TCU is working to combat eating disorders and unhealthy body image, university officials say. Here is a look at eating disorders on campus and the women who struggle with them every day.

Alex

Alejandra Rodriguez Criexell remembers being 13, and vowing to be the skinniest of all her friends.

She knew how much all of her friends weighed, and that she was taller.

Didn’t matter.

They didn’t have curves or hips, she did.

Didn’t matter.

She was going to win.

She wanted to be the most beautiful, and to Alex that meant being the thinnest.

Alex, who is an international student from Spain, is one of an estimated 70 million individuals worldwide affected by eating disorders, according to the Renfrew Center Foundation for Eating Disorders.

Eating disorders affect up to 24 million Americans, according to the Renfrew Center.

While 1 in 5 women struggle with an eating disorder, according to the National Institute for Mental Health, this is not an issue that is exclusive females.

An estimated 10 to15 percent of people with anorexia or bulimia are male, according to the Alliance for Eating Disorder Awareness.

Eating disorders, such as anorexia are ego syntonic, which means someone who has one will believe that the disorder is part of their identity, said Jim Harris, doctor of psychology and manager of the eating disorders program at Texas Health Presbyterian Hospital Dallas.

“Often patients don’t see it as a problem, they see it as a solution,” he said. “It just takes them over.”

Anorexia is so difficult to treat because the woman will feel like her eating disorder is part of what defines her as a person, Harris said.

“It’s a serious mental illness, it’s not a matter of willpower or choice,” he said.

For Alex it started innocently, skipping a lunch here. A dinner there. Until she was living on a diet of red bull and cigarettes.

Anorexia took over her life. Food became Alex’s sole focus. Every minute of every day was devoted to counting calories, to checking her weight, to losing.

“I was never overweight. I just wasn’t skinny enough,” said Alex, whose weight eventually dropped to 105 pounds.

When Alex was 17 years old, agents asked her to consider modeling. The attention fueled her obsession. She thought she must be doing the right thing.

“It’s an obsession,” Alex said. “You literally cannot think about anything else.”

Alex remembers being depressed.

“You’re like a zombie,” she said. “And when you are feeling something, it’s being miserable.”

At some point, she realized there was a problem, but she tried to convince herself that that she was fine. She knew she was anorexic, but she didn’t want help.

“I told myself no, I’m not, because I didn’t want to gain weight,” Alex said.

She resisted until her doctor told her heart was already showing damage from her habits and that left unchecked she was going to die.

“I realized then that I didn’t want to die,” Alex said.

She said it’s hard to ask for help.

“It’s not easy to do this alone.”

The Problem

About 5 percent of the people seeking treatment at counseling centers have eating disorders, said Eric Wood, the assistant director of the Counseling, Testing, and Mental Health Center at TCU.

At TCU that number represents about 8 percent of students seeking help, said Wood. He added that private institutions tend to have a higher percentage of eating disorders than public universities and colleges.

“There is a mindset that if you are in a private school it’s more imaged-based,” he said.

Last fall, Wood led focus groups of women and men with eating issues to discuss factors at TCU that contribute to disordered eating. Almost everyone said there was an unspoken pressure to look a certain way, Wood recalled.

They couldn’t identify where exactly it came from— friends, the university’s image, or campus organizations. It’s just there.

Wood said that many students have a negative body image because of this pressure.

“Even though they are very attractive they don’t see it,” Wood said.

An already negative body image might be compounded by TCU’s 60-to-40, female-to-male ratio.

Women feel pressure to be attractive, Wood said.

“Some females think that there aren’t very many guys… [they] will get competitive with other female students,” Wood said.

Although there is a higher rate of students with eating disorders in sororities and fraternities, Wood said he isn’t convinced those organizations are a factor.

In fact, he said, fraternities and sororities can offer the right support a person needs to get help.

“There’s a lot of research that says if you’re in a close knit group that will help, and one of their brothers and sisters would confront them about it,” Wood said.

Vice Chancellor of Student Affairs Kathy Cavins-Tull said some of the characteristics that helped students get accepted to TCU can also cause an eating disorder.

“When you look at some factors that correlate with eating disorders, you think of high-achieving students that are under a lot of pressure,” Cavins-Tull said.

Often, TCU students were heavily involved in organizations and extracurriculars when they were in high school, she said. That was probably one of the reasons they were accepted to the university.

Sometimes, this involvement can cause a lot of pressure for perfection.

Cavins-Tull suspects the number of students with eating disorders is higher than 8 percent. Many cases go unreported.

Part of what makes an eating disorder so hard to track is that it can sometimes be hard to tell who is struggling, both Wood and Cavins-Tull said.

“You can’t just look at someone and say they have an eating disorder,” Wood said.

Cavins-Tull suspects the number of students with eating disorders is higher than 8 percent. Many cases go unreported.

Part of what makes an eating disorder so hard to track is that it can sometimes be hard to tell who is struggling, both Wood and Cavins-Tull said.

“You can’t just look at someone and say they have an eating disorder,” Wood said.

Need to know: A cause for concern

Counselors see a lot of ‘disordered eating,’ not just diagnosed, recognizable eating disorders, Wood said.

“Disordered eating means eating in a way that could or does harm you physically or psychologically,” according to Women’s Services and Resources at Brigham Young University. This can include continuous dieting, or over-using laxative pills or diet pills.

One sign of disordered eating is if someone is really preoccupied with what they are eating, Wood said.

TCU’s new dietician, Lauren Watson, said a hyper-focus on diet can lead to disordered eating. “In some way I think women can become too obsessed with counting calories… it can work against them.”

Later, these habits can progress into an eating disorder like anorexia, Watson said.

Lindsey’s Secret*

Lindsey tried to think of what she had eaten that day. She asked herself out loud if she had eaten anything at all.

She paused for a few minutes: A cup of tea.

“Does that count?”

Lindsey knows she has a problem. She knows the facts. She knows that it’s important to eat.

But she doesn’t.

“It’s not that I don’t want to eat… It’s that I chose not to eat,” Lindsey said.

Her father died of complications from obesity. She is terrified of becoming like him.

“I’ve always had this weird relationship with food,” she said.

Lindsey said it’s just easier not to eat. It’s less expensive, and she knows she will never become like her dad.

“I’ve only tried to talk to one person… after he dismissed it, it kind of shut me down to talking to someone about resolving it.”

She knows she needs to get help.

“I’m not ready to do that.”

*Note: This student was granted anonymity due to the sensitive nature of the topic. She will be referred to as Lindsey to preserve her identity.

What to do: Warning signs and support

As a dietician, Watson says there are things a friend can look for to see if someone needs help.

Possible signs of disordered eating include:

• underweight

• brittle nails

• dizziness

• fainting

• scars or sores on the back of their hands (from self-induced vomiting)

• going to the bathroom after every meal

• secretly eating

• over-exercising

If you are concerned about a friend…

Experts say that if you notice a change in a friend’s eating habits, or general attitude, it is probably worth a conversation.

“They may hate you now, but they will be alive to love you later,” said Shannon Cutts, founder and executive director of MentorConnect, the first global eating disorders mentoring community.

Cutts battled anorexia, bulimia, and depression for 15 years.

“When I first shared my struggles with the community it helped me find the strength to fight back,” she said.

It took a long time for Cutts to feel ready to accept help. When she finally was prepared, the memories of people being brave enough to approach her and try to help gave her the strength to recover.

“I was very aware that people cared about me, even if I couldn’t take notice of it at the time,” she said.

She has experience speaking to college students about how to help their friends who are battling eating issues.

MentorConnect is run by recovered men and women, including Cutts herself.

The most important thing when trying to help a friend or loved one is to trust your gut. Never assume that it is an eating disorder, but never assume that it isn’t, Cutts said.

“If you reach out to somebody they may say ‘You’re wrong’ but if you’re really worried about someone don’t wait, because eating disorders are deadly and it doesn’t take long,” she said.

When approaching a friend, do not tell them they have an eating disorder, Cutts said.

An example of something appropriate to say would be, “Hey I’ve been noticing that you seem a little off lately, and I think you might need help.”

“Reach out to them in general terms and if that doesn’t work reach out to someone in authority,” she said.

Ultimately, relationships with others will help the most with recovery, she said. Isolation is one of the worst influences on someone who already has tendencies towards disordered eating.

“Relationships with supportive caring people will replace feeling stuck with that eating disorder,” she said.

She stressed that the two most important things a person needs to overcome an eating disorder are strong relationships, and a sense of perspective.

Every person struggles with something in his or her life. For some, it’s their relationship with food, she said.

“It doesn’t make you different, it makes you a part of. This is being human, and part of that is struggling through life’s challenges.”

College is a very overwhelming, confusing time, Cutts said.

“In our culture because being slim… is still very celebrated… it can feel confusing,” she said.

Opening the lines of communication, and seeking help is essential, Cutts said.

Alex’s Recovery

Talking about eating disorders is still a taboo. That’s why Alex thinks it’s so important to be open about her journey.

“It’s not something to be ashamed of,” she said. “You learn a lot from it, but it’s serious and it’s dangerous.”

People don’t really fully recover from an eating disorder, Alex said.

“Now that I’m recovered, it’s still sometimes hard to eat,” she said. If a food looks different, or smells weird she can’t eat it.

Alex said she eats three meals every day. She can’t skip any meals.

“If I do that, I get myself into the vicious circle of skipping.”

She hasn’t weighed herself in years. She has decided she is 110 pounds,because knowing her weight could tempt her to bad habits.

“When I go to the doctor, I tell the nurses they can’t tell me how much I weigh.”

Alex said being the friend trying to help is the most difficult responsibility. It’s frustrating, and it’s easy to say the wrong things.

Saying “You look really skinny” doesn’t help, she said.

“When you see someone who is losing weight you should ask them, ‘Well, why do you want to do that?’” Alex said.

It’s tempting to skip meals, or resort to unhealthy habits to lose weight but it’s not worth it, Alex said.

“You stop enjoying life,” she said.

As a friend, Alex said it’s important to eat with the person and encourage them when they are improving.

“If you eat alone you don’t eat… distract her so she doesn’t think about eating,” Alex said.

Alex smiled as she remembered the friends who helped her when she needed it the most.

“My friends were very warm when I ate something… they would give me a hug… they seemed proud,” she said. “I felt supported.”

Alex remembers something her aunt said to her when she wasn’t eating. Now, she understands its importance.

“When I was struggling with weight my aunt said to me, ‘What would you rather be, skinny and unhappy, or fat and happy?’” she pauses.

“I said, ‘Well, you can’t be fat and be happy. If you are skinny, you are happy,’” she remembers.

“But it wasn’t until I was comfortable with my weight that I was truly able to be happy.”