Eating Disorders at School

How to Spot the Signs & Where to Get Help for College Students

Eating disorders are a growing problem on college campuses. 15 percent of women aged 17 to 24 have an eating disorder and 20 percent of all college students reported they have or previously had an eating disorder, according to the Multi-Services Eating Disorder Association (MEDA). Stress is one of the biggest contributing factors of developing a disordered relationship with food, and the transition from high school to college is a big life change. Students and their families can use this guide to learn about different signs of an eating disorder, how they’re treated and where to get help.

How to Spot the Signs of an Eating Disorder

Disordered eating behaviors often crop up when students are busy and stressed with school priorities and activities. This can make it difficult for those with the disorder and those around them to recognize the signs of an eating disorder until it has already taken hold.

Symptoms of eating disorders differ by type, but the following helpful lists can alert students, friends and family members to the warning signs.

  • Constant, negative thoughts about your body

    Rather than being appreciative of everything your body helps you achieve, you become consumed with all the things you don’t like about your body.

  • Food dominates your thoughts

    You obsess about your next meal, how many calories it contains and how you can make it less calorically dense.

  • You stop spending time with others

    The thought of eating with others, having anyone see you eat or being questioned about your eating habits causes you extreme anxiety.

  • You feel you have no control around food

    You are unable to stop eating when comfortably full and consistently eat more than is necessary.

  • Food is something you use to soothe emotions

    While eating can be part of pleasure or celebration, you find yourself eating when stressed, tired, angry, upset, scared or lonely.

  • You skip meals

    In an effort to cut your daily calorie total, you skip meals, try to fill up on liquids or eat foods that are low in calories but don’t provide real nutrients.

  • Foods are categorized as good or bad in your mind

    You think certain foods should be off-limits for reasons unrelated to health, or have an increasingly shrinking list of foods you think are acceptable to eat.

  • Concentration is difficult

    Your mind often feels fuzzy and you are unable to focus on the daily tasks at hand.

  • You think people who are thinner than you are somehow better

    You idolize others you know (or see in popular culture) who are smaller than you and either ask about their diet or do research to find out how people in the public eye remain thin.

  • You become obsessed with the idea of healthy living

    Whether reading healthy living blogs obsessively, only buying foods from the health food section or cutting out former foods that brought you joy and satiation, you mask disordered eating behaviors behind the idea of self-improvement.

  • Swollen cheeks

    This can be a result of swollen glands caused by bulimia.

  • Excessive exercising

    While regular exercise is healthy, if your roommate shows extreme anxiety about missing exercise or appears to be exercising to the point of injury, it can be a sign of an eating disorder.

  • Disappears after meals

    Frequent use of the bathroom after a meal or snack can be a sign of bulimia.

  • Eating extremely small portions

    Eating significantly less than others present can either be a sign of anorexia or that they may be binge eating when alone.

  • Stepping away from friendships

    Withdrawal from friends or family, particularly after being asked about their eating habits, can be a sign of numerous types of eating disorders.

  • Cracked or red knuckles

    One of the visible signs of purging is consistently red, calloused or cracked knuckles at the base of the finger.

  • Develops an aversion to favorite foods

    If your roommate suddenly rejects formerly favorite foods or begins severely limiting the types or number of foods he or she eats, it could be a sign of an eating disorder.

  • Leaves empty food containers

    Binge eating often takes place while alone or late at night. If there are an inordinate number of food containers present, a binge session may have recently taken place.

  • Expresses disgust at their bodies

    Individuals with many different types of eating disorders may also experience body dysmorphia. If your friend or roommate is constantly picking out flaws, they may be struggling with an eating disorder.

If you or someone you know is struggling, don’t hesitate to tell someone. Talk to a trusted adult, go to your school’s health center, seek help in your community or call a support line. See our “Where to Get Help” section below for a list of resources. Call the NEDA (National Eating Disorder Awareness) Hotline if you need immediate support: (800) 931-2237. Or call 911 if there is a medical or psychiatric emergency.

Types of Eating Disorders

Eating disorders come in many forms, but treatment specialists and scientists agree the root causes are often the same. Previous abuse, trauma, societal pressure to look a certain way and genetics are some of the many factors that can contribute to disordered eating behaviors.

Anorexia

Anorexia nervosa affects nearly three million people annually, including a significant number of high school and college students. Characterized by weight loss and the individual exhibiting an unhealthy weight for their stature, anorexia can be a fatal disease if left unchecked.

Anorexia typically comes in two forms:
Binge/Purge

Individuals may eat a normal-sized meal initially, but overwhelming feelings of guilt cause them to vomit, use laxatives or over-exercise to remove what they perceive is too much food.

Restrictive

Individuals eat only miniscule portions of food that do not provide the nutrients or energy needed for even basic body functions to take place.

To be diagnosed, individuals must meet three criteria:

  1. They severely restrict calories to the point of reaching a body weight that is significantly lower than what is considered healthy

  2. They have an intense and irrational fear of weight gain or becoming overweight, even when malnourished

  3. They deny the seriousness of the problem and have a disturbed view of their weight or shape

Symptoms of anorexia are wide-ranging and potentially fatal. They include:
  • Depression or lethargy

  • Constant feeling of being cold; unable to control body temperature

  • Loss of or thinning hair

  • The absence of a normal menstrual cycle

  • Severe body dysmorphia

  • Phobias related to eating specific foods, or eating in public

  • Dizziness or fainting

  • Consistent exhaustion and inability to focus

  • Irregular heart beats

  • Dehydration

  • Osteoporosis

Bulimia

Up to four percent of all females in the U.S. will experience bulimia at some point in their life, but the most common age to develop this type of eating disorder is during the high school and college years.

Bulimia is a serious and potentially fatal eating disorder characterized by a binge and purge cycle. Bulimics may eat more than 2,000 calories in a single binge session before purging what they’ve consumed. Purging may take the form of vomiting, but it can also include laxatives, enemas or excessive exercise to remove calories from the body.

Symptoms of bulimia are long-lasting and potentially fatal. They include:
  • A lack of control in relation to eating

  • Ever-present sense of fear around food

  • Body dysmorphia

  • A fear of eating in front of others

  • Lack of a regular menstrual cycle

  • Puffiness or swelling

  • Joint/muscle pain

  • Burst blood vessels in the eyes

  • Dehydration

  • Tooth decay and/or gum disease

  • Digestive issues

  • Anxiety and/or depression

  • Irregular heartbeat or heart failure

Overeating and Binge Eating Disorder (BED)

The National Eating Disorder Association (NEDA) reports that binge eating disorders often begin in the late teens or early 20s. Individuals who’ve been diagnosed with BED frequently consume large quantities of food during a short amount of time and often feel they have no control over their eating. Unlike individuals with bulimia, those with BED feel distress and guilt about the amount of food consumed but don’t resort to purging.

Feelings of hunger are rarely if ever taken into consideration during binge eating episodes, although the individual may allocate a set amount of time (e.g. 30 minutes) in which they “allow” themselves to eat as much as possible. The majority of those diagnosed with BED have these episodes when alone, either during normal times of day or in the middle of the night.

Symptoms of binge eating disorder are wide-ranging and can lead to serious health problems. They include:
  • Feelings of stress or anxiety around food

  • Numbness or lack of sensations while binging

  • Lack of any sense of satiation or satisfaction, no matter the amount of food eaten

  • Inability to sleep or sleep apnea

  • Gastrointestinal issues

  • Muscle and/or joint pain

  • Type 2 diabetes

  • Cardiovascular disease

  • Hypertension

  • Gallbladder disease

The American Psychological Association conducted a study in which 26 percent of all teenagers reported overeating at least once a month due to stress, with 52 percent saying they engaged in the behavior weekly. The pressures of college—coursework, dorm life or trying to fit in—can lead to overeating in students who haven’t learned to manage stress effectively.

What separates overeating from binge eating disorder is the frequency of binge episodes. Those diagnosed with BED have at least one bingeing episode per week for three months or more.

Symptoms of overeating can have long-lasting repercussions if left untreated. They include:
  • Eating more than is needed

  • Consuming food more rapidly than normal

  • Secretive eating habits

  • Negative self-talk after consuming food

  • Believing food will help alleviate stress

  • Feeling uncomfortably full but continuing to eat

  • Obesity and associated issues with heart disease, diabetes, sleep apnea, and joint problems

Other Types of Eating Disorders

There are many types of disordered eating behaviors that can potentially affect college students, including:

  • Eating Disorders Not Otherwise Specified (EDNOS) and Other Specified Feeding and Eating Disorders (OSFED)

    These account for 40 to 60 percent of all cases of reported eating disorders. Examples of these types of eating disorders include atypical anorexia nervosa, limited-duration bulimia, low frequency binge eating, purging disorder and night eating syndrome. EDNOS and OSFED are not currently recognized by the Diagnostic and Statistical Manual of Mental Disorders.

  • Orthorexia

    A disorder where the individual becomes overly concerned with the concept of healthy living and exercise. Common symptoms include self-prescribed food allergies, an unwillingness to eat “bad” foods previously enjoyed, or the avoidance of foods with fat, sugar, and/or salt.

  • Muscle Dysmorphia

    A newly recognized disorder that mainly affects men and may also be called reverse anorexia or bigorexia. Individuals diagnosed with muscle dysmorphia demonstrate unhealthy behaviors or thoughts related to building muscles. Symptoms may include excessive weight-lifting, preferring time at the gym over social interactions, anxiety over a missed gym session, disordered eating and steroid use.

  • Diabulimia

    A rare but serious eating disorder specific to individuals with Type 1 diabetes. In an order to lose weight, diabulimics reduce their insulin intake. Symptoms include high glucose levels, exhaustion, severe dehydration, bacterial skin infections, staph infections, neuropathy and even death.

Treating Eating Disorders

Treatments for eating disorders are as varied as the issues they seek to address, and professionals in this field work tirelessly to develop individualized plans for diagnosis, treatment and recovery.

Eating disorders don’t always provide outside signs to the simple observer, and diagnosing them takes the expertise of a medical or psychological professional. Diagnoses may be provided by a medical doctor, mental health provider or other experts who work with students battling eating disorders.

Studies have shown that early diagnosis and diagnosis at an earlier age greatly improves the outcome of individuals with eating disorders, making it crucial for students to be aware of their behaviors and seek help.

A series of tests or examinations are typically performed and fall into three categories:

  • Physical examinations.

    The first step is to be examined by a medical professional who can distinguish the symptoms of eating disorders from other medical issues. Depending on the type of eating disorder and the severity, lab tests may also be ordered at this stage.

  • Psychological evaluations.

    These may be performed by a psychologist, psychiatrist or other licensed mental health specialist who understands the psychological, emotional or sociocultural dynamics at play. Students at this stage of diagnosis may be asked a series of questions about their thoughts and feelings, and how they interact with and feel about food. A psychological self-assessment questionnaire may also be used.

  • Additional tests.

    Depending on whether or not there are complications due to the specific eating disorder, a doctor or mental health expert may order additional evaluations to ascertain nutritional requirements and create a plan of action.

Once students begin this process, diagnosis can take between a few hours or a few weeks to ascertain the specific type of disorder and the severity before developing a plan of treatment.

Treatment plans are created after considering the type of eating disorder, the severity and the individual seeking treatment. Treatment is offered by a range of different providers, including hospitals, residential facilities or private offices. Different types of treatment are explored below.

  • Outpatient Therapy.

    The least restrictive of all levels of care, outpatient therapy is provided for individuals who need to continue going to school or working but are able to receive care two-to-three times per week. Those who seek outpatient therapy often receive the same type of care as those at inpatient facilities, but to a lesser degree of intensity. Individuals in these programs may take part in individual/group therapy, nutritional counseling, art therapy and medical evaluations.

  • Intensive Outpatient Treatment.

    IOT is a step above outpatient therapy and designed for patients who need more support and guidance but are still able to continue with their daily lives. Patients in these programs meet with their support team of doctors, therapists and dieticians two-to-five times per week. Common tools in this program include one-to-one therapy, individualized nutrition plans, eating disorder group therapy and family support groups.

  • Inpatient Residential Treatment.

    Inpatient treatment centers provide 24/7 care to patients through a team of doctors, nurses, dieticians and therapists. Individuals admitted to inpatient residential treatment typically have an eating disorder that is too severe to allow them to continue attending school or working – at least for a short time. Treatments provided in this environment range from individual to group therapy and typically offers a very structured day to help patients focus solely on psychological and bodily healing.

  • Acute Inpatient Hospital Care.

    Acute inpatient hospital care is provided to patients who are having serious medical issues due to their eating disorders. Rather than focusing on the psychological or nutritional factors at play, these hospitals are singularly concentrated on stabilizing the patient and ensuring they do not lose any more weight. Once stabilized, patients are typically moved to an inpatient residential treatment center.

Unlike recovery from medical procedures or short-term illnesses that typically have a definitive recovery point, eating disorders can be a life-long process. The goal of treatment, then, is to get the patient to a place where they are in recovery – a place where they have the tools needed to refrain from the unhealthy behaviors of their past.

Measurements used for recovery don’t revolve around reaching a certain number on the scale or going a specified number of days without engaging in harmful behavior. Instead, recovery is achieved when patients, in consultation with their medical and psychological team, are able to meet the set treatment goals and live a healthy life away from previous urges.

The National Eating Disorder Association provides the Stages of Change as a loose model for recovery, which includes five steps:

  • Pre-Contemplation.

    Prior to acknowledging disordered behaviors around food, individuals are said to be in the pre-contemplation phase. This season is marked by friends or family members bringing up concerns around restriction, binging/purging or unrealistic viewpoints about their weight or appearance. The individual isn’t necessarily open to change at this point, but it’s a critical first step in lovingly making them aware of the heartbreaking effects of eating disorders.

  • Contemplation.

    An individual has moved into the contemplation stage when they can admit they have an issue with disordered eating and are willing to consider treatment options. Fear during this stage can be crippling, and it’s important that a qualified mental illness professional is available to provide support and counseling needed for the patient to understand the root cause of the eating disorder.

  • Preparation.

    Once admitting the issue and considering treatment options, the individual moves into preparation by setting boundaries, finding ways to deal with negative thoughts surrounding food and developing coping mechanisms. Patients continue working with their treatment team to identify barriers and develop a toolkit.

  • Action.

    Once the action stage begins, patients are prepared to implement the strategies they created in the preparation stage and face the eating disorder fully. Continued work with medical and mental illness professionals is crucial at this stage as the patient begins implementing new behaviors and ideas about themselves while also confronting fears. A trust in the treatment team is paramount to success at this stage.

  • Maintenance.

    Individuals are considered to be in maintenance mode (or recovery) when they’ve been able to sustain all the steps of the action stage for a period of at least six months. Even in maintenance, individuals who formerly struggled with eating disorders are encouraged to maintain close ties with their treatment team to revisit potential triggers as a means of preventing relapse, develop new interests and focus on building a meaningful life free of the tight hold of an eating disorder.

Men & Eating Disorders

Although the majority of research up until recently was focused on the prevalence of eating disorders in female populations, the reality is that men are also at risk for these life-threatening issues.

  • 10 million men

    will be diagnosed with a “clinically significant” eating disorder at some point in their life.

  • 40%

    of those suffering from binge eating disorder are males.

  • Disordered-eating behavior is almost as common in men as it is in women.

  • 3.6% of male students

    at large university campuses had positive screenings for disordered food or exercise behaviors, while 2.9% of 20-year-old males had an eating disorder, according to a 2013 study.

  • Some studies suggest that men may be more likely to die from an eating disorder than women.

It’s important to remember that men and women both experience extreme social pressure to look and behave a certain way, especially during the college years. While college-aged women may feel like they need to be as thin as possible to be considered attractive, men experience similar pressure to have a fit and muscular physique.

Male college students may be reluctant to get help when experiencing symptoms of eating disorders, especially since many eating disorder resources focus primarily on the experience of women. However, groups like The National Association for Males with Eating Disorders (N.A.M.E.D.) are increasingly providing research, information and support for men.

Where to Get Help

  • Campus health center.

    These comprehensive care centers offer support and resources such as medical and psychiatric evaluations, nutritional support and arranging off-campus services, if needed.

  • College counseling center.

    Staffed with mental health professionals and often offering services for free or at a discount, college counseling centers provide a range of services. These may include eating disorder screenings, individual therapy or support groups.

  • Campus fitness center.

    Depending on the type of eating disorder a student has, campus fitness centers can help them forge a better relationship with exercise and develop a suitable and healthy fitness plan.

  • Residence Life.

    Colleges are working to educate resident directors in how to best support and care for students in their dormitories who are fighting against an ED. Dormitories can be a stressful form of living, and it never hurts to have an ally.

  • Campus food services.

    Whether seeking a specialized meal plan or meals developed in concert with a nutritionist, campus food services can provide tailored plans to help students in their recovery.

How to Improve Your Mind & Body Health

A report by the International Journal of Eating Disorders found that, within the 10 most popular magazines with young male and female readers, a significant number of ads targeted women for weight loss and men for body shape change. Because poor body image is a significant factor in developing an eating disorder, individuals who view their body as flawed are on a slippery slope.

To combat negative media messages and peer pressure, college students can take active steps to improve their body and mind health.

  • Follow body-positive (#BoPo) accounts on Instagram, Twitter, Facebook and other social media websites.

  • Skip mainstream magazines, blogs and websites promoting distorted body image and instead focus on media that celebrates more diverse body types.

  • Find mentors who have positive views of their body and ask how they empower themselves.

  • Remind yourself that true beauty has nothing to do with outward appearances.

  • Whenever you see a mainstream media message that undermines positive body health, take a moment to reject that message in your mind.

  • Find a volunteer opportunity that you care about and devote your time to caring for and empowering others.

  • Subscribe to an affirming podcast or guided meditation that supports the beauty and power your body holds – regardless of shape or size.

  • Find exercises that incorporate your passions instead of doing workouts that feel like a chore.

  • Instead of reading food labels to ascertain carbs, fat, or sugar, think about how they feed your body and mind.

  • During exam time or other seasons of school that are particularly stressful, practice self-love and remember to get lots of rest.

  • Listen to musical artists that celebrate their self-worth solely because of who they are, rather than what others tell them.

  • Learn about the variety of counseling and mental health services available at your college and take advantage of them.

  • Set exciting goals for yourself that have nothing to do with size, weight or exercise levels (e.g. learn a new language, visit a new country, or take up an instrument).

  • Start a daily or weekly gratitude list of all the things you like and appreciate about yourself.

  • Buy clothes that make you feel good in your body.

Interview with Malia Dunn, Registered Dietitian

In the midst of school and personal priorities and busy schedules, how can students with eating disorders find safe, discrete support?

If you’re struggling with an eating disorder, make time for individual therapy! In our high-tech world, we can schedule online with therapists, do phone or video sessions and even find e-therapists (solely internet related therapists).

It can be hard to make time for recovery if you are busy with work or school, but addressing the eating disorder during busy times in life will ensure that you can maintain a solid recovery when things are quieter. Eating disorders show up in times of stress, when we’re vulnerable. Busy schedules can sometimes welcome in these stress-induced eating disorder thoughts, urges, and behaviors.

People can call the NEDA (National Eating Disorder Awareness) Hotline if they need immediate support. (800) 931-2237.

How can students use the built-in community on a college campus to help achieve their goal of being free of an eating disorder?

Stay socially active! Eating disorders thrive in isolation. Use food as a social tool when connecting with others. When people connect over food we find that the connection is stronger, the interactions are more pleasurable and less stressful, and it sends the message to the eating disorder that food can be fun, useful for interaction and nourishing—all at the same time.

If you find others in recovery, set up times to eat meals together if you or they need additional support (do this with non-ED friends too!).

What advice do you have to students who will soon be graduating and are worried they will relapse? 

It’s okay to take time off between college and your career to take care of yourself. Be clear about long-term goals (health, life) versus the short-term (finding a job). Find a team (therapist, registered dietitian, psychiatrist, doctor) to support you through this big life change. Depending on the job you get after school, consider sharing with your company early in employment (maybe not during interview) that you have struggled with an ED in the past so they are aware of this if you need to take time off to take care of yourself.

What is the most important thing that a student struggling with an eating disorder can be told?

Talk to someone and ask for help! Tell a friend, family member, professor, resident assistant or medical clinic staff about your eating disorder thoughts and behaviors. The deadliest symptom of an eating disorder is silence.

In a research study done in Australia, students were more likely to tell a fried about their eating disorder or struggles than a parent or coach. Those students felt that telling someone in an authoritative role would mean they would be viewed as “weak” or imperfect; however, it takes great strength to ask someone for help or to say “I’m struggling.”

If you are a friend of someone with an eating disorder and you are concerned for them, please share with a supportive person that can encourage them to get help.  Friends can save lives by sharing with parents/supportive people.  Don’t try to fix it on your own!