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Published in final edited form as: Eat Behav. 2022 Dec 16;48:101699. doi: 10.1016/j.eatbeh.2022.101699

Social Support Across Eating Disorder Diagnostic Groups: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

Sharon Kim 1, Kathryn Smith 2, Tomoko Udo 3, Tyler Mason 4
PMCID: PMC9974791  NIHMSID: NIHMS1860539  PMID: 36565528

Abstract

Introduction:

Previous studies have suggested the positive influence of social support on the treatment and recovery of eating disorders (EDs). Yet, more research is needed on how objective and subjective social support differ between ED diagnostic groups using nationally representative data. Therefore, the current secondary data analysis examined associations between EDs and objective and subjective social support using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study.

Methods:

Participants completed measures of lifetime and past year diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and items assessing objective social support (i.e., number of close friends and close relatives) and subjective social support (i.e, perceptions of availability of support).

Results:

Compared to those without EDs, those with AN, BN, and BED had poorer subjective social support—or lower perceptions of social support. However, there were fewer differences regarding objective social support. Individuals with BN reported a lower number of close relatives compared to those without EDs and those with AN, but there were no differences in the number of close friends between ED groups. Those who experienced remission from EDs had higher perceptions of social support compared to those with past year EDs.

Discussion:

The findings show deficits in subjective social support across EDs, but only lower objective social support in BN. This highlights the clinical utility of increasing perceptions of social support across EDs. The findings also show the importance of perceived social support in recovery from EDs.

Keywords: Social support, eating disorders, anorexia nervosa, bulimia nervosa, binge-eating disorder, perceived support

People with eating disorders (EDs) often report a history of life stress, including childhood physical, emotional, or sexual abuse; diet-, weight-, or body-related discrimination and criticism; and traumatic experiences in adulthood (Chami et al., 2019; Mason et al., 2021a; Vidaña et al., 2020; Webster & Palmer, 2000) and elevated mood and anxiety symptoms (Garcia et al., 2020; Smith et al., 2018). Social support and positive interpersonal relationships are critical protective factors for mental health and can buffer the negative impacts of stress and adversity. Consistently, previous studies have examined the association between social support and psychiatric disorders, finding that those with high levels of social support are less likely to have psychiatric disorders, including EDs (Harandi et al., 2017; Hefner & Eisenberg, 2010; Moak & Agrawal, 2010; Paykel, 1994; Stice et al., 2004; Wang et al., 2018). According to the interpersonal theory of EDs, social support and problems with social interactions may be critical in the etiology of EDs but also in the maintenance and recovery from EDs (Ansell et al., 2021; Rieger et al., 2010). For instance, studies have found evidence for the examined the association between social support and EDs and found that lack of social support is related to the higher prevalence and poor management of EDs (Bodell et al., 2011; Ghaderi & Scott, 2001).

It is widely believed that family and close friends can influence disordered eating behaviors and thoughts. Family and friends may provide emotional, tangible, and informational support to those with EDs, which can buffer the negative impact of disorder- and nondisorder-specific symptoms and may play an important role in recovery (Geller et al., 2017). For example, family and friends can gather psychoeducational information that can provide strategies and steps for recovery, offer to eat meals together at routine times, and provide emotional support, including feelings of connection and understanding, which can play a positive role in treatment and recovery from EDs (Linville et al., 2012; Meno et al., 2008; Shomaker & Furman, 2009). However, studies also suggest potential negative impacts that family or friend support could have on those with EDs. For example, the informational and tangible support provided by close family and friends could be received as disempowering or controlling, and emotional support as hurtful, thus negatively influencing the recovery process and causing emotional disturbances (Brown & Geller, 2006; Linville et al., 2012; Patterson et al., 1997). This might be partially due to higher perfectionist tendencies and low tolerance of flexibility that is common in EDs. (Baudinet at al., 2020, Hempel et al., 2018). On the other hand, other studies suggest that there is not a strong relationship between social support and recovery (Darrow et al., 2017). Such discrepancies may be due in part to variations in preference and perception of social support among individuals with EDs (Geller et al., 2017). That is, the same support may be perceived differently across individuals and friends and family may be seen as both supportive and non-supportive (Ma et al., 2021). Further, some people with EDs may even intentionally withdraw from their social support networks, suggesting how the perception of support may be more important than availability. Thus, while having available resources of social support is important (i.e., objective social support), how people perceive social support (i.e., subjective social support) may be more important when examining the relationship between social support and EDs. Therefore, it is critical to examine both objective and subjective support among those with EDs.

While several studies have examined the association of social support and EDs, few studies have examined this relationship by ED diagnoses. Previous studies have primarily focused on anorexia nervosa (AN) and bulimia nervosa (BN) and showed better family support among patients with AN compared to those with BN (Limbert, 2010; Schmidt et al., 1993; Tiller et al., 1997). However, both patients with AN and BN had lower levels of perceived social support compared to those without EDs (Tiller et al., 1997). More research is needed on social support across AN, BN, and binge-eating disorder (BED). Further, previous studies of social support in EDs are based on small, non-random samples with little diversity of sex, race, ethnicity, and age. To ameliorate these limitations, we examined the relationship between social support and lifetime EDs with a nationally representative sample of adults in the United States to develop a better understanding of social support in adults with AN, BN, or BED. We hypothesized that those with EDs would be more likely to have lower objective and subjective perceptions of social support compared to those without EDs. We also hypothesized that decrements in social support would be particularly robust in individuals with BN and BED. In addition, among those with lifetime EDs, we examined social support as a predictor of past year ED vs. remittance (i.e., not meeting criteria for ED in past year) status. We hypothesized that social support would be higher among those who were in ED remission.

2. Method

2.1. Data and Participants

A secondary data analysis from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), which is a nationally representative, cross-sectional data of the civilian noninstitutionalized U.S. population aged 18 years and older, was conducted. Sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the original aim of NESARC-III was to estimate prevalence and correlates of psychiatric disorders, including EDs. A total of 36,309 adults completed computer-assisted face-to-face personal interviews (Grant et al., 2015a). Multi-stage probability sampling was used with counties or groups of contiguous counties as primary sampling units, groups of Census-defined blocks as secondary sampling units, and households within secondary sampling units as tertiary sampling units. Within each household, eligible adults were randomly selected, with oversampling of Hispanic, Black, and Asian household members (i.e., two respondents from households with more than four eligible minority members) relative to White household members.

2.2. Measures

ED diagnosis.

Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIA-5) was used to assess past year and lifetime symptoms of AN, BN, and BED, including eight, weight, food intake patterns, and feelings towards their eating habits (Grant et al., 2015b). Due to reported errors in ED diagnostic codes originally provided as part of NESARC-III dataset, this study used a diagnostic coding scheme established by Udo and Grilo (2018). Respondents were then categorized into the following groups: AN, BN, BED, and no ED diagnosis. If a respondent met more than one ED diagnosis, the hierarchy of AN >BN >BED was applied (e.g.,, those who had both AN and BN in their lifetime were categorized as having lifetime AN).

Objective social support.

Objective social support is the structure of social network and contact (Kahle et al., 2020). To quantify this functional social support, we used two questions: “How many close friends do you have?” (range of 0 to 50) and “How many of your other relatives, not counting spouses, partners, children, parents, or parents-in-law, do you feel close to?” (range of 0 to 60). The measures from these two questions were used to indicate the extent of social support networks in addition to immediate family members.

Subjective social support.

We measured subjective social support using the Interpersonal Support Evaluation List (ISEL). The ISEL was designed to measure perceived interpersonal social support among general population (Cohen & Hoberman, 1983; Cohen et al., 1985). The original ISEL consists of a list of 40 statements regarding the perceived availability of potential social resources. In NESARC-III, there is a 12-item shortened version of this scale. Sample items include, “If I wanted to have lunch with someone, I could easily find someone to join me” and “If I was stranded 10 miles from home, there is someone I could call who could come and get me”. Six questions measure negative social support while six questions measure positive support. The choices of the answer are (1) definitely false, (2) probably false, (3) probably true, and (4) definitely true. Negative questions are reversed so that a higher score in all questions indicates a higher level of perceived social support. Cronbach’s alpha for this measure indicated good internal consistency (α=.83)

Covariates.

Data on participants’ age, sex, race/ethnicity, education level, and socioeconomic status were collected, which were found to be related to EDs in previous studies (Dura & Bornstein, 1989; Maxwell et al., 2011; Udo & Grilo, 2018; von dem Knesebeck et al., 2013). Race/ethnicity was categorized into non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian/Pacific Islander, and non-Hispanic American-Indian/Alaskan Native. Education was used as a continuous measure: 1=no formal schooling, 2=completed kindergarten, 1st, 2nd grade, 3=3rd, 4th grade, 4=5th, 6th grade, 5=7th grade, 6=8th grade, 7=9th −11th grade, some high school, 8=12th grade, completed high school, 9=high school equivalent, 10=some college but no degree, 11=associate or other technical 2 year degree in college, 12=bachelor’s degree, 13=some graduate or professional studies but no degree, and 14=master’s or higher graduate degree. Whether or not someone received food stamps in the past 12 months was used to indicate a respondent’s socioeconomic status.

2.3. Statistical Analysis

Analyses were conducted using SPSS v25.0. Complex samples general linear models (CSGLM), which incorporate the complex survey sampling design, were used to examine how lifetime EDs (i.e., no ED, AN, BN, and BED) are related to the level of social support (i.e., number of close friends, number of close relatives, and perceived social support. The model effects for the CSGLM comparing the no ED group with each of the ED groups were examined. Covariates included in all models were age, sex, education, race/ethnicity, and socioeconomic status. Effect sizes were denoted as R2. To explore differences between ED groups, models were re-run with AN and BN as the comparison group. Lastly, we used a complex samples logistic regression to examine associations between social support and past year ED versus remitted ED (lifetime ED but not past year). Independent variables included number of close friends, number of close relatives, and perceived social support and covariates (i.e., age, sex, education, race/ethnicity, and socioeconomic status).

3. Results

The sample description by lifetime ED status is shown in Table 1. ED diagnosis significantly differed by gender, p<.001. The majority of those with EDs were women, such that 91.7% of those with AN, 85.7% of those with BN and 74.9% of those with BED were women, p<.001. Those without EDs tended to be older than those with EDs, p<.001. ED diagnosis significantly differed by race/ethnicity, p<.001. About half of those without EDs were non-Hispanic White, while about 20% of those without EDs were each non-Hispanic Black and Hispanic. The percentage of participants identifying as White was much higher for AN (74.6%) and BED (64.8%), and the percentage of participants identifying as Hispanic was higher among those with BN. ED diagnosis differed by education (p<.001), with those with AN having the highest level of education and those with BN having the lowest education. There were differences in ED groups by food stamp receipt status, with particularly elevated levels in those with BN or BED, p=.03.

Table 1.

Descriptive Statistics of Participant Characteristics, by Lifetime Eating Disorders Diagnostic Group

No Eating Disorders Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) p-Value for Test of Group Differences
Sex, % <.001
 Women 55.8 91.7 85.7 74.9
 Men 44.2 8.3 14.3 25.1
Age, mean (SD), years 45.68 (17.57) 41.84 (14.69) 38.61 (13.37) 44.34 (14.93) <.001
Race/Ethnicity, % <.001
 White 52.6 74.6 54.5 64.8
 Black 21.6 6.2 15.6 13.4
 Hispanic 19.4 13.0 24.7 17.4
 Asian/Pacific Islander 5.0 3.3 2.6 3.6
 American-Indian/Alaska Native 1.4 2.9 2.6 0.8
Education, mean (SD), highest grade or year of school completed 9.71 (2.41) 10.61 (2.32) 9.91 (2.60) 10.06 (2.37) <.001
Receiving Food Stamps, % 19.0 17.0 22.1 25.9 .031
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Note. P-value for eating disorders diagnostic group differences from χ2 (categorical variable) or ANOVA (continuous variable) test

Table 2 shows the regression parameter estimates for models with lifetime ED groups (no EDs as the reference group) and covariates. Table 3 shows the adjusted means for each ED group on the social support variables. Effect sizes for models were small with variables explaining 5% of the variance in subjective social support and 3% and 1% for close friends and close family, respectively. Compared to those without EDs, those with AN (p=.003), BN (p=.007), and BED (p=.004) reported lower perceptions of social support. Those with BN had fewer close relatives than those with no EDs (p=.009), but there were no differences between those with no EDs and those with AN or BED. There were no significant differences in number of close friends between those with versus without EDs (Tables 2 and 3). Next, we compared the differences among AN, BN, and BED on social support measures by modifying the reference group in analyses (see Table 4). Those with BN had fewer close relatives compared to those with AN (p=.022), but there were no differences between AN and BED or between BN and BED. There were no differences between AN, BN, and BED for number of close friends or subjective social support.

Table 2.

Parameter Coefficients of Complex Samples Generalized Linear Models

Number of Close Friends
(N=36,309)		 Number of Close Relatives
(N=36,309)		 Subjective Social Support
(N=36,309)
Estimate SE p R 2 Estimate SE p R 2 Estimate SE p R 2
Intercept 2.93 0.28 <.001 .03 4.89 0.29 <.001 .01 3.55 0.02 <.001 .05
Race/ethnicity1
 Black −1.77 0.11 <.001 1.41 0.17 <.001 −0.03 0.01 .002
 Hispanic −0.93 0.12 <.001 −0.19 0.14 .182 −0.06 0.01 <.001
 Asian/Pacific Islander 0.01 0.23 .956 0.41 0.23 .083 −0.11 0.02 <.001
 American Indian/Alaska Native −0.13 0.37 .733 1.17 0.55 .037 −0.06 0.03 .050
Male 0.78 0.10 <.001 −0.58 0.11 <.001 −0.03 0.01 <.001
Received food stamps −0.87 0.14 <.001 −1.08 0.13 <.001 −0.17 0.01 <.001
Age 0.03 0.00 <.001 −0.01 0.00 .002 −0.00 0.00 <.001
Education 0.15 0.02 <.001 0.17 0.03 <.001 0.02 0.00 <.001
Eating disorders2
 AN −0.62 0.39 .114 0.75 0.86 .387 −0.07 0.03 .003
 BN −0.92 0.50 .066 −2.05 0.77 .009 −0.14 0.05 .007
 BED 0.028 0.64 .966 −0.34 0.63 .589 −0.12 0.04 .004
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Note.

1

White is the reference group;

2

No eating disorders is the reference group.

AN=anorexia nervosa; BN=bulimia nervosa; BED=binge-eating disorder

Table 3.

Adjusted Means of Objective and Subjective Social Support

Number of Close Friends Number of Close Relatives Subjective Social Support
M SE 95% CI M SE 95% CI M SE 95% CI
No ED 5.35 0.09 5.16, 5.53 5.91 0.13 5.65, 6.18 3.41 0.01 3.40, 3.43
AN 4.73 0.40 3.94, 5.51 6.66 0.91 4.86, 8.46 3.35 0.03 3.29, 3.41
BN 4.42 0.51 3.42, 5.43 3.87 0.77 2.35, 5.39 3.27 0.05 3.18, 3.37
BED 5.37 0.65 4.08, 6.67 5.57 0.64 4.30, 6.84 3.30 0.04 3.22, 3.38
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Note. Age, sex, race/ethnicity, education, food stamps status were included as covariates. AN=anorexia nervosa; BN=bulimia nervosa BED=binge-eating disorder

Table 4.

Mean Difference Tests between Eating Disorder Groups on Social Support

Number of Close Friends Number of Close Relatives Subjective Social Support
M Difference p M Difference p M Difference p
AN versus BN 0.31 .640 2.79 .022 0.08 .212
AN versus BED −0.64 .385 1.09 .293 0.05 .369
BN versus BED −0.95 .260 −1.70 .100 −0.03 .695
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Note. AN=anorexia nervosa; BN=bulimia nervosa; BED=binge-eating disorder

Table 5 shows the results of the models examining associations among social support and past year vs remitted ED status. The Cox and Snell psudeo R2 was .07. Among those who have had lifetime EDs, 382 people had remitted EDs and 218 had past year EDs. Males were more likely than females to have had EDs in the past year (p=.015) and those with a higher level of education were less likely to have EDs in the past year (p=.008). Lower perceived social support was related to greater likelihood of having a past year ED compared to remitted EDs (OR=0.62, 95% CI: 0.44–0.87, p=.007). That is, those with EDs within the past year had lower subjective social support compared to those with remitted EDs, Objective social support was unrelated to past year versus remitted ED status.

Table 5.

Logistic Regressions of Associations of Social Support with Remitted Versus Past Year Eating Disorder

Estimate SE t OR 95% CI p
Race/ethnicity1
 Black 0.11 0.32 0.33 1.11 1.11,1.38 .744
 Hispanic −0.10 0.31 −0.33 0.90 0.90,1.36 .741
 Asian/Pacific Islander 0.01 0.54 0.01 1.01 1.01,1.72 .992
 American Indian/Alaska Native −0.88 0.58 −1.53 0.41 0.41,1.78 .131
Male 0.71 0.29 2.48 2.03 2.03,1.33 .015
Received food stamps −0.50 0.27 −1.85 0.61 0.61,1.31 .068
Age −0.01 0.01 −0.88 0.99 0.98,1.01 .381
Education −0.13 0.05 −2.70 0.88 0.80,0.96 .008
Number of close relatives −0.02 0.01 −1.22 0.99 0.96,1.01 .226
Number of close friends 0.03 0.02 1.37 1.03 0.99,1.08 .174
Subjective social support −0.48 0.17 −2.77 0.62 0.44,0.87 .007
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Note.

1

White is the reference group;

OR=odds ratio; CI=confidence interval

Discussion

Because social support is of significant importance in buffering the negative impacts of stress and adversity, our study examined how objective and subjective social support differed across those with and without EDs. Our hypothesis that those with EDs would have lower objective and subjective social support compared to those without EDs was partially supported. Overall, having an ED of any type (i.e., AN, BN, or BED) was related to lower subjective social support, but EDs relation to objective support was somewhat marginal and more inconsistent. Generally, EDs were not related to objective social support, except those with BN having significantly fewer close relatives. Also, our hypothesis that those with BN or BED would be more likely to have reduced social support was only partially supported, such that BN had significantly fewer close relatives compared to those without EDs and those with AN. In addition, our hypothesis that social support would be higher among those in ED remission than those with past year EDs was partially supported. We found that among those with lifetime EDs, those with higher perceived social support were more likely to be remitted from EDs versus having an ED in the past year. Although effect sizes were small, our study findings suggest that it may not be the quantity of close connections but the quality and degree of support individuals feel in their social interactions that are important in maintenance and recovery from EDs. Consistent with other research, social support deficits in EDs may be more dependent on individuals with EDs finding less fulfillment from social support rather than practical support areas such as the number of people available to help (Rorty et al., 1999).

To this end, low perception of social support may be closely related to ED behaviors. Research has shown interpersonal factors, including lower perceptions of social support, loneliness, and interpersonal stress, to be important daily and momentary predictors of ED symptoms (Goldschmidt et al., 2014; Mason et al., 2016; 2018). Interpersonal factors may precipitate key momentary predictors of ED behaviors including negative affect (Goldschmidt et al., 2014) and subjective appetite (Maclntyre et al., 2021). Further, reduced perceptions of social support may reduce one’s ability to cope with negative affect and related experiences (e.g., Wonderlich-Tierney & Vander Wal, 2010), which, in turn, could make it more difficult to recover from EDs and prolong the period of convalescence and recovery. Interestingly, subjective social support was particularly low among those with BN and individuals with BN had fewer close relatives compared to inviduals without EDs and with AN or BED. This finding may be related to symptom presentation in BN (e.g., compulsive behaviors such as purging, fasting and excessive exercise; Johnson & Larson, 1982). For example, purging behaviors could be more difficult to talk about with friends and family as they may be associated with greater levels of interpersonal distress (Mason et al., 2021b), which could lead to withdrawal and isolation. In addition, shame and guilt surrounding binge-purge cycles may lead to avoidance of social events (Levine, 2012). Further, given association of BN with lower close relatives compared to AN and BED, lack of close relatives could be an important predictor of onset of purging-related symptoms specifically.

Contrary to expectations, objective social support was not consistently related to EDs. It is possible that objective social support in one’s life could have either positive or negative effects on ED symptoms depending upon ones’ perceptions of the support they receive from these people. For example, statements from a family member that are intended to be supportive may be taken the wrong way by someone with an ED and perpetuate symptoms (Brown & Geller, 2006; Patterson et al., 1997). In addition, having a low number of close friends and family may not matter if the few close friends and family provide quality support. Therefore, perceived social support may mediate or moderate the relationship between objective social support and EDs.

Understanding how objective and subjective social support are related to EDs provides useful clinical implications for ED treatment. Although treatment coverage for people at high-risk for EDs is increasing (Ward et al., 2019), EDs are becoming increasingly more prevalent (Galmiche et al., 2019; Ward et al., 2019) and the process of receiving assessment and treatment for EDs still remains difficult, with more than half of those with EDs not seeking help (Hudson et al., 2007). In that sense, social support is crucial for those with EDs in recovery, both those yet to seek professional help and those who are currently in professional treatment. Lower quality of social support may be improved by professional therapeutic interventions. Given that interpersonal difficulties, possibly both a cause and consequence of EDs, are often common in those with EDs and they exacerbate symptoms (Goldschmidt et al., 2014; Maclntyre et al., 2021), interpersonal therapy can be useful to lead those with EDs into rediscovering meaningful relationships, managing conflict, and comfortably interacting with others (Champion & Power, 2012). Novel interpersonal therapy interventions delivered with close others (e.g., couples, dyadic) or delivered via novel methodologies, such as via mobile phone applications, may be efficacious in improving ED outcomes by increasing subjective social support. Cognitive behavioral therapy such as Radically Open Dialectical Behavior Therapy (RO-DBT) may be also useful in helping those with EDs develop openness, flexibility and social connectedness by treating problems of overcontrol, which would, in turn, help alleviate ED symptoms (Baudinet et al., 2020; Hempel et al., 2018; Lynch et al., 2013).

While this data was collected before the COVID-19 pandemic, this study has implications for understanding the effect of the pandemic on EDs. EDs increased and deteriorated during the COVID-19 pandemic, and those with EDs reported a negative impact of the pandemic on social factors (Kim et al., 2021; Schneider et al., 2022). Our data shows that the effects of the pandemic on subjective social support during the pandemic may have been more detrimental opposed to any objective social support changes. Any permanent changes to subjective social support caused by the pandemic may have continued impacts on EDs in the post-pandemic world. Although individuals had to socially isolate during the pandemic, the ability to stay in contact virtually may have been an important preventive factor for EDs.

We must note some limitations in this study. First, the data were cross-sectional and thus do not allow us to determine causal relationships betwen social support and EDs. People may have developed or exacerbated their EDs due to lower levels of social support (consistent with the interpersonal theory of EDs, Ansell et al., 2011), or their EDs may reduce levels of support. Future studies using longitudinal data are needed to examine the causal and possibly bi-directional relationship between social support and EDs. Second, since we used population-based data, there were a relatively low number of individuals with EDs. Third, the classification of EDs in our study does not include other ED diagnostic categories, such as avoidant/restrictive food intake disorder or other specified feeding and eating disorder.

Fourth, this study relied on self-report survey responses, which are subject to recall biases and do not measure intra-individual variability in social support. Future research should continue studying the effects of social support on EDs and utilize methods, such as ecological momentary assessment and experimental designs to build theoretical models of causal and prospective associations of social support and EDs. Fifth, effect sizes were generally low but may be impacted, and possibly attenuated, by the aforementioned methodological limitations mentioned above. Sixth, the NESARC study did not collect data on children. It will be important to examine objective and subjective social support in relation to childhood EDs in future research as social support may function differently for children. This study focused on EDs in a Western population. Social support is often viewed and pursued differently in various social/cultural contexts (e.g., individualistic vs. collectivistic). Examining the relationship between social support and EDs among various nationalities and cultures is a key future direction. Finally, our no ED group may include respondents with subthreshold BED and BN or Other Specified Feeding and Eating Disorder (OSFED), which we were unable to examine due to the skip-pattern and lack of specific questions in the AUDADIS-5. Overall, implications of this study are to further research how subjective social support is associated with onset and maintenace of EDs, including changes and fluctuations in symptoms, as well as how subjective social support can be bolstered to prevent and treat ED symptoms.

Highlights.

  • We examined associations between objective and subjective social support and eating disorders (EDs).

  • Those with lifetime EDs had lower perceptions of social support.

  • Adults with lifetime bulimia nervosa had a lower number of close relatives.

  • Adults remitted from EDs had higher perceived social support compared to those with past year EDs.

Acknowledgements

Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases: Award Numbers K01DK124435 and K23DK128568. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflicts of Interest

The authors have no conflicts of interest.

Availability of Data, Materials and Code

Codes used for this study are available on request from the corresponding author. The NESARC-III data are publicly available: https://www.niaaa.nih.gov/research/nesarc-iii

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Codes used for this study are available on request from the corresponding author. The NESARC-III data are publicly available: https://www.niaaa.nih.gov/research/nesarc-iii

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