College Readiness and Eating Disorder Recovery

Going to college is one of the biggest transitions in young adult life. The move to college involves dramatic changes in routines, structure, and support. These shifts, coupled with academic and social pressures, can be destabilizing–especially if you’re working to recover from an eating disorder.

For young people early in their eating disorder recovery, readiness for this college transition must be carefully evaluated. It’s essential for treatment providers, families, and patients to think about the baseline functioning expected to be best prepared to weather the challenges of transition while continuing to move forward in health.

Most eating disorder experts will advise that certain benchmarks in the recovery process should ideally be met at least several months before departing for college. Chances of maintaining recovery once at school increase dramatically if primary features of stabilization have been achieved: full weight restoration, ability to eat with flexibility in a variety of settings, cessation of all compensatory behaviors, and confidence in a range of skills to manage challenging emotions and events.

The "College Readiness Guide" below is an informal checklist that can guide the process of preparing for college and establishing with confidence if the rising freshman is ready to go or if they might benefit from some more time before making the transition.

For the last three months, the individual has demonstrated the ability to nourish themselves effectively, which is evidenced by the following:

• If weight restoration was part of the individual’s treatment plan, they have maintained their goal weight with minimal parental support.
• They are at ease with a wide variety of food for both meals and snacks (for example, they eat breakfast options that are both hot and cold, and they’re comfortable with at least four different lunch rotations that can be readily available in a college café and can order off the menu without substitutions).
• They eat every three to four hours every day, meeting caloric requirements without prompting from their support system.
• They can independently plate adequate meals and snacks.
• They can go out to eat, order takeout, and work off existing menus without substitutions.
• They can go to a buffet or cafeteria setting and select/complete an adequate meal.

For the last three months, the individual has demonstrated the ability to not engage in compensatory behaviors, which is evidenced by the following:

• They have been free of binging, purging, laxative use, and any other compensatory behaviors.
• They are demonstrating normative exercise patterns (non-driven exercise that’s with the capacity to take breaks, focusing on health benefits and enjoyment rather than controlling body weight, and embracing rest days).
• They increase nutrition if they engage in more movement on a particular day (i.e., considers walking back and forth to classes)

For the last three months, the individual has demonstrated the ability to challenge negative body image-related thoughts and behaviors, which is evidenced by the following:

• If the individual has a history of body checking (i.e., frequent weighing, mirror checking, squeezing body parts) or body avoidance behaviors (i.e., refusing to be photographed or wearing baggy clothes to hide their body), they have committed to continue targeting/decreasing these behaviors while at school.
• They no longer vocalize the desire to control body weight and have evidenced the ability to accept their body in its healthy form.

For the last three months, the individual has demonstrated how to effectively regulate emotions, which is evidenced by the following:

• They recognize emotions that make them vulnerable to using eating disorders behaviors to cope (i.e., stress leads to urges to restrict or binge), and they have a repertory of more adaptive coping skills to use (distraction, self-soothing, and mindfulness).
• They use their support system effectively (i.e., they know who they can go to for social distraction and who they can go to for help.)

For the last three months, the individual has demonstrated understanding and accepting their eating disorder diagnosis, which is evidenced by the following:

• They can speak openly about their eating disorder with their support system.
• They can verbalize how they will navigate and/or respond to fat or diet talk in a way that honors their recovery, values, and goals.
• If the individual used regular weigh-ins in treatment to ensure they were maintaining their progress, they are willing to continue to get weighed (blind or open) at a frequency their provider recommends to them.
• The individual knows the warning signs that they are relapsing and when they need more support and professional help; they have a plan in place for how they’ll respond if they see these warning signs.
• The individual has investigated/secured resources that are available to them at school.

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