Transitioning to College with an Eating Disorder: Are You Ready?

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Kirsten Book, FNP-BC, PMHNP-BC

It is that familiar time of year when many of my young adult patients are returning from their summer eating disorder treatment. They find that in working with their discharge planner, they are now faced with the choice to either go back to college or take time off for their recovery.

It is an individual decision for each person, but in my own personal experience, I actually NEVER made the conscious choice to put my recovery first. I continued to take medical leave from college to go to treatment, then a few months later I came back to school, and by the next semester I was in treatment again.

I brought my school work with me to the hospital and I refused to surrender, despite my treatment team’s strong clinical recommendation to take a year off of school to work on my recovery.

My identity and validation came from my academic achievements, and I was too scared to let the one thing go that I excelled out. I was constantly fighting the ultimate challenge of looking within myself and confronting my bulimia. There is a saying that “whatever you put in front of your recovery, you stand to lose.”

I struggled in and out of treatment from the age of 15 to the age of 30. Today, I strongly believe that if I made the choice to put my recovery first, I may not have struggled as long as I did. Unfortunately, I was not willing at the time to put myself first. It is proven that the longer the stability in recovery, the higher the chance of success of long term recovery.

Many eating disorder experts recommend at least six months to one full year of solid recovery before going back to college. The reality is that attending college while still struggling with eating disorder thoughts, obsessions, and behaviors will actually just rob the “normal” college experience that is so desperately desired by many. Trying to force college too soon is a common cause of relapse, which can further delay the ability to live a normal life.

I have also learned in recovery, that life is not black or white. There is a way to find a middle ground. While going away to college may not be possible at the moment, there are other ways to continue to move forward with one’s academic goals. Some individuals live at home and take college classes online part time while spending the remainder of time working on their recovery and seeking support, in order to one day transition back to college life on campus.

Factors to consider when making the decision to go to college:

  • Medical Stabilization: Stable weight, hydration status, psychologically stable
  • Awareness of triggers and plan to manage them
  • Healthy coping behaviors established and utilized consistently
  • Treatment team sessions and support groups scheduled
  • Time management and ability to prioritize recovery
  • Healthy relationship with exercise
  • Living arrangements conducive for recovery
  • Medical and psychiatric services at the school established
  • Accountability plan with dietitian, therapist, psychiatrist

If one’s recovery is far enough along and the right support system is in place, college can be an exciting opportunity for them to gain independence and begin to build a life without their eating disorder. But if recovery is new and/or the college environment too challenging, school could be a major setback and distraction while doing more harm than good.

There is no one right or wrong answer to this question. Each individual will experience their own truth if they can quiet their mind and begin to trust their intuition. The good thing is that whatever choice one makes, everyone always has the ability to make a different choice the next time around.

Kirsten Book, FNP-BC, PMHNP-BC, is a dual board-certified family nurse practitioner and psychiatric nurse practitioner who specializes in treating adolescents and adults struggling with eating disorders, substance use, and co-occurring disorders. Not only does Kirsten have the education and clinical experience, but she also is in recovery from an eating disorder. She uses her own personal experience to draw empathy, compassion, and humility when working with her patients. Kirsten has the unique opportunity to help improve an individual’s mental health, by not only utilizing medications and psychotherapy, but also by instilling hope, which she believes is just as powerful and effective as what any medication can do. Kirsten has an outpatient private practice in Chicago, Illinois. She also is licensed to practice in Arizona and Washington. Kirsten is also the Medical Liaison for IAEDP (International Association for Eating Disorder Professionals), and she speaks at local schools to help educate the adolescents and staff about eating disorder prevention and treatment.