Eating disorder symptoms often occur during times of pressure, stress or transition, and college is no exception to this. College students are disproportionately more likely to develop an eating disorder during this season of life, but that doesn’t have to be the case. The following guide arms students and families with knowledge about common eating disorders, their symptoms and how to seek treatment.
Dr. Ariane Machin
Dr. Ariane Machin is a Clinical Psychologist who specializes in working with individuals struggling with disordered eating and body image struggles. Dr. Machin has worked as a university counseling center therapist at a variety of Division I universities, providing therapy and support to countless college students working to overcome eating disorders. She has also provided the same services in private practice. Dr. Machin is experienced in working with college athletes that experience eating disorders alongside the pressures of their sport. She currently serves on the board of Healthy is the New Skinny and has been featured in many national magazines and online media outlets.
30 million people in the United States alone suffer from eating disorders, which have the highest mortality rate of any mental illness. In fact, at least one person dies every 62 minutes as a direct result from an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).
How many college students are affected by clinical eating disorders
How many college students diet to lose weight
The average ages for developing anorexia and bulimia respectively
How many students at national universities take advantage of mental health services, with 23% at liberal arts colleges
How many female college athletes exhibit eating disorder symptoms, with two percent having a diagnosed eating disorder
The percentage of individuals with an eating disorder who are between the ages of 12 and 25
Anorexia nervosa is a life-threatening eating disorder that manifests in extremely low body weight, distorted body image, inability to maintain a healthy body mass index (BMI) and an intense fear of weight gain. Students who have been diagnosed with anorexia may severely limit their food intake, purge after meals, exercise more than is healthy or take laxatives or other supplements in an attempt to lose weight or suppress their appetites.
According to the Diagnostic and Statistical Manual (DSM), an individual may be diagnosed with anorexia nervosa if he or she exhibits the following criteria:
Restricting calories (energy-intake needs), resulting in a significantly lower body weight than what is healthy based on age, development, physical health and gender
Fearing any type of weight gain, even if one is already below a healthy weight
Inability to see one’s body weight or shape in rational terms (such as thinking one is overweight when actually underweight) or the denial of the harmful effects of one’s current low body weight
Anorexia has a wide range of physical symptoms, including:
Extreme weight loss
Dizziness or fainting
Dry or yellowish skin
Constantly feeling cold
The appearance of fine hair across the body (called lanugo)
Changes to hair, including thinning, brittleness or loss
And behavioral symptoms, including:
Frequent negative comments about appearance or feeling overweight
Avoidance of mealtimes or eating in front of others
Refusal to eat certain individual foods or categories of foods (such as carbs, fats, etc.)
Excessive exercise even in the event of illness or injury
A withdrawal from usual social activity or friendships
A development of ritualistic behavior around food (such as the need to eat food in a certain way or order)
NEDA provides a full list of physical and behavioral symptoms.
When left untreated, anorexia can drastically impact a person’s mental and physical health. When treating this type of eating disorder, a three-pronged approach is typically employed to ensure patients receive the holistic care needed to recover physically and emotionally:
Medical professionals lead this critical first step in the treatment plan to establish if the patient is experiencing any severe health problems. Malnutrition from anorexia can cause organ malfunction, an unstable heartbeat and many other serious conditions. These factors need to be assessed and stabilized immediately before any additional treatment is given.
Once any medical concerns are treated and stabilized, nutritional experts create a plan to bring patients to a healthy weight while also providing a tailored meal plan to help establish healthy eating patterns. Patients also work with a nutritionist or registered dietician to overcome food phobias and move towards recovery.
The final piece of treatment addresses the underlying mental health issues that made it possible for anorexia to take root in the first place. Patients work with counselors, therapists or licensed psychiatrists to identify the underlying issues, develop coping mechanisms and find healthy ways to deal with difficult emotions or life events.
Nutrition Clinics.Many schools, such as the University of Michigan, are beginning to offer nutrition clinics staffed with registered dieticians who can help students struggling with anorexia nervosa face their issues with food.
Mental Health Centers.Most schools offer resources for students struggling with eating or body image issues through their mental health centers, such as The Mindful Eating Program offered at The University of Texas at Austin.
Local Support Groups.NEDA maintains a comprehensive list of locally-based associations and community outreach programs across the country.
Treatment Centers.Organizations like the Center for Change provide a safe and supportive environment for individuals seeking in-patient treatment for anorexia nervosa. You can find a list of treatment options and support groups through ANAD.
Anorexia Nervosa and Related Eating Disorders. ANRED provides information on anorexia, including warning signs, resources for self-help and tools for parents of adolescents struggling with this type of eating disorder.
National Association of Anorexia Nervosa and Associated Disorders (ANAD). This national nonprofit offers assistance in finding support groups, recovery mentors, grocery buddies and treatment centers to individuals who want to put anorexia behind them.
Bulimia nervosa is a psychological eating disorder that, left unchecked, can cause life-threatening health issues. Individuals with bulimia consume unusually large amounts of food over a short period of time, then rid the food from their bodies via purging. These binge and purge episodes can happen many times per day, all in secrecy. Common methods of inducing a purge include vomiting, excessive exercise or the use of laxatives and diuretics.
Bulimia has a number of symptoms that can be observed both by the person affected by the eating disorder, and his or her friends or family.
Physical symptoms can include:
Continual fluctuations in weight
An enflamed esophagus
Calluses or aggravated skin on the knuckles of fingers (from inducing vomiting)
Broken blood vessels in the eyes
Behavioral symptoms can include:
The disappearance of abnormally large amounts of food
Eating when others aren’t around
Stealing or hoarding food
Constant use of the bathroom after meals
An aversion to spontaneous meals or snacks
NEDA provides a full list of physical and behavioral symptoms.
There’s no single cause of bulimia. Various factors—genetic, cultural, environmental and physiological—can all contribute. Because of this, those who seek treatment often need a holistic approach to tackle the root of the cause. Bulimia treatment specialists often focus on three phases:
Breaking the cycle.Because bulimia nervosa’s symptoms are cyclical in nature (bingeing followed by purging), the first step of recovery is stopping that cycle. Nutritionists work with their patients to make them aware of the harmful affects of bulimia and help them establish healthy eating behaviors.
Improving the mind.Bulimia is a mind game where control and poor body image are used to keep the individual in the cycle. Therapists work with these patients to reverse harmful thoughts and develop an appreciation for the many beautiful aspects of their bodies that have nothing to do with weight or size.
Strengthening emotions.Getting to the root of the emotions that cause individuals to be trapped in the binge/purge cycle is the crucial final step of recovery. Counselors and psychologists help patients identify events in their life that may have caused emotional trauma. They then provide a range of treatments that address this trauma and ongoing concerns, such as issues with interpersonal relationships.
Women’s Centers.Many colleges, such as Boston College, provide health resources for eating disorders through women’s centers.
Psychiatry Programs.Some colleges provide resources and services related to eating disorders through their psychiatry department. The University of Chicago provides such a program.
Anorexics and Bulimics Anonymous. ABA uses the 12-step program and provides a directory of meetings throughout the country.
Treatment Centers and Dual Diagnosis Rehab. Bulimia.com keeps an up-to-date database of locations where bulimic individuals can find support and treatment.
Online support groups. A number of support groups, chat rooms, and forums with a pro-recovery approach can be found via Bulimia.com.
Recovery Spark. Dedicated to providing online resources and support to individuals on the road to health, Recovery Spark offers articles, scientific journals, and a list of other support organizations.
Binge eating is the most common of all eating disorders in the United States, affecting three times as many Americans as anorexia and bulimia combined. Individuals with binge eating disorder (BED) compulsively overeat and feel they have no control over their consumption of abnormal amounts of food. Men and women alike struggle with this type of eating disorder, which often leads to unwanted weight or even obesity if left unchecked.
Overeating and BED are frequently lumped into the same category, but there are some factors that differentiate the two. BED is typically characterized by binge eating episodes at least once a week over a period of a three months. Overeating, conversely, may be less extreme and occurs less frequently, but can still cause negative effects on an individual’s health over time.
While it’s normal to enjoy more food than usual on special occasions, overeating becomes problematic when it’s more frequent and/or tied in with negative emotions such as shame and guilt.
Signs of a binge eating disorder may include:
Continuing to eat when full
Lacking control over what and how much is eaten
Storing food in secret stockpiles to consume alone
Hiding eating habits when around others but binge eating later
Feelings of stress or anxiety that are only alleviated by bingeing
Absence of satiation or satisfaction, no matter how much is eaten
If left untreated, BED can cause severe physical and mental complications, including:
Type 2 diabetes
Overeating shares many of the same symptoms as BED, but to a lesser extreme. Common indicators of overeating include:
Feeling no control over how much is eaten
Ingesting food rapidly
Eating alone out of feelings of embarrassment
Cyclical feelings of guilt
Withdrawal from social groups
Eating in secret or at strange times (e.g. keeping food in a bedside table to eat in the middle of the night).
Overeating can also deplete dopamine receptors over time, making it harder for overeaters to feel satisfied when eating a normal-sized meal.
Binge eating disorder treatment specialists run the gamut from medical doctors and therapists to dieticians and mental health specialists and offer a range of support services designed to treat the whole individual.
Common types of treatment for BED include individual psychotherapy sessions, support groups, family member education, nutrition counseling and psychiatric support. The goal in all of these treatments is to dig down to the underlying issues that cause individuals to overeat and feel they have no control over food.
In much the same way that binge eating disorder is approached, therapists and nutritionists help their patients who overeat recognize trigger emotions, identify feelings and build a toolkit for disarming the psychological constructs that make them overeat in the first place.
In addition to helping patients develop healthy eating habits that consist of normal-sized meals, overeating specialists educate them on the process of recovery and how to practice emotions management and behavior modification.
Eating Disorder Screening. Many colleges, such as Miami University, now provide discrete yet comprehensive online screening tests students can use to learn about prevention, early detection and treatment options.
Counseling Services. Pennsylvania State University’s Center for Counseling and Psychological Services is a prime example of the types of individual and group therapy services available at many college campuses.
Campus fitness and nutrition resources. James Madison University is a great example of the type of food and exercise support students can receive when they want to overcome compulsive overeating.
Overeaters Anonymous. OA has chapters throughout America and the world to help individuals understand their issues with food and find healthy solutions to overcome them.
Binge Eating Disorder Association. BEDA maintains an up-to-date database of BED treatment providers in cities throughout the country.
Compulsive Eaters Anonymous. CEA advocates for honesty, open-mindedness and willingness from those who attend this 12-step program. A directory of meetings can be found on the website.
Food Addiction Institute.The FAI maintains information about inpatient and outpatient services throughout the country that help individuals stop overeating.
Online Eating Disorder Support Groups. Eating Disorder Hope has a comprehensive list of internet-based groups providing support, 12-step programs and treatment options.
Recovery Warriors.Podcasts, resources and a directory of eating disorder professionals are just a few of the services offered by this pro-recovery website.
Normal Eating. Founded in 2002, Normal Eating is an online support group that provides the support and acceptance many individuals are looking for when working to overcome overeating.
OA Virtual Services. Overeaters Anonymous provides a host of support services and resources exclusively online.
There are many other types of disordered eating that have distinct symptoms but are not recognized by the Diagnostic and Statistical Manual (DSM). Some of these include:
Terms used to describe distressing symptoms or psychological issues around food that don’t fit into a defined DSM eating disorder. Approximately 40 to 60 percent of all eating disorders fit into this category.
Compulsive behavior related to healthy eating and exercise. Orthorexia is not currently recognized as a clinical diagnosis by the DSM.
This disorder primarily affects men and causes them to develop obsessive behavior related to building muscle and participating in extreme diets. Also called bigorexia, this disorder is a subset of body dysmorphia.
A disorder whereby Type 1 diabetics withhold necessary amounts of insulin to make it possible for them to lose weight more easily.
Because none of the eating and body disorders listed above are recognized by the DSM, identifying symptoms can be difficult and most EDNOS and OSFED issues vary depending on the disorder.
Orthorexia symptoms typically include:
Avoiding entire food groups without medical consultation
Overreliance on supplements or herbal remedies
Limited scope of acceptable food choices
Feelings of guilt when missing a workout
Fixation over the preparation of food, particularly the cleanliness of food or utensils
Muscle dysmorphia symptoms include:
An unrealistic perception of muscle mass and leanness in oneself
Extreme exercise programs
Overabundance of protein sources and food supplements
Consistently choosing the gym over social functions.
Diabulimia symptoms include:
High glucose levels
Irregular menstrual cycles
Neuropathy and even strokes, comas or death
As with the vast majority of other eating disorders, those outside the realm of DSM-recognized disorders typically need to be treated in a holistic manner. Issues like orthorexia or diabulimia may require the services of medical professionals to ensure no lasting damage has been done to vital organs, while nutritionists should also be on hand to help recovering patients identify normal eating habits and food choices.
Mental health specialists and psychiatrists are also vital in the treatment of all of these disorders because each can be traced back to emotional issues, imbalances trauma or unresolved feelings.
Recreation or Athletic Centers. Students who feel like they may be on the verge of developing unhealthy relationships with exercise and/or muscle building can work with certified trainers at their colleges to ensure they maintain healthy mindsets.
Counseling Centers.Campus counseling centers, such as the one at the University of Tennessee can provide myriad individual and group services for students struggling to overcome a wide range of eating disorders.
Eating Disorders Anonymous. Students can find a database of meetings throughout the country that provide fellowship and support.
EDReferral. Since 1999, EDR has worked to connect students seeking help with their eating disorder to qualified specialists and treatment centers in their area.
Almost everyone has negative thoughts about their body from time to time. In our image and weight-obsessed culture, it’s difficult to not compare ourselves to others and feel inadequate. But for some, these thoughts become persistent and can actually distort the way they perceive their own body.
Those with a negative body image may look at their body as a whole, or individual body parts, and see them differently than others. They may also feel embarrassed, awkward or ashamed about their body. They may be convinced that only other people are attractive and they never can be.
This negative body image often goes hand-in-hand with eating disorders. These persistent, negative thoughts lead them to believe that controlling their weight will improve their appearance and reduce their negative feelings about their body.
In fact, the opposite often occurs. The negative thoughts don’t lessen with weight loss and may become more intrusive and persistent.
Individuals with negative body image often find it difficult to regain control of their thoughts, but it can be done. Positive affirmations are used extensively to combat flawed perceptions. Learning to love and appreciate your body as it is now can help improve body image and replace the negative feedback loop with positive thoughts.
|Negative body image thoughts||Positive body image affirmations|
“Everyone else around me is skinnier”
“I love my unique body as it is today”
“I’ll never have the body proportions I want”
“Thank you for taking care of me, body, and for making it possible for me to do the things I love”
“Who is going to find me attractive?”
“I am allowed to take up space”
“Wearing a bathing suit is my worst nightmare”
“I am confident in my body”
Although the most attention is typically paid to young women, the reality is that many different groups of people suffer from eating disorders and negative body image. Understanding how to address symptoms and care for the different needs of varied populations struggling with eating disorders is a crucial step in providing help and support.
Although eating disorders have typically been considered a “woman’s disease,” the National Association for Males with Eating Disorders (N.A.M.E.D.) estimates that as many as 40 percent of people with eating disorders are men. The exact number of men suffering from an eating disorder is hard to estimate due to the stigma against men seeking treatment for these conditions.
Men of all ages, races and socioeconomic backgrounds struggle with many of the same types of disorders as women, the most common being anorexia nervosa, bulimia, muscle dysmorphia and binge eating disorder.
Symptoms of these eating disorders are the same for men and women, but the risk factors for men often stem from different influences or psychological pressures. Some common factors that contribute to disordered eating or exercise habits in men include:
The pressure to have a lean and fit or extremely muscular body type can leave men feeling like any other type of body is unacceptable in our society.
Men receive many cultural messages about the expectation that they be in control – be it of their emotions, their finances or their families. It’s very easy for this message to be intertwine with body image and lead to unhealthy behaviors.
Boys are encouraged and pressured to be physically strong from a very young age, even before their bodies are capable of achieving that level of strength. This can lead to negative body image and, in some cases, disordered eating and exercise habits.
Individuals in the LGBTQ community have a disproportionately higher chance of struggling with disordered eating. Eating disorders feed on stress, fear, depression, anxiety and doubt; unfortunately, all emotions and feelings that LGBTQ individuals tend to experience at a higher rate.
Factors that can contribute or lead to disordered eating for LGBTQ college students include:
Bullying and/or discrimination
Fear of rejection, particularly in regards to coming out
Internalizing negative messages
Unsafe home environments (many LGBTQ students are homeless or have experienced violent home environments)
Lack of access to eating disorder education or support that speaks directly to the LGBTQ experience
I would tell a college student that THEY ARE NOT ALONE. Eating disorders are most prevalent during the college years as students navigate various pressures from academics, relationships, etc. Please know that they are not alone in this struggle and that there are people that care about them and resources that can help. Things can be different and they do not have to suffer by themselves.
There are many pressures (especially for females) to do, be and have it all. We must look a certain way, we must achieve in a certain way, we must exercise and eat in a certain way. All of these (often unspoken) pressures build up and even though we might be succeeding, we feel like we are failing.
Students, many who might feel alone in these struggles, might isolate or withdraw and thus, not get the help them need. They are also away from parents and their direct support system and their struggles may not be identified right away, allowing the problem to persist.
A lot of time the problem didn’t just “begin” in college, but it has a set of “ingredients” that foster it to become exacerbated during this point in life. Students are trying to become more independent, they are away from their family, they have a lot of academic pressures and standards to meet, they need to make many of their own choices and be on their own for the first time … all of these factors add up into a perfect storm (combined with personality factors and our cultural pressures) that contribute to an enhanced likelihood of the development of eating disorder symptoms.
All college campuses are equipped to handle eating disorder symptoms within the student population. There are counselors at the university counseling center that can help the student identify and manage various factors that might be contributing to their struggles, and help them make some positive shifts in the way they see their body size and shape and in their emotional experiencing.
If the college counseling center is not a good fit for the student for some reason, they can also get the student connected with other, local resources.