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Eating Disorders in College: Why Are Students Especially Vulnerable?

Written by: Katie Huber & Samantha DeCaro, PsyD

Eating disorders are unfortunately very common among college students. In this post, we review the biological, social, cultural, and psychological reasons for why students are so vulnerable, and review the risk factors to watch out for.

Transitions are hard. They take us through a range of emotions, and often include complex and difficult paths we must figure out how to navigate. This is particularly true for college students, who sometimes cope with their emotions in unhealthy ways.

As a result, students may activate – or even relapse – the onset of disordered eating.

Why Are College Students Vulnerable to Eating Disorders?

College creates the perfect storm of biological, social and cultural factors that contribute to the development of an eating disorder. It is well-known that transitions and change often trigger an eating disorder, putting students at an increased risk considering the degree of expectations and pressure they are faced with over the course of a college experience.

What Biological Factors Contribute to Eating Disorders in College?

Biologically, the age of onset of an eating disorder is often the teenage years or early adulthood. As students straddle the transition from late adolescence into young adulthood, they often find this developmental milestone of individuating and separating from family difficult. Who am I? What am I doing with my education and life?

These are big questions and understandably carry a lot of emotions. Eating disorders sometimes provide a false sense of identity, control, and stability, while distracting from the intense emotions associated with this stressful transition.

What Social Factors Contribute?

Socially, students are up against many socially constructed norms in the college experience. Diet culture is everywhere on campus. Dining halls may include messages that support diet culture, such as caloric information in buffet lines or materials that insinuate or promote perceived pillars of health. Fat phobia is prevalent, often heightened by a “fear of the freshman 15” weight gain—although that has been debunked in various studies.

Realistically, some weight gain during college years is normal and part of maturing into a young adult.

Diet culture and socially constructed beauty ideals are constantly perpetuated across social media, a cycle which is difficult for students to escape given the numerous ways by which these channels dominate social connection with peers.

Binge drinking also dominates the college experience; restricting calories to compensate for drinking alcohol is often normalized. This concept, known as “drunkorexia” and more recently, Food and Alcohol Disturbance (FAD), continues to receive attention from healthcare professionals as it has dangerous and long-term implications for students.

What About Cultural & Psychological Factors?

Culturally, it is important to consider the many facets of a student’s identity that may play a role in the development and maintenance of an eating disorder such as race, ethnicity, socioeconomic status, gender expression, gender identity, sexual orientation, body size, and more.

These aspects, and the intersectionality of them, can result in disparities across care, including access to on-campus resources. For example, a Boston University study found that “among African American students with a mental health problem, only 21% had received a diagnosis, compared with 48% of their white peers.”

Unfortunately, there are medical and mental health professionals who carry their own biases, resulting in the minimization or misdiagnosis of eating disorders in those who do not fit the stereotypical thin, young, white, female patient.

Individuals in larger bodies also experience weight stigma and discrimination, which can not only increase disordered eating behaviors and other psychological symptoms, but also decrease the student’s willingness to trust or utilize the college’s psychological and health services, potentially resulting in a longer duration of symptoms.

Stigma and the Toll of Student Mental Health

Anxiety, depression and other psychological concerns often go hand in hand with eating disorders. This perfect storm for college students brings stigma and a lack of resource awareness with it.

A Healthy Minds study shares that 34% of students self-report anxiety, with 16% of that categorized as severe while 39%  self-report depression, with 21% of that categorized also as severe.

13% of students surveyed experienced suicidal ideation in the year of study, and 23% experienced non-suicidal self-inquiry in that timeframe.

45% of students perceive that they are judged negatively for receiving treatment and 22% of students report they “do not know where to go for help on their campus.”

11% of students in this study self-identified as having an eating disorder. It is assumed this number is much higher because of the denial and secrecy around eating disorders which, unfortunately, thrive in isolation.

What Can Peers & Authority Figures Do to Help?

As with most disorders, early recognition is critical and eating disorders are no exception.

As noted above, the denial around eating disorders plays a big part in delaying treatment and there are also other barriers that come into play in identifying when an individual is struggling. Students’ increased focus on food and exercise, as well as negativity around body image issues, often get in the way of the college experience.

Risk Factors to Watch Out For:

  • Grade fluctuations and/or steadily dropping grades
  • Social withdrawal from friends and family
  • Discrimination or marginalization
  • Participation in a weight focused sport (e.g., ballet, wrestling, gymnastics)
  • Being bullied in the past for appearance or weight
  • Trauma or abuse history
  • Perfectionistic or impulsive personality
  • Difficulty accessing care/a treatment team
  • Financial/tuition loss
  • Limited parent involvement

Signs You Should Take Action or Intervene:

  • Ongoing restricting, bingeing and/or purging
  • Excessive guilt, anxiety or fear associated with food or exercise
  • Medical complications, even minor ones
  • Weight fluctuation – significant over short period of time, relative to each individual’s trends
  • Depressive episodes and/or anxiety
  • Suicidal ideation or other safety concerns
  • Substance abuse, self-injury or other dangerous behaviors
  • Refusal or manipulation of medication or insulin
  • Social, emotional, educational, functional impairment

Conclusion

Being a college student is too often difficult—academically, socially and, perhaps most important of all, mentally. Individuals with eating disorders can make a full recovery and once identified, are best approached with empathy, compassion, and in a non-judgmental manner. It is important to connect the dots of mental health concerns to identify, dig deeper and support students silently struggling with eating disorders.

If you are a loved one of a college student, please take the information above seriously – an eating disorder rarely, if ever, just “goes away” on its own.

Eating disorders are complex; effective recovery involves the expertise of a team of professionals who provide specialized treatment for each aspect of the medical, nutritional, mental, relational, and other issues keeping your loved ones from living the life they deserve. As an important member of the treatment alliance your participation is invaluable.

If you are a college student, you know first-hand about the effects an eating disorder can have on every aspect of your life. This probably isn’t the first time you’ve considered getting help. Renfrew adheres to the strong belief that full recovery is possible over time. We know it’s not easy getting there, but we know it works. This is an important decision – rather than feeling you may be missing out; we believe getting treatment will enhance your experience of college and beyond. Whether you choose to utilize on-campus support or seek out connections in the community, you deserve to prioritize your mental health. If a higher level of care is the right fit for you, we will support you in collaboration with college counselors and administrators to help you make a seamless transition for admission to the level of care option recommended by your team.

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