On this episode, Dr. Karen Nelson is joined by licensed marriage and family therapist Megan Tarmann. Megan currently works at Carleton College. Karen and Megan discuss eating disorders on college campuses as well as tips for how family and friends can support their loved ones.
On this episode, Dr. Karen Nelson is joined by licensed marriage and family therapist Megan Tarmann. Megan currently works at Carleton College. Karen and Megan discuss eating disorders on college campuses as well as tips for how family and friends can support their loved ones.
Click here for a transcript of this episode.
Dr. Karen Nelson 00:00
[Accompanied by piano music] Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals: a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by my friend and former colleague, Megan Tarmann. Megan is a licensed Marriage and Family Therapist. We used to work together at Melrose and now she is currently working with students at Carleton College. For many students, college is an exciting and confusing time. They are thrust into new experiences, responsibilities and expectations. We hope this episode will be helpful for both college students, their friends and their families. Now, before I begin, I invite you to take a deep breath and join me in the space. [Music fades] Well Megan, thank you so much for joining me today.
Megan Tarmann 01:21
Yes. Hi, my name is Megan Tarmann. I'm a licensed Marriage and Family Therapist. I currently work at Carleton College in Northfield, Minnesota, and I had previously worked at Melrose for about five and a half years before that.
Dr. Karen Nelson 01:33
So let's talk a little bit about specifically eating disorders on college campuses. Can you get an eating disorder in college?
Megan Tarmann 01:43
Yes, so I would say between the ages of 18 and 21 are those traditional ages to go to college. And that is, that is the prime time when we really see eating disorders either develop or reemerge. That's when we can see relapse happening, too.
Dr. Karen Nelson 02:01
Tell me a little bit about what might contribute to developing an eating disorder in college.
Megan Tarmann 02:07
Yeah, I think like kind of generally speaking it's a really stressful and vulnerable transition in life. And I think kind of more specifically, some contributing factors can be a history of dieting, if there's a history of an eating disorder. Particular groups are more at risk of developing eating disorders. So like trans students are four times more likely to develop an eating disorder. Then their cis gender counterparts. Athletes, especially those individual sports like cross country or wrestling. They're at greater risk as well. And then there's just like, you know, how much support do students have or not have, can be a huge contributing factor as well.
Dr. Karen Nelson 02:55
It can be kind of a... some people have described it as kind of a perfect storm at times, right? We're away from home. We have a lot of pressure on us, maybe academic pressure. We might have pre-existing mental health stuff. And then I'm alone, trying to figure out how to feed myself. I mean, does that make sense? Or what do you think? I mean, do you think those factors do come together?
Megan Tarmann 03:17
Oh my gosh, yeah. It's definitely like a bio-psychosocial. So there's like, of course, there's the genetic vulnerabilities, is there a family history of eating disorder? Temperament can be a big piece of it, too. You know high achievers, perfectionism, that kind of thing. And then I come from a structural lens. So I often think about the systems that surround people. And that might mean, you know, what's your family's relationship to food and body? What's society's relationship? What does society say about your body, for example? And the medical community... what sort of experiences have you had in that system? So it's a time where you want to be accepted into your community. That's huge for thriving, and the way we look or the pressures on how we're supposed to look, is a huge piece of that, too. And social media is just... I mean, it's a part of our life, and especially that age group.
Dr. Karen Nelson 04:21
For sure, for sure. I mean, we get so many images, right?
Megan Tarmann 04:24
Yeah, all that like goes into our subconscious. Part of like, when I work with students, part of our work is to sometimes like... go through social media and like, can we delete some of these accounts? And can we actually actively search out accounts that are more recovery oriented? And that can be a pretty helpful and important intervention in a way for them to work on the recovery outside of session that doesn't feel so, you know, coming from this therapist who, you know, is older right, so that's often an intervention. We'll do at some point...
Dr. Karen Nelson 05:00
For sure. [Overlapping]
Megan Tarmann 05:01
...In our sessions is talk about social media. How can we make it into a helpful and not a harmful thing?
Dr. Karen Nelson 05:07
Well, I think too... I mean, college in that kind of 18 to 22 age, it's a really critical developmental stage. We're really working to develop and create our identity. So no wonder I want input, right? From maybe social media, or my friends or family. So I could potentially be pretty susceptible, like you're saying, to some of these images.
Megan Tarmann 05:34
Right, the brain's still developing during that time well into our 20s. And our identity development is like really taking off at that age. And it's such a... like I was saying earlier, such a vulnerable and exciting time to figure out like, "Who am I? What's important to me?" And, you know, the eating disorder can certainly hijack that.
Dr. Karen Nelson 05:59
Well, I was talking with a client recently. We were talking about our inherent need to belong. And it can feel maybe heightened when I'm in college, right? Like you were saying, kind of identity development, "Who am I? Where do I fit?" And looking for feedback on that, And...
Megan Tarmann 06:17
Right. [Overlapping}
Dr. Karen Nelson 06:17
...The eating disorder, like you said, can kind of weasel in there and give us some messages about how I might look or how I should look.
Megan Tarmann 06:25
Right. Well, and I think there's that like difference. I know, you... you know, this will resonate with you, because I think it comes from Brené Brown, but just that like difference between fitting in and belonging and, you know, the eating disorder more aligns with like fitting in... like, "What do I need to do to have some sort of, like, superficial worthiness?"
Dr. Karen Nelson 06:47
That's right. [Overlapping}
Megan Tarmann 06:49
So, yeah, I think when people have those vulnerability factors, especially when they're more isolated, the eating disorder can give some sort of level of comfort.
Dr. Karen Nelson 06:58
Well, Brené Brown... She does not know this, but she is my best friend. [Both laughing] And so anytime someone mentions her...
Megan Tarmann 07:06
I mean, I knew you would like that one. [Overlapping. Both laughing]
Dr. Karen Nelson 07:07
I know! You really do know me. I absolutely love that. [Overlapping]
Megan Tarmann 07:11
It really goes along, though... with that age, when they're like trying to find their place, you know, getting away from their community at home. A lot of them too, might be really far from home...
Dr. Karen Nelson 07:21
That's right. [Overlapping]
Megan Tarmann 07:22
...So really not know anybody. And... That's right. [Overlapping] ...And not even know who they are. So, yeah.
Dr. Karen Nelson 07:27
Well. I think also even just kind of encompassing sometimes that urge to control shows up in over controlling food, but also an eating disorder can express itself in a different way. You know, some students may come to us and say, "I'm feeling so overwhelmed. I'm binging on food. I feel out of control with food, I feel like I'm so overwhelmed that I can't stop eating." Does that resonate? Or do students share those ideas with you?
Megan Tarmann 07:56
Yeah, I think that... you know, I think there's still often that attempt or that desire for control and the expression is often it feels really out of control. And we see a lot of the all-or-nothing approach to food, which I'm sure you see all the time. Shows up in students as well, where... I study, I go to all these classes all day, I might be working a job, and I'm restricting all day. And then sure enough, eating feels out of control later at night, when I'm going out with my friends, and we might stop somewhere to get food. And this is where a lot of the education is helpful in our sessions with like... Well, your body is actually just trying to take care of you because it thinks it's in a famine. And of course, you're gonna binge after restricting all day, it's just your body being resilient. But it can come with so much shame...
Dr. Karen Nelson 08:49
Good point. [Overlapping]
Megan Tarmann 08:49
...Where they think like, "Oh, I just need more willpower. No, it's just not...
Dr. Karen Nelson 08:54
That's right. [Overlapping]
Megan Tarmann 08:55
...Right. [Overlapping]
Dr. Karen Nelson 08:56
Well, I think that all-or-none thinking can really trap a lot of students, right? And all-or-none, meaning, you know, "I'm following these rules perfectly around food, or I'm not going to follow any of them." So some of that rigid thinking around food of like, you know, "I'll only eat this particular type of food and if I have one bite of Kit-Kat, well, the whole day is blown." And I could be susceptible to binging.
Megan Tarmann 09:23
Right. I think like, inadvertently, I think sometimes the education system reinforces some of this binary thinking around success, all-or-nothing, or success or failure. And that can show up in my relationship with food either has to be like "perfect," whatever that even means or "healthy," whatever that even means. And then if I'm not that way, then something's wrong, then I'm failing. And I think really high-achieving students, I mean, not even really-high achieving students... I think students in general with eating disorders can feel that like, sort of parallel process in their... you know, as they're striving to get good grades and kind of show up with relationship to food as well.
Dr. Karen Nelson 10:10
I love that point of that binary thinking that you mentioned kind of that all-or-none, either in that space of almost perfectionism, I think is what's coming up for me, right? Either I'm perfect, I do it all beautifully, I only get A's, I only eat carrots or whatever it might be right? And if I do one thing, "wrong," it's all blown.
Megan Tarmann 10:32
Right. And it can feel so... I think maybe I already said this, but like, you can feel like counter-cultural when people start to work on the recovery, it can start to feel like, "Okay, Megan, you're telling me to challenge the eating disorder..." and to work on let's say, intuitive eating, if that's where they're at, in the recovery, for example. Or "You're telling me to eat this many times a day. But everything around me is really actually reinforcing my eating disorder and fueling that." Like all the systems around them, and including, again, like medical... you know, oftentimes, you know, the medical systems and families and just diet culture in general is like... telling the eating disorder like, "Yep, that's the route to go." So it can feel like just kind of overwhelming to start working on recovery...
Dr. Karen Nelson 10:43
For sure. [Overlapping]
Megan Tarmann 10:59
...During the college years because there's so much that they're already navigating.
Dr. Karen Nelson 11:32
Absolutely. Is binge eating disorder on campus, as far as like an eating disorder diagnosis, or would you say it is more kind of anorexia, bulimia? Tell me about that.
Megan Tarmann 11:43
Yeah, I actually recently just stumbled across some research and I can't remember where I read it, but the median age of onset for bulimia and anorexia is 18. And the median age for binge eating disorder is 21. So it does show up. It sounds like it shows up later in the college experience. And I'm not sure you know... I'd be curious why that is, but it is, it just, it sounds like it shows up a little bit later.
Dr. Karen Nelson 12:14
What I'm hearing is that eating disorders definitely do show up on campuses. And what we know and we were sharing about, you know, the most recent data that we were looking at is the incidents of eating disorders on campus is higher than in the general population. So there's more people, right? This kind of smaller community on campus, there are more people there that are going to have an eating disorder than in the general population.
Megan Tarmann 12:41
Yeah, I was... you know, I was reading some research and on the NEDA website, so the National Eating Disorder Association website, I think it was like from 2013... between 10-20% of females on college campuses develop an eating disorder, have an eating disorder. 4-10% of males have an eating disorder. And then it said that 4 out of 10 students either have an eating disorder or know someone who has an eating disorder. So it's...
Dr. Karen Nelson 13:10
Very prevalent. [Overlapping]
Megan Tarmann 13:11
...Very prevalent. Yes.
Dr. Karen Nelson 13:12
Absolutely. For sure. And so having some ability to have some conversation about it, because oftentimes, I think talking about not only eating disorders, but just mental health can feel scary. And we can feel almost like... unprepared.
Megan Tarmann 13:32
Right, right. I think thankfully, anecdotally, it feels like there's so much less stigma now than maybe, you know, 10 years ago. Students from what I've seen are very okay with seeking out mental health services and you know, even joking sometimes with their friends, like "My therapist said this," and it's so much more normalized, not that there's not stigma and shame, but it does feel like it's getting better.
Dr. Karen Nelson 14:01
Talking about some of the prevalence of eating disorders, we know men absolutely struggle with eating disorders. What might be some contributing factors for men?
Megan Tarmann 14:11
You know, body image ideal. So again, coming from that system's lens, how does society view male bodies and what's valued? What's worthy? I think mass toxic masculinity is also a piece of this. You know, we see more around, you know, muscle mass, protein intake, that kind of thing.
Dr. Karen Nelson 14:37
Absolutely.
Megan Tarmann 14:37
Um, what it means to be a man. I do think there's a lot of stigma and shame for males reaching out for care, not only in eating disorders, but mental health in general.
Dr. Karen Nelson 14:51
And again, as a, you know, so we know that there's a higher prevalence in college to potentially struggle with an eating disorder of those college students. The risk to develop an eating disorder if you are a college athlete is also increased.
Megan Tarmann 15:04
Yes. So for athletes there's that greater risk of developing or again, that reemerging of an eating disorder, especially for the individual sports like cross-country, wrestling... And again, trans students, too, are at greater risk of developing eating disorder. So it definitely shows up in all genders, and all ways. But there are those groups who are facing, you know, maybe oppression, stigma... just more stressors...
Dr. Karen Nelson 15:38
Absolutely. [Overlapping]
Megan Tarmann 15:39
On top of an already stressful time.
Dr. Karen Nelson 15:41
Absolutely. And again, I think about that piece of athletics, someone you know potentially working to achieve a particular type of body or gain strength or whatever it might be, it sometimes sounds like it can diverge into more destructive eating or disordered eating.
Megan Tarmann 16:05
Yeah, depending on... this is where I think it can be really helpful for the coaches and even their relationship to food and body. Because sometimes those messages can trickle from the top down. And we can see these norms that show up in their meal times together where everyone's eating a lot of safe, you know, "healthy foods." and so some of those things can show up on teams that really fuel the eating disorder. Or there's a lot of myths too like, "Oh, if I'm this size, I'll be more, I'll be faster, or my performance will be better if I if I eat in this way." And they're all myths.
Dr. Karen Nelson 16:48
That's right. [Overlapping]
Megan Tarmann 16:49
But that can certainly fuel disordered eating.
Dr. Karen Nelson 16:52
That's right. Absolutely. Well, I love it how you talk about looking for the function of the behavior. I think sometimes that dissipates some of the shame that might be attached of like, our brain is really smart, and it wants to help us figure out a solution. Sometimes the solution ends up being problematic, though. And what I hear you saying is, let's look at the function of that, right? You know, "If I have to write this 30-page paper but my focus is on finishing this bag of Cheetos, I don't have to write the 30-page paper." And now "Uh-oh, I still gotta write the 30-page paper. And I feel real bad that I the Cheetos," that can show up, I think, for students.
Megan Tarmann 17:35
Yeah, I'm very intentional when we have those conversations in the therapeutic process. But I think it's a vital conversation to have. And I often will say, we do need to honor the fact that certain things show up in our life for a reason. An eating disorder is no different. We're just trying to do the best we can and survive this thing called life. We are not taught how to do a lot of life. And in fact, we're sent a lot of messages that actually do reinforce the eating disorder. So I think that can help release some of the shame. And the person can feel like, "Okay, I am just trying to do the best I can. And this does serve many different functions for me, and how do I do this in a new and different way? Because this is definitely not working for me."
Dr. Karen Nelson 18:27
That's right. Well, you bring up the point that binge eating often happens in secret. And so it makes sense to me that would a roommate maybe missed the signs or what might be the signs if we think someone might be struggling with that? Is there anything specific we should look for? Or what do you think about that?
Megan Tarmann 18:47
I think with binge eating disorder there can be similarities with other eating disorders where there might be, you know, all-or-nothing approach to food. We can see, you know, with the roommate situation, there might be food that disappears that was there. But when they're with the person they might appear to be eating quite normally. Because again, when the symptoms are occurring, if it's binging, for example. But this can be all symptoms, it's often happening behind the scenes when they're alone. But that can be a big sign, like, "Hey, there's a lot of food that tends to be missing, or I'm noticing wrappers, for example, kind of in different places, sometimes hidden places."
Dr. Karen Nelson 19:39
What should a student do if they suspect another student might be struggling with an eating disorder? I think there's several different ways. Fellow students can approach someone they're concerned about. Some students will just approach their friend and say, "Hey, I'm noticing, you know, you always go to the bathroom right after we eat, or whenever we go out to eat you don't come with." So those direct conversations are happening. But I also think sometimes if they're not comfortable with that, they might send a message to the counseling center and seek guidance. Or they might go to their dean, which is a really helpful resource on campus. And then the dean can approach the person who's struggling and go from there. So it can, it can kind of take off in different ways. What are some signs that they can look out for?
Megan Tarmann 20:30
The the friend, for example... So it might be again, if they're going out to eat and their friend typically tends to avoid that. Or maybe they start to notice behaviors when they are eating with them, like, "Oh, you're eating the same thing all the time." Or maybe, "You're talking about your food, or our food or your body a lot." Or... again, going to the bathroom right after the meal a lot of the times or "There's like this hyper-focus for you on food and body in general." That can definitely raise red flags for friends.
Dr. Karen Nelson 21:13
What is treatment like for a student on campus?
Megan Tarmann 21:17
Yeah, that really depends. So treatment can be kind of clunky at times, for various reasons. If the college campuses in... let's say, it's a liberal arts college in a rural area... there can be transportation barriers, or can be insurance barriers. Not all the time, but sometimes. So, again, the ideal situation is that the college counseling center would have some kind of specialists. The ideal would be if there's a therapist who specializes in eating disorders. There's medical staff who are trained in knowing how to identify eating disorders. If there's a dietitian, that would be great. But oftentimes, the student is needing specialized care. Then we refer to the appropriate place like Melrose or a place like other places in... within the area.
Dr. Karen Nelson 22:07
Do most college campuses offer eating disorder treatment? I don't know the statistics on that, honestly. But I know that it's often valued and sought-after to have somebody on the team who knows something about eating disorders. Sometimes... this doesn't happen all the time, but sometimes it can be really helpful if a student can take a medical leave of absence and really focus on themselves and their well-being. Sometimes that just doesn't happen. And the treatment, if it's needing that higher level of care, will happen over breaks, like summer breaks, winter break, things like that. If you're a parent or a guardian and your student comes home from a break, and you suspect that maybe they're struggling with an eating disorder, or maybe they have been diagnosed with an eating disorder while on campus, how might you support them?
Megan Tarmann 23:01
I see parents often learning about eating disorder when the student comes home for break for sure. They notice changes in many different ways. And how parents have approached that is... ideally having a conversation with their child and coming up with a plan. But that often entails reaching out to the college. And sometimes it starts with the dean. The dean is just a highly-utilized resource. And they then can start that coordination and connection with the student to the counseling center. And of course, you know, we need the releases of information because we're a confidential service. But parents will often reach out to their dean or the college and get the ball rolling.
Dr. Karen Nelson 23:51
What signs might parents look for? Changes in weight is one. More isolation... hyper-focus on food and body, body checking behaviors, behaviors surrounding food, like dieting, avoiding foods. Just being really preoccupied with food and body... not themselves. We hear parents often say, you know, "I miss my daughter, I miss my son." And that's when we start to see when the healing process happens. We often will hear the opposite "Oh, I have my child back. Their personality is shining again." What might a parent say? So, you know, if the parent is hanging out, it's almost Thanksgiving break... The parent is sitting on the couch with their son or daughter... what might be some examples of how they could bring it up or what could they say? Agh, this is so hard 'cause I know parents don't want to do harm. But again, I think parents often fear that and then that can kind of hold them back from expressing their concern. But the reality is that once it's addressed, oftentimes it's so relieving for the child, the student. It can be, you know, I think being non-judgmental is obviously really helpful. Giving unconditional, positive love. It might sound something like, "I'm really concerned about you, here's what I'm noticing. Let's come up with a plan. I'm here for you." I love that. Yeah, just having the conversation, right? Because oftentimes in that space of fear we might want to avoid it. Yes, sometimes we think that like, "No, this is gonna make it worse." And it's not the reality. It's a scary conversation to have, but there's so much relief after it takes place. And we know that eating disorders are the second deadliest mental health disorder out there. So they need to be addressed sooner than later, too. Because we also know that the sooner that they are dealt with the the better the recovery long-term. Absolutely. Absolutely. And that there is care available. And absolutely it's one of the things we believe here at Melrose and talk all the time about, recovery is possible. We watch people recover. And it's far more challenging to recover from an eating disorder if you don't access care. Oh my gosh. Recovery in isolation...Really, really challenging. Having that community is vital. How do you encourage students in their recovery?
Megan Tarmann 26:39
I do really go along the stages of change. So depending on where they're at in their motivation to make changes, I try to meet them where they're at. If they're in a place where they are incredibly ambivalent about change, I'm not going to get the hammer on. [Both laughing] Let's start, like, let's do this. So I try to meet them where they're at. I'm really transparent and I give them the facts. So I say things like "Eating disorders are the second deadliest mental health disorder out there. The earlier we address this the better long term. Community support is incredibly helpful. Having a full team is really..." So I give them all the facts, but I also try to meet them where they're at. And, like, "What changes can we make today? What are you ready to do?" So it's like this delicate balance of like challenging them, pushing them to the edge of their discomfort, but like, not necessarily pushing them over the edge. Unless, of course, I mean, there's obviously times if it's safety, we have to intervene...
Dr. Karen Nelson 27:44
Absolutely. [Overlapping]
Megan Tarmann 27:46
...Use some leverage here.
Dr. Karen Nelson 27:47
Right. Right. Is there anything I haven't asked you that you'd like to say?
Megan Tarmann 27:53
Um, oh, gosh, probably. [Both laughing]
Dr. Karen Nelson 27:58
So many things to say. When I think about it I just think college time is just such a wonderful, exciting identity-development stage in life. It's so fun and exciting. And it's so flippin hard, too. And so I guess I would say it's okay to get help and you don't have to be ready. I don't know, I guess that would be really important, because I think sometimes people feel like they have to like... you don't have to be ready. Show up. We'll meet you where you're at. What is the biggest thing you'd like people that take away from listening to this episode today?
Megan Tarmann 28:39
Just that there's no shame in it. I think we've talked about... we're just trying to do the best we can. Also we're still going through a pandemic. And I think we're so like numb to it now. Like, "Oh, it's no big" like... No, we're going through a pandemic, and college is hard. And so stuff shows up.
Dr. Karen Nelson 29:01
That's right.
Megan Tarmann 29:01
And there's no shame in it. We're just trying to get through it. We've all got our stuff. So get help.
Dr. Karen Nelson 29:07
That's right. Well, Megan, I cannot even begin to tell you how fun it was to chat with you today. Thank you so much.
Megan Tarmann 29:14
It was a pleasure. Thank you so much for having me. It was wonderful. Thank you.
Dr. Karen Nelson 29:18
[Accompanied by piano music] That's it for today. Thanks for joining me. We've covered a lot, so I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, "Take notice. Pay attention, and we'll take it as it comes." I'll talk to you next time. Melrose Heals: a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation. [Music fades]