Are Social Difficulties a Risk Factor for Anorexia?
Research has consistently shown that many people living with Anorexia Nervosa report difficulties with social situations, smaller social networks, and trouble regulating emotions in some social settings. Here we’ll explore why social difficulties are often a precursor to and maintenance factor of anorexia and what can be done to mitigate the issue.
Anorexia Nervosa is a severe eating disorder characterized by dramatic weight loss, excessive calorie restriction and obsessive thoughts about food and body image. While anorexia is an illness individuals can recover from, it has the highest morbidity rate among all psychiatric disorders, so it is essential to get treatment as soon as possible. Read more about anorexia here.
Social skills refer to the communication skills needed to allow people to interact effectively and appropriately with those around them. These skills can include the ability to form various kinds of relationships, connect with others, share stories, offer and receive emotional support and set boundaries. Good social skills facilitate the growth of a strong social network, where individuals find belonging and are free to express themselves and what matters to them.
Most basic social skills are learned over time, starting in the family and expanding with a person’s life experience. By grade school, most parents will have taught their children how to introduce themselves to others and play nicely. By high school, most will have an understanding of how social groups work and how to communicate effectively within them. While social skills can be gained and refined throughout life, scientific evidence does suggest that certain traits like sociability and anxiousness are at least partly hereditary (Katsnelson, 2017). So, while it may become habitual for individuals to introduce themselves to new people, the desire and degree to which a person wants to socialize is somewhat predetermined by their genes. This predetermination may result in certain people experiencing social difficulties and result in a lack of a social support system.
Social difficulties typically refer to challenges that result in an individual feeling disconnected or isolated from those around them. These difficulties may include social anxiety, an inability to form new friends and an absence of strong boundaries. This lack of social ease causes people to suffer in various ways. In a study conducted by Chris Segrin, the head of the University of Arizona’s Communication Department, it was shown that those “who had deficits in [social] skills reported more stress, more loneliness, and poorer overall mental and physical health.” In particular, the social traits they looked at were feelings of inadequacy, a sensitivity to rejection, pain-avoidance, a lack of assertiveness and a lack of general social competence. They saw that when individuals didn’t feel like part of a social group and chose to actively work to avoid judgment, they developed tendencies to engage in other methods of control, such as restriction and disordered eating. While poor social skills were noted as a precursor to eating disorders, it was also shown that they were a major factor in maintaining the illness.
Social Difficulties as a Precursor to Eating Disorders
Another similar study found that social difficulties do precede eating disorders in a vast majority of people (Segrin, 2018). Specifically, those diagnosed with anorexia recalled struggling during childhood to assert themselves in their family and friend groups. They also demonstrated a fear of negative judgment, which resulted in abnormal eating habits and behaviors. For example, when individuals felt judged for their appearance or weight, they tended to use disorder eating behaviors in an effort to control their appearance and eliminate judgment. When it came down to it, individuals noted that they used dietary restrictions and weight loss as a way to control their social status and to maintain being seen as attractive and socially acceptable.
Social Difficulties as a Maintenance Factor in Eating Disorders
While social difficulties may be a precursor to disordered eating, they are a definite factor in maintaining the illness.
- Perfectionism: The National Eating Disorder Association (NEDA) states that many people who suffer from anorexia experienced behavior inflexibility growing up—that they felt as if they always had to follow the “rules” and complete tasks the “right” way. This rigidity in a person’s belief systems lends itself to perfectionism, anxiety and obsessive tendencies. These psychological factors focused around control can increase a person’s likelihood to develop and suffer long-term eating disorders.
- Bullying: Those who experience an inability to connect with others or communicate effectively may be teased or bullied by their peers. This teasing could take the form of online mocking, in-person insults or comments about an individual’s appearance. Bullying is such a significant risk factor in eating disorders that it has gained notable attention in the past decade. NEDA states that 60% of those affected by eating disorders reported that bullying directly contributed to the development and maintenance of their eating disorder.
- Minority Communities: Those from racial and minority ethnic groups are particularly at risk for experiencing social difficulties. This is due to the fact that they are expected to adapt to the cultural “norm,” (which is often Western beauty ideals). When a person’s body presentation doesn’t align with what is “expected,” social consequences may follow. These individuals may have trouble finding clothes to fit their body, see significantly less representation of people who look like them in the media, and may be subject to teasing or being labeled as “other.” These results may cause individuals to think differently about themselves and negatively about their bodies, which may cause disordered eating or further exacerbate it. To prove this point, a study was conducted in Fiji, where women were introduced to western television shows. After three years of this, women who previously reported being comfortable with their bodies, developed serious problems. Of the women, “74% felt too fat; 69% dieted to lose weight; 11% used self-induced vomiting; and 29% were at risk for clinical eating disorders” (NEDA).
- Loneliness: Social difficulties, such as an inability to form or maintain a strong social network, sometimes force individuals into loneliness and isolation. A limited social network and feelings of seclusion are hallmarks of anorexia. Many individuals who have anorexia report having fewer friends than normal, fewer social activities to attend and less social support. This lack of support is shown to maintain, and potentially worsen, eating disorder behaviors in individuals. It is important to note here that disordered eating and loneliness are cyclical. Eating disorders may cause individuals to isolate: they may not want to attend social events involving food, may not want to be seen as inferior and may not want those around them to know what is going on. This results in increased loneliness, which may cause an individual to further restrict or engage in disorder eating behaviors in an attempt to regain a sense of control.
What Can We Do?
If a lack of social skills not only contributes to an eating disorder but also to maintaining it, what can those suffering from anorexia and other eating disorders do? For those living with an eating disorder, it is important to start small and to realize each choice you make can lead you to a brighter, fuller life. First, it is recommended to seek professional treatment and to take the first step to recovery. If you are seeking treatment, reach out to The Emily Program at 1-888-364-5977 for personalized help. Second, try setting a small goal for each day. This could be reaching out to a friend or saying hello to someone you see regularly. As this becomes easier, start slowly building a strong social network of people who will be in your corner during recovery. Meet up with supportive friends when possible, or maintain friendships via texting or phone calls. Recovery is easier if individuals are connected to others who advocate for their recovery as well, so it’s important to reach out and stay connected.
If you are not experiencing an eating disorder but know someone who does, who may also have social difficulties, you can help, too! Reach out to them and express worry and concern. Offer treatment resources and be a listening ear. By offering this support, the individual may feel more able to take the hard step of starting treatment. If you offer suggestions for treatment, it could also alleviate social anxiety they have about finding options and speaking to folks on the phone at various facilities. As always, if you know someone struggling and have reached out and suggested treatment options, don’t give up! Be patient and remind them that you are there when they are ready. The most important thing you can do for a loved one who is suffering from an eating disorder is to stay present, stay engaged and stay on their team.
It is important that we understand that eating disorders can affect anyone, regardless of their gender, race, or any other demographic categorization. If you suffer from an eating disorder or know someone that does, see our self-assessment quiz, information on warning signs or information about referring a patient. For additional questions or someone to speak with, call The Emily Program at 1-888-364-5977.