No magic formula, but plenty of support for disordered eating

When Laura Fitzgerald ’14 first began seeing a nutritionist, she was terrified of gaining weight.

It was the summer after her junior year at the College, and she’d been struggling with restrictive eating for over a year. This year, however, the end of the varsity swim season triggered not only poor body image and dietary restrictions, but purging.

By finals week, Fitzgerald was purging daily. By the time she made an appointment to see a nutritionist in her hometown, she’d lost 20 pounds in two months.

In the face of Fitzgerald’s resistance to gaining back weight, her nutritionist started slowly, encouraging her to eat small amounts of food every four hours. Still, the transition was difficult.

“When I felt really triggered, I would purge, and that was really hard to put on my food log because I felt like I had failed, and I felt really guilty about that,” she said.

Because of the emotions underpinning disordered eating habits and their varying degrees of intensity, treatment plans often include different combinations of therapy, nutritional counseling and medication. According to the National Eating Disorder Association, long-term success usually results from psychological counseling alongside monitoring of medical and nutritional needs. At the College, Counseling and Psychology Services (CAPS), nutrition specialist Debbie Westerling, and Director of Worth Health Center Beth Kotarski work together to address the needs of individual cases.

“We really try to collaborate on care,” Kotarski said. “There isn’t that one perfect set of treatment for eating disorders. It’s as nuanced and complex as individuals, so I think we’ve gotten more understanding of how treatment needs to be more fluid and adaptable.”

For Sarah Eppley ’14, who utilized all three components of the College’s treatment offerings, contacting CAPS as a sophomore was a difficult first step: struggling with undiagnosed anorexia, anxiety and depression, it was only after a breakdown in front of a friend that she decided to schedule an appointment. She found her bi-weekly meetings triggering.

“Every single time I ended up in tears, completely panicked,” Eppley said.

After a month of meetings, Eppley was told to seek the help of a psychiatrist at the Health Center, who diagnosed her with anxiety and depression and prescribed medication. While Eppley maintains that medication ultimately allowed her to recover from anorexia, she considers her emotional turning point to have been a conversation with Westerling, whom she began seeing to supplement her meetings with CAPS.

“I remember one meeting [Westerling] pointed out, ‘These are the bones that you’re going to have for the rest of your life and this is the body you’re going to have for the rest of your life, and you’re destroying it now,’” Eppley said. “And I just realized that my favorite things in the world are running, horseback riding, hiking, being outside, and if I want to be able to do those things I have to start feeding myself.”

Westerling serves as the Director of Nutrition Services at the Renfrew Center, a residential treatment facility in Philadelphia for women suffering from eating disorders. She spends one day a week working at the College, where she primarily meets with students dealing with eating disorders and disordered eating.

Although initial appointments with CAPS provided the first steps to treatment for Eppley, she stopped seeing her counselor as the medication and meetings with Westerling helped her develop a healthier relationship to food. When she returned to therapy months later, she sought out an off-campus resource.

Molly*, who has struggled with stress-induced restrictive eating since fourth grade, also began her recovery process by reaching out to CAPS and, like Eppley, eventually sought help elsewhere. She believes her CAPS counselor downplayed her disorder in their first meeting: despite the fact that she’d lost ten pounds in a week, she says the counselor told her that she didn’t have a serious problem.

“I was expecting more of an aggressive response, considering how poorly I was doing, but he was just like ‘Nope, you seem fine,’” Molly said. “It was a little bit bizarre.”

Kotarski emphasized that the Health Center is not meant to operate in the capacity of an eating disorder clinic; although able to provide successful care to many, some cases of eating disorders may demand more intensive treatment. In Director of CAPS David Ramirez’s opinion, the transitional role CAPS sometimes plays between different treatment plans isn’t necessarily a negative.

“What we do is assess if the student who comes to us can be helped by what we have to offer,” Ramirez said. “If we don’t think they can be, then we advise them that we think they could benefit from a more specialized protocol. Having said that, during my time here we’ve treated hundreds of students who have identified as having eating disorders.”

For Molly, a therapist who specializes in eating disorders has been key to her recovery. She was able to step away from scales completely as a sophomore; weigh-ins had previously played into disordered eating behavior.

“It was really the first time since fourth grade that I hadn’t been counting calories,” Molly said. “[Previously], even when I hadn’t been in an episode [of severe food restriction] I’d always had a running tally in my head on how much I had eaten.”

Initially, high hourly fees and inconvenient transportation options mandated a four-mile round-trip walk in the evenings to the therapist’s practice in Media; however, after explaining the situation to her parents, a switch in health insurance and a car on campus have alleviated much of the burden.

An important component of Molly’s recovery process has been played by friends, whom she began to confide in after her initial meeting with CAPS.

“If people are aware of what’s going on and are making comments to me, saying ‘just eat’ actually does work,” she said. “I’m kind of a perfectionist, so if people are unhappy with me in that respect I’ll kind of feel guilty.”

“Just eat” may not always be the solution. Fitzgerald, who continues to Skype with both her therapist and nutritionist, finds that setting aside time to discuss her relationship to food with professionals is more beneficial than hearing comments from friends in the dining hall, when she isn’t mentally prepared to field concerns. Like many others coping with disordered eating, increased scrutiny of eating behavior is often a source of anxiety, and not always beneficial.

For Eppley, however, who had withdrawn from friends as she coped with anorexia, reconnecting herself provided valuable support outside the context of the dining hall.

For Kotarski, the most valuable role a friend can play is reminding those who may be dealing with disordered eating that they aren’t alone, and that there are resources in place to provide support as they feel ready.

“Students might hear about lack of success with other folks’ treatment and see that as a reason not to ask for help,” Kotarski said. “Encouragement and acknowledgment about the difficulty and complexity of individual’s treatments are often important reminders to students who believe this.”

When I met with Beth Kotarski, she mentioned that many students may feel as though issues they deal with in high school around disordered eating will disappear when they arrive at the College.

“I think a lot of people may think, ‘oh, I’m going to be enlightened, and I’m going to be with enlightened people, and maybe my disorder will go away,’” Kotarski said. “And what we find is that that’s not so, and that it can actually be exacerbated.”

Like Eppley, who associated eating disorders with students at larger universities, or Fitzgerald, who thought it less likely that students at the College were dealing with eating disorders than mental illness, I believed that my problems with disordered eating were my problems alone. I figured my unhappiness with my body, while certainly not the only cause for restricted eating behaviors, would be interpreted as shallow or vain at an “enlightened” institution, that restricting food intake would be interpreted as my inability to handle the intellectual rigors of the College.

But in Kotarski’s opinion, thinking of Swarthmore as an exceptional place doesn’t carry over to the realm of disordered eating. Transitional periods — especially the move away from home and to a new environment — are often times during which people struggle with disordered eating. When it comes to the likelihood of a Swarthmore student having an eating disorder, it’s the same likelihood as men or women anywhere else in the nation: one in five women, and up to one in ten men.

When we talk about the visibility of eating disorders, we can fool ourselves into thinking it’s a problem that we don’t have. Ella*, a transfer student, commented on the healthy campus environment here in comparison to her previous university, where she says as many as a third of the women appeared visibly anorexic. Molly characterized the College as a place where most people aren’t overly concerned with appearances, and appear generally healthy.

But in the past month, I’ve heard from men and women I’ve sat next to in class, who I’ve seen in the gym, who lead clubs and captain sports teams. I’ve received emails from friends sharing their own stories. Beautiful men, beautiful women, many of whom have felt — and may still feel — completely alone.

If you can’t see it, I hope you’ve heard it: you’re not.

For the spring semester, first steps are being made in organizing a student support group. For more information, email skestel1@swarthmore.edu.

*This student chose to remain anonymous.