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In the more than 18 months of COVID-19, there has been an explosion of eating disorder awareness driven by various body positivity accounts on Instagram, Facebook, Twitter, and TikTok. The pandemic drove millions and millions into quarantine, making social media even more important than ever before. It’s pervaded people’s lives deeply – in many ways our online presence has become as important as our “IRL” selves. The rise of awareness campaigns and honest discussions of body image and acceptance are heartening – in these difficult times, seeing the power of social media to help support people with eating disorders provides a lot of hope.

However, social media has a downside as well.

Although body positivity and eating disorder recovery accounts have become more prominent in 2020 and 2021, they are only belatedly addressing some of the many problems social media brings with it. Although virtually no one is maliciously trying to promote eating disorders (pro-eating disorder accounts do exist, but they have largely been banned), many accounts inadvertently send the wrong message to at-risk social media consumers. Namely, both online bullying and a pervasive diet/fitness and beauty industry can have strong effects on a person’s body image. According to a decade-long study published in 2017, there are several factors involved.

How Did Social Media Spur Body Dissatisfaction?

Social media wasn’t always a primarily visual medium, but the increasing availability of high-quality cameras and recording equipment in ubiquitous, affordable cell phones have made it so. This and the pressure to establish a social media presence leads to people carefully curating their online presence through selective and often manipulated photos that put themselves in the best light possible. The difficulty when it comes to this practice for people prone to eating disorders is that they tend to compare their body and appearance with others’. These comparisons can lead to increased body dissatisfaction and trigger body dysmorphia, which are powerful contributing factors to the development of eating disorders. The desire to put one’s best face forward can lead to more than cropping and filtering photos; it can also lead to disordered behaviors designed to prevent weight gain or attain an “ideal” body.

In addition to the pressures put on a person’s body image by influencers and peers, there is also a large and powerful diet and fitness industry that has a large presence on various social media platforms.They also use carefully cultivated images, but instead of trying to make a positive impression like an individual might, they are trying to set a goal for weight loss of beauty that may be unattainable for “regular people.” Diet companies, in particular, can show before-and-after images that show weight loss. While obesity is a health problem in the United States and healthy eating is important, these kinds of advertisements, especially on social media, can send a devastating message to people at risk for body dissatisfaction and/or eating disorders.

Recently, the National Institute of Health’s National Library of Medicine published a study thatestablished s relationship between the use of social media and the incidence of eating disorders among young people in the USA. It’s an important subject to study; although eating disorders are still considered rare by some laypeople, they are much more common than they know. Any insight about what might cause or contribute to developing an eating disorder will help potentially millions of people. Studies performed by national psychiatric institutions indicate that up to 2.6 percent of the population will need treatment for bulimia nervosa or another eating disorder by the time they reach 20 years old. This research showed a relationship between eating disorders, self-image (a common contributing factor for eating disorders), and social media in a sample of about 1800 adults aged 19 to 25.

For this reason, modern bulimia nervosa treatment centers have begun to take social media into account when making treatment plans. Although some people assume only teenagers live their whole lives on social media, older clients also feel the pressure to compare themselves with influences are peers online. In cases where self-image is impaired and individuals compare themselves to the “beautiful people” they see on Instagram, Facebook, and Twitter, social media can be a strong triggering factor in the rise of bulimia nervosa and other eating disorders.

What Are the Signs and Symptoms of Bulimia Nervosa?

Although it’s relatively well-known, it’s important to outline the signs and symptoms of bulimia nervosa. In some situations, people might be confused about the difference between bulimia nervosa and anorexia nervosa. Some aspects of bulimia nervosa may be present in other eating disorders, such as binge eating episodes, which of course are found in binge eating disorder.

For an eating disorder to be classified as bulimia nervosa, the DSM-5 (the official listing of mental health disorders) requires certain criteria. The most prominent behavioral symptom is repeated and regular binge eating episodes, usually in secret, and often accompanied by feelings of guilt or shame about the caloric intake. This is coupled with a lack of control concerning being able to stop or control how much or what is being eaten.

Binge eating episodes are followed by purging. Purging methods, such as calorie restriction or fasting after a binge eating episode, self-induced vomiting (the classic behavior symptom), excessive exercise, or the misuse of diuretics, laxatives, and other purging medicines, are used as a way to offset the potential weight gain. These behaviors must both occur at least once a week for three months, on average.

Another symptom that relates to bulimia nervosa is a poor, negative, or distorted body image – thinking they are “fat” or “ugly.”  As we’ve seen, this directly relates to social media in many cases.

Other signs of bulimia nervosa can be the presence of compulsive dieting, an obsession with weight loss, and the controlled intake of food. The signs of purging and binge eating episodes, like the smell of vomit or visiting the bathroom frequently right after eating, food wrappers or hidden food, or boxes of diuretics and/or laxatives – all these indicatea possible struggle with bulimia nervosa.

Eating Disorders, Body Image,and Social Media

Social media’s impact on self-image and self-esteem, especially among young people, can hardly be overstated. While social media can certainly help people connect with new friends and old, it can also be a source of harassment, pressure, and bullying, as well as unrealistic depictions of others’ lifestyles and bodies. Through the use of social media, young people can reach out for support and make new connections.

It’s even more dangerous than the traditional media in promoting a “thinness” narrative which can influence eating disorders because someone like an Instagram model can interact with the person being mediated. Because our entire lives are now lived online, treatment for eating disorders must take this into account as well. Bulimia nervosa treatment has been honed for decades, and the needs of clients at a treatment center go beyond medical and psychiatric therapy, but also must include psychosocial aspects as well.

The successful treatment of bulimia nervosa disorder is easiest to achieve when early intervention is made when bulimia nervosa symptoms appear so that a proper diagnosis and treatment plan can be begun. During this treatment, body image distortions, anxiety, depression or other co-occurring issues can also be addressed.

Carefully crafted and created solutions for bulimia nervosa recovery must be tailored to address each individual’s circumstances and treatment needs. Although social media can trigger bulimia nervosa and other eating disorders, it can also provide many avenues for maintaining recovery after treatment ends. Besides alumni groups set up by the treatment centers, there are myriad support and awareness accounts on Instagram, Facebook, and the like. These communities are easier to find than ever, and the people in them can become close friends as well as support systems.

A long-term, successful recovery does begin with professional treatment, though. While many young people count on social media to stay connected to their support systems, a psychologically gentle treatment plan that focuses on high-frequency individual therapy provides the foundation for a recovery that can withstand the inevitable bumps that life — and social media — can deliver.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.