Written by Carla Giddings OT Reg. (Ont.), Canadian Mental Health Association, Eating Disorders Program

It’s that time of year! Within the context of the COVID-19 pandemic disruptions, we find ourselves at the beginning of another school year. As an occupational therapist, I’ve worked alongside students to transition to College and University for the first time, re-adjust plans along the way, and return after taking a leave of absence for eating disorder (ED) treatment. Over the years, College and University students have taught me much about the many paths to and through school.

1. Assess your school readiness:

Is this the right time for school? If you’re already in school, does it make sense to return this year or take a break? Is your recovery at a place where you can take on new experiences and stressors? How do you want to engage with school? Lauren Muhlheim and Katie Grubiak (2015) recommend being symptom-free from an ED for six months before attending post-secondary. They offer a checklist to think through when deciding if school is the best option for your recovery and education/career goals. For many people, this might mean deferring (i.e., delaying the start of school) or taking a break to focus on recovery. Most Universities/Colleges have options for deferring from one semester to one year, and supports for a leave of absence.

Be mindful of “all or nothing” or perfectionist thoughts about school like “I need to attend University full-time living in residence or not at all”. You have options! You might want to test out College or University by taking 1 or 2 courses through distance education. Maybe you keep your living situation consistent for the added structure and support. If this is where you’re at, that’s completely ok.

If after careful consideration, you think it’s the right time for post-secondary, read on for more ideas.

2. Match your school schedule to your recovery needs:

I know as a student, I was completely unaware of options for taking part-time or a partial course load. I thought I needed to be enrolled in a full-time program taking 5 courses each semester. This is not true! There are lots of options for taking fewer courses. Going to school at your own pace that supports your wellbeing will mean you have space to engage in the process more fully like making new friends, getting to know a new city, and exploring new interests. It also means you reduce your likeliness of relapse.

So how do you know the right balance of school and recovery? When planning out your weekly schedule, start with recovery-related activities: your “non-negotiables”. For many people, these are your meals, snacks, meal planning/preparation, sleep, therapy and medical appointments, and support groups. After you fill in your “non-negotiables” for treatment/recovery work, consider self-care, leisure/recreation and other responsibilities (childcare, family support, community obligations, etc.). Many students also have financial considerations to take care of and may have work schedules to navigate. For these reasons, some students find it helpful to have a full day off school each week for catching up on rest, time with friends or family, meeting new people, exploring new interests, and doing things they enjoy outside of school.

Now take a look at your schedule. How many courses can you reasonably take while prioritizing your wellbeing? For many people, a part-time or a reduced course load makes sense. Students with eating disorders can register with the school’s Accessible Learning and a reduced course load is a common accommodation. A reduced course load is when you take fewer courses and are still considered a full-time student. That means your OSAP (Ontario Student Assistance Program) funding can remain at the full-time amount for ongoing financial support. This accommodation recognizes that recovery is work – it takes time, energy, and resources!

3. Access accommodations: Academic accommodations are arrangements put in place to create equitable access and opportunities for all students to succeed at school. It is your right to have the accommodations you need: you are not asking for a favour – you are deserving of the same opportunities as any other student to learn.

Academic accommodations are based on your specific needs and can include reduced course load, preferential seating, more frequent breaks (e.g., for meals and snacks), extensions on assignments, a separate location for exams, and others. All Universities and Colleges across Ontario have Accessible Learning Services (although they may have a different name) and Counselling Services. Register as soon as possible so your academic accommodations are in place if/when you need them – there will be information on their website, or you can call them directly.

To register with Accessible Learning, your school may ask for documentation. In Ontario, it is your choice if you want to disclose information related to mental health. Your information will be kept confidential, and your Instructors will not know your diagnosis. The only thing your Instructor will receive is a letter from Accessible Learning saying what accommodations you need. This is your private information and it’s your choice if, what, when and how you share. Typically, it’s up to you to follow-up with your Instructors to put your accommodations in motion. For example, Accessible Learning works with you to determine an accommodation like having an extension on assignments then sends a letter to your Instructor. You will then tell your Instructor if you need the use that extension. Your Accessible Learning Advisor will have more information about the process.

4. Build your support networks:

With times of transition, it’s important to consider the formal and informal supports available to you while at school. Formal supports might be your Nurse Practitioner / Family Doctor, Therapist, Dietitian, or Academic Advisor. This might also include your Accessible Learning Advisor or Counsellor through your University/College. Make sure to have your local crisis line and ED helpline/instant chat on your phone and another place you can easily access it.

Good2Talk: Free and confidential 24/7 Helpline for Post-Secondary Students across Ontario

· Phone: 1-866-925-5454

· Text: GOOD2TALKON to 686868

· Website: https://good2talk.ca/

HERE24/7: Addictions, mental health and crisis services in Guelph-Wellington.

· Phone (Toll Free): 1-844-437-3247 (HERE247)

· Phone (Local): 519-821-3582 TTY: 1-877-688-5501

· Website: https://here247.ca/

National Eating Disorder Information Centre (NEDIC): Information about EDs, finding providers and support groups, or speaking to someone directly through their instant chat/Helpline.

· Phone (Toll Free): 1-866-633-4220

· Phone (Toronto): 416-633-4220

· Website: https://nedic.ca/

· Instant chat: Monday – Thursday 9:00am – 9:00pm and Friday 9:00am – 5:00pm

Informal supports are family, friends, peer support groups, housemates, classmates, and others. These are people and services that are supportive of your wellness that you can contact when you need help. Each support will have a different function and it makes sense to build a robust network. Your informal supports might also include podcasts, blogs, online groups, and recovery websites.

Throughout your school journey, it is common to encounter oppressive messaging or behaviours about bodies, food, and diet culture (ACHA-NCHA-II, 2019). Many students find it essential to build their skills in identifying unsafe situations / triggers, setting clear boundaries, thinking critically about intersecting forms of bodily oppressions (Crenshaw, 1989) and diet culture, connecting to positive role models and/or peers, and strengthening (self-)advocacy strategies such as challenging stigmatizing language/beliefs (Venturo-Conerly et al., 2020; Rice et al., 2020). There may be spaces and supports on your campus such as advocacy groups for International No Diet Day and organizations for gender empowerment + diversity. Online communities can also be an important space that pushes back against toxic diet culture such as Recovery Warriors or The Eating Disorder Recovery Podcast. You might also find it helpful to check out an intersectional social justice approach such as the work of Sonya Renee Taylor’s online community The Body is Not An Apology: Radical Self-Love for Everybody and Every Body and/or the Body Justice Podcast – BIPOC & Eating Disorder Recovery with Julissa Minaya. Students who identify as LGBTQ2IA+ may want to connect with student organizations on campus or find online supports such as Fighting Eating Disorders in Underrepresented Populations (FEDUP)’s website and blog or thirdwheelED: Two Queer Perspectives on ED Recovery. Be sure to see WWEDC’s Supports and Services and NEDIC’s Resources to find supports that represent your multi-faceted lived experiences and treatment/recovery process.

5. Reinforce your skills

Reflect on what is working well in your treatment and/or recovery. It can be helpful to write out a list of skills and strategies as a reminder. Keep it somewhere where you will see it often while still maintaining your privacy (e.g., journal, on your locked phone, etc.). As a quick reminder, some students find the acronym PLEASE helpful. It’s grounded in Dialectical Behavior Therapy (DBT) (Linehan, 1993, 2015), and I’ve modified this Emotion Regulation skill so it is specific to ED recovery:

· P – Plan your meals, sleep, and daily activities

· L – Look out for triggers / high stress situations

· E – Eat regular meals and snacks according to your meal plan to give your body and mind nourishment

· A – Assert boundaries and advocate to prioritize your wellbeing

· S – Seek support from informal supports (e.g., friends, family) and formal services (e.g., therapists, dietitian, Doctor or Nurse Practitioner, group therapy, counselling services, Accessible Learning, etc.)

· E – Express your feelings / emotions (rather than act them out through ED behaviour)

Additionally, there are Apps that can help remind and reinforce your recovery work. You may want to try Recovery Record or Rise Up & Recover.Treatment and recovery will not always go as planned as you get ready for school and work to find a balance. There will be days when something might not happen in the way you want or expect. Start again. Return to what works. Access your supports.

References:

American College Health Association – National College Health Assessment (ACHA-NCHA-II) (2019) Canadian Reference Group Data Report: Spring 2019. Available from: https://www.cacuss.ca/files/Research/NCHA-II%20SPRING%202019%20CANADIAN%20REFERENCE%20GROUP%20DATA%20REPORT.pdf

Centre for Innovation in Campus Mental Health (CICMH). (June 11 ,2020). CICMH webinar: Increasing capacity to support students with an eating disorder. Available from: https://www.youtube.com/watch?v=sqdZ_6Htm_k

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. University of Chicago Legal Forum, 1989: 139-167.

Muhlheim, L. and Grubiak, K. (2015). If your young adult with an eating disorder ready for college? Available from: https://www.eatingdisordertherapyla.com/wp-content/uploads/2015/10/Is-your-ya-ready-for-college_-_11_23.pdf

Rice, C., Pendleton Jiménez, K., Harrison, E., Robinson, M., Rinaldi, J., Lamarra, A., and Andrew, J. (2020). Bodies at the intersections: refiguring intersectionality through queer women’s complex embodiments. Signs: Journal of Women in Culture and Society, 46(1): 177-200.

Venturo-Conerly, K., Wasil, A., Shuingleton, R., and Weisz, J. (2020). Recovery as an “Act of Rebellion”: a qualitative study examining feminism as a motivating factor in eating disorder recovery. Eating Disorders, 38 (3): 265-271.