Eating Disorders And Social Media : What Does This Mean For Treatment?
According to the National Association of Anorexia Nervosa and Associated Disorders, as many as 9% of Americans will be affected by eating disorders in their lifetime, with the highest risk group being adolescents and young adults. Less than 6% of eating disorder patients are clinically diagnosed as underweight, suggesting that disordered eating is prevalent in even those who present as healthy or overweight, which can be even more difficult to identify.
Eating disorders are also the second leading cause of death due to mental illness in the United States, yet remain among the most difficult mental illnesses to effectively treat (Eating Disorder Statistics, 2020). The rapidly increasing presence of social media in young adults’ lives coupled with the bodily dissatisfaction and comparison so common in eating disorder patients has created a dangerous combination that has the potential to make the treatment of eating disorders ever more elusive. In a world where adolescents are being exposed to social media at increasingly younger ages, it is critical to examine the possible link between the use of social media and the perpetuation of disordered eating behaviors in order to find a more contemporary and effective treatment method.
Rodgers et al. (2020) took a broad approach to the relationship between social media use and eating disorders by examining a biopsychosocial model of the two. Participants of the study were young adolescents who were asked to self-report on multiple indices of self-esteem, body dissatisfaction, ideal image internalization, upward appearance comparison, depressive symptoms and disordered eating behaviors. They were also asked to self-report the frequency of their social media use. Results of the study found that body image ideals as well as physical appearance comparisons were positively correlated with body dissatisfaction and disordered eating behaviors such as dietary restraint (Rodgers et al., 2020).
Wilksch, O’Shea, Ho, Byrne and Wade (2019) similarly examined the relationship between social media use and the presentation of disordered eating symptoms in adolescents. Participants in this study were middle-school aged boys and girls. The participants completed self-report questionnaires of disordered eating cognitions and behaviors and their social media use. Statistical analysis of participants’ reports led researchers to the conclusion that disordered eating and social media usage were significantly associated with each other in adolescent girls and boys. Particular behaviors that were more associated with significant social media use were eating little food, meal skipping, following a strict meal plan, and strict exercise regimens.
Participants with two or more social media accounts were more likely to present both disordered behaviors and over-value their shape and body weight (Wilksch et al., 2019). This overvaluation of adolescents’ personal image is important to note because the perpetuation of disordered eating behaviors is often image-based, which is particularly relevant to explore in the context of social media platforms that rely on image sharing as their primary means of communication. Studies that examine eating disorders in the context of these platforms could be extremely helpful in determining what it is about social media that has such a high association with disordered eating.
One such study explores the relationship between disordered eating behaviors and the use of these image-heavy platforms, particularly Instagram, Facebook and Snapchat. Saunders and Eaton (2018) sought to determine what aspects of these social media platforms were most related to body dissatisfaction and eating disorder outcomes. Participants in this study consisted of female, daily social media users who had never received a clinical eating disorder diagnosis. These women completed two rounds of surveys.
One survey was to determine disordered cognitions concerning their appearance, specifically upward and downward appearance comparison, and subscales of the objectified body consciousness scale and the eating pathology symptoms inventory. The women also answered questions about which social media platform they used most frequently, how frequently they used it, and their overall experience on the platform, which they rated positive or negative. For those that indicated they used Snapchat and Instagram the most frequently, a highly negative platform experience was associated with a higher tendency to engage in upward appearance comparison and body surveillance.
Across all three platforms, the associations between upward comparison, body dissatisfaction and disordered eating behaviors were significant (Saunders et al., 2018). It is clear that social media platforms that rely heavily on image sharing foster environments of comparison and have adverse effects on impressionable young people. This toxic environment of comparison and competition is most prevalent in the fitness community on social media and the perpetuation of diet culture. With the tendency towards disordered eating associated with regular social media use established, it is crucial to now examine how social media based movements that focus directly on eating and body image would affect those prone to disordered eating behaviors and cognitions.Griffiths et al. (2018) explore the role of “thinspiration” and “fitspiration” in the severity of symptoms for those diagnosed with eating disorders. Thinspiration and fitspiration refer to categories of social media posts that idealize the lifestyles of the ultra-thin or the ultra-fit.
This study consisted of male and female participants with self-reported eating disorders and surveyed them on their frequency of use of several image-centric social media platforms as well as how often they encounter and interact with fitspiration or thinspiration content on these platforms. They then evaluated the participants on their physical appearance comparisons and eating disorder symptoms on a self-report scale. Results of this study demonstrated that frequent use of image-centric social media was associated with frequent exposure to fitspiration or thinspiration content.The exposure to this content was associated with increased physical appearance comparison in participants which in turn was associated with higher eating disorder symptoms (Griffiths et al., 2018).
The fitness culture on social media, particularly platforms that rely heavily on the sharing of images, can create a toxic comparison culture. This culture of comparison often leads many young social media users to feel pressure to edit the photos they share, which in turn can have compounded negative effects on adolescents’ body image and create an impossible standard to strive towards.Wick and Keel (2019) sought to analyze the relationship between posting edited photos and disordered eating in this two part study. In stage 1, the researchers utilized self-report questionnaires that evaluated if students endorsed posting edited photos of themselves on Instagram. These questionnaires also evaluated the presence of disordered eating symptoms, depression and anxiety.
Results demonstrated that those who admitted posting edited photos of themselves had higher reports of disordered eating and anxiety symptoms. Individuals who indicated that they endorsed posting edited photos during stage 1 were recruited for stage 2. Participants were photographed then randomly assigned to one of four conditions: edit their photo as they would and then post it to Instagram; edit their photo but do not post it; post the photo unedited; and neither edit nor post the photo. After completing their assigned tasks, participants completed various inventories for eating disorders.
Researchers found through both stages of this study that posting edited photos caused marked concern in individuals over their weight and shape. These participants also reported increased anxiety and maintained disordered eating behaviors such as strict exercise and restricted food intake. Overall, the results of the study indicate that posting edited photos increases risk of disordered eating behaviors in young adults (Wick et al., 2019).
Eating disorders have long been characterized by elusive treatment pathways that vary greatly in degrees of efficacy from patient to patient. One common thread among many eating disorders is body dissatisfaction. This research demonstrates how the growing presence of image-heavy social media in young people’s lives capitalizes on this dissatisfaction and compounds disordered eating behaviors through fostering hostile environments of comparison and competition. Specifically, fitness directed content on social media can perpetuate harmful body standards and increase image-based insecurities and disordered cognitions about appearance, which can drive disordered eating behaviors.
The difficulty in treating eating disorders stems from difficulties in understanding what actually causes disordered eating. This research presents multiple instances where disordered eating and negative self image is associated with heavy social media use, but it can not infer causality. It is possible that treatment could be approached more effectively from a diathesis-stress model using this information.
In this case, social media use is a stressor that capitalizes on an individual’s vulnerability or tendency towards disordered eating.Some of the research in this review evaluated comorbid diagnoses of anxiety or depression, but others did not. Focusing on comorbid diagnoses for some of the more difficult to treat mental illnesses can be extremely helpful in helping to find a pathway to treatment through the elimination of stressors.
Another way that researchers could approach the relationship between social media use and disordered eating is by studying the addictive or obsessive properties of social media use and body dissatisfaction.Eating disorder behaviors often present as obsessive-compulsive behaviors so this could be a crucial approach to understanding what drives disordered eating. Overall, understanding that there is a well-established relationship between social media use and disordered eating helps point researchers in the direction of new causes and therefore more effective treatments for eating disorders.
Written by Catherine Hadro
References
Eating Disorder Statistics. General & Diversity Stats: ANAD. (2020, November 16). Retrieved December 07, 2020, from https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/Griffiths, S., Castle, D., Cunningham, M., Murray, S. B., Bastian, B., & Barlow, F. K. (2018). How does exposure to thinspiration and fitspiration relate to symptom severity among individuals with eating disorders? Evaluation of a proposed model. Body Image, 27, 187-195.
doi:10.1016/j.bodyim.2018.10.002Rodgers, R. F., Slater, A., Gordon, C. S., Mclean, S. A., Jarman, H. K., & Paxton, S. J. (2020). A Biopsychosocial Model of Social Media Use and Body Image Concerns, Disordered Eating, and Muscle-Building Behaviors among Adolescent Girls and Boys. Journal of Youth and Adolescence, 49(2), 399-409. doi:10.1007/s10964-019-01190-0Saunders, J. F., & Eaton, A. A. (2018). Snaps, Selfies, and Shares: How Three Popular Social Media Platforms Contribute to the Sociocultural Model of Disordered Eating Among Young Women. Cyberpsychology, Behavior, and Social Networking, 21(6), 343-354.
doi:10.1089/cyber.2017.0713Wick, M. R., MS, & Keel, P. K., PhD. (2020). Posting edited photos of the self: Increasing eating disorder risk or harmless behavior? International Journal of Eating Disorders, 53(6), 864-872. doi:10.1002/eat.23263Wilksch, S. M., O’shea, A., Ho, P., Byrne, S., & Wade, T. D. (2019). The relationship between social media use and disordered eating in young adolescents. International Journal of Eating Disorders, 53(1), 96-106. doi:10.1002/eat.23198