Starving for perfection

By the end of freshman year, Maria ’11 was living off nothing but vegetables and no-calorie hot beverages from the Rocky-Mathey dining hall.

“It was about making myself look sick,” Maria said of the eating disorder she suffered from during her freshman year at Princeton, adding that she wanted her parents to see how unwell she was after her skin cancer relapsed. Maria's name, like those of all students interviewed for this article, has been changed to protect her privacy.

Achieving that goal became more feasible when she left home for the University.

“I was able to get away with … things I don’t think I could have gotten away with at home,” she explained. “Here, I could just eat whatever — or not eat whatever.”

Maria’s case is far from an isolated incident. Nearly 40 percent of college-age women have some sort of eating disorder, while nearly 91 percent of college-age women attempt to control their weight through dieting, according to estimates by the Massachusetts Eating Disorders Association.

Unrealistic images supporting such behavior pervade American culture and media. In 2006, researchers found evidence that the anatomically impossible and aesthetically unreachable Barbie doll, which was first released 50 years ago this month, promotes a body image that leads to an increased risk of developing an eating disorder.

Students at Princeton are far from immune to the eating disorders that persist nationwide. As undergraduates like Maria enter a new environment fraught with academic and social pressures, the manifestations and causes of the eating disorders they suffer from are varied and intimately personal.

While Maria practiced extreme dietary restraint, Jenny ’11 had issues with “late-night grazing” in the dining hall that began to spiral out of control.

“I would make mindless trips for something chocolatey,” she said. “I gained a lot of weight.”

This uncontrolled eating was a reaction to the restrictive diet she had in high school. When her success as a runner began garnering a great deal of attention, Jenny said she felt she needed to control her eating to improve her running.

“I’ve gotten into the swing of playing with food’s effects,” she said. “I was a bit more obsessed with it.”

Jenny’s change in eating habits was magnified by the transition from eating at home with her parents to eating in the dining halls at Princeton.

“No one was monitoring me that much anymore,” she said, adding that the variety of foods available in the dining halls led her to eat things she wouldn’t have previously when she was restricting her diet in high school.

On the other hand, Karen ’09 took restriction to a whole new level upon coming to Princeton. An athlete, she became so thin that she was barred from competing.

“[My coach] withheld me from the season and I was put in the care of several athletic doctors,” Karen said in an e-mail.

Exerting such control is frighteningly easy at Princeton, students said, where nutritional information such as calorie content is listed online for almost all items served at dining halls.

Karen’s food restrictions, however, did not reflect insecurity about her body, she said.

“I was thin to begin with,” she explained. “[Anorexia] was about control, and wanting to know that I could succeed at this.” On a campus full of over achievers, the desire for perfection in all areas of life can have dangerous ramifications.

Maria also found extreme dieting to be a dangerous source of pleasure.

“The weird thing about anorexia is it makes you very proud of yourself,” she said.

Finding the cause

Dr. Evelyn Attia ’82, director of the Columbia Center for Eating Disorders, an internationally recognized program that specializes in treatment and research of eating disorders, said there is no distinct set of causes for eating disorders.

Anorexia nervosa has “a more biological piece [than bulimia],” Attia explained, noting that the “patterns of inheritance” often associated with it suggest the disorder may be genetic.

Bulimia nervosa seems to be more influenced by environmental factors, Attia said, but she added that there are no universal rules or instigators: What leads to a disorder in one person some may not affect others in the same way.

Karen acknowledged that her environment had a large role in facilitating her own disorder.

“It was really not good having someone with a severe eating disorder around a bunch of other athletes,” she said. “In many regards, this disease is contagious.”

Debbie Boyce ’79, who leads an eating concerns group for the Princeton Evangelical Fellowship (PEF), noted that a little bit of exposure can be dangerous when it comes to eating disorders.

“I think I would have developed an eating disorder if I had known how to do it,” she said, explaining that eating disorders weren’t a discernible part of the culture during her time at Princeton.

“Eating disorders seem to spread more when there is more knowledge of them, when women know what others are doing to lose weight or stay thin, even if the behavior is unhealthy,” she  added in an e-mail.

Compared to her undergraduate years, Boyce said, students now are under more stress which  contributes to the increased prevalence of eating disorders.

“We did not go at quite the pace as today’s students,” she said. “We weren’t this busy.”

Courtney Martin, author of “Perfect Girls, Starving Daughters,” said the incredible abundance of activity and competition at Princeton contributes to the manifestation of “delusional standards.”

“Princeton ... is rife with women who have adopted the unhealthy belief that a successful female life is defined by achievement and appearance rather than joy, fulfillment, and relationships,” she said in an e-mail.

The “highly competitive academic environment” and “the party scene surrounding the eating clubs” contribute to the desire for achievement and the formulation of unrealistic and unhealthy standards of success she added.

Jenny said her eating disorder stemmed in part from the stress she encountered at Princeton.

“Stress makes people do really odd things,” she said. “They need to comfort themselves, so they seek comfort food.”

This search for security often leads her to consume foods she would not normally eat. “I eat things that are nutritious … in my diet for meals,” she said. “The extra stuff I eat on top of it … that’s where it’s completely mindless.”

Getting help

For students who suffer from eating disorders, there are a number of possible roads to recovery.

Jenny’s treatment for her disordered eating is intimately tied to religion, as she is a member of PEF’s eating concerns group.

“The whole point of the group is to grow closer to God ... to rely on Him to fill whatever needs to be filled,” she explained.

The group, which began in 1999, uses a Christian workbook to promote a relationship with God as a means to physical and psychological healing.

“[Our] guiding principle is that God can help sort out these issues [with disordered eating],” Boyce explained.

As a new member, Jenny said she is very hopeful that PEF’s eating concerns group will help her overcome her issues related to eating.

“The other people are so open and accepting,” she said. “We all have similar goals and our shared faith.”

Though the group believes in the power of God as an inspiring source of influence, it is not “anti-medical,” Boyce said.

“We want people to get medical evaluation,” Boyce explained, adding that the counseling services available through University Health Services (UHS) are a “good complement” to the PEF group.

McCosh Health Center offers “multidisciplinary treatment” to students with eating disorders, UHS psychiatrist Robin Boudette said in an e-mail, including “therapy, medical monitoring, nutrition therapy, and psychiatric treatment.”

“We provide short-term treatment and provide referral services to off-campus, higher levels of care and inpatient when needed,” Boudette added.

Yet UHS’ policy of providing short-term treatment impairs its ability to meet the needs of all students, Joan ’08 said.

Though she had found a counselor whom she liked at UHS, capacity issues forced her “to start over with another lady [counselor]” in Princeton Junction with whom she wasn’t as compatible, she explained.

“I just didn’t really click with her,” Joan said, adding that she ultimately sought counseling when she went home for the summer.

UHS director John Kolligian explained in an e-mail that such referrals are part of UHS’ standard practice.

“Often [we] do work with students towards referrals,” Kolligian said. “Both because we aim to be responsive and accessible (keeping our wait times as short as possible) — and because extended therapy services are often best managed by private clinical practitioners in the local community.”

For Maria, a referral to counseling outside Princeton was pivotal in alerting her to the seriousness of her condition. Following this realization, she took a year off from Princeton after the fall of her freshman year to get therapy and treatment without “dealing with academics.”

Breaking the silence

This fall, even as Maria progressed toward recovery, signs about eating began popping up on various lampposts on campus. Statements such as “I wish I could be anorexic” or “I was good today so I can have some cheesecake,” courtesy of the Eating Concerns Advisors (ECA), jolted passers-by.

ECA president Madeleine Endicott ’10 explained that all comments on the posters were actual students’ statements overheard by ECA members.

“It’s not just us being provocative ... [It’s] just what people actually said,” she explained.

Though the campaign was controversial, Endicott said that the discourse it raised contributed to a greater awareness of eating disorders on Princeton’s campus that was absolutely necessary.

“There’s a stigma in [Princeton] culture” which makes it more difficult for people who struggle with eating disorders to get help, Maria explained. “Eating disorders by nature are secretive.”

“I never talked about food with anyone,” she added. “I just wanted to avoid the topic because I was so afraid of being found out ... [The poster campaign] was not reaching out to the eating disorder community.”

This cultural stigma needs to be overcome by increased “awareness in general” to help people with eating disorders, Joan said.

“Most people have negative thoughts and concerns about food,” she noted.

Promoting that awareness is one of the ECA’s primary goals.

“Our mission statement is to de-stigmatize eating disorders,” Endicott said, adding that the group hopes to improve society’s general attitudes toward food.

She explained that while one of ECA’s primary goals is to increase recognition of disordered eating, she also hopes the organization’s peer advisers will help students who have a disorder but do not want to seek help at UHS.

“[We’re] a nice intermediate,” Endicott said, adding that the stigma surrounding eating disorders makes people unwilling to talk to UHS officials.

In addition to greater campus awareness, the reinforcement of positive attitudes toward the body at home may also help prevent eating disorders, Boyce said.

“I was proactive about not emphasizing physical beauty,” she said of raising her three daughters. “We were pretty vigilant about comments that had to do with their physical appearance.”

Dealing with the aftermath

Even after a student acknowledges having an eating disorder, the struggle is far from over.

Attia said that while medical treatment for bulimia nervosa has been “extremely helpful” to the cessation of binging and purging, progress in anorexia treatment is slow. She noted that around 40 percent of people hospitalized for anorexia are hospitalized again to be treated once more.

Maria said she “came back a lot happier” after receiving counseling during her year off, but she still deals with the residual effects of her eating disorder.

“The hardest part is learning when I am full and when I am hungry,” she said, adding that her perception of her own hunger “gets out of whack.”

For Jenny, though, focusing on her faith in the eating concerns group instead of food is bringing relief.

“We are memorizing scriptures that we find particularly helpful,” she said.

Joan, who graduated last spring, said that after struggling with an eating disorder, she now views herself less critically.

“I think way less about food [than I used to],” she said “When you have an eating disorder ... you’re consumed by [thoughts about food]. I have a lot of time to think about other stuff now.”