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Attending college is a significant milestone, offering new freedoms, a sense of independence, and new responsibilities. However, with change, there are challenges.
For many college students, that new way of life also includes new food routines, performance stress, appearance-focused culture, college parties, and the lack of structure in dorm living.
And for those in recovery from bulimia nervosa (BN) or other eating disorders, these shifts can be especially tricky, and potentially trigger disordered eating behaviors.
But if you’re in eating disorder recovery, there are ways to maintain your progress while still getting the best out of the college experience.
Bulimia Risk Factors in College
Bulimia in college dorms may be more common than people think, with research finding the condition showing up more prevalently in college women living in group housing, such as dorms, on campus. 
That connection may have something to do with a number of potential risk factors that commonly show up in a college setting.
The dining hall may be one of the most challenging aspects of campus life for someone recovering from BN, thanks to their unlimited access to a huge variety of foods, including those that may be associated with binge eating.
The free-for-all atmosphere of these areas may also cause anxiety, especially if someone previously had rigid behaviors or rules around food. This could lead to food avoidance and/or restriction, along with other disordered thoughts and behaviors.
Most college students experience pressure from their peers to drink alcohol or attend parties at some point. But the partying lifestyle can be a slippery slope for someone in BN recovery.
At many college campuses, a condition called “drunkorexia” is reportedly on the rise. The condition involves the use of purging behaviors, such as self-induced vomiting, excessive exercise, and extreme food restriction, to compensate for the extra calories consumed through binge drinking, increase the intoxicating effects of alcohol, or both. 
And much like recreational drug use, which also often happens at college parties, drinking loosens inhibitions, which can make it difficult for someone trying to walk the already challenging path of recovery to maintain their focus and positive habits.
Pressure to Fit In
Like many subsets of people, college students may feel particular pressure to maintain a certain body image, particularly to help them fit in with peers or find new friends or romantic partners.
Among younger students, the “freshman 15,” a nickname for the weight first-year students may gain from the combination of new food routines, freedom, and partying, can be an especially big concern. Previous reports showed that the pressure to lose or keep this weight off was particularly high among college freshmen hoping to rush a sorority. 
And it’s not just women who feel the pressure to achieve the perfect body. Another study found that college men who felt dissatisfied with their muscularity and body fat were more likely to report restrictive eating behaviors, a preoccupation with body size, and the use of steroids. 
While college may be an exciting time, it’s also one often marked by stress, from the pressure to find friends, to managing one’s own time, most likely for the first time, and maintaining good grades and a heavy workload. And these increased stress levels can lead to the development of anxiety and depression. 
Depression and anxiety have both long been linked to low self-esteem, poor body-image and disordered thoughts and behaviors around food. And studies show that students with depression or an anxiety disorder are more likely to struggle with an eating disorder or disordered eating behaviors. 
Tips for Maintaining Bulimia Recovery in College
Between the stress, the new lifestyle, and the distance from parents or a regular support network, it can be a particular challenge to stay away from eating disorder behaviors in a college environment.
But if you’re a college student who’s going through BN recovery, there are some tips that can help you keep your healing journey on track.
Make a Plan
Applying for, getting into, and moving away to college are all in-depth processes that take no small amount of planning to achieve. Likewise, maintaining your recovery effort once you arrive at college can also benefit from some forethought.
Strategies to help you stay accountable to your recovery without your usual support network will be a key part of transitioning to a college environment.
When coming up with your plan, make sure to consider not only all the factors that may help your recovery continue as smoothly as possible, but all the resources you would have available, should you want more help on campus, such as:
- Contact information for mental health support services on campus
- Information on any eating disorder support groups, therapists, or dietitians local to campus
- A list of people you can call when you’re in distress or need a little extra support
Talk to Your Treatment Team
Your treatment team will be able to help you make a plan and connect you with eating disorder specialists close to your college campus.
Once you find out more information about the food options available on campus, your treatment team can also help you create a meal plan. This can help ensure that you continue meeting your nutritional needs and avoiding potentially triggering foods, while giving you the assurance of a plan, which can also help alleviate anxiety.
You may also want to arrange with your treatment team a way to stay in contact while you’re away at college, whether through continued in-person check-ins or telehealth appointments.
Manage Your Triggers
A trigger can be anything that challenges your recovery, from hearing someone talk about calories or losing weight, to encountering foods that may have previously given you trouble, to skipping meals during particularly busy times.
Managing triggers is one of the most difficult aspects of maintaining recovery. Depending on the type of therapy you participated in to help you overcome your eating disorder behaviors, you may have learned several types of coping mechanisms, and practicing these in times of stress is particularly important.
If the triggering situation is coming from a friend, peer, or even professor, you can also ask them not to talk about that subject or participate in that activity around you. They may not know that what they’re doing is upsetting to you. But setting and maintaining healthy boundaries is another important part of sustained recovery.
Be Kind to Yourself
College can be hectic, but taking some time for self-care can help you find relief from stress or anxiety, and even help boost your self-esteem.
Try to make some time for yourself every day, to participate in something that will help you feel good or help you relax. Anything from taking a walk to having a coffee at your favorite coffee shop or writing in your journal can help.
And most college campuses also host a number of activities that can help bring you joy, such as mindfulness or meditation events, volunteer opportunities, or clubs dedicated to something you’re passionate about.
The more time you spend in college, the more opportunities you’ll have for making friends and forging the kind of connections that can help you stay grounded and accountable. But even before that point, there is always support for you on campus.
If you’re struggling with a situation that is harmful to your recovery, you can reach out to your RA, counselors at the campus’s health or wellness facility, or other school staff members.
You may also want to consider joining a support group for eating disorders. This doesn’t have to be a campus- or college-run group, but it could still be helpful to be in touch with a nearby community of people going through similar experiences.
What to Do if You’re Worried About Relapsing
If you’re worried that the pressures of college may increase your risk of a relapse, there are some steps you can take to help offset that risk, and some considerations you should keep in mind to stay ahead of the situation.
Know the Signs
Relapse can occur at any time during the recovery journey. Still, there are some common indicators that you may be at risk of relapsing, including:
- A preoccupation with weight. This could manifest as weighing yourself frequently, regularly checking yourself in the mirror or hiding from mirrors, assessing the weight of others, or talking about your weight and physical appearance.
- Unhelpful thoughts around eating and food. You may find yourself being preoccupied with food, thinking about forbidden foods, or worrying about the calorie content of foods. You may start becoming secretive about food, prefer to eat alone, or limit the amount you eat.
- Negative self-talk. When you’re struggling in your recovery, you may start to tell yourself that you’re unattractive, unlovable, or deserve to be alone. You might start berating yourself about your food choices and behaviors. A key warning sign of bulimia nervosa relapse is that the majority of your self-perception is negative.
What to Do After a Relapse
Relapses are a common part of recovery. What matters more than the fact that a relapse happened is how you respond to it.
The most important thing is to not let the situation defeat you, or take away from all the hard work you put into your recovery effort. Some other tips for dealing with these situations include:
- Acknowledging that the relapse occurred and practicing self-compassion
- Reaching out to your treatment team or support network for help
- Figuring out what contributed to the relapse, and thinking about more positive ways to manage a similar situation in the future
- Identifying the skills and coping strategies you have learned that could help you get back into a healthier recovery rhythm
Put Your Recovery First
If you do relapse, you may want to consider going back into treatment. While a few booster sessions may be enough to get you back on track, it may be necessary to put your schooling on hold so you can get some more intensive treatment.
Your college will be supportive and accommodating if you need to take a break to address your eating disorder, so you can return to your studies once you feel your recovery is in a better place.
Dealing with an eating disorder is a difficult and often long-term responsibility, but with some help and self-love, it’s possible to maintain recovery, and enjoy every stage of life in a healthy way.
- Drewnowski A, Hopkins SA, & Kessler RC. (1988). The prevalence of bulimia nervosa in the US college student population. American Journal of Public Health, 78(10):1322–1325.
- Drunkorexia 101: Increasing alcohol’s effects through diet and exercise behaviors. (2016, June 27). ScienceDaily. Accessed May 2023.
- Moore A. (2012, July 16) Prepping students for sorority rush. New York Times. Accessed May 2023.
- Grabmeier J. (2006). Pressure To Be More Muscular May Lead Men To Unhealthy Behaviors. University of Ohio. Accessed May 2023.
- Muniz H. (2022, January 19). Understanding eating disorders in college. BestColleges.com. Accessed May 2023.
- Eisenberg D, Nicklett EJ, Roeder K, & Kirz NE. (2011). Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. Journal of American College Health, 59(8):700–707.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published July 5, 2023, on EatingDisorderHope.com