In one sentence
In a large English cohort of adolescents treated for anorexia nervosa, higher social anxiety and peer problems at assessment predicted less early weight restoration at six months — a finding that matters for autistic teens, who often share these social vulnerabilities.
What the researchers did
Researchers analysed routine clinical data from 983 adolescents aged 12–16 seen in children’s community eating-disorder services in England (2017–2023). At assessment, teens completed the Revised Child Anxiety and Depression Scales (including a social-phobia scale) and/or the Strengths and Difficulties Questionnaire (peer problems and prosocial behaviour).
The primary outcome was early weight restoration: reaching at least 85% of median BMI for age and sex by six months. Multiple linear regression tested how social phobia, peer problems, and prosocial behaviour together predicted that outcome. The authors note that autism and social anxiety frequently co-occur with eating disorders and that social cognition difficulties are common in this population, which makes baseline social measures clinically relevant.
What they found
Together, the three social predictors explained about 20% of the variance in six-month weight restoration. Social phobia showed the strongest negative association (standardised β ≈ −0.38). Peer problems and lower prosocial behaviour also predicted poorer early weight outcomes, with smaller effects.
In plain language: teens who were more socially anxious, struggled more with peers, or showed less everyday social engagement tended to regain less weight in the first half-year of community treatment.
What this means for families and therapists
Eating-disorder care that only tracks calories and BMI may miss a major recovery lever. For autistic adolescents — who already face higher rates of social anxiety, peer exclusion, and atypical eating patterns including ARFID-like restriction — social support is not optional soft skill work; it may sit on the same pathway as medical recovery.
Families can ask the team how social anxiety, friendships, and school peer load are being assessed and supported alongside refeeding. Therapists and ABA practitioners collaborating with ED services can share communication profiles, sensory mealtime needs, and peer-skill goals so programmes do not assume neurotypical social motivation. See also our guide on food selectivity and picky eating and anxiety in autistic children and teens.
Limitations and what we don't know yet
The design is observational: social difficulties may mark severity or comorbidity rather than causing slower weight gain. Outcomes rely on questionnaires and service data from England. Only the first six months were analysed. Autism diagnosis itself was not the primary stratified variable in the summary we have, so autism-specific effect sizes are not reported here. Longer follow-up and intervention trials that treat social functioning as a target are still needed.
This is a plain-language summary of Social Anxiety and Peer Relationships Predict Weight Recovery in Adolescent Onset Anorexia Nervosa by Burmester V, Cini E, Baksh T et al., European Eating Disorders Review (2025). Source license: CC-BY. It is not medical advice — talk to a qualified clinician before changing therapy.