Running head: EATING DISORDERS IN HIGHER EDUCATION 1

Eating Disorders in Higher Education

Cassie McLaughlin

Northern Illinois University

EATING DISORDERS IN HIGHER EDUCATION 2

Eating Disorders in Higher Education

Concerns about weight and body image are a significant issue within a college-aged

population, and many college students are actively engaging in behaviors to lose weight. For

instance, 51.3% of students reported exercising in the last 30 days to lose weight; 38.3% of

students reported dieting in the last 30 days to lose weight; 2.9% of students reported vomiting or

using laxatives in the last 30 days to lose weight; and 3.3% of students reported using diet pills in

the last 30 days to lose weight. Furthermore, six percent of undergraduate students report that

they experienced an eating disorder or problem within the last twelve months (American College

Health Association, 2017).

Issues of weight and body image greatly impact college students, and it is important for

college educators to remain mindful of these tendencies and to work to actively promote healthy

practices through intentional programmatic interventions. It is the responsibility of educators to

remain mindful of the needs of the population that they serve, and so educators must remain

mindful of the trends related to body image, weight loss, and eating disorders. Educators should

also remain mindful of what research says about students who experience symptoms of

disordered eating. Furthermore, educators should use the findings of previous research to guide

their programmatic and educational interventions in order to most effectively target the issue of

eating disorders.

Literature Review

Predictors

The research has shown that there is a relationship between self-objectification and

disordered eating. Self-objectification is the process whereby women begin to view themselves

as objects where their worth is based on their physical appearance as a result of the way that
EATING DISORDERS IN HIGHER EDUCATION 3

broader society tends to objectify women. The research suggests that this experience of self-

objectification is positively correlated with disordered eating. The research also suggests that

this correlation occurs through the mechanisms of body shame and appearance anxiety

(Tiggemann, 2013). Thus, the social pressures that women experience regarding their physical

appearance can lead to feelings of insecurity regarding appearance, which can then lead to

patterns of disordered eating. There is also a correlation between inaccurate body weight

perception and underweight status (Groff & Wilke, 2016), which suggests that individuals with

eating disorders are perceiving themselves to look differently than they actually look,

contributing to further disordered eating and weight loss. These findings can help educators to

understand the types of thoughts that students with eating disorders are experiencing.

Another trend is that women who experience sexual violence are more likely to engage in

purging behaviors (Groff & Wilke, 2016). On college campuses, 11.2% of students will

experience rape or sexual assault (RAINN, 2016), which is a considerable statistic. This is a

common issue that educators must handle with their students, and knowing that disordered eating

or purging behaviors may occur as a result of this particular trauma can help educators to remain

aware of more of the potential psychological consequences of sexual assault.

There is a relationship between attachment insecurity and binge eating behaviors, where

emotion regulation acts as a mediating variable (Han & Pistole, 2014). As has been previously

discussed, cognitive and emotional processes play a role in the development and maintenance of

eating disorders.

Other Populations

Eating disorders may manifest differently in various populations. For instance, men tend

to idealize a more muscular and lean body type that what women may idealize (Mayo & George,
EATING DISORDERS IN HIGHER EDUCATION 4

2014), and so disordered behaviors may look different in a student who is a man than they would

look in a student who is a woman. Furthermore, there are differences in the ways that an eating

disorder may manifest in a heterosexual man versus a non-heterosexual man. Although there are

no sexual orientation differences in the likelihood of an individual being muscle-concerned,

college-aged sexual minority men tend to be more lean-concerned than heterosexual men (Calzo,

Masyn, Corliss, Scherer, Field, & Austin, 2015).

Women student athletes experience dissonance regarding their bodies, as they receive

messages that an athletic body is ideal for an athlete, but that a thin and feminine body is ideal

when they are off the court (Steinfeldt, Zakrajsek, Bodey, Middendork, & Martin, 2013). It is

important for educators to remain mindful of the fact that eating disorders may manifest

differently in other populations. If educators do not remain mindful of this fact, they may miss

out on warning signs in a student, since the warning signs are different for this particular student

than what one would expect to see in a student with a “typical” eating disorder.

There are also racial and cultural differences in the likelihood of an eating disorder and in

the manifestation of an eating disorder. Although there are no racial differences in the existing

relationship between trauma exposure and eating disorders, Blacks and Latinos report more

experiences of interpersonal trauma (Edman, Watson, & Patron, 2016), which may contribute to

higher rates of eating disorders and other mental illnesses in these populations. Although

educators should not assume that a student will have an eating disorder due to their racial or

cultural identities, it can be beneficial for educators to remain aware of these trends so that they

can remain mindful of the sorts of issues that they may encounter when working with students

from a particular population.

EATING DISORDERS IN HIGHER EDUCATION 5

Another trend based on populations is that different populations may experience different

types of eating disorders. For instance there is a higher prevalence of binge eating disorder

symptoms among obese students than non-obese students (Filipova & Stoffel, 2016). It is

important for educators to remain aware of the existence of binge eating disorder, as binge eating

disorder can often be forgotten. The students who suffer from binge eating disorder come from a

different demographic than the type of people that are stereotypically associated with eating

disorders (i.e. underweight people). Thus, educators should not assume that a student cannot be

suffering from any sort of eating disorder based on their weight.

Consequences

A majority of college women engage in weighing and body-monitoring behaviors, and

although most of these women do not perceive self-weighing to be a harmful behavior, many

women are impacted psychologically by their weight. For instance, 63% of women report that

their weight impacts their mood, 50% of women report that their weight impacts their sexual

comfort, and 48% of women report that their weight impacts their self-esteem (Mintz, Awad,

Stinson, Bledman, Coker, Kashubeck-West, & Connelly, 2013). These self-weighing behaviors

have become normalized for many college women, despite the fact that it can have a negative

impact on their mood and their psychological well-being.

Although the impact on psychological well-being is an important consideration on its

own, educators should also consider the impact that eating disorders may have on academics. For

instance, students who displayed symptoms of moderate binge eating disorder tend to experience

decreased classroom productivity and daily activity impairment (Filipova & Stoffel, 2016).

Disordered eating and weight concerns are impacting students negatively on many levels,

including psychological and academic. Eating disorders themselves also impact the sufferer
EATING DISORDERS IN HIGHER EDUCATION 6

physically, and so eating disorders impact students negatively in a very holistic way, which is

one reason why the common occurrence of eating disorders on college campus is so alarming.

Substance Use

Although the manifestation of symptoms of eating disorders is concerning on its own,

college students who experience eating disorders also tend to engage in substance use. For

instance, college women who were at risk for or who were currently experiencing eating

disorders tended to misuse attention-deficit/hyperactivity disorder (ADHD)- specific stimulants.

The severity of eating disorder behaviors and other comorbid pathology was associated with a

higher likelihood of stimulant abuse (Gibbs, Kass, Eichen, Fitzsimmons-Craft, Trockel, Wifley,

& Taylor, 2016). There is also a relationship between energy drink consumption and “weight

loss attempts, poor body image, and unhealthy weight loss behaviors” (Jeffers, Vatalaro, &

Benotsch, 2014). Keeping these trends in mind, educators and counselors should remain aware

of the common comorbidity of these two issues. Although a student with an eating disorder will

not always experience issues with substance abuse, educators should still remain mindful of

these trends.

Another pattern that can be seen in college students is that some students engage in

calorie restriction or strenuous exercise to counteract the calories that they consume through

alcohol use (Davis, Riley, Smith, Milich, & Burris, 2017; Piazza-Gardner & Barry, 2014; Ward,

Galante, Trivedi, & Kahrs, 2015). Given the fact that many students choose to engage in

drinking behaviors during college, educators should be aware of the fact that some students will

engage in compensatory behaviors to “allow themselves” extra calories for drinking.

Intervention
EATING DISORDERS IN HIGHER EDUCATION 7

Only 35.3% of students report that they have received information about eating disorders

from their college or university (American College Health Association, 2017). As has been

previously discussed, issues of body image are prevalent on college campuses, and so it is

concerning that there is not a stronger presence of programming and educational interventions

regarding eating disorders on college campuses. Educators and counselors on college campuses

should proactively create programming and educational campaigns to bring awareness to the

topic of eating disorder. Furthermore, educators and counselors should remain aware of what

sorts of interventions have been shown to be most effective in targeting this particular issue. The

following paragraphs will look at some of the best practices that research has found.

One intervention technique that has been shown to reduce risk factors and symptoms of

eating disorders is a group eating disorder prevention program in which the women participating

engage in a critical dialogue about the thin ideal. It can be difficult to find a qualified person to

mediate this dialogue, but an Internet prototype of this intervention has also been shown to be as

effective as the in-person intervention (Stice, Rohde, Durant, & Shaw, 2012). This research

suggests that engaging critically in topics of body image and body size can be beneficial for

women who may be at risk for developing an eating disorder. Thus, open dialogue about body

image issues can be a beneficial intervention technique, which provides further evidence for the

importance of incorporating programmatic interventions and dialogues rather than neglecting the

issue of eating disorders. Another implication of this study is that it may be particularly

beneficial for students to actively engage with the topics of body image and eating disorders;

rather than simply lecturing to students about eating disorders, it may impact students more

strongly to participate in a dialogue (including, but not limited to, programs or support groups).
EATING DISORDERS IN HIGHER EDUCATION 8

Another potential intervention technique may be targeting positive health behaviors to

encourage a holistically healthy student. Generally, students who sleep more and engage in

exercise have healthier mental health in terms of social anxiety, depression, and eating concerns

(Sterba, 2013). This provides support for the idea that more positive behaviors focused on

physical health can positively impact mental health. Thus, although interventions that

specifically focus on eating disorders are beneficial, there is also merit in interventions that focus

more generally on positive health behaviors; these types of programmatic interventions can also

have a positive impact on undergraduate mental health, including eating concerns.

Conclusion

College students experience a lot of concern over their weight and body image, and it is

important for people who work with this population to remain mindful of these tendencies. If

educators are to serve their students most effectively, it is vital that they actively work to

increase their own awareness of issues that are impacting their students. Modern students care a

lot about their body image, and so educators should be working to understand the ways that these

worries manifest in undergraduates, including patterns of disordered eating.

When it comes to disordered eating and disordered body image, researchers have

identified a variety of predictors and patterns of other behaviors that are associated with eating

disorders. Predictors and patterns such as the ones discussed in this literature review can help

educators to remain aware of the types of students who may be particularly vulnerable to

developing eating disorders. These trends can also help educators to identify behaviors that may

be indicative of a broader problem, including behaviors or experience that often occur at the

same time as eating disorders.

EATING DISORDERS IN HIGHER EDUCATION 9

Although research can be vital in terms of helping educators to identify at-risk students, it

is also important for college educators to rely on clinical research to inform their programmatic

intervention attempts to best serve the needs of at-risk students. For instance, many college

students report that they have not received information about eating disorders from their college,

but the research suggests that students benefit from engaging in critical dialogues regarding body

image. There is a gap between what colleges are offering and what students benefit the most

from, and educators should take the initiative to serve their students more effectively.

Continuing to ignore issues such as eating disorders does not help students to get the assistance

that they need, and it is the responsibility of educators and administrators in higher education to

do what they can to change these trends.

EATING DISORDERS IN HIGHER EDUCATION 10

References

American College Health Association (2017). American College Health Association – National

College Health Assessment II: Undergraduate student reference group data report Fall

2016. American College Health Association. Retrieved from

http://www.acha-ncha.org/docs/NCHA-

II_FALL_2016_UNDERGRADUATE_REFERENCE_GROUP_DATA_REPORT.pdf

Aviña, V., & Day, S. X. (2016). Eating disorders: Explanatory variables in Caucasian and

Hispanic college women. Journal Of College Counseling, 19(1), 31-44.

Brown, L. B., Larsen, K. J., Nyland, N. K., & Eggett, D. L. (2013). Eating competence of

college students in an introductory nutrition course. Journal Of Nutrition Education

And Behavior, 45(3), 269-273.

Calzo, J. P., Masyn, K. E., Corliss, H. L., Scherer, E. A., Field, A. E., & Austin, S. B. (2015).

Patterns of body image concerns and disordered weight- and shape-related behaviors in

heterosexual and sexual minority adolescent males. Developmental Psychology, 51(9),

1216-1225.

Chiu, I., & Graham, J. A. (2017). The effect of a peer-based personal stories intervention on

focus of anxiety and social distance towards people with mental illness. Journal Of

College Student Development, 58(1), 101-107.

Davis, H. A., Riley, E. N., Smith, G. T., Milich, R., & Burris, J. L. (2017). Alcohol use and

strenuous physical activity in college students: A longitudinal test of 2 explanatory

models of health behavior. Journal Of American College Health, 65(2), 112-121.

Edman, J. L., Watson, S. B., & Patron, D. J. (2016). Trauma and psychological distress among

ethnically diverse community college students. Community College Journal Of Research

EATING DISORDERS IN HIGHER EDUCATION 11

And Practice, 40(4), 335-342.

Filipova, A. A., & Stoffel, C. L. (2016). The prevalence of binge eating disorder and its

relationship to work and classroom productivity and activity impairment. Journal Of

American College Health, 64(5), 349-361.

Gibbs, E. L., Kass, A. E., Eichen, D. M., Fitzsimmons-Craft, E. E., Trockel, M., Wilfley, D. E.,

& Taylor, C. B. (2016). Attention-Deficit/Hyperactivity Disorder-specific stimulant

misuse, mood, anxiety, and stress in college-age women at high risk for or with eating

disorders. Journal Of American College Health, 64(4), 300-308.

Groff Stephens, S., & Wilke, D. J. (2016). Sexual violence, weight perception, and eating

disorder indicators in college females. Journal Of American College Health, 64(1), 38-

47.

Han, S., & Pistole, M. C. (2014). College student binge eating: Insecure attachment and emotion

regulation. Journal Of College Student Development, 55(1), 16-29.

Iles, I. A., Seate, A. A., & Waks, L. (2016). Eating disorder public service announcements:

Analyzing effects from an intergroup affect and stereotype perspective. Health

Education, 116(5), 476-488.

Jeffers, A. J., Vatalaro Hill, K. E., & Benotsch, E. G. (2014). Energy drinks, weight loss, and

disordered eating behaviors. Journal Of American College Health, 62(5), 336-342.

Juarascio, A., Shaw, J., Forman, E., Timko, C. A., Herbert, J., Butryn, M., & ... Lowe, M.

(2013). Acceptance and commitment therapy as a novel treatment for eating disorders:

An initial test of efficacy and mediation. Behavior Modification, 37(4), 459-489.

Landry, A. S., Moorer, K. D., Madson, M. B., & Zeigler-Hill, V. (2014). Protective behavioral

strategies and alcohol use outcomes among college women drinkers: Does disordered
EATING DISORDERS IN HIGHER EDUCATION 12

eating and race moderate this association?. Journal Of Drug Education, 44(3-4), 95-115.

Maloch, J. K., Bieschke, K. J., McAleavey, A. A., & Locke, B. D. (2013). Eating concerns in

college women across sexual orientation identities. Journal Of College

Counseling, 16(3), 275-288.

Masuda, A., Goodnight, B. L., Ng, S. Y., Ward Schaefer, L., Tully, E. C., Chan, W. Y., & Drake,

C. E. (2017). Help-seeking stigma in Asian American college women: The role of

disordered eating cognitions and psychological inflexibility. International Journal For

The Advancement Of Counselling, 39(2), 188-201.

Masuda, A., Le, J., & Cohen, L. L. (2014). The role of disordered-eating cognitions and

psychological flexibility on distress in Asian American and European American college

females in the United States. International Journal For The Advancement Of

Counselling, 36(1), 30-42.

Mayo, C., & George, V. (2014). Eating disorder risk and body dissatisfaction based on

muscularity and body fat in male university students. Journal Of American College

Health, 62(6), 407-415.

Mintz, L. B., Awad, G. H., Stinson, R. D., Bledman, R. A., Coker, A. D., Kashubeck-West, S., &

Connelly, K. (2013). Weighing and body monitoring among college women: The scale

number as an emotional barometer. Journal Of College Student Psychotherapy, 27(1),

78-91.

Oost, K. M., Livingston, N. A., Gleason, H. A., & Cochran, B. N. (2016). Gender performance

stress and risk for psychopathology: Looking beyond sexual orientation. Journal Of

LGBT Youth, 13(3), 231-248.

Piazza-Gardner, A. K., & Barry, A. E. (2014). A qualitative investigation of the relationship

EATING DISORDERS IN HIGHER EDUCATION 13

between consumption, physical activity, eating disorders, and weight

consciousness. American Journal Of Health Education, 45(3), 174-182.

Prowse, E., Bore, M., & Dyer, S. (2013). Eating disorder symptomatology, body image, and

mindfulness: Findings in a non-clinical sample. Clinical Psychologist, 17(2), 77-87.

RAINN (2016). Campus sexual violence: Statistics. RAINN. Retrieved from

http://www.rainn.org/statistics/campus-sexual-violence

Shelton, V. L., & Valkyrie, K. T. (2010). College student stress: A predictor of eating disorder

precursor behaviors. Alabama Counseling Association Journal, 35(2), 14-27.

Simone, M., & Lockhart, G. (2016). Two distinct mediated pathways to disordered eating in

response to weight stigmatization and their application to prevention programs. Journal

Of American College Health, 64(7), 520-526.

Steinfeldt, J. A., Zakrajsek, R. A., Bodey, K. J., Middendorf, K. G., & Martin, S. B. (2013). Role

of uniforms in the body image of female college volleyball players. Counseling

Psychologist, 41(5), 791-819.

Sterba, A. M. (2013, January 1). The relationship of sleep and exercise to salient indicators of

college student emotional well-being. ProQuest LLC.

Stice, E., Rohde, P., Durant, S., & Shaw, H. (2012). A preliminary trial of a prototype internet

dissonance-based eating disorder prevention program for young women with body image

concerns. Journal Of Consulting And Clinical Psychology, 80(5), 907-916.

Taliaferro, L. A., & Muehlenkamp, J. J. (2015). Risk factors associated with self-injurious

behavior among a national sample of undergraduate college students. Journal Of

American College Health, 63(1), 40-48.

Taylor, J. V., & Gibson, D. M. (2016). Crisis on campus: Eating disorder intervention from a
EATING DISORDERS IN HIGHER EDUCATION 14

developmental-ecological perspective. Journal Of American College Health, 64(3), 251-

255.

Tiggemann, M. (2013). Objectification theory: Of relevance for eating disorder researchers and

clinicians?. Clinical Psychologist, 17(2), 35-45.

Ward, R. M., Galante, M., Trivedi, R., & Kahrs, J. (2015). An examination of drunkorexia,

Greek affiliation, and alcohol consumption. Journal Of Alcohol And Drug

Education, 59(3), 48-66.