Several features of bulimia nervosa make it very hard to spend appreciable time with others. When an individual who suffers from the binge-purge cycle finds no way out of a social meal, she tends to sit down with others and eat but feel tormented by the questions of where and when she’ll purge. Were she to venture on a slightly longer outing, such as an overnight, the logistics of her bulimia (how, when, and where to obtain food, binge eat, and purge) would likely be problematic. To engage in these habits around friends who know about her disorder is embarrassing, but being furtive is also a strain.

Furthermore, the inordinate amounts of time involved in planning and engaging in the behaviors leave the individual limited opportunities to take in anything else about the outing. In the long run, a person with an eating disorder often considers social eating such a burden that she gives it up completely.

You’ll want to explore with your child which friends, if any, she would feel comfortable with. Are some social situations more feasible for her than others? In any event, dialogue about socializing is potentially a difficult one for both you and your child, so pace it, offering her ongoing reassurance and ending each discussion on as positive a note as possible.

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David B. Herzog, M.D., Debra L. Franko, Ph.D., Pat Cable, RN

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David B. Herzog, M.D., is the Harvard Medical School Endowed Professor of psychiatry in the field of eating disorders at Massachusetts General Hospital and the director of the Harris Center at Massachusetts General Hospital.
Debra L. Franko, Ph.D., is a professor in the Department of Counseling and Applied Educational Psychology at Northeastern University and the associate director of the Harris Center at Massachusetts General Hospital
Pat Cable, RN, is the director of publications at the Harris Center.