have not yet finished growing yet.

Finally, body image concerns, which play a major role in disordered eating can be provoked by student-athletes. An NCAA study indicated that 45 percent of swimmers identified revealing swimwear to be a stress factor that disturbed their body image. This can lead to restrictive or purging behaviors as well as compulsive exercise. Not only swimmers are affected; there were similar reports from volleyball players, wrestlers, and gymnasts, too. It’s not only traditional “sports,” either – similar issues have been known to occur among dancers and actors in college who need to maintain a certain body image or wear revealing clothing.

  1. More People to Meet and Compare Against

One of the defining experiences of college life is meeting a whole new group of peers, with varied life experiences and perspectives. It expands a student’s point of view and opens new avenues for socialization and relationship building. However, for people prone to developing body image distortions and eating disorders, a bevy of new people around them also means there are more people to compare themselves against.

One of the prominent signs of a developing eating disorder is when a person starts to compare their body or “attractiveness” against people they see in the media, and especially in real life. From the same article that interviewed Claire Mysko, a student recounted her experience with body image while she was in college:

“Seeing all the pretty girls and going through a really crazy relationship my first year of college made me feel like I was nothing,” she told Healthline.

 Stresses in life such as keeping up academically, having a family setback, or even a difficult relationship can drop a person’s self-esteem and possibly provoke disordered eating behaviors. College isan important time in a young adult’s life – transitioning from child to adult, finding your place in the world, and taking on new responsibilities can all be major stressors.

  1. Alcohol and Dieting

Although by all means, not everyone in college drinks alcohol, it is no secret that binge drinking is a major problem on many campuses. Alcohol can cause issues in people without body image distortions or an eating disorder, of course; it’s linked to various health problems as well as depression. For people with eating disorders, it can take on another dimension. Restrictive eating disorders such as anorexia nervosa often focus on counting and minimizing caloric intake. Alcoholic drinks contain empty calories, and as such people who control their calories may choose to restrict their food intake to keep their calorie counts down. This can lead to extreme dieting or a full-blown case of anorexia nervosa. In some extreme cases, “drunkorexia” (please note this is a slang term and not considered clinically appropriate) can develop, where a person receives a large percentage of their caloric intake via alcoholic drinks.

What Can College Students Do to Help Avoid Disordered Eating?

Although the college experience brings with it newfound freedom and independence, it can also bring a feeling of being alone or without support. For people with eating disorders, it can bring on an even deeper sense of isolation than they already have. However, resources for help are most definitely available.

For starters, parents are always a good place to turn when a student is starting to feel stressed or overwhelmed and beginning to show signs of an eating disorder. That said, many young adults don’t want to turn to their parents, undercutting their independence. Most colleges and universities provide mental health services for their enrolled students. Checking in with these services can help in a crisis situation, and they can usually provide referrals to a therapist who specializes in eating disorders. They can also point the student to a day treatment or virtual programming treatment center to provide ongoing treatment.

There are also online resources from nonprofits devoted to supporting the recovered/recovering community. NEDA provides a questionnaire for people who think they may have a problem to determine if they should consider professional help. It’s a great way to get an objective look at your behaviors and see if you should be concerned. They also provide a Student Life portal on their website which can provide education and other resources about eating disorders. There are also various recovery communities on Instagram, Pinterest, and Facebook for recovered people to provide support.

Finally, if the eating disorder gets out of control, residential treatment is always an option. Normally beginning at 30 days, it may require a hiatus from school but provides the best outcome rates for eating disorders ranging from bulimia nervosa to orthorexia. These programs normally allow for support and alumni groups for long-lasting recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.