Self-Isolation: How Eating Disorders Affect Relationships

Eating disorders impact every area of life, including relationships. Without intervention, eating disorders can lead to self-isolation, disordered eating and an inability to form relationships. With treatment and psychotherapy, those with eating disorders can rebuild or cultivate new relationships that are positive and supportive.

Do eating disorders affect relationships?

Eating disorders affect all areas of life, including relationships with family, friends and romantic partners. Meals and physical activity (like sports) are often group experiences, so it’s no surprise that when an eating disorder affects one’s relationship with food and exercise, it also begins to harm interpersonal relationships.

Those with eating disorders may not only skip making food for themselves, but also avoid dining out with friends, attending family dinners or going out on dates.

Feelings of guilt and low self-esteem can also lead individuals to become more withdrawn and negatively affect their relationships. Feelings of loneliness and isolation can strengthen disordered eating behaviors and contribute to further withdrawal, which in turn worsens the eating disorder.

Having a supportive network can help break this cycle and provide encouragement for healthier coping and recovery.

How Eating Disorders Negatively Impact Relationships

Self-Isolation

Many individuals with an eating disorder tend to gradually self-isolate from family, friends and loved ones as the disorder develops and disordered eating behaviors take hold. They might isolate themselves to avoid being seen, to prevent pressure to eat or because they feel nervous about appearing in public or around others due to appearance anxiety.

Guilt can also lead to self-isolation. People with eating disorders often have low self-esteem, which can make them feel unworthy of meaningful relationships, that they aren’t worth others’ time or that they are a burden. Consequently, they might withdraw from others, creating a cycle where their low self-worth causes them to isolate, and their isolation further worsens their self-esteem.

Unwillingness to Share Feelings & Struggles

Shame and guilt can lead to hiding feelings and facing struggles. An individual’s desire to isolate themselves might grow if their loved ones notice changes in their behavior.

They may believe that if others find out, they could be disappointed, angry or upset. They could feel overwhelmed by the potential consequences of being discovered, like being afraid to enter inpatient treatment and hesitate to tell anyone out of fear they will be pushed to go.

Risks of Self-Isolation

Increase in disordered eating behaviors

Disordered eating behaviors often occur in private. When alone, individuals with eating disorders may skip meals or eat very little, purge or exercise obsessively without anyone noticing. The lack of social pressures allows these symptoms to worsen unnoticed.

Decrease in social support

Isolation leaves people with eating disorders lacking social support. Without a support system, an individual’s wellbeing and satisfaction may start to decline, and negative self-perception may grow. These combined factors can make it harder to handle life's challenges, worsening an eating disorder.

Inability to form relationships

When relationships start to decline, it can feel very lonely. Rebuilding and forming new relationships may require a lot of time and effort, but with low self-worth and negative self-perception, it might seem like relationships are a lost cause.

Delay of eating disorder treatment

Individuals with an eating disorder often struggle to recognize their disordered eating.^1,2 They often justify their eating behaviors and minimize the negative consequences. When they are isolated, there's no one to challenge their thoughts, which can delay treatment and allow the disorder to worsen.

This is especially dangerous because eating disorders are the second deadliest psychiatric condition. Self-isolation can worsen thoughts of suicide, which is a major cause of death for those with anorexia nervosa and bulimia. Up to a third of individuals with anorexia and bulimia attempt suicide.³  Eating disorders can also lead to severe medical complications, which, if untreated, can become fatal.

The Importance of Positive Relationships

Relationships are crucial in recovering from eating disorders. Conditions like anorexia nervosa and bulimia tend to be isolating illnesses. Support from loved ones is essential to face the challenges of recovery.

Relationships are crucial to recovery. Many individuals with eating disorders have mentioned that accepting a relationship with a loved one was essential to their healing.⁴ Relationships offer unconditional love, support, trust and hope that ease the burden of recovery and strengthen people to make positive changes.

The Spectrum of Love

There are many different kinds of love, each serving a unique purpose. While love is often linked with romance, there is no hierarchy that ranks one type of love as more or less important. Each person has their own priorities and may value different types of love more than others. Some individuals find that certain forms of love are not a priority at all, or that over time, the types of love they prioritize change.  

Self-Love 

Self-love is the regard for one’s own well-being and happiness, built through appreciation of one’s value, worth, and qualities. Self-love enables you to love others for the right reasons and more effectively. It also serves as the foundation for participating in and building healthy relationships based on mutual respect and understanding. Self-love, particularly self-compassion, can help:^5-7

• Reduce eating disorder symptoms
• Improve mental health and wellbeing
• Promote positive relationships

Practicing self-love

Self-love doesn’t happen overnight. It can take months or years – and for some even decades – to develop lasting self-love. No matter how long it takes, there are ways to practice self-love in your daily life.

• Talking positively to and about yourself
• Learning to say no and building healthy boundaries
• Practicing self-compassion
• Appreciating alone time
• Asking for help and understanding your limitations

Familial Love

Familial love is the first type of love experienced. Since families are around from day one and know each other the longest, they understand the most about one another and still choose love regardless. Families share a unique history, culture and quirks that inspire people to build relationships with their current family or start new ones.

Family relationships provide resources that can help an individual cope with stress, engage in healthier behaviors and enhance self-esteem.⁸

Cultivating family bonds

Building strong family bonds is crucial. You can strengthen family bonds by:

• Spending quality time together
• Maintaining good and open communication
• Acknowledge and celebrate differences and strength

When familial relationships fail

Not everyone has a supportive family and might not share positive familial experiences. Others may have had a caring family, but those family members have since passed. Being unable to depend on the people who raised you or were present for much of your life can feel very isolating.

Reaching out to a therapist or counselor is a positive first step to addressing these feelings and navigating grief, reunion, boundary setting or moving on from your family.

Chosen family

For those with abusive or estranged families, a chosen family can fulfill the same role. A chosen family is a non-biological bond of kinship. Unlike biological family, which you cannot choose, chosen families are based on choice.

Chosen families are especially common within the LGBTQ+ community, as misunderstandings and rejection of their identity often lead individuals to seek love and support elsewhere.

Friendships

Platonic love – friendships – is a type of relationship in which there are no romantic feelings. Platonic love also involves high levels of intimacy, or reciprocated information sharing, that allows you to be vulnerable with another person.

Platonic love offers distinct advantages over family love. Friends are equals in their relationships, unlike family bonds where generational gaps heavily influence the interactions between children and other relatives. Friends also share common interests and provide unique bonding experiences.

Maintaining friendships

Most people focus on maintaining their health, exercising, working, and caring for family, often overlooking the importance of building friendships. Healthy friendships are vital as they help reduce stress, anxiety and loneliness, while also enhancing physical health, mental wellbeing and overall life satisfaction.

If you want good friends, you also need to strive to be a good friend:

• Be vulnerable, open and honest
• Be consistent and be there when it’s most important
• Be positive and uplifting, but not afraid of conflict

Do you need a lot of friends?

Many people feel insecure about the number of friends they have, but the truth is that you don’t need to have a lot of friends. Most people have three or fewer close friends, and time and again it’s been shown that the quality of friendships is much more important than quantity.^9,10

Romantic Love

Romantic love refers to a specific type of affection, attraction and idealization that can lead to a committed relationship. Romantic love can evolve over time, beginning with infatuation and developing into a more mature form of love as time passes.

Building healthy romance

Building a healthy romantic partnership takes effort, time and self-reflection. Understanding yourself and your boundaries is essential. You want to start the relationship on the right foot, which means carefully considering your must-haves and deal breakers.

You also need to:

• Be open and honest with your communication

• Have quality couple time while also having time to yourself
• Show gratitude and appreciation for the unique things you both bring to the relationship

Abusive relationships

Not all romantic relationships are healthy. For individuals with an eating disorder, you may start to revert to disordered eating behaviors as a way to cope with abusive relationships or because partners may encourage you to return to disordered eating as a means of control.

Abusive relationships can be physical, mental, emotional, sexual or financial. Some signs you may be in an abusive relationship include:¹¹

• Insulting, demeaning or shaming you
• Preventing you from making your own decisions
• Extreme jealousy, possessiveness and controlling behavior
• Intimidating you through threatening looks or actions
• Destroying your belongings
• And many others

The Role of Psychotherapy in Relationship Building

Psychotherapy interventions such as interpersonal therapy can help those with eating disorders build, navigate and reintegrate into their relationships while also supporting recovery from an eating disorder.

Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is an evidence-based treatment that focuses on improving relationships to relieve mental health symptoms. IPT explores how interpersonal dynamics play a key role in mediating different psychiatric conditions and can help patients improve social support networks and reduce feelings of isolation.

Family-based treatment

Family-based treatment (FBT) is one of the most successful treatments for eating disorders in children and teens. This home-based treatment approach places parents and caregivers at the center of eating disorder treatment, which can help strengthen family bonds and promote a supportive home environment.

Dialectical behavioral therapy

Dialectical behavioral therapy (DBT) can be used to address eating disorders and other conditions. DBT is a form of psychotherapy that focuses on mindfulness, distress tolerance and emotional regulation which can help patients reduce conflict and develop healthier relationships.

Moving Forward with Support

Living with an eating disorder can feel isolating and overwhelming, but you don’t have to face it alone. Building supportive connections with family, friends and care providers is an essential part of lasting recovery. With a strong support network and evidence-based treatment, healing and stronger relationships are possible.

References

1. Konstantakopoulos, G., Tchanturia, K., Surguladze, S. A., & David, A. S. (2011). Insight in eating disorders: clinical and cognitive correlates. Psychological Medicine, 41(9), 1951–1961. https://doi.org/10.1017/s0033291710002539
2. Konstantakopoulos, G., Georgantopoulos, G., Gonidakis, F., Michopoulos, I., Stefanatou, P., & David, A. S. (2020). Development and validation of the schedule for the assessment of insight in eating disorders (SAI-ED). Psychiatry Research, 292, 113308. https://doi.org/10.1016/j.psychres.2020.113308
3. Smith, A. R., Zuromski, K. L., & Dodd, D. R. (2018). Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Current Opinion in Psychology, 22, 63–67. https://do.c.c.i.org/10.1016/j.copsyc.2017.08.023
4. D’Abundo, M., & Chally, P. (2004). Struggling with Recovery: Participant Perspectives on Battling an Eating Disorder. Qualitative Health Research, 14(8), 1094–1106. https://doi.org/10.1177/1049732304267753
5. Morgan-Lowes, K. L., Thøgersen-Ntoumani, C., Howell, J., Khossousi, V., & Egan, S. J. (2023). Self-compassion and clinical eating disorder symptoms: a systematic review. Clinical Psychologist, 27(3), 269–283. https://doi.org/10.1080/13284207.2023.2252971
6. Crego, A., Yela, J. R., Riesco-Matías, P., Gómez-Martínez, M., & Vicente-Arruebarrena, A. (2022). The Benefits of Self-Compassion in Mental Health Professionals: A Systematic Review of Empirical research. Psychology Research and Behavior Management, Volume 15, 2599–2620. https://doi.org/10.2147/prbm.s359382
7. Lathren, C. R., Rao, S. S., Park, J., & Bluth, K. (2021). Self-Compassion and Current Close Interpersonal Relationships: a Scoping Literature Review. Mindfulness, 12(5), 1078–1093. https://doi.org/10.1007/s12671-020-01566-5
8. Thomas, P. A., Liu, H., & Umberson, D. (2017). Family Relationships and Well-Being. Innovation in Aging, 1(3). https://doi.org/10.1093/geroni/igx025
9. American Perspectives Survey. (2020). Survey Center on American Life. https://www.americansurveycenter.org/download/may-2021-american-perspectives-survey/
10. Demir, M., Özdemir, M., & Weitekamp, L. A. (2006). Looking to happy tomorrows with friends: Best and close friendships as they predict happiness. Journal of Happiness Studies, 8(2), 243–271. https://doi.org/10.1007/s10902-006-9025-2
11. Warning signs of abuse. (2023). The Hotline. https://www.thehotline.org/identify-abuse/domestic-abuse-warning-signs/