For many people, college is a time of tremendous transition and change. It provides new freedom and responsibility and offers lessons in life far beyond the classroom.
It is a milestone time—and one far too often hijacked by eating disorders.
All types of eating disorders can develop, return, or worsen in young people during their college years. Though these illnesses occur across the lifespan, they are particularly prevalent between the ages of 18 and 21. Research has found that the median age of onset is 18 for anorexia and bulimia and 21 for binge eating disorder, both findings within the age range of the traditional college student.
This article examines eating disorders in college students, including potential risk factors, warning signs, and tools for screening and intervention. Learn what makes college students particularly vulnerable to these complex mental illnesses as well as ways to identify and support those affected by them during college and beyond.
Eating disorders in college students
A 2013 NEDA survey estimated that between 10% to 20% of women and 4% to 10% of men in college suffer from an eating disorder. Four of ten students have either experienced an eating disorder themselves or know someone who has. Another study of college students identified that 13.5% of women and 3.6% of men showed eating disorder symptoms.
Research also indicates rising rates of eating disorders on campus. According to NEDA, the rate of male respondents with eating disorders has risen dramatically in recent decades, as has the rate of female respondents, albeit less dramatically.
Gender minority (GM) students and college student-athletes experience particularly high rates of eating disorders.
Gender minority (GM) students
According to a 2019 study, gender minority (GM) students exhibit a significantly higher prevalence of eating disorder symptoms than do their cisgender peers. GM students had a 2–4 times higher prevalence of anxiety, depression, eating disorders, and non-suicidal self-injury (NSSI).
Similarly, a 2015 study found that transgender college students are four times more likely to suffer from an eating disorder and twice as likely to engage in purging. In this study, approximately 13.5% of transgender college students reported using diet pills, and 16% of transgender individuals had been diagnosed with an eating disorder.
Studies have shown that both female and male student-athletes are also at greater risk of developing an eating disorder as compared to non-athletes. Research suggests that the risk is particularly high for those involved in sports that emphasize body weight or shape and/or normalize disordered eating as part of the sport.
Risk factors for college students
All eating disorders are complex conditions that arise from biological, psychological, and social factors. Among the factors that may make college students uniquely susceptible to these illnesses are:
- Newfound independence and increased responsibility
- Unfamiliar environment; loss of personal space and privacy
- Living away from parents, friends, and other support people
- An abundance of food choices and food-centered activities
- Change in routine; loss of structure
- Increased workload
- Academic and financial pressures
- Desire to fit in
- Exposure to drugs and alcohol
- Fear of the “Freshman 15”
- Increased screen time with online classes
When does disordered eating become an eating disorder?
Disordered eating is normalized in our culture, and especially in college. Examples of disordered eating normalized on college campuses include:
- “Saving up” calories during the day to justify drinking or partaking in social activities in the evenings and on weekends
- Using Adderall, nicotine, energy drinks, and other appetite suppressants in place of meals
- Missing meals because of irregular sleeping patterns or feeling “too busy to eat”
Harmful in its own right, disordered eating differs from an eating disorder. We worry about eating disorders when any of the following are present:
- Is there a pattern of behaviors?
- Is there a preoccupation with food and body?
- Is there impairment?
Eating disorder signs and symptoms
Signs and symptoms of eating disorders in college students are similar to those in other groups affected by these conditions. They may be subtle and kept hidden, especially in the earlier stages of illness.
- Unusual and rapid weight fluctuations
- Fainting, fatigue, low energy, interrupted sleep
- GI discomfort, dysregulation, bloating
- Dry hands/hair or poor circulation
- Hair loss or development of lanugo
- Chest pain or heart palpitations
- For females, disruption in menstruation
- Dieting or chaotic food intake
- Preoccupation with food, weight, size, and shape
- Excessive exercise
- Frequent trips to the bathroom
- Change in clothing style (sometimes to hide or to flaunt body)
- Eating in isolation
- Severe mood swings
- Increased isolation, irritability, anhedonia
- Low self-esteem; complaints about body
- Perfectionistic tendencies
- Sadness or comments about feelings of worthlessness
- Increase of depression and/or anxiety
Screening college students for eating disorders
Eating disorders are not “phases” that pass on their own, but rather illnesses that warrant serious care and attention. The majority of people with eating disorders never receive professional support—but it is available. The earlier detection and intervention happen, the better the recovery outcomes.
Consider these steps to help identify eating disorders in the college students you treat:
1. Start the conversation.
Many young adults who meet the full criteria for an eating disorder never talked about their concerns with a health care provider. Ask all patients about their eating habits, just as you do to assess for drug and alcohol use and/or sexual behaviors.
2. Follow up with additional questions.
If you suspect that your patient may be struggling in their relationship with food, ask if you can inquire further. For example, “I’m concerned about your eating. May we discuss how you typically eat and your relationship with food?”
The following questions can help to assess the situation:
- Do you worry about your weight and body shape more than other people?
- Do you avoid certain foods for reasons other than allergies or religious reasons?
- Are you often on a diet?
- Do you feel your weight is an important aspect of your identity?
- Are you fearful of gaining weight?
- Do you often feel out of control when you eat?
- Do you regularly eat what others may consider to be a large quantity of food at one time?
- Do you regularly eat until feeling uncomfortably full?
- Do you hide what you eat from others, or eat in secret?
- Do you often feel fat?
- Do you feel guilty or depressed after eating?
- Do you ever make yourself vomit (throw up) after eating?
- Do you use your insulin in ways not prescribed to manage your weight?
- Do you take any medication or supplement to compensate for eating or to give yourself permission to eat?
- Do you exercise for the sole purpose of weight control?
- Have people expressed concern about your relationship with food or your body?
3. Refer as needed.
In this informal survey, two or more “yes” answers strongly indicate the presence of disordered eating. Refer the patient to a professional or program that specializes in eating disorders, such as The Emily Program.
Eating disorder treatment
Those struggling with an eating disorder generally need a multidisciplinary team of support, including therapy, nutritional counseling, and medical services.
Care at The Emily Program is informed by Sackett’s three-legged stool model of evidence-based practice. Incorporating research, clinical expertise, and client preferences, we aim to help individuals: