Eating disorders rising among college students

Naomi Brown, a staff psychologist at Stanford University, was stunned by the number of students with anorexia and bulimia that she encountered when she began working at the student health center a decade ago.

"I was a bit overwhelmed when I had so many eating disorder cases," Brown recalled.

But she's since grown accustomed to it.

In her office in the Vaden Health Center, she now routinely provides support to students who are fearful of their destructive eating habits. Or she strives to connect with emotionally numbed young adults in denial that their gaunt figures reveal an often-fatal psychiatric disturbance.

And to her relief, the Lucile Packard Children's Hospital in March opened the doors of its esteemed Comprehensive Eating Disorders Clinic to 18- to 21-year-olds. Prior to the expansion, young adults required special approval to receive treatment there.

"They offer a really special form of therapy," Brown said.

In the past, she usually referred students for more intensive treatment to private physicians, who don't typically offer the state-of-the-art care the hospital provides. Packard Children's Hospital is a national leader in the often-neglected field of eating disorders research.

While data on prevalence remains sketchy, one 2004 survey from the National Eating Disorders Association offers a preliminary picture with its finding that 20 percent of more than 1,000 college students polled believed they

In comparison, between 0.5 percent and 4 percent of the general population will grapple with anorexia, bulimia or binge eating during their lives, according to statistics compiled by the association.

It's often a surprise for people to learn of the existence of such severe mental disorders among students at elite colleges, where rigorous selection processes screen for the best and the brightest.

But it's that atmosphere that can also trigger eating disorders or perpetuate them in incoming students, Brown noted.

"There's a perception that smart people should have better mental health," she said. "But psychiatric illnesses don't spare anyone."

In fact, eating disorders are particularly prevalent among high-achievers, who often tend to be perfectionists, she noted.

"Being in an environment like Stanford isn't helpful," Brown added, "because the expectations for performance are so high."

A team of experts at UC Berkeley also treats students with eating disorders, said Kim LaPean, communications manager for University Health Services, the student health center. A Web site provides online support.

"It definitely exists, we definitely do outreach," LaPean said. She believes, however, that eating disorders are less common at UC Berkeley than at another elite university she once worked at.

"I really don't see as much of a culture of being thin to fit in at Berkeley as I have in other universities," LaPean added.

While about 90 percent of those with these conditions are women, Brown said she's seeing more men with eating disorders, particularly athletes.

"Athletes are a special population struggling with eating disorders," she said, noting that many sports require maintenance of low body fat. Brown cited track and field, gymnastics, diving and swimming as examples of sports demanding lean bodies.

"Sometimes, they are so ashamed of their eating disorder they don't want their coaches to know," she said.

A Stanford student group called MIRROR, which provides support for "eating disordered" students and their concerned friends, noted that anorexia, bulimia and binge eating don't just affect the fringes of student life, but "are cultural issues at Stanford."

Brown provided graphic accounts of what others encounter when living with a bulimic student, such as finding jars of vomit in a closet, or carpets rotting from repeated exposure to the acidic regurgitation. Janitors warn dorm supervisors when they're regularly cleaning up vomit in the bathrooms, she said.

Food mysteriously disappearing from kitchens is another common sign, Brown said.

"Other times, we see people who are clearly emaciated jogging six miles a day," Brown added, describing a close cousin of eating disorders — excessive exercise.

Dr. James Lock runs the Eating Disorders Clinic at Lucile Packard, and he said he expanded the program "to fill an unmet need for care in this vulnerable age group, both at Stanford and the region as a whole."

Anorexia kills more people than any other psychiatric disorder, said Dr. Walt Kaye, director of the eating disorders program at UC San Diego. Kaye's center is one of seven nationwide participating in a clinical trial Lock is running at Stanford on anorexia funded by the National Institutes of Mental Health.

One in 10 will die of the condition, he said, citing statistics of the mental health institute. They'll succumb to starvation, heart or kidney failure, or suicide. And those living with the condition suffer from early-onset osteoporosis, hair loss, tooth decay, anemia and cessation of menstruation, among other conditions.

"You have a really diminished future," Lock emphasized.

And while those with eating disorders respond well to treatment, only a fraction receive help, which in part reflects the shame surrounding eating disorders, for both sufferers and their families. Parents, Kaye noted, are often still erroneously blamed for causing eating disorders. Instead, genetics and biological factors also play a key, but still unclear, role in the development of these conditions.

"We know less about the biology and treatment of eating disorders than we do about other major psychiatric disorders," he said, noting that Lucile Packard is among the leading research institutes seeking more effective treatments for these conditions.

Lock said that while anorexia was first named as a disease in 1874, only five clinical trials involving about 500 adolescents — the usual age of onset — have ever been conducted on it.

"People have thought of this as a disease of choice," he said. "They have blamed the patients or the families for it, and in that way diminished the biological and psychiatric severity of it."

As a result, fewer researchers are willing to devote a career to researching the subject. "I'm a rare bird," Lock noted.

For Christine Henneberg, 24, of San Francisco, he's also a hero. Henneberg, who's about to enter medical school, sought treatment from Lock in 2001 for anorexia, joining one of his clinical trials.

"The therapy was the crux of my recovery," Henneberg said. Shortly after starting, she began eating more normally and gaining weight. And when she went to college in Southern California, she was able to cope on her own, without relapsing.

How would she have coped without the treatment? "I think facing all those options at a dining hall, I would have been completely overwhelmed," she said. "And I might have just chosen to eat less and less."