Helping Your College Student With an Eating Disorder Find the Right Therapist

Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy

Sending your child off to college is a big transition under any circumstances. But when your college student is struggling with an eating disorder? That transition can come with…well, an entirely unique set of concerns.

Will they actually eat in the dining hall? Will anyone notice if they start skipping meals? How can you monitor their weight? Who will they talk to when eating disorder thoughts become louder? What happens if their symptoms get worse once they are away from home? How will you be able to keep tabs on their well being while also giving them the chance to try their hand at being independent?

And perhaps one of the biggest questions parents find themselves asking is: How do I get my college student connected with a qualified eating disorder therapist?

The good news is that you do NOT have to figure this out on your own. Colleges do have counseling or mental health services available to students, and the campus counseling center can be an excellent place to start. At the same time, it is important for parents and students to understand that a college counseling center is often not able to provide the specialized, ongoing eating disorder treatment that a student needs. I want parents to understand that their child WILL likely be referred out shortly after presenting at the university counseling center if they have an active eating disorder that requires ongoing weekly therapy.

In most cases, the best plan is for a college student with an eating disorder to have an outpatient therapist who specializes in eating disorders, either near campus or through telehealth, while using the college’s counseling and health resources as additional supports (for example, group therapy services.)

Why eating disorder treatment can look different in college

College students are navigating a unique combination of independence, academic pressure, social changes, irregular schedules, and often a completely different food environment (like… night and day from being at home.) For a student with an eating disorder, those changes can make symptoms tricky to manage.

A student who previously had regular meals at home may suddenly be responsible for feeding themselves several times a day. They may be eating in a dining hall surrounded by hundreds of other students, navigating unfamiliar foods, attending parties where alcohol and food are present, or spending long days in class without a predictable schedule, and without access to snacks when needed.

We also know that even in the best of times, there tends to be a tremendous amount of pressure around appearance, exercise, and body image on college campuses. It is virtually unavoidable for this season of life.

Does every college student with an eating disorder need intensive treatment? Nope. But any college student with an active eating disorder, or in early recovery should ideally have a thoughtful treatment plan in place before symptoms escalate can make a significant difference.

At Wildflower Therapy, we always recommend establishing a treatment team and planning ahead for issues such as meals, social eating, routines, and support when transitioning to college. It’s best to get this team in place prior to your child getting to campus, or very very shortly after they arrive.

Should my college student use the campus counseling center?

Yes! The campus counseling center can absolutely be a very helpful resource.

In fact, it is often one of the easiest places for a student to begin. Campus counseling centers are familiar with the particular challenges college students face, and many provide free or low-cost counseling for a certain number of sessions. They also tend to have relationships with outpatient therapists in their area, and can help students connect with these therapists if need be.

But the important distinction for parents to know is that there is a difference between having access to every other week or once a month general counseling and having access to specialized eating disorder treatment.

College counseling centers vary tremendously. Some have clinicians with extensive eating disorder training and may be able to provide ongoing individual therapy. Most have clinicians who are comfortable screening for eating disorders and providing short-term support, but who do not specialize in eating disorder treatment, and hence cannot see students with eating disorders in an ongoing way.

Most counseling centers also operate on a short-term or session-limited models. If a student needs weekly therapy throughout the semester, that may not be something the counseling center is designed to provide (regardless of if the student has an eating disorder- their stance tends to be that a need for weekly therapy often warrants a referral to an outpatient therapist.) The Jed Foundation specifically recommends that students consider whether their campus counseling center can provide the regular appointments and full range of care they need, or whether an off-campus clinician would be a better fit.

This is why we encourage parents to think of the counseling center as one piece of the support system rather than necessarily the entire treatment plan.

Why might a college student be referred to an outside therapist?

It is fairly common for a college counseling center to recommend that a student with an eating disorder connect with an off-campus provider.

This does not necessarily mean that the eating disorder is severe, and it does not mean that the counseling center has failed your child. In many cases, the referral simply reflects the fact that eating disorders are specialized conditions requiring specific training and, often, more consistent treatment than a college counseling center can offer.

A student might be referred to an outpatient eating disorder therapist because the counseling center:

• does not have a clinician who specializes in eating disorders

• provides only short-term counseling

• cannot offer weekly or ongoing appointments

• does not have the ability to coordinate the full treatment team

• believes the student would benefit from more specialized eating disorder therapy

• does not have the medical or nutritional resources needed to monitor the student’s recovery

Outpatient eating disorder care often involves multiple professionals, potentially including a therapist, registered dietitian, medical provider, and a psychiatrist. For some students, an outpatient therapist may become the central person coordinating the psychological side of treatment while the student also works with a dietitian and medical provider. An outpatient therapist usually has more time and ability to coordinate care with dietitians and medical providers than counseling center staff tend to have.

How do I find an eating disorder therapist for my college student?

If your student has been referred off campus, or if you know from the beginning that they need specialized eating disorder care, we always recommend starting the search sooner rather than later.

Look specifically for a therapist who truly specializes in eating disorders, rather than simply someone who says they “work with food and body image.”

Eating disorder treatment is a specialized area of mental health care. A therapist may be an excellent clinician and still not have the training or experience necessary to treat anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, or other eating disorders.

When you contact a prospective therapist, ask directly about their experience treating eating disorders. You can also ask what treatment approaches they use, how frequently they typically see college students with eating disorders, and whether they collaborate with dietitians and medical providers.

We also suggest asking prospective providers about their eating disorder experience, treatment philosophy, qualifications, family involvement, communication with other providers, and emergency procedures.

You can also use eating disorder treatment directories, ask the campus counseling center for a list of referrals, or ask your student’s pediatrician, primary care physician, dietitian, or previous therapist for recommendations.

Should my student see someone near campus or continue with their therapist at home?

There isn’t one right answer!

For some students, continuing with a trusted therapist from home is ideal. If that therapist provides telehealth in the state where the student attends college and the student has a strong therapeutic relationship with them, continuity can be incredibly valuable.

For other students, working with someone near campus makes more sense. An in-person therapist may be able to better understand the student’s campus environment and help them navigate practical challenges such as dining halls, roommates, athletics, and social situations. It also can be helpful for therapists to be able to visually assess students for physical signs of a worsening eating disorder, and in-person therapy is more ideal for this.

Some students benefit from a combination: continuing with their established therapist from home while also developing relationships with providers near campus.

The most important question is not simply, “Can my child find a therapist?” It is:

“Can we create a treatment system that will realistically support this student throughout the school year?”

That means thinking about what happens during Thanksgiving break, winter break, spring break, summer, and periods when the student is under unusual academic or emotional stress.

Don’t forget about the rest of the eating disorder treatment team

Therapy is an important part of eating disorder recovery, but it is not always the only piece of care a college student needs.

Depending on the eating disorder and the student’s medical status, their treatment team may include an eating disorder therapist, registered dietitian, primary care or adolescent medicine provider, and psychiatrist or other prescribing clinician.

This is particularly important because eating disorders can have significant physical consequences, even when a student does not “look sick.” Medical monitoring may be appropriate alongside psychological treatment.

A college student’s therapist should also be willing to communicate with other members of the treatment team when appropriate. With the student’s permission, coordinated care can help everyone understand what is happening and respond more effectively when symptoms change.

What should parents do if their student doesn’t want therapy?

This is one of the hardest parts.

Eating disorders are often accompanied by a strong ambivalence about recovery. A student may know that something is wrong while simultaneously feeling deeply attached to the eating disorder behaviors. They may insist that they are “fine,” say that they don’t need therapy, or become frustrated when their parents bring up food or weight.

This does not necessarily mean that they don’t need help.

For an older college student, it is important to respect their developing independence while still communicating clearly that you are concerned and want to help them access appropriate care.

Instead of making the conversation entirely about weight, food, or appearance, try focusing on what you are noticing and how it seems to be affecting their life.

You might say:

“I don’t want to fight with you about food. I love you, and I’ve noticed that eating and exercise seem to be taking up a lot of your energy lately. I want to make sure you have someone at school who understands eating disorders and can support you. You don’t have to figure this out by yourself.”

Sometimes the first goal is not convincing a student that they have an eating disorder. It is simply helping them become willing to talk with someone who understands eating disorders.

Start before you think you need to

One of the biggest mistakes families can make is waiting until a student’s eating disorder becomes severe before establishing care.

If your student is already showing significant eating disorder symptoms, it’s important to start reaching out to therapists as soon as possible. Eating disorder specialists can have wait lists, and finding someone who is a good fit may take some time.

We always suggest that students establish a treatment team rather than waiting until a crisis occurs.

Your college student doesn’t have to recover alone

College is a time when young adults are learning to manage more of their lives independently. That doesn’t mean they have to manage an eating disorder independently, too.

The right therapist can give your student a place to talk honestly about what is happening without judgment. They can help the student understand the eating disorder, challenge the thoughts and behaviors that keep it going, develop strategies for navigating college life, and build the skills needed for a sustainable recovery.

And parents can still have an important role! Yes, even when your child is away at school.

Sometimes that role looks like helping to find a therapist. Sometimes it means making sure there is a medical provider nearby. Sometimes it means checking in about how things are going without turning every conversation into a discussion about food. Sometimes it means holding them accountable to ensure that they attend their sessions.

Most importantly, it means reminding your student that needing support is not a failure of independence.

Getting your college student connected with an eating disorder therapist is an investment in their health, their college experience, and their life beyond college. They deserve specialized support, and you DO NOT have to wait until things get worse to put that support in place.

If your college student is struggling with an eating disorder and you are looking for specialized eating disorder therapy in the Philadelphia area or through telehealth in Pennsylvania, Wildflower Therapy can help you explore what type of support may be appropriate for your student. Please feel free to reach out today for your free consultation call to find out if we might be a good fit to help your child.