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.
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.
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:
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.
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.
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.
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:
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.
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.
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.
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.
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.
Sources: Eating Disorder Hope National Eating Disorders Association The National Association for Males with Eating Disorders
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.
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.
Academy for Eating Disorders.
Prevention, treatment, research and education are the main tenets of this global organization focused on eradicating eating disorders.
The Alliance for Eating Disorders Awareness.
Founded in 2000, AEDA works tirelessly to provide outreach, education and early intervention programs throughout the country.
Binge Eating Disorder Association.
BEDA is a national nonprofit focused on educating the public about BED and providing events, resources and advocacy efforts.
Eating Disorder Hope.
EDH is a national organization working to end disordered eating behavior by providing education and prevention alongside resources for treatment, recovery and support.
Since 1999, EdReferral has partnered with the American Eating Disorder Association to ensure individuals seeking help for their eating disorders can receive information on treatment centers and professionals in their area.
Families Empowered and Supporting Treatment of Eating Disorders.
FEAST provides online forums, learning centers, services and advocacy for families supporting their loved ones with eating disorders.
The National Association for Males with Eating Disorders.
N.A.M.E.D. has been providing support and raising awareness for men affected by eating disorders since its founding in 2006.
National Association of Anorexia Nervosa and Associated Disorders.
ANAD offers support groups, recovery mentors and grocery buddies to those recovering from anorexia or other eating disorders.
National Eating Disorder Association (NEDA).
This nonprofit serves millions of individuals each year by providing critical resources such as a help-line, online screening tool and support groups.
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!