How to Handle Anorexia Nervosa While Attending College

Starting and attending college can be both the best of times, and the worst of times for an individual suffering from Anorexia Nervosa: the best of times for their illness, and the worst of times for the actual person.

Sudden independence, the stress of on-campus dining, various social pressures, and not knowing how or where to seek help can contribute to increased struggles with this illness on a college campus.

Paying attention to warning signs, seeking help, and normalizing food and exercise behaviors to healthfully fit a college atmosphere and lifestyle are vital to appropriately managing anorexia.

college student studying

I can do whatever I want? Oh yeah!…

Until college, most students have been living at home with their families who see them every day. A person might have disordered eating and abnormal exercise patterns throughout their adolescence, however, it may be mistaken for “healthy” or “picky” eating or masked by competitive sports and athletics.

Being away from home for the first time, and only seeing family during school breaks, can allow the severity of symptoms to increase before being noticed.
Major life transitions are exciting but can be very stressful.

“Good” stress and “bad” stress?

Though stress is “good” stress, your body does not recognize the difference between “good” stress, and “bad” stress; stress is stress. Stress and anxiety burn a lot of energy, and therefore require more calories to be consumed.

A college student without eating disturbances will tend to naturally increase their food intake during times of stress, whereas their peer with anorexia will likely do the opposite – decrease food intake.

Almost 50% of individuals with anorexia suffer from depression/anxiety disorders as well, which increases their risk of isolative behaviors [1]. Isolating can be a harmful behavior, especially in a college atmosphere, making it easy to restrict, exercise at the free access gym, and go unnoticed in a large community where people do not know one another.

Additionally, because most people in society misunderstand this illness, individuals suffering from anorexia have the opportunity to be very secretive and suffer in silence.

Why are there so many choices?…

Identifying where to dine on a college campus can be anxiety-provoking for any student for a variety of reasons:

  • There are a wide variety of choices
  • Navigating campus-scattered dining hall
  • Having to eat alone frequently
  • Crowded dining areas
  • Waiting in line for each meal
  • Chaotic and inconsistent schedules
  • “Eating out” for every meal

This is particularly anxiety-provoking for an individual with anorexia, and they can feel a true sense of loss of control. The stressors that the on-campus dining environment presents can be yet another facilitator of isolative behavior, increased restriction, and a gateway to other unwelcomed anorexic behaviors.

cafeteria line with carbs

Who are all of these people? What do they think of me?…

College can be a very competitive environment, and being the “new man on campus” can be both exciting and intimidating at the same time. A study revealed that 58% of female college students felt pressure to be a certain weight [2], and another study revealed that 91% of women on a college campus have attempted to control their weight through dieting or exercise [3].

Anorexia possesses a competitive component regarding body image that causes sufferers to notice and compare themselves to the body types of others. This mindset often leaves the individual feeling insecure and disconnected from their social environment.

Balancing act…

Students with anorexia should be appropriately involved on campus, but also need to be aware of over-involvement, which can lead to being “too busy” to eat. The social pressure to drink can be both difficult to manage and very dangerous if anorexia is not well-treated.

A rising phenomenon on college campuses referred to as “drunkorexia,” is an issue being seen more frequently in the college-aged eating disorder population. This involves restricting caloric intake throughout the day in order to avoid weight gain from drinking alcoholic beverages heavily at night.

students in a classroom

Encouraging a new way of thinking about food and activity

There is hope! Using an “all foods fit” paradigm that “legalizes” all food groups and allows for flexibility and food trust. This method is utilized to help the individual learn how to:

  • Appropriately portion foods to meet their individual needs
  • Include a variety of foods in their daily diet
  • Steer away from having a “good foods/bad foods” mindset

Meeting with a specialized treatment team (licensed therapist, registered dietitian, and psychiatrist), can help with anxiety management, learning how to piece meals together, expanding variety, and ensuring health and nutrition.

Encouraging the individual to think about activity differently is also helpful. Avoiding the school gym and instead utilizing walking to and from class, and/or intramural sports can be better alternatives for body movement. These forms of activity tend to be less compulsive and encourage social interaction.

So, what can you do if you or if you suspect someone you know is struggling with anorexia or an eating disorder at college?

  • Do not wait to seek help. Tell someone immediately: your residence assistant, a trusted teacher, student health, or your doctor on campus or at home.
  • Do not try to fix it on your own. Treatment of this illness involves a specially trained team of professionals including a psychiatrist, licensed therapist, and registered dietitian.
  • Look for support groups on campus, in town, or in surrounding towns.
  • Spread awareness: most college campuses have an eating disorder awareness group, and if your college does not, start one!

Contributed By: Claire Gish, MS, RD/LD of Laureate Eating Disorders Program

1. Mortality in Anorexia Nervosa. American Journal of Psychiatry, 1995; 152 (7): 1073-4.

2. National Association of Anorexia Nervosa and Associated Disorders. “Eating Disorders Statistics.” ANAD. Accessed July 22, 2014, disorders/eating-disorders-statistics/.

3. Kurth CL, Krahn DD, Nairn K & Drewnowski A: The severity of dieting and bingeing behaviors in college women: Interview validation of survey data. Journal of Psychiatric Research. 1995; 29(3):211-25.

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