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Essay: How far should social media be held responsible for the growth of eating disorders?

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Prior to addressing the question, we need to be clear with the definitions of eating disorders, which have traditionally been misconceived. 1According to the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5), eating disorders are “characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning”. The DSM-5 serves as a universal authority for psychiatric disorders in the United States of America. 2The National Health Service (NHS) identifies the most commonly diagnosed eating disorders as Anorexia Nervosa (AN), characterised by obsessive desires to restrict eating to keep weight as low as possible; Bulimia Nervosa (BN), characterised by self-induced vomiting after severe overeating to prevent weight gain and Binge Eating Disorder (BED), characterised by regularly losing control and overeating all at once. Other specified feeding or eating disorder (OSFED) are diagnosed when symptoms do not meet the criteria of disorders already defined yet the individual still has a serious illness and experiences significant distress. As awareness of the range of eating disorders has increased, researchers are questioning the origins and reasons for growth. These compromise a number of complex social, psychological and biological causes. Social media is an evident important aspect of our lives, which shapes society. This therefore brings me question the causes of eating disorders. 3As of January 2017, there are 2.8 billion active social media users, which is a 22% increase since the last year. The increase in social media is coinciding with the increase of eating disorder statistics with a 34 per cent increase in admissions for inpatient care since 2006. 10The NHS has revealed that the number of teenagers being admitted to hospital with eating disorders has nearly doubled in just three years. The purpose of this essay is to explore the growth of such eating disorders in relation to social media in order to determine how far it should be held responsible.

Social media

Within the last decade in particular, social media is blamed for the increasing incidence of eating disorders on the premise of its “compare and despair” cycle through promoting an idealised body. It is used to share everything and significantly influences others by placing value on the perfect body and appearance in many ways. 4One way is body objectification. Many pictures on social media including ones that are altered, play a role in how people seek validation for example through how many likes and comments are received. In my opinion, as a teenager I believe that the amount of likes indicates popularity more than validation and many people don’t get likes but done have an eating disorder. Selfies on social media can send a message that beauty determines our worth and our body, this is something that people with an eating disorder struggle with. Another way is comparison. The nature of social media lends itself towards comparison, as we often judge ourselves against others success and happiness which consequents in insecurity. This is particularly detrimental for someone anxious about their body and vulnerable to eating disorders as they compare their body image to those seen on social media which is unachievable for most viewers. Another way social media has significance is through triggers. For those in recovery, social media offers triggers to engage in eating disordered behaviours. This can occur through posts about weight loss, workout routines, dieting and images of unrealistic ideals of body sizes. This is a blog from the Magnolia Creek Treatment Center for Eating Disorders.

5A 2016 study, from the charity child line, found social media pressures were leaving girls with crippling fears about how they looked and anxiety over body image that had grown by 17 per cent in the previous year. The 2016 UK government report produced similar findings with girls saying that they felt upset if their posts weren’t liked enough times and felt they didn’t look as good as their pretty, popular friends. One third of girls in this study of 30,000 teenagers showed symptoms of psychological distress. Marjorie Wallace, chief executive of the mental health charity Sane, cites the 24/7 exposure to social media and its “potentially destructive effect on issues such as self-esteem, body image” 6Further research from clinical psychologist Groesz et al also found body image to be significantly more negative following exposure to thin media images. When considering my first source The A-Z of Eating Disorders which presented several useful studies, I can conclude that the author Emma Woolf has vast expert knowledge in this field. After studying at Oxford University and working in psychology publishing, she now writes for a range of newspapers in the United Kingdom such as The Times and internationally. She speaks at schools and universities on issues relating to eating disorders and body image having lived through anorexia and recovery herself so therefore also having first-hand knowledge. This demonstrates her level of expertise around the subject of eating disorders. The reliable research and statistics she provides also make her claims credible. Despite this, to aid my research I emailed The National Centre for Eating Disorders to which the founder Deanne Jade replied. She is one of the UK’s most quoted experts on eating disorder and obesity issues appearing widely in broadcast and written media as well as being a media representative of the British Psychological Society. One of the questions I put forward was “Do you have any statistics surrounding other causes holding high responsibility for eating disorders?” to which Deanne replied “We don’t offer statistics on eating disorders because there are many hidden cases in the community. Many people don’t report eating distress if they have severe forms of eating distress due to shame, and there are milder occurrences of eating distress which are not included in statistical reviews.” This is important and worthwhile to take into account when considering other statistics surrounding eating disorders.

7Since the 1990s people with eating disorders have turned to the internet to connect with other sufferers through blogs, websites and forums. For many, this provides solace and a space to cope and recover with others who understand. This therefore demonstrates how social media can infact help those with eating disorders. However, the internet still offers dangerous information for weight and body conscious users. Pro ano (anorexia) and pro mia (bulimia) are alarming subcultures which are online communities informing vulnerable people on how to work or practice bulimia practices into their lives. 8Maria Rago, president of the National Association of Anorexia Nervosa and Associated Disorders says “There’s this whole dark side where people will encourage other people to be anorexic or bulimic.” This association is a reliable source as it is a non profit organisation working in the area of support, awareness and education of eating disorders and this. 9A recent study identified at least twenty pro anorexia websites that offer encouragement for disordered eating behaviours. “The general attitude of the pro-ana and pro-mia sites is one of superiority, empowerment, and pride, where young women encourage one another to demonstrate self-control and reject weak societal values.” These unmonitored sites are a danger to vulnerable, seriously ill young people. The typical visitors on these sites are overweight young women and others who have eating disorders or other mental health problems. When considering reliability of “Body images, eating disorders and the media” the authors Marjorie J Hogan and Victor C. Strasburger are paediatricians and so serve as primary care providers for teenage patients, acting as a point of first contact when they require medical assistance. Both have an interest in the impact of media on health and Dr Strasburger is the author of nearly 200 journal articles and book chapters on Adolescent Medicine and on Children, Adolescents, and the Media. This makes the information highly credible as this is their area of expertise.

10This graph shows the rise of eating disorder related hospital admissions over ten years. The NHS figures present how in 2010/11 there were just under 1,000 admissions of 13-19 year-olds but by 2013/14 it has almost doubled to more than 1,800. Experts warned that although the figures are relatively low, the rate of increase was mirrored by a larger number of cases that did not go to hospital. The Royal College of Psychiatrists (RCP) said images and apps available online place huge pressure on young people. This powerful evidence indicates that social media is part to blame for the rise of eating disorders. The RCP said it had seen an “unprecedented” rise in the number of eating disorder sufferers. And it added that the millions of images of “perfect bodies” online were putting vulnerable teenagers under pressure about their own body image. Spokeswoman Dr Carolyn Nahman told the BBC: “We’re getting increasingly concerned about the pressure of social media. Literally with one click of a button very vulnerable young people are able to access 10,000 images of ‘perfect looking’ people which places them under a lot of pressure. Young people who look at these images often develop body image dissatisfaction, quite low self-esteem, because they’re constantly comparing themselves to these perfect images. This is a risk factor for disordered eating and more serious eating disorders which can prove fatal”. This information comes from the telegraph and when considering it as a reliable source it should be noted that the author is Emma Woolf who I have already stated to have expert knowledge therefore increasing credibility of the overall source. The Telegraph itself is moderately right wing in bias as well as known for often publishing factual information that utilises loaded words in attempt to influence readers through emotion. It is generally trust worthy for information and therefore credible. The RCP is an organisation dedicated to improving health and healthcare through advocacy, education and research so the so this information has high provenance.

There is a common assumption that females are the only people affected by eating disorders. This is an obvious misconception proven by 11NHS Digital data which shows that in England, hospital diagnoses in men over the age of 19 rose from 480 in 2010-11 to 818 in 2015-16. Andrew Radford, chief executive of charity Beating Eating Disorders, told Sky News the significant increase could have been caused by images across social media. He said “If you look at the pressures on men, there is a reasonable chance that social media is having an effect on the rise of eating disorders.”

When looking at how far social media should be held responsible for the growth of eating disorders it is useful to consider this question from a global perspective. Research seems to show that when cultures start to internalise Western standards, eating disorders begin to rise. Australia can be described as economically developed, 12The Australian Government Department of Health released a document in 2005 stating, “those most seriously ill from [anorexia] are often in the 20 – 45 year age group.” In comparison to 13Facebook usage demographics in Australia, the most frequent users on this social media platform are in the 25 – 39 age group with approximately 6.1 million users. This is 2 million more than the second highest using category, which was the 40 – 55 year age group. This could be a reason why anorexia is generally most detrimental in the age group that are most exposed to Facebook. The Australian Government Department of Health is a trustworthy source however their document is outdated as it was published in 2005. Since then, there will have been a number of changes to the conclusions as many more recent studies conclude that a younger age group are most seriously ill. The facebook statistics are taken from a website which is dedicated to studying online usage so this is reliable. Despite this, the statistics may be less reliable due to limitations such as vagueness in defining the ‘usage’ of Facebook. Even though there is more users in the 25-39 age group, other age categories may use this social media more frequently spending longer durations of time on facebook despite having less users in their age range.

China can be described as a newly industrialised country. 14Shanghai Mental Health Centre saw the largest rise in eating disorders from 2011 to 2016. 15The BBC reports that China has the largest online population in the world – making it the largest media market, this could indicate that the increase in use of media is the reason behind the rise in eating disorders in recent years. 16This is supported by statistics from China Internet Watch that estimate Chinese adults spend over 3 hours on digital media each day in 2016. The overexposure to media could be another valid factor to why eating disorders have affected China. Shanghai Mental Health Centre serves as a mental health clinic involved in research. Information regarding China is less accessible due to the media censoring however the sources used have been factual and reputable.

Ghana is a less developed country with less impact from social media. 17This is apparent through a case study where the cause of 10 of 668 students with BMIs under 18kg was due to self-inflicted food restriction. These students had “ideas of self-control and denial of hunger, without the typical anorexic concerns about weight or shape”. This could be a sign that although the physical symptoms of anorexia are present, the mental illness is not, as the consequential mental symptoms are not displayed. These results come from the National Centre for Biotechnology Information, who have been cited over 5000 times in many relevant health-related articles. The NCBI is a branch of the US National Institutes of Health, making it a reliable source.

18Social media can be detrimental, but it also gives people a place to be a voice of change and to advocate. Social media can transform from a triggering space to one of encouragement, learning, and support. Online campaigns against body shaming are becoming more common. Social media can promote a sense of community to those suffering from an eating disorder by for example posting an inspirational message related to body image, a recovery-oriented blog, or an article related to eating disorder education. 19The national association for eating disorders hosts several social media events during national eating disorder awareness week including #CaptureHope campaign where participants were asked to upload photos encouraging healthy body to Instagram. 20In a 2016 study published in the British Journal of Social Psychology, researchers looked at transcripts from online eating disorder support groups. They discovered that online conversations help people build a new shared “recovery identity,” which they say helps them talk about their eating disorders and treatment. One person recovering with anorexia told Self “I don’t think I would have made it this far in my recovery without social media,” Brenda K. Wiederhold, president of the Virtual Reality Medical Center told SELF “When someone has an eating disorder, they often think, I’m the only one who has this, but online, they can find people who understand the struggles they’re going through and realize they aren’t alone.” Deborah R. Glasofer, clinical psychologist at Columbia Center for Eating Disorders at the New York State Psychiatric Institute added they can realise how different recovery can be for each person “Reading a diversity of stories helps people feel less alone in their recovery and can help them tolerate the common experiences of recovery that are really challenging”. When researchers surveyed 311 visitors of the site Proud2Bme, a positive body image site, respondents reported that those shared experiences, as well as the information on the site, helped them feel empowered, optimistic, and confident. And even if women never comment or join a forum, simply reading eating disorder memoirs like the first-person essays on Proud2Bme and Recovery Warriors may help women in recovery, according to a 2015 study. Additionally, women who start their own blogs and post about their recovery on social media get the added benefit of built-in accountability. 21Photo sharing site Pinterest began banning or reviewing terms like “thinspiration” which often lead viewers to pro-anorexia accounts or groups, and other social media platforms have made it a point to review communities which are considered harmful. 22Additionally, social media communities trying to help those fighting against eating disorders provide a necessary support. In 2013, social media platform Instagram banned harmful hashtags such as thinspiration and updated its community guidelines to denounce promotion of self harm. I tested this on Instagram through searching for the hashtag thinspration to which a message came up asking “can we help? Posts with words you’re searching for often encourage behaviour that can cause harm. If you’re going through something difficult we’d like to help” There is an option to “See support” which includes contacting a helpline and getting tips and support. However the other option is to “see posts anyway” 23A 2011 study from the University of Haifa examined 248 young women from the ages of 12 to 19 and found that more exposure to social media contributed to higher rates of eating disorders and related concerns. Specifically, the more time these young women spent on Facebook, the more likely they were to struggle with “…bulimia, anorexia, physical dissatisfaction, negative physical self-image, negative approach to eating and more of an urge to be on a weight-loss diet.” These findings hardly mean that Facebook and lack of parental supervision inevitably lead to the development of disordered eating. As mentioned, there are many factors that contribute to eating disorders and all mental health disorders 24This concept was also explored with case studies by Paola Tubaro, an expert on pro-ana sites who published ‘Social media: Feeding eating disorders? (2015)’. Tubaro states, ‘Small groups of peers, especially online, provide a welcoming and non-judgmental environment where persons with eating disorders can share their concerns.” Tubaro offers examples of several women who have benefited from blogging their experiences of battling anorexia and found a way to connect with people supportive of their recovery efforts. The author quotes Bella from London, from the recovery blog, bellabirdie.blogspot.com, who stated, “When you connect with people who are similarly affected by eating disorders, you can receive comments of encouragement from people all over the world. It’s almost like getting a virtual hug.”

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