Washington Center for Eating Disorders & Adolescent Obesity

PERFECTIONISM
Many college students are perfectionists - about grades, friends, image, clothes and weight. Perfectionism about weight and external appearance can provide fertile ground for anorexia or bulimia.
LEAVING HOME
The transition to college life can be very stressful and dramatic for students who are leaving home for the first time. Even for students who have lived away from home, new responsibilities and infinite freedom create stresses that can precipitate or exacerbate an eating disorder.
EATING DISORDERS ARE CONTAGIOUS
In sororities, on sports teams, and among performers, food restricting or binge/purge behaviors can be popular and seem 'normal' if 'everybody else is doing it.' Anorectic tendencies can thus be masked as 'normal' too.
EATING DISORDERS NUMB THE PAIN OF ROMANCE ANXIETIES
Young women and men have constant interactions with potential romantic partners in college. They are more likely to become involved in sexual activities unaccompanied by the fulfillment of a caring, committed relationship. Conflicts and break-ups are painful. Anorexia, bulimia, and binge eating are ways to cope with pain.

You can help
Your presence in students' daily lives places you in a special position. You may be the first to recognize that a student is struggling with an eating disorder. The student may seek your assistance and you may be wondering, "How can I help?", or "What if I get in over my head?" You may be in over your head if:

The situation is life threatening. If you have any concern, however slight, that the student is a threat to himself or herself or others, you need to consult with the Counseling Center. There may be legal liability involved.
Your involvement is getting the best of you. It is natural to hope that your relationship with a troubled student will make a difference. This is especially true if the relationship you have with the student is a good one. Sometimes a student's psychological issues are just too complex to be able to benefit from your relationship. This may result in frustration and discouragement for both you and the student.
Things in your personal life are getting triggered. Advising students may lead to a close relationship where the student talks about things that bring up your own unresolved conflicts. When this happens, you may experience surprising emotions.
You find yourself keeping secrets that make you uncomfortable. If a student shares something and swears you to secrecy, you are also being sworn into a secret relationship. You may be legally required to report the information you have. If this happens, it is best to consult with a counselor (names withheld) to help you clarify your situation.
The relationship is demanding too much of your time and energy. If you are feeling resentful about the amount of time spent with an advisee, you probably cannot be very helpful to that person. Be especially mindful if your close friends believe that your relationship with a student is being nurtured at the expense of other important relationships in your life. They are usually, though not always, right.
If you feel like you are in over your head, you probably are. Trust your own judgment. If you feel uncomfortable, chances are you could use some assistance.
The staff at the AU Center for Psychological and Learning Services is trained to assess the degree of seriousness of an eating disorder and to recommend the proper course of treatment. Should you suspect a student has an eating disorder, discuss your concern with the student and suggest a referral to the Counseling Center.

WHEN TO REFER
Should you encounter a student who you think is in trouble, your role as a helper may save his or her life. The following is a summary of the most common signs that things are not going well (in general) and a student may need a referral. It is important to that any one symptom may not indicate the presence of a serious problem. When using these checklists, look for combinations of symptoms and overall patterns. Many people do not fit neatly into one category or another.

Signs of restricted eating such as sever fasts or dieting
Odd food rituals, such as counting bites of food, cutting food into tiny pieces, or preparing food for others while refusing to eat.
Intense fear of becoming fat, regardless of low weight
Fear of food ad situations where food may be present
Rigid exercise regimes
Dressing in layers to hide weight loss
Bingeing
Use of laxatives, enemas, or diuretics to get rid of food

Bingeing.
Secretive eating, evidenced by missing food.
Constant preoccupation with and constant talk about food and/or weight.
Avoidance of restaurants, planned meals, or social events of food is present.
Self-disparagement when too much has been eaten.
Bathroom visits after meals.
Vomiting, laxative abuse, or fasting.
The use of diet pills
Rigid or harsh exercise regimes.
Fear of being fat, regardless of weight.

Swollen glands, puffiness under the cheeks, or broken blood vessels under the eyes.
Complaints of sore throat or hoarseness.
Complaint of fatigue and muscle ache.
Unexplained tooth decay.
Frequent weight fluctuations, often within a 10- to 15
Unexplaineind Weight loss (often in a short period of time).
Cessation of menstruation without physiological cause.
Paleness.
Complaints of feeling cold.
Dizziness or fainting spells.

If you notice a student with several of the above characteristics it is best to mention what you have observed or what you have heard them say. For example: "...I noticed that you've missed several classes and when you're here you just don't seem to be yourself. Is something on your mind or did something happen?" or, "...You've missed work a few times this week and the quality of your work isn't as good as it usually is. Is something on your mind?" Or the case may be that you do not notice many of the above symptoms, but a student has confided in you regarding a situation that is causing distress. You may periodically follow-up on your initial conversation. For example: "...Last week you mentioned that things in your family were really stressing you out. How are things now...any better? About the same? Or worse?" Is it OK for me to ask you about this stuff?" The last question is important, since it is likely that a student will be grateful that you've taken an interest, but it is always best to check to be sure you are not crossing a boundary.

Next, observe how the student responds to your initiative. Does he or she seem willing to discuss more, or is this just not the right time? If you perceive the latter, it is best to mention your concern and willingness to talk in the future if the student would like. Don't consider this a "failure." Many times a student just isn't ready to talk, yet may return to speak with you several days or weeks later. In this case, showing your concern initially made enough of an impression upon the student that you are sought out later for support. If the student is willing to talk, simply listen to his or her story. Ask questions for clarification and be sensitive to concerns that underlie what you are hearing (issues that are unstated, brushed aside, or intimated).

As always, make an effort to communicate that you understand the student's feelings about the story they are telling you. For example: "...that must have made you very angry," or "...sounds like you were completely blown away by the whole mess." This is not a time to offer advice or your own personal point-of-view. Above all avoid arguing a point with the student or the use of judgmental statements that are of secondary concern. For example: it's probably best not to say: "...I can see you were upset, but you can't just drink this problem away," or "...do you really think yelling at your parents was the proper thing to do?" or "...I just don't see it that way at all."

It is also helpful to explore any previous attempts at problem resolution. What things have they tried? How did these work or not work? Can the student think of anytime when they had a similar problem? If so, how did they solve it that time? Encourage the student during this time, if you can do so sincerely. For example: "...I am surprised (or impressed) that you've been able to do as well as you have considering the circumstances. How do you manage?" After listening carefully it is helpful to summarize for the student what you've heard. This is important since it is a great encouragement for a student to be understood and, if you've misinterpreted any detail or nuance, the student can correct you at that time. For example: "...Let me see if I've got the story right here. You tried to talk to..." or "Let me give this back to you to make sure I've understood correctly, and you need to feel free to edit anything I've misunderstood or left out, OK?"

At this point in the conversation, you will probably need to make an initial assessment of the situation. Do you believe the problems mentioned are not beyond your ability or experience? Are you and the student both comfortable dealing with the content of the problem (i.e. sexual issues, bizarre behavior, or content to which you find yourself responding in an overly emotional manner) Are you able to commit to the student in this way? (Time, emotional investment, boundary issues).

If you answer no to any of the above, a referral may be in order. To begin a referral process it is important that you familiarize yourself with the services, procedures, and personnel of the Center for Psychological and Learning Services.

First, introduce the idea of a referral in a straightforward manner. For example: "After getting a better understanding of what's going on with you, I want to be able to support you as you work through this mess. At the same time, I don't think I'm in the best position to give you all the assistance that you need. I am familiar with the folks over at the psychological and Learning services Center and think they might be of help to you. What do you think about that idea?" If the student is favorable to the idea, suggest that the student make the call right then. You might even make the call for the student. For example: "I could call the Center now about an appointment, if that's OK with you," or "If it's OK, we can walk over to the Counseling Center now and see about getting an appointment." It is also permissible, if the student wishes, to be accompanied by you to the first, or even second, appointment. If the student is reluctant to act on this immediately don't be overly concerned. Simply ask when he or she plans on doing so, and ask if it is OK for you to follow-up later to see if the student actually made an appointment.

If the student does not wish to be referred and you are nevertheless concerned about the seriousness or urgency of the problem, please call the Center or myself for consultation. You need not disclose the student's identity to obtain this consultation. Also, in some way let the student know that acting on a referral doesn't mean that you plan on having no further contact with him or her. You will continue to be concerned and caring in a way that is appropriate for you. This is important as no one particularly appreciates being "dumped," especially if they perceive you are "washing your hands of the matter." At this point, it is probably best to give students a clear statement about what you can and cannot do for them.

Conversely, a student who has followed up with counseling may not wish to discuss with you many details of this work. If you sense this is the case, you can limit your queries to an occasional, "How are things going with the counseling?" The student may say, "fine" and then you can say, "good" and that's that. If the student maintains contact with you after the referral, continue to be supportive and maintain confidentiality. Again, it is usually advisable to stay within your realm of responsibility (e.g., financial problems, health concerns, academic needs, job responsibilities) after a referral is made, even if the student appears to be willing to have you as a second counselor.

Should you wonder about the advisability of a referral you can always discuss this with a counselor. Again, it is suggested that when doing so you not disclose the identity of the student. It is unnecessary to the discussion and allows the privacy of the student to be maintained. This is also the case if the student accepts the idea of a referral. It is important that you not discuss with a counselor any details of the student's story unless you have the permission of the student. While confidentiality laws do not bind you, this is simply respectful and prudent.