When Nell S. Hawley ’11 arrived at an international boarding high school nestled in the foothills of India’s Himalayas for her sophomore year, she never expected that in the following months she would grapple with the onset of an eating disorder.

Hawley explored nature through hikes and shopped in bazaars. Her classes were less demanding than those offered by her New York City school, providing her with more time to devote to her friendships. She entered her first steady romantic relationship. “Along with all of this unadulterated joy,” she said, “came a newfound appreciation for food.”

Hiking to and from school each day, her growing appetite was satiated with Indian meals, which she said were abundant and accessible.

“I ate a lot and loved it,” Hawley said. “I noticed my clothes fit me differently, but I shrugged it off and still thought I was beautiful, desirable, smart, funny, et cetera. My self-confidence was through the roof.”

Hawley was unconcerned by her figure until a week-long school historical sightseeing trip to Delhi where one night, as she ate a candy bar, a girl told her, “When you came here you were so thin, but now you’re nice and plump and healthy!”

While Hawley said she recognized that the comment was intended as a compliment, she felt exposed.

“At that moment I saw myself through different eyes, through outside eyes, and I saw myself having too much fun, too much pleasure,” Hawley said. “All of a sudden my independence and happiness became dangerous things; they were things that needed to be curbed and tamed.”

Hawley began to monitor her portions, but after a two-week winter break, her eating issues “spiraled out of control,” setting in motion a vicious cycle of skipping meals, studying compulsively and withdrawing from friends.

“I drank black coffee with sugar for breakfast, skipped lunch, and ate bananas, sometimes oranges, for dinner,” she said. “When I looked in the mirror I didn’t even recognize myself. I slept for 12 hours a night and could barely walk up a flight of stairs.”

Hawley developed anorexia at age 16.

Now 22, Hawley said she has largely recovered through therapy and treatment.

“For the past seven years not a day goes by when I don’t struggle with it. I know how hard it can be,” she said.

While Harvard offers a number of resources for students with eating disorders, including peer counselors and Harvard University Health Services Support staff, the issue is often stigmatized and can slip under the radar.

“You can’t admit it if you’re depressed or struggle with college or are throwing up,” Hawley said. “I don’t want to be anonymous. I do not want people to be ashamed of struggling.”

EATING IN SECRET

Louis R. Evans ’13, a resident of Canaday last year, said he ran downstairs to the bathroom by the Women’s Center one day to find a sign that surprised him. He recalled that it read: “The cleaning staff has reason to believe that someone who used this bathroom has an eating disorder. We encourage you to get in touch with resources.” Below the sign was printed a list of phone numbers.

“It was an odd experience to come face-to-face with the fact that maybe someone I knew was struggling with something,” Evans said. “It’s an issue that I hadn’t been aware of.”

Natalie C. Chapman ’11—a member of the Eating Concerns Hotline and Outreach for the past seven semesters—attributes Harvard’s lack of awareness to a sense of social shame that pervades campus.

“It’s more common than people realize but no one talks about it, so how would you know?” Chapman said.

While she could not reveal the number of students who visit ECHO, Chapman said that “it is more than you think, but fewer than it should be.”

MORE THAN FOOD

Megan, whose name has been changed to protect her identity, was a junior in high school when she developed anorexia. While frantically writing her college applications, her school threatened to expel her if she fell below a certain weight. She said that her unhealthy relationship with food exposed her to misconceptions about eating disorders.

“It’s not all about wanting to lose weight and be skinny,” Megan said. “People mistakenly think that if you physically force food into someone you’re fixing the problem. That’s just not true.”

Hawley shared Megan’s observation, saying that her therapy sessions did not discuss eating. Instead, she worked to confront problems without “punishing the body.”

Melissa Henriquez—a recovered disordered eater and a writer for “Let There Be Light,” a blog about disordered eating—says it is common for people to change their eating habits in unhealthy ways to cope with anxiety.

“Instead of dealing with whatever I was dealing with at the moment that I couldn’t control, I’d turn to something I could control,” said Henriquez, referring to food and exercise.

Anna Lucia Lister ’13, an ECHO peer counselor, said that despite what many people think, eating disorders can be complex and deadly conditions.

“Students often don’t appreciate how lethal eating disorders can be,” said Margaret S. McKenna ’70, a psychiatrist at UHS.

She cited mortality rates for anorexia as high as 5 to 10 percent.

Another myth about eating disorders is that they are just a “girl problem,” Lister said.

“I saw a multimedia presentation on male eating disorders—body dysmorphia—which focused on steroid use and obsessive gym use,” Lister said. “There is still stigma attached to men and eating disorders, although it may take a different form, ”

A PERFECTIONIST’S PROBLEM?

Hawley points to the academic and social forces at Harvard as a source of pressure on students to fixate on body image.

“I go to the gym and see girls working out for hours and hours. It’s painful and triggering,” Hawley said. “Academically, socially, and extracurricularly the way to show you have it under control is to be skinny.”

With the day to day stresses of undergraduate life, it can be difficult to find time to “press pause” and deal with an issue.

“Life is so busy here that it’s hard to think and process things,” Megan said. “You’ll put your problem off and deal with this next week when activities die down but time passes and you don’t ask for help.”

Despite comments that Harvard’s Type-A culture facilitates eating disorders, the incidence of eating disorders on Harvard’s campus have been consistent with numbers around the country, according to McKenna.

About 1 percent of students nationally are diagnosed with anorexia and about 3 to 5 percent with bulimia.

Nonetheless, Lister said that at competitive academic institutions, the pressure to achieve perfection is pervasive, and people often feel alone.

“At Harvard everyone is so high-functioning and we have a very skinny campus to begin with, abnormally so,” Lister said. “People feel like if something is going wrong, they’re the only one who’s going through it.”

To reduce such feelings of loneliness, Chapman, the long-time member of the Eating Disorder Hotline, said that the College is taking steps to provide mental health training and information about peer counseling during Freshman Opening Days, where she hopes eating disorders will be addressed.

“Freshman year is a gateway to knowing so much about Harvard. Information you get about resources will stick with you,” Lister said. “People see the posters, but don’t really know about the resources until later in their Harvard careers.”

FINDING A SAFE SPACE

“We have very robust resources to care for students with eating disorders,” said McKenna, referencing the UHS “Eating Disorder Team.”

UHS provides many forms of care, including individual therapy, group therapy, and medical monitoring by a primary care nurse or doctor, according to McKenna.

Aside from UHS and Mental Health Services, Megan said that the Bureau of Study Counsel, where she met with a counselor three times, was a helpful resource.

“The counselor was very non-judgmental and not trying to make me change anything. She just listened, which was a nice change from high school,” Megan said.

In addition to professional resources, Lister says peer counseling groups, all of which are non-directive, provide safe spaces to talk.

“We are open to anything. It can be an eating-specific call that turns into how blocking is terrible and contributing to stress,” Lister said.

“If it affects your stress level and level of happiness here, it could be affecting a disorder.”

While Megan and Hawley noted the value of therapy and eating disorder-specific resources, they said that opening up to people was instrumental in their recovery. Megan says that friends comprise her biggest support network, and Hawley said she found a validating space at Hillel, where she served as president.

“I found people who valued me based on who I am. We see the good and the God in everyone,” Hawley said. “This community looked beyond the body and competition and academic success. They helped me put focus on what makes my life meaningful.”

—Staff writer Nadia L. Farjood  can be reached at nadiafarjood@college.harvard.