At Harvard, Eating Disorders Common

When Rachel arrived at Harvard as a first-year student, she was determined to avoid the dreaded "freshman 15." She ate salads, rather than the dining hall's main courses, and avoided desserts.

But after she gained three pounds in the fall of her first year, she panicked.

"I had this horrible fear of getting fat," the junior says.

The first time she tried to make herself throw up, just after her first-year winter break, she failed. But the next time, she stuck two fingers in her throat and purged.

"It was the only way," she says. "I sort of felt I was watching someone else do it. It seemed like the logical solution to me at the time."

Rachel's situation is far from unique at Harvard.

About 20 percent of Harvard's undergraduate women have serious clinical or subclinical eating disorders, according to a 1992 survey by former Assistant Professor of Psychology Todd F. Heatherton.

About five percent of all Harvard women have clinically diagnosable eating disorders, which are more serious than their sub-clinical counterparts, according to the survey. One percent of Harvard men have a clinical eating disorder, the study found.

Rachel says societal pressure to be thin and the normal stress of undergraduate life at Harvard made her problem worse.

"A part of the profile of someone with an eating disorder very much matches part of the profile of the sort of person Harvard values: high-achieving, perfectionist, people-pleasing, and driven," says Sheila M. Reindel '80-'81, a counselor at the Bureau of Study Counsel.

The College offers several resources for students with eating problems. The Bureau of Study Counsel, the University Health Services (UHS) and the undergraduate-run Eating Concerns Hotline and Outreach (ECHO) all cater to their needs with counseling, peer groups and medical attention.

New resources will also likely become available this year--including a proposed student outreach organization--filling some voids in the Harvard support structure.

But despite the treatment options, most of the troubled students do not seek help.

In Heatherton's survey, "what became clear is that most people felt they could handle [their eating disorders] on their own, probably unsuccessfully," Heatherton says. "There's a resistance to using the resources available."

Common Problem

At Harvard and other competitive schools, disturbed eating patterns are almost an accepted part of college life.

"It's a college-bound sort of thing--it has to do with the environment: the competition, issues of the dating scene, controlling your eating for the first time, dealing with the stress of exams," Heatherton says. "Some of the behaviors are almost normative, [even] expected. It's more like crowd behavior."

Heatherton's survey found problems with food and exercise are widespread among Harvard students.

According to his study, 32 percent of Harvard women believe that they are overweight and 80 percent want to lose weight. Twenty-four percent of women and four percent of men say they have used starvation fasting as a method of weight control some time during college.

Eighteen percent of the women who responded to Heatherton's survey were binge eating at the time, while five percent of women and one percent of men said they vomit to get rid of unwanted calories.

Thirteen percent of women and five percent of men identified themselves as compulsive overexercisers, and 45.7 percent of women and nine percent of men reported that they dieted sometimes, usually or always.

Many of these respondents, who are likely not suffering from full-blown clinical disorders, still have cause for concern, Heatherton says. If eating is causing anxiety, there is a problem, he says.

"If someone is extremely worried about [eating] then that's a problem...if the eating behavior is really interfering with their lives," he says. "It doesn't have to be a clinical thing. A person doesn't have to be emaciated to seek help. They just have to feel its not going the way they'd like it to be."

Students say anxiety about eating is commonplace on campus. One undergraduate says her roommate has never been diagnosed as anorexic, but looks far too thin.

"Sometimes at a meal together I'll notice she's taken a lot of food, made a mess of her tray, peeled an orange, but she hasn't really eaten anything," she says.

Many students start to focus obsessively on calories and weight gain.

Sara, a sophomore at Harvard, says she doesn't "binge or purge or starve" herself, but still "thinks about food way too much."

Even a routine trip to the dining hall can cause fear and guilt for Sara, who says she also feels guilty if she doesn't exercise every day.

"I don't usually eat cheese, I don't eat butter on bread, I don't ever eat ice cream," the sophomore says. "Most of my girlfriends are the same way, so I don't feel like it's a weird thing."

The stress of the Harvard atmosphere may augment students' feelings of inadequacy. Dieting can become contagious, as friends evaluate one another's eating choices.

One sophomore, Lena, feels women compete with each other in the dining hall.

"I see it all the time, every day. 'I can only have three pieces of broccoli and a spoonful of cottage cheese. How about you?" she says. "Who can be the most disciplined in their eating?"

But once students leave the pressure-cooker of college, their eating problems often decrease, Heatherton says.

The five percent of Harvard women who have clinical eating disorders is higher than the general population average of two percent, though Harvard's numbers are typical of most competitive high schools and colleges.

"We have data from people 10 years out of college and most people get a lot better once they get out of college," Heatherton says.

Bulimia Nervosa

Bulimia, a disorder characterized by frequent binge eating and purging, is widely believed to be the most common clinical eating disorder at Harvard.

Nationally, bulimia occurs in five percent of college-aged women, and more than 90 percent of bulimic patients are female, according to the New York-based American Anorexia/Bulimia Association.

Sufferers may use vomiting, laxatives, diuretics, enemas, fasting or excessive exercise to purge their food. Those who have the disease purge twice a week on average for three months or more.

Concerned with their weight and body image, they also lack control over their eating patterns, according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

For Lena, bulimia began in high school, when she started dieting even though she was "very, very thin."

Purging seemed like the perfect solution, she says.

"I wanted to lose weight. I wanted the golden key," she says. "I wanted to be able to eat whatever I wanted and not worry."

After failing several times to make herself throw up, Lena took a drug to induce vomiting. Eventually, Lena says, she could do it at will.

"At the worst I was throwing up maybe 30 times in one day. Basically one sitting would consist of maybe 15 times," she recalls.

"Sometimes I would sit down and know I would purge afterwards," she says. "Other times I would sit down just to do it, almost in a trance. Certainly there was no physiological hunger."

"There were times when for hours I would go back and forth from the kitchen [to the bathroom]," she says. "I would have a bowl of cereal and then go throw up, then go have a bagel and go throw up."

Binging and purging, however, had serious physical consequences.

"I lost enamel on my teeth. My fingers were raw all the time," she says. "My eyes were bloody, you lose definition of the chin, you get chipmunk cheeks. I had terrible stomach problems."

Things got better at first with the new freedom Lena found at college. During the second half of her first year, however, things got worse again.

And having friends at school who have similar problems doesn't help, she says. "I have a crazy group of friends. They are just insane about eating, insane about working out."

Lena was in therapy for half of high school, but no one ever tried to stop her bulimic behavior, she says. The thing that seems to have helped her most was a summer spent living and working in New York City.

She does not consider herself recovered and occasionally purges, but says she recognizes it is an enormous accomplishment to eat when she is hungry and to stop when she is full.

"The only thing that helps is if you lose interest in doing it," she says. "I feel a stronger sense of self."

Anorexia Nervosa

Anorexia is the other common clinical eating disorder, though it is not so prevalent among college-aged students as bulimia. While bulimic behavior commonly begins in the late teens or twenties, anorexia usually sets in earlier, at ages 12 to 13 or age 17.

"Anorexia usually starts younger," Heatherton says. "It's prognosis is usually more severe."

One percent of teenage girls nationwide develop anorexia, and as many as 10 percent may die from the disorder, according to the American Anorexia / Bulimia Association.

The disease is characterized by rapid loss of 15 percent of body weight, loss of menstrual cycle in women for three consecutive months, intense fear of weight gain, and highly distorted body image.

For one Harvard senior, the disease began in junior high school.

Elizabeth moved around a lot growing up both in the United States and abroad, and was also heavily involved with "figure-oriented" sports such as track and gymnastics.

"I lived on the 12th floor and would never use the elevator," she says. "I swam a lot, I ran a lot, I just did everything a lot, to extremes."

The summer after seventh grade, living abroad, Elizabeth began to drop weight. "I just didn't eat. I numbed out to the world," she says. "It was a very disturbing time of upheaval because I had just moved and moved again."

At 5'4', she reached a weight of 88 pounds and stopped weighing herself.

"At that point the weight didn't even matter, I just had to keep on losing it," she says. "I blocked out a lot of it, but [I remember] that whenever I hit something with my hip bones I'd get a bruise. I could count my ribs."

A typical daily menu would include a breakfast consisting of one half a pear, a half glass of milk and half a piece of bread. Lunch would consist of the other halves of each of these items, and dinner would be a small portion of the family's meal.

No matter how much she lost, it never seemed to satisfy her. Elizabeth recalls. "I went to bed at night and count the calories I'd eaten that day. I remember thinking one night that I'd reached my goal, and feeling totally bottomless misery."

En route to back to the United States before eighth grade, Elizabeth's mother read an article in Seventeen magazine about anorexia and recognized her daughter's symptoms.

"My parents sat me down in the hotel and said 'If you don't start eating again you're going to die,"' Elizabeth recalls. "It was beneficial in that they realized what was going on and it had a name. That's a very scary thing to hear. I had just thought I'm going to get skinnier and skinnier and happier and happier."

Recovery entails a lot more than just gaining the weight back, she says.

"It's not about the food. The food is a symptom of everything else," she says. "Food is always going to be a part of everybody's life. Built into recovery is learning how to eat normally without attaching undue significance to the food."

Now a counselor at ECHO, Elizabeth says that counseling has helped her as well as the callers with whom she speaks.

"It has helped me reflect a lot," she says. "I feel I have a solid foundation of knowledge of eating disorders from a clinical and theoretical standpoint. It's also about being around a group of people who are very receptive to your various foibles."

Control

For one junior, now an ECHO counselor, anorexia began around age 15, when she started dieting along with some of her close friends. Reflecting on her experience, she says her desire to achieve played a large role in developing her disorder.

"When you're in high school there's a pressure to perform, to be good at everything you do," Jane says. "You need control of your life, you need to feel you're living up to what everyone expects from you."

Dieting and exercising brought her weight down 15 pounds, then another 10. By age 16, Jane had dropped 35 pounds, leaving the petite 5'4" teen with only 85 pounds left.

Clothing began to seem too big. "That was when I got kind of scared," she says.

Although her parents tried to talk to her about her eating habits, their intervention didn't really help. "When you look at yourself in the mirror, you don't see the true picture," she says.

"Many anorexics obsess about when, where and what they eat," she says. "The symptoms are so formalized. I weighed myself more than once a day, I would make it difficult to go out to eat, I was really fixated on how much fat content and how many calories exactly I had eaten that day. It takes a lot of enjoyment out of food."

And like many anorexics, even when she realized her habits were detrimental to her health, she was reluctant to give them up.

"We [at ECHO] get a lot of calls from people who realize their eating habits aren't normal. But it's something to hold onto," she says.

Things began to get better for her senior year of high school, when pressures seemed to decrease. But recovery has been by no means short-term or easy, she says.

"For me it was a long, slow, peeling away and realizing there was more to life. Food takes up less brain space [now]. At my last family gathering, my cousins were like 'wow, you look really great.'"

Through counseling at ECHO, she hopes to help others who are in a similar situation. People with eating disorders and concerns should know, she says, that their problems have serious underlying causes that need to be unearthed.

"They should maybe step back and realize what it is that's really eating at them," she says.

Reaching Out

While eating disorders are widespread at Harvard, most who suffer from them choose not to use the available resources for help, according to Heatherton's survey.

But while sufferers often feel confident they can handle their own problems, doctors disagree.

"If someone has a significant eating disorder, rarely can they deal with it on their own," says Dr. Richard D. Kadison, who now heads the eating disorders program at UHS.

ECHO Co-Director Amy E. Langston '96 says the organization's 8 p.m. to 8 a.m. hotline receives about five or six calls a week.

Dr. Margaret S. McKenna, who stepped down last month as head of the UHS eating disorders program, says she has personally evaluated 100 students a year, and that more students may see other staffers.

At UHS, Chief of Mental Health Services Dr. Randolph Catlin says that about 10 percent of each undergraduate class uses the mental health services, though not exclusively for eating concerns.

The Bureau of Study Counsel refuses to comment on how many students use its workshops and counselors.

The bureau, which oversees ECHO, offers an Eating Concerns Group, as well as periodic workshops for students who are concerned about friends, roommates and loved ones.

Psychotherapy and individual counseling are available through the bureau, as well as informational handouts and pamphlets compiled by the staff.

The Department of Athletics is also trying to better inform athletes, captains and coaches about eating disorders. In 1993, the department had a conference on the issue, and it may hold another one.

"Athletic women are at higher risk because they're physically active pushing their bodies in training," says Senior Associate Director of Athletics Patricia W. Henry, who organized the conference. "No one is free of the issue--everybody has to deal with it."

The bureau, UHS, Harvard Dining Services, the athletic department, ECHO and other groups are also linked through the Eating Concerns Network, a group of professionals who refer students to each other as appropriate and periodically discuss the issues faced by students with eating disorders on campus.

But some students suffering from eating disorders say they have not found the services they wanted on campus.

Women's Swim Team Captain Deborah L. Kory '95, who says she has observed eating concerns on the team, says she would like to see more emphasis on helping students with sub-clinical eating concerns.

"People feel guilty about what they're eating. The next level down [from anorexia and bulimia] would be nice to address: why the general population of women on this campus is not happy about the way they look, why people feel pressure to always be a little thinner, a few pounds lighter," she says. "It's a major problem--most women carry around this little cloud."

Eve F. Kaplan '95, who was a compulsive overeater her first year at Harvard, says she tried going to ECHO drop-in hours but did not find what she felt she needed.

"I felt like they didn't want to talk about it. It's obvious that you want to talk," she says. "It was also obvious to me that they had issues with eating. I just felt more alone after I left."

ECHO counselors say, however, that it is not always evident when callers or visitors want to talk openly, or what kind of help a caller needs.

"Sometimes the caller may feel helpless and frustrated, when a person feels they cannot be helped," Langston says.

Some students go outside Harvard for long-term therapy, though the Bureau of Study Counsel does offer some long-term care.

Rachel sought help at the bureau through individual counseling but was not satisfied, so she paid to go to private, off-campus therapy.

"At the doctor's there is a more structured professional approach," she says. "The Bureau of Study Counsel didn't seem that professional to me. It is an important resource because anyone can go there, but if you have the means I would recommend going outside it."

Kaplan chose to go off-campus for help when she saw a poster in her Canaday Hall entry-way.

"I was just lucky my parents didn't mind paying for it," she says of the $50-an-hour private counselor she hired.

But bureau Director Charles P. Ducey says that on-campus help is perhaps more experienced and better qualified to help students than off-campus clinics are.

"The positive thing about getting help on campus is that a student can have a more coordinated approach," Ducey says. "If a student has an eating disorder it's probably best no only to have just the psychological help you need to understand why you're doing this, but help form a primary care physician, a nutritionist, a nurse practitioner."

New Services

A few new services for students with eating disorders may answer undergraduates' complaints.

UHS may offer a new bulimia support group this year.

And Kaplan is now trying to found a group to do outreach on the issue around the campus.

Demystifying Eating concerns with Awareness, Discussion and Education (DECADE) has won provisional approval from Dean of Students Archie C. Epps III, but is still awaiting an okay from the Committee on College Life.

"The mission is to inform, to raise awareness about eating concerns on the Harvard campus, and to make resources on the Harvard campus widely available to people," Kaplan says. "The idea is to stop it from being a taboo issue. Right now, I feel people don't even talk about it."

Kaplan says she hopes to get her message out through events such as panel discussions and video screenings in the houses.

"You deserve to lead a life where how you feel about yourself doesn't rest on how you feel other people look at you," she says. "It's a thing a lot of people wish they didn't worry about."

'It's a college-bound sort of thing--it has to do with the environment: the competition, issues of the dating scene, controlling your eating for the first time, dealing with the stress of exams'--Former Professor Todd F. Heatherton

Help at HarvardUHS PsychiatristRichard D. Kadison, MD  5-6478Bureau of Study CouncilSuzanne Repetto, EdD &  5-2662Sheila Reindl, EdMUHS Nurse PractitionersCheryl Cobuzzi Solomon, RNC  5-8414Gayle Clemens, RNC  5-5181UHS NutritionistsBarbera Boothby, RD &  5-2012Charlie Smigefeld, RDPeer Counseling HotlineECHO*  5-8200*Eating Concerns Hotline & Outreac

Heatherton's survey found problems with food and exercise are widespread among Harvard students.

According to his study, 32 percent of Harvard women believe that they are overweight and 80 percent want to lose weight. Twenty-four percent of women and four percent of men say they have used starvation fasting as a method of weight control some time during college.

Eighteen percent of the women who responded to Heatherton's survey were binge eating at the time, while five percent of women and one percent of men said they vomit to get rid of unwanted calories.

Thirteen percent of women and five percent of men identified themselves as compulsive overexercisers, and 45.7 percent of women and nine percent of men reported that they dieted sometimes, usually or always.

Many of these respondents, who are likely not suffering from full-blown clinical disorders, still have cause for concern, Heatherton says. If eating is causing anxiety, there is a problem, he says.

"If someone is extremely worried about [eating] then that's a problem...if the eating behavior is really interfering with their lives," he says. "It doesn't have to be a clinical thing. A person doesn't have to be emaciated to seek help. They just have to feel its not going the way they'd like it to be."

Students say anxiety about eating is commonplace on campus. One undergraduate says her roommate has never been diagnosed as anorexic, but looks far too thin.

"Sometimes at a meal together I'll notice she's taken a lot of food, made a mess of her tray, peeled an orange, but she hasn't really eaten anything," she says.

Many students start to focus obsessively on calories and weight gain.

Sara, a sophomore at Harvard, says she doesn't "binge or purge or starve" herself, but still "thinks about food way too much."

Even a routine trip to the dining hall can cause fear and guilt for Sara, who says she also feels guilty if she doesn't exercise every day.

"I don't usually eat cheese, I don't eat butter on bread, I don't ever eat ice cream," the sophomore says. "Most of my girlfriends are the same way, so I don't feel like it's a weird thing."

The stress of the Harvard atmosphere may augment students' feelings of inadequacy. Dieting can become contagious, as friends evaluate one another's eating choices.

One sophomore, Lena, feels women compete with each other in the dining hall.

"I see it all the time, every day. 'I can only have three pieces of broccoli and a spoonful of cottage cheese. How about you?" she says. "Who can be the most disciplined in their eating?"

But once students leave the pressure-cooker of college, their eating problems often decrease, Heatherton says.

The five percent of Harvard women who have clinical eating disorders is higher than the general population average of two percent, though Harvard's numbers are typical of most competitive high schools and colleges.

"We have data from people 10 years out of college and most people get a lot better once they get out of college," Heatherton says.

Bulimia Nervosa

Bulimia, a disorder characterized by frequent binge eating and purging, is widely believed to be the most common clinical eating disorder at Harvard.

Nationally, bulimia occurs in five percent of college-aged women, and more than 90 percent of bulimic patients are female, according to the New York-based American Anorexia/Bulimia Association.

Sufferers may use vomiting, laxatives, diuretics, enemas, fasting or excessive exercise to purge their food. Those who have the disease purge twice a week on average for three months or more.

Concerned with their weight and body image, they also lack control over their eating patterns, according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.

For Lena, bulimia began in high school, when she started dieting even though she was "very, very thin."

Purging seemed like the perfect solution, she says.

"I wanted to lose weight. I wanted the golden key," she says. "I wanted to be able to eat whatever I wanted and not worry."

After failing several times to make herself throw up, Lena took a drug to induce vomiting. Eventually, Lena says, she could do it at will.

"At the worst I was throwing up maybe 30 times in one day. Basically one sitting would consist of maybe 15 times," she recalls.

"Sometimes I would sit down and know I would purge afterwards," she says. "Other times I would sit down just to do it, almost in a trance. Certainly there was no physiological hunger."

"There were times when for hours I would go back and forth from the kitchen [to the bathroom]," she says. "I would have a bowl of cereal and then go throw up, then go have a bagel and go throw up."

Binging and purging, however, had serious physical consequences.

"I lost enamel on my teeth. My fingers were raw all the time," she says. "My eyes were bloody, you lose definition of the chin, you get chipmunk cheeks. I had terrible stomach problems."

Things got better at first with the new freedom Lena found at college. During the second half of her first year, however, things got worse again.

And having friends at school who have similar problems doesn't help, she says. "I have a crazy group of friends. They are just insane about eating, insane about working out."

Lena was in therapy for half of high school, but no one ever tried to stop her bulimic behavior, she says. The thing that seems to have helped her most was a summer spent living and working in New York City.

She does not consider herself recovered and occasionally purges, but says she recognizes it is an enormous accomplishment to eat when she is hungry and to stop when she is full.

"The only thing that helps is if you lose interest in doing it," she says. "I feel a stronger sense of self."

Anorexia Nervosa

Anorexia is the other common clinical eating disorder, though it is not so prevalent among college-aged students as bulimia. While bulimic behavior commonly begins in the late teens or twenties, anorexia usually sets in earlier, at ages 12 to 13 or age 17.

"Anorexia usually starts younger," Heatherton says. "It's prognosis is usually more severe."

One percent of teenage girls nationwide develop anorexia, and as many as 10 percent may die from the disorder, according to the American Anorexia / Bulimia Association.

The disease is characterized by rapid loss of 15 percent of body weight, loss of menstrual cycle in women for three consecutive months, intense fear of weight gain, and highly distorted body image.

For one Harvard senior, the disease began in junior high school.

Elizabeth moved around a lot growing up both in the United States and abroad, and was also heavily involved with "figure-oriented" sports such as track and gymnastics.

"I lived on the 12th floor and would never use the elevator," she says. "I swam a lot, I ran a lot, I just did everything a lot, to extremes."

The summer after seventh grade, living abroad, Elizabeth began to drop weight. "I just didn't eat. I numbed out to the world," she says. "It was a very disturbing time of upheaval because I had just moved and moved again."

At 5'4', she reached a weight of 88 pounds and stopped weighing herself.

"At that point the weight didn't even matter, I just had to keep on losing it," she says. "I blocked out a lot of it, but [I remember] that whenever I hit something with my hip bones I'd get a bruise. I could count my ribs."

A typical daily menu would include a breakfast consisting of one half a pear, a half glass of milk and half a piece of bread. Lunch would consist of the other halves of each of these items, and dinner would be a small portion of the family's meal.

No matter how much she lost, it never seemed to satisfy her. Elizabeth recalls. "I went to bed at night and count the calories I'd eaten that day. I remember thinking one night that I'd reached my goal, and feeling totally bottomless misery."

En route to back to the United States before eighth grade, Elizabeth's mother read an article in Seventeen magazine about anorexia and recognized her daughter's symptoms.

"My parents sat me down in the hotel and said 'If you don't start eating again you're going to die,"' Elizabeth recalls. "It was beneficial in that they realized what was going on and it had a name. That's a very scary thing to hear. I had just thought I'm going to get skinnier and skinnier and happier and happier."

Recovery entails a lot more than just gaining the weight back, she says.

"It's not about the food. The food is a symptom of everything else," she says. "Food is always going to be a part of everybody's life. Built into recovery is learning how to eat normally without attaching undue significance to the food."

Now a counselor at ECHO, Elizabeth says that counseling has helped her as well as the callers with whom she speaks.

"It has helped me reflect a lot," she says. "I feel I have a solid foundation of knowledge of eating disorders from a clinical and theoretical standpoint. It's also about being around a group of people who are very receptive to your various foibles."

Control

For one junior, now an ECHO counselor, anorexia began around age 15, when she started dieting along with some of her close friends. Reflecting on her experience, she says her desire to achieve played a large role in developing her disorder.

"When you're in high school there's a pressure to perform, to be good at everything you do," Jane says. "You need control of your life, you need to feel you're living up to what everyone expects from you."

Dieting and exercising brought her weight down 15 pounds, then another 10. By age 16, Jane had dropped 35 pounds, leaving the petite 5'4" teen with only 85 pounds left.

Clothing began to seem too big. "That was when I got kind of scared," she says.

Although her parents tried to talk to her about her eating habits, their intervention didn't really help. "When you look at yourself in the mirror, you don't see the true picture," she says.

"Many anorexics obsess about when, where and what they eat," she says. "The symptoms are so formalized. I weighed myself more than once a day, I would make it difficult to go out to eat, I was really fixated on how much fat content and how many calories exactly I had eaten that day. It takes a lot of enjoyment out of food."

And like many anorexics, even when she realized her habits were detrimental to her health, she was reluctant to give them up.

"We [at ECHO] get a lot of calls from people who realize their eating habits aren't normal. But it's something to hold onto," she says.

Things began to get better for her senior year of high school, when pressures seemed to decrease. But recovery has been by no means short-term or easy, she says.

"For me it was a long, slow, peeling away and realizing there was more to life. Food takes up less brain space [now]. At my last family gathering, my cousins were like 'wow, you look really great.'"

Through counseling at ECHO, she hopes to help others who are in a similar situation. People with eating disorders and concerns should know, she says, that their problems have serious underlying causes that need to be unearthed.

"They should maybe step back and realize what it is that's really eating at them," she says.

Reaching Out

While eating disorders are widespread at Harvard, most who suffer from them choose not to use the available resources for help, according to Heatherton's survey.

But while sufferers often feel confident they can handle their own problems, doctors disagree.

"If someone has a significant eating disorder, rarely can they deal with it on their own," says Dr. Richard D. Kadison, who now heads the eating disorders program at UHS.

ECHO Co-Director Amy E. Langston '96 says the organization's 8 p.m. to 8 a.m. hotline receives about five or six calls a week.

Dr. Margaret S. McKenna, who stepped down last month as head of the UHS eating disorders program, says she has personally evaluated 100 students a year, and that more students may see other staffers.

At UHS, Chief of Mental Health Services Dr. Randolph Catlin says that about 10 percent of each undergraduate class uses the mental health services, though not exclusively for eating concerns.

The Bureau of Study Counsel refuses to comment on how many students use its workshops and counselors.

The bureau, which oversees ECHO, offers an Eating Concerns Group, as well as periodic workshops for students who are concerned about friends, roommates and loved ones.

Psychotherapy and individual counseling are available through the bureau, as well as informational handouts and pamphlets compiled by the staff.

The Department of Athletics is also trying to better inform athletes, captains and coaches about eating disorders. In 1993, the department had a conference on the issue, and it may hold another one.

"Athletic women are at higher risk because they're physically active pushing their bodies in training," says Senior Associate Director of Athletics Patricia W. Henry, who organized the conference. "No one is free of the issue--everybody has to deal with it."

The bureau, UHS, Harvard Dining Services, the athletic department, ECHO and other groups are also linked through the Eating Concerns Network, a group of professionals who refer students to each other as appropriate and periodically discuss the issues faced by students with eating disorders on campus.

But some students suffering from eating disorders say they have not found the services they wanted on campus.

Women's Swim Team Captain Deborah L. Kory '95, who says she has observed eating concerns on the team, says she would like to see more emphasis on helping students with sub-clinical eating concerns.

"People feel guilty about what they're eating. The next level down [from anorexia and bulimia] would be nice to address: why the general population of women on this campus is not happy about the way they look, why people feel pressure to always be a little thinner, a few pounds lighter," she says. "It's a major problem--most women carry around this little cloud."

Eve F. Kaplan '95, who was a compulsive overeater her first year at Harvard, says she tried going to ECHO drop-in hours but did not find what she felt she needed.

"I felt like they didn't want to talk about it. It's obvious that you want to talk," she says. "It was also obvious to me that they had issues with eating. I just felt more alone after I left."

ECHO counselors say, however, that it is not always evident when callers or visitors want to talk openly, or what kind of help a caller needs.

"Sometimes the caller may feel helpless and frustrated, when a person feels they cannot be helped," Langston says.

Some students go outside Harvard for long-term therapy, though the Bureau of Study Counsel does offer some long-term care.

Rachel sought help at the bureau through individual counseling but was not satisfied, so she paid to go to private, off-campus therapy.

"At the doctor's there is a more structured professional approach," she says. "The Bureau of Study Counsel didn't seem that professional to me. It is an important resource because anyone can go there, but if you have the means I would recommend going outside it."

Kaplan chose to go off-campus for help when she saw a poster in her Canaday Hall entry-way.

"I was just lucky my parents didn't mind paying for it," she says of the $50-an-hour private counselor she hired.

But bureau Director Charles P. Ducey says that on-campus help is perhaps more experienced and better qualified to help students than off-campus clinics are.

"The positive thing about getting help on campus is that a student can have a more coordinated approach," Ducey says. "If a student has an eating disorder it's probably best no only to have just the psychological help you need to understand why you're doing this, but help form a primary care physician, a nutritionist, a nurse practitioner."

New Services

A few new services for students with eating disorders may answer undergraduates' complaints.

UHS may offer a new bulimia support group this year.

And Kaplan is now trying to found a group to do outreach on the issue around the campus.

Demystifying Eating concerns with Awareness, Discussion and Education (DECADE) has won provisional approval from Dean of Students Archie C. Epps III, but is still awaiting an okay from the Committee on College Life.

"The mission is to inform, to raise awareness about eating concerns on the Harvard campus, and to make resources on the Harvard campus widely available to people," Kaplan says. "The idea is to stop it from being a taboo issue. Right now, I feel people don't even talk about it."

Kaplan says she hopes to get her message out through events such as panel discussions and video screenings in the houses.

"You deserve to lead a life where how you feel about yourself doesn't rest on how you feel other people look at you," she says. "It's a thing a lot of people wish they didn't worry about."

'It's a college-bound sort of thing--it has to do with the environment: the competition, issues of the dating scene, controlling your eating for the first time, dealing with the stress of exams'--Former Professor Todd F. Heatherton

Help at HarvardUHS PsychiatristRichard D. Kadison, MD  5-6478Bureau of Study CouncilSuzanne Repetto, EdD &  5-2662Sheila Reindl, EdMUHS Nurse PractitionersCheryl Cobuzzi Solomon, RNC  5-8414Gayle Clemens, RNC  5-5181UHS NutritionistsBarbera Boothby, RD &  5-2012Charlie Smigefeld, RDPeer Counseling HotlineECHO*  5-8200*Eating Concerns Hotline & Outreac