College Readiness and Eating Disorders: Navigating the Transition with Caution and Clarity
The transition to college marks a significant developmental milestone. For most young adults, it represents independence, opportunity, and growth. However, for those with a history of eating disorders, this period is also a time of heightened risk. Clinical experience and research both underscore that times of major transition—including starting college—are associated with a high risk of relapse in individuals recovering from an eating disorder (ED).
In this article, we examine the key factors that determine college readiness in young adults with EDs, share research-backed risks and recommendations, and offer a structured framework for families and providers to evaluate and support readiness—including a college contract and clinical checklist.
The Vulnerability of Transition
Multiple studies highlight the challenges that college introduces for individuals in recovery from an ED. Transition stressors—such as changes in routine, new social pressures, food environment unpredictability, and decreased parental oversight—can disrupt progress and increase relapse risk (Schaumberg et al., 2017).
One study by Holdaway, Larkin, and Madden (2014) examined life transitions in ED recovery and found that transitions often served as triggers for relapse, particularly when support systems were not robust. Furthermore, Becker et al. (2002) found that college students are at elevated risk of disordered eating due to social comparison and academic stress, even without a prior ED diagnosis.
This context underscores the importance of cautious optimism. While it's appropriate to support a young adult’s desire for autonomy and growth, readiness for college should be based on clear, clinical indicators—not just a date on the calendar or pressure to "move forward."
Guidelines for Assessing College Readiness
Determining whether a client is ready to transition to college involves assessing psychological, behavioral, and medical stability. Below is a clinically informed College Readiness Checklist, adapted from expert consensus and best practices from the Academy for Eating Disorders (AED) and the Journal of Adolescent Health (Golden et al., 2003):
College Readiness Checklist for Young Adults with Eating Disorders
Medically stable for at least 6 months (e.g., stable vitals, labs, weight within safe range, regular menstrual cycle, if applicable)
Autonomous eating without daily prompts or supervision
Ability to independently and consistently choose and prepare meals that maintain their medical stability/weight
Flexible eating patterns across a variety of foods and settings
Absence of fear foods, or ability to consume them with minimal distress
Minimal or no compensatory behaviors (e.g., purging, excessive exercise, restriction)
Ability to eat comfortably at restaurants and choose items on the menu other than safe foods.
Ability to eat comfortably in front of other people, including with friends or in class
Ability to eat a normal place and without disordered eating behaviors, such as small bites, picking at food, smearing food, etc.
Demonstrates a flexible relationship to exercise, including taking rest days, exercising intuitively, taking breaks when injured or sick. Exercise is not obligatory or rigid.
Ability to refuel following exercise, including walking around campus (walking on campus is estimated to be 5 miles per day)
Ability to self-monitor and challenge ED thoughts independently or with minimal prompting
Use of healthy coping mechanisms for stress, anxiety, and academic pressure
Willingness to maintain contact with treatment team (e.g., therapist, dietitian, physician)
Ability to be honest with self and others about the status of ED recovery
Openly acknowledges ED and has insight about the need to construct a life and schedule that supports recovery
Willingness to reach out to support system
Agreement to a relapse prevention plan with clear indicators for when to seek help
Meeting the majority of these criteria increases the likelihood of a successful and sustainable college experience. Falling short in key areas may suggest the need for a delayed start, a local or part-time option, or continuation in a structured treatment setting.
The Role of a College Contract
A College Contract is a collaborative document developed between the young adult, their family, and treatment team that outlines expectations, goals, and safeguards. It serves not as a tool of control, but as a framework for accountability and support. A typical college contract includes:
Commitments to ongoing therapy, dietetic follow-ups, and medical check-ins
Agreements on maintaining target weight range and abstaining from ED behaviors
Open communication to parents and treatment team about the status of recovery so that plans can be made for additional support when needed.
A “return to home” clause if certain behaviors or clinical indicators worsen (e.g., weight drop, frequent meal skipping, isolation)
Emergency contact plans and mental health support resources on campus
Academic support accommodations (if needed) through disability services
Using a contract creates a shared understanding and protects both the young adult's autonomy and their recovery.
Practical Recommendations for Families and Clinicians
Start planning early—ideally 6–12 months before the intended college transition
Visit the college dining halls, counseling center, and housing options together
Include the young adult in all aspects of planning to promote autonomy
Prepare for "slips" without panic—normalize them as part of recovery and have a clear, compassionate plan to address them
Avoid comparing readiness to peers; prioritize mental and physical health over external timelines
Practice refueling to account for the increased amount of walking expected on college campuses
Practice grocery shopping, eating a buffet style eateries, and eating in front of others
Transitioning to college with a history of an eating disorder is not inherently unsafe—but it does require careful, individualized planning. Recovery must be strong enough to withstand the inevitable changes and pressures that college brings. By combining objective readiness criteria, collaborative contracts, and continued therapeutic support, young adults can move forward with both courage and caution.
Being cautiously optimistic doesn't mean being fearful—it means recognizing the risks, respecting the process, and investing in sustainable well-being.
If you are seeking eating disorder treatment or mental health therapy for you or your adolescent, Cypress Wellness Collective can help. Cypress Wellness Collective is located in the San Francisco Bay Area where they specialize in Family Based Treatment (FBT), therapy, and nutrition counseling for teens, adults, and families going through eating disorder recovery. They offer in person and virtual appointments throughout all of California. Call today for your free consultation to see if Cypress Wellness Collective is right for you!
References
Becker, A. E., Grinspoon, S. K., Klibanski, A., & Herzog, D. B. (2002). Eating disorders. The New England Journal of Medicine, 340(14), 1092-1098. https://doi.org/10.1056/NEJM199904083401407
Golden, N. H., Katzman, D. K., Sawyer, S. M., Ornstein, R. M., Rome, E. S., Garber, A. K., ... & Position Paper of the Society for Adolescent Health and Medicine. (2015). Position Paper on Eating Disorders. Journal of Adolescent Health, 56(1), 121-125. https://doi.org/10.1016/j.jadohealth.2014.10.124
Holdaway, L., Larkin, M., & Madden, S. (2014). Recovery from eating disorders: A systematic review of qualitative studies. The British Journal of Clinical Psychology, 53(3), 278-299. https://doi.org/10.1111/bjc.12045
Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn-Chernoff, M. A., ... & Bulik, C. M. (2017). The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders. European Eating Disorders Review, 25(6), 432-450. https://doi.org/10.1002/erv.2553