Eating disorders brought to attention during awareness week

During National Eating Disorder Association (NEDA) Awareness week, the College community gathered to discuss issues surrounding eating disorders and disordered eating on campus. While the College has put effort into combating these issues over the past 10 years, they are still some of the most difficult for administrators and staff members to deal with effectively.

Background information

Eating disorders – the overarching umbrella term that includes anorexia nervosa, binge eating and bulimia nervosa – and disordered eating, which defines irregular eating behaviors outside of the eating disorder classification, are consistently recognized as issues on college campuses nationwide.

According to a 2006 NEDA survey on college campuses, “nearly 20 percent of respondents believe that at some point they have suffered from an eating disorder.” Only 75 percent of those who admitted an eating disorder in the survey accepted some form of treatment.

The College itself does not maintain statistics on the percent of students who have sought treatment for eating disorders or disordered eating due to confidentiality, nor do statistics exist to indicate what percent of students admit to having experienced one of these problems.

According to Co-Director of Psychological Counseling Services Margi Wood, generally around 40 percent of a graduating class has sought support for any issue from Psychological Counseling Services at the College in at least one session prior to graduation. In the class of 2010, 38 percent of students visited Psychological Counseling Services. According to Wood, the average number of sessions per student for those seeking counseling during an academic year is seven to eight.

“In the last five years, we have been seeing an increasing volume of students,” Wood said. “For all contacts, we saw 20 percent of the student body and 18 percent in some combination of regular treatment [during the 2009-2010 academic year].”

The Health Center is now participating for the first time in the National College Health Assessment (NCHA), which “is the most comprehensive study of college student health in the nation,” according to Director of Health Services Ruth Harrison. The NCHA includes questions related to weight, nutrition, exercise and mental health, amongst other components of healthy living.

“We really hope to be able to use the information from the survey to see what the campus needs,” Harrison said.

Student organizations

The two main student-run organizations on campus dedicated to health at the College are Peer Health and Active Minds.

Peer Health is designed to enable students to reach out to their peers for health advice. The organization holds walk in hours with trained student counselors every Sunday through Thursday from 7:00 p.m. to 9:00 p.m.

“Peer Health is basically a liaison between the student body and the Health Center,” Peer Health Co-Head Santi Sanchez ’11 said. “We refer people who come to us and want to talk about some particular health issue and don’t know how to approach the Health Center.”

While Peer Health does not keep official records of who comes in to their offices and for what purpose, Sanchez does view eating disorders and disordered eating as major issue at the College. “In my experience, the most common issue besides selling condoms would probably be friends concerned about someone with an eating disorder,” he said.

Whereas Peer Health is designed to deal with all forms of health, Active Minds, a national organization with chapters spread across college campuses, is specifically focused on mental health awareness. The College’s chapter was founded in 2007.

The chapter was created in order to fill an observed gap regarding mental health awareness at the College, according to Wood, who in addition to her role at the Health Services works as an Active Minds advisor.

“There had been a number of both national and more local high-profile events, for instance Virginia Tech [shootings], and in the spring of 2007, a Williams student died by suicide. So there were a number of things both nationally and locally that really put mental health issues in a lot of people’s awareness,” Wood said. “But there really wasn’t any student organization addressing what is going on at our campus or encouraging a more open conversation about mental health issues amongst ourselves.

Last week, Active Minds collaborated with Peer Health, Psychological Counseling Services and other organizations on campus in order to create “Love Your Body Week,” as a manifestation of NEDA Awareness week. Taylor Nutting ’14 and Aliza Shatzman ’13 coordinated a fashion show in Goodrich during Stressbusters on Feb. 23.

While these organizations can help to point students in the right direction in order to seek help for eating disorders, their role is limited to serving as a liaison to other resources at the College – most commonly the Health Center.

Most eating disorders are not categorized as causing “imminent danger” to the student or others around him or her. As a consequence of this distinction, confidentiality cannot be breached and others cannot be informed of a student’s illness.

“We can’t force people to go to the Health Center for an eating disorder,” Sanchez said. “Some people come in asking for help about how to talk to their friends about eating disorders. Not as many people come in to talk about their concern about their own potential eating disorder or disordered eating.”

Friends of an eating disorder victim often are put in the position of having to serve as the impetus to seek the College’s assistance. Due to the secrecy and shame often associated with eating disorders, “the people who are actually worried about their own eating disorders don’t generally come [to Peer Health],” Sanchez said.

Campus culture

Students and administrators alike acknowledged the College’s culture as a potential spark for eating disorders.

“It’s even more important to raise conversations about the issues of eating disorders because of the College’s culture of ‘effortless perfection,’” Nutting said.

“We do seem to have types of students that are very high-achieving across all arenas of student involvement. In the way of context, I see that as a recipe that seems to fit the profile [for eating disorders],” Associate Dean and Dean of First-Year Students Dave Johnson ’71 said. “Whether or not that’s a Williams thing or a national thing, I don’t know, but it’s an issue.”

Peer Health has seen similar concerns manifest themselves on campus: “The way this campus works just makes it not so easy for you to get help, just psychologically and in terms of the social norms,” Sanchez said.

Athletics have also been viewed as a potential cause for the supposed need to be in top physical shape. “We have a 4 p.m. ‘Estro-gym’ culture – people have called it eating disorder central – where a lot of girls go to lose a lot of weight,” Shatzman said. “In a high stress place like Williams, it’s very easy to take your stress out on your body, especially in a place where everyone wants to be really fit.”
Peer recommendation is the main detection device for potential eating disorder victims at the College. However, this system leaves students unsure how best to broach the issue.

“It’s hard to have a friend with a problem no matter what it is. Eating disorders are a particularly poignant problem like other mental health disorders … It’s awkward and hard to deal with,” Sanchez said.

As student-based organizations, Peer Health and Active Minds try to reduce the stigma of reaching out for help. Yet ultimately their recommendations fall into the hands of the College’s Health Center and deans’ office to attempt to find permanent solutions.

“These are the most baffling, complex, impossible diseases to work with if you are an administrator at a college,” Johnson said, “because it defies explanation why wonderful, high-performing kids need to turn to this as a stress-reducer.”

College protocol with students’ consent

If a student facing an eating disorder consents to treatment, the College has a formulated plan that is adopted on a case-by-case basis.

“It’s crucial that we support students who are struggling with eating disorders,” Dean Bolton said. “Our Health Services staff, including physicians, nurses, psychological professionals and the nutritionist, work collaboratively to assist these students.”

The ideal approach to combat an eating disorder, Harrison said, is team-based. The Health Center, in conjunction with the student consenting to treatment, tailors a team to suit the student’s particular issue. The eating disorder team commonly consists of an administrative official – generally Harrison herself – an individual from Psychological Counseling, a nutritionist and a medical staff member. If the patient is an athlete, they may opt also to include an authority from athletics in the effort to combat the disorder.

The Health Center is positioned to deal with long-term treatment for eating disorders. “An important aspect of Williams’ psychological health services is that unlike many colleges we do not have a session limit,” Wood said. Because there is no limit, the Health Center “can provide really in-depth counseling or psychotherapy” to students for as long as it takes to defeat the illness.

Wood noted that the diagnosed eating disorders at the College would constitute a “pretty low statistic” as most instances “don’t rise to the clinical definition of a full-blown eating disorder.” The Health Center uses DSM-IV diagnoses for patients. “Most of our diagnoses fall under what is called adjustment disorders, some major mood disorders and [some] anxiety disorders,” she said.

“There’s a continuum of eating issues on campus,” Wood continued. “Although it’s only a small proportion for which a clinical diagnosis of an eating disorder might fit, nevertheless eating and body image problems are a very real and painful part of many Williams students’ experiences.” She also added that the very manifestations of disordered eating can play an emotional role in many students’ lives.

College protocol without students’ consent

When a student is unwilling to admit to or seek help for an eating-related problem, the College and the Health Center are left with little formalized recourse, except in extreme cases.

The Health Center may learn of a student with a possible eating disorder from the deans’ office, other students, faculty, coaches, parents or community members. The Health Center may directly approach students if they are able to acknowledge their source in broad terms – noting that a family member or group of friends felt this individual needed help, for example. However, the situation must be deemed of imminent risk in order for treatment to be deemed compulsory.

“We come up against the same reluctance with students. Unless students are willing to self-acknowledge, we have limited means to find solutions,” Johnson said.

“If a student’s eating disorder does put them in medical jeopardy, then we … have to discuss with them the risk factor. In that way, the College does get involved,” Wood said. “But … the risk has to be imminent.”

“The College has dealt with some very severe cases, where the point of real health concern has allowed us to come forward in a more active way,” Johnson said. “Frankly, we don’t want it to come to that point. Unfortunately, over the past 10 years, it has reached that point.

“Ninety percent of the problem is just getting students to self-identify [as having an eating disorder] or accept the recommendations of friends who come in,” he said. “Too many people wait until there is a physical crisis.”

For athletes, their participation on a team can often lead to the detection of an illness, as athletes must maintain a certain level of health in order to compete in their sport. Athletic screenings prior to the season enable the Health Center to get involved via coaches. “This doesn’t necessarily guarantee that we get a good solution,” according to Johnson. “Many students decide not to play their sport to evade the issue.”

While treatment is available, the process of seeking it is more difficult. “As [is] across the country, there are far more students who struggle with these issues than seek us out,” Wood said.

Johnson acknowledged that the College lacks a formalized approach in dealing with these circumstances of denial. “It’s a system that doesn’t have a very clear protocol to it,” he said. “I’m sure we can do better … We’re hoping that increased awareness will help us try and figure out a way that professionals can be more trusted as partners in helping people get help.”

The College began to realize how critical of an issue eating disorders were on campus about a decade ago, according to Johnson. “It’s a confounding situation that clearly we haven’t done a very good job with because I don’t feel the situation is any better than it was 10 years ago,” he said.

The deans’ office is authorized in extreme cases to mandate a referral to the Health Center. “That would be the final straw in terms of reaching out for help, but that’s rarely ever successful as a treatment plan,” Johnson said. “This is only used when we have no other way to deal with the situation.”

Going forward

Students, administrators and the Health Center have expressed interest in raising awareness at the College about mental health and eating disorder issues on campus.

“A lot more could be done – at the same time, it’s not so clear what it would be best to do and how to do it,” Sanchez said. “At the very least, having more conversations and talking would be helpful. Mental health is a very serious, very real issue and one that people don’t want to talk about enough.”

Johnson also hopes to add more actors into the equation. Currently, the College has “to identify [issues] based on students who come to us. We want to encourage other members of our community besides friend groups to come forward,” Johnson said.

“Within the Health Center, there are many routes to get into some sort of discussion and treatment,” Wood said. “The Health Center needs to gain access to students in order to provide its services and hopes to encourage more individuals to reach out.”

“If students are concerned about someone, please come talk to us,” Harrison said. “We can help.”

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