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Six Tips for Managing Eating Disorder Recovery When Going Back to College

Starting a new semester is a stressful time. Incoming students need to arrange their classes, meet and greet new roommates, get their financials in order, and get started on extracurriculars, all in the space of a few weeks. For incoming freshmen, it’s even more stressful – they’re not only balancing all these tasks but adjusting to a fresh start away from home as well. It can all be overwhelming.

While starting a new school year is an exciting time, the stresses involved can result in triggers for mental health problems. For many people in recovery from eating disorders, these stresses can be the roots of a relapse. Disordered eating behaviors are oftentimes (maladjusted) coping mechanisms for stress and other negative emotions. As an example, consider binge eating disorder. Binge eating episodes release dopamine into the bloodstream, both from the food eaten and from the “catharsis” or eating. Dopamine acts as a “feel-good” chemical in the brain, so binge eating alleviates negative emotions and stress.

However, it can become a compulsive behavior almost akin to an addiction.

Risk Factors for Eating Disorders in College-Aged Students

Stressors can trigger eating disorder behaviors at any age. Eating disorders have been observed in people from age 7 through middle age. However,  according to several studies, including this one from Golisano Children’s Hospital, the average age of onset for anorexia nervosa is between 12 and 25, squarely within the normal age for college students. This makes eating disorder awareness and relapse prevention even more important for students going back to school or heading to college for the first time.

Adolescent treatment programs exist, and many young adults headed off to school are in recovery already. Many have completed a residential program, typically 30 – 60 days over their summer break, and are ready to get back to daily life. Others might still be enrolled in an IOP or PHP program or another kind of day treatment program to further their recovery. In either case, managing the stress and turmoil of going back to school is an essential element of continuing their recovery.

Tips Students Can Use to Help Manage Their Recovery

Continued recovery for students is all about managing the stresses that might trigger a relapse or cause disordered eating behaviors. It’s not always easy, but it is possible. Here are some tips to help you stay away from disordered eating behaviors when headed back to college:

  1. Build a Support System

No man (or woman) is an island. Stress can overwhelm any person, especially if they have to bear the brunt alone. That’s why people in eating disorder recovery should find people close to them who can act as a support system. Of course, family members and close friends should be numbered on this list, but any person that the recovering person finds comfort in talking to can help. People with eating disorders often feel isolated and ashamed of their disorder, so this step is perhaps the most important.

  1. Take Advantage of Resources Available to You

For someone coming out of treatment, alumni programs are often available. However, if the college isn’t located near their treatment center, this support might be limited to virtual or telehealth options. Fortunately, most colleges and universities are aware of how common eating disorders are for their students and have support groups in place. These might be conducted through the campus health/mental health centers, or be organized less officially through student groups. Whether in the form of peer groups or on-campus mental health professionals, there will be resources available to students who are coping with disordered eating, or even when they simply need someone to talk to.

  1. Manage Time Wisely

You’ve got three papers due by Friday, no one will cover your part-time job, there’s a cute new prospect for this weekend’s party, and your vocal club is having a center in three days. Guess what suffers? Your mental health. For people in recovery, time crunch can be one of the most powerful triggers. Once again, the stresses caused by overscheduling or mismanaged time often lead to the dopamine release from disordered behaviors. Make sure to plan a workable schedule and stick to it – and don’t forget to pencil in some downtime for yourself.

  1. Get Enough Sleep

Related to number 3, it’s important to make consistent and sufficient sleep part of your schedule. We’ve pointed out elsewhere in our blog how sleep affects mental health, but it bears repeating. Poor sleeping affects stress levels, decision-making, and physical health. Even worse, eating disorders negatively affect the ability to sleep due to malnutrition or anxiety. Poor sleeping habits and eating disorders can thus become a never-ending cycle. As part of your scheduling, make sure you plan out time to get your forty winks – and consider visiting a sleep therapist or doctor if insomnia begins to affect your routine.

  1. Reward Yourself

Maintaining recovery is no easy feat. Keeping yourself free from disordered eating behaviors and keeping your collegiate life in check is a real accomplishment – so take some time to reward yourself! When you reach a milestone, i.e. 60 days behavior-free or having a meal with others without urges to binge or purge, give yourself a treat as congratulations. You might splurge on tickets to a concert, take a trip, or even just let yourself veg out with your favorite show for a few hours. Anything to remind yourself of the challenges you’ve overcome will help keep your motivation strong.

  1. Embrace HAES (TW – weight discussions)

Healthy At Every Size (HAES) is an essential concept in modern eating disorder treatment. It centers on the notion that worrying about your weight is counterproductive and can trigger disordered eating behaviors. HAES thought teaches that as long as a person is healthy, their weight is unimportant, regardless of what some medical professionals or the diet industry might say. There is a lingering trope about the so-called “freshman fifteen” or a tendency for new college students to gain some weight. It’s important (not just for people in recovery, but all college students) to remember that health is much more important than a number on a sale. As long as you are eating for satiation and enjoyment, don’t let calorie-counting or scale-watching get in the way of your recovery.

Treatment Can Be Part of A Collegiate Life

Eating disorder treatment and attending university doesn’t have to be mutually exclusive. Although residential treatment may be needed in extreme cases, and would necessarily prevent a person from attending school, there are generally options beyond residential available. After residential treatment, step-down programs are usually recommended – and they often have locations near major college campuses. They are usually conducted on a weekly or biweekly basis and consist of sessions with therapists and/or nutritionists, as well as group therapy sessions. Even if they don’t virtual treatment is an increasingly viable option in the wake of COVID-19.

For many people in recovery, residential treatment is unnecessary – day treatment can provide the recovery care they need to regain their happier, healthier selves. If you or a loved one is in eating disorder recovery and returning to college after treatment, take care of yourself by entering an ongoing treatment program or finding a support system nearby. It can mean the difference between enjoying the best and most rewarding years f your life and falling back into disordered eating. Trust in yourself and keep working toward the brightest future.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, 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.