In conversation with Dr. Amanda Swartz
“Growing up in the 90s, I was exposed to a lot of diet culture and restrictive culture, and I was never in a small body…that fit in with that era. I started to see eating disorders develop in my friends…it was everywhere…I really noticed a spike [in eating disorders] in college. That was when I decided I wanted to be a part of the solution.”
Dr. Amanda Swartz is a Psychologist and Certified Eating Disorder Specialist at Texas Christian University (TCU). She earned her doctorate in Clinical Psychology with concentrations in group psychotherapy and health psychology. She has also earned her Certified Eating Disorder Specialist and Supervisor Certification through the International Association for Eating Disorder Professionals. In her current role, she has significantly progressed how TCU addresses eating disorders within its student body.
For the last 15 years, Dr. Swartz has been passionately working within university counseling centers. She developed the TCU’s multi-disciplinary eating disorder team to support students through a collaborative treatment model. In addition, she developed the disordered eating and eating disorder team for the Big 12 student conference athletes.
Dr. Swartz is passionate about working with the LGBTQ+ community and has twice received the TCU Pride Award, which honors a TCU staff or faculty member for exceptional contributions in promoting awareness of issues in the LGBTQ+ community.
“[College] is a huge period of transition…students with eating concerns really struggle with change.”
Research indicates that there is a high prevalence of eating disorders in the college population. Between 11 and 17% of females and approximately 4% of males on college campuses screen positive for eating disorder symptoms.1
Most individuals attend college at the age when most eating disorders develop, which is between 18 and 21.2 While college is typically considered an exciting time in young adults’ lives, it is also a period of significant change. With change comes new challenges and pressures that can put students at risk of developing disordered eating behaviors, eating disorders, and other mental health disorders, such as anxiety and depression.
Additionally, food and routines surrounding food change significantly when attending college. For example, a person with food security issues may find the abundance and endless choice of the food hall incredibly overwhelming.
“Eating disorders are not about food, they’re about thoughts and feelings, and not knowing how to express things…food becomes the expression.”
“The model has been working so well because it looks at what a student needs and tries to provide them with it.”
The Comprehensive Collaborative Care Model (CCCM) was founded in 2019 by Dr. Eric Wood, Director of Counseling and Mental Health at TCU. It was founded to address the recent shift in campus dynamics that present challenges to college counseling services, including:
The CCCM consists of four key objectives:
There are several tracks in the CCCM including a triage and crisis track, a general therapy track, a peer-support community track, and a high-needs student track within which the eating disorder track falls. There is also a referral track that works with community providers to help students that don’t fit into the CCCM.
Dr. Swartz helped build the eating disorder track of the CCCM, which aims to set up a student with a certified eating disorder specialist on campus. Students follow a multidisciplinary treatment plan, which may include meeting with a physician, dietitian, psychotherapist, and psychiatrist, depending on their unique needs.
For students to be accepted onto the eating disorder track, they are required to meet the three criteria for the model:
Peer educators from the Wellness Center at TCU provide many outreach programs for students in the likes of body image issues, eating disorder symptoms, and more. At each event, the information for the TCU Counseling Center is available so students recognizing issues in themselves or others, know where to seek help.
Furthermore, Dr. Swartz places importance on educating campus partners too. Therefore, those in the dean of student offices, professors, and other campus staff members can also notice signs of eating disorders, so they can refer students to the Health Center if they see a need.
The prevalence of eating disorders continues to be a concern across collegiate student-athletes in all sports:
TCU is part of the “Big 12,” i.e., has a large population of student-athletes. There they have taken steps to address the increased prevalence of eating disorders and disordered eating behaviors among student athletes.
Dr. Swartz worked closely with a physician in the athletic department to form the Disordered Eating and Eating Disorders Team, specifically for student-athletes. This team is separate from the eating disorder team at the Health Center as student-athletes require specific monitoring when in recovery, e.g., bone density scans before competition, assessing if an athlete is in competing condition, and when an athlete should be pulled from competition and training for their safety.
Dr. Swartz believes strongly that therapists such as herself, should not be in contact with athletic coaches regarding their athletes. So, to help educate coaches on the impact of certain language—such as weight and body composition—and the signs and symptoms of eating disorders, the Eating Disorder Team for Student Athletes contains a Sports Psychologist who interacts with the coaches.
“As a general rule, ‘Doom Scrolling’ i.e. scrolling for hours not very mindfully, looking at all the gorgeous bodies (by American standards)...can be harmful to students.”
The movement towards an ideal body image has dominated social media in the past decade, with content about weight management and diet culture shared widely and receiving high levels of engagement.6 Excessive use of social media can lead to toxic social comparison and negative body image perceptions that can be reinforced and normalized by friends and ‘influencers’ on the platform.
Many studies have investigated the negative psychological impact of social media. For example, a recent study found that social media exposure directly influences body image, with time spent engaging with image-based content on social media being associated with body dissatisfaction and internalization of the thin ideal.6 Other studies support a similar correlation.
Dr. Swartz is keen to stress that there are positives to social media, such as a sense of community and support from pro-recovery groups and websites. Therefore, it’s important to teach students how to use social media in a positive way, such as:
“The first thing I want to offer is hope. People with eating disorders do get better, and it can be done with the support of a college campus.”
Marks, R. J., De Foe, A., & Collett, J. (2020). The pursuit of wellness: Social media, body image and eating disorders. Children and Youth Services Review,119, 105659.