Kayla* was a 19-year-old sophomore art student who garnered the attention of her 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. She suffered a cardiac arrest in her studio at the art school on a Tuesday night and with her, her art died.
Kayla had struggled with anorexia in high school and never fully recovered, and her relapse went unaddressed in a college environment because her eating disorder bloomed and gained strength in her isolation.
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 the illness is often accompanied by distorted beliefs about food and body shape and size. Eating disorders are cunning, manipulative and self-protective making it all the more difficult for the person suffering to independently reach out for help.
According to the National Center for Education Statistics, in 2016 41% of all US adolescents aged 18 – 24 were enrolled in a college or university. This number has increased by 16% since 1970, and this shift has changed the experience of university life, including the extent and availability of student support services such as counseling centers and student health. 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 criteria for anorexia or bulimia, as many as 40% report body image concerns, weight management behaviors and out of control eating (Schwitzer & Choate, 2015). In other words, social pressures, burgeoning identity, and first tastes of independence combine to create the perfect conditions for disordered eating.
Further, western cultural idealization of a thin frame is an added complication for college students today, and while faced with these often unattainable 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, of these, NEDA reports that 35% of “normal” dieters progress to unhealthy dieting, and of those, 20-25% develop partial or full syndrome eating disorders.
Meanwhile, the landscape of college mental health has shifted considerably in the past two decades. While enrollment has exponentially increased, so has the demand for support services such as counseling, but for most universities, the demand far exceeds the available resources. For example, between 2011 and 2015, Virginia Commonwealth University’s counseling center experienced a 45% increase in the number of students seeking counseling services. The impact of this increase is significant, and while accessing college mental health is a priority, it also means that the availability of ongoing services for students is scarce. According to the Center for Collegite Mental Health (CCMH), most college counseling centers are beginning to move to a triage model of mental health and focusing their efforts on crisis intervention, brief counseling, and referral to community providers. Also according to CCMH, the average number of appointments attended by students in a college counseling center is 4.55.
Contrast this with the typical length of outpatient treatment for patients with eating disorders, for which estimates range from 30 sessions 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 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 life-long 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 symptoms of an eating disorder as quickly as possible and at the highest level of care needed likely leads to the best possible outcome for those students. Early identification through student health, residence halls as well as university counseling services are likely the best way to ensure that young people do not struggle unnecessarily.
Strategies to Support Students with Eating Disorders or in Recovery:
Educate students with a history of disordered eating/eating disorders, along with their parents and treatment teams about the risk of relapse that entering college presents.
Ensure that students with a history or current struggle with disordered eating are equipped with a treatment team (RD, MD, psych provider, and therapist) with scheduled appointments 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 ED 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 staff to know how to intervene with students who are struggling with eating concerns or body image issues.
*Name changed for privacy
Veritas Collaborative can partner with your university counseling center, providing assistance in efforts around early identification and the referral process. For more information, please contact firstname.lastname@example.org or (855) 875-5812.
About the author:
Sydney Brodeur McDonald, Ph.D., LCP is passionate about providing best-practice, research-informed and multiculturally competent treatment to patients and their families suffering from 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. Before joining Veritas Collaborative as the Senior Director of Clinical Services, she served as the eating disorder specialist and Associate Director for Training at University Counseling Services at VCU.