Two years ago, sophomore journalism student Lauren Marshall says she never would have imagined she would be struggling with an eating disorder as a college student.

Marshall says an increase in free time gave her more time to focus on herself in a negative way. Eventually, this led to an unhealthy focus on her body in order to avoid problems in her life.

“It was sort of a maladaptive coping skill from my family dynamics and the situation that was going on,” Marshall says.

Eating disorders include extreme emotions and behaviors surrounding weight and food issues, according to Mental Health America, but they are not just about obsessing over the way your body looks. There may be several factors that can contribute to an eating disorder.

Amy Wasserbauer, clinical lead at the downtown Phoenix office of Counseling Services, has worked with patients with eating disorders for over 15 years.

“An eating disorder can be described as an iceberg,” Wasserbauer says. “So, the tip are the behaviors. That’s what you see. What’s under the waterline are their thoughts, their feelings and their story that’s taken them to use (an) eating disorder as a coping mechanism to deal with their life.”

What is an eating disorder?

Although it is more common for women to have eating disorders, the disorders are prevalent in both genders.

According to the National Eating Disorders Association (NEDA), surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives.

Marshall has struggled with anorexia since January 2016.

Marshall says she had to start attending counseling and group therapy as treatment. However, beginning treatment was not easy for her.

“I thought I didn’t have a problem. I was like, ‘Treatment is for crazy people,’” Marshall says. “Once I went, I was really just so taken aback about how everyone was almost just like me.”

Marshall says she just wants to have a normal life and feel happy, but people with eating disorders internally struggle at all points of the day.

“It’s sad because it’s like I want to be a regular college student. I want to be a regular teenager and it’s a daily, hourly … struggle to fight against what the compulsions are and what the negative thoughts are telling you,” Marshall says.

The voice in your head

Eating disorders are classified as mental illnesses, but they are not due to a chemical imbalance like depression.

“An eating disorder from a diagnostic criterion is considered a thought disorder which is why it’s deemed a mental illness, but it’s also an emotional dysregulation disorder,” Wasserbauer says. “It’s not schizophrenia, but it literally gives messages.”

Marshall says there is a voice in her head saying negative things about her body, which leads to compulsive eating behaviors.

“Whether it’s bulimia, a binge-eating disorder or anorexia, it’s all the same voice that you’re hearing,” Marshall says.

When people with eating disorders hear this voice telling them to stop eating, they act on it.

“Starvation is painful, and the brain kicks in neurotransmitters and endorphins, so there’s a high,” Wasserbauer says. “The more a person starves, the more it can potentially become addictive to starve and they feel stronger and better. It numbs emotion, so it works almost like a drug high.”

For people with bulimia, they can become addicted to the action of binging and purging.

“Sometimes people will just get addicted to the behavior, so it can hook them and the person becomes very unconscious to even sometimes why they’re doing it,” Wasserbauer says. “They don’t understand it’s numbing emotion or that the trauma they had as a child made them feel not OK in their skin.”

These behaviors can start because parents unknowingly taught their children to suppress emotions at a young age.

“Most people with an eating disorder have a gifted sensitive personality that sees things and takes things in in a way that often others don’t, but, unfortunately, the family may say, ‘stop being so sensitive’ and they’ll shut it down. Intent might be pure, but we look at the effect on the person and they may have gotten a message that it’s not okay to feel,” Wasserbauer says.

If people continue on this path of eating disorders and starvation, they have a higher risk of dying Wasserbauer says.

“Anorexia has the highest deaths of any mental illness,” Wasserbauer says.

According to NEDA, heart failure and suicide are the most common causes of death in people with eating disorders.

Getting help

Marshall uses social media to share her journey with anorexia in a positive way. She posts about her struggles, organizations she is a part of and anything that raises awareness on this issue.

“I am trying to show people that it’s okay to have negative thoughts, and it’s OK to go to the counselor because that is where you really start to do the self-discovery,” Marshall says.

Additional support can be found at ASU Counseling Services, who work to get students the help they need. They assess for eating disorders, partner with health services and diagnose, but cannot fully treat diagnosed eating disorders on their own.

“It takes a team to help that person,” Wasserbauer says.

Once a person is diagnosed with an eating disorder, they need dieticians, psychologists, counselors and peers for group therapy to really take in the full treatment, Wasserbauer says.

Targeting body negativity 

Aside from personal reasons, negative body images portrayed in forms of mass media can lead to poor self-esteem, which can lead to an eating disorder, according to dosomething.org.

Ad campaigns often portray an unrealistic body type. The average size of a model is 5 feet 11 inches and 117 pounds, according to the “Girl Model” PBS documentary. However, the average size of a “typical” American woman is 5 feet 4 inches and 140 pounds.

As a response to the negative body images portrayed in the media, several groups on campus are striving to raise awareness about eating disorders and start sharing body positivity.

One organization that promotes body confidence and healthy self-esteem is Proud2Bme. This is a nationwide organization started by NEDA, and ASU’s chapter is based on the Downtown Phoenix campus.

Senior nutrition major Madison DeHaven is the president of Proud2Bme at ASU.

“This organization is a safe space for people to talk about these issues primarily and then for us to practice leading by example by being body positive in our everyday lives,” DeHaven says.

Junior criminal justice major and vice president of Proud2Bme Maddison Fitzsimmons says she feels like she has struggled with body image for a long time.

“I was really fit in high school and I still didn’t think that I was the perfect girl or the standard size,” Fitzsimmons says.

Now, Fitzsimmons promotes body positivity on her Instagram by posting pictures of herself that she wouldn’t usually.

“I think social media really played a big role for me,” Fitzsimmons says. “I was doing photoshoots for myself which really helped my body image. I posted all them on Instagram and just got really good feedback. My number one compliment is, ‘I love how confident you are’ because it’s not complimenting your body. It’s complimenting who you are, and I think that’s more important.”

Fitzsimmons says that once she found happiness in loving her body the way it was, she wanted others to feel like that too. She promotes Proud2Bme as something she is passionate about and encourages people to come find themselves and their own happiness.

“I think once you find this true joy inside loving yourself, it really affects your life and how happy you are,” Fitzsimmons says. “Good vibes are everything.”