Student Recovery Contracts: Supporting Eating Disorder Recovery in College Transitions

Aubry Orlino
Apr 15
4 min read

The transition to college is a thrilling leap into independence, academic pursuit, and new social landscapes. For many students, it’s the beginning of a fresh chapter. But for those recovering from an eating disorder, this exciting time can carry hidden risks.

New routines, heightened stress, peer influences, and reduced family oversight can quietly trigger relapse—sometimes undoing months or even years of hard-earned progress.

So, how can families, clinicians, and students themselves maintain recovery while still embracing the freedom and excitement of college life?

Establishing a Student Recovery Contract offers a proactive, clinically informed agreement designed to support students through one of life’s most vital transitions. More than just a set of rules, it's a personalized roadmap that combines structure with autonomy, safety with self-direction.

What Is a Student Recovery Contract?

A Student Recovery Contract (SRC) is a collaborative agreement between the student, family, and clinical providers that outlines behavioral, medical, and therapeutic expectations for maintaining health and stability while attending college. These contracts are designed to promote accountability, ensure continuity of care, and empower the student in their recovery journey.

What’s Inside the Contract?

A contract outlines the following critical components:

Medical Requirements:
- Weekly health monitoring via weigh-ins and vital signs.
- Pre-college physical exams to establish a medical baseline.
Parental Involvement:
- Regular communication between parents and the clinical team.
- Collaboration with on-campus health services.
Nutritional Monitoring:
- Submission of weekly food logs.
- Participation in bi-weekly meal planning sessions.
Medication and Therapy Compliance:
- Adherence to prescribed medications.
- Weekly therapy and regular check-ins for emotional and psychological support.
Contingency Plans:
- Criteria for returning home or re-entering treatment if stability is compromised.

Why It Works

Recovery contracts are backed by growing evidence:

Behavioral contracts boost adherence. A 2021 study by Sweeny et al. found that students who agree to structured treatment plans are more likely to stick with their recovery, even during stressful college transitions.
Structured contracts reduce relapse risk. Carney et al. (2022) showed that behavioral contracts, with early monitoring, lower relapse rates in adolescents and young adults, especially in eating disorder recovery.
Family involvement improves outcomes. Le Grange et al. (2014) demonstrated that family-based treatment (FBT) enhances recovery, and integrating family into recovery contracts improves long-term success while allowing students to maintain independence.
Individualized planning matters. Liu et al. (2021) found that tailored treatment plans and recovery contracts helped college-aged individuals with anorexia achieve sustained recovery by offering personalized support and autonomy.
Check-ins reduce symptoms. Rosenbaum et al. (2024) showed that telehealth-based recovery programs with regular check-ins and family involvement significantly reduce eating disorder symptoms in college students.
Autonomy fosters engagement. Bishop et al. (2023) found that students who actively participate in their treatment plans through behavioral contracts are more likely to engage in their recovery, setting clear goals and taking ownership of their journey.

Why It’s Effective

Catches early signs of relapse before they become crises.
Builds autonomy within a supportive framework.
Clarifies expectations, reducing stress and miscommunication.
Supports students without compromising their college experience.

Is It Ethical and Legal?

Yes—when done right. Contracts should be:

Voluntary and signed by all parties.
HIPAA-compliant with proper consent for info sharing.
Regularly reviewed and updated based on student progress.

Clinicians should document the agreement and coordinate with campus health services as needed.

Conclusion

A Student College and Recovery Agreement is not just a set of rules—it is a personalized, clinically informed safety plan. It empowers students in recovery to pursue academic goals while prioritizing their mental and physical health. Rooted in evidence-based practices and guided by interdisciplinary collaboration, a contract can serve as a crucial step in promoting lasting recovery and reducing the risk of relapse during one of life’s most challenging transitions.

Review SB Contract below

Student and Recovery Contract

References

Bailey, A.P., Parker, A.G., Colautti, L.A. et al. Mapping the evidence for the prevention and treatment of eating disorders in young people. J Eat Disord 2, 5 (2014). https://doi.org/10.1186/2050-2974-2-5

Bishop, S., et al. (2023). The role of behavioral contracts in eating disorder recovery: A review of outcomes in college students. Journal of Eating Disorders, 41(1), 1-15. DOI: 10.1186/s40337-023-00788-z

Carney, D.M., et al. (2022). Structured behavioral agreements in adolescent psychiatry: A systematic review. Adolescent Psychiatry, 28(4), 211-224. DOI: 10.1080/15332691.2022.2052458

Le Grange, D., et al. (2014). Family-based treatment for adolescents with anorexia nervosa: A randomized controlled trial. Archives of General Psychiatry, 69(3), 226-233. DOI: 10.1001/jamapsychiatry.2013.4366

Liu, W., et al. (2021). Early monitoring and individualized treatment planning in anorexia nervosa: Outcomes in college-aged individuals. International Journal of Eating Disorders, 54(7), 1232-1240. DOI: 10.1002/eat.23459

Sweeny, S. et al. (2021). Behavioral contracts and treatment adherence in eating disorders. Journal of Clinical Psychology in Medical Settings. DOI: 10.1007/s10880-021-09756-0

Rosenbaum, S., et al. (2024). Telehealth-supported recovery programs for college students with eating disorders: The role of consistent check-ins and family involvement. Eating Disorders Journal, 32(4), 395-407. DOI: 10.1080/10640266.2024.1913