Returning to School after Eating Disorder Treatment

Every year around this time, the back-to-school bonanza begins. Stationery stores are stock-piled with school supplies. Bedding and home stores are advertising all the latest dorm room designs. And clothing stores are clamoring about ways to refresh a fall wardrobe.

However, if your summer involved intensive eating disorder treatment, you may have some other important back-to-school concerns. Here are a few of the worries commonly voiced by people with eating disorders as they approach the start of a new school year:

Will people notice changes in my eating or my appearance?

The simple, yet perhaps unsatisfying answer is, “it depends.” Many people are consumed with their own worries, and therefore may not be as acutely aware of the changes that you’ve made as you are.

That said, the friends (or teammates) who know you well – those with whom you were eating regularly before treatment, or with whom you were avoiding eating – may notice that your eating has improved. People who had previously expressed concern for your wellbeing may feel happy that you are now willing to join them in the cafeteria or relieved if they notice you finishing your meal or trying out a new dessert.

If your treatment resulted in a weight change, the extent to which others notice may be a reflection of how dramatic the change was and how attentive your peers tend to be. Keep in mind that your view of a significant weight change will not always reflect a change noticeable to the casual observer. If normalizing your weight clearly required significant gain, others’ awareness of this change could be viewed as a reflection that you’ve gotten yourself into a clearly much more physically healthy state. Hard as it may be to imagine, that’s something worth being proud of.

Friends may also be noticing other markers of changes in appearance – not just weight – such as brighter eyes, clearer skin, healthier hair and nails, or a face that is more frequently smiling.  Their reminders about these changes may help you to remember more of the positive repercussions of recovery.

How can I respond to others’ comments about my appearance or eating?

To the extent that you know what does and does not feel helpful to hear, consider talking with others about the kind of comments that feel most reassuring.

Unfortunately, lots of people don’t know quite what to say and get it wrong – even with intended compliments. In this case, you might (1) reflect on the intention behind the comment, (2) get a trusted friend’s or clinician’s perspective on the appropriateness or inappropriateness of the statement, and then (3) choose whether or not it could be valuable for you to express how you experienced the exchange.

Putting one of the following statements into your own words might get a productive dialogue started:

• “When you said _______, I heard it as _______ and that’s doesn’t make me feel great because…”
• “I’m not sure what you meant when you said _______, but that’s the kind of thing that’s not so helpful for me here right now. Maybe we could talk about ________ instead.”
• “It’s not easy for me to hear compliments like __________. “
• “What you said at the meal felt like criticism. Maybe next time you can point out what you’re noticing by saying something like ________.”

What can I do when I overhear people talking about their latest diet or desire to lose weight?

This is an important scenario to anticipate because the reality is that lots of young people are dieting and/or experiencing body dissatisfaction. Findings from the 2015 Healthy Bodies Study report (a web-based survey overseen by researchers at the University of Michigan), revealed that more than half of undergraduate and graduate student respondents were afraid of weight gain and strongly desired to lose weight in the past month.

Speaking negatively about body shape and weight, a phenomenon sometimes called “fat talk,” contributes to body dissatisfaction and disordered eating. This kind of talk can be particularly upsetting to those in recovery from an eating disorder and may even be detrimental to the recovery process.

Because it’s hard to control what other people are worrying about or saying, arm yourself by continuing to challenge your own thinking. Identify the statements being made by your friends that you find especially persuasive (e.g.: “I need to lose 5 lbs. to look good on our spring break trip.” “Eating carbs is so bad for you.”), and practice reworking the thoughts into more balanced beliefs.

If you find yourself falling prey to a way of thinking that will be toxic for your recovery, you may need to limit how much time you spend with certain people, or the types of activities you do with them. Seeking out opportunities with advocacy organizations that are pro-recovery and pro-healthy body image can be a way to find like-minded individuals.

What are the other big challenges to my recovery that I may face?

There are other obstacles that can threaten recovery with a return to school. Some examples include:

• A class schedule that interferes with regular meals and snacks.
• Food shopping and/or cooking independently.
• Excessive use of substances (such as alcohol) known to impact mood and eating behavior.
• Unlimited access to a school gym.
• Return to collegiate-level athletics.
• And, other general back-to-school stressors.

The more you can anticipate these risks and plan for them, the more likely your back-to-school transition will promote getting back-to-health.

There is no need to navigate the back-to-school transition on your own. Enlist your current treatment providers to help you get set up with a reasonable treatment plan at school, and identify local clinicians who can support you as particularly challenging situations unfold. Reach out to your parents and your friends liberally, and consider establishing a routine for them to check in with you in a way that will feel helpful and supportive.

For additional tips on tackling an eating disorder while at school, read this related post.

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