Common Threads of Social Anxiety and Bulimia

Article Contributed by Staff of The Meadows Ranch

one sad woman sitting on the floor with social anxietyMeeting new people, giving presentations and socializing with friends are typical, every-day activities for many individuals. Normal reactions to upcoming events can range anywhere from happy anticipation to stress over what to wear to fear of embarrassing ourselves. Yet even when afraid of failure, we are able to manage our feelings and “get out there.”

For over 15 million American adults who have social anxiety disorder, the extreme fear of being scrutinized by others in social situations can severely reduce the overall quality of life. Social Anxiety Disorder means that someone’s brain is not working correctly, and the result is that feelings of stress, discomfort and danger are provoked by what others consider normal activities (and sometimes by simply thinking about or planning these activities). The experience can be so extreme that it becomes unbearable, paralyzing, or so painful that the individual prefers to avoid any possible encounters completely. [1]

Social anxiety is a type of anxiety disorder that typically begins in childhood or adolescence. The level of anxiety that is experienced with this mood disorder often lead to significant interference with daily routines, making it challenging to attend school, go to work, develop a career, or engage in relationships.

What is the Connection with Bulimia?

Bulimia stems from a habitual feeling of regret after eating that is out of proportion with reality. If a child swallows certain poisons, we are told to induce vomiting to save his or her life. An individual with Bulimia may feel just as strongly that he or she needs to “get rid of” regular food, even though there is no danger.

For some individuals who are susceptible to eating disorders, social anxiety can trigger one of these mental illnesses, such as bulimia nervosa. Maladaptive eating behaviors, such as binging and purging, may develop as an attempt to cope with and manage the intense anxiety that is experienced with social anxiety.

Social Anxiety Came First

businesswoman writing about social anxietyIn one study of women with eating disorders, 1 of every 8 women with Bulimia also had Social Anxiety Disorder. [3] The majority reported that their Social Anxiety Disorder came first, suggesting that the overactive fear system in the brain that makes social situations seem frightening and dangerous also makes eating seem dangerous.

The Fear of Negative Evaluation

Another connection between Social Anxiety Disorder and Bulimia is “Fear of Negative Evaluation” – the worry that others will not like you. Fear of Negative Evaluation can cause overeating, a situation which someone with Bulimia might mistakenly interpret as dangerous and requiring immediate attention. [4]

Social Appearance Anxiety

A third connection is “Social Appearance Anxiety” – the worry that others will not like you specifically because of how you look. As a group, individuals with Bulimia have higher Social Appearance Anxiety than normal [5]. Excessive worry about appearance, size, shape or weight (or all of the above), can lead to dieting and other dysfunctional eating behaviors that can then lead to bulimia.

Body Surveillance

Young woman walking fighting social anxietyA fourth link is “Body Surveillance” – excessive checking to see if unwanted changes have occurred in your appearance.

Using a scale several times a day or checking a mirror so often that it interferes with your day are examples. [6]. Fear of Negative Evaluation, Social Appearance Anxiety, and Body Surveillance all occur in both Social Anxiety Disorder and Bulimia.

What Do I Do?

If you are struggling with either of these conditions or are unsure where to turn, please reach out for professional help. Online options may be available if you are unable to leave home for appointments. Bulimia and Social Anxiety Disorder can both be successfully treated with a combination of medication, nutritional therapy, and counseling.

Article Contributed by Staff of The Meadows Ranch:

For over 25 years, The Meadows Ranch has offered an unparalleled depth of care through its unique, comprehensive, and individualized program for treating eating disorders and co-occurring conditions affecting adolescent girls and women. Set on scenic ranch property in the healing landscape of Wickenburg, Arizona, The Meadows Ranch allows for seamless transitions between its structured multi-phase treatment. A world-class clinical team of industry experts leads the treatment approach designed to uncover and understand the “whys” of the eating disorder through a host of proven modalities. Providing individuals with tools to re-engage in a healthy relationship with food – and with themselves – disempowers eating disorders and empowers individuals with a renewed enthusiasm for life. Contact us today at 888-496-5498 and find out why The Meadows Ranch is the best choice for eating disorder treatment and recovery. For more information call 1-888-496-5498. or visit


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
  3. W. Kaye, C. Bulik, L. Thornton, N. Barbarich, K. Masters. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004; 161:2215–2221.
  4. C. Levinson, T. Rodebaugh. Negative social-evaluative fears produce social anxiety, food intake, and body dissatisfaction: Evidence of similar mechanisms through different pathways. Clinical Psychological Science, 2014.
  5. A. Dakanalis, M. Clerici, M. Caslini, L. Favagrossa, A. Prunas, C. Volpato, G. Riva, M.A. Zanetti. Internalization of sociocultural standards of beauty and disordered eating behaviours: the role of body surveillance, shame and social anxiety. Journal of Psychopathology 2014;20:33-37.
  6. A. Koskina, F. Van den Eynde, S. Meisel, I.C. Campbell, U. Schmidt. Social appearance anxiety and bulimia nervosa. Eating and Weight Disorders. 2011;16: e142–e145.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Published August 22, 2017
Edited & Updated on August 22, 2017 by Crystal Karges, RD
Recently Reviewed By: Jacquelyn Ekern, MS, LPC on July 2, 2018
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