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The Silent Suffering of Eating Disorders

Eating disorders, trust, and social withdrawal syndrome

By Ken J. Rotenberg1 and Pamela Qualter2

By the age of 20, 15 percent of women have an eating disorder, including anorexia nervosa (.08 percent), bulimia nervosa (2.6 percent), and binge eating disorder (3.0 percent) (Stice, Marti, & Rohde, 2013). The prevalence of eating disorders in men is considerably less (about 50 percent less).

Anorexia nervosa involves the successful pursuit of weight loss to achieve a body mass index that is less than 85 percent of the median expected for age and gender. Individuals with this disorder engage in a severe and selective restriction of food intake, and they refuse to eat what they view as fattening foods. Anorexia nervosa is associated with depression, irritability, impaired concentration, loss of sexual appetite, and obsessive behavior (Fairburn & Harrison, 2003).

Bulimia nervosa entails attempts to restrict food intake that are punctuated by repeated binges. Binges are episodes in which individuals experience a loss of control and consume a large amount of food. During these binges, individuals experience intense distress, including shame. Some individuals with bulimia nervosa purge themselves from their overconsumption of food by vomiting and using laxatives (Fairburn & Harrison, 2003). Research shows that compared to the public at large, people with these eating disorders show greater social impairment (e.g., poor family relationships, poor work performance), psychological problems (e.g., depression, loneliness), suicidal tendencies, and mental health issues (see Spoor et al., 2007).

It is disheartening to report that there is evidence that people with eating disorders suffer in silence. Researchers have found that people with eating disorders: (1) hold low trust beliefs in others (Rotenberg, Bharathi, Davies, & Finch, 2013), (2) show an unwillingness to disclose personal information to others, notably about eating (e.g., Basile, 2004), and (3) show elevated loneliness (e.g., Coric & Murstein, 1993). These patterns are presumably part of the shame that people with eating disorders experience regarding their eating behavior (see Swan, & Andrews, 2003). We refer to this as social withdrawal syndrome, and we believe that it places those with eating disorders at risk for social, mental, and physical health problems.

We have found that bulimia nervosa (as indexed by bulimia symptoms) is linked to social withdrawal syndrome — and notably to low trust beliefs. In one study (Rotenberg et al., 2013), we tested 137 young adults and found that bulimic symptoms were associated with low trust beliefs in close others (mother, father, and friends), an unwillingness to disclose personal information to them, and high loneliness. Furthermore, we found that there were close links between these variables. This supports the conclusion that low trust beliefs in close others are associated with an unwillingness to disclose personal information to them, which promotes loneliness and bulimic symptoms. In a follow-up study (Rotenberg & Sangha, 2014), we tested a group of 101 early adolescents (11 to 12 years of age) across a five-month period. We found that the adolescents’ low trust beliefs in close others (mother, father, and friends) predicted an increase in their bulimic symptoms over time, and that relation was due, in part, to the relation between low trust beliefs in close others and loneliness. These findings support the hypothesis that having bulimia nervosa is attributable, in part, to a person holding low trust beliefs, and a resulting unwillingness to disclose to others and experiences of loneliness.

Are there health problems associated with being lonely? Human beings are social animals and experience pain and distress when they are separated from others (Baumeister & Leary, 1995). They have an inherent need to belong to social groups — and therefore need human contact and close relationships. When those needs are not met — and people experience loneliness — they show mental health difficulties and physical health problems, including increased mortality (see Hawkley, & Cacioppo, 2010; Qualter et al., 2013). Because those with eating disorders experience loneliness as part of their social withdrawal syndrome, they are disposed to those problems. Our research directly shows that loneliness contributes to eating problems (Rotenberg & Flood, 1999). In our study, we increased the extent to which participants felt loneliness by asking them to imagine being in situations that lead to that mood. Some participants were not exposed to that mood-inducing instruction. Afterwards, the participants had the opportunity to consume food (cookies) as part of a taste test. We found that dieters consumed more food when they had experienced loneliness as compared to dieters who had not. The findings show that experiencing loneliness caused a form of binge eating in persons who normally restrain their food consumption (i.e., dieters). We propose that loneliness contributes to bulimia nervosa in particular, because it causes individuals to experience a loss of control over their eating behavior (Rotenberg et al., 2005), and this intensifies the food binges which are part of the disorder (Rotenberg & Flood, 1999).

Does social withdrawal syndrome pose a problem for those with eating disorders? As noted, the loneliness experienced by those with eating disorders predisposes them to a wide range of social and health problems. We have proposed that social withdrawal syndrome, specifically the unwillingness to disclose personal information to others, results in the tendency for them not to seek out psychological and medical treatment. Accordingly, those with eating disorders are unlikely to tell other people, such as close others and doctors, about their eating problems — as well as the accompanying social and health problems — and therefore do not receive the treatment they require (Rotenberg et al., 2013). If you have an eating problem, we strongly encourage you to overcome your social withdrawal syndrome and seek out help. Please do not suffer in silence.

Affiliations and Acknowledgments

1 Professor Ken J. Rotenberg, School of Psychology, Keele University, Keele, Newcastle -Under-Lyme, Staffordshire, UK, ST5 5BH, e-mail:

2 Dr. Pamela Qualter, Reader in Developmental Psychology, School of Psychology, University of Central Lancashire, Preston, UK, PR1 2HE, email:

The authors thank Professor James Hartley (Keele University) for his assistance in writing this blog.


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