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Quest for perfection: eating disorders at Yale

By Alan Schoenfeld

"If I'm disciplined enough to pull a 1540 on my SATs and a 3.8 GPA, then I'm disciplined enough to be thin," Sara* said as she put down her cigarette and took a sip of her Diet Coke—"Of course Diet Coke. Why waste the calories?" She rubs her eyes and sighs. "The assumption is that if you're fat, then you have no control over your life and that you're a total emotional mess. And people can't reconcile that with the fact that you're going to Yale. The pressure is amazing."

Like scores of other Yalies, Sara struggles with an eating disorder. Her weight has fluctuated over a range of 30 pounds since she graduated from high school in 1997. Though she is more in control of her weight now, she still is under constant surveillance by friends, parents, and professionals. "Getting over an eating disorder is totally a group effort," she said.

Even so, eating disorders are highly individualized problems and very difficult to diagnose. According to Silliman Master Kelly Brownell, director of the Yale Center for Eating and Weight Disorders (YCEWD), many more people than those diagnosed as having an eating disorder are suffering from "disordered eating." "You must fit a series of criteria to qualify for a diagnosis of anorexia nervosa or bulimia nervosa," he said. "There is a significant number of people that do not fall under the criteria of either disease but who have problems with eating that are significant enough to affect their lives." Yalies are no exception.

The Yale factor

According to Naomi Rogers, who teaches Women's Health, the epidemiology of eating disorders makes colleges in general, and Yale in particular, hotbeds for their development. Victims of eating disorders are predominantly white, upper-middle to upper-class women—an epidemiology that places a significant portion of the Yale population at risk.

More importantly, however, the personality sketch of a potential anorexic or bulimic is eerily reminiscent of the type of student Yale recruiters and admissions officers target: high achievers who strive to be perfect. "That drive is likely to spill over into your sense of identity, not a small part of which is your body image," Rogers said.

In his graduate Health Psychology class, Brownell asks his students whether they think Yale would have a lower or higher percentage of students with eating disorders than in the general population. "The first response I get is that people here should have fewer eating disorders, since they have more to base their self-esteem on than physical appearance," he said. "But it kicks in shortly afterwards that people here are used to being good at everything. They have personality traits that are predisposing to eating disorders." Brownell believes that these two forces balance each other. "A lot of people feel like they're out of their element, that they no longer stand out as exceptional among whatever group they're in. So they focus on making themselves as perfect as they can."
Some telltale signs of eating (clockwise from top left):
1. Compulsive watching of what one is eating.
2. Compulsive exercising.
3. Not entering the bathroom while other people are there so as not to reveal one's body.
4. Eating alone.

"You don't have to sort out the complexities of food," Michelle, a senior who has dealt with an eating disorder since sophomore year, said. "You can have total control over it and it will never reject you. With school work, your fate is up to your professor. With activities and sports, it's up to a million other people. With eating, what-ever you say, goes. You realize that it's the only thing that you own."

Danger zones

Experts suggest that eating disorders are a national problem affecting the large majority of colleges, yet Yale's social and academic environment offers some unique challenges. The perfectionism, and competition that pervade the Yale academic and social environment inevitably affect students' perceptions of themselves and their bodies. "If someone is able to go to the extreme in one thing then they can be extreme in anything. They can never find a middle ground," Jessica, a sophomore, said. Since behaviors associated with eating disorders can be learned, the nature of college residential life is conducive to their development. "You can watch the way other women control their weight and pick up tips, sometimes very dangerous tips. There is the pressure of being in a college environment where you are constantly aware of your body," Rogers said.

Common bathrooms and eating areas are especially troublesome aspects of typical college life. Exposing one's body or eating habits can lead to an even worse body image, since people's reactions are never acceptable to an anorexic or bulimic. "I only shower after everyone else has gone to bed," Laura, a sophomore, said. "I refuse to allow anyone to see my body."

According to several students, common eating areas pose the greatest threat to their confidence about body image and food. "There is nothing harder than eating in front of people whose opinions you care about,"Jessica said. "Sometimes, I don't go to the dining halls because I can't deal with [people saying] `How many fat grams are in that?'" Jessica said that she has honed her skills to such a point that she can immediately tell me how many fat grams and calories are in the muffin she's eating. The myth that "all Yale girls are ugly" is another factor that complicates Yale women's relationships with their bodies and with food. The "Yale Scale"—the standard of beauty that some Yale men use in judging Yale women—creates an environment in which most women feel unattractive. "I walked in on a bunch of my guy friends watching girls passing by and rating them on how hot she is in reality and how hot she is at Yale," Jessica said. "Guys here have the attitude that they are settling for Yale girls."

Yet women are not the only ones who feel they need to compensate for supposed physical inadequacies. While most people affected by eating disorders are female, some males also have unhealthy relationships with food. Because they are in a minority, such behavior is embarrassing for them. "I rarely eat in the dining halls, because no one understands why I only eat small salads and water," Michael, a junior, said. "No one thinks boys can be anorexic. How many times can you listen to, `You're always on a diet. You're such a girl'?"

Sweating away the pounds

For athletes, the drive to perfect the body stems from more than just beauty concerns. Body size and shape are crucial to an athlete's success in whatever sport they may play, and in some weight-classed sports are quantitative criteria by which their ability to play is judged. According to one female athlete, most of her athletic friends realize that maintaining a healthy diet and weight are critical to their success. Yet she has witnessed some slipping into dangerous cycles of starvation and excessive exercise. "Before big games or meets, some of my friends barely eat and spend most of their time at the gym," she said. "They think that losing weight is an easy way to make them perform better."

Since athletes have to exercise constantly and watch what they eat in order to be in peak form, their habits can sometimes spin out of control. "Maybe someone will try to lose weight to run faster, and that's all right," Mark Young, the head coach of women's track, said. "But it can eventually become a very dangerous spiral. Disciplined runners maintain their ideal running weight, and most of them realize that there is a point of diminishing returns. As she's getting there [to the ideal weight], you're a little nervous because you don't want a dangerous spiral to manifest."

Since that point of diminishing returns does exist, athletes are in the precarious position of managing their weight loss towards that point. "Athletes who suffer from eating disorders would like to believe that their eating is not going to have an effect on their performance or health," said Dr. Barry Goldberg, physician for Yale's athletic teams. "The problem is that eating disorders are beset with a number of emotional issues that are so excessive that they override the necessity of eating well."

For sports like crew, weight becomes not only an issue of performance, but of the ability even to participate. The need to "make weight" compels many college athletes to pursue dangerous cycles of crash dieting. Since coaches are aware of these dangers, getting rowers down to their ideal weight is a year-long process of education and training. "We educate the guys about proper weight loss because, in general, people don't want to just lose weight and not be smart about it. The ultimate goal is to have people be ready to race, and if we're not smart about how we go about making weight, it will affect our racing," men's crew coach Mike Irwin said.

Finding a helping hand

Though early education about issues of body weight is helpful to some students, others—athletes and non-athletes alike—slip into the "dangerous spiral" Young warned against. A vast network of resources, ranging from college masters and deans to freshman counselors to health practitioners, is available to help. Yet the nature of the diseases and of their victims—their secretiveness, obsession with control, and feelings of embarrassment—leaves this help network in the position of having to reach out to those who frequently don't want help. And once students with eating disorders do pursue help, they must overcome the obstacle of being comfortable enough with their bodies to return to a healthy weight.

According to Lorraine Siggins, chief of Yale University Health Services' (YUHS) undergraduate department, Yale offers a comprehensive system of treatment to students who seek help. "We have individual and group therapy, nutritionists on site, etc. We like to exercise a coordinated approach," she said.

One glaring omission from the YUHS suggested protocol for dealing with eating disorders is the use of the YCEWD, a world-class facility for research and treatment of eating disorders. "The university is not calling on us for as much service as we can provide," Brownell said. "We should be involved in the training of freshman counselors, training of coaches and athletes, and treatment for more students with eating disorders. I really can't understand why we're not."

Regardless of the treatment possibilities, though, the real problem lies in the detection of eating disorders and in the process by which sufferers make the difficult decision to pursue help. "Eating disorders are about control, and if someone is feeling that they want to get control of their life by being as thin as possible, they don't want to see their thinness as a problem, but rather as the result of hard work," Siggins said.

An important misconception that further dissuades students, particularly athletes, from pursuing help is the idea that such treatment is punitive. "We don't automatically kick you off a team if you have an eating disorder," Goldberg said. "We might keep you at safe activity levels, but we will do everything we can to keep you healthy and playing."

According to Siggins, a network of concerned friends, roommates, deans, and freshman counselors, are needed to help ease the reluctance to seek help, whatever the reason. "It's become so mainstream for girls to hate the way they look, for them to diet and exercise every day," Kinney said. "People stop perceiving that as a problem. But it is a problem. It's up to friends and roommates to be aware of what is going on."

Experts agree that concern expressed by close friends is often the best means of getting a sick student to confront their illness. "It's important that you not criticize them, but just express concern about their health. Suggest that they go to a nutritionist, get a physical, or go to mental health," Siggins said.

Regardless of how well sick students' anxieties about getting help are assuaged, students should not expect a "fantasy outcome" from their confrontations with friends and roommates. "You can't anticipate that the offer will be accepted or that they'll respond to you positively," Brownell said. "But the positive human interaction that occurs when you show that you care can nudge them closer to getting help."

Confrontation between close friends, however, is not very appealing to many Yalies. ECHO, an anonymous hot line for eating concerns, provides advice for Yalies who are concerned about their own or someone else's health. "Most of the time, we get calls from friends who are concerned about someone else and want to know how to know if the person is really sick and what the options are for treatment," Kinney said. ECHO also plans panels, discussions, and other events to increase campus awareness about the symptoms and treatment options for anorexia and bulimia. Likewise, freshman counselors are trained to be sensitive to symptoms of eating disorders, since the specter of the "Freshman 15" can contribute to freshmen's anxiety about weight.

It all comes with the territory

Sara's sophomore year roommate told her that she needed to get help after she realized that Sara hadn't been to the dining hall in five days. "I figured no one would notice," Sara said. "I was pissed as hell that I was found out. I really hated her. I had tried so hard to build up this image of total control and total coolness. In the long run, though, she probably either saved me from having to drop out of school for a while or maybe even from dying." She took another puff of her cigarette, rubbed her eyes again, and stared at her fingernails: "Yale's a great place to have an eating disorder—and I mean that in both senses," she said. "It's a great place to feel really lonely and seize control of a really isolated life, and it's a great place to get help from a lot of caring people. And neither of those is really easy. I hope people know that."

* Names of those suffering from eating disorders have been changed.

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