Editor’s Note: This article contains references to eating disorders that may be troubling to some readers. Additionally, since the students in this article spoke with The Daily on the condition of anonymity to discuss private medical information, they are referenced by their class years.

As COVID-19 upends students’ college experiences, some students with eating disorders are suffering from heightened triggers.

Due to the uncertainty around COVID-19, students are facing changes in academic circumstances, financial and housing security and their everyday routines. For most people, these adjustments are understandably stressful and anxiety-inducing. But for people struggling with mental illness, especially eating disorders, these small changes can send them into a spiral of relapses.

Those disruptions are magnified for college students, many of whom have been forced to leave their routines and residences on campus. 

“Something that impacts college students, in general, is that psychotherapists can only practice in the states where they are licensed … so when students left for states outside of California, even if video therapy is available, they potentially lost access to these specialty providers,” said Kristine Luce, a clinical associate professor of psychiatry and behavioral sciences.

At the beginning of the COVID-19 outbreak, before Stanford had decided how it would approach undergraduate education, students with histories of eating disorders were already beginning to feel heightened stress. Now, the University is working to help students cope.

“Dietitian/Nutritionist visits are available online within certain US states based on licensure laws,” wrote Bryan Lian, a dietitian for Well-Being at Stanford. “According to this map wherever you don’t see red, we can offer telehealth or virtual visits in those areas. We currently don’t have an international policy. Students can reach out to us for a consultation for local resource navigation as well.”

Students in search of help can also reach out to Sheila Levin, a psychotherapist and eating disorder specialist at Counseling & Psychological Services (CAPS).

“I created an educational video on eating disorders for students, which is on the CAPS webpage,” Levin said. “In that video, I also give my name, phone number, email address and invite students to contact me if they wish to connect.”

But even with all the virtual support, students still described struggles.

“If I go back home I won’t have access to a gym and if I don’t have access to the gym I will gain weight,” said one sophomore.

Missing the gym, which may come across as a mild inconvenience, can be the first trigger for people recovering from binge-eating behavior and over-exercising, experts say. Additionally, people who cannot go to the gym may be more susceptible to reverting to old restricting habits. Restricting habits can vary from choosing not to eat for extended periods of time or choosing to eat a small variety of low-calorie foods.  

A burst of social media pressure around exercising has exacerbated the problem, a junior told The Daily.

“It has been very very difficult to keep that stuff off my various social media feeds,” she said. “I keep having to fight the little voice that’s telling me I need to do something about my body.”

Luce said the junior isn’t alone.

“It’s all over social media, people are being bombarded,” Luce said. “Someone told me they’re calling it the ‘COVID-19’ like the freshman 15. And those things can be very triggering.”

As it became clear that a majority of undergraduates would need to leave campus, food became an increasing concern, the junior told The Daily. Students who rely heavily on their routines and guaranteed food sources, such as student meal swipes and the assurance that the dining halls would have healthy options, prepared to face different food options while away from campus.

After spending the last six months at Stanford and becoming used to the wide array of food that is offered in dining halls, the thought of going home and having limited variety and resources was daunting to the junior.

“I have my own sort of safe foods that I feel comfortable turning to … so prior to being away from Stanford I was extremely concerned about having access to those foods and making them last … it could easily derail all of my recovery success,” she said.

Change, for many students with disordered eating, is a simple trigger that can cause relapses of varying lengths.

“Even the thought of spending a day traveling through airports, with all the food available, was enough to make me panic,” said a frosh.

Being back in a home setting can be harder than being in college for some students, especially during a pandemic. Students comfortable eating a narrow range of food are now dispersed around the world and may or may not have access to those same foods that acted as a safety net. Additionally, students who relied heavily on their in-person therapy to monitor recovery likely no longer have that opportunity. 

“I attended an international meeting for eating disorders professionals a few weeks ago,” said Levin, an eating disorder specialist with CAPS. “At this meeting, I learned that there are very few in-person services worldwide for people struggling with eating disorders.”

Although physical interactions are limited, she added, online services have so far been successful. 

Whether students continue their treatment from home, switch care providers or try to manage on their own, the change in environment may still have an effect on their disorders. 

“For some people, perceived or real food scarcity exacerbates eating disorder symptoms,” Luce said. “Our student population is diverse so we have some people whose access to food hasn’t changed, but some people are experiencing food scarcity because of economic issues, availability of food at stores, or because of their home environments. This can trigger eating disorder symptoms.”

Many families have begun making fewer trips to the store and purchasing a larger portion of non-perishable goods. Goods such as beans, pasta, rice and canned fruits and vegetables tend to be higher in calories than fresh alternatives. Lack of availability of fresh foods and an abundance of higher-calorie non-perishables can be an easy trigger for people struggling with binge and restricting eating disorders.

As more food is stored within the house, the frosh said, their “temptations have risen.” Students back home are having a harder time controlling their food temptations, a dangerous situation if they have binge-related disorders. 

“When you talk about eating disorders, there is a whole continuum of eating-related behaviors,” Luce said. “For some people, the eating disorder was triggered by their home environments, and returning to their home environment is psychologically challenging.”

But for some who have decided to go home, live with extended family or friends, or rent out their own places, their anxieties related to food have actually improved, according to another female junior interviewed by The Daily. 

The junior introduced earlier in this article, who had originally planned to stay on campus due to housing insecurity but eventually decided to live with a friend, said that they are “surprisingly doing well,” and that “eating in group settings has been a big key to actually ensuring that I eat.” 

Students in larger homes, with an abundance of people that eat together, may be able to recreate an atmosphere similar to a dining hall. Some students additionally find it easier to control what they eat by keeping around only food they are comfortable consuming, which they find harder to do at college.

For students who have chosen to remain on campus, dining options have become limited, creating a higher-stress environment for those who struggle with disordered eating habits. Some students said having only one distant location for food on campus would lead them to eat less, possibly reverting back to restricting habits. But other students find that although dining options are limited, they still prefer having access to food that is already prepared.

“Eating disorders encompass a continuum of behaviors,” Luce said. “Some people have had a genuine loss of appetite and many struggle with the lack of structure which challenges regular eating. Some people are at risk of undernourishment and undereating and others struggle with binge eating. And I would say that regardless of which eating disorder diagnosis, this is a uniquely challenging time of uncertainty and unpredictability that makes managing an eating disorder more difficult.” 

The National Eating Disorder Hotline is (800) 931-2237.

The Vaden Health Center and the CAPS website have an abundance of resources for students affected by COVID-19.

Contact Jenna Ruzekowicz at jruzekow ‘at’ stanford.edu.