If you are sending a young adult with a history of an eating disorder to college (or seminary or another away program), it is a good idea to have a college contract in place. This is our recommendation for young adults with anorexia, bulimia, binge eating disorder, ARFID, and OSFED.
College and living away from home for the first time brings novel stressors and recovery challenges. Any transition can challenge the most stable of recoveries. The freedom and independence can provide a breeding ground for an eating disorder. Your young adult will be eating in an entirely different context than the one they have practiced recovery in. Relapses during college or the first period of independence are not uncommon.
Prior to sending your young adult with an eating disorder off to college or a similar independent experience you will want to ensure that your young adult is ready for the challenge of being away from home. A contract is NOT a substitute for readiness. Read more about our criteria for readiness in our post about college readiness. If you deem them ready, a college contract can be very helpful.
A contract is an agreement between the parents and the student—obviously not a legally binding document. Treatment professionals may help develop the contract or play a role in supporting the contract, but they are not parties thereto. I think about a contract as a safety net rather than something adversarial. Parents are on the side of their young adult—and are merely saying, “We want you to be in college, but we want to ensure that you are healthy enough to stay there in order to fully benefit from the college experience.” They then use the contract to specify the criteria required for the student to stay in college, as well as the consequences if those criteria are not met.
As long as you are paying for some of your young adult’s school or living expenses, you have leverage and can require a contract. I do not advise counting on the school to ensure your young adult stays well. No college, even those with excellent mental and physical health resources, is able to provide the level of oversight that parents do.
A contract should include the following:
- A minimum healthy weight for your student based on optimal physical and psychological recovery and historic weight patterns, ideally developed with a treatment team and taking into account that young people are expected to gain weight until about age 20
- A release of information signed by your student, allowing treatment professionals to communicate with you
- A plan and cadence for your student to get weighed and have their vitals checked
- Some families are able to set this up with the college health center; others with private practice professionals (MD, RDN, or therapist)
- The frequency of weighings and vitals will be determined based on length in recovery and stability
- A plan for consistent communication of the above weights and vitals information (i.e., each time it’s checked, or only if concerning; to whom on the team and when to parents).
- Recommended treatment follow-up with various professionals. This ideally follows the recommendation of the prior treatment team and may include as many team members as necessary. Some individuals may need a full team; others may just need weights and vitals.
- An expectation regarding behaviors:
- Meals—how many meals and snacks the student is expected to have and any associated guidelines, such as a meal plan.
- Exercise—any appropriate restrictions.
- Any other behaviors of concern, such as purging
- The specific steps parents will take if there is a lapse including weight loss or an increase in eating disorder behaviors.
- For smaller lapses, parents may give the young adult some time to self-correct or regain weight independently and maybe increase sessions with team members before initiating other steps.
- Some parents specify that they will come to school and stay with the student and try to help them for a time to get on track while staying in school.
- If these steps are not working and for more significant lapses, parents may require the student to come live at home or go to residential treatment.
As with any consequence, parents should not include anything in the contract on which they are unwilling or unable to follow through.
I recommend that parents and their students start talking about the college contract and college readiness at least six months before the start of college, so the young adult is not surprised by the idea of a contract. I suggest parents write the first draft and then share it with their treatment team and their young adults and then incorporate feedback. The agreement should be signed by the parents and the student and the current treatment team members may also sign it showing their endorsement.
Sample College Contract:
In order for Mary to be successful at college, we agree to all the terms set out in this agreement and will not take action beyond what is prescribed in the agreement without a review with Mary and her team first.
- We will treat Mary like a responsible adult.
- We will not show up at college unannounced.
- We will give 24 hours’ notice before visiting.
In order to remain at college:
- Mary will be weighed weekly at her counseling sessions with Dr. Freud. Dr. Freud will communicate her weight to her parents each week.
- Mary will attend weekly counseling sessions with Dr. Freud and bi-weekly appointments with dietitian Nancy.
- Mary will eat 3 meals in the dining hall and 3 snacks daily containing appropriate amounts of fats, carbs, and protein in order to maintain her weight. She will eat a dessert daily.
- Mary will not become a vegetarian.
- Mary will maintain a minimum weight of 140 pounds.
- If Mary binges/purges, she will discuss it with Dr. Freud and Nancy and develop a plan.
- Mary agrees that physical and emotional health and safety are a higher priority than educational progress or participation.
- Mary will be mindful of exercise as a potential trigger and will limit exercise to no more than 3 times a week for 30 minutes. Mary agrees she needs to consume sufficient food to fuel her level of exercise.
The following backup plan is not a punishment but a safety net to facilitate ongoing progress:
- If Mary’s weight drops below 140 pounds, she has 2 weeks to regain the lost weight. Her parents and dietitian will help with suggestions and provide more snacks.
- If lost weight is not regained by the 2-week mark, one of her parents will come to college at the end of classes for the week and all meals and snacks will be supervised by her parents for the weekend, even if Mary has to cancel something. Mary can return to classes after the weekend after the Sunday evening snack. Supervised weekends will continue until weight is back above 140 pounds. Once the weight is regained, Mary can remain at school without parental supervision.
- If supervised weekends do not result in expected weight regain in 2 weeks, Mary will return home until weight is regained.
- If Mary fails to comply with any of this agreement, she will need to withdraw and either enter residential treatment or seek employment.
We will review this contract at the beginning of each academic semester and revise it as needed to help Mary maintain healthy eating habits.
Signed:______________________ Date: _______________
Witness: _______________________ Date:_______________