A few weeks ago, the mental health group Mind Matters tabled on Cross Campus. Volunteers offered information about mental health resources at Yale in the form of flyers and conversation. If people were willing, they could write their thoughts about mental health on colored sticky notes and place them on a cardboard display for others to ponder.

“Sometimes I skip lunch on purpose.”

This light blue sticky note in the center of the board — a quiet admission of skipped meals, written in a neat hand — was surround by confessions of depression, anxiety, fear, loneliness and porn addiction.  The sentence seemed so simple; many can admit to accidentally skipping meals, and a pattern of missed lunches would be easy to overlook. But the note’s author was admitting to something intentional, a problem below the surface.

Had they confided in anything other than a sticky note? Had they spoken the written words aloud?

Start to talk about eating disorders at Yale, and a familiar, simplified narrative soon emerges: Yale is an intense place, and in our collective scramble to reach the top, students find solace in control — be it academic or nutritional. Disordered eating, especially anorexic tendencies, follow from this competitive nature, as the outgrowth of an overworked and self-critical student body.

Some of this may true — and students’ intensity (both in the classroom and out) does translate to a heightened frequency of disordered eating. While a widely accepted statistic is difficult to find, given that many of those suffering are left undiagnosed, according to the National Association of Anorexia Nervosa and Associated Disorders, roughly 1% of the population suffers from eating disorders. In a recent survey conducted by the News, sent to 500 students with 141 responses, 8% of respondents self-reported that they had been diagnosed with an eating disorder.

Perhaps because of this markedly higher prevalence, 59% of students surveyed also said they thought “disordered eating” is an issue on campus. But though many believe these unhealthy habits develop on campus, few observed a satisfactory level of awareness. When asked to rate on a scale of one to five — one being “not at all” and five being “often or always spoken” — how often discussions of eating disorders occur, respondents rated campus conversation at a low 1.92.

For those diagnosed with eating disorders, or suffering from potentially harmful eating habits, this silence only fuels the problem. Those with disorders have few opportunities to articulate their problems to friends, administrators or even themselves. And, according to many who have suffered in secret, beginning to talk is the first step to a solution.

BURNT TOAST

Find the smallest piece of bread and burn it. Each day of her freshman year, Skyler* served herself the same breakfast, sometimes adding a cup of black coffee. The first meal of the day had always been her favorite, but most of Yale’s offerings — eggs, pancakes, bagels — scared her with the possibility of consuming fattening oil and calories. So she stuck to the one option she deemed “safe”: the tiniest piece of black toast.

“Burning toast makes it harder to chew, so I would have to chew longer to finish a piece,” she explained.

With classes throughout the day, skipping lunch was easy. All it meant was a strategic swipe at Bass Café for an iced coffee and a pack of gum – “in case I really needed something to chew on.” Dinner was a plate of raw spinach and tomatoes with a dash of mustard, a combination admired by Skyler’s friends, who complimented her apparent healthiness.

By the end of her freshman year, Skyler was struggling with a full-blown case of ED-NOS, “eating disorder not otherwise specified.” This meant that, according to a nutritionist, she did not meet the strict physical definition of anorexia but had severely harmful eating patterns with a strong psychological component.

Skyler’s habits fit into the clinical definition of “disordered eating.” According to the Mayo Clinic, “disordered eating” includes both psychological and physical symptoms, like cycles of severe restriction or binging, excessive feelings of guilt when eating, or defining self-worth based on eating habits.

When given this definition of “disordered eating,” 59% of respondents to the News’ survey reported that they have noticed habits that fit this definition among their friends.

Skyler said she recognizes them “everywhere” at Yale, hidden behind a veil of health-consciousness. She mentioned that many students associate dieting with health, and added that many count the ability to balance physical fitness, academics and extracurriculars as a badge of honor.

“It’s just another stretch for perfection. Yale is filled with all these perfectionists ready to do anything to be the ideal person,” she said.

Katie Chockley ’14 has struggled with an eating disorder since high school. She shared Skyler’s estimation that more people suffer than one might expect. Though, in Chockley’s experience, these habits dominate some groups at Yale more than others.

Chockley has participated in several athletic teams while at Yale and said that for athletes, weight affects performance. Certain sports, like long-distance running, benefit those who weigh less.

But after joining the Yale club rugby team, Chockley said she has found a more supportive environment and that she admires the body-positive attitude of her teammates.

“If someone makes a comment about some food as ‘good’ or ‘bad,’ they’re immediately shut down,” she said.

But while acute in certain areas, some social pressures are constant. For those who already have an unstable relationship with food, there are many stressors built into day-to-day life.

Andrea* has struggled with cycles of severe restriction and binging at Yale. At an interview in Bass Café one afternoon, she was energetic and smiling. She looked healthy, but that hasn’t always been the case.

Andrea said restricted dining hall hours teach students to eat at specific times, not necessarily when they are hungry. Often, she said, emphasis is placed on the “comfort” of foods over their nutritional value. She added that these complaints are not unique to Yale, but endemic to most college environments.

“The dining hall situation is interesting, because it can go both ways. [Buffets make it] easy to binge or restrict. And if you don’t want to eat, you just avoid the dining hall,” she said.

As someone also in recovery during her time at Yale, Chockley added that she felt uncomfortable with the social aspect of food in college, even outside the dining hall.

While students often joke that free food is everywhere on campus — and a hallmark of club meetings — Chockley said these events can be intimidating. Many of these feature unhealthy foods like Claire’s cake and pizza, which are “scary” to those who are over-aware of what they consume.

“There’s this voice in your head that says, ‘Do I have to eat cake for them to think I’m normal?’” she said.

MIND OVER FORK

By their nature, eating disorders have an element of voyeurism that escapes most mental disease. In its most extreme form, these diseases manifest as nearly skeletal: bones jutting out, pencil-thin wrists and countable ribs. But for all their visibility — for all their Hollywood connotations — every eating disorder begins immaterially, as a psychological problem. They derive from an impulse to use food, not for nutrition and fuel, but as a way to gain control.

“Eating is one of those things that we can control in this world,” Andrea said, associating these kinds of disorders with competitive environments. “When things get really stressful, that’s what people can turn to.”

For Andrea, Yale, academically and socially, was that competitive environment. Though Skyler located this pressure not just in classes and clubs, but in a feature specific to Yale: the unspoken expectation of happiness among its students.

Because Yale students pride themselves on a sense of self-control, she said, cracks in the façade are not welcome. The result is an atmosphere in which issues with food can snowball quickly, as students often avoid tough conversations about disordered eating. Skyler exhibited symptoms of ED-NOS before she recognized them as part of a disorder.

“There’s so much more happening than what you decide to eat and not-eat,” Skyler said.

She added that her situation was especially risky because she was at a healthy weight and seemed visibly unaffected. Those with ED-NOS still experience detrimental physical symptoms such as hair loss and dizziness, she explained, but they do not attract the same attention of those who are visibly emaciated.

And so the answer doesn’t lie in judging healthiness by appearance. Skyler said the root of the problem lies in someone’s habits, which are harder to discern, but still noticeable if you pay attention.

“You shouldn’t look at every skinny person on the street and ask if they’re anorexic. But I think if people were more sensitive, it wouldn’t be that difficult to glean who is having problems. There’s an air that’s almost tangible,” she said.

OUT OF CONTROL

We met Eric* at Blue State on York, so crowded with students and businessmen that the collective body heat was making us sweat. Two students sat at a table only a few inches away, discussing a summer program in the Southwest. Concerned that Eric might feel uneasy discussing a personal, sensitive topic in such a crowded place, we suggested a move to somewhere more private. He waved off the idea and said it was no problem. His confidence was astounding, especially for someone who had lived through what many consider a worst-case scenario.

Eric took a year off from Yale mid-semester the fall of his sophomore year after struggling with severe disordered eating habits and mental health issues. His disordered eating habits started second semester freshman year. Like the 51% of Yale undergraduates surveyed who listed that they felt a need to lose weight, Eric felt uncomfortable with his weight and body image.

But the catalysts for his descent into disordered eating were emotional: He struggled with relationships with friends, his sexuality and concerns about his academic future. With all of these things seemingly out of his control, Eric turned to food for stability.

His habits began as an interest in healthy eating. He dubbed himself a “foodie,” and soon became a vegetarian.

“For me, that decision was an excuse to just eat vegetables all the time and not much else,” Eric said.

As time passed, Eric became increasingly restrictive and obsessed with planning meals — what he was he going to eat, and who he was going to eat with. All it took was a cancelled dinner date or an unexpected change in a dining hall’s menu to send him spiraling into anxiety, feeling that he had lost control.

The malnourishment caused by his restriction led to cycles of binging and purging — the body responds to starvation by seeking calorie-dense foods for survival. But after each binge, Eric felt a need to compensate for overeating. If he didn’t purge by vomiting, he ran eight miles to rid his body of excess calories and to ease his obsessive mind.

“[It] was funny, because I felt like I wasn’t really deciding to do those things, but it was just happening,” Eric said. “Deep down I knew it wasn’t going to help and wasn’t what I wanted.”

Eventually Eric realized that he needed to take control, and that meant taking a year off to recover at home, where he saw a therapist on a weekly basis. He said the time away made all the difference for his recovery.

According to Eric, that time off doesn’t seem like an acceptable option to many Yalies. Time away from campus, he said, only feels justifiable if you’re doing something career-focused; otherwise it gives the impression that you simply can’t handle Yale.

But the world doesn’t end if you can’t get everything done in four years, Eric said, though breaking that perception can feel like yet another difficult step on the path to getting better. He found that taking time to recuperate was one of the best things he could have done for his well being, and added that those of his friends who have also spent time away agree that the experience is beneficial.

“The time off was really, really awesome, I learned a ton about myself … I came back with 10 times more confidence than I had previously,” Eric said, smiling.

Unfortunately, Yale does not make the reapplication process to return from time off due to mental concerns easy, Eric said. Instead, this impediment makes the prospect of taking time off even less appealing.

In order to gain readmittance into Yale College, Eric was required to get passing grades in two courses he had to complete during his time off, write an application essay and convince his college dean, Mental Health and Counseling chief psychiatrist Lorraine Siggins and an assistant dean of students that he could be “a real student again.”

He didn’t find out that he was readmitted until mid-August, just weeks before he would have to return.

GETTING HELP

Yale Health now employs one nutritionist. Under the student health plan, Andrea met with that one nutritionist, Lisa Kimmel, twice over a six-month period last year — a process she describes as cathartic and crucial to her recovery process.

But help isn’t consistently available. This year Kimmel works as part of Yale’s “Mind Matters” initiative and no longer provides nutrition counseling. Andrea said adjusting to Kimmel’s replacement, Marita Holl, has been difficult. When she returned to school this semester and called to make an appointment with Holl in late October, she was asked if she could plan to come in January. When she explained the urgency of her need for counseling, she got an appointment at the end of November. After the fact, she described that meeting as “disappointing.”

To those with a history of disordered eating, “recovery” is a process, not a cure, and it is one that does not only depend on professional help. Andrea observed that students, and not just administrators, could do more to encourage a better environment for recovery.

“The only way someone with an eating disorder will decide to get better is with support and education,” she said, adding that we should “at least make it a discussion on campus — it’s just not discussed, along with most mental health issues.”

Chockley, too, said other students influence the dialogue surrounding food. She pointed out that issues with eating habits are a lot more prevalent than most assume, and that those who do not suffer from them unwittingly make the problem worse.

If someone observed that she was “eating healthy” when Chockley was restricting, she felt a pressure to continue. If they commented that she had “a lot” of food when she felt stable, this instilled a sense of guilt and defeat, often leading to more intensely restrictive behaviors.

Skyler echoed Chockley’s concern about the ignorance of the student body, but added that Yale’s administration could better foster student dialogue on this issue. She drew a parallel to the University’s bystander intervention seminars.

“Yale focuses so much on teaching us how to intervene when your friend is about to get raped, but they teach us nothing about how to help a friend who is on [another] really bad path,” she said.

And so the people who could make the most difference — close friends and suitemates — often don’t know how to act.

When he first started to restrict his diet, Eric’s friends recognized that he had lost a lot of weight over a relatively short period of time. For a while, they didn’t address his weight loss or personality changes any further, only mentioning his problems obliquely, and saying that they never see him anymore. Eric could not share his burden with anyone else.

Eventually, his friends took action. They decided to confront him about his weight loss and depression, but only after Eric’s life had been unraveling for months. Looking back, he said it would have been better for him if his friends had spoken up sooner, though he recognized blame on both sides of the conversation.

“On the one hand it was my unwillingness to involve people, and on the other it was people’s either unwillingness or inability to get involved,” Eric said.

But even those that have experience with these psychological conditions find it hard to balance respect for someone’s independence and concern for their well-being.

Lydia was diagnosed with anorexia at the beginning of her sophomore year of high school and came to Yale after being in recovery for two years. But she said even now, she does not feel equipped to intervene when she sees classmates that exhibit disordered eating patterns.

“We’re friends with these people — the dynamic is different. Parents can intervene … but that’s not part of the job description for friends,” she said. “This is the time when people are supposed to start living independent lives, so how can you say to someone, ‘I don’t trust you completely to feed yourself?’”

FIRST WORDS

Eric and Skyler still relapse under stress, but now that those around them are aware of the nature of their issues, they feel more able to face them. Still, to obtain the support of friends and family, they had to divulge one of their most personal secrets.

Before he took time off, Eric believed that most of his friends would subscribe to the common perception that eating disorders are image-driven and simply about starvation. He feared responses that would only address the physical aspects of his problem, such as “go eat some more ice cream.”

The best way to propagate an awareness of the complexities of the issue is to engage in more discussion about disordered eating, Eric said. He called on others who have struggled with similar unhealthy approaches to food to share their experiences with friends, if they’re comfortable enough to do so.

“[Be] willing to be part of the conversation,” he said.

Ten minutes after Eric left our little table at Blue State, a girl who had sat at a neighboring table for the duration of the interview approached us. She asked what the interview was for, and the conversation soon turned to the silence surrounding eating disorders at Yale. Then, she admitted casually what many feel a need to hide.

“I had an eating disorder.”

*name changed for anonymity