College is difficult enough. Asking your body to work hard, study hard, and play hard, when your body is undernourished or compromised, makes college even more difficult. It can also make things very confusing and complicated. Often, thinking around body image can become illogical. Who we might see in the mirror may not be who the world sees. If you or someone you know has struggled with an eating disorder in the past, it is important to consider that transitioning to college can be stressful, as is any major life change. The stress from this, as with any major life change, can contribute to a relapse or reoccurrence of an eating disorder or disordered eating. The Eastern Illinois University Disordered Eating Treatment Team (DETT) understands these difficulties and complexities, working with students to improve their mental and physical health.
Many people who have an unhealthy/problematic relationship with food and poor body image, may not have a diagnosable eating disorder but are still greatly impacted by disordered eating behaviors and thoughts. Disordered eating consists of a spectrum of thoughts, feelings and behaviors associated with problem eating. On one end of this spectrum one might find concerns with body image and preoccupation with certain foods or eating habits. On the other end one might see severe caloric restriction (Anorexia Nervosa) or binge-purge cycles (Bulimia Nervosa), either of which can result in serious health problems and even death.
Preoccupation with body shape/size and eating involves frequently thinking about food, eating, and body image/shape. Here a person may find themselves thinking about what they ate at their last meal and feeling that they need to “make up for it.” A person may be a little inflexible about what they “allow” themselves to eat. There may be moments of guilt or feeling bad for what was eaten. In addition, the person may not like the way certain parts of their body look or may consistently feel that they could lose a few pounds.
Body image confidence is characterized by mostly positive feelings one’s body shape and size. In this range, the person’s body is seen as a good part of themselves. For body confident people, all foods are seen as fitting into an overall healthy diet, without feeling that some foods are “good” and some “bad.” Given the messages we all receive daily about what we “should” look like, it can be challenging to maintain this confidence. Body image is our personal view and interpretation of our body. Some signs and symptoms of a distorted body image include:
-Thinking or talking about the flaws in your body.
- Spending a lot of time in front of a mirror, obsessing about specific body parts.
- Weighing yourself frequently and judging yourself by the number on the scale.
- Refraining from enjoyable activities because you are ashamed or self-conscious about your body.
- Obsessing about food, weight, and fitness level in private and/or in public.
Some things that can help with body image are positive daily self-affirmations, wearing clothes you feel comfortable in, thinking optimistically when looking in the mirror, cutting “fat talk” out of your life, do nice things for yourself, engaging in pleasurable activities, surrounding yourself with loved ones, stop making comparisons, and staying active.
Eating Disorders most commonly refer to Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.
While disordered eating behaviors and thoughts can be viewed on a spectrum, there are three different diagnosable eating disorders:
Anorexia Nervosa is a condition that occurs when a person refuses to maintain a healthful weight resulting in a weight that is at least 15% below normal. Such individuals have an intense fear of gaining weight and view most foods as "fattening." They maintain a highly restrictive diet, often an intense exercise regime, and if they do eat, they typically follow eating with some form of purging. They often believe themselves to be much bigger and heavier than they actually are; therefore, they are unlikely to acknowledge that their low weight is a problem. Anorexia occurs in about 2% of the general population, but it is higher among college students, with some evidence that these numbers are rising.
Bulimia is described as recurrent episodes of binge eating, consuming large quantities of food in a short period of time, followed by some form of purging either by vomiting, laxatives, vigorous exercise, dieting, or fasting. The onset of Bulimia is often preceded by a restrictive diet, which many people find difficult to maintain because of hunger or because they feel frustrated with dieting itself. Although they may initially feel satisfied with being disciplined about their eating, they may also wish to be free of these restraints, especially if the expected rewards in other areas of their lives do not follow. Bingeing can then begin. When an individual feels like a failure for not sustaining their diet or when they fear that going back to normal eating will lead to weight gain, some individuals may try purging as a form of weight control. This can lead to further food restrictions and so the cycle continues.
Some people binge without purging, which is known as Binge Eating Disorder. Binge eating disorder is defined as “recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes accompanied by feelings of lack of control.” Here, a person will often consume food rapidly, feeling out of control. During a binge, the person may feel absent, unaware, or mentally checked out. A person with Binge Eating Disorder may often ignore signs of fullness and eventually may have difficulty recognizing hunger and fullness cues. A person with Binge Eating Disorder will often binge eat alone (sometimes at night) as to hide this behavior. Often, feelings of guilt, shame, or disgust follow the binge.
The Counseling Center offers individual counseling, disordered eating group therapy, and a disordered eating treatment team.
Disordered Eating Treatment Team (DETT): Upon intake at the Counseling Center, a student and their counselor would discuss the treatment team and how it may be helpful. The student can ask any questions they may have regarding the treatment team and if agreed, the student would sign a release to be a part of the team. Then a referral to health services would be sent (information regarding the student) and the student would make an appointment with a specific provider at health service. The DETT is made up of professionals from Health Services, the Counseling Center, as well as a dietician. Possible treatment options at Eastern for individuals with disordered eating are medical assessment and monitoring, individual and group counseling, dietary assessment and care, and consultation services.
The Treatment Team will attempt to make an accurate assessment of the student’s needs. Should a student arrive in a severe state and more intensive treatment is determined necessary, the student will be referred out to more extensive services that may better meet that student’s needs. During the course of treatment, if a student’s physical and/or psychological health deteriorates, or if the student is unable to keep themselves safe, the student may be referred out and others may be notified of the risk and concerns. Eastern treats disordered eating as a serious health risk and will take actions based on this belief. We have an obligation to protect the welfare of Eastern students, to make full use of resources that serve the best interests of our students, and to understand the limitations of our resources and areas of expertise.
Individual Counseling: During individual counseling at the Counseling Center, a treatment plan will be developed and formulated to meet the student’s needs. Goals will depend on the student’s symptoms and motivation, with the priority being to reduce any self-destructive habits/behaviors. An assessment called the EDI-3 may also be administered to gather more information. Psychological treatment is crucial, but needs to be done in coordination with medical, nutritional, and lifestyle goals.
Group Therapy: Besides individual counseling, participating in a therapy group can be an important step in healing body image concerns and interpersonal shame that often accompanies disordered eating. Finding validation from others who also deal with disordered eating can be an important step in regaining self-worth and making progress in treatment. Practicing newly learned skills of authenticity, assertiveness, and emotional openness within the safety of the group can be a step to using these skills in friendships and relationships outside of therapy.
Dietician: The dietician will work in conjunction with the other DETT members. A nutritional assessment will be completed by the student prior to meeting with the dietician. The dietician may explore and discuss things such as any nutrition myths that exist, basic nutrition principles, exercise habits, body weight and shape perception, hunger patterns, and estimated calorie needs. A meal plan may be developed and reviewed periodically.
What are some of the signs of an eating disorder?
1. Preoccupation with food, weight, nutrition, or dieting (talks about it a lot)
2. Frequent changes in weight or severe weight loss
3. Wears baggy, loose fitting clothes
4. Spends large amounts of time exercising
5. Faints, blacks out, has dizzy spells, difficulty concentrating
6. Fine downy hair growth
7. Isolates self; or seems sad, irritable, angry
8. Skips meals, cuts food into small pieces, or eats large quantities of food
9. Steals food, goes through food quickly, and/or has large amounts of food wrappers/containers in the trash
10. Rigid rules (what they can & can’t eat; how they work out and how long, etc.)
11. Makes frequent trips to the bathroom
How To Help a Friend or Loved One That May Be Struggling:
Consider what behavior or appearance makes you believe they have an eating disorder and bring it to their attention in a supportive manner. Keep in mind that that they may be distressed about something else which is provoking a change in their eating behavior. However, approaching a person with specific observations you have made can be very helpful and harder for a person to dismiss.
e.g. "I've noticed that you have gone to the gym every day for 3 hours at and time. I'm concerned about you," or "I think I've heard you vomiting in the bathroom after you've eaten and I'm concerned about it. Are you feeling okay?"
If the person acknowledges the behavior but denies that there is anything wrong, suggest that sometimes when people are upset over something they tend to eat "funny" or feel sick and you are wondering whether anything else may be wrong. The point is to acknowledge the behavior and suggest that something else may be provoking it. Often people are more responsive to questions about how they are feeling rather than to judgments about how they are eating.
You can then address the possibility of pursuing some counseling for their concerns; e.g. "If you are stressed about something, you may find it helpful to talk to someone about it." Planting the seed in someone's mind may be enough to encourage them to pursue counseling.
* Avoid taking charge of the person's eating behavior, monitoring their eating or purging, or spying on them. As their monitor, you are likely to be resented eventually, since you will seem to be more in control of them than they are. Avoid making comments or asking questions about how they have eaten that day such as, "Have you been ‘good’ today?" This can make a person feel more ashamed about their behavior and they will likely avoid talking with you about their difficulties any further. Don't search in private places for evidence of an eating disorder. An eating disorder is not "a crime." It is a way a person copes with how they feel. Instead, ask the person if there is anything else you can do to be of help.
* Do not focus on the person's weight or appearance especially if they bring it up. If it becomes taxing to hear their concerns, address this with them and offer to discuss other issues with them. Say it is more important to you how they think or feel rather than how they look. Avoid making such comments as, "You seem to look much better these days" or "Have you eaten yet today?" Such comments tend to reinforce the person’s sense that you are monitoring them and judging them in terms of their eating behavior and appearance and so they will continue to focus on that around you as well.
* Remember that it takes time for a person to overcome an eating disorder so be patient. The person cannot "just stop" even if you insist or plead. Focus on their accomplishments in regard to this only if they bring it up. Do not focus on their setbacks. Setbacks are part of the process of getting over the eating disorder.
* Remember that a person with an eating disorder is often moody. This is due to both the psychological and physiological consequences of eating this way. Address with the person how their moods affect you. Let them know you understand they are having a hard time but that it has an impact on others. Being aware of the effect their behavior has on others may encourage them to seek help for themselves.
* Don't interfere with a person's therapy. You may offer to help someone find a therapist or to get to one. However, therapy is a private affair. This is in order for the person to trust the therapeutic relationship. Be aware that a therapist cannot give you information regarding the client unless the client agrees. However, you are free to inform the therapist of information you think may be helpful or important regarding the person. The therapist will guide you on how best to do this.
* Remember that a person with an eating disorder often denies that there is a problem or may be reluctant to discuss it. You may never know if the person is seeking help. However, something you say may strike a person later on and they may follow up on suggestions you make. The important thing is to be patient regarding their progress. Better understanding of eating disorders can make it easier to be patient and supportive towards those you wish to help.
At the EIU counseling center, we can always take calls of concerns (consultations) and then reach out to students. We receive numerous consultations each week and this can be a great way to get students into treatment.
FOR FAMILY AND FRIENDS
Katherine Byrne, A Parent's Guide to Anorexia and Bulimia
Laura Goodman, Is Your Child Dying to be Thin?
Jane Hirschmann, Preventing Childhood Eating Problems
Michelle Siegel, Surviving an Eating Disorder
French Toast for Breakfast
Surviving an Eating Disorder