Asking for help never crossed my mind. My internal voice reasoned I couldn’t be suffering from a mental illness; I was doing well in my classes, and I wasn’t falling into the typical college freshman peer pressure traps. I certainly didn’t feel like the stereotype our society portrays of someone suffering from an eating disorder. I reasoned if I could manage my life so well on the outside, I’d eventually be able to solve my internal turmoil.

By the end of the semester, it became readily apparent to my family that I’d hit a breaking point — their daughter, sister and friend had been swallowed by an eating disorder. My rationales, excuses and half-hearted efforts to admit anything was wrong and accept any sort of help were no longer holding up, given my noticeably deteriorated mental and physical health. It was time to take the control out of my hands. One week later I went into treatment, still convinced I was doing just fine.

It has been five years since then, and now with the gift of hindsight and distance, I have a better understanding of why I had, and so many others have, trouble asking for and receiving the mental health support they need in college. Of course we all have unique external and internal barriers that prevent us from seeking help, but it is particularly difficult for a college student suffering from a mental illness.

First, asking for help requires self-awareness; you must understand yourself and your emotions in order to know when things aren’t right. Going to college can be an emotional rollercoaster. It is exciting, stressful, and disorienting, often all in the same day. It’s often a person’s first big life transition, filled with new opportunities, pressures, and responsibilities. There are so many new challenges and emotions that it’s hard to know whether what you’re experiencing is “normal.”

Asking for help also requires confidence and the belief that needing support is not a sign of weakness. This can be hard for several reasons, but chief among them is the tendency for college environments to reinforce the perception that everyone else “has it together.” Since peers tend to put up a composed and idealized facade to others, it can be difficult to express any sense of struggle without seeming inadequate, or feeling inferior.

Beyond confidence, asking for help also requires a willingness to give up control. Since college is often the first taste of significant independence, it can be difficult to voluntarily relinquish this newfound autonomy and admit you need support.

For someone with an eating disorder, this is especially hard, as a desire for control is exactly what leads many people to develop the illness. For people with anorexia and/or bulimia, regulating eating behaviors provides a sense of solace, offering a space in life where you can have complete control, and even feel powerful. Asking for help requires a willingness to sacrifice this control and put it in the hands of someone else.

One of the most potent lessons I learned after suffering from an eating disorder is how unbelievably powerful the mind can be. Despite the fact it was readily apparent I was suffering from an eating disorder, I shut out the reality of my illness and was blind to the overwhelmingly harmful effects it had on my life for over a year. I was distancing myself from the people I love, I couldn’t form relationships with my peers, and I was constantly living inside my own head, torturing myself with endless thoughts of what I “should” be doing at every single moment of the day.

On paper, I was one of the “lucky” ones: I had an attentive family well-versed in mental health challenges, I had some of the best eating disorder specialists in the country on my campus, and I had counselors checking on me.

Despite all of these factors, I was able to exist in private with my eating disorder until it got to a very dangerous point. Situations like mine are evidence that these problems exist in alarming degrees on campuses throughout the country, even when mental health services are readily available. It compels us to examine whether colleges and universities are not only providing strong mental health systems, but using the most effective methods of escorting students into them.

Training staff to identify problems, educating students in coping techniques, providing access to peer support, and offering easy, effortless outreach to those who self-identify the need for help are all critical factors in building an effective college mental health network.

Most importantly, these critical support systems must be an integral part of the day-to-day student experience, taking into account that those who are most at risk may also be the least likely to reach out.

Until there is this much needed systemic change, this epidemic will continue.