Eating Disorders in College Students: Warning Signs and How to Help

Each year, National Eating Disorders Awareness week shines a spotlight on eating disorders and educating the public. TimelyCare supports the mission of this week promoted by the National Eating Disorders Association (NEDA) to spread a message of hope, while putting resources into the hands of those who might be struggling with eating disorders.

What is an eating disorder?

Eating disorders are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes and weights. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. Although eating disorders can affect anyone, they are most often reported in adolescents and young women.

There are many reasons why eating disorders are prevalent during the college years. Most eating disorders begin among young adults between the ages of 18 and 21. Thirty-five percent of young people who diet escalate to pathological dieting, and 25% of them develop partial or full syndrome eating disorders. The increased workloads, reduced structure and focus on peers that comes with college life collide with mental health issues like anxiety, learning problems or poor self-esteem. Eating disorders develop when the need to feel control over a stressful environment is channeled through coping mechanisms like food restriction, eating large amounts of food, excessive exercise and an unhealthy focus on body weight.

What causes an eating disorder?

Environmental factors play a role. Many college students are living on their own for the first time, without parents to monitor their behavior or recognize eating disorder warning signs. Young people who have already been diagnosed with a mental illness or eating disorder face additional struggles with this new-found independence. Dining halls typically serve food in buffet-style settings and many of the available foods are unhealthy. Both of these factors can be triggers for students who are prone to binging food. Student-athletes with a history of eating disorders may also be at risk for excessive exercise, and the communal living environment can lead students to develop negative body image issues.

Another factor is genetics. Studies involving twins who were separated at birth and adopted by different families provide some evidence that eating disorders may be hereditary. This type of research shows that if one twin develops an eating disorder, the other has, on average, a 50% likelihood of developing one as well.

Personality traits are another cause. In particular, neuroticism, perfectionism and impulsivity are three personality traits often linked to a higher risk of developing an eating disorder.

Other potential causes include perceived pressures to be thin, cultural preferences for thinness and exposure to media promoting such ideals. In fact, certain eating disorders appear to be mostly nonexistent in cultures that haven’t been exposed to Western ideals of thinness.

More recently, experts have proposed that differences in brain structure and biology may also play a role in the development of eating disorders. In particular, levels of the brain messengers serotonin and dopamine may be factors.

What are common symptoms?

A college student struggling with an eating disorder generally won’t have all the signs and symptoms listed below at once, and the warning signs vary across eating disorders, as well as disordered eating.

This list is intended as a general overview of the types of behaviors that may indicate problems that needs to be addressed:

• Behaviors and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns
• Preoccupation with weight gain, food, calories, carbohydrates, fat grams and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates)
• Appears uncomfortable eating around others
• Food rituals or out-of-the-ordinary eating habits (e.g., only eats a particular food or food group, excessive chewing, doesn’t allow foods to touch)
• Skipping meals or taking small portions of food at regular meals
• Any new practices with food or fad diets, including abruptly cutting out entire food groups (e.g., no sugar, no carbs, no dairy, vegetarianism, veganism)
• Withdrawal from usual friends and activities
• Frequent dieting
• Extreme concern with body size and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Extreme mood swings
• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (e.g., constipation, acid reflux)
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives.
• Difficulties concentrating
• Abnormal laboratory findings (e.g., anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
• Dizziness, especially upon standing
• Fainting, syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints — a result of inducing vomiting
• Dental problems (e.g., enamel erosion, cavities, tooth sensitivity)
• Dry skin and hair, brittle nails
• Swelling around salivary glands
• Fine hair on the body (lanugo)
• Cavities or discoloration of teeth from vomiting
• Muscle weakness
• Yellow skin — eating large amounts of carrots
• Cold, mottled hands and feet, or swelling of feet
• Poor wound healing
• Impaired immune functioning

Symptoms may vary according to the type of eating disorder: anorexia nervosa, bulimia nervosa, binge eating disorder, otherwise specified feeding or eating disorder (OSFED), avoidant restrictive food intake disorder (ARFID), PICA, rumination disorder, orthorexia, compulsive exercise, diabulimia, etc. More information on each of these eating disorders can be found on the NEDA website.