Managing at-risk eating disorders

Who Stays and Who Goes?
Th e Rehabilitation Act of 1973 and the Americans with Disabilities Act of
1990 prohibit colleges and universities from discriminating against individuals
with physical or mental disabilities. By law, students with eating disorders
have the right to attend institutions of higher education. Academic institutions
can, however, request and even require students to withdraw if they pose a
danger to themselves or others, or if they disrupt the learning environment.
Generally, schools allow students with eating disorders to remain enrolled
if they are not at imminent risk for life-threatening medical problems and if
they demonstrate awareness of their illness by participating faithfully in treatment.
A few college health centers, however, have established physiological
requirements for all enrolled students. Th ese include a minimum body mass
index (an assessment of body fat based on height and weight) and minimum
vital signs (pulse, blood pressure, and temperature). Th ese medical markers
are rough estimates of health that point to severity of eating pathology.
Setting Up a Contract
Some students with eating disorders fall just short of requiring medical leave.
Th ey hover just above a weight that would necessitate intensive care, or they
miss several exams in a semester due to bingeing and purging. Th e severity of their symptoms calls out for close monitoring and heightened concern, but
not immediate withdrawal from school.
For such students, contracts that stipulate agreed-upon terms for maintained
enrollment are useful. Stipulations might include a minimum weight
and vital signs, participation in specifi ed modes of treatment, progress updates
communicated by treatment providers to a school administrator, and goals to
be met by semester’s end. Allowances for variation can be built in. Because
many students will maintain their weight at the bottom of the prescribed
range, it’s easy for them to slip. Adding to the contract that should they slip
they have 1 week to get back in range provides a compassionate cushion for
natural weight fl uctuations and occasional decreases in intake. Allowing students
to help create and sign contracts enlists them in their monitoring and
care and ensures consensus about the conditions under which medical leave
would automatically take place.
Involuntary Leaves
Medical leaves are preferably taken voluntarily. However, since eating disorders
are oft en associated with denial, mandated leaves are sometimes necessary.
Typically, treatment teams issue involuntary leave recommendations to
school deans, who ultimately carry out involuntary action against students.
At some schools, students have the right to appeal leave decisions. Involuntary
leave edicts should always include treatment recommendations for the leave
period and conditions for return. For example, a highly symptomatic bulimic
student who was enjoined to take a leave was urged to enter a residential
treatment program where she would receive structured and intensive care.
When her electrolyte balances and vital signs had been at healthy levels for at
least 3 months (outside of a treatment program), and her treatment providers
could attest to her psychological readiness, she was allowed to return. For
severely underweight anorectic students, setting a minimum weight required
to return can provide incentive to fi ght the disorder and regain the weight.
Many students are able to relinquish their anorexia only for something they
want more—like returning to college.
Although students may threaten to pursue legal action when forced to take
leave, most colleges and universities prefer to err on the side of caution when
it comes to protecting the integrity of the learning environment and the safety
of students.