I’ve been working with people struggling with eating disorders for many years now and have found my passion specializing in helping college students cultivate healthy relationships with food and their body. While eating disorders do not discriminate (they occur in people of all sizes, races, gender identities, sexual orientations, locations, socioeconomic status, and at any age), most begin around puberty or early adulthood, especially during high school and college years.
Why is this?
Well, any time there is a big transition or stressor in life, people with a predisposition to developing an eating disorder are more likely to have the behaviors come out as a way of coping with the stress or worries of the unknown.
An eating disorder develops when someone uses food as a way to cope. Eating disorders are a way of coping with not wanting to feel emotions or deal with certain situations. They allow the person to become numb or focused on something else, in much the same way that someone would misuse drugs or alcohol. Eating disorders are not an addiction, though they can sure feel like it at times.
Eating disorders (EDs, for short) have both genetic and environmental components. This means you need the genes for an eating disorder to develop, but it won’t be expressed without an environmental trigger. Some people can have the genes for an ED and go through their entire lives without seeing it expressed.
As ED expert Dr. Walter Kaye puts it, “Genetics load the gun, and environment pulls the trigger.” In other words, a person can have the genes to develop an eating disorder but never express the thoughts or behaviors if there is no reason to use them to cope. Another person could have the perfect storm of trauma and environmental triggers but, without the genes for the ED, won’t develop one.
Let’s get specific. Why is college, in particular, such a big time for EDs?
Well, there are four things I’ve come to realize:
1) College is a major life transition, especially if the person is living away from home for the first time. College students may feel out of control with all the changes happening in their lives, and their food choices may seem like the only thing they have control over; and for the first time, they have complete autonomy about what foods they choose to buy instead of whatever was at home or put in front of them.
2) College age comes shortly after puberty, hence a normal time for ED development. During this time, hormones and body changes can leave people feeling like they don’t belong in their own body. This is even harder on people who are misgendered by others (trans/gender-fluid/nonbinary). Developmentally speaking, this stage following puberty is very egocentric (“me, me, me”), making people believe that everyone is looking at, and judging, them.
3) The pressure of college, whether self-imposed, or parental, can cause feelings of inadequacy. Striving to achieve the “perfect” diet and body can create a sense of accomplishment for certain individuals. Food can also be used as a form of self-punishment for not feeling “good enough” or “worthy” of care.
4) Though it is not true of everyone, another reason for ED development is the aversion (whether or not it is conscious) to growing up and dealing with normal adult things like bills, laundry, and scheduling appointments. The ED is a way to revert back to needing to be cared for like a child (or experiencing the childhood the person never really had).
What are you avoiding?
Disordered eating and eating disorders are not really about food. EDs are a behavioral way to cope with something else going on in your life, including difficult emotions and feelings. Take some time to think about what your ED is doing for you, both in a positive and negative way. Food behaviors and body image obsession are both symptoms of something else that you are not fully prepared to handle. What is the purpose of your ED? What is it protecting you from? How is it helping you? When you can figure out what reward you’re getting from your ED, you can look for healthier ways to get that “reward.”
Oftentimes, eating disorders are a way to cope with not having to deal with emotions, whether this is from past trauma or a current emotional state. These are different reasons that people use different behaviors to cope.
The binge-restrict cycle (it’s a trap!)
A theme that comes up often in my practice is the “binge-restrict cycle.” I literally have it drawn on the back of every notepad I own. Illustrated below, this cycle is the same for most people with food issues. The behaviors vary, but the concept remains the same.
It starts with restricting, dieting, or “being good” (bottom of circle) by limiting what you eat, eating “clean,” compensating for eating, or other means of creating rules for yourself with food. This leads to feeling physically hungry (the body still has to eat, even if you are trying to override that need) or deprived. The result is overeating, binge eating, or eating “forbidden” foods that we told ourselves we can’t have (for whatever arbitrary reason). In fact, Dr. Neumark-Sztainer, author of I’m, Like, So Fat!, remarked that frequent dieting among teen girls creates a 12-fold increase in the likelihood of binge eating as opposed to girls who don’t diet. Binge eating (or eating “forbidden foods”) creates feelings of shame and guilt. This drives the compulsion to make up for it and “do better” so that it doesn’t happen again.
And round and round we go.
When my clients have tried to interrupt this cycle on their own, they inevitably attempt to stop the binge or eating of the “bad” food. Usually, by the time they get to me, they are so exhausted from using their willpower to try to stop binging that they can’t even see a different route to fixing things. The overeating is what is causing the distress, right? It causes the guilt, shame, and self-loathing, right?
Wrong! The cause of the whole cycle is the restriction piece. Whether it is the true definition of restriction (not consuming enough calories or nutrients to thrive) or depriving yourself of the foods you like (cutting out specific foods or food groups, including dieting) or even compensation for eating by vomiting or over-exercising, this “restriction” creates mental deprivation and physical hunger. The funny thing is that most people fall into this cycle as a result of wanting to regulate or lose weight when, invariably, the restrictions lead to rebound weight gain—the exact opposite of the intention.
It is well documented that losing weight beyond what our body naturally wants to do (our body’s “set point”) is difficult if not impossible to maintain, and inevitably leads to rebound weight gain of equal or greater amounts, as the body starts preparing for what it perceives as famine. The fact is our body doesn’t know if we are in a true famine or on a diet.
To stop the cycle, we must stop the restriction phase. If you are eating enough and not depriving yourself, you won’t feel that gnawing hunger and won’t overdo it; and if you don’t overdo it, you won’t feel the shame or guilt and won’t need to restrict!
I know it is easier said than done, but stick with me. If you commit, you can get out of this cycle and shake ED for good. It’s a long process, but well worth it.
It all starts with learning to listen to your body.
-Excerpt from chapter 1 of Permission To Eat: A practical guide to working yourself out of an eating disorder during college, while celebrating the awesomeness that is you! By Libby Parker, MS, RD
Permission To Eat continues to cover more about the ‘why’ behind eating disorders, and more importantly what to do to help yourself out of one. This is done with actionable steps at the end of each chapter that focus on how to eat well, journal prompts to get you thinking, how to find your treatment team (and how to talk to your doctor about your ED), what exercise restriction means, medical issues that you may notice, and ways to specifically stop calorie counting, binge eating, purging and more.