Stress, Social Support, Coping, and the Recovery of Eating Disorders

BY:  Shuyang Yao

DATE: April 22, 2016

Too much stress is usually considered not good for us. For someone trying to recover from an eating disorder, it may play a role in relapse. For example, a research study that monitored 117 females with an eating disorder for six years found that negative stressful life events increased the risk of relapse.1 The study examined the occurrence of negative and positive life events in different domains including work, school, social/friendship, love, family, health, and finances. They found that the total number of stressful negative life events significantly predicted relapse. Among all the domains, social/friendship and work related stressful life events were the strongest predictors: the risk of relapse was tripled for women with stressful life events in work or social/friendship compared with women without such life events.

Stress-related factors might not only increase the risk of relapse, but also play a role in the risk for developing an eating disorder in the first place. From the patient’s perspective, interpersonal features of family functioning and stress were in the top-three perceived risk factors for an eating disorder.2

On the contrary, factors that reduce stress levels, such as adequate and appropriate social support, may facilitate recovery from eating disorders. Social support is defined as “the perception or experience that one is loved, cared for, esteemed, and valued by others and part of a social network of mutual assistance.”3,4 In a research study investigating perceived contributors to recovery from anorexia nervosa (AN) in women recovered from AN, researchers found that having a supportive relationship was the top factor perceived as contributing to their recovery. Having a supportive friendship was also perceived as a positive factor for recovery.2 Additionally, an improvement in interpersonal relationships has also been observed during the road to recovery from an eating disorder. The researchers who found this improvement in relationships proposed that such improvement may be related to relatives’ and/or friends’ positive responses or “warm” reactions when the patients have made visible changes, such as weight restoration or the cessation of extreme eating behaviors—which might decrease feelings of loneliness and offer the support needed to overcome an eating disorder.5

If we consider social support from others as an external factor (a factor that is external to the individual), coping strategies to manage stress or negative affect could be considered as internal factors (factors that “comes from” an individual). Generally, coping strategies can be categorized in three ways: 1) task-oriented coping, marked by efforts to solve the problem; 2) emotion-oriented coping, emphasizing self-oriented reactions such as “emotional responses, self-preoccupation, and fantasizing;” and 3) avoidance-oriented coping, involving efforts to avoid stressful situations.4,6 If stressful negative life events can play a role in eating disorder relapse, then having effective coping skills to manage these negative events may avert relapse. For example, one research study examining the impact of type of coping skills used on eating disorder symptoms in women with a current eating disorder or recovered from an eating disorder found that females who reported high levels of anxiety and frequent use of emotion-oriented coping had higher levels of eating disorder symptoms than females who had high levels of anxiety and lower use of emotion-oriented coping strategies.4 In contrast, emotion-oriented coping had no impact on the frequency of eating disorder symptoms in women who did not also report high levels of anxiety. This could suggest that learning new coping skills, for women with an eating disorder who tend to use emotion-based coping strategies, could aid in recovery. Importantly however, all individuals are unique, and this study is a good example illustrating that coping strategies should be carefully considered within the context of the unique characteristics of each individual in order to facilitate recovery as coping strategies that work for one, may not work for another. Importantly, this study looked only at women, we do not know if the same results would emerge for men with eating disorders.


  1. Grilo CM, Pagano ME, Stout RL, et al. Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes. Int J Eat Disord. 2012;45(2):185-192.
  2. Tozzi F, Sullivan PF, Fear JL, McKenzie J, Bulik CM. Causes and recovery in anorexia nervosa: the patient’s perspective. Int J Eat Disord. 2003;33(2):143-154.
  3. Willis TA. Social support and interpersonal relationships. In: Clark MS, ed. Prosocial behavior. Newbury Park, CA: Sage; 1991:265-289.
  4. Fitzsimmons EE, Bardone-Cone AM. Coping and social support as potential moderators of the relation between anxiety and eating disorder symptomatology. Eat Behav. 2011;12(1):21-28.
  5. Harney MB, Fitzsimmons-Craft EE, Maldonado CR, Bardone-Cone AM. Negative affective experiences in relation to stages of eating disorder recovery. Eat Behav. 2014;15(1):24-30.
  6. Endler NS, Parker JDA. Coping inventory for stressful situations (CISS): Manual. Toronto, Canada: Multi-Health Systems; 1990.