Running head: EATING DISORDERS AND THE IMPACT OF FRIENDSHIPS 1

The Psychological Impact of Friendships Between Young, Eating Disordered Women.

A Literature Review

Ashley Sefcik (Groves)

San Jose State University

Psychology 100W-01

Joanna Fanos, Ph.D.

Running head: EATING DISORDERS AND THE IMPACT OF FRIENDSHIPS 2

Abstract

Individuals with eating disorders are highly vulnerable to the peer and social influence that

surrounds them. This review focuses on both the negative and positive effects of friendship

networks on individuals suffering from an eating disorder and when they are recovering from an

eating disorder. For young women, body image and body weight are highly susceptible to peer

influence. Social interaction becomes increasingly difficult, resulting in the formation of new

friend groups based on weight and appearance beliefs and attitude. The friend groups developed

from these beliefs form a competitive atmosphere when weight control issues arise. Although the

competitive nature of friends and negative social influences surround young women, positive

outcomes have also come from developed friendships. When in treatment, in-patient and out-

patient, group therapy and the purposeful development of friendships helps individuals identify

issues and help them feel safe in working towards recovery goals. There is a transition from

friends negatively affecting eating disordered sufferers to becoming a support system for those

young individuals. A case example is presented to demonstrate the volatile relationship that can

develop between young, eating disordered women in competitive friendships.

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The Psychological Impact of Friends Between Young, Eating Disordered Women

Case Example

In strong friendships, a great deal of trust and security is instilled upon the individuals

and their bond. When the trust leads to secrecy between eating disordered individuals, the

outcome can be detrimental. As in the case of Sonya and Amanda, the closely formed friendship

caused severe damage when a “diet buddy” plan went wrong and transformed into an ill

competition to be thinner than each other.

Naturally the girls knew each other well and were good friends as they had played sports

together for years. In their first year of high school they made the same team, had the same

classes, and had the same friends. In the early weeks of school the two started to spend more

time together and eventually voiced concern over how they looked and began scrutinizing over

their bodies in comparison to the team. Both felt much larger than each other and the team so

they started to diet slowly. As their body dissatisfaction worsened they began to try extreme

dieting methods including starvation, vomiting after eating, laxative use, and excessive exercise

on top of their already rigid athletic schedule.

What started as a simple diet quickly turned into the two girls losing as much weight as

they could but still able to remain on their sports teams and stay in school. After a while, losing

weight was not enough and their situation began to worsen. Soon they felt inferior to each other

and started to push harder to lose more weight. Both frequently voiced jealously over the other

but continued to diet together as they were each other’s encouragement to keep going. At that

time, they also began to secretly workout and diet to more extreme measures when they were not

around each other.

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The struggle to be thinner and better than each other became increasingly dangerous and

finally lead to Amanda’s hospitalization. After having lost more than 25% of her body weight,

Amanda collapsed. The intense pressure to be thin and the competition between Amanda and

Sonya were detrimental to their health. Several weeks after Amanda’s hospitalization, Sonya

was hospitalized as well for similar health related issues.

The friendship and secrecy developed between them ignited their competitive drive.

Their case illustrates the negative effects that friendships can have on young women with body

image issues and body dissatisfaction. Their disorders were volatile and drove each other to

extremes causing serious medical and mental harm.

Introduction

Every year the prevalence of eating disorders increases, effecting thousands of women all

over the world. Body dissatisfaction, dieting, and body image issues have become especially

common in young women as they are bombarded with the media and other social influences that

reflect being thin and beautiful as being better. As young women grow and develop friendships,

peer influence becomes another factor as body dissatisfaction can influence the need to diet and

develops a competitive nature between young women.

While the developed friendships can create a competitive atmosphere between young

women and can worsen the cycle of the eating disorder, friendships and friendship networks

developed in treatment can provide motivation to successfully recover. Attitudes about body

image and weight have a direct influence on eating disordered individuals and the friendships

between those individuals could make the difference between worsening the disorder and aiding

in recovery from the disorder.

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Friendships in Adolescence

During the early adolescent years, individuals begin forming their friend networks and

the primary groups they associate with. This time period is consequently filled with the need to

be accepted, making it a vulnerable time for adolescents (Woelders, Larsen, Scholte, Cillessen,

& Engles, 2010). At this time, the modeling of ones’ peer group is also highly influential on the

development of the group and the friend interactions. As explained by Woelders, et al. (2010), it

may be a reciprocity in peer influences that is communicated via interaction with each other.

Adolescence is a delicate stage and there is much importance in creating friend networks.

Individuals look to friends to help them in understanding the physical and mental changes they

are all going through and act as a support for each other. Much of this support is also needed as

adolescents are caught at an in-between stage of being treated like a child and treated like an

adult (Berndt, 1982). While adolescents are beginning to develop their own individual identity

away from their parents, their newfound identity also relies on the intimate friendships they

form. Berndt (1982) addresses that adolescents have concern in areas of self-disclosure and

chose to form intimate friendships with other individuals based on their ability to feel as though

they can talk about anything without fear of being judged.

Negative Effects of Friendships

Social Media Influences

Over the last several decades the pressure to be thin has increased with the influence of

the media. Everyday young women are bombarded with images of ideal beauty and how they

“should” look. Our magazines, television shows and commercials all provide the influence that

we need to be thin to be beautiful and successful. Young girls are now growing up with the idea

that they have to be thin to be accepted in society and that they will not be successful if they are
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not thin or beautiful. Socio-cultural influence in western cultures emphasizes appearance as a

factor in ones social relations. As something that is idealized early on, we are teaching young

girls and women that “fat is bad and thin is good” (Griffiths & McCabe, 2000, p. 302).

The constant societal pressure to be thin is influencing young individuals and their peer

groups. The idea of being thin has become a cultural norm and is now about acceptance. This

translates to young women as needing to be thin to be popular or have friends. This persuasion

is leading to changes in eating behaviors and weight related behaviors (Eisenberg, Neumark-

Sztainer, Story, & Perry, 2005). The fear of fat and the obsession over being thin is an idea

being planted earlier and earlier in the minds of girls and young women. Many young models,

television and movie stars are being sexualized, getting thinner, and are increasingly idolized by

adolescents. In doing so, the idea of thin meaning acceptance is only being reinforced and

accepted as a norm itself.

Peer Groups and Friend Influences

As the idea of thin equating to beauty and success has become a socio-cultural norm, it

influences young women about how they perceive their body and weight. It has been identified

that there is peer influence between cliques in regards to body image, attitudes and eating

behaviors among young women (Hutchinson & Rapee, 2007). It has also been found that there

are ties to friend groups from the same age and sex. Rayner, Schniering, Rapee, Taylor, and

Hutchinson (2013) reported that much of the ties between these friend groups held the same

ideas and beliefs on body dissatisfaction and dieting. It was also found that there was internal

consistency with levels of self-esteem reported by the individuals from these groups.

Similarly, it has been found that actual eating disordered behaviors like binge eating and

purging, the use of diet pills and laxatives can be influenced by the individuals friend groups and
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cliques (Eisenberg et al., 2005; Hutchinson, Rapee, & Taylor, 2010). If the individuals friend

group is supportive of the behavior or lacks in judgment towards the eating disordered behavior

then the individual is likely to continue. While individuals seek out the comfort and safety of

friends the fear of being judged by their appearance encourages a “drive for conformity” (p.66)

between young girls (Mueller, Pearson, Mueller, Frank & Turner, 2010). With the social

conformity and the acceptance of negative behaviors, eating disordered behaviors are becoming

a common occurrence in adolescent girls (Eisenberg &Neumark-Sztainer, 2010).

Ironically, the same friends and friendship networks that encourage the negative behavior

can cause further alienation and isolation. The same behaviors that cause individuals to seek

each other out and form friendships will also lead to worsened behaviors because of the

competitiveness and/or the need to be accepted based on physical appearance. Other

explanations of this behavior are the potentially increased social anxiety and friendship conflict

that could develop over the negative behaviors (Schutz & Paxton, 2007).

Positive Effects of Friendships

As eating disorder treatments evolve and improve, the importance of friendships in and

out of recovery has been demonstrated. Recovering from an eating disorder can be a very

difficult task and require the assistance and support of many people including therapists,

physicians, family and friends. Friendships have been found to be an important aspect in

recovery as they not only provide support and understanding, but they also encourage the

development of self-esteem (Geller, Cassin, Brown, & Srikameswaran, 2009). It was also found

that friendship ties are one of the key factors associated with being ready for recovery and to

change the negative habits and behaviors.

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Typically, individuals with eating disorders have social issues with interactions, forming

new friends, having competitive friends, etc. As addressed in an article written by Davies

(2004), friendships are an important part of being young and are especially important for young,

eating disordered individuals going through treatment programs. Aside from potentially

competitive friendships, many individuals with eating disorders become isolated, losing contact

with people they were once close with. The idea of developing healthy friendships and having

group therapy is to give individuals a group support system and to extinguish isolated behaviors.

Not only does having a positive and healthy friend relation give support and self-esteem, but it

also rebuilds social skills and helps improve social interaction (Davies, 2004).

When eating disorders such as anorexia nervosa and bulimia nervosa increase levels of

social anxiety and isolation (Schutz & Paxton, 2007), re-establishing the form of security that

comes with friendships can increase the likelihood of a successful recovery from an eating

disorder. In times when relapse may occur, there is someone to reach out to for help.

Friendships are major factors in ones feelings of social acceptance and self-worth (Gerner &

Wilson, 2005). So while it was said earlier that this idea of acceptance could lead to the

worsening of eating disorders, it can also help if appropriately guided. In the instance of group-

work and friendships, an appropriate connection is made between individuals. Rather than a

degrading friendship that leaves an individual fighting for acceptance, there is a supportive, and

healthy friendship that encourages self-acceptance.

Group Therapy

Group therapy as a part of recovery, has been found to be helpful to individuals in both

out-patient and in-patient settings. Between individuals there is confidentiality, similar or shared
Running head: EATING DISORDERS AND THE IMPACT OF FRIENDSHIPS 9

problems, many common understandings, support from the group, and the ability to recognize

and learn from each other’s issues (Pomerantz, 2013).

The interpersonal relationships formed in group therapy allow individuals to reflect on

their own and on other members’ behaviors. The commonalities between members in group

therapy aid in the understanding of each other and help them work together, as well as learn as

individuals. Having a range of relationships in group therapy also provides multiple outlooks on

issues at hand and helps the individuals realize problems they may not have acknowledge before

they were a part of group therapy (Pomerantz, 2013).

Day treatment programs that primarily include group therapy have also shown significant

positive effects in the treatment of eating disorders. Rigorous treatment programs like this have

successfully shown increases in an individual’s recovery in areas of self-esteem, self-concept,

social anxiety, and overall behavior (Lazaro et al., 2010).

Conclusion

While many people never think twice about closely formed friendships, for those with

eating disorders it could mean the difference between life, death, and recovery. There are many

negative factors that come out of competitive friendships between individuals including the drive

to diet more and be better than the other and the need to be socially accepted among their peers.

Negative friendship influences severely compromise rational thinking, especially when

the media and other socio-cultural influences reinforce those thoughts and behaviors. While

friendships and friend groups can have such detrimental influence over the health of eating

disordered young women, friendships developed can also have a very positive outcome. Positive

friendships can aid in therapy and recovery and can help rebuild the self-esteem that young
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women need to recover from their disorder. The beneficial outcome gives individuals a strong

supporting background for encouragement through their recovery.

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References

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