Eating disorders are mental health illnesses that involve emotional and behavioral disturbance surrounding weight and food issues. The most common are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Eating disorders can have life-threatening consequences and can affect people of any age, gender, race, ethnicity, or socioeconomic status. Full-fledged eating disorders typically begin between eighteen and twenty-one years of age and college helps create the perfect storm for these illnesses.^[1]

Anorexia nervosa is characterized by self-starvation and extreme weight loss either through restriction or through binge-purging. According to The Diagnostic and Statistical Manual of Mental Disorders, there is a restriction of energy intake relative to requirements, in the context of age, sex, developmental trajectory, and physical health; intense fear of gaining weight or becoming fat; and disturbance in the way the one’s body weight or shape is perceived (i.e., misperceptions, evaluations, and not recognizing the seriousness of the low body weight).^[2]

Anorexia nervosa may frequently be a result of body dysmorphic disorder (a condition in which someone feels that their body looks differently than it actually does) or a result of other psychiatric complications, such as OCD or depression. Starvation can cause harm to vital organs such as the heart and brain; can cause nails, hair, and bones to become brittle; and can make the skin dry and sometimes yellow or covered with soft hair. Menstrual periods can become irregular or stop completely. There is a lot of stigma associated with eating disorders and anorexia is no different. Some mistakenly believe that they may not be thin enough to suffer from anorexia. It’s important to note that people can have atypical anorexia, which includes some of the restrictive behaviors and features of anorexia without the low weight. This is currently categorized other specified feeding and eating disorders (OSFED), which is reserved for those who don’t fit into the other categories of eating disorders. Sadly, anorexia nervosa has the highest mortality rate of any psychiatric illness^[3].

People with bulimia nervosa eat large amounts of food (also called bingeing) at least two times a week and then vomit (also called purging) or exercise compulsively. Because many people who binge and purge maintain their body weight, they may keep their problem a secret for years. Vomiting can cause loss of important minerals, life-threatening heart arrhythmia (irregular heartbeat), damage to the teeth, and swelling of the throat. Bulimia can also cause irregular menstrual periods.

People who binge without purging also have a disorder called binge-eating disorder. This disorder is frequently associated with feelings of loss of control and shame surrounding eating. People who are diagnosed with this disorder tend to gain weight, and many will have all the consequences of being overweight, including high blood pressure and other cardiac symptoms, diabetes, and musculoskeletal complaints. Binge-eating disorder is the most common eating disorder in the United States and affects people of all backgrounds.^[4]

The National Eating Disorders Association (NEDA) is the largest non-profit organization focused on supporting those impacted by eating disorders. Watch this video NEDA produced about eating disorders and some common symptoms.

While people may experiment with different diets or ways of eating, particularly in college, it doesn’t necessarily mean someone has an eating disorder. There is a spectrum of what would be considered an eating disorder versus disordered eating. “Not everyone who goes on a diet will develop a formal disorder,” explains Dr. Bunnell. “The difference is a function of latent vulnerabilities and genetics. There’s a continuum. At the high end would be anorexia, bulimia, and binge eating disorder, and at the low end you have disordered eating.”

Disordered eating behavior ranges from fad dieting, or attempts at clean eating by restricting fats, dairy, or gluten, to more severe manifestations such as over-exercising, abusing laxatives, bingeing, or purging, which are serious but don’t yet meet the criteria for an eating disorder.^[5]

If you think you might have an eating disorder, you should go to the student health center or counseling center and get help. Talk with your family and close friends. Going for help and talking to others about your feelings and illness can be very difficult, but it’s the only way that you’re going to get better. Many colleges have treatment programs for these conditions and trained counselors who can relate to people with an eating disorder.