How Northwestern fails to support students with eating disorders.

CONTENT WARNING: This story discusses the experiences of students dealing with eating disorders.

Photo illustration by Agnes Lee

Gisel* was out of options. Early winter quarter of 2017, Gisel was completing a partial hospitalization program in Chicago for an eating disorder when she received an email from Northwestern Residential Services. Because she was not a full-time student while going through treatment, she needed to vacate her dorm. Terrified, Gisel went to Residential Services and asked them to let her stay. Moving home wasn’t an option for her. But the person she needed to speak to wasn’t in the office, so she had 48 hours to figure it out on her own.

“That was probably the worst experience I’ve had in Northwestern, thinking I was going to lose my housing,” Gisel says. “I was 18. I didn’t know anyone. I had no friends.”

Finally, one of Gisel’s psychiatrists led an emergency exception for her to stay in student housing. The University accepted.

Northwestern students with eating disorders often need to navigate a complex web of resources and regulations, with little help from the University.

In general, college students are susceptible to eating eating disorders. About 13 percent of female college students and about 4 percent of male students struggle with eating disorders, according to the National Institutes of Health (NIH).

But advocates say that on-campus resources for students with eating disorders are sparse. Northwestern isn’t unique in sometimes providing insufficient resources: According to the National Eating Disorders Association (NEDA), only 22 percent of college students said there were year-round screening resources on campus. But Northwestern’s productivity culture and intense academics can worsen symptoms of an eating disorder.

The pressure to perform

Supporting students with eating disorders can be particularly challenging at a place like Northwestern, according to Amanda Mueller, senior assistant director of Residential Life. “I think sometimes the pace of Northwestern, met with

some of those pressures of achieving academically, the social pressures that exist in various spaces, that the university can allow [eating disorders] sometimes to go unseen because they look like signs of stress, of someone not eating or struggling with illness or food poisoning,” Mueller says, though she argues this trend can be seen at universities across the country.

Third-year Isabella Noe, who is in recovery from an eating disorder, adds that Northwestern’s intense academics can exacerbate symptoms of eating disorders, which are often about trying to maintain control.

“It’s [that] feeling of not being enough and also feeling really out of control sometimes because you have all of these assignments; you have all of these classes; you have all these extracurriculars that you’ve dedicated your time to,” she says. “And it can be really hard to find enough control in your life because that’s what eating disorders are about.”

Throughout her time at Northwestern, Gisel has generally only taken two or three classes a quarter, because she struggled to manage her anxiety and eating disorder. When she was in treatment, she only took one class each quarter.

“I [wasn’t] used to regulating all these emotions because they’ve been starved out for so long that I couldn’t manage more than two classes. Three was a stretch,” she says.

Because of how few classes she had taken, the school put Gisel on academic probation. While she thought she could take three classes the next quarter (the minimum required to remain a full-time student), Gisel had to take four classes to get taken off probation, as mandated by the University.

Unwilling to explain her circumstances to Northwestern, Gisel took four classes for one quarter, but struggled to keep up and was barely able to come off probation. Though she hasn’t been on academic probation since, she will have to stay for an extra year to complete her degree.

Getting help

Trying to find help on campus for disordered eating can be challenging. Those struggling with eating disorders usually have to find outside treatment options, as Counseling and Psychological Services (CAPS) has notoriously struggled to fully meet students’ needs.

"I wasn't used to regulating all these emotions because they've been starved out for so long." - Gisel*

Noe says she had struggled with an unhealthy relationship with food her whole life, but the stress of applying to college senior year exacerbated a cycle of binge eating and purging. However, it wasn’t until the end of her first year of college that she began seeing a therapist.

Noe says she would not have been able to receive any treatment if she weren’t a sexual assault survivor, since she found her therapist through Porchlight Counseling Services, which offers free counseling to survivors of sexual assault. Porchlight limits their services to 20 free sessions, and since Noe hit that limit, she can no longer afford counseling, she says.

Dr. Renee Rienecke, an adjunct associate professor at the Feinberg School of Medicine and director of research at the Eating Recovery Center, a treatment center in Chicago, stresses the importance of having a support system in place for students in treatment for eating disorders.
“[Universities] should know warning signs and symptoms and things like that,” Rienecke says. “I think universities can play an important role in identifying and getting someone into treatment.”

CAPS operates the Eating Concerns Assessment and Treatment Team, a group of psychiatrists and dieticians that work together to treat students with eating disorders. According to their website, the team provides assessment services to determine if a student has an eating disorder, and consultation services to Northwestern community members worried about a student. For long-term treatment, students need to look outside the University.

In Gisel’s first year, she joined the rowing team. When she mentioned an earlier diagnosis of an eating disorder on the health information form most club and varsity athletes are required to fill out, Northwestern’s Health Service referred her to CAPS.

At the first appointment, a psychiatrist told her that they couldn’t handle her needs. She met with them twice more before they referred her to outside therapy. In January of that year, she began commuting daily to a hospital downtown for inpatient care, taking one class in the morning before she left campus. She remained in inpatient treatment for eight months.

During this time, CAPS stopped communicating with her entirely. Afraid to tell her parents, she was left on her own. No one explained to Gisel how medical leave worked.

It wasn’t until this year, at the suggestion of her therapist, that she received accommodations from AccessibleNU for anxiety stemming from anorexia nervosa.

“I completely don’t trust any of the Northwestern resources, and that’s largely because I had such a bad experience,” she says. “I think it made things worse my freshman year just because I felt so isolated and like a ghost walking around on campus, like no one knew what was happening.”

CAPS declined a request to comment for this story.

Making accommodations

Even for students who do receive treatment, Northwestern’s bureaucracy is often difficult to navigate. As a result, students sometimes don’t receive accommodations that would help them recover.

During her first year, Noe asked to be exempted from the meal plan. As someone struggling with binge-eating, the buffet-style dining halls, with a variety of food available but not enough healthy options, were overwhelming and stressful. Part of coping with an eating disorder, she says, is finding healthy ways of controlling food, from always eating at the same time or knowing all of their ingredients in meals. The dining halls aren’t always conducive to those coping mechanisms.

When she asked for the exemption, Northwestern wanted her to provide a diagnosis from a doctor and documentation. Noe wasn’t comfortable sharing that information.

“That [felt] really invalidating and something that, as a freshman in college starting in a new place, I did not want to disclose,” Noe says. “Where I am now, I would probably fight that harder. But that’s also so far into recovery.”

AccessibleNU will work with students who have learning difficulties stemming from an eating disorder. In addition, because students registered with AccessibleNU receive priority registration, students in recovery from an eating disorder can arrange their schedules to allow for consistent meal times every day.

Though many students have had largely positive experiences with AccessibleNU, not everyone can use their resources. The office usually requires documentation before they create an accommodation plan with students, though students can still ask for exceptions to this rule, according to their website.  

“I get it; they want to make sure that people aren’t abusing that resource,” Noe says. “But at the same time, that’s a really elitist thing to expect from a country that does not have universal healthcare or anything close.”

Gisel says that, at first, she struggled to overcome the shame of having an eating disorder and feeling like she “deserved” accommodations. But balancing her recovery while taking classes has been much easier once she received them.

“I told [a staff member at AccessibleNU] at the end of our meeting, ‘It’s weird to be treated like a human by Northwestern, to be treated as a person with feelings,’” she says.

Before a crisis

Many organizations and campus offices create programming to prevent eating disorders or guide students into treatment before disordered eating becomes dangerous, but there’s a disconnect between the needs of struggling students and available resources.  

Resident Assistants (RAs), for example, receive training to learn how to look for signs of eating disorders in their residents, according to Mueller. They also learn how to report and intervene in a crisis situation, using active listening and open-ended questions. RAs are encouraged to report any concerning behavior they see to residential directors, professional staff members with more extensive training who live in some dorms.

“When we do training with RAs in-house around intentional interactions or something, we call the expectation of RAs to have conversations and get to know every member of their community, whether it’s a floor or a building,” Mueller says.

But she also says RAs usually have 35 residents, while some have up to 50. It can be difficult for them to establish relationships with all of their residents. Gisel says she didn’t know her RA’s name freshman year, and they never spoke while she was in treatment.

Spotting an eating disorder can be difficult, according to NEDA. Those struggling with an eating disorder have varied symptoms, including a preoccupation with food or weight, withdrawal from friends and usual activities and mood swings, among others. These signs may go unnoticed in many college students, according to Rienecke.

Northwestern provides few educational opportunities to help students recognize the signs of eating disorders in their peers. There is no programming during Wildcat Welcome specifically devoted to disordered eating. And while RAs can create a bulletin board or hold a meeting to explain the resources for students with eating disorders, they are not required to, Mueller says.

"It's [that] feeling of not being enough and also feeling really out of control sometimes because you have all of these assignments." - Isabella Noe

This year’s Body Acceptance Week, a CAPS-run program that ran from February 23 - 28 to promote healthy body image, included seminars from University dieticians on food positivity and mindful eating, in addition to stations around campus for students to pick up pamphlets about body image. This can be difficult for students who are struggling because it requires openness about eating issues.

“There is a certain level of confidentiality that you want when you’re dealing with something like that. You don’t want to just show up to the eating disorder club,” Noe says. “Having such big public events that are supposed to support body positivity or body acceptance probably isn’t the most effective way to [help students with eating disorders].”

Possible solutions

Some students in recovery from eating disorders found healing outside of Northwestern’s programming.

Gisel and Noe both participate in Northwestern’s Burlesque show, for example, which produces sex-positive and body-positive performances. They say Burlesque has helped them feel more comfortable in their bodies.

But mental health advocates argue that the University resources need to be adjusted to support students struggling with their mental health, that students should be able to find support directly through the University.

"It's weird to be treated like a human by Northwestern, to be treated as a person with feelings." – Gisel

Part of that task is to reach a wide range of students, says Tejas Sekhar, co-director of ResilientNU, a student group that teaches mental wellness workshops but does not provide group therapy. He says they can only reach so many students that want to learn about mental wellness.

In order to do this, he argues that Northwestern should assign all students a health and wellness advisor, whose job is to help students navigate mental health resources on campus.

“You set foot on campus, and there’s your designated person to be able to talk about this kind of stuff,” Sekhar says. “It’s not necessarily therapy, but they could be like a real person, physical guide to guide you to other resources.”

Rienecke also notes that involving parents and other family members is crucial to treating eating disorders. Treatment is often most effective when family is involved, she says, because those who struggle with eating disorders are often ambivalent about getting treatment because those illnesses are “ego-syntonic,” meaning those who suffer from them may not recognize their severity.

“Eating disorders are really dangerous,” she says. “And so I think to leave someone alone in going through therapy on their own is not particularly helpful. Getting parents involved, no matter where [they] live, is really important in ...getting a college student into treatment.”

A path toward healing

While the recovery process is ongoing for Noe and Gisel, both have found ways to cope with their eating disorder on campus.

Gisel stayed on the rowing team and says her teammates have supported her throughout her time in treatment. Noe has been able to cope with her eating disorder partially through theatre. Her freshman year, while she was struggling with her eating disorder, she participated in a show called Defining Beauty.

“That was sort of the first time that I had ever really opened up about having an eating disorder, feeling sort of trapped in that and out of control,” Noe says. “I think that doing that show was in its own way a very healing process.”

Now that she lives off-campus, Noe cooks her own food, which she says has been instrumental to her recovery. She loves going to the grocery store and picking out ingredients for her meals, which she couldn’t do while she was on the meal plan for her first two years at Northwestern.

For Gisel, she’s more willing to accept help and work with her therapists to manage her eating disorder, which has been helpful in her ongoing recovery.

“It sucks to continue to struggle, but I think I’m a little more gracious with myself about it now than I would have been this time my freshman year,” she says.

*Name changed to protect students’ privacy.