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Anorexia and Friendship: What Eating Disorders Do to Friends

Part two of a four-part series, on the ways anorexia can affect friendships.

This post continues my previous post’s analysis of how anorexia and friendship interact by considering specifically the changes that anorexia can bring about for existing friendships.

Most of the effects of anorexia on friendship are negative. In Westwood et al.’s (2016) qualitative study of friendship experiences before and during anorexia, nine out of ten participants reported negative effects of anorexia on making or maintaining friendships, including feeling their friends don’t understand the disorder, and losing friends or seeing them less. The most common way for friendships to suffer during anorexia is probably social withdrawal: the sufferer simply stops making time for friends. It’s easy when in the depths of illness to start treating friends, as I did in the opening epigraph, as essentially theoretical.

A couple of years earlier, halfway through undergrad, I also wryly observed that I’d had invitations to a music festival and a punting picnic, and ‘used each as an excuse not to do the other. This is why I have no friends…’ (19 July 2002). It’s terribly easy to find yourself prioritizing work over friends, prioritizing exercise or food-control activities over friends, avoiding situations where food is uncertain or otherwise threatening, and generally raising the bar for an actual meeting with another human being so high that it puts ridiculous pressure on any meeting that does still miraculously happen. Thin threads of secrecy and resentment can easily creep into ordinary once-friendly contact, too, once food is at all involved; Caroline Horton’s play Mess (which I reviewed here) had a potent moment of that.

Westwood et al. also observe that an alternative to never seeing anyone is to see people but reduce the type of contact to the least meaningful possible. They give the example of exercising together, meeting for black coffees to chat about innocuous things, or hanging around at the edge of a sizeable friend group. This may still be better than no contact – but not much. And like everything that makes anorexia more liveable, it may also help massage the myth that everything’s fine. Reading Westwood and colleagues’ article makes me realize I probably had my own equivalent: hanging out with people much more talkative than I was. At times, I resented having to listen so much and talk relatively little, but I think it probably suited me pretty well too. Certainly I found the slide into solitude strikingly easy (easy to do if not always to tolerate):

I know I wrecked our ‘perfect friendship’ but maybe it would’ve happened anyway. Maybe it’s better this way. Though maybe all this solitude isn’t good for me. I feel I’m becoming socially inept, where before I always used to be so chilled out and friendly. Now I prefer black marks on white paper to sound waves flowing from mouth to ear. I’m going back to them now – back to the German trenches on the Western Front, the rats and the claustrophobia and the fear… This is my Friday night. My preferred Friday night. (1 September 2000)

These remarks from the summer before my first year at university exist in that borderland where a recent encroachment or accretion starts to feel like a permanent characteristic. It’s interesting to juxtapose that transitional moment with how I am now, very happy again to spend a Friday night in on my own, though probably choosing reading or viewing matter a bit more fun than Erich Maria Remarque on WWI trench warfare, and equally happy, sometimes, to go out eating, drinking, dancing, or whatever. It’s also interesting to think back to how I was long before anorexia: one of my clearest childhood memories is of tucking myself into bed on a warm light summer’s evening around twenty past eight, and looking at the white hands on my round red hot air balloon clock and asking myself, ‘how could anyone ever want to go to bed after nine o’clock?’ Nonetheless, the anorexic extremities of this inclination, aged 18, were a symptom sitting on top of a trait.

One of the biggest problems with social isolation is how it exacerbates everything else that’s wrong. At some point in the extended death throes of my first romantic relationship, there came an evening where I felt I couldn’t cope:

My hunger I suppose exacerbated it all, but I felt suddenly so unbearably alone, I knew what a complete mess I’d made of the only relationship I’ve ever had, I knew how I’ve sacrificed all human contact, all possibility of friendship, to an intellectualism which is worthless, and I knew I had no one I could possibly tell any of this to. (1 December 2001)

The friend I was living with did comfort me with tissues, but I didn’t tell her much, so she couldn’t help much. With the closest friend I made in Germany when I lived for my third undergrad year, I remember being suspicious of her friendliness at first: thinking it must be a sign of condescension or pity. I was totally wrong and left my suspicion behind quite quickly, I’m glad to say, but it’s interesting how mere lack of exposure can so quickly start perpetuating itself.

Part of this is straightforwardly physical. The less spare energy you have, the more stringent you make your criteria for expending effort; this is a simple survival mechanism. Even if you’re pushing yourself to run marathons and deplete yourself further into emaciation, you may well at the same time be miserly, without even realising it, with energy expenditure of less measurable kinds: the energy you use when you’re laughing or taking the stairs two at a time or just putting more expansiveness into any micro-action – the kind that no one may notice disappearing, because it tends to vanish so gradually, but that everyone will realize has returned once you’re well-fed again – even you.

The lack of easily overflowing energy in anorexia often contributes to the switched polarities of pleasure and duty, where fun becomes something you feel you ought to make yourself have, or relearn how to be able to, but working until you’re falling asleep feels if not exactly easy, then at least the constant default to which you revert. A few months into my first year of undergrad, when I hadn’t yet quite given up on the idea of not having a totally miserable student experience, I wrote:

I’d like to do something tomorrow night. I feel guilty at my lazy lack of sociability. I’ll regret it in my dotage – the waste of all these opportunities. But should you make yourself ‘have fun’ if you don’t particularly want to? Isn’t doing stuff only so that you’ll have things to remember just as bad as not doing them for fear you’ll regret them? Isn’t feeling compelled to live on the edge as bad as sacrificing everything for a career that might in fifty years allow you to retire in wealth and exhaustion and characterless virtue? (24 February 2001)

And in my commentary on this passage a few years later, recovering from final exams while writing a nearly unreadable anorexia epic, I reflected:

Can you have fun to order? Is it something to be learnt along with how to do without it? Or does it really come more naturally, as it seems from the language of passives that people employ – let yourself have fun, let your hair down, relax, loosen up, unwind, as if the effort were all the other way; but of course it would be the extroverts who fill the dictionaries – and the rest of us have to tense our nerves for fun, wind up the springs to socialize, deal with the irritations of wispy unbound hair, can relax when the pressure to relax abates… But can here too pretence shift into reality if practised long enough? Someone somewhere said that it’s better to regret the things you have done than the things you haven’t – but every thing done is another not done, every glass of wine is a chapter unread, there is no simple dichotomy of action and inaction, there are only the same inescapable mechanisms of value-judgement. (August 2004)

So, this is a predictably bleak take on it all. But as with so many of the knots anorexia ties you in, the reality is perfectly simple: fun can’t be fun if you have no energy to have it. In line with my earlier comments on normality earlier, there’s no particular reason why fun should have any particular definition: if fun for you is not sociable, say, that’s fine. The problem arises when fun stops meaning anything, and hard work is the only thing you do to substitute for fun.

Lack of available energy in anorexia is mental, of course, as well as physical. Sometimes this manifests as simple lethargy or stasis of mind: sluggishness of thought, inability or unwillingness to grasp new ideas or intervene effectively in a train of argument. A lot of the tiredness of anorexia is also about the state of constant mental distractedness. Early on in my illness, I told my diary,

This food thing’s beginning to scare me now; I’m always hungry, always tired – so I’m not eating enough – but I eat any more and I put on weight. I’m weighing myself every day now, I’m always thinking about food; how to avoid it or how to get it. But it’s losing me my friends, it’s even making me hate Tom [my father]. (31 May 1998)

Combined with the simple physical depletion that may manifest as hunger or tiredness or weakness or fragility, and as rigid leadenness of thought, the preoccupation with anorexic minutiae is a vast drain on any meaningful relationship. If you’re constantly rehearsing past and future calorie counts or meal components or shopping lists or exercise totals or bodyweights past and future, or have half your mind always on the sensation or the imagined appearance of your tummy against your waistband or how much of this cappuccino you can get away with not drinking, you are probably incapable of being a good interlocutor, let alone a good friend.

In a related sense, failure to be a good friend – with or without a difficulty caring about it – often arises from a loss of interest in the ordinary things that make up other people’s lives, like jobs and relationships and hobbies and travels. All these real-world ebbs and flows easily fail to feel important enough, when your mind is consumed by malnutrition and all its attendant distortions, to be worth paying attention to or feeling significant responses to. It’s easy also to fall into a more or less explicit ‘I have anorexia so I don’t need anything else’ attitude, where anything else may encompass friends as well as other relationships and interests and values. This is probably partly a convenient cover for the emotional flatness that arises as an automatic function of malnutrition: if you feel nothing, you invent reasons why it makes sense to feel nothing, and these invented reasons encourage you deeper into the state that made the invention necessary… The lack of interest may sometimes also be part of a more definitively avoidant defense mechanism: nothing is happening or changing in my life, so I don’t want to be confronted by all the things happening and changing in other people’s. the complexities of social contact can also be superficially smoothed with an overlay of anorexic thinking: Westwood et al. mention anorexia’s role as a ‘social comfort blanket’, the background obsessive thinking acting as a distractor from worrying about what others think of you.

As well as avoidance and indifference, control is another common anorexic response to other people, including friends (see Westwood et al., 2016). The control may or may not be overt. It may be a preamble to avoidance: expressing ‘preferences’ (e.g. for places or times to meet or things to do) that are so inflexible that the other person’s choice reduces to doing what you want to do or not seeing you. It may manifest in explicitly telling people how to behave (especially around food) or orchestrating events (especially around food and exercise) in line with anorexic values, whether this means getting other people to eat or do the things you want to so there’s no threat to you; or getting them to do or eat things too lazy or indulgent for you, so you can feel superior and/or vicariously gratified; or creating special exceptions for yourself and expecting others to ignore and/or accommodate them, usually without the benefit of explicit acknowledgement.

One specific way a controlling dynamic can manifest in a friendship involving anorexia is tricky to spot developing because it bears a lot of early resemblance to a healthily supportive relationship: the pseudo-therapeutic relationship. This is perhaps more common between romantic partners when one partner has a mental illness, but it can happen amongst friends too, especially if the person with anorexia has no romantic partner. There’s no hard line between the fitting contributions a caring friend makes to encouraging or supporting recovery and the friendship in which one person is a de facto unpaid therapist, coach, or carer. And as I said, the shift from one to the other is often so gradual and innocuous-seeming that it can take a while to realize that anything is wrong. But if you ask yourself ‘am I looking after this person rather than being a friend to her/him?’, and the answer is yes or maybe, there may be a problem. Friendships can sustain temporary phases of significant imbalance of help given and received, but if it feels more like dependency, and especially if there’s no sign of anything changing any time soon, you may want to do something about it, for your own sake and the sake of the person you are trying to help. Meanwhile, if both of you have an eating disorder or related condition, the likelihood is that your friendship will start to center on related matters, whether through extended conversation or frequent updates on aspects of illness or recovery. As I’ll explore in the next part of this post, this feedback loop can be constructive and it can be dangerous.

Even if only one friend has an eating disorder, that doesn’t necessarily mean everything is fine and relaxed when it comes to food and bodies. Lots of people have ‘issues’, more or less pronounced. One way some people with anorexia develop of avoiding those issues and the discomfort they entail, is by hanging out with members of the opposite sex. Two of Westwood et al.’s participants mentioned this preference, and I’ve felt it myself, ever since undergrad. One of the only things that ever manages to make me wish I were a man is being witness to close male friendships with a level of carefree, acceptant trust I’ve never observed between women, and absence of all or most of the food and body angst often feels like an enabling condition for that. But maybe I’ve just been observing the wrong female friendships, or misperceiving them, and/or idealizing the male ones.

In any case, it’s probably an empirical fact that on average, men talk less about diet- and appearance-related rubbish than women do (yes, they have their own versions of rubbish, but many of them are less toxic, and less tedious*), and that can be a blessing, in illness and especially in the precarious years of recovery. I don’t know whether the same applies in the other direction: whether for men with anorexia, it’s a relief to be amongst women because even if their chat is about calories and workouts, at least their bodies aren’t in direct competition – or whether other men would again more often be preferable low-threat companions. Back to the female case, one consequence of all this is that if you’re a heterosexual woman and do have a romantic partner, you may come to rely on him to serve the functions of friendship even more than your limited energies etc. would already dictate. And this can put strain on a relationship that shouldn’t have to be forced to be everything. For example, in my case:

My deep inherent antisociability has really become clear to me in the last few weeks. I virtually gave up all social contact because M. was all I wanted, and now I realize that I’m very much alone. I don’t have any real friends, no one I can really relax with or chat to on the phone for hours, and I know that’s my fault – I pushed people like Kylie and Gayle away, I never want to go out with Laura or with Molly. Or with M. anymore. And this Saturday night – what am I doing? Sitting in my room reading Shakespeare. And the only person who’s rung me is my English teacher. And during dinner, full of anecdotes and laughter, I uttered maybe five sentences, and not sparkly gems either. I watched them getting drunk and could only criticise and mock them. But I’m no better. I’m worse – at least they’re amusing other people with their well-rehearsed stories and mannerisms. (8 July 2000)

Reflecting on my own friendships with men during my illness, I wonder whether there was also a weird sort of efficiency drive going on too. I enjoyed several in-between not-quite-platonic-but-pretty-sure-that-neither-of-us-would-ever-act-on-it friendships with men, and maybe part of what I enjoyed, beyond the liminality itself, was the sense of filling two gaps at once. Maybe those friendships allowed me to enjoy the mutual validation of physical and intellectual attractions, and so make up, with a double pleasure, for the distinct absence of any social pleasure at all most of the time. Perhaps there was also an element of reassurance there too: despite it all, men still want to hang out with me. (Why I rarely felt the need to reassure myself that of women, I don’t know/see above.)

So, these are some of the ways anorexia can shape how and whether friendships survive. In the next part of this series, I explore the opposite version of cause and effect: how existing friendships can change the course of an illness.

You can read part three of this four-part series here.

* My partner’s response: ‘I wouldn’t go that far. [S] is coming over today and our plan is to watch a baseball game (~3 hours) and then a football game (~2 hours) from the viewing point of a barstool.’


Westwood, H., Lawrence, V., Fleming, C., & Tchanturia, K. (2016). Exploration of friendship experiences, before and after illness onset in females with anorexia nervosa: A qualitative study. PLoS One, 11(9), e0163528. Open-access full text here.