Honors 101
Final Research Paper
How new media and advertising affect anorexia.
Ideals of beauty evolve over time, and popular culture has modeled the current trend where thin has replaced attractiveness. Thin is the new beautiful. Advertising is full of images of ultra-thin models; this overwhelming presentation of images of perfection that are neither attainable nor healthy is having a very strong influence on young boys and girls. There has been a dramatic increase in eating disorders among adolescent children and young adults. This raises a troubling question: does this constant over exposure to ultra-thin models cause an eating disorder like anorexia nervosa or bulimia? Is blame being unfairly placed at the feet of advertising? There is the conflicting opinion that thin ads promote a healthy trend towards enthusiastic dieting in pursuit of fitness. This should be embraced in view of the fact that there is a very high rate of morbid obesity in America. Could there be other factors that are influencing the rising rates of anorexia and bulimia? It is difficult to ignore statstics that show advertising's increasing reliance on thin models to sell perfume, clothing, cars, and even hamburgers. This constant exposure to images of excessive thinness in new media advertising appears to be a major factor in the increase of anorexia and bulimia amongst adolescents and young adults.
The most important and influencial professional medical organization for psychology is the American Psychiatric Association (APA). The APA publishes peer reviewed studies, journals, numerous informational pamphlets for clinicians and the public. The APAs largest undertaking is an indexed manual titled Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual allows health professionals to classify symptoms and behaviors in order to guide diagnosing different mental disorders. This DSM manual is reliable and has become so respected in its usefulness, it is used worldwide as a foundation for diagnosing mental disorders and diseases. The DSM has undergone five revisions. The most current manual, the DSM5 manual classifies Anorexia Nervosa as an eating disorder; it is a serious life threatening condition marked by self-induced starvation and excessive weight loss, and a pathological fear of becoming fat. Body weight is described as Body Mass Index (BMI), an individual's weight has to be below 15% of normal body weight. (1 Pawlowski, 359) Severe malnutrition can damage every body organ and cause premature death. Anorexia nervosa has the highest mortality rate of all psychological disorders. (2,Pawlowski, 359) Other characteristic behaviors present in anorexia are strong goal setting expectations, perfectionist behavior, low self-esteem, anxiety and depression.
Etiology is the cause or set of causes, or manner of development of a disease or condition. For many illnesses there are three etiologies, biological, environmental and psychological. Specifically for anorexia, the biological cause may be a genetic cause, the illness can run in families. The psychological cause can be triggered by emotional characteristics like anxiety, depression, obsessive-compulsive personality traits, and perfectionism. The environmental etiology can arise from cultural pressure to be thin. Success and worth are equated with being thin, the influence of peer pressure, over-exposure to media, and participation in certain sports, specifically judged sports as opposed to refereed sports.(3,Pawlowski, 360)
Anorexia Nervosa is not a new medical condition, as it has been around for hundreds of years. The earliest recorded instance of anorexia was St. Catherine of Siena who lived from 1347–1380. She was the 23rd of 25 children.(4, Catherine of Siena, pg.1) Catherine had an older sister named Bonaventura, to whom she was very attached. Bonaventura was married and had an abusive husband. Women in this time period were little more than property and had few rights. Bonaventura chose to fast until her husband changed his behavior. This long fast worked, and Bonaventura’s husband changed his behavior towards his wife. Shortly afterward, Bonaventura died in childbirth. Catherine’s parents wanted her to marry her widowed brother in law as was the custom of the period. Catherine refused to marry. She repeated her sister’s behavior and began a long fast. This prolonged fast forced Catherine’s parents to remove their demand that she wed her brother in law. Catherine learned this fasting behavior from her sister. When Catherine was allowed to stay unmarried, she chose to live as a lay person associated with the religious Dominican order. She continued to fast for long periods of time for the rest of her short life. (4,Catherine of Siena, pg,1)
This historical recording is valuable for insights of both the time period and the nature of anorexic behaviors. One troubling aspect of anorexia nervosa is it is largely a learned behavior.(5, Pawlowski, 360) St. Catherine’s biographer, a priest named Raymond of Capua O.P. recorded the details of her life from direct conversations with Catherine.(6, Catherine of Siena, pg,1) Psychologists can use this careful historical recording to construct a psychological autopsy of sorts. Catherine learned to change her eating habits and fast for prolong periods of time from her sister. When her sister Bonaventura gained positive results from her fasting, this served as re-enforcement for Catherine’s eating behavior too. The social context is the importance of religion in Catherine's time. Her family was lower class but her religious nature raised her importance in society. The Catholic religion used fasting for specific holy days. Catherine used fasting more often. Her belief was fasting gave her a closer relationship with God. Catherine used fasting as a symbolic way of renouncing this physical world and striving for a spiritual existence. Living an austere, reflective life of fasting, prayer and devotion to God elevated Catherine’s standing in her community during her actual lifetime. She was considered to be a holy person while she was still alive. This perception of her divine communion with God fostered an increase in religious fasting that persisted for more than a century after her death. (7, Catherine of Siena, pg,1)
The most accurate description of anorexia nervosa was made by an English physician named Richard Morton in 1689. His description of the illness was accurate and concise, it has stood the test of time and can be used to identify modern cases of anorexia. Dr. Morton also mentioned men could suffer from this illness. (8,Curry J, pg. 358) Case descriptions fitting anorexic illnesses continued throughout the 17th, 18th and 19th centuries. In the late 20th century, anorexic descriptions excluded males. In the newest Diagnostic and Statistical Manual of Mental Disorders revision, commonly referred to DSM5, the description for anorexia nervosa only specifies females. (9,Curry J, pg.358) Lack of male representation in disease descriptions leaves males without treatment. This is dangerous because eating disorders can cause seizures, organ damage and even death. There may be male deaths that are not properly attributed to eating disorders.
A large concern regarding Anorexia Nervosa and Bulimia in the DSM5 manual is this manual's requirement to meet the diagnosis of these medical conditions are extreme behaviors that result in BMI to be at least 15% lower than normal. An individual has to exhibit and practice Anorexic behaviors for prolonged periods of time before she can be classified as having the medical diagnosis of anorexia. These same dangerous behaviors but without extreme weight loss is classified as Other Specified Feeding or Eating Disorder (OSFED) in DSM-5. The reasoning behind using BMI as a key condition for diagnosing between OSFED and Anorexia is severe malnutrition is a medical condition. Once an individual has weight loss drop below 15% BMI, the human body is incapable of functioning properly. This can cause damage to body organs, including seizures, a suppressed immune defense, kidney, liver, heart, and brain damage, and ultimately death. (10, Curry J, 358)
People with OSFED partake in very dangerous behavior. The incidence of OSFED far outnumbers anorexia and diagnoses. OSFED is not a medical condition until weight drops to 15% under BMI. This distinction has caused controversy in the medical community. The World Health Organization (WHO) has a BMI chart; it quantifies being underweight at below 18.5% BMI, and severe thinness at below 16% BMI. These are more conservative measurements than are used in the new DSM5 manual.(11,BMI classification, pg. 1) How the DSM manuals classify illnesses directly impacts how insurance companies cover these mental illnesses. OSFED is recognized as troubling behavior but it is not strictly speaking a medical condition. As a result, OSFED classifications are for the most part, not covered under medical insurance. This leaves individuals with an OSFED condition without access to psychological counseling, therapy and medical appointments to monitor their physical health. The have to pay for this care out of pocket unless the individual has a medical condition like bradycardia (slow or uneven heart rate) or kidney damage caused by self imposed malnutrition. The majority of clinicians advocate intervention for OSFED symptoms based on WHO guidelines for BMI and before the individual reaches the medical definition for anorexia or bulimia. Early psychiatric and medical intervention provides a better chance of recovery, relapses are possible but are less severe relapses.
The drastic weight loss required for a medical diagnosis for anorexia or bulimia by the DSM5 has created an astonishing social effect on two age groups, adolescents and young adults. Young people can practice unsafe, high risk behaviors ranging from self denial of food, dietary aids, supplements, drugs, mechanical purging and drug induced purging and still not meet the medical definition of anorexia or bulimia. These dangerous often life threatening behaviors can qualify as OSFED behaviors but if an individual's medical insurance does not cover treatment, the behavior can persist. The lack of medical treatment is replaced by the individual's peer group consisting of physical and online friendships. This is troubling because online and social media offer vast sources for negative influences which reinforces anorexic and bulimic behaviors in young people.
This obsession with thinness did not develop overnight, it was gradual. The most prominent parallel development can be attributed to the fashions of the 1960's, a line dresses and the famous mini skirt craze. This short skirt made strong social statements about growing social and sexual rights for women. Political and social movements aside, the practical reality was the miniskirt was not flattering for every body type. Not everyone looked attractive in a miniskirt. Successful advertising is always attuned to social movements. Slender models in A line dresses and mini skirts were used in advertisements for department stores, cars, cigarettes. The success in these ad campaigns for luxury items expanded to having the same type of models in advertising for more mundane, need based purchases like kitchen appliances, cleaning products, and food items. The slender model in a mini-skirt added cachet to one brand of cereal or soap out of the many brands available in the store. The model's progressive image was effectively transferred over to the product in the ad regardless of the product being pitched. The message being, socially progressive women chose this brand of coffee or use this hand mixer when they return home from work.
One of the first supermodels was a tall thin attractive teenager with large eyes nicknamed "Twiggy". Her ultra thin body shape was natural, which is how she acquired her nickname. She was a natural fit for A line dresses with strappy shoulder tops and had very slender, long legs that complimented mini-skirts. Twiggy became so popular, she sold clothing, makeup, and made short cropped haircuts trendy. Twiggy is remarkable in that she was one of the first models to replace the image of beauty from full figured curvy women with long hair that was popular during the '30s, 40's and 50's.
A very popular musician during the 1970's was Karen Carpenter, her public life and premature death showed it was possible to be too skinny. Alongside her brother Richard, they formed a band called "The Carpenters". Karen played the drums and sang, eventually, she had to stop playing the drums so the audience could see her. She suffered from anorexia nervosa and bulimia. These medical conditions were not familiar to the public at the time. The public only noticed Karen was getting thinner during concert or television appearances. Karen used Ipecac syrup to induce vomiting after binge eating. Ipecac used correctly can prevent death in the case of ingesting poison or overdosing on medication. Ipecac syrup if used repeatedly can be toxic to the heart. This is what caused Karen's heart attack at the age of 32. Her fame and her death had two positive outcomes. Her misuse of Ipecac syrup changed the way the drug was dispensed, it was no longer sold over the counter. This saved countless lives. Karen Carpenter also gave rise to public awareness of anorexia and bulimia. (12, Latson J. pg,1)
The next decade saw the emergence of supermodels and their presence moved out of magazines and print ads to television and movies. They were thin and surgically enhanced to have thin noses, fuller lips, and large breasts. Models became celebrities. This trend has continued but the cosmetic alterations are more diverse and subtle. There are botox injections that fade wrinkles, sculpting surgeries that can add muscle definition, skin tucks, knee lifts to remove excess skin, and mild acid facial procedures that remove aged skin to restore the appearance of small pores and youth. New media can enhance the work of nature and surgeons. Photographers use better lighting, better makeup and high definition cameras to capture images of surgically altered models. Then these carefully posed images are perfected using airbrush and photo-shopping techniques. A casual observation of the image will show symmetrical perfection. A careful observation will reveal the result is a model with unrealistic and unattainable perfection.
A condition of eating disorders like anorexia is a distortion of body image called body dismorphic disorder. The individual will not be able to see herself accurately when viewing her image in a mirror or photograph. The individual can be severely underweight and still think she is fat. The individual can focus on one body part like legs, hips or arms or can see fault in her entire body. This inability to accurately access correct body proportion will lead the individual to have an unrealistic fear of gaining weight by consuming a low calorie meal.
In a 2004 study titled, "Does size matter?", co-authored by Drs. Halliwell and Dittmar, the purpose of the study was to gauge the impact of model's body size on female viewers of the advertising. (13, Halliwell , pg 104) The researchers measured the viewer's body focused anxiety and the overall effectiveness of the advertising. They used three variables in otherwise identical advertising. First, ultra thin models, second, average sized models, and third, no models, just the product. The study found exposure to ultra thin models in advertising can have a negative effect on young women's body image of themselves. The average sized models produced no anxiety and were still effective. The researchers specifically noted these normal models were attractive in addition to being average sized. The ads without models produced no anxiety and were still effective. The result of the experiment showed people are willing to accept larger sized models provided they are attractive. The study is informative for two reasons. First, it illustrated effective advertising can exist without producing anxiety in the viewer as a form of persuasion to buy the advertised product. Secondly, it showed that prolonged exposure to ultra-thin models coincides with growing incidents of women's dissatisfaction in self body images and increases in the incidence of eating disorders. (14, Halliwell, pg. 106 )
Outside of clinical research, an opinion written by a lay person has value. It presents an "everyman's" perspective of a slice of society. Micah Issitt is a freelance writer who authored a magazine article criticizing airbrushing in advertisements. The result of these altered images creates an unrealistic standard of beauty, an unnatural perfection. Celebrities and models do not have imperfections and are not affected by the aging process. The result is consumer deception, the viewer is left observing his or her realistic body that has flaws, and the large difference can contribute to body image issues, depression and eating disorders. (15, Issitt M., pg.1) Issitt's article specifies two troubling statistics from the National Association for Anorexia Nervosa, a study reporting, "47 percent of middle-school and high-school girls want to lose weight because of images in magazines, while 69 percent admit magazine ads affect their perception of the ideal body shape." (16, Issitt M., pg.1)
Drs. Curry and Ray authored a research paper titled "Starving for Support: How Women With Anorexia Receive 'Thinspiration' on the Internet." These clinicians linked two important aspects of eating disorders like anorexia and bulimia; the hiding of maladaptive behavior and how they use the internet and other new media for support.(17, Curry J., pg. 358) There are many websites people can access to help overcome anorexic and bulimic behaviors. There are reputable sites that are associated with real health care professionals. The authors also discuss "pro-ana" sites. These are websites people go to that promote anorexic behaviors and offer numerous tips to hide this harmful behavior. These pro-ana sites are particularly dangerous. They replace parents and family as a source of information for diet, health and wellness.
These online and social media sources for negative influences have a specific target group: young social media savvy teens, especially young girls, but there are emerging parallel sites for young males in the same age group. Pro-ana websites encourage anorexia or bulimic behaviors by providing specific examples. They teach strategies for food restriction, how to discretely vomit in public locations, use emetics to vomit, laxatives and enemas to produce diarrhea, crash diet recipes, how to endure hunger pains with bullion broth, the calorie count of vitamins. These sites also offer tips on how to hide behaviors and lie to parents about pro-ana behavior.
Large websites were taken down years ago, now pro-ana sites are migratory in nature. They are semi-private groups that use Tumblr, Facebook, Myspace, Twitter, Pinterest and Xanga to support eachother in their pursuit of support for their eating disorder. These websites make photo sharing very easy. Pro-ana sites are filled with photo diaries of weight loss progress. Providing feed back is both possible and very easy. Typical comments are positive and encourage additional weight loss. Coupling a photo with a dangerously thin girl, or young woman with praise fixes a distorted image in one's mind, it reinforces body dismorphic thinking. (18, Rosemary B., pg 1) Individuals with anorexia and bulimia have low self esteem and are socially isolated. Their strong reliance on these pro-ana sites makes treating eating disorders more difficult. The online support group fosters unity the individual may have never encountered in their real life.
Drs. Curry and Ray are not encouraging these pro-ana websites, they are trying to educate other health professionals and parents. Many parents know their child has an eating disorder, what they may be unaware of is that there are numerous harmful pro-ana sites. Individuals with anorexia and bulimia tend to be socially isolated, parents may not question what their child does when alone, never realizing they are gaining support on new media sites. If parents are informed, then they can visit these pro-ana sites as a resource to learn the secretive behaviors and excuses used by people with anorexia and bulimia. It will aid the parents during their child's treatment and aid in recognizing relapses.
Smart phones are added complication. The small screens are hard for parents to see content. Parents don't understand apps, young people can visit sites, parents won't know what to look for, do not recognize app names. Smart phones can also be locked. Most adolescent girls and young women constantly have their smart phone close at hand. This creates a strong sense of accessible support, in turn creating a cult like group that accepts harmful behavior, creates a false sense of acceptance. Pro-ana sites make treating anorexia and bulimia harder to treat. Eating disorders are characterized by low self esteem. This sense of community, acceptance, praise are very difficult to break an individual away from.
Clinicians report patients with eating disorders are secretive and deny symptoms. This leaves medical professionals with the task of going to pro-ana sites for research. They see new trends in behavior on pro-ana sites so they can help clients. Clinicians need to learn how to break bonding with other members on pro-ana sites. A large component of therapy is working to transfer the patient's trust from pro-ana members to clinician and family so the patient can work towards a recovery plan.
In 2005, Drs. Toro, Castro and Gila created a questionnaire for physicians and patients with the intention of improving the diagnosis of anorexia in males.(18, Toro, J. pg. 350) There are many studies about eating disorders in females but males are frequently excluded. There is emerging evidence that eating disorders is not gender specific. The earlier, historical descriptions of anorexia and bulimia are accurate in that males while affected in lower proportions, are still affected by eating disorders. In the research paper titled, "Assessment of sociocultural influences on the body shape model in adolescent males with anorexia nervosa, " gender similarities and differences in eating disorders emerged. Answers to the questionnaire by male patients revealed there is a profound effect on body image due to advertising and media images.
As for differences, females want weight loss; males want to change their body shape and become more muscular. Both sexes suffer from differing degrees of body dismorphia, will exercise to excess, alter diets for either muscle gain or weight loss. Males will overlap with females in their low self-esteem, rigid behavior, strive for perfection and fear of gaining weight or seeing themselves as imperfect. Males participating in sports can increase susceptibility for eating disorders. Sports like boxing, wrestling, mixed martial arts (MMA), have weight classes. These sports commonly use excessive exercise, crash diets and dangerous home remedies to drop weight in days. The use of protein supplements and energy drinks as food substitutes can lead to organ damage. Males can practice unsafe behaviors more openly because being a top contender in a school sport is socially acceptable. In some instances it can be difficult to diagnose because the male student can have the support and supervision of adults to avoid disqualification for not making the weight class.
Another socially acceptable form of media dictating physical appearance are shows like "The Biggest Loser". The premise of this popular show is health is the reason for changing personal lifestyles. The subtle misdirection in this show is how it is socially acceptable to mortify the obese contestants. These shows are built around shaming the contestant at the start of the weight loss journey paired with the idea that losing weight will give contestant control and success in life. Contestants are coached to visualize themselves as thinner, more successful, attractive. People become accustomed to show formats, seeing more than one episode of this weight loss show will de-sensitizes the viewer to the insults and embarrassment the contestants endure. A quick re-orientation method to employ is to realize it would be very unacceptable for a doctor or other health professional to insult or shame their obese clients. There is no ethical reason to stop treating a client with respect.
Children spend on average about four to six hours using new medias like internet, smartphones, video games and television. This seems impossible until school work on computers is factored in to the total. If during this portion of the day, young people are exposed to advertisements, they will see far more ultra thin models than realistically sized models. Repeated images of these ultra thin models can mold their opinion of beauty as thin. Studies show exposure to ultra thin models cause disillusionment with self image. stress, anxiety, and low self esteem.(20, Halliwell, E., pg 105) It is very important to state correlation in studies does not prove causation. A common example would be the numerous studies on the effects of smoking. There is a strong correlation that smoking and cancer are linked. These studies cannot say smoking causes cancer. Anorexia and bulimia are rare, they are also dangerous mental illnesses. When anorexia and bulimia patients are questioned, they overwhelmingly mention they were strongly impacted by advertising showing ultra thin models.
At present, there is a discrepancy between the knowledge of eating disorders and the successful treatment of anorexia and bulimia. Eating disorders have the highest death rate of all mental illnesses. There is a very large rate of co-morbidity with depression, anxiety, drug use, attempted suicide and medical conditions caused by body organ damage. There are several components of therapy that are helpful, imposing a limit to new media to minimize exposure to thin beauty ideals, transferring a patient's trust from a pro-ana site to a therapist, setting weight gain goals and frequent follow up appointments when the ideal weight has been reached. Giving patients new goals to work towards to occupy their physical and mental activity. This will replace constant ruminations with productive activities. Most importantly is early intervention in patients with OSFED symptoms and behaviors and using the same treatment therapies employed with patients that meet the medical diagnosis of anorexia and bulimia.
Sources
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