Understanding Students with Eating Disorders

Rebecca Encao is a team lead and adjunct faculty member teaching psychology and social science courses at Southern New Hampshire University.

Chances are, if you haven’t already, you will encounter a student with an eating disorder.  By understanding more about eating disorders, we can better understand our students and be able to provide student-centered support.  A National Eating Disorders Association (NEDA) study shows that an estimated 4-10% of male and 10-20% of female college students are suffering from eating disorders, so it is possible you have even had a student with an eating disorder. 

I have worked with a number of college students who were patients in inpatient, residential, and partial hospitalization units in Denver, CO.  Some patients who were also students asked me to write letters to their professors, deans, or disability services explaining that they were in treatment.  Others, however, did not want anyone to know.  Many patients would enter treatment the day after classes ended and give a deadline to be discharged the day before classes resumed.  Sometimes, students would take a term off or take online classes for a term so they could receive treatment.  My patients often talked about wishing their instructors, advisors, and the college staff at large had a better understanding of eating disorders.

Not all students with eating disorders will admit to the challenge.  Some of them may not even realize it themselves.  It can be very difficult to determine if someone has an eating disorder without him/her providing you with information.  You may see subtle clues within a student’s work that may raise a red flag.  For example, I teach a course where students review and discuss advertisements.  One term, all of the ads one student selected were related to food.  When asked what her thoughts and feelings were about those ads, she made comments about the foods being fattening or making her feel unhappy.  With my background, this caused me a lot of concern.  I sent an email to the student and let her know what I had noticed, and I asked her if she had been screened for an eating disorder.  The student told me that she had been diagnosed with anorexia nervosa as a teenager and she continued to struggle with it.  I reminded her that there are treatment options for people with eating disorders.  While instructors are limited as to what we can ask a student to divulge, providing a student with information about supports available is permitted and can help the student.  After our conversation, the student emailed me a few weeks later and told me that she had met with a therapist to resume treatment for her eating disorder.

With so many misconceptions and confusion about eating disorders, it helps to consider some frequently asked questions.

Frequently Asked Questions About Eating Disorders

What are eating disorders?

Eating disorders refer to a set of mental health and behavioral issues combined with physical symptoms that revolve around eating and food.  Anorexia nervosa, bulimia nervosa, and binge eating disorder are the three most common types of eating disorders. 

Anorexia nervosa is the most well-known eating disorder and the one that people refer to most often when discussing eating disorders.  People with anorexia will:

• Restrict food intake and calories.
• Typically be underweight.
• Have a fear of gaining weight.
• Have a distorted body image.
• Link weight to self-esteem and self-worth.

In bulimia nervosa, a person will not restrict or count calories as a person with anorexia would.  Instead a person with bulimia will:

• Eat a large quantity of food in short period of time.
• Feel a lack of control over food and eating during an episode.
• Have recurring compensatory behaviors, called purging, to avoid weight gain.
• Purging can come in the form of vomiting, excessive exercise, laxatives, diuretics, or enemas. 

Binge eating disorder (BED) was added to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5); it was not previously recognized as an official eating disorder.  People with BED have lost control over their eating and will have the following symptoms:

• Eating despite feeling full or not being hungry.
• Eating large quantities of food at a time.
• Eating alone or in secret to avoid embarrassment.
• Eating more rapidly than normal.
• Feeling a lack of control in regards to eating.

Who suffers from eating disorders?

Eating disorders don’t discriminate.  People of all ages, genders, races, religions, and socio-economic backgrounds can develop eating disorders.  Contrary to what we may have heard or learned in school or through the media, eating disorders do not only affect women worrying about their image.  While there are women who develop eating disorders as a result of peer pressure, pressure from the media, or a desire to be more attractive, they are the minority of eating disorder patients.

Many of the patients I worked with developed eating disorders as a result of being victim to some type of trauma, such as rape or assault.  A lack of self-worth that developed as a result of the trauma led to restriction of food and a feeling of being unworthy of food or proper nourishment.  For some, the traumatic event led to feeling a lack of control.  Food intake was something the person could control, so restricting food became a way for that person to feel in control again.

I had some patients whose eating disorders developed as a result of parental influence on them as children; parental restriction of food intake on them as children resulted in them developing an eating disorder as an adult. 

Some people develop eating disorders while in a traditional, residential college.  This can be caused by the stresses of feeling out of control with a new environment or being forced to mature and be independent in a new environment.  According to a study by NEDA, anti-obesity campaigns on college campuses can be harmful to students and can contribute to eating disorders.  College athletes are at a higher risk for eating disorders due to the pressure to win and maintain a certain body weight and body image.

Many people who develop eating disorders also suffer from depression, anxiety, post-traumatic stress disorder, or other mental health issues.

Severity and Consequences of Eating Disorders

It is important to understand the severity of eating disorders and their complexity.  According to a study by Smink, Van Hoeken, and Hoek, eating disorders have the highest mortality rate of all mental illnesses.  According to the Eating Disorders Coalition, every 62 minutes someone dies as a direct result of an eating disorder.  Research published in Archives of General Psychiatry has also shown that one in five people with anorexia will commit suicide.

When someone is not feeding his/her body, every organ suffers.  This includes the brain.  A person engaged in an eating disorder is hindering his/her brain function, particularly those who are anorexic or bulimic.  Their brains are robbed of the calories and nutrients needed to function correctly.  I worked with some patients whose malnutrition led to poor decision making, difficulty concentrating, difficulty remembering things, and even dizziness and fainting.  All of this can make college success much more difficult.

Helping College Students

Having basic knowledge helps us help our students who may be dealing with an eating disorder; it can help us to understand better what they are going through and to be more student-centered.  College staff and faculty should direct at-risk students to the online wellness center. Southern New Hampshire University’s Online Wellness Center is an accessible and useful resource for all our students.

Eating Disorders Awareness Week

National Eating Disorder Awareness Week is February 25 – March 3.  This year’s theme is Come as You Are.  The goal is to send a message to people at all stages of body acceptance and eating disorder recovery that their experiences and stories are valid and to encourage them to speak out and share their stories. 

If you or someone you know is suffering from an eating disorder, there is help available through the National Eating Disorders Association.

Know the Signs

The National Eating Disorders Association website lists emotional and behavioral signs of anorexia nervosa including:

• Is preoccupied with weight, food, calories, fat grams, and dieting.
• Makes frequent comments about feeling “fat” or overweight despite weight loss.
• Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury.
• Feels ineffective.
• Has strong need for control.
• Shows inflexible thinking.
• Has overly restrained initiative and emotional expression.