An estimated 30 million Americans will struggle with an eating disorder in their lifetime, and a greater number of them are beginning on college campuses.

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Approximately 40 percent of incoming freshmen will already have some sort of struggle with disordered eating when they enter college. Getty Images

Gill Low had a history of depression and self-harm dating back to her early teen years, but it wasn’t until she went away to university in Wales that she began binging and purging.

By the time she started pursuing her master’s degree, what had started as an occasional stress reliever developed into a full-blown eating disorder.

“I did not buy proper food the whole year I was there,” she told Healthline. “When I ate, it was junk food from the local shop. And I threw up pretty much every single day.”

This went on for four to five years, slowing down (but not stopping entirely) only when she got pregnant with her son.

Low is hardly alone. According to research compiled by the National Eating Disorder Association (NEDA), approximately 30 million people will struggle with an eating disorder at some point in their lifetime in the United States alone.

After a 2011 study found eating disorders had increased on college campuses from 7.9 percent to 25 percent for men, and from 23.4 percent to 32.6 percent for women, over a 13-year period, NEDA launched the Collegiate Survey Project to determine how universities could better address this growing problem.

Claire Mysko, CEO of NEDA told Healthline “College is a period of development in which disordered eating is likely to arise, resurface, or worsen for many young men and women.”

She cited the increased social pressure to make friends, have romantic relationships, achieve academically, and fear of the “freshman 15” (gaining weight), as being among the potential risk factors for disordered eating as well as other maladaptive coping mechanisms for college students.

For Patty Heard, it started with relationship drama. “Seeing all the ‘pretty’ girls and going through a really crazy relationship my first year of college made me feel like I was nothing,” she told Healthline.

That was when she started binge eating.

“The guy I was seeing and had talked about marrying came out as gay, and while I wasn’t mad at him, the stress of feeling like I wasn’t good enough for someone to love was hard,” she said.

She explained she would go days without eating much of anything, and then would eat and eat until she threw up. “It was a bad time in my life.”

Healthline spoke to Mike Gurr, a licensed professional counselor and executive director at The Meadows Ranch, an eating disorder treatment and recovery center in Wickenburg, Arizona.

He told Healthline that approximately 40 percent of incoming freshmen will already have some sort of struggle with disordered eating. Maybe not full-blown eating disorders, but they enter college with less-than-healthy relationships with food to begin with.

“And when you look at only females entering college,” he said. “That number goes up to 80 percent.”

From there, he said there are a few things that contribute to the increased development of actual eating disorders.

“For starters, it’s a huge shift. And the people who struggle with eating disorders tend to have these temperaments where they struggle with change. For a lot of these students, it’s their first time ever leaving home. So there is a lot of anxiety, a lot of newness, and that is just one component.”

He explained that playing the compare game can also contribute to the development of issues. New students look around, whether in the dorms or on their sports teams, and they’re surrounded by more people than they were in high school. So there are more opportunities to compare.

“As we know, when we start comparing ourselves to others, we’re ultimately going to fall short.” Gurr explained. “That’s when shame comes into play. And shame is the hallmark of any eating disorder — I’m not good enough, smart enough, pretty enough. That’s why you see a prevalence in those college years.”

The question then becomes what responsibility colleges have to their incoming classes — and how they could better create an environment where students aren’t as likely to fall into these traps.

Mysko explained, “One of the ways we work with colleges and universities is by encouraging schools to promote NEDA’s free online screening tool which allows students to take a quick, anonymous self-assessment survey.”

If a student’s results indicate they are at risk for an eating disorder, they can speak to a counselor on campus or contact the NEDA helpline for treatment options and support.

NEDA also has a program called Student Life, a national initiative to bring students, faculty, and campus services together in the fight against eating disorders.

Mysko acknowledged that eating disorders arise from various factors, and develop differently for each affected person, so it isn’t always possible to prevent an eating disorder. However, prevention efforts, like the Body Project, that reduce negative risk factors (body dissatisfaction, depression, or self-esteem) are effective strategies to reduce the rate of eating disorders.

A recent poll conducted by NEDA on Instagram highlighted the need for programs like the Body Project. When NEDA asked their followers if their college campuses had eating disorder resources, 83 percent (out of over 1,000 responses) replied “no.”

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Most eating disorders revolve around silence and secrecy. Can you spot the signs? Getty Images

So, if college campuses are thus far ill-equipped to help students identify and treat these issues, what signs of a potential problem should friends and family members be looking for?

Gurr explained this can be difficult, as most eating disorders revolve around silence and secrecy.

“On average, a person with an eating disorder has an IQ between 125 and 135 — so they’re pretty smart. And they’ll go to extreme means to not be found out,” he said, noting it’s not unheard of at all for siblings, parents, and friends to say they had no idea the person they loved was suffering.

Warning signs Gurr described to look for include:

  • a preoccupation with food (talking about it more, obsessing more, checking labels more, no longer wanting to go to restaurants — any kind of change in the relationship with food)
  • mood dysregulation
  • loss of memory or an inability to concentrate
  • hands and feet feeling cooler to the touch — extremities can get as much as 12 degrees cooler than core body temperature
  • wearing layers or wrapping up in a blanket in a room where everyone else seems fine
  • hair dullness
  • chapped lips, dry skin, dehydration
  • feeling apathetic and low energy
  • disengaging in activities they once cared about
  • isolating themselves
  • scabs and sores on the back of their hands
  • peach fuzz developing on cheeks, neck, and arms
  • weight fluctuations
  • constantly feeling their bodies, putting their hands around their wrists, their arms, or pinching the sides of their stomachs

If you suspect someone you love may be suffering from an eating disorder, Mysko recommends expressing your concerns with honesty and respect in a loving and supportive manner. “It is also important to discuss your worries early on, rather than waiting until a person shows physical and emotional signs of a full-blown eating disorder.”

She suggests using “I” statements like “I’m concerned about you because you refuse to eat breakfast or lunch,” and avoiding accusatory “You” statements like, “You have to eat something! You’re out of control!”

“What I have found over the years is that when parents actually recognize what’s going on, they want to fix it right away. Being a parent myself, I understand that,” Gurr said. “But 9 times out of 10, the response from parents they think will help actually drives their child’s eating disorder even more.”

He urges parents to not become so focused on the behavior, because their child is so much more than the eating disorder. Instead, he wants parents to look at that behavior as a sign of struggle, and to ask themselves how they can support that struggle.

“Parents have to learn how to listen, empathize with, and understand something that is quite honestly crazy,” he explained. “If you think about eating disorders themselves, they don’t make any logical sense. But there is a function behind the behavior. There is always a reason for everything we do. And part of supporting someone in their struggle is trying to understand it.”

He said this is something most parents have a very hard time with, which can often lead to them making things worse.

“It just creates a vicious cycle. This is an issue with a high mortality rate, and I get it, it’s a scary thing to watch their child go through. But sometimes, they can make things so much worse.”

Gurr says parents and friends of a person with an eating disorder can either be the biggest part of the solution or the biggest part of the problem. The choice is ultimately up to them.