If you are a college student or the parent of a college student or a soon-to-be college student with an eating disorder, you may be looking for more information about how eating disorders present in college students, what some of the warning signs are, and how to get help for a college student experiencing an eating disorder.
Why Are Eating Disorders So Common on College Campuses?
Eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder, are relatively common on college campuses. They affect approximately 11% to 17% of female students and 4% of male students. Furthermore, much greater numbers of college students—20% to 67%—experience subthreshold eating disorder symptoms. Eating disorders often commonly begin during the late teenage years, which coincides with the common age of college enrollment. Eating disorders are caused by a complex interaction of genetic and environmental factors. However, some aspects specific to the college experience may contribute to the development of eating disorders.
The College Environment
First of all, colleges attract individuals who may have clinical perfectionism, a trait that has been associated with the development and maintenance of an eating disorder. College is stressful and the transition itself may be hard. In addition, the campus environment presents a number of novel and challenging situations for students. They are often living away from their parents for the first time without the structure and support provided by family. They often must navigate living with roommates and the loss of personal space and privacy. For most college students the academic environment is more challenging than high school. The food environment is different too. Student dining halls may present the first time a student has unlimited access to such a large variety of food. Students who had previously been restricted in the home may find the availability of food to be a trigger for binge eating. Students who are rigid in their eating may be anxious about the food in the dining hall and the lack of control they have over their own food compared to what they previously had at home. There are new social pressures to navigate including the pressure to fit in. Drugs and alcohol are more present and sororities and fraternities can heighten the pressure to conform. A New York Times article in 2012 highlighted the pressure female college freshman feel to lose weight in order to secure a successful bid in sorority rush. Diet culture is alive and well on college campuses and there is a common fear of “the freshman 15.”
Who Is Affected?
Although it has commonly been believed that males are much less likely than females to experience an eating disorder, the prevalence of eating disorders among males is higher than was once thought—they are also at risk. Additionally, transgender college students reported experiencing disordered eating at approximately four times the rate of their cisgender classmates.
What Are the Warning Signs?
Some of the potential symptoms of an eating disorder include:
Skipping meals or eliminating food groups in order to lose weightPreoccupation with thoughts of food and/or your bodyFear of or avoidance of eating with peers or in the dining hallExercising more than one hour a day (unless for sports conditioning) or not being able to take days off exercise without feeling guiltyEating large amounts of food in a short amount of time and feeling out of control while doing soPurgingWeight lossRestriction of eating prior to drinking in order to reduce the impact of drinking on weight
If you are a parent whose child is living away at college, you may not be able to observe these symptoms. Unfortunately, this can give an eating disorder the room to develop and become more serious before you learn about it. If your college student comes home from a break and has lost weight and/or is exhibiting the above symptoms, do your best to open the conversation and discuss what’s going on, and then if need be, seek help on their behalf.
What Services Are Available to College Students with Eating Disorders?
Unfortunately, there are insufficient eating disorder resources and services on college campuses to treat these common and severe disorders. According to one study, among college students who screened positive for an eating disorder, only 20% received treatment. The barriers to care on college campuses include increased numbers of students with all kinds of mental health issues and understaffing at college counseling centers. Other barriers include stigma, the time-intensive nature of treatment interventions, and financial costs. Eating disorders should usually be treated by a multidisciplinary team including a therapist, dietitian, and medical doctor. Some colleges have eating disorder specialists and specialist teams on campus encompassing these three disciplines. More often, college counseling centers are overloaded and only provide short-term counseling, referring many students who need eating disorder care out to providers in the community. The nature of therapist licensure is another complication. Many families are unaware that licensure is by state. Most states determine that therapy, including video sessions, occurs where the patient is physically located at the time of the session. As a result, students who go to school out of state may have to have one therapist in their home state and one in the state where they go to college.
The Impact of Eating Disorders on College Students
Eating disorders and subclinical eating disorders may be associated with significant health problems and may negatively affect a student’s social life, academic performance, and entire college experience. There can be long-term medical consequences if eating disorders are not appropriately treated. On top of that, undergoing treatment can be time-consuming and can interfere with participating in the full college experience students and families hope for. The interaction of disordered eating with binge drinking is relatively common on college campuses with as many as 46% to 58% of college students engaging in these behaviors at least “sometimes." The interaction of alcohol misuse on top of disordered eating can lead to even more significant physical issues.
If You Are a Parent of a Student With an Eating Disorder
If you are planning to send a student to college and they have had an eating disorder or show signs of one, please consider carefully whether sending them now is the best decision for their health. When they are out of your sight, it will be harder to determine how they are doing. Although colleges become in loco parentis, they will never provide the same level of oversight that parents do. Although you likely feel pressured to let them go to college on time with their peers, consider whether they might benefit from a gap year during which time they can strengthen their recovery before adding the challenges of a college environment. If you do send them, it is recommended that you send them with a college contract: a written agreement between the parents and the student that specifies specific criteria for remaining on campus (such as maintaining a healthy weight, refraining from eating disorder behaviors, keeping appointments with treatment providers) and what will happen if criteria are not met. Examples of the latter are that a parent may go to school to supervise meals, or the student may be required to move home or enter more intensive treatment. You might want to consider tuition insurance, a policy that covers the cost of tuition if a student withdraws for serious mental health problems, among other reasons. This will reduce the pressure on you and them to stay enrolled in the event they become too ill to remain in school. In terms of medical insurance, residential colleges in the U.S. will usually require that the student either be enrolled in the campus’s student health plan or remains on the parent’s policy. You may want to consider what the treatment resources are in the community and line up providers near to the school and consider which insurance policy to use for your child ahead of time. Remember that your young adult may be more interested in having a college experience and may be ambivalent about treatment. So, if they do need to be in treatment, having convenient providers will make it easier to navigate.
A Word From Verywell
If you are a student and are concerned you might have an eating disorder, it is important to seek help. Reach out to your student counseling center and make an appointment for an assessment. Please follow through on the recommendations for treatment. Sometimes it may be necessary to take time off from college to focus on treatment. If this is the case, please don’t feel that you have failed! Eating disorders are mental illnesses and not anybody’s fault. With time and treatment most people do recover. It is okay to take time off if you need to—you can always go back to college later.
