This article was written by Victoria Cane, Ph.D, LP, a member of SMEDA. She is a licensed psychologist with a focus on treatment of eating disorders and emotion-regulation disorders for over 10 years.
Eating Disorder Symptoms and the Transition to College.
As an eating disorder treatment provider working with clients who are transitioning to college, my first thoughts aren't always welcome ones. If someone is struggling with symptoms like inability to sustain weight or general management of nutrition, or has not achieved abstinence from behaviors like bingeing/purging, it is hard to give support to taking on something as stressful as leaving home to start college life. And it is stressful. I recall my first semester at NYU and I'm really proud I made it through. There were times I wasn't sure I was going to. There was just so MUCH to take in and acclimate to. I had no idea I would become a psychologist back then (my major was drama) but I do recall the girl I met during that first week and being truly baffled that she would consider broccoli and a gallon of diet coke to be dinner when there was so much else to choose from at the cafeteria.
Parents/loved ones of those who have struggled with an eating disorder often find themselves paralyzed at the thought of not supporting the move to college. After all, it represents growth, progress, a natural next step in life development. My point as a provider, however, is that some of those growth markers, both literal and figurative, need to be in place first. This is where full participation in recovery-oriented treatment is so important. Although one study indicates that the transition doesn't necessarily trigger the onset of symptoms (the study found that most eating disorder symptoms were present before college), it also found that body image disturbance may worsen and symptoms were certainly not helped (Vohs, 2001). One on-line resource very clearly calls for symptom absence before transitioning.
Assuming that the student has indeed engaged in their own recovery and symptoms are not acute at the time of transition, I begin to talk about transition management, including: finding mental health and medical resources beforehand and signing appropriate releases, identifying ways of staying accountable including weight checks if applicable, identifying other potential supports like student groups, and have a solid plan for what we call "cope-ahead" strategies; that is, rehearsing stress management skills before they are needed. We may also make a plan to check in and/or return to regular contacts when the student is on break.
In the type of therapy I rely on most often in the treatment of eating disorders, Dialectical Behavior Therapy (DBT), the provider hopes and "shoots" for the desired outcome at all times, while simultaneously being prepared for and helping the client prepare for set-backs. We do not "expect" set-backs, but should they occur, we make every attempt to correct them as quickly as possible. When a client leaves for college I wish them well and cheer for them. I think of them as fall gets colder, and I hope they are okay. Should they need to take a break to focus on health, and they seek my help, my immediate questions return to "what are the goals?" and "what is needed for recovery?"
On-line resource: http://www.mirror-mirror.org/transitioning-to-college.htm
Anonymous. (2012). Life Transitions May Trigger Eating Disorders. U.S. News and World Report. Retrieved September 18th 2013 from: http://health.usnews.com/health-news/news/articles/2012/04/25/life-transitions-may-trigger-eating-disorders
Strober, M., & Johnson, C. (2012). The Need for Complex Ideas in Anorexia Nervosa: Why Biology, Environment, and Psyche All Matter, Why Therapists Make Mistakes, and Why Clinical Benchmarks Are Needed for Managing Weight Correction. International Journal of Eating Disorders, 45, 155-178.
Vohs, K.D., Heatherton, T.F. and Herrin, M. (2001), Disordered eating and the transition to college: A prospective study. Int. J. Eat. Disord., 29: 280-288. doi: 10.1002/eat.1019