Linking Eating Disorders, Stigma, and Media

The summer prior to my freshman year of high school was marked, unexpectedly, by an eight week excavation into a sole fragmented psyche at Camp Blue Ridge. The all-girls sleep-away camp served as a sort of social training ground to prepare incoming high school students for their new roles as freshmen. Every day, one of the girls in my bunk, Sarah, would wake up looking exhausted and leave the bathroom after getting ready with a self-assured smile upon her face. At first this seemed like the routine of a girl who was unhappy with her physical state prior to her morning ritual of hygiene; a few days later, the real reason became apparent. The first time I walked in on Sarah vomiting into a toilet, I was enveloped with a shroud of worry and panic. Sarah insisted to me frantically that she was "just sick." I found that explanation plausible until I noticed that Sarah was "just sick" a lot. When I confronted Sarah about her illness, she begged me not to tell anyone. I knew I could not continue to comply with Sarah's cry for secrecy, so I acted upon my gut feeling to inform the camp's counselors. Sarah and I have not communicated since.

This experience sparked my inquisition about Sarah's illness and the secrecy behind it. Why didn’t Sarah want to seek the help of the camp’s counselors? Why was she so afraid of reporting her illness? What could I have done to help?
 
I have since learned that Sarah is not an isolated case; legions of men and women who suffer from mental illnesses silence themselves rather than seeking help. According to Stacy L. Overton and Sondra L. Medina’s peer-reviewed article “The Stigma of Mental Illness,” less than 30% of people diagnosed with mental illnesses actually seek treatment (146). Eating disorders are among the multitude of conditions that are classified by the Academy for Eating Disorders (AED) as mental illnesses. The National Eating Disorders Association defines the illness and its set of causes as “complex conditions that arise from a combination of long- standing behavioral, biological, emotional, psychological, interpersonal, and social factors” (“Contributing Factors & Prevention”). These conditions include nutritional deficiencies, irregular hormone functions, poor self-esteem, negative body image, and a dysfunctional family dynamic, according to Eating Disorder Hope, an affiliate organization of NEDA ("Causes, Symptoms, Signs & Treatment Help”). In their article, Overton and Medina cite stigma as a principal reason why the majority of the population afflicted by mental illnesses do not explore potential remedies.
A breadth of studies exists that delves into the relationship between mental illness and stigma. According to Overton and Medina, stigma is “a multifaceted construct that involves feelings, attitudes, and behaviors” (143). In this paper, I use this definition while also emphasizing stigma as fundamentally associated with shame. It is important to note that the stigma surrounding mental illness has long historical roots and continues to persist, as corroborated by University of Chicago professors Patrick W. Corrigan and Amy C. Watson in a research article titled “The Paradox of Self-Stigma and Mental Illness.” The article details personal narratives of those impaired by mental illness, highlights the damaging effects of stigma on their disease, and explores the paradoxical nature of self-stigma. According to Corrigan and Watson, stigmas against psychiatric patients permeate public perception. The general population discerns the mentally ill from the physically ill by picking up on behaviors that they feel are out of the ordinary or abnormal (36-38). Corrigan and Watson indicate the three components that comprise this stigma towards the mentally ill: stereotypes, prejudice, and discrimination. Discrimination is one consequence of stigma, a prejudicial bias born from stereotypes that tarnishes the quality of life for a mentally ill individual (37).

Although stigma against mental illness is pervasive in contemporary society, the stigma against eating disorders is more often misunderstood because it takes a variety of forms. In this paper I argue that simplistic attitudes towards eating disorders in the media have contributed to a continually morphing social stigma that trivializes the severity of eating disorders. I will evidence this claim by highlighting the dietary and gendered construction of eating disorders that advertisements in magazines endorse. I will then proceed to critique the depiction of eating disorders as a lifestyle choice that is fundamentally disconnected to psychological and biological factors, pointing out that a deeper understanding of eating disorders’ complexities might provide the empathetic environment necessary for more women and men suffering from those afflictions to seek help.

The existing literature that investigates the stigmatization of mental illnesses suggests that eating disorders are stigmatized more severely than other mental illnesses. Perhaps this is because eating disorders can be “picked up on” or identified more easily. According to the National Eating Disorder Association, 20 million women and 10 million men are afflicted by eating disorders throughout their lifetime; even more astonishing is the fact that eating disorders have the highest mortality rate out of any mental illness. Despite these concerning figures, studies theorize that the stigma surrounding eating disorders is more prevalent than
 
that of other mental illnesses. In their article “Stigmatization of Anorexia,” Maria-Christina Stewart, Pamela K. Keel, and R. Steven Schiavo assess a study that was conducted to measure international perception about a healthy person, a personal with a physical illness, a person with a non-eating disorder mental illness, and a person with anorexia. Their findings underscore the hypothesis that eating disorders are stigmatized as fundamentally connected to self-blame and self-infliction. Participants identified schizophrenia as more inherently biological and psychological than eating disorders; this is a salient indication of the inapt belief that eating disorder pathology is socially constructed (323). Stewart, Keel, and Schiavo explain the public’s lack of knowledge about the biological and psychological factors that contribute to eating disorders and the consequent trivial attitude towards them. They write, “It is likely easier for a lay person [without an eating disorder] to understand body dissatisfaction as a cause of AN [anorexia] than to comprehend the possible role of genes that code for the 5-HT2a receptor in the etiology of the disorder” (324). In other words, people without eating disorders find it easier to place the blame on social factors that cause eating disorders than accepting that any part of the cause for the eating disorders derives from genetics.

Although academics and experts concur that eating disorders arise from a number of factors, the research exploring eating disorder symptomatology tends to overemphasize the influence of social factors. In their article “Adverse Effects of the Media Portrayed Thin-Ideal on Women and Linkages to Bulimic Symptomatology," Eric Stice and Heather E. Shaw, from Arizona State University, report on a study which evidences that the internalization processes that emanate from exposure to the thin-ideal in media have both direct and indirect links to the development of bulimia (302). Television, advertisements, social media, and online content have been identified as mediums that prompt thin-ideal internalization, self-objectification,
 
weight dissatisfaction, and the drive for thinness, and in turn eating disorders. In the critical study conducted by Marika Tiggemann and Amanda S. Pickering presented in their article “Role of Television in Adolescent Women’s Body Dissatisfaction and Drive for Thinness”, television content was found to be predictive of eating disorder symptomatology. In particular, soaps and serials were the key programs that spark these patterns of thought and symptoms.

Furthermore, Anne E. Becker and her colleagues in “Social Network Media Exposure and Adolescent Eating Pathology in Fiji” posit that social media transmits eating disorder symptomatology. Their study found that when young Fijian girls viewed Facebook photos of thin women online, the rate of internalization increased; as a result, eating disorders became more widespread in the region (Becker et al.).

Advertisements are a visual medium responsible for fostering widely-held stereotypical attitudes and stigmas towards eating disorders that lead to misguided perceptions about the illness. Incessantly littered throughout a variety of publications, these ads commonly feature images and stories about celebrities and models who epitomize the thin- ideal. Myriad studies unveil the clear link between often-idealized celebrities, their influence, and body dissatisfaction, which in turn catalyzes eating disorders. John Maltby, David C. Giles, Louise Barber, and Lynn E. McCutcheon published the results of their study in an article titled “Intense-Personal Celebrity Worship and Body Image: Evidence of a Link Among Female Adolescents,” which found that admiration for celebrities and their body images affects eating pathology in female adolescents. Their article invokes the example of a young girl Kara who developed anorexia in an effort to emulate Vogue model Kate Moss’ physique (19).While some sufferers develop their eating disorders in an attempt to closely resemble glorified celebrities, not all sufferers are influenced by celebrity culture and the thin-ideal that surrounds it. The emphasis on advertisements that endorse the thin-ideal has led to false representative samples of eating disorder sufferers. Society has manifested a grossly misconstrued and obviously distorted idea of those afflicted by eating disorders by simplifying a real, complex mental illness that is caused by a multitude of factors down to a vain aspiration that is born out of societal pressure to equate beauty with thinness.

Some may argue that there are indeed several eating disorder cases that are directly attributed to exposure to images of underweight models and celebrities in advertisements. While this is true in some cases, this argument skews public perception by engendering false generalizations about the larger population of eating disorder sufferers. This shortsighted perspective emphasizes the social factors that play into eating disorders and ignores the biological and psychological foundations of the disorder. Some sufferers concur that advertisements reduce the severity of their mental illness to an unwise choice that they make in order to succeed in the pursuit of societally accepted aesthetic presentation. Recovered anorexic Amelia Tait expressed her frustration with this simplistic attitude in an article she wrote for VICE; she details numerous stories of eating disorder sufferers she met who had causal attributes that were entirely independent of media. The failure to consider the non-social factors that inspire eating disorders suggests that social factors such as media portray eating disorders as a lifestyle choice, distinctly different from a deleterious pathology that is the crux of a serious mental illness.
The prominent magazines that delineate the thin-ideal via advertisements and discuss dietary habits of celebrities have gendered stigmas that further contribute to the social stigma that trivializes eating disorders. Magazines such as Cosmopolitan, Vogue, Teen, Young Miss, and Seventeen target an audience of primarily female adolescents (Vaughan and Fouts 314).
 
The bulk of content of these publications is painfully stereotypical of the societal attributions and expectations of the female sex. These supposed pieces of self-help literature are plagued with endorsements promoting makeup and clothing, as well as advice and tips regarding being a homemaker rather than assuming roles as independent working-class individuals.

The thin-ideal of beauty propagated by magazines suggests that women physically should take up less space than men, thus supporting the existence of a patriarchal society. Because magazines that sell the thin-ideal are directed towards a teenage female demographic, the pathologies that they aid in forming are often seen as mere byproducts of the standards of beauty that females are expected to meet. This notion hugely trivializes the severity of eating disorders because it fails to legitimize the complexity and reality of the psychological factors that are at play in manifesting eating disorders.

Some may argue that approaching the stigma through a patriarchal lens perpetuates sexism and minimizes the plight of male sufferers of eating disorders. While it is true that the majority of eating disorder and media studies focuses on females, the point that eating disorders are on the rise in males supports the idea that a myriad of factors, including nonsocial factors, need to be investigated for their roles in those conditions. Such a hypothesis is backed by a study Jennifer A. O’Dea and Susanne Abraham conducted to measure disordered eating and exercise disorders among a sample of the male populace called “Eating and Exercise Disorders in Young College Men”. According to O’Dea and Abraham, “significant exercise concerns” were present in one third of the participants in the study (276). These findings imply that there is a relationship between societal standards of attractiveness that are established by presentation in the media and disordered eating behavior. However, academia and society at large have not
 
given sufficient consideration to how this phenomenon affects men. Men suffer from some intriguingly different yet equally complex psychological disturbances relative to women, and in both cases eating disorders need to be treated with more nuance and awareness of each
situation’s complexity.

Framing eating disorders as a lifestyle choice and using images to motivate disordered eating behaviors is unintentionally stigmatizing due to the way that they influence popular streams of thought, particularly within those afflicted. If eating disorder sufferers believe that they are making the choice to succumb to societal pressure and develop an eating disorder, society will be inclined to view eating disorders as social in their nature and not strongly affiliated with genetic, biological, and psychological dispositions. Such an unfortunate mischaracterization perpetuates the stigma against eating disorders by lending false credibility to the idea that eating disorders are a choice and that visual media is a vehicle to encourage making the “right” choice. Rarely on these sites are the psychological elements of eating disorders discussed; the absence of scientific and emotional discussion on these sites underscores a significant cause of the social stigma that surrounds eating disorders because of their supposed lack of intricacy and causes outside the realm of media and social pressures.

Social media outlets have given way to the aforementioned “thinspiration” movement, which has given way to an oversimplified way of looking at eating disorders. As described by USA Today reporter Marcela Rojas:
Social media, where users exchange information and photos and communities form over common interests, has become a bastion for some struggling with eating disorders.
Images of spindly legs, concave stomachs and jutting ribs emerge on various sites by searching hashtags like #thinspogram #thighgap or #bonespo. The disturbing photos are often accompanied by even more shocking “thinspirational” messages - “Pretty girls don’t eat,” “Skip dinner, be thinner” and “You have to exercise for a week to work off the thigh fat from a single Snickers.

Numerous scholars have explored the effects of thinspiration on public perception of eating disorders and on those afflicted. Professors Jannath Ghaznavi and Laramie D. Taylor at the University of California, Davis crafted the research article “Bones, Body Parts, and Sex Appeal: An Analysis of #thinspiration Images on Popular Social Media”. They look at thinspiration content on social media through the lens of social cognitive theory. According to Ghaznavi and Taylor, “Social cognitive theory proposes that people learn from modeled behaviors and are more likely to imitate such behaviors when they can relate to the model and when the behavior is rewarded socially or otherwise” (55). While this is generally a valid way to view social behaviors, when applied to eating disorders, it yields an inept oversimplification of a grave mental illness. Eating disorders are not merely social behavior.

Some argue that media is a vehicle for facilitated recovery and that these media outlets provide unique opportunities to forge connections and create solidarity among eating disorder sufferers. According to a Huffington Post article “How Instagram Is Helping Me Recover from an Eating Disorder" written by a recovering anorexic, “the Instagram recovery community is a place where people are genuinely proud of you if you're doing well or feeling OK, but they also want to support you if you're not” (Proud2BMe). While constructive use of social media in aiding eating disorder sufferers is praiseworthy, this viewpoint obscures the fact that, on social media outlets such as Tumblr, content that encourages eating disorders is almost five times more pervasive than content that serves to help provide a sense of community and hope to those afflicted by eating disorders (De Choudhury 48). The fact that a proportion of the population believes that eating disorders can be mitigated through the use of social media should not overshadow the fact that the media’s role to this point has been more of a facilitator of eating disorders than a commendable source of self-help advice.

The relationships between eating disorders, media, and stigma demand further scientific research, but hopefully the findings of those studies can make their ways eventually to the public and not simply the physicians, psychologists, and psychiatrists, who are attempting to treat eating disorders. The realization that eating disorders are not entirely derived from social institutions but rather emanate from a number of multi-dimensional factors is the first step in raising public awareness about the issue. If society recognizes the pervasiveness of the stigmas associated with eating disorders, those afflicted by eating disorders will likely feel less reticent towards admitting their illness and more likely to seek proper treatment.