College relapse season

How often do eating disorder patients who have successfully recovered at home struggle with relapse when they go to college? I'm guessing, from the families I know, about half - at least a third. In our family, of course, it was 100%.

Keep in mind that the families I know are primarily those who were pretty clued up. These are parents who generally did a home-based, family-centered, Family-Based Maudsley or something close to it after going the traditional route. These are parents who did some of the most difficult parenting of their lives, and successfully got their kids back to FULL health and functioning.

Yet, college relapse is still happening, and as often as not.

I say this not to be depressing, and not to judge the decision to send your kids to college. I say this because you deserve to know. I don't think that college is out of reach for recovered eating disorder patients, though:  we need to change the way we approach it, what we ask of our kids, what we expect for ourselves, and what we ask of schools.

I think the problem is us: that we think recovery will hold just because we want it to. Because we want to give them "normal." We want normal. We treat this transition as if it isn't the greatest challenge our loved one will face since recovery.


In the US, especially, turning 18 and going off to residential college far from home is nearly a rite of passage. Since many of our kids are already - by virtue of the traits of high anxiety and perfectionism - terrific students it is normal to expect they will go off to the best college or university they can gain entry for - just like their friends.

It is heroic parenting to say no, despite our doubts. It is all-out battle to set limits on how far, how independent, and how little monitoring will go on. It is humiliating to attend the orientations at school where parents are chided and admonished not to be "helicopter parents."It just feels wrong to have your loved one say "you don't trust me?"

But we're a few months from the Thanksgiving break, when invariably the eating disorder treatment world and advocates are inundated by parents who for the first time really see the heartbreaking signs of relapse. Every parent sends their son or daughter off with high hopes but ours are even higher: not to lose the ground we so carefully and painfully gained - and the young person probably doesn't even remember.

What can we do?
  1. Reconsider. Is college the right thing for the child, or is the primary reason because of inertia and social pressure? A gap year is an option. So is forgoing college. And local community college or a school near home. If your parental instincts are nagging at you, listen to them. This may be your last chance to be parental in this way, and your last chance to prevent a life-changing mistake. Each month, each semester, each year into maturity is a stronger guard against relapse.
  2. Who's in charge? Is it ED? Is it your child who doesn't remember recovery well and like any teenager believes she is invincible? Do you believe recovery means the predisposition is gone and your very young adult is now as competent as you are to assess the situation?
  3. Does it have to be all or nothing? It is okay to have a contract, a plan, to start small, to do a test, to start out with lots of protections and ease off later, to "be that parent" who hovers, emails, shows up, requires weigh ins, requires local therapy, requires weekends at home, etc.
  4. No secrets. An eating disorder history is a pretty significant thing. It isn't shameful, and it isn't uncommon. The roommate and the RA and the school deserve to know, to be educated. You deserve to know what THEY think - because a roommate on a diet, a Big Fat Loser contest in the Residence hall, an RA who thinks college students need their privacy except if they are suicidal, the school that thinks the student has to "want" help is an unsafe environment for your college-aged child.
  5. Have an escape plan and don't call it failure. Taking time off is not failure. Being ready to withdraw from school at the most inconvenient, humiliating, GPA-crushing, expensive moment of the semester is a superpower against ED. The goal of college is a better life - not a better college experience. A better life - a life, period - is at risk if an ED is in the picture.
"MY child won't relapse" is a statement no parent should fool him or herself with. The predisposition is there - you know that - and it is our job to make sure it doesn't take hold. College is for healthy people, and supporting college is for parents who are confident and involved.

P.S. Our daughter struggled through freshman year and took a semester off due to relapse. It was a wonderful time, believe it or not, and a relief to all of us including her. She went back STRONG, and all of us with our eyes on ED, rather than averting and avoiding and tip-toeing. She has been healthy ever since - not because everyone stopped worrying about it but because staying recovered is about facing, not avoiding the issue.

Great blog posts on the same theme:
Leaving the Nest: 10 Tips for Parents
Learning from relapse


  1. Great tips Laura :) I was one of those people who went off to university and relapsed, severely and quickly. But then I wasn't anywhere near weight restored before I left. The last time I moved away from home I'd been in recovery for eighteen months and weight restored for close to a year, and I still had a few problems when I had a couple of stomach bugs close together. Even at 25, a long way from being an invulnerable teenager, it was humbling to discover that I wasn't quite as stable in my recovery as I thought I was. Luckily I managed to get through it and this year has been far easier. Leaving home can unsettle the most solid recoveries, so it should always be approached with caution and a lot of planning!

  2. I went to university in my home city (at age 18) and lived at home for the first year, out with friends during the second year (which I didn't cope with at all well..), then at home for the final year. I had not recovered fully from AN and was still underweight (not critically), but neither did I get worse. I got a good degree and enjoyed my time at university, even though I didn't mix in much socially.

    I then went 200 miles down South, still not weight or mind restored, to do an Master's degree. I didn't feel ready to leave home, but many people told me it would be "the making of me". In some ways they were right. I thrived and had a fantastic year, met my first boyfriend and gained weight. It was the best thing I ever did. I made some great friends and felt secure.

    I then went on to do a research degree at another university in quite good health - but relapsed badly... The main trigger for my relapse was difficulty fitting in, loneliness and lack of structure. I over-exercise terribly, lost a lot of weight and developed very restrictive eating again.

    For me, the most vital support that had kept me well, and indeed improved my health during my first year away was good social support - in the form of great friends, including a boyfriend, who knew I had AN and encouraged me to eat.

    You make a great point, Laura, that taking time out is NOT failure. I was forced to drop out of my first research degree (despite finding the academic work easy) because of relapse into very rampant AN. I was actually the one who was desperate to leave and to have some stability. It was others who were telling me to 'pull myself together' - which is a really bad thing to say to someone with AN...

    You offer great all-round tips :)

  3. A wonderful post, Laura. Should be required reading for all parents of children with EDs, recovered or not, who are thinking about sending them "away" to college.


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