Resources and Support for Nursing Students Coping with Eating Disorders
Going to nursing school can put students at risk of being affected by an eating disorder. Keep reading to learn how to recognize the warning signs, the unique stressors that can impact you, and how you can access help.
Nursing students should be paragons of health, right? After all, they are learning all about health problems and how to fix them. It’s understandable that you might think eating disorders are less common among those in the allied health field, but the truth is a little tougher to swallow.
Eating disorders can affect anyone, regardless of their age, sex, or choice of academic studies.
Many nursing students struggle with eating disorders and body image issues. Females usually experience eating disorders more often than men, and there tends to be a higher proportion of women than men in nursing school.
All of this to say that if you’re a nursing student with an eating disorder, you’re far from being alone.
We created this guide for you. In it you’ll learn about common eating disorders, including their warning signs and symptoms, as well as special risk factors that apply to nursing students. Finally, if you are struggling with an eating disorder or at risk of developing one, this guide provides several resources so you can get help.
Major Types of Eating Disorders and Their Warning Signs
The American Psychiatric Association defines an eating disorder as a recurring and severe disruption of eating habits that causes negative thoughts and emotions in an individual. Given this broad definition, there are many different types of eating disorders. Let’s look at some of the most common and serious disorders, as well as potential signs that someone is suffering from one or more of them.
Anorexia Nervosa
Anorexia nervosa is one of the most well-known and common eating disorders. It’s also one of the deadliest. Someone who experiences anorexia nervosa might have an abnormally low body weight, an intense fear of gaining weight, a skewed perception of healthy weight, and extreme restrictions on what or how much they eat. Other characteristics that may be present include excessive exercising, binge and purge cycles, and/or misuse of enemas, diuretics, and laxatives.
Anorexia nervosa can overshadow everything else in a person’s life, including their schoolwork. One of the symptoms of anorexia is trouble concentrating, so a nursing student might show a decline in academic performance as the eating disorder continues.
Warning Signs: One of the most serious warning signs is that the person not only engages in extreme calorie-restrictive eating and/or exercise habits, but no matter how much weight they lose, it’s still not enough for them. Other common signs and symptoms of anorexia include:
- Prone to feeling dizzy or fainting
- Lack of menstrual cycles
- Muscle weakness
- Cold intolerance
- Frequency bone breakages or stress fractures.
- High levels of depression, irritability, and/or anxiety
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is one of the newly recognized eating disorders. This eating disorder includes an aversion to food, resulting in a nutritional deficiency. ARFID can manifest itself in several ways, including lack of appetite, food avoidance, extremely picky eating habits, and/or having unique anxiety or fear about eating.
Someone may be diagnosed with ARFID if there isn’t another explanation for their unusual feelings about food, such as cultural or religious reasons, another disorder, or a medical condition. In addition to the physical problems associated with malnutrition, AFRID can negatively affect someone’s social life, because someone with AFRID will often have difficulty eating with others or take an abnormally long time to eat a meal.
Warning Signs: In addition to what’s already been discussed above, if someone suffers from ARFID, they’ll usually exhibit one or more of the following:
- Malnutrition
- Extreme weight loss
- Reliance on a feeding tube or supplements to receive proper nutrition
- Trouble keeping warm
- Fatigue or lethargy
- Gastrointestinal issues, with no known cause
- Extremely particular about what they eat, which worsens over time
- Prefers to eat (or avoid) foods of a certain texture, color, taste, or smell
- Anxiety about eating, related to constipation, choking, allergic reaction or food poisoning, rather than weight gain or body image.
Binge Eating Disorder
Binge eating disorder is similar to bulimia nervosa in that they both involve eating large amounts of food while feeling a loss of control in the type or amount of food consumed (binging). However, unlike bulimia, someone with a binge eating disorder will not take drastic measures to compensate for the binge episode by extreme exercising, fasting, or purging.
However, someone with a binge eating disorder may feel ashamed, depressed, or guilty about their eating habits. As a result, these negative feelings could hinder their motivation to do well in school or take their nursing studies seriously.
Warning Signs: Overindulging with food on occasion is normal and doesn’t signal a binge eating disorder. A person suffers from a binge eating disorder if they binge at least once a week for three months and do three or more of the following:
- Eating very quickly without a good explanation
- Continuing to eat despite feeling full or not feeling hungry
- Binging in secret
- Feeling guilty about the binge eating
Bulimia Nervosa
The key characteristic of bulimia nervosa is that the individual alternates between episodes of binge eating (eating a large amount of food with a perceived loss of a control of the type and amount of food consumed) and eliminating consumed calories.
In regards to this latter characteristic, someone with bulimia may go on a strict diet, exercise a lot, or fast to reduce the calories consumed. But often, someone with bulimia will use a “purge” method of eliminating calories. Common purge methods include laxatives, enemas, weight-loss supplements, diuretics, and/or forced vomiting.
During a binge phase of bulimia, a person will usually feel shame and embarrassment. Bulimia differs from anorexia in that both may entail binge and purge episodes, but someone with anorexia will usually have an abnormally low body weight.
Bulimia can adversely affect nursing students in that they become preoccupied with their weight and food instead of their schoolwork or other responsibilities.
Unique Risk Factors Impacting Nursing Students
Nursing students are at risk for eating disorders just like anyone else. Yet there are unique features about their training and profession that may increase the chances of eating disorders. Let’s take a look at some of these risks and how they relate to students in nursing school.
Access to Knowledge and Drugs
One of the core classes nursing students take is pharmacology. This is where students learn about various drugs and how they work in the human body. Part of the curriculum will cover specific drugs or chemical substances and how they’re used to treat patients. They will also take biology and chemistry courses.
During these courses, nursing students will learn about medications and treatments that could facilitate an eating disorder. For example, they might learn of a different type of laxative or emetic that makes purging easier for them. Even if these were only available as a prescription, they will know what they need to say to their primary care provider to have them prescribe those medications to them despite not needing it.
Heightened Stress
Getting into a nursing program is challenging. Even after completing prerequisite classes and getting great grades, there’s still no guarantee of getting into a nursing school; many are fiercely competitive due to limited class or cohort sizes. Once accepted into the program, there will be a host of more challenging courses in scientific and technical areas. Afterwards there are the clinicals, where not only is graduation eligibility on the line, but so is the health and even life of real patients. All this stress can easily lead to anxiety, which can sometimes lead to unhealthy eating patterns.
Increased Risk of Mental Health Issues
Nursing school is stressful enough that it can commonly lead to mental health struggles, like extreme stress and anxiety. Aside from the academic-side of nursing school, students are also at risk of being exposed to events that could lead to emotional trauma, like a patient suffering from a serious illness or having a life-threatening event in front of them.
While mental health disorders like depression don’t necessarily cause an eating disorder, they often co-exist. For example, of those with an eating disorder will also have symptoms of depression. Many people use food as a coping mechanism, whether it’s overeating or not eating enough. Subsequently, depression often leads to feelings of low self-worth, and many people also develop an eating disorder because of their skewed self-image.
Lack of Personal Time and Self-Care
Attending nursing school as a full-time student often means that there’s not much time for other needs including self-care. A nursing student may only have a few hours each week when they are not studying, but that time may go to a part-time job and/or family obligations.
When there’s not enough time in the day, a nursing student’s personal needs are This could mean that nursing students may not have time to exercise or sleep, the lack of either of these are also associated with weight gain.
Don’t forget, many people choose a nursing career because they want to help others and have a propensity for putting the needs of others before their own.
Shift Work
Nurses typically work in shifts, but this means that they won’t always be working a 8-5 shift as there are so many other hours in the day that need to be covered, especially by newer nurses. In addition, there’s often a need for overtime.
With long hours and irregular schedules, a recently graduated nursing student might not eat on a regular schedule. They may also not eat healthy foods, which could lead to guilt about food and possible weight gain.
As for nursing students, their clinicals will usually occur during the day, but sometimes they can require students to wake up at odd hours to get to an early-morning clinical. This type of disruption in schedule can lead to problematic eating habits.
Weight Stigma for Healthcare Professionals
It’s well-documented that doctors will exhibit bias towards overweight patients. And this bias makes it less likely for people to seek medical care. For example, from 2004 to 2006, 16% of female patients and 8% of male patients endured weight and/or height bias from a healthcare provider.
While there’s a lot less data showing bias in the reverse direction (a patient being biased against an overweight medical provider), it wouldn’t be surprising given the existence of weight discrimination in society that’s so prevalent that at least one state has made weight discrimination illegal in certain situations.
Therefore, a new nurse could feel pressure to maintain a certain body weight, if for no other reason than to just avoid stigma. But there is also pressure to set a “good example” as a healthy individual and come across as more credible.
How and Where to Find Help for an Eating Disorder
If you or someone you know has an eating disorder, help is available. For many who have an eating disorder, outside intervention may be necessary. This is especially true with some of the more dangerous eating disorders, such as anorexia nervosa.
But where do you look to get this help? Luckily, nursing students will have access to a plethora of resources.
Campus Counseling and Psychological Services
College is a difficult time, so it’s not surprising that many college students suffer from mental health issues. Schools recognize that these can hinder academic progress and offer various forms of counseling services or therapies. These resources can be helpful to those suffering from eating disorders because these disorders may be closely connected to mental health problems.
Even if the eating disorder isn’t related to another psychological problem (like depression or anxiety), treating the eating disorder will typically involve psychological treatment from a licensed mental health professional, such as those found at a school’s counseling services center.
- Loyola University – Maryland: Counseling Center: University students have access to a variety of counseling, consultation, psychiatric assistance, and telehealth services, with specific support for eating disorders.
Educational Workshops and Seminars
Workshops and seminars are excellent ways to learn about eating disorders. These seminars and workshops can cover basic information to provide foundational knowledge to those who want an introduction to eating disorders. They are available from many providers, sometimes for a fee but often at no charge. You can attend in-person but many of them are available online, either through live attendance or watching the recorded presentation at a later time.
- Udemy – Eating Disorder Courses: Udemy is an online education platform offering MOOC courses. These courses cover a plethora of topics, including food, nutrition, and eating disorders. The courses may have a cost, but some are free.
- The Eating Disorder Foundation’s YouTube Channel: The Eating Disorder Foundation offers workshops to anyone who wants to learn more about eating disorders. These presentations are uploaded to the Eating Disorder Foundation’s YouTube channel for those who prefer a more casual way to receive these educational opportunities.
Student Health Centers
Sometimes called a wellness center, almost every college campus will offer some level of medical or health-related care for their students. However, the type of care offered, as well as availability of that care will depend on the specific school.
For example, some may only be open when school is in session or provide only basic medical care, such as what can be found at an urgent care clinic. Others may offer additional services, such as specialists to deal with common problems, like allergies or disordered eating.
It’s possible for counseling services to be offered through the student health center, assuming it’s not available from a standalone counseling center or department.
- University of Florida Student Health Center: The UF Student Health Center offers primary care services to the students of the University of Florida. Also available are emergency care, nutrition, laboratory, and immunization services.
- UT Martin Student Health and Counseling Services: This is where University of Tennessee Martin students can obtain basic medical care, such as dealing with the flu or STD/STI treatment. Counseling services are also available.
Other Resources
There are many other resources for helping those dealing with an eating disorder. Below is a brief list to give you an idea of what’s available, including informational resources, as well as those to help reinforce healthier habits. Many of these are available from multiple sources or providers (such as an app for hotline), but they will help you get started.
- Eating Disorders Helpline: Offered by the National Association of Anorexia Nervosa and Associated Disorders, this is a toll-free number to call for emotional support and referrals to additional help.
- Rise Up: Eating Disorder Help: This app is also available through the Apple Store and uses self-monitoring to help those dealing with disordered eating or other challenges with body image, food, and exercise.
- The Recovery Warrior Shows: This podcast focuses on people sharing their personal stories and/or scientific research to help anyone who has been affected by an eating disorder.
- National Institute of Mental Health: This government organization has a wide array of information about eating disorders, including basic overviews of the different types, statistical data, scholarly journals, and access to opportunities to join studies about eating disorders.
- National Eating Disorders Association (NEDA): NEDA is one of the most prominent nonprofit disordered eating organizations in the United States and works to support anyone affected by an eating disorder.
Expert Advice: Hear From a Licensed Mental Health Counselor
Brian Jones is a Licensed Mental Health Counselor based in Seattle, Washington. He has been specializing in eating disorders for half a decade, in settings ranging from residential care to individual private practice. He also specializes in working with adults in the areas of religious trauma and spiritual abuse, careers, and relationships. You can visit his website at www.bjonescounseling.com.
Can you provide an overview of the prevalence of eating disorders among nursing students? Are there any specific factors that contribute to this population being at higher risk?
Because I haven’t been involved in the research side of eating disorders, I can’t say much about the scientific data in terms of eating disorder prevalence in nursing students. One study did not find much difference in eating disorder prevalence between nursing students and students in other fields. A study of medical and paramedical students in South India found a prevalence of being at high risk of eating disorders at 13%, they mention contributing factors of high stress, severe body shape concerns, peer pressure, excessive exercise, and history of behaviors such as laxative use and dieting. A study of nursing students at Benha University in Egypt discovered that more than half of the participants had moderate eating disorders. Another study of nursing students published in September 2022 determined that 8.9% of the participants were at risk of an eating disorder.
In short, the numerical data seems to be a bit unclear, and more research is probably needed. There may already be meta-studies published on the subject that I am not aware of. In conversations with clients and colleagues, I have developed the personal belief that professionals in nursing and other medical fields often seem to be at a higher risk of disordered eating and exercise than folks who work in other industries. It’s possible that disordered eating is a method of coping with the high stress level of their education and work settings, as well as the perfectionism students place on themselves (and may also be placed on them by family and school expectations).
In your experience, what are some common challenges that nursing students with eating disorders face while pursuing their education and clinical practice?
Nursing students with eating disorders often report struggles with maintaining a focus on their recovery. This can be because taking the time to schedule meals and other self-care can be difficult with their high-demand schedules. Their motivation to recover can also cycle back and forth, as they are often surrounded by conversations with classmates and coworkers about health, wellness, dieting, exercise, and so on. People with restrictive eating disorders typically need to recover by eating more; but adding more food to their daily intake can create feelings of shame. They might also find it unfair when they see their peers receive praise for continuing to restrict food.
Fatphobia is also highly present in nursing and medical fields. I’ve had clients who ended up questioning their recovery every time they attended classes led by openly fatphobic professors. When fatphobic messages come from authoritative sources like professors and supervisors, it becomes that much harder to question those messages. Students who gain weight can experience stigma from professors, friends, and even patients. All in all, these students can feel an enormous amount of pressure and scrutiny on their habits and appearances.
How do eating disorders impact the physical and mental health of nursing students, and what potential implications can they have on their professional performance?
The consequences of eating disorders can be brutal. People who engage in recovery often feel an internal dilemma every day, either questioning their choice to recover or struggling to find alternative ways of coping with stress. As eating disorders progress, students can experience physical symptoms such as GI distress, inability to concentrate, fainting spells, or worse – all of which can create serious problems, especially while they are working in hospital settings. Working with low energy to the point of exhaustion can also lead nurses to make dangerous mistakes when working with patients. Academic performance can certainly be negatively affected by eating disorder symptoms.
When eating disorders are severe enough, higher levels of treatment such as residential care may be indicated, meaning that some students need to take time away from school. Leaving school in the middle of a term can aggravate the financial commitments. In some situations, students who go on medical leave don’t come back to school
Students who are able to recover enough from their eating disorders to move forward with their careers can still experience problems. Medical settings can be extremely triggering. Nurses who see their own patients suffering from eating disorders or similar problems might struggle to stay present with those patients. Nursing usually continues to be a high-demand job after completing school, which means that nurses with eating disorder histories must continue to prioritize their self-care and recovery-related values. Managing all of this, especially indefinitely, can be very challenging.
Are there any specific signs or symptoms that faculty or peers should look out for in identifying nursing students who may be struggling with an eating disorder?
I think the most apparent signs of eating disorders are changes in energy level and mood, as well as severe weight loss. Are any students struggling to concentrate or stay awake? Do they also seem to be depressed most or all of the time?
Other signs include frequent talk about diet and exercise, or trying to “control” their body. Maybe you notice habits that may seem odd to you when they eat (to avoid triggering any readers, I won’t get into specifics). Do any students seem to be particularly affected when working with patients who have eating disorders?
NEDA has an in-depth list of warning signs, although they aren’t specific to nursing students.
What are some effective strategies or interventions that can support nursing students in managing and recovering from eating disorders while maintaining their academic and professional responsibilities?
The first thing I’d say to nursing students in recovery is to prioritize their self-care. This includes scheduling meals and sleep, advocating for their needs at school and work, finding time for alternative coping skills such as meditation, and reaching out for support from a therapist and dietitian. I recognize that this is far easier said than done, but in all my work with nursing and other graduate students, the conversation has always come back to self-care.
Sometimes this means asking your school for extra accommodations. Many schools and professors are understanding of this relationship and will do what they can to help. Your doctor or therapist may be able to provide a letter to assist you in your advocacy efforts.
I’d also suggest searching for a peer support group with other nursing students in recovery. Even if your school doesn’t have a group like this, you might be able to find one online.
What are some misconceptions or stigmas surrounding eating disorders that you frequently encounter, and how can we work towards dispelling them within the student community?
I’d say the two most common misconceptions I encounter about eating disorders are (1) that eating disorders aren’t real, and (2) that they always appear the same way. Eating disorders are very real, and people who experience eating disorders can’t just will themselves to start eating differently. People with eating disorders also show up in all shapes and sizes, so you can’t always tell if someone is struggling just by looking at them.
One of the most dangerous ideas I hear about eating disorders is that there are “healthy” ways to lose weight, and people with eating disorders simply go too far. I say this is dangerous, because where do you draw the line? People often take their first steps into eating disorders by trying a new diet.
I think we can reduce stigma and encourage recovery by making eating disorders a more commonly understood idea. The more we talk to each other, the more people will understand how disordered eating is a coping mechanism for things like anxiety and stress. We can also practice changing the way we communicate about weight and health. Some universities have adopted a non-diet approach in their curricula for nursing, medical, and dietetic programs. They are also understanding how conversations about weight can stigmatize patients, and are teaching these lessons to their students, and I think that’s a very good thing. More schools need to adopt a Health at Every Size framework.
From your perspective, what advice would you give to nursing students who are currently struggling with an eating disorder and trying to balance their education and recovery journey?
Please reach out for help if you haven’t already. You can start with national resources like ASDAH or NEDA, you can Google or ask your insurance provider for referrals to eating disorder providers, or you can walk into your school’s clinic and ask for help there.
If you’ve got support but are still struggling, what is it that you’re coping with? If it’s the stress of school, think about the risks of putting off or deprioritizing recovery. You might schedule all your time to focus on nursing school, but what is the quality of that focus? Is your current lifestyle sustainable? Sometimes taking a break, even for a semester or more, will be worth it in the long run.
I don’t blame anyone for doing what they have to do to cope with all the barriers they’re experiencing in school, but taking the time to find safer ways to cope could literally save your life.
Are there any emerging trends, research, or best practices that you believe are important for nursing students and healthcare professionals to be aware of in relation to eating disorders?
Responses to eating disorders are full of stigma, even from people who want to help. BIPOC and LGBTQIA+ students who seek eating disorder treatment may experience further mechanisms of oppression and stigmatization from providers. Not all providers and treatment centers are the same, so please do your research as you seek treatment or recommend treatment to others.
I also only recommend Health at Every Size/weight-neutral/fat-positive providers when I make referrals. Nearly everyone in our society has internalized fatphobia, and I think that has to be reckoned with as part of recovery. This applies to both people in recovery, and to the people who support them. Whether you are a student, professor, or professional, please take the time to address your own biases – with the help of other professionals, if need be.
