Do you know the difference?
Have you ever skipped a meal because you felt like you were “at your calorie limit” for the day. Maybe you choose to run an extra mile because you ate a little too much the night before. These are known as disordered eating habits… and college students are far too familiar with them. In a study done by the National Eating Disorders Association (NEDA), diagnosable eating disorders begin between the ages of 18 and 21. NEDA estimates that 10-20% of women and 4-10% of men in college suffer from an eating disorder.
Prevalence in College Students today
Eating disorders are a huge concern in college students in the United States today. Clothing and workout trends have become huge factors that affect the number of students who suffer from eating disorders. You might be asking yourself, “What is an eating disorder anyway?”. According to the American Psychiatric Association, eating disorders are “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions”. Anorexia, bulimia, and binge eating are most prevalent in college students today. On average, 4.2% of adolescents suffer from anorexia nervosa, 3% of adolescents suffer from bulimia, and 2.8% of adolescents suffer from binge eating. On top of that, many eating disorders develop into more severe disorders once the body has adapted to the trauma, making it much harder to recover.
How are these disorders diagnosable?
You might be wondering how these disorders are diagnosable if they are so subjective. The Diagnostic and Statistical Manual of Mental Disorders creates a standard for these disorders. There are currently two versions of this document, the DSM-IV and the DSM-5 (updated in 2013). The differences come from new scientific evidence that calls for necessary revisions.
What are the characteristics of these disorders?
What are the differences between anorexia nervosa, bulimia nervosa, and binge eating? Anorexia nervosa is “characterized by distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat”. Bulimia nervosa is “characterized by frequent episodes of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain”. Binge eating is the reason for the rewrite of the DSM document. Before it was rewritten, binge eating fell under specific types of anorexia and bulimia. Now, it is described as “recurring episodes of eating more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control”.
An integral part of this research is to address why college students are more susceptible to eating disorders. Many college students find themselves feeling out of control during their first few months in school. This feeling causes them to search for something that makes them feel in control, and this oftentimes is weight. This feeling paired with how overwhelming college is creates the “perfect storm” for these disorders. Social media, fashion trends, working out, and relationship status also add to the stress of students’ education. Underlying mental health issues such as anxiety and depression can also play a role in the development of eating disorders. These exterior influences are what we call risk factors.
As we all know, college is not easy. We are thrown into the deep end of both adulthood and self sufficiency, which is a lot. The transition from adolescence to young adulthood is the easiest time for weight change due to the physical maturation in the body. College students are also facing adulthood for the first time which can cause excessive comfort eating due to stress. These new experiences and emotions are examples of risk factors.
Emotions such as sadness, anger, frustration, anxiety, and fear can influence humans to rely on “comfort food”. Comfort food makes you feel happier in the moment, but is low in nutritional value. This is also associated with the college student budget. The college budget also influences college students to turn to food delivery services because it is cheap and easy. This is a result of both the lack of home cooked meals and the regularity of ordering in during the pandemic. Along with comfort eating, positive emotions can lead to overeating due to the feeling of needing to indulge or celebrate. There are still inconsistencies in this body of research, but studies are being conducted currently to reconcile the gap. Either way, changes in eating habits are directly related to emotional strain.
Another external factor that can cause eating disorders are peer groups. Sometimes activities in a university setting promote a specific weight or size. For example, college students involved in sororities or collegiate athletics are sometimes at greater risk of developing eating disorders.
Another important aspect of this research to observe is the previous research done in this field of study. In the past, studies could recognize these disorders but not their development or ways to prevent them. Currently, more studies are being done to examine eating disorders specifically in college students. Studies done in the past also did not account for gender, racial, or sexual identity, three crucial risk factors to observe. Student identity can play a key role in determining why they suffer from eating disorders.
In a study done by The Journal of Treatment and Prevention, the main factor causing eating disorders is extreme dieting. Another finding from this study was a significant increase in men affected by eating disorders. Historically, women were more prone to these disorders due to social norms and pressures. Now, with newfound gender constructs and cultural ideals for the size and shape of men, they have become more susceptible to these disorders.
Transgender people are underrepresented in eating disorder research because the gender identification is relatively new. New research suggests that transgender people uniquely experience body image issues and eating disorders. Traditional masculine and feminine body image ideals do not always match up with the ideal body image of transgender people. This is because they experience “perceived mismatch with one’s own body and sociocultural body ideals”. This is also known as body dissatisfaction, and it is one of the most common stressors experienced by transgender people. Eating disorders are unique in transgender people because they are often used to “repress secondary male/female characteristics” from their identify given at birth. Furthermore, the lack of support to this minority group exacerbates the symptoms and risks of eating disorders. Minority groups face a lot of adversity, but transgender people face intense discrimination. Other risk factors in transgender students include perfectionism, anxiety, and low self-esteem. Along with these disorders, transgender people tend to also have an increased risk for self-harm.
Sexual Orientation and Minority Stress Theory
Sexual orientation is also a factor in the development of eating disorders. Queer students tend to be more likely to have an eating disorder compared to heterosexual students. Queer students are also more likely to partake in unhealthy weight control behaviors such as fasting, skipping meals, vomiting, using laxatives, diuretics, or weight loss pills. Like transgender students, queer students suffer from body dissatisfaction at a disproportionate rate compared to heterosexual and cisgender students.
Minority stress theory is a direct cause in the disproportionate rates of eating disorders and body dissatisfaction among sexual and gender minorities. This theory suggests that minorities can suffer from such intense stress that overtime it can cause long-term health problems.
Racial and Ethnic Background
There are some risk factors that have faults when identifying these disorders. For example, there are higher prevalence rates among white students than Hispanic and Asian students in the United States. However, the prevalence rate in black students is significantly lower than white, Hispanic, and Asian students. Why is that? Well, socioeconomic status plays a big role in this. Higher income communities put more time and money into the treatment and prevention of eating disorders. Due to this economic divide, many lower income black communities don’t even know where to start to prevent these disorders. Because of this, black students who suffer from an eating disorder might not have had the opportunity to reach out for help. This creates inaccuracy in these national studies, which shows higher income students being disproportionately affected by eating disorders.
Eating disorders in college students continue to change based on the social climate. 10-20% of women and 4-10% of men in college suffer from an eating disorder. This number continues to grow, and universities must be accountable for having the resources to deal with these disorders. Through this body of research, I have found that racial, gender, and sexual identity play large roles in determining what students suffer from eating disorders. Though they may vary among these identity and minority groups, many of the risk factors for eating disorders overlap and are similar. Minority stress theory combined with the pressures of college and social life create a perfect environment for these disorders to develop. For the students who are not minorities, the pressures of college life are still large factors in affecting their struggle with eating disorders.
College health professionals need to spread greater awareness about the resources provided to students on campus. College health professionals also need to encourage healthier behaviors and increase treatment to prevent these disorders early on. My hope is that these high prevalence rates will decrease and are fought with resources and support groups nationwide. College students who suffer from eating disorders should receive the help they need to recover.