Eating Disorders on Campus

Guidelines for Intervention

The intention of these guidelines is to promote consistent action across campus when assisting students who are suspected of, report, or exhibit eating disorders symptoms or behaviors.

Eating disorders can be harmful, and even deadly, if not managed in a timely and appropriate manner.
The Counseling and Psychological Services Office is available for consultation to assist faculty, staff, students, and parents by providing guidance and support in coordinating care for students in need.

You are not expected to engage in professional counseling with distressed students. Your individual role as a staff or faculty member is of being supportive of their needs and referring them to appropriate campus resources.

If you are unable to intervene with a student, please consult with Counseling and Psychological Services about other ways to assist the student. The privacy of these students will be respected as much as possible.

The staff of Counseling and Psychological Services and Health Services are acutely aware of the prevalence of disordered eating among college-aged students.

We know that eating disorders are associated with devastating psychological and medical consequences, including death. Unfortunately, the diagnosis of eating disorders can be elusive, and many cases go undetected.

We also are aware of particular issues related to the care of students in the residential college setting. Ironically, students with eating disorders may come to our attention more readily on a residential campus, but caring for these students is particularly challenging, for a number of reasons.

Issues Affecting the Campus Community

The student with an eating disorder is often well known to the campus community, so referrals are often community-initiated.
Community concern and anxiety about the eating disordered student is often high, demanding involvement and education of the student’s peers, faculty, etc.
Community pressure to “fix” the student is high.
The community can have difficulty recognizing and accepting the individual’s right to refuse treatment.
The time commitment from staff can be significant.

Issues Affecting the Individual

Providing adequate care for persons with disordered eating almost always demands a team approach, integrating at least general medicine and psychiatry/psychology, and possibly nutrition education/therapy and exercise consulting.
Not all professionals needed to complete the treatment team are available on campus.
Collateral community resources may be limited.
Different eating disorders—anorexia, bulimia, binge-eating disorder, atypical eating disorders—require different types of treatment.
Eating disorders often co-exist with other psychiatric disorders, including personality disorders, anxiety disorders, substance abuse (especially with bulimia), and depression.
Risk of death from starvation, secondary health problems (e.g., heart failure), and suicide can be high.

Treatment Challenges

Often, persons with eating disorders do not want treatment: their symptoms are “ego-syntonic,” meaning the person with the disorder is not experiencing distress from the symptoms.

Indeed, they are often actually intent on maintaining their disorders. Thus, they often resist or refuse
treatment, much to the consternation of the campus community.

Medical risk creates special issues of student safety, especially when students refuse treatment.
Confidentiality can be especially complicated, given the frequent combination of a treatment-resistant student, a community demanding the student be treated, and medical risk.
Eating disorders implicate policy issues at several levels: medical safety & leave policies, behavioral codes of conduct, and the Americans with Disabilities Act.

Students with eating disorders can have great difficulty recognizing and accepting the need to assess not only the safety of the individual but the effect the individual has on the well-being of peers in the campus community.

In recognition of the challenge of managing these students’ care, this protocol is intended to provide
guidance about the management of students at Cabrini who have eating disorders.

Staff may believe there are compelling reasons to deviate from these guidelines, and doing so may at times be
appropriate. The reasons for any such deviations, however, which will invariably center on safety issues,
should be well articulated and should include the voices of all treatment providers.

Our philosophy is that effective treatment requires coordinated efforts among all those concerned in the care of students with eating disorders in an effort to improve the health and welfare of the student while attending Cabrini.

It is our hope that providing this coordinated care will have a beneficial impact on our students and our larger campus community, helping all to be well and successful in their current and future lives.

Eating Disorder Behaviors and Symptoms

A wide range of behaviors, symptoms, and medical issues are associated with eating disorders:

Restriction of food intake
Rapid weight loss
Purging behaviors
Abuse of medications such as diet pills, enemas, diuretics, Ipecac, and psychiatric drugs used to induce appetite suppression or weight loss
Excessive exercise
Physical ramifications of eating disorder behaviors including fatigue, chest pains, fainting, seizures, loss of menstrual periods
Distress that impairs academic, social, and interpersonal functioning

Students experiencing eating disorders will vary significantly in the intensity, volume, and types of behaviors exhibited or engaged in, making it difficult to predict medical consequences.

Faculty, staff, and students should not be in a position of diagnosing eating disorders nor determining the severity of the symptoms or behaviors, deferring to health professionals to make such evaluations.

Referrals should be made to Counseling or Health Services if a student reports any of the above behaviors.

References

American Psychiatric Association (2006). Treatment of patients with eating disorders: Third Edition.

Emory University Student Health Services & Counseling Center (2004). Eating disorders on campus:
Guidelines for intervention.

Gettysburg College Counseling & Health Services. (2009). Eating Disorders on a Residential, Rural Campus.

Towson University Counseling Center (2010). Eating Disorders on Campus: Guidelines for Intervention.

Werth, J.L., Wright, K.S., Archambault, R. J., & Bardash, R. J. (2003). When does the “duty to protect”
apply with a client who has anorexia nervosa? The Counseling Psychologist, 31(4), 427-450.