So your daughter is headed off to college, and she has only recently stabilized her eating after experiencing eating disorder symptoms. You're worried. You've already been surprised at how talented she is at hiding her behaviors from you, and now you won't be able to monitor her. What do you do? How can you help?
Pressure on College Students Susceptible to Eating Disorders
A number of new variables are in a new college student's life. There is pressure to get established socially. Classes are more difficult, homework more intense. He must now choose what to eat and when. And there's no one watching anymore, which allows a person to become isolated and anonymous.
A son or daughter adjusting to a new environment, with much more freedom, may scramble for something that's predictable. The routines and rituals of anorexia and bulimia can provide that. Binge eating can also numb students to their environments and temporarily relieve pressure.
As a parent, you may not have direct influence on your son or daughter while he or she is away, but you do have options. At this critical time in your teen's life, it's important to use those options.
Keep Them at Home if an Eating Disorder is Present
The first time to take action is before your child leaves for college. Check with an eating disorder therapist or a registered dietitian. If disordered eating is significant, tell your teen in the kindest way possible that you can't let her go. This is a hard choice to make. You're happy to see your daughter (or son) finish high school, and you know she's been talking with friends about where she wants to attend college. She may even have plans to be someone's roommate.
But you can use the hope of going to school as leverage. In general, even if your grad is 18 years old, she's probably only as old emotionally as her age when the eating disorder began (and would you send your 14 year old to college?). She'll be angry when you say that she can't go until she demonstrates good recovery. But it's likely to spur her forward.
Another option is to send her to a local community college. It may not be her preferred option, but she may want to move forward with her education anyway. Community college provides a way for parents to see her frequently. She may come home on weekends, and even if she lives on campus, she's close enough that parents can check on her easily.
Setting up Care for Eating Disorders at College
If your college-bound son or daughter has recently emerged from eating disorder treatment, has milder symptoms, or develops an eating disorder after beginning classes, you must be clear: He must get involved in monitoring and/or treatment while in school. He needs adequate support to keep the eating disorder in check.
If there isn't adequate care available, and your son or daughter develops significant active symptoms, he needs to switch to a school at which support is available or come home until he is recovered enough to handle the college environment. At larger universities, there may be enough resources on campus to help a person pursue or maintain recovery. Smaller schools that lack on-campus help may have resources in the surrounding area.
But suppose that your son can't be convinced to enter treatment. What then? You notify the school administration and bring him home. When there is a history of disordered eating, this is a consequence to discuss with your daughter or son before symptoms develop. For those who develop disordered eating for the first time after leaving home, all you can do is provide a choice: Either start treatment or come home. Once you've explained this to your teen, it's vital to carry out the consequence when he refuses to receive help.
As parents, you also can have a role in monitoring. You don't want to bother your kid constantly, but it's appropriate to show up at school for visits -- both announced and unannounced. Spend the day with him. Watch how he handles mealtimes and what he does afterward. You can inform his team of doctors about your observations.
When Your Grad Skips Treatment Appointments at College
At the beginning of treatment, you'll need to remind your teen that being in treatment means making all appointments, and that she can't stay in school if she fails to show up for them. And if your daughter does not attend scheduled appointments for counseling, dietary monitoring, or medical support? You keep your word and remove her from school. In short, you must demonstrate as parents/caregivers that you are serious about recovery. Let the treatment team know your intentions well in advance, and work with them to know when to make this move.
When You Can't Monitor Your Child Often, Consequences Are Good Care
These consequences may seem harsh. But you're dealing with a situation that could ravage your daughter's (or son's) health or even take her life. Until she is ready to take charge of her recovery, it's your job to encourage her to get started.
Source:
Levenkron S. Anatomy of Anorexia. New York: Norton; 2001.
