The Impact of Social Media on Teenagers’

Body Image & Eating Disorders

Ku-ring-gai Council

Body Image Forum for Parents

Dr Gary Galambos, Lawson Clinic Gordon

Lawson Clinic psychologist, Agatha Niezabitowski:

“it is important teens understand that social media

doesn’t show a balanced perception of one’s life”

A very clear message

• “If you notice who you’re following is sending

you unhealthy images such as an inadequate

meal or constantly snapping their bikini bridge

or thigh gap, just unfollow them and follow a

more healthy idol.”

Eating disorders

and their Management

• Ms Niezabitowski will also discuss eating

disorders and preventive measures.

Anorexia nervosa -- intentionally self starve

Bulimia nervosa – consume large amounts of food and then purge

Binge eating disorder -- eating large amounts of food rapidly & feeling guilty or depressed after overeating

Eating Disorders Not Otherwise Specified (EDNOS) -- 40 - 75 %

Body dysmorphic disorder, OCD, Muscle Dysmorphia

The Impact of Media on Body Image

• Media plays a big role on body image and how teenagers perceive themselves.

• People all over the world use the media every day. Whether it's using a computer, watching TV, reading a newspaper, or listening to the radio, media is a way to communicate.

Vedika Rai. Andrea Riolo, Reanna Aikawa

History of Women in Media

• 1920s: The Victorian hourglass figure gave way to the pencil thin flapper

• 1950s: A thin woman with large breast was seen as most desirable

1960’s

• Slenderness became the single most important indicator of physical attractiveness following the arrival of British Super Model Twiggy

• Playboy Magazine promoted the slim body type as ideal between 1958-1979

1970-1980

• Increased emphasis on weight loss & body shape in content of a popular womens’ magazines such as Cosmopolitan & Vogue

1990’s

• The ideal body type for women was slight and slender but with a more athletic and toned look.

2000’s

2014

The “thinspiration movement”

•The average weight of a model is 23% lower than that of an average woman, c/w 8% 20 years ago

•There is now a $33 billion diet industry that was non-existent 20 years ago

•In a recent survey by Teen People magazine, 27% of the girls felt that the media pressures them to have a perfect body.

•69% of girls in one study said that magazine models influence their idea of a perfect body shape.

US Statistics

Commentaries about pro-ana social media

terms “thigh gap” & “bikini bridge”

• “Thigh gap is not a normal body shape for most women"

• "you're going to have to distort and really modify your behaviors. It's almost like a foot-binding kind of thing, it's so distorting of the natural shape of women."

Dr James Lock

Director of Eating Disorders Program for Children and Adolescents, Stanford University School of Medicine

Co-author of "Help Your Teenager Beat an Eating Disorder"

• “What it is is sort of a pathway to

conversations that set girls up for being

unhappy with their bodies”

Dr Anne Becker

Psychiatrist & eating disorders specialist at

Harvard Medical School

• “You have to be severely underweight for [the thighs] to separate, but that's not the message that's being perceived by teens”

• “Engaging in these body-checking behaviors is likely to reinforce body dissatisfaction and negative body image”

• “The quest for a thigh gap could lead to a full-fledged eating disorder”

A/Prof Angela Guarda

Psychiatrist & Director Johns Hopkins Eating Disorders Program

• “Probably the single best documented risk factor for the development of eating disorders is what's referred to as weight and shape concerns”

Prof Linda Smolak

Psychologist & eating disorders body image/social media researcher

Kenyon College, Gambier Ohio

Negative Body Image a major

contributor to Eating Disorders

• Eating disorders have increased 400% since 1970

How do you see yourself when looking in the mirror?

Roles of Social Media: stereotypes

• “There's no question that mass media is one of the social influences that glorifies slenderness and either vilifies fat or ignores it completely. There's also no doubt from our research that fashion magazines and, to some extent, television and movies make it crystal clear that the most important thing for a girl or a young woman is her looks”

Professor Michael Levine

Psychologist & eating disorders body image/social media researcher

Kenyon College, Gambier Ohio

Media depicting women in a

stereotyped way

• Models

• Health and fashion magazine covers

• Computer doctored photos

• “Barbie” and Arnold Schwarzenegger

• Music-video queens and kings

• Movies, billboards, television

Roles of Social Media:

group / meme reinforcement

• Blogging platforms such as Tumblr have become a

forum for "pro-ana" (short for pro-anorexia) and

"thinspiration," or "thinspo," communities that

glamorize, glorify & rationalise the pursuit of

excessive weight loss.

• These platforms pose dangers for vulnerable

people in part because they provide community

& mob mentality to reinforce the maladaptive ED

behaviours.

• Authors of these blogs boast about how much weight they have lost or how little they have eaten, and implore followers to exercise frequently and excessively.

• Users support one another's self-destructive behaviors through shared tips and tricks —and promote the notion that an eating disorder is a lifestyle choice, not a serious mental illness

Male Body Image

• Building a muscular body

offers men the chance to

and reinforce their

masculine identity

• Muscles are seen as signs

of: dominance, control,

authority, physical

strength, and power

• A Muscular body is seen

as: desirable, male power

and domination

Body Image Continuum

Eating Issues Continuum

RANZCP Australian Treatment Guide

for Anorexia Nervosa

What is Anorexia Nervosa (AN)?

• AN is an eating disorder that’s– Severe

– Very distressing

– Has significant physical complications

– Can become a chronic mental illness

• AN can lead to:– severe weight loss

– Chronic physical disabilities such as osteoporosis

– Growth retardation

– Infertility

– Impaired thinking

– Impaired concentration

– Bowel/intestinal disorders

– Major depression

– Major disruptions to emotional, social & educational devt

– Can be life threatening

Characteristics

• Intense anxiety & preoccupation with: • body weight & shape

• Eating & weight control

• Premorbid:• Perfectionism

• Low self-esteem

• External validation

• Comorbid: • Depression

• Obsessional thinking

• Other Eds like bingeing & purging

• Lasts 5-7 years in adults or chronic

• Partial relapses / remissions

• High rates of recovery after 12-18 months with appropriate treatment

Who gets AN & why?

• All ages groups, socioeconomic & cultural

groups

• F>M

• Females aim for a thin body, males aim for a

muscular / toned body

• Genetic link through personality features such

as perfectionism, OC tendencies, anxiety

• Trauma link but not enough on its own

How common? How serious?

• 0.5 % of girls / young women in developed societies

• 1/10 is a young male

• In <13 yo children affected, ¼ are male

• 10-20% death rate in 20 years

• Death from physical causes 5x expected

• Death by suicide 32x expected

• Can start innocently with a diet

• People feel in control & good about themselves at the start, get compliments, feel theyre achieving, it may then feel like a solution to anixety & negtaive feelings

• Malnutrition & obsesive eating/dieting rituals make the sufferer feel out of control / in a downward spiral

Is it a lifestyle choice?

• No!

• Sufferers need reassurance that

– they have an illness

– They’ve not brought it on themselves

– They can’t just choose to stop dieting

– They need to accept help / treatment to get well

Is AN caused by families?

• No evidence for cause (same % with prior

r’ship probs to those without EDs)

• But evidence that family involvement in

treatment improves outcomes

• Common for families to become distressed &

anxious after Dx

• For some families, family r’ship probs develop

in course of illness

Recovery possible?

• People can fully recover

• If treated early, particularly in children & adolescents, recovery occurs more quickly & more often than in those with delayed treatment

• If return to near-normal weight during 1st treatment, do better

• Picture ‘recovery’ as a journey

• Quote of a survivor:– “Getting my life back … living in peace from intrusive & repetitive

thoughts … going out to eat with friends & family and not having to worry about the food … having the space in my head to think about more important things again … Getting back to education & work … being OK with who I am and what I look like now … having more confidence & self esteem to do things I never thought I could … having more meaningful relationships … having energy & motivation to discover, plan and follow my dreams again … having more joy in my life and also feeling sadness in a more authentic way … not feeling numb anymore”

Prevention?

• Reduce severity & impact if treated early

• Prevention focuses on:– Treat anxiety

– Boost self-esteem

– Teaching to be critical of media messages that promote thinness as being successful in life

• Monitor at-risk groups:– Those who play sports that focus on high control of diet & demand

slim or muscular build e.g. ballet dancers, jockeys, athletes, gymnasts, football players

– Those in occupations focus on thin body e.g. modelling, TV, media, fashion industry, advertising

– Those with low self-esteem & perfectionistic personality traits

• Watch for Early Warning Signs in young children that may indicate greater risk of AN

Clues

that young person is developing AN• Physical clues

– Failure to begin or loss of menstruation

– Weight loss w/o other illness

– Poor peripheral circulation (mottled, cold hands & feet)

– Unexplained fatigue /fainting

– Dental decay

• Psychological clues– Obsessive concern about body wt / shape / dieting

– Unrealitsic perception about being fat

– Extreme fear of getting fat or gaining wt or of eating

– Denial

• Behavioural clues– Cutting out foods once enjoyed

– Avoiding sharing meal times with others due to food anxieties

– Excessive or secretive exercise

– Vomiting & using laxatives (purging) as part of pursuit of thinnness (don’t confuse vomiting of AN with purging of BN)

– Social withdrawal

Progression of illness• Mental deterioration

– Increased depression, anxiety & irritability

– Increased rituals related to eating to avoid anxiety

– Increased body image distortion

– Lack of concentration

– Difficulty thinking logically & rationally

– Increase in irrational thoughts in relation to fear of fat

• Physical deterioration– Poor peripheral circulation

– Fainting

– Loss of periods

– Fatigue

– Changes to skin/nail/hair texture

– Yellowing of skin (excessive carotene consumption)

– Loss of hair

– Fine body hair growing on back / arms / face (lanugo hair)

– Metabolic slowing to save energy (slow pulse, reduced BP, lowered body temp)

– Dental probs

– Heart & kidney failure / liver inflammation

– Swollen ankles / dehydration

What to expect at initial assessment

from GP or health professional

• GP is often 1st point of contact

• Conduct assessment including self-harm

• Do full physical checkup – BMI (kg/m2), %IBW, body fat, monitor BP, HR, growth, pubertal devt

• Will provide diagnosis

• Tactics to regain weight, handle feelings AN produces, strategies to improve self & identity

• GP Mental Health Treatment Plan

• Organise other health professionals such as psychiatrist, psychologist, dietician, family therapist, social worker

• Regular physical exams & tests - ECG, ECHO, EUCs, bone density, TFTs, E2

What to expect from MH assessment

• Questions about

• Life at home, school, uni, work, with family & friends

• When it started

• Whether it started with a diet

• Motivations for dieting e.g. encouragement by someone

else

• Feelings about weight, body, looks

• Anxiety about eating

• Eating problems e.g. dietary restriction, exercise,

vomiting, laxative use

• Substance use

• Exercise routines

• Relationships at home, school & work

• Coping patterns, support

Dietician assessment

• Eating patterns

• Food diary

• Quality of what eating

• Restoring normal nutrition slowly

Treatment aims

• Restore weight, reverse malnutrition (prevent

physical disability)

• Achieve wellbeing (prevent relapse)

• Aim for safety & health (not make ‘fat’)

• Give freedom from mental anguish (address

concerns & fears re eating & wt)

• Give back life (normal function & work, school,

social)

• Identify true values – discover passions &

identity

• Set free (restore autonomy)

• Support families / partners

Treatment types

• Multi-disciplinary team

• Specialist psychotherapy

• Inpatient hospital - life saving for refeeding

• Day programs

• Outpatient

• Family therapy (Maudsley) for children & adolescent cases will illness course < 3 yrs

• Weight restoration improves treatment response & prevents LT physical complications

Basic principles

• Restoring nutrition is essential for recovery, but on its own isn't enough to prevent relapse: psychological change is also needed

– “Unless your brain is fed, you cant think & therapy will not work. Every effort will be made to help you do this yourself by supporting you around meal times. Your dietician or nutritionist is able to help you design a snack plan that is right for you. At first you will find it difficult to eat food, but the goal is to get you eating normal foods without fear. You will need to be supported by your treatment team, family & friends to help you stick to your meal plan.”

What to expect from Psychological

Treatment

• Overcome anxiety about change & getting help by moving from denial � contemplation � acceptance � recovery

• Give families the tools to help via education & reducing negative reactions /behaviours

• Priority 1: Get help to eat again to restore nutrition, which gives psychotherapy / family therapy a chance of being internalised

• Priority 2: maintain / normalise eating by working on distorted perceptions / obsessional thoughts

• Priority 3: Address anxiety / depression , restore normal function

• Maintenance: prevent relapse, address other health impacts, ongoing support with lifestyle, socialisation and fitting back into normal life, stress management skills.

Treatment components

• Medical & psychological assessment: define illness & plan treatment

• Behaviour program / special diet: normalising eating behaviour

• Supported eating by dietician / nutritionist / counsellor

• Specialist psychotherapy provided by psychologist / psychotherapist / counsellor / family therapist -- qualified to treat AN & in working within a team that includes a doctor & dietician

• Medications: Psychiatrist / GP

Components of Specialist

psychotherapy • Supportive

• Family therapy

• Psychoeducation

• CBT

• Interpersonal

• Psychodynamic

• Narrative

• Motivational interviewing

• Group psychotherapy

• Support Groups

Medications

• No specific anti-AN medication

• Used for comorbidity – MDD

– Anxiety disorders SSRIs preferred

– OCD

– Distorted perspective Antipsychotics

• Calcium, Vit D, biophosphanates, other supplements

• OCP / HRT

Duty of Care

• Heath professionals required by Law to ensure safety

• In crisis situations when a person– Refuses medical treatment that may be life saving

– Refuses psychological treatment that may be life saving

– Is at immediate risk of suicide or self-harm

• Hospitalisation against will may occur using– MHA

– Child protection legislation

– Guardianship Board

– Next of kin in crisis

• Advance Care Directive – an agreement spelling out steps to be followed in a crisis

How to be a ‘treatment ally’

• Direct involvement in treatment

• Discuss what support helpful

• Emotional support & encouragement

• Financial support

• Communicating with health professionals when approp

• Caring home environment

• Support after discharge

• Encourage pt to keep apptmts

• Upgrade knowledge of illness

• Contact ED support assoc for info

• Mindful of illness & impact on the person

• Try not to diminish person’s overall autonomy / independence

• Support at , before & after mealtimes, offer encouragement

How the illness may affect the family

• Grief, isolation, powerlessness, fear witnessing their loved one struggling with AN

• Frustrated and guilty

• Can become consumed with the illness

• Stress about meals

• Sibs may feel ignored esp around mealtimes

• Worry for health of family member

• Friends unsure how to assist – risk of isolation

• Family benefit from external professional support