When the typical college student hears the words "eating disorder," plenty of images come to mind: emaciated bodies, salad-only dinners and image-conscious high school students puking in the bathroom after lunch.
Though American teenagers learn about eating disorders and their dangers in middle and high school, most students only hear about anorexia and bulimia, characterized by patterns of self-starvation or binging and purging, respectively. But according to a study conducted at McLean Hospital and published in February edition of academic journal "Biological Psychology," the most common eating disorder in America is less well-known: binge eating.
The study found that anorexia was prevalent in 0.6 percent of the general population, and bulimia was prevalent in 1 percent. Binge eating was found to be more common than both disorders combined, with a prevalence of 2.8 percent.
"Binge eating is common, and has been for a long time," Health Services Medical Director Dr. Margaret Higham said in an e-mail. While Higham did not have specific statistics for Tufts students, she said that binge eating does not seem to be a new phenomenon here: "I have not had an impression that is more common now than, say, six years ago," she said.
According to Higham, binge eating is currently gaining more attention than it had in the past. As a result, she said, the number of diagnosed cases may be rising while the actual number of people afflicted remains steady.
"Binge eating has been better described and recognized as a specific disorder over the past decade," Higham said. "So it's hard to say if clinicians are more aware of it, or if it is really increasing."
A proposed disorder in the official manual of psychiatry, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), binge eating disorder is characterized by repeated periods of binge eating at least twice a week for six months, separate from anorexia and bulimia nervosa. Binges typically involve eating more food or more rapidly than normal in a short amount of time.
Some research has shown that binge eating may be related to obesity in that morbidly obese people tend to have more binge eating disorders than others. A surprising characteristic of binge eating is that it often comes hand-in-hand with dieting.
"I think that dieting can lead to binge eating, because people are watching what they eat - so when they eat a lot, they just binge," said Professor of Psychology Robin Kanarek, who studies psychology and nutrition and has researched binge eating in the past. "[People who diet] restrict themselves so much that when they get access to food or allow access to food, they binge."
One student said that she thinks the pattern of dieting and binging does happen among Tufts students.
"People think of dieting as 'going on a diet' - not maintaining it - so they don't make healthy choices consistently," junior Ashley Griffin said. "People go on swings of binging and then being 'good' for a few days, eating rice cakes. I see a lot of girls walking around eating rice cakes."
According to Kanarek, viewing different foods as decidedly good or bad is part of the foundation for binge eating disorders.
"Most people in our society and particular people with eating disorders tend to dichotomize food," she said. "Fruits and vegetables are good, candy is bad, for example ... Even those of us who don't have eating disorders tend to think of cakes and cookies as being not as good of food as an apple, but one cookie is one cookie."
When people do eat that one cookie, Kanarek said, they often see it as a total loss: "People get into a dichotomous thinking, so that if they have one cookie, they say 'Oh, I've been bad,' and binge," she said.
College students on the whole tend to have fewer binge eating disorders than slightly older young adults - the McLean study found that the mean age of onset is 25 years old. The stresses of college life, though, can certainly contribute to disordered eating habits.
"Binge eating is a common response to stress," Higham said. "Often food is used to relieve emotional distress - loneliness, sadness, anxiety. College students are certainly vulnerable to many of these factors."
The crazy routines that college students follow can add to their emotional stress. "Many of them come to college without good skills in regulating their daily life, being unable to provide structure and routine in their life," Higham said. "Regular meal times are lost, regular sleep [is lost]."
Other "binging behaviors" are frequent in college, too, Higham explained: study binges, drinking binges, sleeping binges, etc., can all contribute to how students eat. Many students will binge eat after drinking, too, according to Kanarek.
Jumbos themselves don't seem to find that binge eating is much of a problem. "My overall perspective of Tufts is that the university is fairly healthy and fit, based on the atmosphere of encouragement of exercise and health," graduate student Mike Ferrelli said. "With running programs and the school of nutrition, there are a lot of programs for students to take advantage of."
Senior Rachel Leven agreed.
"The majority of people I know are pretty healthy in their eating," Leven said. "I think Tufts students are generally pretty aware of what's healthy, and they regulate themselves."
For Jumbos who find themselves binging frequently - or infrequently - Kanarek has simple advice: "One thing to do is start looking at food as food, not a good or bad thing," she said. "You can allow yourself the freedom to have a cookie or ice cream every once in a while."
But changing our most basic thoughts about food isn't easy. "It's hard because people tend to develop these patterns of thinking about food early on, in childhood. [The dichotomous thinking about food] has become more prevalent because of awareness of nutrition," Kanarek said.
