Navigating the university transition among women who self‐report an eating disorder: A qualitative study

Abstract

Objective: Although developmental milestones have been observed to alter eating disorder (ED) symptom burden, it remains unknown how the transition to university affects symptomatology. To address this gap, we designed a qualitative study to elucidate how students with an ED perceive their general university experience and to describe how the university environment shapes their ED. Method:Undergraduate students who self-reported an ED were recruited through fliers, an undergraduate advocacy organization, and local treatment centers. We conducted audio-recorded semi-structured individual interviews. Two investigators separately coded verbatim transcripts using an editing approach, and final themes emerged from the pattern of descriptors.Results: Fifteen undergraduate students participated. Participants endorsed a variety of ED symptoms and sought various levels of treatment. Most participants transitioned to university with an already-established diagnosis. Participants described that ED symptoms tended to worsen in university for a variety of reasons including (a) minimization of ED severity, (b) loss of external accountability, (c) use of ED symptoms as a coping mechanism, and (d) glorification of ED behaviors in campus diet culture. Subsequently, the ED disrupted the university experience by (e) hindering participants' ability to focus on academic responsibilities and (f) leading to social isolation on campus.Discussion: We identified challenges unique to the university experience that can be addressed by ED treatment teams in order to provide anticipatory guidance and patient-centered care. Study limitations include lack of formal diagnostic ED assessment by research team and sampling of students from one university. K E Y W O R D Seating disorder, qualitative research, student health services, students, universities

“I’m not a teenager, I’m 22. Why can’t I snap out of it?”A Qualitative Exploration of Seeking Help for a First-Episode Eating Disorder During Emerging Adulthood

“…su cient help in itself), a determination often underpinned by feelings of shame and embarrassment regarding their experiences. Indeed, this nding echoes that of a recent qualitative study, which found that moving to university speci cally was perceived as a "new start" and associated with minimisation of perceived severity of the young person's ED (43). Other times transitions were viewed as an impetus for help-seeking.…”

“…Stressful life events are a core characteristic of emerging adulthood, and are experienced in greater numbers by emerging adults, than by older age-groups (42). Indeed, a recent study which examined university students' experience of EDs, found that participants understood ED behaviours as a way to manage external stressors (43).Consistent with previous studies across age-groups, this study found help-seeking is unlikely when symptoms are highly egosyntonic (14). However, this study outlines more speci c implications for help-seeking when egosyntonicity is present during EA.…”

“I’m not a teenager, I’m 22. Why can’t I snap out of it?” A Qualitative Exploration of Seeking Help for a First-Episode Eating Disorder During Emerging Adulthood

“…To our knowledge, the role of life-events has not been previously reported in the help-seeking literature, and may be relatively unique to EA populations, given that stressful life events and transitions are a core characteristic of EA (33). The findings of the present study do echo those of a recent qualitative study, which found that moving to university specifically was perceived as a "new start" and associated with minimisation of perceived severity of the young person's ED (41).…”

“…Whilst egosyntonicity might be common across age-groups, the perceived "coping with life-stress" function of EDs may be particularly pertinent to emerging adults, given that stressful life events are a core characteristic of EA, and are experienced in greater numbers by emerging adults, than by other age-groups (40). Indeed, a recent study which examined university students' experience of EDs, found that participants understood ED behaviours as a way to manage external stressors (41).…”

Eating Disorders During Emerging Adulthood: A Systematic Scoping Review

“…The transition to university was found to have no impact on ED symptoms (Palladino et al, 2013). This is perhaps surprising, given existing qualitative research which has found that ED symptoms tend to worsen during this transition (Goldschen et al, 2019). However, there are some concerns regarding the included study's methodological validity (e.g., lack of comprehensive assessment of ED symptoms), and its findings should be regarded with caution.…”