Eating Disorders In College Students: Diagnosis And Treatment

According to a study published in Psychiatry Research, the risk of eating disorders among college students rose by approximately 13% between 2013 and the 2020-2021 academic year. The same study stated that college students’ eating disorder risk rose by around 3% during the pandemic in 2020-2021. Eating disorders can affect people of any age, but young adults tend to have a higher risk of developing these disorders. The median age of onset is generally between 18 and 21, which can highlight the need to foster awareness of eating disorders among college students and their families. 

Below, we’ll look at eating disorders in college students, diagnostic criteria, and treatment options, including therapy.

Which eating disorders are common among college students?

Anorexia nervosa, bulimia nervosa, and binge eating disorder are typically the most common eating disorders among college students. These disorders may develop due to pressure among young people to maintain a certain weight or body shape, or because of the desire for a sense of control.

While many people may experience concerns about body image from time to time, in people living with an eating disorder, these concerns tend to be more intense and lead to potentially dangerous behaviors. 

To be diagnosed with an eating disorder, individuals must meet specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It may be tempting to self-diagnose, but only a licensed clinician can determine whether a person meets the criteria outlined in the DSM-5.  

Criteria for a diagnosis of anorexia nervosa

The DSM-5 also lists two subtypes of anorexia: the restricting type and the binge eating/purging type. The restricting type is primarily characterized by weight loss attempts through restricting food intake (fasting), going on diets, or engaging in excessive exercise. To be diagnosed with this type of anorexia, an individual must not have engaged in binging or purging episodes during the last three months, as these are typical of the other subtype. 

Eating disorder treatment for anorexia 

Treating anorexia may first involve medical care to curb weight loss and begin nutrition rehabilitation. Anorexia can be life-threatening in severe cases, and some people may require hospitalization. 

Treatment usually also involves therapy, which may be challenging at first, as some people living with anorexia may not accept that they have a serious disorder. Therapy may involve building self-esteem and addressing any comorbid disorders, such as depression and anxiety, for which a doctor may prescribe medication. 

Therapists may use a variety of approaches, including cognitive behavioral therapy (CBT), which typically aims to help a person identify and challenge inaccurate thoughts. Replacing these thoughts with more constructive ones may lead to fewer harmful behaviors. 

Therapists may also use approaches like dialectical behavior therapy (DBT), interpersonal therapy, or cognitive remediation therapy. Family therapy may also be helpful to educate family members on anorexia and ways to support their loved one. 

Criteria for a diagnosis of bulimia nervosa

The following are the DSM-5 criteria for bulimia nervosa:

• Frequent binge eating episodes, which can be characterized by the following:
• Eating large amounts of food in a short timeframe
• A sense that one is out of control or cannot stop eating
• Frequent compensatory behaviors to prevent weight gain, such as laxative or diuretic use, fasting, self-induced vomiting, or excessive exercise
• Binge eating and compensatory behaviors that happen at least once weekly for three months
• A self-evaluation that is inordinately influenced by the individual’s weight and body shape

Treatment for bulimia symptoms

Treatment for bulimia may involve nutrition counseling, medication, and therapy. A doctor may prescribe medication to address underlying mental health concerns like anxiety or depression, which tend to be common comorbidities with bulimia. 

During therapy, a therapist may use CBT principles to help a person identify and change their unhelpful thought patterns, which may lead to more productive behavior. A therapist may also recommend support groups for those living with bulimia.  

Criteria for a diagnosis of binge eating disorder

While binge eating disorder may seem similar to bulimia, there are some key differences. The following are the DSM-5 criteria for binge eating disorder:

• Frequent binge eating episodes characterized by eating large amounts of food in a short timeframe and having a sense of being out of control or not being able to stop eating
• Binge eating episodes that occur at least once a week for three months and are associated with at least three of the following:
• Eating more quickly than normal
• Eating past the point of fullness
• Eating alone due to embarrassment
• Experiencing guilt, disgust with oneself, or depression symptoms after the binging episode
• Distress associated with binge eating
• A lack of compensatory behavior 

Treatment for binge eating disorder

Binge eating disorder is typically treated with psychotherapy, such as CBT or interpersonal therapy (IPT). IPT is a short-term approach that tends to focus on solving current challenges. Therapists may also recommend group therapy for some college students with binge eating disorder. 

In some cases, those living with binge eating disorder may be prescribed certain medications, but this generally occurs on a case-by-case basis and must be determined by a doctor or psychiatrist. 

Doctors may also recommend nutritional supplements and counseling for college students who have experienced malnutrition as a result of binge eating disorder.

Help for college students with eating disorders and concerns about food and weight

While many college campuses have counseling centers available, some students may be hesitant to seek help on campus. In these cases, students might consider reaching out for help off-campus. 

Assistance is available for eating disorders both in person and online. For example, there are support groups for those who are experiencing concerns related to food and weight, regardless of whether they have a diagnosed disorder. 

Students may also benefit from speaking with a therapist off-campus. Those who are interested in therapy but aren’t comfortable with traditional in-office therapy might consider online therapy. 

Online therapy for binge eating disorder and other eating disorders 

Online therapy generally allows college students to connect with a licensed mental health professional from any location with an internet connection. They can communicate with a therapist by audio, video, or live chat. The latter may be more comfortable for students who prefer to communicate in writing. 

How effective is online eating disorder treatment? 

Research suggests that online therapy can effectively treat eating disorders, although some individuals may require in-person medical treatment, depending on the severity of the disorder. A 2021 study published in the European Journal of Public Health found that online therapeutic interventions usually reduced symptoms of eating disorders in participants.