Background: Social difficulties in eating disorders can manifest as predisposing traits
and premorbid difficulties, and/or as consequences of the illness.
Objective: The aim of this paper is to briefly review the evidence of social problems in people with
eating disorders and to consider the literature on treatments that target these features.
Method: A narrative review of the literature was conducted.
Results: People with eating disorders often manifest traits, such as shyness, increased tendency to
submissiveness and social comparison, and problems with peer relationships before illness onset.
Further social difficulties occur as the illness develops, including impaired social cognition and
increased threat sensitivity. All relationships with family, peers and therapists are compromised by
these effects. Thus, social difficulties are both risk and maintaining factors of eating disorders and
are suitable targets for interventions. Several forms of generic treatments (e.g. interpersonal psychotherapy,
cognitive analytic therapy, focal psychodynamic therapy) have an interpersonal focus and
show some efficacy. Guided self-management based on the cognitive interpersonal model of the
illness directed to both individuals and support persons has been found to improve outcomes for all
parties. Adjunctive treatments that focus on specific social difficulties, such as cognitive remediation
and emotion skills training and cognitive bias modification have been shown to have a promising
Conclusion: More work is needed to establish whether these approaches can improve on the rather
disappointing outcomes that are attained by currently used treatments for eating disorders.