Eating Disorder College Contracts

The college environment brings numerous additional stressors and recovery obstacles, including separations from loved ones and friends, a new cohabiting living situation, a new social environment, a more challenging academic demands, a different food setting, new peers, and the loss of the old supports including family, friends, and treatment team. In addition, college students are often more active as they walk around a large campus which adds a wild card element. It is possible that they may have greatly increased nutritional needs..

For these reasons, college can challenge and even potentially derail a young adult in recovery. Relapses during college are not uncommon, so it is important to ensure that your young adult child is truly stable in their recovery when they depart for college. This means they have been eating independently and maintaining weight without bingeing, purging, or excessive exercise for at least six months. Even though every young adult and parent feels pressure to “keep up” and make life transitions on the expected schedule, there are times when delaying college may represent the most responsible course of action.

If you and your child in recovery have made the decision to proceed with college, it is wise to have a contract with your student even if they seem strong in their recovery. On the one hand, as parents you are ultimately responsible for the welfare of your child even though he or she may technically be an adult. They still need you, and you retain a great deal of leverage as long as they are not entirely financially independent. On the other hand, the school will never provide the level of oversight that you could when your child lived at home. The college is generally unable to mandate treatment. Parents need to remain mobilized as they remain the student’s primary backup.

A college contract is not a binding legal document, but instead a safety net to protect your child should they stumble or relapse while at college. It is an agreement between you and your child – the school and treatment professionals may play a supporting role, but they are not parties to the contract. Although your child may perceive the contract as adversarial, remind them that the goal of the contract is to support them, keep them safe, and try to help them to remain in school.

The Contract Should Include The Following:

  • A minimum healthy weight for your child based on childhood growth trajectories. This range, determined in conjunction with a treatment team, should be the range at which he or she functions optimally and menstruates (if appropriate).
  • A requirement for a release of information, signed by your child, allowing treating professionals to communicate with you.
  • A commitment to who will weigh your child and how often.
    • Some colleges can arrange for the campus medical clinic to do regular weighings and monitoring. Alternatively, families may arrange to do this off-campus with private practice professionals.
    • How long the child has been in recovery will likely impact the frequency of the weighings. The shorter the time in recovery, the more frequent the weighings should be; at the beginning of recovery, as often as weekly.
  • The follow-up your child will have with eating disorder and medical treatment professionals. This will ideally follow the recommendation of the prior treatment team. Many individuals will need a full team including a therapist, an RD, and a medical doctor. Those individuals further along in recovery may only need a single provider.
  • What other behaviors (bingeing, purging, overexercising etc.) would be a concern. Parents should specify what type and amount of exercise (if any) would be permitted under the contract.
  • What steps parents would take if the child loses weight, relapses, etc.
    • For smaller lapses, some parents specify that the frequency of treatment visits will need to increase.
    • Parents may also specify a window of time for the student to get themselves back on track and what will happen if the student cannot get themselves back on track.
    • Some parents specify that either they will come to school and supervise meals for a time and/or they will bring the child home or send them for residential treatment.

You should not put anything in the contract that you are not willing to enforce. You may want to consider buying tuition insurance. School breaks are good opportunities to bring the student home and observe eating firsthand.

Some sample college contracts are available here and here.

Additional Reading:

Transitioning to College When in Recovery From an Eating Disorder
Eating Disorders in College
Young Adults With Anorexia: Not Too Old For Family Therapy


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Written by Dr. Lauren Muhlheim – 2015