This paper intends to examine bulimia nervosa through the lens of social media culture in America. Both cultural and acultural aspects of the psychological disorder are discussed. Culturally sensitive treatment methods are also considered with provided examples.
Culture: Social Media
Social media culture encompasses favoriting, following, tweeting, and trolling. This culture is one with high levels of activity and engagement; Facebook’s platform alone generates 4.5 billion likes per day and half of its users ‘like’ at least one post per day (Burrow & Rainone, 2017). The culture assumes a rather omniscient role since social media networks and apps are invariably accessible through smart phones owned by the vast majority of Americans. It is also a culture that is new and emerging. Social media usage among American adults sat at 12% in 2005 and then leapt to 90% just a short decade later in 2015 (Lau, 2017).
Despite its recent inception in the 2010s, social media creates a culture that patterns the proposition of Leary & Baumeister’s sociometer hypothesis published back in 2000. Their theory states that self-esteem is calibrated from cues of either inclusion or rejection. A drive for inclusion and a fear of rejection motivates people to engage in behaviors and mannerisms that others will accept (Leary & Baumeister, 2000). This theory can certainly be extrapolated to present-day social media culture. Studies published by Kim et al. & Wang et al. report that the most prevalent instigators for Facebook usage include seeking attention and validation from friends and followers (2016, 2010). Another study showed that a higher amount of likes on Facebook had a positive correlation with higher self-esteem; as the likes increased, self-esteem did as well (Burrow & Rainone, 2017). Social media culture certainly encourages users to behave in a way that yields positive responses from their peers.
Psychological Disorder: Bulimia Nervosa
The mental disorder under examination through the cultural lens of social media is bulimia nervosa, the most prevalent eating disorder in the United States (Durand, 2016). Bulimia nervosa is characterized by “binge eating and inappropriate compensatory methods to prevent weight gain” (American Psychiatric Association, 2013). Binge eating consists of consuming large amounts of food during a short amount of time: the individual often experiences this as an out of control ordeal. Following the episode, compensatory behaviors, called purging techniques, almost always occur. These behaviors can include self-induced vomiting, fasting, excessive exercise, and use of laxatives and diuretics (Durand, 2016). According to the DSM-V, this cycle needs to occur at least weekly for three months to be diagnosed (2013).
A second distinguishing feature of bulimia nervosa involves the belief that valuation of oneself is determined by one’s body shape and weight (Durand, 2016). This psychological component drives the disordered food behaviors so complex that they are extremely difficult to reverse or repair. Bulimia, like all other eating disorders on the DSM-V, holds particular prevalence in Western societies in which food is abundant. Bulimia affects much more females than it does males (Durand, 2016).
Acultural Aspects of Disorder
Clients with bulimia nervosa experience a myriad of physical and medical complications, regardless of their involvement, or lack of involvement, in social media culture. These unfortunate complications result particularly from the purging technique of self-induced vomiting (Durand, 2016). Enlarged salivary glands are common because of the constant oral manipulation. This increases the susceptibility of infection to the area and can be incredibly painful to chew, swallow, or open the mouth. Dental enamel can also erode due to the excessive acid passing out through the mouth from constant vomiting. It is common for the esophageal lining to tear because of the acid as well. Another physical disruption involves the upsetting of chemical balances within bodily fluids. This can lead to more serious complications, such as seizures, kidney failure, and cardiac arrhythmia (Durand, 2016).
A second acultural aspect of bulimia involves the range of behaviors that can result from the disorder. Due to the excessive caloric consumption, the monetary cost of bingeing quickly adds up, becoming unaffordable for most. Some diagnosed with bulimia will turn to shoplifting as a method to finance their expensive binge episodes (Durand, 2016). This behavior is found independent of presence on social media.
Bulimia nervosa is also highly related to behaviors involving substance abuse. According to the Center on Addiction and Substance Abuse [CASA], approximately half of all clients that suffer from eating disorders, bulimia in particular, also abuse illicit drugs or alcohol (Killeen et al., 2015). There are several theories that offer an explanation for this high comorbidity between bulimia and substance abuse. One of these hypotheses focuses on the shared etiological factors among the disorders, such as biological vulnerability, familial history, and personality (Baker, Mazzeo, & Kendler, 2007). As an example, personality type considers the similar addiction traits that are present in both disorders, such as denial, craving, and exhibiting a lack of control (Pearlstein, 2002). Another hypothesis of the comorbid relationship includes scrutiny of the familial history among people that struggle with bulimia and substance abuse. In a study conducted in 1993, over 75% of women diagnosed with bulimia and substance use disorder reported that at least one of their family members had an alcohol disorder (Bulik & Sullivan). These independent acultural components illustrate the universality of bulimia nervosa, rather than being strictly defined to any culture.
Culture Specific Aspects of Bulimia
Many aspects of bulimia nervosa are specific to the culture of social media. As earlier mentioned, a hallmark characteristic of bulimia is evaluating one’s self worth based off of body shape or weight. In a study conducted by Garfinkel, only 3% out of 107 women with bulimia did not experience this psychological component of the eating disorder (1992). This unfortunate belief that looks determine worth is certainly exacerbated in the world of Instagram, Twitter, Facebook, and YouTube. Smolak & Thompson have found that internalization of unrealistic beauty ideals that saturate social media leads to body dissatisfaction, and body dissatisfaction is a major predictor of disordered eating thoughts and behaviors (2009).
Comorbidity with anxiety is another culture specific aspect of bulimia. A national survey reported that 80.6% of clients with bulimia also report having an anxiety disorder (Hudson et al., 2007). Similar results are found when comparing the correlation between anxiety and social media use. Research published in 2017 reported that more time spent on social media indicated greater symptoms of anxiety (Vannucci, Flannery, & Ohannessian, 2017).
Consideration of Cultural Aspects in Treatment
Small bodies have come to represent dominant and desirable cultural virtues like self-discipline, power, and self-control (Shuriquie, 1999). Women in established Western societies are increasingly prioritizing beauty before almost any other character trait. This idolization of being thin is referred to as the thin ideal. The ubiquitous ideal especially romanticized in social media culture should be considered in treatment of bulimia nervosa because social media is the most popular method to disseminate thin ideal images (Qi & Cui, 2018). In a study reported just in 2018, women aged 18-23 were shown images of thin bodies on social media; after viewing, the vast majority of these women experienced a lower self-perceived body image and, intriguingly, an increase in unhealthy food consumption (Qi & Cui). This thin ideal must be considered in treatments of patients with bulimia because chasing after an unattainable thin ideal could very well be the driving force of both the continuation and the inception of bingeing and purging.
Culturally Sensitive Treatment
Cognitive-behavioral therapy [CBT] has been proven as the most effective method of treatment for bulimia nervosa multiple times (Wilson, G., Fairburn, C., Agras, W., Walsh, B., & Kraemer, H., 2002; Lunn, S. & Poulsen, S., 2012). This type of treatment focuses on the disordered thought process regarding body size and the harmful actions taken to control weight. CBT can be used in a culturally sensitive context through therapist prioritization of disrupting the client’s utopian premise of the thin ideal.
Clients would benefit from considering and developing personal values outside of physical aesthetic. Encouraging their cognitive process to convert toward internal attributions, rather than a constant centration of appearance, would develop a more substantial level of self-confidence that would discourage physical and emotional self-harming behaviors. This paradigm shift is difficult to implement, but the premise of the thin ideal that is constantly flaunted in social media culture must be addressed and annihilated in order for the client to progress towards recovery.
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