Eating disorders

School & studying

Being in education, at school, college or university, could be difficult as well as rewarding. For many people we spoke with, doing well in school was really important and often a big part of who they are. People talked about the risk of becoming too obsessive about school work when they were unwell; their behaviour and thoughts could spiral out of control. The social side of being in education could be challenging. Fitting in with other students could be hard, and some had been bullied in school. Being at university meant being independent and having more flexibility. Freedom could be a shock, but a starting a new chapter in life could provide positive motivation to get better and to stay well. We also spoke to people who had attended school at hospital during their inpatient treatment (for more see ‘Staying in hospital’). 
School work & exams

Many young people described themselves as having “perfectionist” tendencies, being “driven” and “hard-working”. Some said that their self-confidence mainly came from doing well at school. Being able to do some school work or sit exams even during hospital stays could be hugely important.
For many, the pressure and competitive environment of school had contributed to becoming ill or relapsing. Often the pressure came from the person themselves: it wasn't about wanting to be better than others but the best they possibly could. Exam times could get especially stressful and people described working “obsessively”, especially when unwell. Zoe described how school work took over everything else: social life, relationships and hobbies. Eva had to learn to find the right balance between school work and social life because she could easily become totally absorbed in work.
Not everyone felt able to engage with their school work. They described not being bothered about school work, or missing school because they were unwell or being bullied. Georgia disliked everything about school and Andrew refused to go to school because he associated his problems with the school environment. People often struggled with moving between schools. For some, the move from primary to secondary school had been a trigger to develop the eating disorder, or they had relapsed when moving to college or university. This was because of the new environment and increased pressure but also the more informal structure of college or university. People were so used to control and rigid routine that having more free time and a flexible study arrangement could drive them to exert control over their food; they may start to restrict or purge.
Some had failed or underperformed in their GCSE or A-level exams because they had been too unwell. For Rob and Sam, for example, not being able to do well in exams “hindered” their future opportunities. Not being able to apply to university meant they had to find other options.
Peers & bullying 
“You’ve got to look a certain way within schools to fit in.” -Nico
Many young people we spoke with shared a sense of “not fitting in” with their peer groups or having “an alternative” outlook; they could feel isolated and lonely. They often compared themselves, or felt compared, to others and some described feeling “inferior”. Some said they didn't feel comfortable in the “superficial” culture at school where they felt most people were focused on looks and popularity. Sometimes people felt self-conscious of their weight, felt over or underweight or were teased about their weight see ‘The beginning of an eating disorder’.
Some had been bullied in school. Sam nearly dropped out of school after years of increasing verbal abuse. Another result of the bullying was that Sam didn’t get the exam results he wanted and was not able to apply for university.
The bullies often targeted people who already were quiet or had low self-esteem. Some had been called names referring to their weight. Craig was bullied from the age of 8 for being shy and quiet. Being singled out and bullied often knocked people’s confidence even further and could have long lasting impact on their lives.
Teachers and support from school

Some had extremely supportive teachers they could trust and talk to openly whereas others found their teachers were not very supportive. Sometimes a teacher was the first person the young people confided in or who picked up on the eating problem. Suzanne was able to talk to a teacher she “adored” and Eva used to eat her lunches in her teacher’s office at times when lunch breaks felt too much to cope with. The school could also support through school nurses or counselling and by offering flexibility around exams and hospital appointments during school hours.
Others were less fortunate and talked about teachers who were unaware, uninterested or incapable of stepping in to stop bullying and/or lacked understanding about eating disorders. Lack of support from the school could lead to people feeling more inadequate and angry.
“It was just the change of environment, going somewhere, the fact that nobody knew. Like you could meet people, without a label - have a kind of a bit of a fresh start.” -Katie
For those who went to university, there was often a complete change of lifestyle, which was both exciting and a little daunting. Moving to a new place and leaving family, home and peers behind could be “a fresh start”, free from the triggers and reminders of their past experiences. They felt free to meet new people without having a label. Moving away from home was a huge “relief” for Andrew as most of his problems were connected to family relationships at home. Some people felt that leaving the daily practical and emotional support provided by their family was hard at first.
Going to University also meant a change in the formal support services such as GPs and mental health professionals; this could have good and bad sides. There could be a gap in counselling, for example, before seeing anyone new. Some people couldn’t find a new therapist, or set up a regular contact with services. New health professionals could turn out to be great and university towns were more likely to have GPs with a special interest in eating disorders or young people’s mental health issues.
University also usually meant a big change in eating routines. It could be an opportunity to leave old unhealthy eating habits behind. Young people became either solely responsible for buying and cooking their own food or some stayed in catered halls. Sharing kitchens and eating with others could be hard and some people felt uncomfortable. Katie said seeing how others ate, and their portions sizes was actually helpful in learning to eat more “normally”. It could be helpful to tell housemates about their issues and if they didn’t want to share foods in the fridge, for example. Living in catered halls made it easy because people didn’t have to plan meals but people also felt that eating with others could be tough.
Usually universities had more support available than schools for those who needed it. Some people had been supported by their university’s disability and welfare office. Practical support could include:
Help with time management
Extra time for exams
Informal emotional support
Information about other services 
The university just being aware of possible issues. 
Francesca felt strange at first about getting support from the disability office but realised that an eating disorder was like any other illness and she deserved the same support as others. She was also able to apply for accommodation with private kitchen and bathroom on medical grounds. For Nikki, her time at university was “rough going”. She had recently come out of hospital and didn’t have the right support. She was “dead set” on doing her degree and, although it was tough, she never regretted it.
Sometimes people got in touch with the university support services before they moved to university to make sure there was help available for them.
People often found social life and meeting new people much easier at university than before. Many felt that people were more “mature” and “accepting” and they could find people they clicked with. 

For more see ‘Social life and public places’ and ‘Friends and Relationships’.

Last reviewed October 2018.


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