Introduction
Bulimia Nervosa is, by definition, an eating disorder involving a cycle of binge eating, prior to purging and other compensatory behaviours, in fear of weight gain. Around 5 million females and 1.5 million males in the US are affected by bulimia. The Diagnostic and Statistical Manual of Mental disorders, fifth edition (DSM-V) from the common disorders in axis-1, can help with the understanding of bulimia diagnosis. Some symptoms include continuous cycles of binge eating, self evaluation and body image being heavily influenced by weight size, and the development of compensatory behaviours like the squandering of laxatives occurring at least once a week for a span of 3 months. In most cases, bulimic patients are of adolescent years, and tend to be of average weight, which makes its prevalence difficult to condition as people can suffer its symptoms in silence to avoid the feeling of shame and embarrassment. This may also be a reason why males are less prone to eating disorders, in addition to fitting into the stereotype of “masculinity” rather than “femininity” by denying to confess their symptoms.
Being a lifestyle disorder, the causation of Bulimia Nervosa can be associated with many factors like hormones, stress, genetics, parenting, and peer pressure. However, as per the growing popularity of interactive media among adolescents, the investigation is mainly focused on the impact of media on females, which later may lead to Bulimia. The term “Media” refers to the mass of communication mediums and other publishing systems used to present sources of information to the public. With great advances and development of digital technologies, the world has become more reliant on the use of media, making it easily accessible and more efficient to gather information, educate, and entertain people through various forms.
According to 2018 reports from the media company, We Are Social, the number of social media users worldwide have risen by 13% to around 3.196 billion in 2018. Even people living in underdeveloped countries like the Democratic Republic of Congo, are familiar with words such as “Twitter” and “Instagram”. Statistics by Statcounter recall that 94.2% of Congolese citizens have used Facebook at some point in 2018, making social media a readily accessible and almost inevitable cluster in today’s growing society.
As a result of being a universal engagement source, social media’s excessive use can contribute to the development of eating disorders. Researchers at the university of Ottawa and the children’s hospital of Eastern Ontario conducted a research survey on 383 undergraduate students where 70% of them were female. The researchers aimed to determine participants’ social media use, body image and eating behaviour. The study found that people who were already dealing with body issues used more social media sites than others. Additionally, it was found that the use of social media affected both genders differently. Excessive social media was correlated with restraint eating, where individuals restricted their eating behaviours and visioned negative body images. Social media use was mostly linked with emotional eating in females only, where they would eat in order to help ease their mind from stress and discomfort.
Another study examines the desperation of facebook likes that facebook users want in order to feel satisfied. Researcher Keel studied 960 college women and found that those who were more active on facebook were most likely to develop an eating disorder. Females who were more interested on the amount of comments and likes they received on facebook had the highest levels of getting diagnosed by an eating disorder. This brings out the relevance of how self consciousness and low self esteem arisen through the use of social media can highly lead to certain eating disorders.
The concept of social media can be an additional factor to a person’s cognitive, sociocultural, and physiological influences.This may highly be due to the bodily adverts and stereotypical standards of beauty portrayed on media platforms like instagram and facebook. With a build up of experiences from such platforms, the brain processes schematic and preconceived thoughts about one’s body in relation to what they see on the media, which can lead to self consciousness that pressurise them into conforming to society’s ideal body image for satisfaction. Hence, leading to eating disorders like Bulimia Nervosa. As a result of this issue, I have developed my research question; To what extent can the exposure of ideal physique on social media, lead to bulimia nervosa in adolescent females in the US? With this generated knowledge, I intend to help enhance researchers in spreading awareness and designing intervention strategies for adolescent females. Being ethnocentric, the findings derived can be generalised to other cultures as well.
The preceding question will be answered in respective to theories and studies within psychological approaches (biological, cognitive and sociocultural). I will investigate the question by evaluating and discussing nature perspectives (evolution and genetics) using the Catalyst Model and the Diathesis Stress Model, then proceed to the nurture predisposition, where I will mention the social cognitive theory and the objectification theory. The concept of the Schema theory and the Cultivation Theory will be used to address cognitive factors, all in relation to the rich ideal presented on social media, enhancing the likeliness of developing Bulimia Nervosa.
Nature predisposition to Bulimia Nervosa
Ferguson et al. (2014) developed the Catalyst model to help explain body dissatisfaction in women using an evolutionary perspective. It is predicted that a behaviour is seen as adaptive if it continues to remain and exist with time, increasing its chances of survival by staying in the genes. If the behaviour was taken out through the process of natural selection, then it is claimed to be maladaptive. Hence eating disorder like bulimia, which are still prevalent, can be seen as adaptive. The model shows that body dissatisfaction may be due to the competition of getting a mate, which may vary depending on the culture, affecting desires of meeting an ideal physique. This may be due to the options of partners a woman can choose from, the type of food she regularly eats surrounding her culture, etc. The model also shows that the pressure of wanting to mate is dependent on the behaviour of peers and their importance of meeting a standard body type.
The Catalyst model states that peer groups and family members tend to impact female body views negatively due to competition. Although the media can also play a role, it’s use is not as effective as real life’s. This may be because the fictional sources seen on the media can be learnt in a similar manner to that in real life. Additionally, media is seen to take a globalised response, whereby it presents information that is universally shown, is rather predictable in relation to idiographic considerations that are specific to a personThe evolutionary explanation that females are competing with each other to find their best mate, rather than competing with women from media platforms, hints that they are aware about most media images being fake and not correlating with realistic images. Therefore the Catalyst model suggests that media isn’t as effective for the development of eating disorders overall.
One study examined 202 undergraduate females at the University of Arizona. Participants carried out computed surveys that included scales to measure their competition for mates, for status, their general competitiveness, and their Eating Disorder Inventory (EDI). The results were correlated, and a structural equation model was formed for all the scale measurements. It was found that these competitive scales for women contributed to the concept of perfectionism, self dissatisfaction, slenderness, and having a high general competition.
Participants were additionally asked about their personal preferences and their ideal type of mate. Similarly, the findings also expressed signs of body dissatisfaction and the need to have a slender figure, which supports the Catalyst model, whereby participants feel these factors as a result of competition, negatively motivating them to reach a desired level, which, if taken too severely, may contribute to the exposure of disorders like bulimia.
Binge eating can be seen as a sign of survival, as the binged food can be stored as body fat. These fat reserves can be used for future purposes such as pregnancy and lactation. The bingeing gene can possibly be mutated with another that empties the stomach once it’s full, leading to purging. On the other hand, this purging behaviour isn’t healthy, which may not make it successful through the concept of evolution. Additionally, it does not bring out correlations between factors of bulimia and the media’s thin ideal as it overemphasizes the role of nature and does not show signs of nurture that may affect the development of bulimia through competitiveness. Other factors like cultural variations or genetic mutation may contribute, making bulimia maladaptive instead.
The concept of having an ideal body type can contribute to bulimia’s development, which may occur through the use of mass media, depending on a person’s cultural environment. However, researchers found that genetics may result in bulimic symptoms as well. Genetic alterations can derive from the media’s idea of perfectionism, making the etiology of eating disorders like bulimia difficult to inform.
Laboratory experimental research indicate that the exposure to slim body ideals can lead to acute self dissatisfaction. These studies however, do not imply whether the findings may lead to long term results. 219 adolescent girls were randomly assigned to a 15 month fashion magazine with two conditions with either a subscription or not. The longitudinal experiment did manipulate participants exposure to the fashion magazine. However, there was no clear long term effect of wanting to meet the ideal slim body standard, body dissatisfaction, or any other bulimic symptoms. However, adolescents who were seen to be under the pressure of wanting to to be thin, had high self dissatisfaction, including social affiliation, as they were highly affected by seeing the presented images. This exposure to thin ideal body types can negatively impact an already vulnerable individual. The symptoms of eating disorders such as body dissatisfaction can intensify as a person undergoes a time of stress. The exposure to stressors can exert emotional pressure in the person, which can lead to genetic vulnerability. These alterations can therefore increase the risks of a person developing bulimia.
The concept of how genes predispose rather than cause eating disorders like bulimia, can be explained using the Diathesis Stress Model. According to this model, an individual might inherit vulnerability towards a certain disorder (bulimia nervosa) due to genes that may affect structures in the brain or even body perception (the diathesis), and due to the high levels of psycho-social stressors, they are at a greater risk of being diagnosed with the disorder. This however, does not conclude that genes are fully responsible for the development of bulimia and it’s symptoms of wanting an ideal body type. Other factors like the environment and social experiences may contribute to the desires of meeting body standards and bulimia.
The gene-environment interaction is a common way that can clear the correlation between genes and the environment, to help in the understanding of bulimia and the concept of media. This interaction explains how an individual’s built up genes may impact their response to the environment. In western countries like the US, this interaction can be used to help in understanding how eating disorders may develop through the media’s implementation of ideal physiques in female’s minds.
Unlike previous sociocultural theories, the model of gene-environment interaction explains how and why certain people are affected by the cultural norms of reaching a certain body standard, when all people are exposed to it. The reason being, that the development of an eating disorder may initiate from a person’s genotype, which may be impacted due to the person’s exposure to certain insults like strict dieting or binging. For example, a person with fewer genetic loading may be exposed to ideal thinness, try the binging and purging process, dislike the experience, and return back to their regular habit. Whereas, someone with a higher genetic loading my forcibly continue with the binging/purging process and manipulate their minds into thinking it’s effective, hence making them more prone to the risk of developing an eating disorder like bulimia.
Nurture predisposition to Bulimia Nervosa
The prevalence of eating disorders are mainly seen on young adult women, which explains their psychological and medical concerns. Treating their disorders are complicated due to the various types of etiologies. Sociocultural factors derived from experimental and observational research claim that social transition like immigration, the exposure to western media, and being around peers that bring up negative mindsets such as social comparison and teasing, can contribute to the development of eating disorders such as bulimia.
The social cognitive theory (social learning theory), developed by Bandura can help with the understanding of the development of bulimia through observational learning of role models. The first stage of this observational learning starts with a presence of a role model, whether it be a parent or celebrity. The individual then identifies with the role model and relates to it in someway, whether it be gender or culture. The behaviour is then observed through four terms; attention (attending behaviour), retention (retain the behaviour in memory), reproduction (ability to imitate the behaviour), and motivation (reason behind the imitated behaviour e.g a reward).
Bandura (2001), claims that the social cognitive theory (SCT), can be used to understand how people’s observation can modify their behaviour in a way to reach their desired outcome. Women may feel the need to emulate the ideal physique presented to them by the media or by their peers. This pressure and competition therefore, may lead to body dissatisfaction and low self efficacy.
Anthropologist, Anne Becker, aimed to investigate the correlation between new western TV media and the level of purging, body dissatisfaction, and dieting in young Fijian women. Two groups were formed and observed in two different years (1995-before Tv was introduced and 1998-after TV was introduced). Participants were school girls around the age of 17 years. There were 63 participants in 1995 and 65 in 1998. Participants were asked to carry out an EAT-26 questionnaire to see their status of body image and health. Researchers then carried out a semi-structured interview. Although both the groups’ BMI (Body Mass Index) was on the average range, the level of tv viewing was 41% in 1995 compared to 1998, which was 71%. The chi-squared results showed that there was a 99.9% significance of a sample’s likeliness to watch TV. No girls in 1995 claimed to have purged to deal with her body, whereas 11.3% of the 1998 girls did.
Dieting is not glorified in the Fijian culture, however, researchers reported that 74% of the 1998 participants felt too fat, and 69% of them claimed to have dieted at some point. Additionally, 83% of the 1998 participants felt that TV influenced their view on body image and weight.
The people portrayed on western TV were seen as role models by the Fijians, which pressurized them into wanting to be thin instead of remaining in their natural state, which in the Fijian culture, is more muscular and full.
The SCT shows that observation is learnt through reinforcement and imitation from role models. The theory also relates eating disorders like bulimia to a cultural phenomenon as different cultures are willing to alter their eating habits to develop their desired expectations. The behaviour portrayed can be seen as environmentally deterministic, as it expresses how a change in the environment can change behaviour. Contrarily the SCT is reductionist as it only talks about the nurture perspective of behaviour.
Other factors like genetic influences can impact a person’s thought process and lead to body image concerns, increasing the chances of developing bulimia.
Additionally, other factors like cultural differences can impact one’s vision of body size and appearance. A qualitative research done by Rand and Kuldau (1990), aimed to investigate the prevalence of obesity and other weight concerns in 2,115 African American and White females. When interviewed, teenage white girls reported to have “no weight problem”, but found to be falling under their “ideal weight range”. On the other hand, teenage African American participants who also claimed to have the same, were more fitted in their “ideal weight range”. This highlights an etic approach to the research, whereby, the cultural norms of a white individual’s acceptable weight is thinner than average, compared to an African American’s.
The research carried out a structured interview, which is appropriate for comparative research. However, the topic of weight is sensitive and can lead to participant bias like social desirability and sensitivity bias, thus impacting the study’s credibility.
To decrease epistemological reflexivity (critical thinking of methodology) and researcher bias, Rand and Kuldau found that age can also affect the way women perceive their weight. They concluded that older African American women who were overweight claimed to have “no weight problem” in relation to younger African Americans.
In relation to the development of Bulimia, a comparative study by Gray et al. (1987) focused on bulimic college African American and white females. It was found that more white participants expressed a level of fear concerning food and weight control compared to black participants. This additionally shows etic factors that contribute between the two ethnicities. The African American culture may be more supportive and appreciative socially on an average or full body size, compared to the white culture, which may be more concerned on physical appearances. Such aspects can act as “protective factors” for African Americans to limit their likelihood of developing bulimia (Root 1989).
Cognitive factors influencing the diagnosis of bulimia.
The significant difference between men and women’s way of dealing with digital technology can help in the understanding of cyberfeminism. Cyberfeminism refers to many theories and movements that attribute the relationship between genders and the digital culture. Worldwide statistics show that women outrank men in the use of social networking and are at a greater risk regarding their security and safety. Females are expected to conform to the feminine stereotypes portrayed on social media in order to not only avert negative comments and criticism, but avoid harassment and assault as well.
Some online communities like pro-bulimia (pro-mia) and pro-anorexia (pro-ana) consist of various websites, blog posts, and discussion groups that have tips, hacks, photos, videos, etc. which promote eating disorders. This negative message and content, also referred to as ‘thinspiration’ or ‘thinspo’, can be implemented in one’s head, whereby they heuristically normalize unhealthy eating habits and further damage their body to the extent of developing an eating disorder.
The use of internet and digital technology (cyberspace) is widely pervasive nowadays as it continues to develop. Digital technology includes devices such as computers, smartphones, calculators, etc. which process information and enable a form of communication. Social media apps are major modes of communication, vastly used through many digital devices. Although the use of digital technology can be very advantageous when socializing amongst others, it can also build up many concerns like fitting within beauty standards, which can negatively impact the cognitive processes of a person. This concept tends to be more prevalent in female users however, as they are more sensitive, vulnerable, and tend to easily conform to topics such as ideal body standards, compared to males overall. Therefore the concept of schema is different between the two genders. In psychology, the term schema (schemata) organizes and describes the categories of information (thought or behaviour) in one’s mind. This information is then used for better understanding of new knowledge and to make sense of the future.
One study carried out a repeated measures design and aimed to see the type of effect attractive models portrayed on the media have on women’s mood and body image. The sample of 106 college females was divided and categorized into two groups (high appearance self-schema and low appearance self-schema). An interval of four weeks measured each participants mood and behaviour towards their body. It was found that the attractive models’ images didn’t have a significant effect on participants body image scores. However, participants moods were affected and expressed signs of anxiety and depression. Participants with high appearance self-schema had greater negative moods and lower levels of body dissatisfaction.
This shows that media influenced the participants cognitively rather than physically. Their vision of an attractive figure resulted into cognitive changes and mindset, affecting their schema on how they perceive themselves, hence why, they elevated anxiety and depression.
Another study supporting the schema theory investigated the relationship between 88 college women participant’s ideal body image and their own appearance, mood and self esteem. A two-part experimental design was carried out whereby, participants completed measures of their perceived body type, self esteem, self discrepancy (self comparison), and self schema of their appearance overall. After a span of 2 weeks, participants were shown 16 attractive media pictures and asked to give out measures of their own body image, self esteem, and mood again. It was found that participants self schema provided a good explanations to their body image perception and self efficacy.
Using the schema theory on the two studies helped in explaining how cognitive processes such as perception and memory function in both the genders. The information they stored in their memory about body standards shown, lead them to perceive the new information, which is the way they see themselves compared to what is shown on the media, leading to health concerns such as developing an eating disorder. Contarily, the concept of schema is unclear (Cohen 1993). It is too vague to give us in depth details about how these thoughts implemented on females actually formed.
In a content analysis by Borzekowski et al. (2010), out of the 180 pro- ED (pro-eating disorders) webpages, 84% of the websites contained pro-ana content and 64% had pro-mia content. This high promotion of eating disorders may manipulate and build up schematic information in people’s minds, especially females, leading to eating disorders like bulimia.
Another theory that helps in the understanding of the cognitive factors influencing bulimia is the cultivation theory. This theory shows the correlation between the exposure to media and one’s perception of ‘reality’. In many media platforms, messages and images are disseminated and spread around with the idea of ‘extreme slenderness’, encouraging women to change their eating habits and think their body is rather ‘abnormal’ (Seid, 1994). Researchers Ogden and Munfray (1996), apply the cultivation theory by showing thin female images to women. The results of their surveyed participants expressed a high body dissatisfaction within themselves. Similar findings by researchers Stice and Shaw (1994) also supported the cultivation theory when they randomly showed magazine pictures to undergraduate female participants. They found out that the exposure to these pictures showed signs of stress, shame, body dissatisfaction, etc. which, are part of the symptoms of bulimia nervosa.
Conclusion
Psychological explanations of the development of bulimia come in many forms. This means that using one of the influences can be reductionist because it only brings out a one sided explanation, therefore, a multidimensional approach must be shown.
Although studies mentioned in the aren’t all specific to the US, it can still be generalized and applicable to women, gathering a xenocentric approach. Additionally, it gives a holistic understanding of social media’s universal influence on the development of bulimia. However the generalizability is limited as cultural factors may impact the findings of situations.
The development of bulimia is unique to each individual as it is dependent on their own self perception, genetic vulnerability, a person’s schema, and they cultural background all contribute to bulimia diagnosis through the concept of dieting, binging, and purging. These compensatory behaviours can get even more evident through the use of social media, which if used, people can observe the characters displayed and feel the need to imitate them. This lowers their self efficacy, self esteem, and increases their level of body dissatisfaction, and their willingness to be thin. Hence, increasing their chances of developing Bulimia Nervosa.