Eating disorder behaviors go hand in hand with increased social isolation and social withdrawal, loss of interest in previously enjoyed activities and a negative impact on self-esteem. The individual develops a primary relationship and identity with the eating disorder, therefore making the individual's world much smaller and not leaving time and energy for other people or activities. As the illness progresses and symptoms intensify the individual tends to withdraw more. Individuals with eating disorders will seek to avoid eating whenever possible and this includes avoiding situations where it would be expected that they eat, i.e. family functions, meals, social gatherings and at the same time demonstrate a preoccupation with food.
These symptoms are also associated with malnourishment, even without weight loss, and in all humans as seen in the Minnesota Semi-Starvation Study.
Parents should be on alert for seemingly plausible but frequent explanations to get out of eating with the family, like "I ate before coming home," "I'm meeting my friends for dinner," "I'm not hungry," "I ate a really big lunch," "I'll eat later." Negative body image, guilt, shame and self discontent contribute to isolation and social withdrawal. These are often expressed as "feeling fat" or by them believing that they are undeserving of having fun, going out, getting dressed.
Part of the recovery process is directly confronting the feared/avoided behaviors by planning exposures in advance to promote success, i.e. planning a social eating opportunity in advance with treatment providers, adding accountability, discussing plan of action and having follow up and later identifying ways to generalize this to other situations.
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