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Social Anxiety and Peer Relationships Predict Weight Recovery in Adolescent Onset Anorexia Nervosa.

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Title: Social Anxiety and Peer Relationships Predict Weight Recovery in Adolescent Onset Anorexia Nervosa.
Authors: Burmester, Victoria (AUTHOR), Cini, Erica (AUTHOR), Baksh, Tahmida (AUTHOR), Julius, Nikita Catalina (AUTHOR), Chung, Keziah (AUTHOR), Nicholls, Dasha (AUTHOR)
Source: European Eating Disorders Review. May2026, Vol. 34 Issue 3, p655-662. 8p.
Subjects: Anorexia nervosa treatment, Pearson correlation (Statistics), Research funding, Secondary analysis, Body mass index, T-test (Statistics), Affinity groups, Questionnaires, Multiple regression analysis, Mann Whitney U Test, Descriptive statistics, Social skills, Convalescence, Interpersonal relations, Data analysis software, Social anxiety, Weight gain, Psychosocial functioning, Adolescence
Geographic Terms: England
Abstract: Background: Adolescence is period of social change during which peer relationships are prioritised. The desire for social approval, which heavily influences behaviour, is often linked to an increased risk of developing an eating disorder (ED). Social cognition is impaired in ED and both autism and social anxiety frequently co‐occur. It is difficult to disentangle the contributing factors of cognitive and interpersonal difficulties in adolescents who present at children's ED services, and whether these relate to treatment response. We investigated whether baseline social measures predicted early treatment response after the initial 6‐month period. Methods: Adolescents aged 12–16 years (N = 983) treated by children's community ED services in England, UK, between 2017 and 2023, completed the Revised Child Anxiety and Depression Scales (RCADS) and/or the Strengths and Difficulties Questionnaire (SDQ) at assessment. Early weight restoration, defined as reaching at least 85% median‐BMI adjusted for age and sex, at 6 months, was the primary outcome. A multiple linear regression was conducted using three measures: RCADS' Social Phobia, SDQ's Peer Problems and SDQ's Prosocial Behaviour to predict the degree of early weight restoration (85%medBMI), which was the primary outcome. Results: The combined baseline social predictors: social phobia (standardised β = −0.382), peer problems (standardised β = −0.118) and prosocial behaviour (standardised β = −0.105) explained 20% of variance in weight restoration at 6‐months post assessment (p < 0.001). Individual predictors regressed to %mBMI, were not moderated by age, with peer problems negatively predicting weight at 6 months and prosociality scores demonstrating significant skew because self‐rated scores were high. Exploratory analyses showed that social anxiety was greater in those who did not reach early weight recovery at 6‐months post assessment. Conclusions: Assessing and addressing difficulties in social/peer group functioning might be a central consideration in treatment for AN in adolescents. Further research is needed to better understand the role of social functioning in recovery from AN. Highlights: Baseline social functioning significantly predicts early weight recovery in adolescents with anorexia nervosa (AN): A combined model incorporating social anxiety, peer problems, and prosocial behaviour explained 20% of the variance in weight restoration at 6 months, with social anxiety and peer difficulties emerging as significant negative predictors.Peer problems independently and consistently predicted poorer weight outcomes: Across both combined and individual regression analyses, higher peer difficulties were associated with reduced likelihood of achieving early weight recovery, underscoring the importance of peer dynamics in treatment response.Prosocial behaviour showed a complex relationship with recovery: While higher prosociality was associated with better outcomes in the combined model, it paradoxically predicted lower weight gain when analysed independently, likely due to ceiling effects in self‐report measures, suggesting limitations in current assessment tools. [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Background: Adolescence is period of social change during which peer relationships are prioritised. The desire for social approval, which heavily influences behaviour, is often linked to an increased risk of developing an eating disorder (ED). Social cognition is impaired in ED and both autism and social anxiety frequently co‐occur. It is difficult to disentangle the contributing factors of cognitive and interpersonal difficulties in adolescents who present at children's ED services, and whether these relate to treatment response. We investigated whether baseline social measures predicted early treatment response after the initial 6‐month period. Methods: Adolescents aged 12–16 years (N = 983) treated by children's community ED services in England, UK, between 2017 and 2023, completed the Revised Child Anxiety and Depression Scales (RCADS) and/or the Strengths and Difficulties Questionnaire (SDQ) at assessment. Early weight restoration, defined as reaching at least 85% median‐BMI adjusted for age and sex, at 6 months, was the primary outcome. A multiple linear regression was conducted using three measures: RCADS' Social Phobia, SDQ's Peer Problems and SDQ's Prosocial Behaviour to predict the degree of early weight restoration (85%medBMI), which was the primary outcome. Results: The combined baseline social predictors: social phobia (standardised β = −0.382), peer problems (standardised β = −0.118) and prosocial behaviour (standardised β = −0.105) explained 20% of variance in weight restoration at 6‐months post assessment (p < 0.001). Individual predictors regressed to %mBMI, were not moderated by age, with peer problems negatively predicting weight at 6 months and prosociality scores demonstrating significant skew because self‐rated scores were high. Exploratory analyses showed that social anxiety was greater in those who did not reach early weight recovery at 6‐months post assessment. Conclusions: Assessing and addressing difficulties in social/peer group functioning might be a central consideration in treatment for AN in adolescents. Further research is needed to better understand the role of social functioning in recovery from AN. Highlights: Baseline social functioning significantly predicts early weight recovery in adolescents with anorexia nervosa (AN): A combined model incorporating social anxiety, peer problems, and prosocial behaviour explained 20% of the variance in weight restoration at 6 months, with social anxiety and peer difficulties emerging as significant negative predictors.Peer problems independently and consistently predicted poorer weight outcomes: Across both combined and individual regression analyses, higher peer difficulties were associated with reduced likelihood of achieving early weight recovery, underscoring the importance of peer dynamics in treatment response.Prosocial behaviour showed a complex relationship with recovery: While higher prosociality was associated with better outcomes in the combined model, it paradoxically predicted lower weight gain when analysed independently, likely due to ceiling effects in self‐report measures, suggesting limitations in current assessment tools. [ABSTRACT FROM AUTHOR]
ISSN:10724133
DOI:10.1002/erv.70056