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
- Restricted food intake leading to a low body weight (although individuals who are not underweight may be diagnosed with atypical anorexia nervosa)
- An intense fear of gaining weight, or persistent behavior interfering with weight gain, even when a person is at a significantly low weight
- Body image disturbances, undue influence of weight or body shape on an individual’s self-evaluation, or a lack of recognition of the seriousness of their low body weight
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.
Takeaway
If you’re concerned that you or someone you love may have an eating disorder, it may help to speak with a doctor or mental health professional who can identify eating disorders using the criteria in the DSM-5. Therapy is available for eating disorders both in person and online.
Are eating disorders in college students always about food and weight?
Findings suggest that eating disorders are not always specifically about weight loss, but that some individuals can develop symptoms of ED as a way to control over a stressful environment. Disordered eating behaviors in young adults who are university students can appear due to suddenly having to deal with existing mental health conditions or mental health problems on their own, while also juggling their newfound independence, college life, maintaining a decent grade point average, and other stressors. If, on top of all of this, certain individuals also experience low self-esteem and distorted body image, they can be at risk for developing an eating disorder during their college years.
How do you help someone who has symptoms of an eating disorder?
If you notice warning signs that a loved one may have an eating disorder, the kindest thing you can do is to encourage them to seek mental health treatment. Often eating disorders develop in people under 25, with a lifetime prevalence of 9% in the US population. Early intervention can be essential for effective treatment.
When speaking to your loved one, do so with love and without judgment or blame. Let them know that you are there to support them. Offer to go with them to on-campus health services to find out more about how they can get help.
What are the risk factors for an eating disorder?
Research has shown elevated ED risk can be connected to a variety of factors. Potential risk factors can include family history of ED, existence of mental health issues such as major depressive episodes or depressive symptoms, generalized anxiety disorder or anxiety symptoms, high levels of stress, perfectionism, and trauma.
What causes eating disorders in students?
Young adult populations are at high ED risk for a number of reasons. Students struggling with already unhealthy eating habits or eating behaviors may find that when they are faced with feeding themselves in the dining halls or shopping for themselves, that ED symptoms get worse with the additional stress. Female college students or college athletes may face additional pressure to lose weight to look or perform a certain way. In addition, young college students whether away from home for the first time, or graduate students struggling toward their degree can feel that they’ve lost control of their lives in many ways, and may seek to find that control in policing their food intake, or to cope with stress through excessive eating.
How do people get an eating disorder?
According to administrative data collected from the National Comorbidity Survey Replication, eating disorders very often develop in those who already experience a mental health condition like anxiety, depression, or OCD. High stress, trauma, poor body image and existing mental health symptoms can come together in a perfect storm that may lead to symptoms of ED.
How do you know if you have an eating disorder? What are the symptoms to look for?
According to the National Eating Disorders Association, some symptoms of eating disorder to be aware of include:
- A preoccupation with food, calorie counting, dieting, and/or weight loss
- Extreme concern with body weight or shape
- Developing food rituals
- Refusing to eat foods to the point of avoiding entire food groups
- Weight fluctuations
- Fatigue
- Gastrointestinal issues
- Menstrual irregularities
What are the factors affecting eating disorders?
Risk factors for eating disorders include: genetics or biological factors, certain personality traits such as high neuroticism and perfectionism, high stress, poor body image, experiencing other mental health conditions such as anxiety or OCD, and trauma.
Who is most at risk for an eating disorder like binge eating?
Eating disorder demographic characteristics include all genders, ages, races, religions, ethnicities, and body shapes with lifetime prevalence estimates at 9% of the US population. Current findings highlight that younger people are at higher risk of developing eating disorders, and while females are still affected more frequently, male risk for ED continues to grow.
What does eating disorder treatment involve?
Treatment of eating disorders often requires a comprehensive team approach. Doctors and nurses supervise medical services, while a psychologist or other mental health professional oversees psychological and emotional care. A registered dietician offers nutritional counseling, and the patient may also attend support group meetings or family therapy as well.
How can we prevent eating disorders?
Statistical analysis of data collected from screening university students, as well as from student’s completed online surveys, found that a statistically significant number of those in college suffer from disordered eating but find it difficult to access care. Education is one of the most essential tools for preventing eating disorders. Catching disordered eating early can help to change unhealthy thinking before it becomes behavior, or changing behaviors before they become ingrained. A new screening tool called the SCOFF questionnaire is a simple way to determine whether behaviors point to disordered eating.
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