Understanding Eating Disorders in College

Eating disorders are serious medical conditions that, though treatable, can be life-threatening. The National Eating Disorders Association (NEDA) estimates that 20 million women and 10 million men in the U.S. will develop an eating disorder during their lifetime. What’s more, most eating disorders begin between the ages of 18 and 21.

While generally considered an exciting time in young adults’ lives, college can introduce new challenges and pressures that put students at risk of developing eating disorders, unhealthy eating patterns, and other mental health conditions like anxiety and depression.

Research shows that 11-17% of female college students and 4% of male students in the U.S. exhibit signs of an eating disorder.

There are many reasons why eating disorders are so prevalent among college students. Most people with eating disorders develop them due to a combination of factors.

“College is a period of development in which disordered eating is likely to arise, resurface, or worsen,” said Chelsea Kronengold, MA, an eating disorders activist and associate director of communications at NEDA. “The increased social pressure to make friends, have romantic relationships, and achieve academically, as well as the fear of the ‘freshman 15,’ are all potential risk factors for disordered eating.”

Below are some of the most common causes of eating disorders in college.

The pressure to succeed in school and maintain good academic standing can lead to increased stress, eating disorders, anxiety, depression, and other mental health conditions. According to the Anxiety and Depression Association of America, eating disorders often coexist with anxiety, and one may exacerbate the other.

Students who are susceptible to anxiety and stress are considered at risk for binge-related eating disorders. These individuals may overeat or consume large amounts of unhealthy food in an effort to alleviate their intense feelings.

Many first-year students are living on their own for the first time, without family or friends to help monitor their behavior and recognize the warning signs of an eating disorder. Young people who were previously diagnosed with an eating disorder may face additional challenges with this newfound independence and self-reliance.

Studies show that people with certain genotypes may be predisposed to developing eating disorders. According to information shared on the Anorexia Nervosa and Related Eating Disorders website, you are 12 times more likely to develop anorexia and four times more likely to develop bulimia if your mother or sister has the disorder.

In terms of personality, people with traits like obsessive thinking, perfectionism, hypersensitivity, and impulsivity tend to be at higher risk of developing an eating disorder.

Eating disorders often appear in people with low self-esteem, which stems from negative body image. By far the most common trigger for eating disorders is dieting. When people accidentally break a diet rule, they can experience guilt, leading to unhappiness with the way they look. This can trigger disordered eating.

First-year students may feel extra pressure to diet so they can avoid gaining the “freshman 15.”

Today’s media may also help perpetuate eating disorders. Many people feel influenced by what they perceive as attractive or culturally acceptable body types presented on social media and in movies, TV shows, and magazines.

American media often portrays the “ideal” body type for women as thin, which may explain why 90% of those with eating disorders are girls and women. Many of the images circulated that depict this body type are heavily edited, thereby perpetuating unrealistic expectations of physical appearance.

Some of the most common eating disorders in the U.S. are anorexia nervosa, bulimia nervosa, and binge eating disorder, but these aren’t the only eating disorders students can develop.

It’s important to note that anyone can develop an eating disorder. “Eating disorders do not discriminate. You cannot tell if a person has an eating disorder based on their age, race, gender, socioeconomic status, or even weight,” explained Kronengold.

Here are some of the most common types of eating disorders in college students.

Anorexia nervosa, or anorexia, is characterized by extreme avoidant or restrictive eating behaviors and self-induced weight loss. Underlying psychological factors may include a fear of gaining weight, an exaggerated view of one’s appearance, low self-esteem, and negative body image. In the U.S., roughly 1 in 100 women will develop anorexia at some point in their lifetime.

Long-term anorexia may cause menstrual cycles to disappear in girls and women and reduce testosterone levels in boys and men. Other health effects include anemia, heart disease, bone loss, gastrointestinal issues, low electrolyte levels, and kidney problems.

Anorexia has the highest mortality rate of all mental health conditions, and around 6% of people with anorexia die of complications. Common causes of death include suicide and heart problems.

Bulimia nervosa, also known as bulimia, entails periods of excessive eating followed by attempts to reduce caloric intake through compensatory behaviors like inducing vomiting, overexercising, fasting, and ingesting laxatives.

According to American Addiction Centers, approximately 1.5% of women (4.7 million) and 0.5% of men (1.5 million) in the U.S. will have bulimia during their lifetime. Research also suggests that 1 in 25 college-aged women has bulimia.

If left untreated, long-term bulimia can lead to severe dehydration, heart problems, laxative dependence for bowel movements, depression, and irregular menstrual cycles. One study found that the condition has a 3.9% mortality rate.

Recognized as a formal diagnosis in 2013, binge eating disorder (BED) involves excessive eating patterns accompanied by feelings of shame, guilt, and/or a lack of control. Unlike bulimia, BED does not have a purging component. As such, many people with this condition are overweight or obese.

Based on the results of a 2013 survey, around 2.8 million people in the U.S. had BED, including roughly 3.5% of women and 2% of men

Long-term BED can lead to poor productivity at work, interpersonal problems, and feelings of isolation, as well as other psychiatric conditions like depression, anxiety, and substance misuse.

Medical complications linked to chronic obesity — a common side effect of BED — include heart disease, diabetes, joint problems, gastroesophageal reflux disease, and sleep disorders. People are most likely to develop BED-related habits in their late teens and early 20s.

OSFED, a relatively new umbrella term that stands for Other Specified Feeding or Eating Disorder, is characterized by certain symptoms related to anorexia and bulimia without meeting the criteria for an official diagnosis of either condition. OSFED was previously known as EDNOS, or Eating Disorder Not Otherwise Specified.

Examples of OSFED include atypical anorexia nervosa, purging disorder, low-frequency or limited-duration BED or bulimia, and night eating syndrome.

The term is generally considered a catch-all for eating disorders that don’t fall neatly into the categories above. That said, OSFED is just as serious and considerably more common. It’s estimated that around 40-60% of people seeking treatment for an eating disorder have OSFED.

Long-term OSFED can lead to serious physical complications, such as inflammation of the esophagus or stomach, chronic constipation or diarrhea, renal failure, osteoporosis, heart problems, absent menstrual cycles, and infertility.

Orthorexia is defined as an abnormal fixation on food and healthy eating. The condition often begins with a genuine, healthy concern about maintaining a proper diet. Over time, however, people with orthorexia become preoccupied or obsessed with food quality and quantity, adhering to a rigid set of standards when it comes to daily meals.

Though not an officially recognized eating disorder, many mental health practitioners consider orthorexia a genuine mental health condition that requires treatment.

If unaddressed, orthorexia can lead to symptoms of other eating disorders, including anorexia and bulimia. Common symptoms include malnutrition, starvation, feelings of isolation, and mental health conditions like depression and anxiety.

Body dysmorphic disorder (BDD) is a psychiatric condition that entails a preoccupation or obsession with one’s appearance and perceived physical flaws. A subtype of BDD, muscle dysmorphia (MD) is when a person feels their muscular build is too small or otherwise inadequate.

For that reason, MD is often viewed as the opposite of anorexia. Whereas people with anorexia fixate on attaining a smaller physique, those with MD strive to become larger and stronger, often turning to unhealthy and destructive strategies in order to achieve that goal. MD more commonly appears in men than in women.

People who have MD often regulate their eating to unhealthy extremes by consuming too much protein or severely limiting their intake of carbohydrates and fats. Unaddressed MD can lead to complications like depression, anxiety, and substance misuse.

All eating disorders are considered treatable. According to NEDA, effective treatment of an eating disorder typically involves psychotherapy and/or psychological counseling accompanied by nutritional counseling and medical monitoring.

“Early detection, intervention, and treatment is extremely important and gives an individual the best chance of recovery [from an eating disorder],” said Kronengold.

Due to the array of underlying factors and the physical and emotional effects of different eating disorders, treatment strategies should be tailored to individual students. In some cases, medication may be a component of an individual’s treatment and recovery.

Many college students with eating disorders receive outpatient therapy. Inpatient care — either hospitalization or in-house treatment at a medical facility — may become necessary when an eating disorder results in serious physical, psychological, and/or behavioral complications.

If you or someone you know may have an eating disorder, consult a physician or mental health professional prior to seeking treatment.

Students with eating disorders should carefully research colleges before deciding where to attend. Their top-choice schools should offer a combination of counseling services, strong health education programs, and medical services geared toward students with eating disorders.

NEDA’s 2013 study on eating disorders in college surveyed dozens of colleges across the U.S. using 23 criteria points related to eating disorder prevention, awareness, and support.

Based on the study’s findings, students with eating disorders should ensure the following campus resources will be readily available to them:

Recovery from an eating disorder begins with an honest self-assessment about your habits, behaviors, and beliefs regarding the importance of weight and body image.

NEDA provides a free screening tool students can use to find out whether they meet the criteria for an eating disorder or whether they’re considered at risk of developing one.

If you or someone you know may have an eating disorder, call or text NEDA’s toll-free hotline at (800) 931-2237. In crisis situations, you can text HOME to 741741 to connect with a trained volunteer at Crisis Text Line or call the 988 Suicide and Crisis Lifeline (dial 988), available 24 hours a day, seven days a week. In case of an emergency, call 911.

If you’ve identified any symptoms or warning signs of an eating disorder, seek help from friends and family. Support systems are vital to recovery. If someone you know may have an eating disorder, learn how to discuss your worries openly without judgment.

“Be sure to address your concerns in a calm, caring, and nonconfrontational manner,” advised Kronengold. “Address specific behaviors using ‘I’ statements (e.g., ‘I’m concerned about you because you refuse to eat breakfast or lunch’) and try to avoid accusatory ‘you’ statements (e.g., ‘You have to eat something! You’re out of control!’).”

Once there’s a support system in place, you or the person you’re concerned about can begin mental health treatment from a licensed professional who specializes in eating disorders. These practitioners can help patients come to terms with their specific health concerns and form a comprehensive plan for long-term recovery.

“It is … important for people to know that if they’re struggling, they are not alone and recovery is possible with the right help and support,” said Kronengold.

Disclaimer: The information provided on this website is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment; instead, all information, content, and materials available on this site are for general informational purposes only. Readers of this website should consult with their physician to obtain advice with respect to any medical condition or treatment.