Eating Disorders in Special Populations

Medical, Nutritional, and Psychological Treatments

Jonna Fries, Veronica Sullivan

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351649162
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Eating disorders are among the most complex disorders to treat, typically requiring medical, nutritional, and psychotherapeutic interventions. High relapse rates and the sense of urgency to save lives and minimize or prevent lifelong problems present challenges for even the most seasoned treatment providers.In an engaging, clear, and concise manner, Eating Disorders in Special Populations: Medical, Nutritional, and Psychological Treatments prepares physicians, dietitians, and psychotherapists to navigate the labyrinth they enter with eating disordered patients. Aggregating a vast amount of information and perspectives in a clear and concise format, readers will gain insight into the minds on both sides of the treatment room.From leading experts in the field, readers will learn how dietitians, physicians, and psychotherapists conceptualize and treat people with eating disorders, and treatment providers will discover the nuanced etiologies of eating disorder symptoms in a range of diverse populations. Increase your cultural competency and expand your practice by learning how eating disorders are created, maintained, and resolved. Join us in bringing light, health, and hope to our patients and to our colleagues across disciplines.

Section II

Special Populations

6 Eating Disorders in College Students

Mandy Golman, PhD, MS, MCHES, Marilyn Massey-Stokes, EdD, CHES, CWHC, FASHA, and Susan Karpiel, MS, RDN, LD

CONTENTS

Learning Objectives

Prevalence

Special Concerns

The Female Athlete Triad

College Sororities

Drunkorexia

Screening and Assessment

The SCOFF Questions

Treatment Resources

Prevention

Conclusion

References

LEARNING OBJECTIVES

After completing this chapter, you should be able to do the following:

• Identify prevalence rates of eating disorders in college students
• Describe the most commonly used measures in assessment and evaluation of eating disorders
• Identify the risk factors specific to college students that contribute to the development of eating disorders
• Address the physiological consequences of eating disorders in college students
• Address the psychosocial consequences of eating disorders in college students
• Describe the most common treatment approaches for college students with eating disorders

Dear Mom and Dad,

Well, I have just completed my first month at college. I’m not really sure what to say. I have made some nice new friends, but feel pretty homesick. I haven’t slept too well in my new bed-it is really hard. My classes are tough and I feel overwhelmed by the work. I think I flunked my first test! I can’t find anything to eat in the cafeteria-everything is gross. I don’t want to gain the Freshman 15. I’m not sure I’m ready for college at all!

This note, sent home from a first-year college student, summarizes many of the stressors college students can experience during this significant life transition. New environments, sometimes far from home, coupled with pressures to excel academically, make new friends, and manage new responsibilities, can create a very challenging situation for any student. For those struggling with negative body image, disordered eating (DE), or clinical eating disorders, the college campus can be even more daunting and become a perilous environment. Even though research shows that freshman gain between 2.5 and 3.5 lb. and that this is only 1/2 lb. greater than peers their same age who do not attend college, the dreaded Freshman 15 causes much concern for many college women (Zagorsky and Smith 2011). This concern can lead to obsessive thoughts of dieting, dietary restraint, and negative body image, even when no weight gain exists (Delinsky and Wilson 2008; Graham and Jones 2002). Substantial evidence has been found to support that pressure to be thin is predictive of dieting behaviors and onset of bulimic pathology (Cattarin and Thompson 1994; Stice 1998). The pressure to adhere to the thin ideal, the lack of support services, and the freedom of unmonitored behaviors makes the transition to college a period of high risk for the development of an eating disorder (Delinsky and Wilson 2008; National Eating Disorders Association [NEDA] 2013; Striegel-Moore et al. 1986).

PREVALENCE

It is estimated that 30 million people in the United States have an eating disorder at some point in their life (NEDA 2015). The Healthcare Cost and Utilization Project reported that between 1999 and 2006, hospitalizations involving eating disorders increased by 19% for patients aged 19−30 (Zhao and Encinosa 2009; American College Health Association 2015). In addition, eating disorders in the college population are on the rise and show no signs of slowing down. Three percent of females and 0.4% of males reported receiving a diagnosis of anorexia; 2% of females and 0.2% of males reported a previous diagnosis of bulimia; and 4% of females and 1% of males reported vomiting or taking laxatives to lose weight in the previous 30 days in the American College Health Association’s National College Health Assessment (Hudson et al. 2007; American College Health Association 2015). In a recent random screening in a large midwestern university, prevalence rates appeared to be 9%–13% among females and 3%–4% among males significantly higher, than noncollege attending peers (Eisenberg et al. 2011). Mintz et al. (1997) found that while only 4% of college women in their sample had eating disorders, 19% of them had an identifiable risk factor for the development of an eating disorder. Although a small percentage of college students have a diagnosable eating disorder, some estimates predict that as many as 30% may be at risk for developing an eating disorder (Franko et al. 2005). Some studies report 64% of college women have reported dysfunctional eating behaviors (Mintz and Betz 1988). A survey conducted by Global Market Insite, Inc. for NEDA found similar startling results. Over 20% of those surveyed reported suffering from an eating disorder at some point in their life, and of that 20% who reported suffering, almost 75% did not seek treatment (NEDA 2015). In terms of mortality rates, eating disorders have the highest rate among mental illnesses with eating disorder not otherwise specified (EDNOS) having a higher mortality rate than anorexia nervosa or bulimia nervosa (Crow et al. 2009). Comorbidities are commonly seen with eating disorders and include depression, anxiety, and substance abuse (Jones et al. 2012). It is also found that these comorbidities can lead to eating disorders, especially in college students with body image concerns. The risk of developing an eating disorder increases from 4% to 60% when students have one or more comorbidities (Jones et al. 2012).

SPECIAL CONCERNS

THE FEMALE ATHLETE TRIAD

Disordered eating can be characterized by a range of unhealthy dietary and weight management attitudes and behaviors that don’t warrant a clinical diagnosis of an eating disorder, yet still negatively impact health, wellness, and quality of life and potentially lead to actual eating disorders. Disordered eating includes, but is not limited to, excessive concerns about body weight, shape, and size; poor nutrition and/or restrictive dieting; very rigid and unhealthy eating and exercise habits; feelings of guilt or shame when unable to meet self-imposed eating and exercise standards; binge eating; use of diuretics and diet pills; purging through laxatives, vomiting, or excessive exercise; and self-obsession with body weight and size, food, and exercise to the extent of causing distress and lowering quality of life (Anderson 2015). College athletes can be susceptible to DE due to the physiologic demands of sports (Granger et al. 2008) and the emphasis that some sports place on body weight and shape (e.g., gymnastics, dance, swimming, diving, cross-country, etc.). Furthermore, DE can lead to a condition referred to as the female athlete triad (Triad), which consists of three interrelated conditions—menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density (Nazem and Ackerman 2012; Nattiv et al. 2007). Low energy availability (with or without an eating disorder) can negatively impact health, both physically and psychologically. Furthermore, the conditions associated with the Triad can lead to serious health issues, such as clinical diagnoses of eating disorders; functional hypothalamic amenorrhea; osteoporosis; bone stress injuries and decreased athletic performance; and complications in endocrine, gastrointestinal, renal, and neuropsychiatric functioning (Nattiv et al. 2007; De Souza et al. 2014).

Studies have indicated that female college athletes are at increased risk for experiencing problems related to DE and the Triad (Greenleaf et al. 2009; Mitchell and Robert-McComb 2014; Reinking and Alexander 2005). In a study of female college athletes from 17 sports at three universities, approximately 26% of the athletes exhibited subclinical symptoms of an eating disorder (Greenleaf et al. 2009). In another study, athletes in “lean” sports (e.g., dance, diving, distance running, gymnastics, and swimming) exhibited more DE than athletes in “nonlean” sports and nonathletes (Reinking and Alexander 2005). According to the National Athletic Trainers’ Association (2008), prevalence estimates of eating-related problems have been as high as 62% among female athletes and 33% among male athletes (Granger et al. 2008). However, the extent to which college female athletes engage in pathogenic eating and weight management behaviors and experience clinical eating disorders is not clear (Mitchell and Robert-McComb 2014; Reinking and Alexander 2005; Smolak et al. 2000). Part of the uncertainty can be attributed to methodological differences that can affect findings. It also appears that college-level sports participation can increase risk for eating problems and yet be protective in some cases (Smolak et al. 2000). In addition, a systematic review revealed that the prevalence of the Triad conditions (subclinical and clinical) occurring simultaneously, in combination, and individually is not clear (Gibbs et al. 2013). It was contended that further prevalence research on the Triad is needed to better understand the scope of the problem and develop effective screening, prevention, and treatment strategies for the Triad conditions (alone or in combination).

A NEDA survey of 163 colleges and universities from across the nation revealed that there is a paucity of programs designed to prevent, screen for, and refer student athletes with eating problems, especially in high-risk sports such as gymnastics, wrestling, and swimming (NEDA 2013). Only 22% of the respondents indicated that their school’s athletic department offers screening and counseling referrals for athletes in high-risk sports. Furthermore, only 2.5% of the colleges and universities surveyed have ongoing prevention education programs for athletes in high-risk sports. Of those who offer screening and referrals through the athletic department, 100% believe these services are very/extremely or somewhat important. Of all surveyed respondents, 91% stated that such programs are very/extremely or somewhat important. Overall, survey findings revealed that “there is a large unmet need for screenings and counseling services for athletes” (NEDA 2013).

There is general agreement that the most efficacious approach to addressing DE and the Triad conditions (alone or in combination) is early detection and prevention (Gibbs et al. 2013; Granger et al. 2008; Mountjoy et al. 2014; Nattiv et al. 2007; Nazem and Ackerman 2012). Possible warning signs of the Triad include performance regression, mood changes, noticeable weight loss, and frequent injury, particularly fractures. Therefore, maintaining keen awareness and creating an atmosphere that facilitates open communication can help with early detection and successful intervention (Nazem and Ackerman 2012). Moreover, published guidelines and tools are available to facilitate the prevention, detection, and management of DE in college athletes (Granger et al. 2008; Mitchell and Robert-McComb 2014; Nattiv et al. 2007; Rodriguez et al. 2009).

COLLEGE SORORITIES

College sororities are an important social system to target for eating disorder prevention interventions (Becker et al. 2008). Studies have suggested that sorority members highly value physical appearance and may be at increased risk for internalization of the thin ideal, body dissatisfaction, and eating disorders (Basow et al. 2007; Becker et al. 2005). Furthermore, it appears that social influence and modeling may play important roles in promoting DE, especially when sorority members live together (Basow et al. 2007; Crandall 1988; Hoerr et al. 2002). Social influence, particularly from family and peers, is thought to play a key role in the development of body dissatisfaction and internalization of the thin ideal, subthreshold eating problems, as well as clinical eating disorders such as bulimia (Basow et al. 2007; Crandall 1988; Luce et al. 2008; Stice 1998). In addition, social influence and modeling such as binge eating can be problematic within a social system like a sorority (Crandall 1988). In turn, these same social influences may function for compensatory weight control methods (Luce et al. 2008).

A study showed that college females at risk for developing negative body image and DE are attracted to sororities; findings showed that those who intended to join sororities were similar in body objectification to the women who were already members (Basow et al. 2007). In addition, women planning to join sororities rated perceived more social pressure to be attractive and social than nonsorority members and women who didn’t plan to rush. Furthermore, the study revealed that...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Editors
• Contributors
• Introduction
• SECTION I A Multidisciplinary Approach to Treatment
• SECTION II Special Populations
• Index