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Why Do Some Develop Eating Disorders in College and What are Effective Treatments?

Olivia Steinberg

April 27, 2011




Introduction to the different eating disorders and DSM IV diagnostic criteria

            It is important that individuals have a strong understanding of the many different eating disorders and each of their diagnostic criteria’s. This paper will focus on three types of eating disorders: anorexia nervosa, bulimia nervosa, and EDNOS (eating disorder not otherwise specified). provides information on the diagnostic criteria for each of these three eating disorders. Anorexia nervosa is classified as the unwillingness to maintain body weight at or above the minimum normal body weight typical for one’s height and weight, females never getting their periods, also known as amenorrhea, extreme apprehensiveness of weight gain, despite being too thin, and disturbances in the way that one views or perceives their own body. There are two subtypes of anorexia nervosa: restringing type, which is when one does not engage in binge-eating or purging behavior and binge-eating/purging type, which is when one does engage in binge-eating or purging behavior.

            The DSM IV criteria for bulimia nervosa includes eating more in a discrete period of time than one would under the same circumstances, a feeling of lack of control over what one eats, engaging in compensatory behavior, a self-evaluation that revolves around one’s body, and a requirement of binge eating and compensatory behavior occur at least two times a week for three months. There are two subtypes of bulimia nervosa, purging type and non-purging type. Purging type is when one engages in behaviors such as vomiting or uses laxatives, enemas, or diuretics. Non-purging type is when one uses other compensatory behaviors, such as over-exercising, but does not vomit or use laxatives, enemas, or diuretics.

            The DSM IV criteria for EDNOS is meant to diagnose individuals whose behaviors do not fall under the specific criteria of anorexia nervosa or bulimia nervosa, but clearly still have an eating disorder. The criteria includes the same criteria as anorexia nervosa, however females get their periods and may meet the normal weight requirement for their age and height, the same criteria as bulimia nervosa, however frequency of behavior does not last at least twice a week for three months, the use of compensatory behaviors after eating a small amount of food without swallowing it, and finally, engaging in binge-eating episodes without using compensatory behaviors. While the diagnostic criteria’s for eating disorders are complicated, it is still vital that they are recognized before one can fully understand any other aspect of eating disorders.


Groups effected the most

            Eating disorders are most frequently found in Westernized societies. Around 90% of individuals diagnosed with anorexia nervosa and bulimia nervosa are women, and only around 10% are men. Within “the female population, approximately .05% of women will be diagnosed with AN and 1% to 3% will be diagnosed with BN” (Phillips, Pratt 2005), and more will be diagnosed with EDNOS. Phillips and Pratt state that college students, athletes, dancers, dietetic students, and models are all groups that face high risks of developing an eating disorder. They also state that the rates of eating disorders are relatively consistent across races and ethnicities, however occur at a lower frequency among African American women (2005).


College as a trigger

            “Eating-related problems”, explain Schwitzer, Bergholz, Dore, and Salimi, “are a very prevalent problem on college campuses”. They continue to explain that eating related problem can include “body image dissatisfaction, weight preoccupation, and unhealthy weight management” (1998). Despite all of these eating-related problems, eating disorders are the most perilous to one’s health.  According to Wright and Hanson, “college females are a high-risk group for developing eating disorders” (1997). Phillips and Pratt explain that the issues involving “emancipation, individuation, and intimacy” (2005) all contribute to possible explanations as to why eating disorders are so prevalent among college students. While only 1%-3% of college women have eating disorders that are diagnosable (other studies have reported numbers that are much higher), up to 10%-30% of college women are at risk of developing an eating disorder throughout their years in college (Franko et. al. 2005).

            There are multiple theories of eating disorders, many having to do with family relationships. Kenny and Hart conducted a study and found that having a “positive and emotionally supportive parental relationship, in conjunction with parental fostering of autonomy, is inversely associated with weight preoccupation, bulimic behavior, and feelings of ineffectiveness” (1992). In addition to this, “secure parental attachments” among college students “were found to be positively associated with measures of social competence, psychological well-being, and career development” (Kenny, Hart 1992). Feeling socially competent and having a positive career development decreases stress levels and raises confidence levels, both of which decrease the risk of an individual developing body dissatisfaction or an eating disorder. Also, not being preoccupied with weight allows individuals to develop a sense of self esteem that revolves around other factors than just their body. Some researchers, however, have found fault with this theory. They hold that adolescents who are too securely attached to their family have a hard time building meaningful relationships outside of the family, which lead to problems when they enter college and are living apart from their family. They argue that these problems will cause individuals to develop low self esteem once they enter college, which may result in an eating disorder.


Realistic prevention and treatment options for college students

            Making sure that colleges provide support as well as treatments for their students who have eating disorders is extremely important. Many students, especially students who attend residential colleges, are not around their family and old friends who would be the most likely to notice early signs of an eating disorder as well provide that person support so that it never develops into something more serious. For these reasons, it is vital that colleges provide easily accessible treatment programs that focus on both primary and secondary prevention. “Primary prevention is the prevention of new cases from arising, so it is aimed at healthy individuals. Secondary prevention is the reduction of the duration of a disorder by detecting it early and treating it early. Secondary prevention is aimed at people who are in the early stages of an illness” (Wright, Hanson 1997).

            According to Wright and Hanson, all eating disorder treatment programs use an information-giving strategy. This strategy is effective because it provides individuals with  a strong understanding of the different types of eating disorders which often cause a change in attitude among individuals. A change in attitude is the first step to creating a change in one’s behavior. Unfortunately, studies have proven that sometimes this information-giving strategy introduces individuals to a behavior and causes them to engage in it (Wright and Hanson, 1997). However, this is not the first time a typical college student is presented with the concept of an eating disorder, so the information-giving strategy is more beneficial than harmful in most cases. The majority of secondary prevention programs emphasize the importance of influencing individuals who feel that they may be developing an eating disorder or having another episode of an eating disorder to seek help before the eating disorder becomes out of control.

            There are many different types of specific treatments of eating disorders. Philips and Pratt state that “in the college community, most eating disordered students are psychologically and medically stable enough to show symptom reduction or remission through weekly psychologic treatment combined with some form of nutritional counseling, medical monitoring, and when warranted, psychotropic medication” (2005). Psychological therapy is a widely known and used way of treating eating disorders. One complication that often effects the efficiency of psychological therapy is “patients’ ambivalent attitudes about recovery” (Wilson, Grilo, Vitousek, 2007). Because individuals with eating disorders have such disturbed views of their bodies, they often do not realize how thin they are and therefore do not feel the need to gain any weight. Nutritional counseling is also a widely used treatment because it teaches individuals the proper amount of food that should be eaten for their age and height and informs individuals about how to eat healthy. Lastly, medication can be used to treat other symptoms that are associated with eating disorders. Fore example, people with eating disorders often have high levels of anxiety. These individuals might benefit form taking an anxiety medication which may reduce eating disorder symptoms.

            As long as there is a hospital in close proximity to one’s college, intensive outpatient programs are also an option for students with more severe eating disorders. This is often a good option because it “allows students to continue with their college courses but receive intensive treatment approximately 4 hours per day for 8 to 14 weeks” (Philips, Pratt 2005). According to Walshe, Wheat, and Freund, outpatient treatments are most effective for patients who are motivated to change their problem behavior (2000). These patients must be proactive about their treatment, rather than fight or resist it, as eating disorder patients often do. The exact treatment plans and specific goals must be explained to the patient, so that they can work together with the doctors in order to achieve the desired outcome.

            Hospitalization, or an inpatient program, is the most severe option for treating eating disorders. This treatment option is typically only used for college students when the student is too “medically or psychologically  unstable” (Philips, Pratt 2005) to function or participate normally in their daily lives and to show a reduction of symptoms from the other two less intense forms of treatment. While this option is expensive and limiting, it is often the only way for an individual to get better. Colleges need to be, and usually are, very accommodating of students who need to be hospitalized in order to receive appropriate treatment and care. Colleges and professors are usually willing to work together with the patient, doctors, and the patient’s family in order to create an adjustment on either the student’s workload or schedule (Philips, Pratt 2005). For some, taking a semester off from college is often the best and only option.



            Eating disorder prevention is very important, especially on college campuses. Many people face new challenges and stressors once they enter college which may lead to a low self image and possibly an eating disorder. Spreading awareness and knowledge about the different eating disorders and the dangers of eating disorders is essential if colleges want to promote a healthy body image on campus. Colleges should also include parents and family members in prevention programs because of the large role that family plays in helping a child to have a confident self-image which decreases the risk of developing an eating disorder.     

            From my research, it can be gathered that there is not one most effective type of program for treating eating disorders. The amount of success an individual will have with each treatment depends on the severity of the eating disorder, the individual’s personality, and the individual’s life circumstances. For example, if an individual is just starting to develop an eating disorder so it is not in a very advanced stage, the individual is motivated to change, and the individual is a college student with no access to a hospital nearby, I would conclude that the best treatment option for this patient would be psychological treatment and nutritional counseling. If a different individual has an eating disorder that is in a very advanced stage and it is greatly affecting his/her life, the individual is not motivated to gain any weight, and the individual is a college student with no access to a nearby hospital, I would suggest that the best treatment program for this patient would be inpatient program at a hospital. The most important conclusion that can be made from my research is that different individual cases of eating disorders, especially among college students, call of different treatment programs. All individual cases are so different from one another which is why it is so important for colleges to offer or make accessible all of the different treatment programs.




Works Cited


Franko, D., Mintz, L., Villapiano, M., Green, T, Mainelli, D., Folensbee, L., Butler, F., Davidson,            M., Hamilton, E., Little, D., Kearns, M., Budman, S. (2005). Food, mood, and attitude:             reducing risk for eating disorders in college women. Health Psychology 24(6), 567-578


Kenny, M., Hart, K. (1992). Relationship between parental attachment and eating disorders in an         inpatient and a college sample. Journal of Counseling Psychology, 39(4), 521-526


Phillips, E., Pratt, H. (2005). Eating disorders in college. Pediatric clinics of North America,



Schwitzer, A., Bergholtz, K., Dore, T., Salimi, L. (1998). Eating disorders among college          women: prevention, education, and treatment responses. Journal of American College         Health, 46(5), 199-207


Walshe, J., Wheat, M., Freund, K. (2000). Detection, evaluation, and treatment of eating   disorders: the role of the primary care physician. Journal of General Internal Medicine,        15(8), 577-590


Wilson, G., Grilo, C., Vitousek, K. (2007). Psychological treatment of eating disorders. The           American Psychologist, 63(3), 199


Wright, A., Hanson, K. (1997). Are two interventions worse than none? Joint primary and   secondary prevention of eating disorders in college females. Health Psychology, 16(3), 215-225





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