Starting university was an exciting and long awaited experience for Lucy*, a third year arts student. But as the beginning weeks of first year hit, Lucy found herself living the cliché of a small fish in a big pond. She felt overwhelmed, lonely, stressed out, and depressed. Lucy dropped out after three weeks and spontaneously took a trip to South America. Four months later she got off the plane exhausted and numb. Lucy was suffering from anorexia nervosa. The next three years would be a blur of appointments, scans, tests, hospital stays, and meal plans set within a world of loneliness, self-hatred, and desperation. How did this happen?
The move to university can be challenging for most of us: the unlimited freedom to learn, work, and play as an adult is often in stark contrast with the anonymity of campus life. Free from the spoon-fed world of high school, we are left to our own devices – to see whether we will sink or swim. For some, this is the time when a number of factors align leaving them vulnerable to an eating disorder – as they did for Lucy.
A dietitian specialising in eating disorders, Genevieve Michael points to the convergence of the expectations and responsibilities of adulthood with the pressures of newfound independence and a propensity for anxiety and depression; coupled with feelings of anonymity and the confusion of new sexual relationships as leading to an increase in the likelihood of developing an eating disorder at university. She emphasises the extent of such a dangerous dynamic. “It is important to seek help as early as possible rather than punish your body or your capacity for clear thought in the short term and in the long term, the possibility of reproduction,” she says.
Professor of Clinical Psychology and Co-Director of the Peter Beumont Centre for Eating Disorders, Stephen Touyz, also acknowledges the prevalence of eating disorders at university. Although statistically anorexia nervosa typically begins in high school, Touyz argues that the lack of adequate diagnostic criteria and successful treatment methods at this time means that “even if you pick up someone at the ages of 12 or 14, only 30-40 per cent are likely to recover, so by the time you get to university they are pretty sick.”
“If someone asked me to pick one place to find one hundred eating disorder patients, I’d go to campus,” he continues. “Because that’s where you’ll find them. Where I wouldn’t go is a group of people in their sixties, because most people with anorexia nervosa would have died by then.”
Research also suggests that certain personality traits can be linked to anorexia nervosa sufferers, which again increases the instances of the disease occurring at university. Patients tend to be obsessional, driven, absolutely determined, and perfectionistic, which Touyz says often leads to them getting the highest marks at school and continuing on to university.
Professor of Journalism and Director of the Journalism and Media Research Centre at UNSW, Catherine Lumby, agrees. “Universities attract a proportion of very high achieving students who may be prone to putting unrealistic pressure on themselves,” she says. This challenges common misconception that sufferers of anorexia nervosa are vain and stupid.
“Anorexia nervosa doesn’t change your IQ. Smart people get anorexia nervosa. If you’re in high school and you can’t eat with other people, what do you do? You can’t go out, you can’t see friends…so you just study,” Touyz says.
Unlike anorexia, the later onset of bulimia nervosa typically occurs around 18-20, and can also be facilitated by the tumultuous transition to university. But bulimia is much harder to detect, as sufferers may not exhibit severe weight loss. Nevertheless, bulimia nervosa is an equally serious disorder. It is characterised by an inability to cope with emotional distress, as sufferers attempt to diet but become trapped in a cycle of bingeing and purging of food.
It is clear that university is a place where age range and environment can collide to provoke the onset of an eating disorder. Why then are there so few resources to combat the disease in the university environment, let alone a definitive debate around these issues in the public sphere? The stigma surrounding mental illness is one reason the discussion of eating disorders is still very much taboo. Despite increasing awareness of mental health issues such as suicide and depression, eating disorders have been very much neglected in the debate.
In fact, any focus on eating disorders in the mainstream media assumes one of two attitudes. The first is your typical tabloid sob story; expect to see a piece about tears and tragedy followed by a derogatory analysis of the trivial obsessions of teenage girls, a vox-pop about gossip magazines and ‘industry expert’ decrying the impact of the fashion industry. Essentially, the overall tone is one of voyeuristic curiosity, moral judgment, and ultimately dismissal.
The second approach glorifies extremely underweight fashion models and celebrities, whereby gossip magazines place images of emaciated women alongside dieting and weight loss advice.
Genevieve Michael says this is almost the reverse of a social taboo, as young women suffering from eating disorders are depicted as having the ideal body shape. Ultimately though, it is society’s prevailing dismissiveness regarding mental illness that strengthens the impact of both media narratives. A youth consultation process by the National Eating Disorders Collaboration (NEDC) evidenced this depressing truth in a study that identified 51.3 per cent of 12-17 year olds who agreed or strongly agreed that a person with an eating disorder should “snap out of it, there are more important things in life to worry about”.
Lucy remembers countless conversations with friends and family who challenged her commitment to recovery. One friend asked: “Why don’t you just go and eat a heap of Maccas?” Another relative would frequently demand to know if she had put on any weight. “I felt like I was constantly telling people I wasn’t obsessed with Victoria Beckham,” Lucy says.
Despite the obvious impact of the media on public attitudes and awareness, it is important to realise that eating disorders are not the result of media and social pressures to diet.
“There is often a too simplistic connection made between images of thin models and eating disorders, which suggests as a straightforward cause and effect relationship,” says Catherine Lumby, “as if people simply ‘catch’ eating disorders from media images.” In reality eating disorders are caused by a number of genetic, psychological, and behavioral factors including perfectionism, anxiety, and a low sense of self worth. Most importantly, eating disorders are not self-inflicted. As Lumby says, “Don’t assume that someone with an eating disorder has simply ‘swallowed’ a media message to be thin. It’s not that simple.”
In essence, if everyone woman on a diet developed an eating disorder we would be in the middle of an epidemic. Nevertheless, the disturbing fact is that the mortality rate for people with anorexia nervosa is 20 per cent, or one in five, the highest of all psychiatric disorders and over 12 times the rate seen in people without eating disorders. The risk of successful suicide is also 32 times higher than that expected for major depression, in which deaths from suicide are 21 times greater than expected in the general population. Those who do not go on to make a full recovery are also likely to suffer from major, persistent physical abnormalities, including osteoporosis and anovulation, as well as psychiatric problems such as major depressive disorder and obsessive compulsive symptoms.
Perhaps less well known are the extreme dangers of bulimia nervosa through which excessive vomiting, laxatives, enemas, and diuretics can cause a loss of fluid and electrolytes in the body. This can lead to severe electrolyte imbalances causing kidney failure and cardiac arrest. Less common causes of death in bulimia include choking, rupture of the esophagus or stomach, and suicide. Sadly, there are also debilitating and sometimes profound psycho-social handicaps that result from long-term eating disorders, including isolation and failure to establish autonomy and independent living.
According to the NEDC website, “the social handicap experienced by so many of these more chronic patients is as great as that found in schizophrenia”.
Raising the issue of eating disorders in the university population would not be complete without addressing the complexities of speaking up about mental illness. It is extremely challenging to confront a loved one about their mental health, whether or not it is concerning an eating disorder.
Lucy remembers discussing her health with her grandmother, who insisted on referring to it as her ‘problem’. Yet, as we have become more aware of the importance of social awareness in mental illnesses like depression, eating disorders are ignored. Just like other psychiatric illnesses, eating disorders require early intervention, support and aggressive treatment in order to give sufferers the best chance of recovery.
Even at an institution such as Sydney University, where the occurrence of eating disorders is a significant issue for the student population, there are very few options available in terms of treatment or even basic information.
Lucy has slowly returned to a normal weight range. She agrees there is a lack of awareness regarding services on campus for those with an eating disorder. She only discovered the Psychology Clinic in her third year, and knows a fellow sufferer who was turned away from the counselling service due to staff shortages. Professor Touyz agrees that the university has to work harder to address this issue through strategies like lunchtime talks, seminars, leaflets and online resources.
For the moment there remain only three non-specific places to go for help: the University Health Service, the Counselling Service and the Psychology Clinic.
It is clear that with the rise of mental health in the national agenda, the seriousness of eating disorders can no longer be dismissed. Touyz stresses his disappointment in the current approach because “[anorexia nervosa] is not recognised as the most serious psychiatric illness, but it is.” Despite her recovery, Lucy also emphasises the all-consuming nature of the disease. “Every day is a constant struggle with the anorexic voice inside me. I think it will be something I have to deal with for the rest of my life,” she says.
The NEDC estimates one in 20 Australians has an eating disorder and the rate of those affected within the wider Australian population is rising. With the high risk of eating disorders amongst students, university is the best and most important place to raise awareness and provide much needed services. With the renewed focus on student health, such as the recent smoking ban and the proposed ‘Healthy Campus’ initiative, it will be interesting to see whether Sydney University will step up to combat a disease that can no longer be overlooked.
*names have been changed