Eating Disorders and College Students
Kayla* was a 19-year-old art student who garnered the attention of her college professors and was thought of as a protégé in the expression of abstract images. She was quiet with pink streaks in her hair. She wore layers of clothes and sometimes seemed to disappear into her own internal world. Mentors at times wondered if she was too thin, but her work was impeccable, and they had no idea how to express their concern.
Kayla suffered a cardiac arrest in her studio at her art school on a Tuesday night, and with her, her art died. She had struggled with anorexia in high school and never fully recovered. Her relapse went unaddressed in a college environment, where her eating disorder gained strength in isolation and ultimately proved fatal. Eating disorders have a very high mortality rate relative to other mental health disorders, and they thrive on secrecy.
Contrary to popular belief, eating disorders are not a choice and are often accompanied by distorted beliefs about food and body shape and size. These illnesses are cunning, manipulative, and self-protective, characteristics that make it all the more difficult for the person suffering to independently reach out for help.
Eating Disorders on College Campuses
College can be an exciting time marked by exponential personal growth, social and education knowledge acquisition, and entry into adulthood. However, it is also a vulnerable stage of life, and a time when young people are at risk for an eating disorder developing or worsening. While approximately 6% of women on college campuses meet the criteria for anorexia or bulimia, as many as 40% report body image concerns, weight management behaviors, and out of control eating (Schwitzer & Choate, 2014). In other words, social pressures, burgeoning identity, and first tastes of independence combine to create the perfect conditions for disordered eating.
Not only faced with often-unattainable appearance ideals, college students are also in an environment where regular well-balanced meals are rare, binge eating and drinking is normalized, and diet mentality is rampant. This creates a risky environment for a cycle of binge eating, weight gain, dieting, body image disturbance, and disordered eating cycles. As many as 36–50% of adolescent girls diet and, according to NEDA, 35% of “normal” dieters progress to pathological dieting. Of those 35%, 20–25% develop partial or full syndrome eating disorders.
Meanwhile, the landscape of college mental health has shifted considerably in the past two decades. According to the National Center for Education Statistics, in 2020 40% of all U.S. adolescents aged 18–24 were enrolled in a college or university. This number has increased by 14% since 1970. The shift has changed the experience of university life, including the extent and availability of student support services such as counseling and student health centers.
While college enrollment has exponentially increased, so has the demand for support services such as counseling. Still, the demand far exceeds the available resources in most universities. For example, in 2019, nearly 90% of counseling center directors reported an increase in students seeking services, according to the Association for University and College Counseling Center Directors (AUCCCD) Annual Survey. The impact of this increase is significant, and while accessing college mental health services is a priority, it also means that the availability of ongoing services for students is scarce. According to the Center for Collegiate Mental Health (CCMH), most college counseling centers are beginning to move to a triage model of mental health and focus their efforts on crisis intervention, brief counseling, and referral to community providers.
The average number of appointments students attend in a college counseling center is 4.55, according to CCMH. Contrast this with the typical length of outpatient treatment for patients with eating disorders, for which estimates range from a few dozen sessions to regular sessions over the course of up to seven years. This essentially means that college students with eating concerns are unlikely to receive adequate treatment at their college counseling centers. However, counseling centers can and should assist with early identification and be an entry point into appropriate outpatient services or higher levels of care.
Early identification of eating disorders is critical in order to effectively prevent the potentially lifelong impact of the disease on the body and brain. Malnutrition can lead to bone density loss, suspend brain development, interrupt reproductive processes, and more. Without prompt and sufficient treatment, physical consequences can be irreversible. Furthermore, eating disorders can negatively impact social, psychological, and academic functioning. Treating people who are struggling with the onset of eating disorder symptoms as quickly as possible and at the highest level of care necessary often leads to the best possible outcome for those students. Early identification through student health residence halls and university counseling services are likely the best way to ensure that young people do not struggle unnecessarily.
Strategies to Support College Students with Eating Disorders or in Recovery:
- Educate students with a history of disordered eating or eating disorders, along with their parents and treatment teams, about the risk of relapse that comes with the transition to college.
- Ensure that students with a history or current struggle with disordered eating are equipped with a treatment team (registered dietitian, medical doctor, psych provider, and therapist) and have appointments scheduled before beginning college. Parents and college students should not expect that the university resources will be sufficient if someone has an active eating disorder or an eating disorder in remission.
- Provide resources for understanding warning signs and strategies for early identification and intervention to professors, residence life personnel, and other university support providers.
- Align universities with eating disorder support networks and provide them with resources for understanding the first signs and efforts of early identification.
- Assist university counseling center staff with developing a network of external providers experienced in treating eating disorders so that the referral process is as seamless as possible.
- Train residence hall personnel and other front-line university staff to know how to intervene with students who are struggling with eating concerns or body image issues.
Although college is an enriching experience for so many, complete independence and large life changes can also cause stress. This stress can lead to students being more vulnerable to an eating disorder developing, reappearing, or worsening. College students with eating disorders would benefit greatly from greater access to healthcare personnel trained to recognize the signs of an eating disorder and get them the proper treatment. Universities, specifically the healthcare providers, counselors, and residence hall staff, can be invaluable when it comes to the experience of students with eating disorders.
*Name changed for privacy
About the Author
Sydney Brodeur-Johnson, PhD, LCP, CEDS, is passionate about providing best-practice, research-informed and multiculturally competent treatment to patients and their families suffering with eating disorders. She is committed to increasing access to effective treatment, training professionals to deliver gold-standard care, and empowering them to be the best providers and people they can be.
Dr. Brodeur received her PhD in Counseling Psychology from Virginia Commonwealth University (VCU) in 2005 and completed a postdoctoral fellowship at the University of Alabama at Birmingham with a concentration in the interdisciplinary treatment of adolescents with eating disorders. She assisted with the opening of Carolina House, a residential eating disorder treatment facility in Durham, NC, and was the first Center Director there. From 2008–2019 Sydney served as the eating disorder specialist and Associate Director for Training at University Counseling Services at VCU. In that role, she maintained APA accreditation of the psychology internship program and was the administrator for the training program for students in psychology, social work, and counselor education. She also served as a member of the center’s executive team.