Eating disorders (EDs), such as anorexia nervosa and bulimia nervosa, have been steadily increasing over the past 50 years, particularly in young women and adolescents. These disorders are characterised by disturbed attitudes towards weight, body shape and eating, resulting in both impaired physical and mental health [Treasure, 2020]. 

Recently, there has been a growing concern that the use of social networking sites by those suffering from, or at risk of, EDs may lead to an increase in symptoms and adverse effects on their mental health. Research suggests that their exposure to very thin and toned body images (so called “fitspiration,” an amalgamation of the words “fitness” and “inspiration”), and harmful advice and images of restricted and extreme weight loss (“thinspiration”), could lead to the development or exacerbation of EDs. It has also been suggested that EDs are being glamorised, romanticised and promoted on these social media platforms [Jadayel, 2017]. 

Adverse effects of frequent exposure to pro-ED websites 

A 2017 meta-analysis of data pooled from nine studies found that exposure to pro-ED websites was associated with increased body dissatisfaction, dieting and negative emotional states, with small to large effect sizes – although no significant effect was found for bulimic symptoms [Rodgers, 2016]. These findings were supported by a larger meta-analysis of 39 studies published in 2021. This showed a correlation between problematic usage of the internet and significant ED symptoms, body dissatisfaction, drive-for-thinness and dietary restraint in predominately female participants. Interestingly, males experienced a similar degree of body dissatisfaction [Ioannidis, 2021]. 

Frequency of social network site use may also predict changes in how users feel about their body over time. Modelling of the findings of a longitudinal study of Dutch adolescents predicted that more frequent social network site use increased body dissatisfaction18 months later [de Vries, 2016]. The authors investigated peer appearance-related feedback as a potential factor. However, although feedback was also predicted to increase with social media use, it did not predict body dissatisfaction. Boys appeared to be affected in the same way and to the same extent as girls. 

An association between greater social networking site use and significantly higher internalisation of a thin ideal has also been reported [Mingoia, 2017]. This was particularly associated with specific appearance-related features of social media use such as posting or viewing photographs.

Users develop a positive association with an unattainable, idealised model of thinness portrayed in the media, one that is often associated with attractiveness and success.

The underlying mechanisms behind the association between problematic use of social media and EDs have not been completely elucidated. However, the findings of a recent study of young adults support the possibility that muscle dysmorphia (a preoccupation with physical appearance and muscularity involving compulsive exercise) may be involved [Imperatori, 2022]. 

Pro-ED social networking in people with and without ED 

Compared to people without an ED, people with an ED have a significantly higher use of social media and of posting selfies, and a significantly higher frequency of comparing their own physical appearance to that of people followed. Such comparison with others has been associated with body dissatisfaction and drive for thinness [Jiotsa, 2021]. The level of education appeared to be a factor here. A higher level of education was associated with a lower frequency of comparing one’s own physical appearance to that of people followed on social media. Also, the highest level of education was associated with lower scores for the body dissatisfaction and drive for thinness scales. 

The most common advantages noted by people with clinical or subclinical ED for posting/following thin-ideal content were motivation/encouragement to engage in a certain behaviour (e.g. to be thin, get healthy, work out or restrict their eating or diet), socialising, and information giving/seeking. In particular, increased motivation to engage in harmful eating/dieting thoughts and habits was significantly greater in those with clinical or subclinical ED compared to those without an ED [Cavasos-Rehg, 2020]. In contrast, people without an ED cited increased motivation to engage in healthy eating/dieting habits, such as to “get healthy” and “work out”, as advantages to ED social networking. These findings suggest that pro-ED social networking by people with EDs has the potential to reinforce ED behaviours and lead to exacerbation of their condition. 

Interestingly, when individuals with an ED were asked open-ended questions about the possible causes of ED, they less frequently identified media/culture ideals compared to people without an ED. This suggests they may not be fully aware of the impact of exposure to social media [Blodgett Salafia, 2015]. 

Perceived positive effects of pro-ED social networking by people with ED 

Alongside the negative effects of pro-ED content on the mental wellbeing and physical symptoms of people with, or at risk of ED, some beneficial consequences of the use of social media in this context have been reported by users, such as increased social support, recovery, helping others and access to healthy eating information [Valente, 2022].

An online survey of Facebook use by individuals who were being treated for an ED showed that, although comparison to their peers was associated with greater ED psychological impairment and ED-related symptoms, conversely, positive interaction was associated with lower ED psychological impairment and ED symptoms [Saffran, 2016]. 

Feeling connected to others and accepted for their struggles and successes were benefits expressed by participants in a recovery community on Tumblr. A minority noted, however, that such acceptance could sometimes reinforce negative behaviours, and connection could lead to pressure to help others. Participants also found both direct advice and indirect support to be motivating for their recovery. However, feelings about competition and comparison were mixed, with some using comparisons as reminders to stay strong in recovery, whilst others found that they had a negative effect. The type of response by these individuals may be related to whether they were already starting to recover or still only contemplating change [Jones, 2022]. 

Conclusions 

Frequent exposure to pro-ED “thinspiration” and “fitspiration” posts on social media sites by people with, or at risk of, ED can lead to the promotion and maintenance of their condition, adversely affecting both their physical and mental health and wellbeing. The underlying mechanisms that mediate this association have not yet, however, been completely identified. In contrast, some users perceive benefits, such as social support, recovery, helping others and access to healthy eating information, from engaging with others on these social media sites. 

Barbara Baker, March 2023

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