Over the course of her eating disorder journey, Equip Peer Mentor Jamie Drago encountered a variety of challenges, but some were more surprising than others. One particular struggle Drago faced is not at all uncommon for those with eating disorders, though she was caught off guard by how difficult it was to overcome: the fear of eating in front of others.

“At certain times during my eating disorder, I worried what others might think of the types of foods I was choosing, or I’d assume that my own anxiety about the content of food must be what others were thinking as well,” Drago says. “Sometimes being around peers that weren’t eating at that time or seeing them eat certain foods were my biggest struggles, as I had a really hard time with comparison in all areas of my life.”

While there are many reasons that a person in the midst of eating disorder recovery might feel uneasy eating in front of others, Drago believes her fear was driven by the desire to emulate those around her. “Oftentimes, I felt like I didn’t know what a ‘normal’ or ‘right’ amount of food was for one sitting, which caused me to get in my head with an anxiety spiral, and the fear of having to sit with that anxiety was enough to make me want to avoid it altogether,” she says.

While this fear is quite common for those struggling with or recovering from an eating disorder, it can be addressed and overcome with the right support. Read on to learn more about why the fear of eating in front of others can be so common for those with eating disorders, the consequences of living with this fear, and what to do if you or someone you care about is struggling.

What is the fear of eating in front of others?

According to Equip therapist Adriana Lindenfeld, the fear of eating in front of others is characterized by intense fear, discomfort, or anxiety about eating in the presence of other people. “This fear can stem from concerns about being judged, embarrassed, or scrutinized for their eating habits, appearance, or food choices,” she says.

This fear or anxiety can lead to significant distress and avoidance behaviors, Lindenfeld explains, driving people to go to great lengths to avoid eating in the presence of others—which, in turn, has a negative impact on their social life and overall well-being. “The fear of eating in front of others is intertwined with both social anxiety and eating disorders,” Lindenfeld says. “People with social anxiety often experience an intense fear of negative evaluation, which extends to their eating behaviors in social settings.”

According to research, about 48% of adults with anorexia, 81% of adults with bulimia, and 65% of adults with binge eating disorder (BED) have at least one co-occurring anxiety disorder. Anxiety tends to come with an intense fear of negative evaluation, while eating disorders often involve significant concerns about body image, control, and self-worth; and when both occur in the same person, the fear of eating in front of others can feel almost inevitable. “The combination of these factors creates a powerful and distressing cycle where the act of eating in public becomes a source of immense anxiety and avoidance, further isolating individuals and exacerbating their overall mental health challenges,” Lindenfeld says.

While there aren’t specific numbers around how many people struggle with a fear of eating in front of others, Drago speculates that it affects a good proportion of those with eating disorders. “It’s hard to say how common this experience is because it can vary so much from person to person, as can the reasons behind the fear,” she says. “Anti-fat bias also causes very legitimate concerns that someone may make a comment about the food choices a person in a larger body might make. It could also be a fear of not knowing what’s in the food someone else prepared, comparing your eating pace to others, or a fear of judgment—there are really a ton of different reasons.”

Lindenfeld says she that in her experience, anxiety about eating in front of other people can be fueled by a number of different reasons, including:

• Self-consciousness. Many people with eating disorders are highly self-conscious about their body image and eating behaviors.
• Fear of judgment. Those with eating disorders may fear that others will judge them for what or how much they are eating.
• Shame and guilt. Feelings of shame and guilt about eating behaviors or body image can also contribute to this fear.

The psychological impact of eating anxiety

While consistently choosing to eat alone—and taking sometimes drastic measures to avoid eating with other people—may seem innocuous to those unfamiliar with the nuances of disordered eating, it can have a significant psychological impact over time. According to Lindenfeld, mental health repercussions can include:

• Isolation: People experiencing a fear of eating may withdraw from social activities that involve food, leading to social isolation.
• Increased anxiety: The avoidance behavior can reinforce the anxiety, making it more intense over time.
• Depression: Persistent social isolation and anxiety can contribute to feelings of depression.
• Negative self-esteem: Constant fear and avoidance can further damage self-esteem and body image.

“Eating anxiety can lead to increased stress, depression, and social isolation in several ways,” Lindenfeld says. “Constant worry and preoccupation about eating in social situations can create chronic stress, the efforts to avoid eating in social situations can be stressful—planning ways to skip or avoid meals or social gatherings that involve food takes mental and emotional energy—and social withdrawal and isolation can lead to feelings of loneliness and depression.”

Lindenfeld also explains that because people with eating disorders often have negative self-perceptions and low self-esteem, anxiety around eating can exacerbate these feelings and lead to a deeper sense of worthlessness and depression. Once again, a vicious cycle is set into motion: “Increased stress and depression can make the eating disorder worse, leading to even greater anxiety about eating in front of others. This, in turn, leads to more avoidance and isolation, further increasing stress and depression,” she says.

Drago says that the longer she went out of her way to sidestep eating with others, the harder it became to engage in social meals. “Something I’ve really found to be true for myself is that avoiding doing a scary thing is what keeps it scary,” she says. “So from a mental standpoint, it was something I really needed to challenge.”

What are the signs that someone has eating anxiety?

While the signs of eating anxiety may look different depending on the person and their specific fears, there are several telltale signs that someone is experiencing fear or difficulty around social eating. According to Lindenfeld, these are some of the most common red flags:

• Avoidance: The person may consistently avoid meals with others or social events involving food.
• Nervousness: They may appear visibly anxious or distressed when faced with eating in front of others.
• Preoccupation: They express excessive worry about food, eating, and body image.
• Changes in eating behavior: The person alters their eating habits in order to avoid judgment (i.e. they may eat very little or avoid certain foods).

“Signs can vary from person to person, but often you might notice that a person is avoiding social gatherings, consistently avoiding eating in public, or preoccupied with knowing what will be served or if others will be eating,” Drago says.

How can someone overcome the fear of eating in public?

While the fear of eating in front of others can be a challenging obstacle to navigate—especially in the context of an eating disorder—there are a variety of effective treatment approaches that can help people overcome these fears.

Lindenfeld says that three specific types of therapy are particularly effective in addressing eating anxiety and helping people become more comfortable with eating in social situations:

• Cognitive behavioral therapy (CBT) helps individuals challenge and change negative thought patterns related to eating in front of others.
• Exposure therapy involves a gradual exposure to eating in social situations to reduce fear and build confidence with the goal of increasing distress tolerance.
• Mindfulness-based approaches include techniques to increase awareness and reduce anxiety in the present moment.

For those in eating disorder treatment, Drago recommends working with your treatment team to identify the feelings that are coming up for you in social eating situations, then exploring reframes or coping skills that might help you manage those feelings. “For me, challenging myself when I was with safe people was a great first step,” she says.

How loved ones can support someone with eating anxiety

There are plenty of ways to show up for a loved one who is struggling with social eating, but each person’s specific support needs will vary. “I think it’s really important to ask the person suffering what is most helpful for them in those moments,” Drago says. “Some people prefer if no attention is drawn to eating to help make it feel more ‘normal’ and less of a focus—especially if their fear centers around being surveilled by others. Others may prefer encouragement during the meal or ahead of time along with planning ahead.”

While individual needs may vary, Lindenfeld offers a few tips for demonstrating support when someone you love has a hard time eating around others:

• Provide understanding and empathy: Be non-judgmental and empathetic towards their fears and anxieties.
• Be loving but firm. Express kindness and compassion, but be candid about how their disordered behaviors may have detrimental effects.
• Be supportive in social situations: Offer to accompany them to social events and provide reassurance.
• Use “I” statements: Focus on the behaviors that you have personally observed, such as, “I noticed you’ve been eating dinner in your room alone and not with us at the dining table.” Using the opposite approach—for instance, statements like “you don’t want to eat with us anymore”—may come off as accusatory and provoke defensiveness.
• Avoid simple solutions. Sometimes, the natural reaction to someone’s eating anxiety is to say something like, “it’s just food,” or “can you just get over it?” But these reactions aren’t constructive, and can actually exacerbate the individual’s suffering.
• Encourage professional help. The fear of eating around others can be difficult to overcome alone, and this is especially true if it stems from an eating disorder. Try gently encouraging your loved one to seek help from a mental health professional, or consider more intensive, comprehensive treatment from a qualified team of experts.