But when this habit for soothing themselves interacts with the pressures girls feel to stay thin, the way is paved for eating disorders to develop. "At first she might start with binge eating," Leon observes. "But to stay thin she may turn to vomiting or laxatives, or intense physical exertion to undo the weight gain from overeating. Another avenue this struggle to handle emotional confusion can take is for the girl not to eat at all—it can be a way to feel you have at least some control over these overwhelming feelings."
The combination of poor inner awareness and weak social skills means that these girls, when upset by friends or parents, fail to act effectively to soothe either the relationship or their own distress. Instead their upset triggers the eating disorder, whether it be that of bulimia or anorexia, or simply binge eating. Effective treatments for such girls, Leon believes, need to include some remedial instruction in the emotional skills they lack. "Clinicians find," she told me, "that if you address the deficits therapy works better. These girls need to learn to identify their feelings and learn ways to soothe themselves or handle their relationships better, without turning to their maladaptive eating habits to do the job."
ONLY THE LONELY: DROPOUTS
It's a grade-school drama: Ben, a fourth grader with few friends, has just heard from his one buddy, Jason, that they aren't going to play together this lunch period—Jason wants to play with another boy, Chad, instead. Ben, crushed, hangs his head and cries. After his sobs subside, Ben goes over to the lunch table where Jason and Chad are eating.
"I hate your guts!" Ben yells at Jason.
"Why?" Jason asks.
"Because you lied," Ben says, his tone accusatory. "You said this whole week that you were gonna play with me and you lied."
Ben then stalks off to his empty table, crying quietly. Jason and Chad go over to him and try to talk to him, but Ben puts his fingers in his ears, determinedly ignoring them, and runs out of the lunchroom to hide behind the school Dumpster. A group of girls who have witnessed the exchange try to play a peacemaker role, finding Ben and telling him that Jason is willing to play with him too. But Ben will have none of it, and tells them to leave him alone. He nurses his wounds, sulking and sobbing, defiantly alone.41
A poignant moment, to be sure; the feeling of being rejected and friendless is one most everyone goes through at some point in childhood or adolescence. But what is most telling about Ben's reaction is his failure to respond to Jason's efforts to repair their friendship, a stance that extends his plight when it might have ended. Such an inability to seize key cues is typical of children who are unpopular; as we saw in Chapter 8, socially rejected children typically are poor at reading emotional and social signals; even when they do read such signals, they may have limited repertoires for response.
Dropping out of school is a particular risk for children who are social rejects. The dropout rate for children who are rejected by their peers is between two and eight times greater than for children who have friends. One study found, for example, that about 25 percent of children who were unpopular in elementary school had dropped out before completing high school, compared to a general rate of 8 percent.42 Small wonder: imagine spending thirty hours a week in a place where no one likes you.
Two kinds of emotional proclivities lead children to end up as social outcasts. As we have seen, one is the propensity to angry outbursts and to perceive hostility even where none is intended. The second is being timid, anxious, and socially shy. But over and above these temperamental factors, it is children who are "off—whose awkwardness repeatedly makes people uncomfortable—who tend to be shunted aside.
One way these children are "off is in the emotional signals they send. When grade schoolers with few friends were asked to match an emotion such as disgust or anger with faces that displayed a range of emotions, they made far more mismatches than did children who were popular. When kindergarteners were asked to explain ways they might make friends with someone or keep from having a fight, it was the unpopular children—the ones others shied away from playing with—who came up with self-defeating answers ("Punch him" for what to do when both children wanted the same toy, for example), or vague appeals for help from a grown-up. And when teenagers were asked to role-play being sad, angry, or mischievous, the more unpopular among them gave the least convincing performances. It is perhaps no surprise that such children come to feel that they are helpless to do any better at making friends; their social incompetence becomes a self-fulfilling prophecy. Instead of learning new approaches to making friends, they simply keep doing the same things that have not worked for them in the past, or come up with even more inept responses.43
In the lottery of liking, these children fall short on key emotional criteria: they are not seen as fun to be with, and they don't know how to make another child feel good. Observations of unpopular children at play show, for example, that they are much more likely than others to cheat, sulk, quit when losing, or show off and brag about winning. Of course, most children want to win at a game—but win or lose, most children are able to contain their emotional reaction so that it does not undermine the relationship with the friend they play games with.
While children who are socially tone-deaf—who continually have trouble reading and responding to emotions—end up as social isolates, this does not apply, of course, to children who go through a temporary period of feeling left out. But for those who are continually excluded and rejected, their painful outcast status clings to them as they continue their school years. The consequences of ending up at the social margins are potentially great as a child continues on into adulthood. For one, it is in the cauldron of close friendships and the tumult of play that children refine the social and emotional skills that they will bring to relationships later in life. Children who are excluded from this realm of learning are, inevitably, disadvantaged.
Understandably, those who are rejected report great anxiety and many worries, as well as being depressed and lonely. In fact, how popular a child was in third grade has been shown to be a better predictor of mental-health problems at age eighteen than anything else—teachers' and nurses' ratings, school performance and IQ, even scores on psychological tests.44 And, as we have seen, in later stages of life people who have few friends and are chronically lonely are at greater risk for medical diseases and an early death.
As psychoanalyst Harry Stack Sullivan pointed out, we learn how to negotiate intimate relations—to work out differences and share our deepest feelings—in our first close friendships with same-sex chums. But children who are socially rejected are only half as likely as their peers to have a best friend during the crucial years of elementary school, and so miss out on one of the essential chances for emotional growth.45 One friend can make the difference—even when all others turn their backs (and even when that friendship is not all that solid).
COACHING FOR FRIENDSHIP
There is hope for rejected children, despite their ineptness. Steven Asher, a University of Illinois psychologist, has designed a series of "friendship coaching" sessions for unpopular children that has shown some success.46 Identifying third and fourth graders who were the least liked in their classes, Asher gave them six sessions in how to "make playing games more fun" through being "friendly, fun, and nice." To avoid stigma, the children were told that they were acting as "consultants" to the coach, who was trying to learn what kinds of things make it more enjoyable to play games.