Expensive treatments have helped Rachel Rifkin gain control of her eating disorder during college. Before she graduates from SU in two months, she hopes to have laid the groundwork for something just as valuable: a network of students who will be able to talk to — and support — each other.
She is working on that now, with help from a local group.
Rifkin extended her idea to a Central New York support center, Ophelia’s Place [13], and got the sponsorship of therapists who offered to facilitate weekly group meetings on campus for the fall semester.
Rifkin has spoken openly about her struggles this month, in a panel and interviews, to increase awareness of eating disorders on campus. She is vice president of SHAPES, or Students Helping Acquire, Promote and Enhance Self-Esteem [14]. Although Rifkin said SHAPES has been an excellent outlet for her, she’s missed peer support from others who’ve shared her struggles with eating.
“When I came to college, I realized that it was physically impossible to live a genuinely healthy lifestyle with food, exercise, work, sleep and stress. As college students we binge eat and binge drink regularly and are under huge amounts of stress,” Rifkin said. She left school to undergo the kind of intense treatment and rehab she could not get on campus, all while attending classes.
Fewer than two dozen students attended a campus panel before spring break that was held to educate students and offer guidance. A 2010 survey by the National Association for Anorexia Nervosa and Associated Disorders [15] found that half of college students who met the criteria for an eating disorder were unaware they even had one.
Rifkin’s preoccupation with food began early, and escalated after she got here to bulimia — a condition marked by binge eating and then purging. It was not an unusual situation. The Eating Disorder Foundation [16] has found that 31 percent of college women are dealing with some kind of eating disorder, which means roughly 2,000 SU women could have some sort of affliction, and most are unaware of it. Those who do know or suspect something’s wrong often deal with it in silence, or alone.
SU alumna Colleen Baker said she could relate to Rifkin’s story, and agreed peer help would be a huge benefit. When Baker returned from rehab, she had a similar longing for comfort from students who knew what she was going through, and knew what it was like to be overwhelmed by an eating disorder. “Being newly recovered made me feel like there was no one to turn to,” Baker said. “I would have loved to have a support group of students that would have helped me feel less alone. My peers were great, but no one really knew what it was like.”
Dr. Elizabeth Reyes, coordinator of University of Southern California’s Eating Disorder Treatment Team [17], said in a phone interview, “Students often don't know anything is wrong because disordered eating is so common in college. It’s normal for students to hate their body and want to lose weight. It’s normal for students to skip meals between classes and then binge eat.”
There is an uncertain boundary between normal and disordered eating on college campuses. Although Rifkin had been suffering from bulimia for more than a year, she did not acknowledge her condition until it became second nature, until she was vomiting half a dozen times a day. Until she forgot what it felt like to be full.
According to the National Institute of Mental Health [18], the average onset for eating disorders falls between ages 18 and 20, putting college students at tremendous risk. Rifkin cannot remember a time when she was not preoccupied with food, but believes that college is what sparked her disorder.
Baker explained that her anorexia “came back like an old friend in college.” She was fully recovered when she graduated high school but immediately found herself sinking into old patterns. The combination of stress, independence and an unpredictable lifestyle turned out to be a recipe for relapse.
“No one monitored when or what I was eating at college so I could restrict as much as I wanted. At home, I had family that noticed when I wasn't eating, but in college, eating was left up to me. The dining halls offered endless amounts of free food to obsess over and individual bathrooms allowed me to purge after every meal.”
The University of Southern California was one of the first colleges to craft an eating disorder treatment team, more than a decade ago. SU formed a treatment team less than two years ago because of the medical severity of student cases. Treatment teams offer short-term and immediate care for students, but greatly differ from off-campus treatment programs that are much more comprehensive.
“The main challenge for students with eating disorders in college is that we can’t meet the demands of students or the intensity of other programs,” Reyes said. “Research shows that eating disorders require long-term treatment of at least five years. Research also shows that recovery takes a team and can’t be solved by just one professional.”
Most university treatment teams consist of a physician, nutritionist, therapist and psychiatrist. According to Dr. Susan Pasco, associate director of SU’s Counseling Center [19], teams offer short-term emotional and medical support as needed. They serve to help students acknowledge they have a problem and to transition back into college after rehab. The primary role of SU’s treatment team is to intervene when medically necessary to ensure the safety of the student. Guardians and healthcare providers are contacted, and students may be required to take a leave of absence. In-patient rehabilitation services offer around-the-clock medical and psychological services that monitor every calorie consumed and every bathroom run that is made. Rehabilitation centers average around $30,000 per month, and offer far more than colleges can handle.
When Rifkin finally came to terms with her eating disorder sophomore year, it had already begun to take a toll on her body. Her weight was fluctuating at a catastrophic level and she was constantly fighting off infections. She had no energy and rarely got out of bed. After her initial appointment with the counseling center, Rifkin was urged to seek long-term treatment off-campus. Rifkin packed up her dorm room and checked herself into a treatment center for an eight-month stay.
“I hated in-patient treatment but had the best mindset that I could for the situation I was in,” Rifkin said. “There were days when I was like ‘Get me the hell out of here’ and days that I knew this was where I needed to be.”
Rifkin returned to Syracuse for the second half of her junior year. She left her treatment center with a plan in place and a team of professionals behind her. She still spoke with her external nutritionist and psychiatrist, but has used therapy through the counseling service. Even though Rifkin had the encouragement of friends, family and an entire medical team, she was missing the support of other student survivors with whom she could relate.
“While I was in treatment, my therapist stressed the importance of a support group during and after recovery,” Rifkin said. “They believe that support groups offer different help that no doctor can provide.”
Colleges are careful about getting involved in these kinds of groups because of liability issues — the fear of being held responsible for students not realizing how sick they are, or for being connected to a group whose members can be in emotional or physical dangers.
As Rifkin reflects on her recovery, she realizes that she is one of the lucky ones — and that since college triggers so many problems, it is a threat even after recovery and treatment in off-campus settings.
“College life is pretty much everything I learned not to do while in treatment,” explains Rifkin. “So colleges need to be prepared for it.”
