Exploring the Relationship Between Social Anxiety and Eating Disorders

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Social anxiety is one of the most common co-occurring disorders of eating disorders. Young people with eating disorders and social anxiety may experience a persistent, intense fear of being judged by others. Social anxiety is more than just shyness. It can make it hard to keep or make friends and affect lots of different aspects of a young person’s life, including school and work.

Scientists still aren’t sure exactly why so many young people with eating disorders struggle with social anxiety. Some research suggests that social anxiety may make the development of eating disorders more likely, while other research shows that eating disorders may lead to social anxiety. Alternatively, common risk factors may lead to the development of both disorders. It’s possible that all these pathways play a role. 

While eating disorders and social anxiety can be debilitating for young people, the good news is that both disorders are treatable. With the right support, teenagers and adolescents can manage and recover from difficult symptoms and lead fulfilling lives.

What Is Social Anxiety?

Social anxiety, also known as social phobia, is a type of anxiety disorder that usually begins during adolescence. It’s a long-term and overwhelming fear of social situations that doesn’t go away. Young people with social anxiety may experience fears before, during, or after a social situation.

Symptoms of social anxiety include:

  • Feeling worried about everyday situations, like meeting with strangers, going shopping, or answering the phone
  • Avoiding or worrying about social activities, like spending time with groups, eating with others, or going to parties
  • Finding it hard to do things when others are watching, from a fear of being judged or doing something ‘wrong’
  • Experiencing physical anxiety symptoms like feeling sick, trembling, heart palpitations, or panic attacks

How Common Is Social Anxiety Among People With Eating Disorders?

Among the general population, about 12% of people experience social anxiety disorder at some point during their lives. For people with eating disorders, these numbers are much higher.

Studies exploring social anxiety among people with anorexia and bulimia nervosa have found prevalence rates between 16% to 88% (anorexia) and 17% to 67% (bulimia). Research also suggests that even among those without a diagnosis, disordered eating behaviours are linked to social anxiety levels.

How Can Social Anxiety Lead to Eating Disorders?

While there is a clear link between social anxiety and eating disorders, scientists still aren’t sure about the mechanisms and causal pathways that lie behind it.

One theory is that symptoms of social anxiety may make the development of an eating disorder more likely. Many young people with eating disorders describe having had interpersonal difficulties and a lack of friends during childhood. These experiences of loneliness, shyness, and lack of social support may lay the foundations for disordered eating to develop. For example, young people who experience fear about how they appear to others may become preoccupied with their shape or weight and how other people may perceive them. 

Social anxiety and eating disorders may also be connected through emotional avoidance. Emotional avoidance is when individuals try to avoid confronting or dealing with difficult emotions, thoughts, feelings, sensations, or other inner experiences. While emotional avoidance may seem to make things easier in the short term, the persistent suppression of feelings can be exhausting and prevent young people from fully experiencing important and valued parts of life.

Young people with social anxiety may try to avoid difficult emotions and interpersonal challenges by focusing instead on food and weight. They may engage in behaviours like binging or diet restriction to avoid confronting their anxieties about social situations. Studies have found that among people with anorexia nervosa, emotional avoidance explains the relationship between depression, anxiety, and disordered eating behaviour.

How Can Eating Disorder Symptoms Lead to Social Anxiety?

In general, research seems to support the idea that social anxiety tends to lead to eating disorders, rather than the other way around. Young people with diagnoses of both social anxiety and an eating disorder usually receive the social anxiety diagnosis first. However, this may not be true for every case – and sometimes eating disorders may also make social anxiety worse.

Some research suggests that undereating may cause young people with eating disorders to have higher levels of anxiety, although a recent study found that social anxiety symptoms were not linked to BMI. Eating disorders may also make young people afraid of social situations that involve food – such as eating meals with others. Given that food often plays such a large role in both our everyday routines and social lives, these fears may have a wide impact on their daily lives.

What Common Factors May Make Both Eating Disorders and Social Anxiety More Likely?

Another explanation for the link between social anxiety and eating disorders is that there are common risk factors for both. That is, young people with certain personality traits or life experiences may be at an increased risk of developing both eating disorders and social anxiety. 

Teenagers and adolescents with perfectionist traits, low self-esteem, and experiences of childhood trauma are more likely to develop eating disorders than others. Some of these traits may also make symptoms of social anxiety more likely.

For example, young people who struggle with perfectionism may be more likely to form an idea of an ideal body shape or weight and feel distressed if they perceive their bodies to be different. Perfectionism may also lead to anxiety in social situations when young people pressure themselves not to make ‘mistakes’, to act in a certain way, or to present a particular impression to others. Research has found that among women without a diagnosis, perfectionism makes both social anxiety and disordered eating behaviours more likely.

What Treatment is Available for Eating Disorders and Social Anxiety?

Both social anxiety and eating disorders can seriously impact the well-being of young people. For teenagers and adolescents who struggle with both, daily life can feel almost impossible to manage.

The good news is that there is help available. With professional support, young people can recover from social anxiety and eating disorders and build a better future.

Treatment for eating disorders usually involves some form of therapy, and often a combination of different therapeutic approaches. These may include:

  • Enhanced cognitive behavioural therapy for eating disorders
  • Dialectical behavioural therapy
  • Interpersonal therapy
  • Family therapy

Treatment for social anxiety typically includes therapy with or without medication. Therapy may involve exposure techniques, where a young person gradually and safely exposes themselves to situations that cause them anxiety to overcome their fear. It may also involve learning coping mechanisms and relaxation strategies to manage and reduce anxiety.

 Treatment approaches for social anxiety may involve:

  • Cognitive behavioural therapy
  • Interpersonal therapy
  • Group therapy
  • Acceptance and commitment therapy
  • Antidepressant medication
  • Support groups

Recovering from mental health disorders isn’t easy, but it is possible. Friends, family, and other loved ones can support a young person’s recovery journey and help them manage difficult symptoms. Practising good self-care can also help make their journey a bit easier and maintain better well-being in the long term.

The Wave Clinic: Expert Recovery Support for Young People

The Wave Clinic offers specialist recovery programs for young people, building life advantage for teenagers and adolescents around the world. We offer a unique approach that focuses on full recovery and positive growth, supporting young people to discover and follow their dreams. We help young people to grow in self-confidence, form life-long friendships, and develop life skills for the future.

Our seven core elements of treatment combine clinical and medical care with education, community responsibility, enriching experiences, and future planning. The safety and well-being of young people is our highest priority and we offer 24-hour intensive medical care for those who need it. Our centre is filled with compassionate professionals from all over the world, each bringing their expertise and experience to make a difference in young people’s lives.

If you’re interested in our programs, contact us today to find out more.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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