Increase in body dysmorphia and eating disorders among adolescents due to social media

Abstract

In this review, analysis of the studies pertaining to the role of social media in body dissatisfaction eventually leading to body dysmorphia and eating disorders was conducted.Objective:The aim was to review how social media creates the urge of attaining unrealistic body images which is impossible in real life but possible in real-life.Methods:Different search mediums including PubMed, Sciencedirect, and Google Scholar were used in order to find out the effects of social media in influencing body dissatisfaction. The inclusion criteria were based on the selection of research articles from 2014-2021 which correlated social media with eating disorder & body dysmorphia. Additionally, the articles that were not original researches, abstract only and not in English were excluded. After exclusion of irrelevant sources, duplicated article, abstract only& articles published before 2014, Total 25 articles were selected for the purpose of systematic review. Result:As per this systematic review, body dysmorphia & eating disorders were related to high levels of social media addiction. Moreover, how much social media has negatively impacted both the physical health of young adults especially in regards to disordered eating patterns as well as mental health. Social comparison in order to attain unrealistic images on social media resulting in body dysmorphia and body dissatisfaction.Conclusion:By reviewing different studies and finding out the effects of social media in body dysmorphia it is revealed that social media can highly influence various types of eating disorders like anorexia nervosa, bulimia nervosa and binge eating disorders.

Full text

Systematic Review
PAKISTAN BIOMEDICAL JOURNAL
Body dysmorphia is a mental health problem in which the
patient perceives a slight or small defect in appearance
that is not even observed by individuals. The patient feels
so embarrassed about that small aw that social situations
are even avoided. It is often recognized in some patients
who come to the plastic surgeon requesting for multiple
cosmetic surgeries. Patients of body dysmorphia may wish
for amputation of healthy limbs. Checking of mirror
repeatedly, seeking reassurance, seeing people's glances
in a negative way thinking that they are noticing your aws,
comparing your appearance with others are some
symptoms of body dysmorphia [1].Two disorders that
centers around body image issues as the pivotal clinical
features, are eating disorders and body dysmorphia.
However, patients suffering from eating disorders are
mostly concerned with the body type whereas body
dysmorphia causes a variety of different self-esteem
I N T R O D U C T I O N
DOI: https://doi.org/10.54393/pbmj.v5i3.205
Rizwan B et al
Increase in Body Dysmorphia and Eating Disorders Among Adolescents Due to
Social Media
¹ University Institute of Diet and Nutritional Science, Department of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
In this review, an analysis of the studies pertaining to the role of social media in body
dissatisfaction eventually leading to body dysmorphia and eating disorders was conducted.
Objective: The aim was to review how social media creates the urge of attaining unrealistic body
images which is impossible in real life but possible in real-life. Methods: Different search
mediums including PubMed, Science direct, and Google Scholar were used in order to nd out
the effects of social media in inuencing body dissatisfaction. The inclusion criteria were based
on the selection of research articles from 2014-2021 which correlated social media with eating
disorders & body dysmorphia. Additionally, the articles that were not original researches,
abstract only and not in English were excluded. After exclusion of irrelevant sources, duplicated
article, abstract only& articles published before 2014, Total 25 articles were selected for the
purpose of a systematic review. Result: As per this systematic review, body dysmorphia & eating
disorders were related to high levels of social media addiction. Moreover, how much social
media has negatively impacted both the physical health of young adults, especially in regards to
disordered eating patterns as well as mental health. Social comparison in order to attain
unrealistic images on social media results in body dysmorphia and body dissatisfaction.
Conclusion: By reviewing different studies and nding out the effects of social media on body
dysmorphia it is revealed that social media can highly inuence various types of eating disorders
like anorexia nervosa, bulimia nervosa, and binge eating disorders.
A R T I C L E I N F O A B S T R A C T
Key Words:
Social media, body dysmorphia, anorexia,
disorder, eating disorder, bulimia nervosa,
depression, dissatisfaction, body image, behavior
How to Cite:
Rizwan, B. ., Zaki, M. ., Javaid, S. ., Jabeen, Z. .,
Mehmood, M. ., Riaz, M. ., Maqbool, L. ., & Omar , H. .
(2022 ). Increase in body dysmorphi a and eating
disorders among adolescents due to social media:
Increase In Body Dysmorphia and Eating Disorders
Among Adolescents. Pakistan BioMedical Journal,
5(3). https://doi.org/10.54393/pbmj.v5i3.205
issues regarding appear ance and patients to give
themselves harsher evaluation and generally have more
complaints and dissatisfaction. Two diseases, however,
are both extremely severe when it comes to body image
and present symptoms that are much more serious than
normal. In addition to that, while both disorders depict
cases with low self-esteem, body dysmorphia presents
more psychological symptoms[2]. Eating disorders can
occur in patients with body dysmorphia, in fact it is quite
common. Patients that suffer from both, body dysmorphia
an d eat ing diso rders, receive more psychol ogi cal
treatments than the ones that only suffer from eating
disorder [3]. Thus, eating illnesses don't only refer to
“gender or appearance” but it's also a coping strategy surely
traumas like racism, heterosexism, poverty, sexual
offense, and classism”. Researchers must also effort on
the inter collectedness of gender, ethnicity, education
VOL. 05, ISSUE. 01
JUN-JUL 2022
*Corresponding Author:
Bahisht Rizwan
University Institute of Diet and Nutritional Science,
Department of Allied Health Sciences, The University
of Lahore, Lahore, Pakistan
bahisht.rizwan@dnsc.uol.edu.pk
1* 1 1 1 1 1
Bahisht Rizwan , Manahil Zaki , Sumaiya Javaid , Zara Jabeen , Minahil Mehmood , Mahesayam Riaz, Laiba Maqbool
and Hamda Omar
Increase In Body Dysmorphia and Eating Disorders Among Adolescents Due to Social Media
PBMJ VOL. 5, Issue. 3 March 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
https://www.pakistanbmj.com/journal/index.php/pbmj/index
Volume 5, Issue 3 (March 2022)
144

R E S U L T S
M E T H O D S
level, sensual orientation, socio-economic status and
aptitude which are commonly seen as separate factors in
involving a combination of cultural and social demographic
variables [4]. The relation between exposure to an
unattainable and unrealistic image on social media and how
it affects the ethnicity of Latina girls should also be
considered by researchers. The use of social media as a
form of precaution, researchers can be encouraged to take
part in content analysis to visually check every day content
to monitor Latina girl's exposure while being online
[5].Social media Programs that will propose sociocultural
pressure on Latina adults cause them to adopt thin ideals,
leading to dieting, body dissatisfaction, and lots of other
adverse effects, hence increasing eating-disorder risks.
Clinicians should integrate culture-specic and family-
based modes of intervention. Therefore, the risk of
dysfunctional eating of Latina women should be minimized.
It's vital to grasp that some risk factors will contribute to
body dissatisfaction and eating disorders in Latina women,
which isn't acceptable by their family [5].
Protocol & Registration: Systematic review of this study
was reported and conducted in line with the Preferred
Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) guidelines. A pre-published protocol
(PROSPERO CRD42017065324) was used in it.
Search Strategy & Data Sources: Pub med, Embase,
Scopus, Science direct, Cochrane Library, Directory of
Open Access Journal, Medline, Medline plus, Science open,
Open DOAR, Biomed Central, PLOS Public Library of
Science, Web of Science, ISTOR, Semantic Scholar, Europe
PMC, SID (scientic information data base).Research
articles from the year 2014 to 2021 were selected.
Data Extraction and analysis: Research articles were
selected from researches done on the social media's
impact on eating disorders and body dissatisfaction and
data was extracted from them. 500 articles were initially
selected from various data bases. 250 of them were
excluded as they were duplicates additionally 150 articles
were excluded because they were published prior to 2014 or
that they weren't in English. 50 articles from the remaining
were further excluded as they were meta- analysis,
reviews, abstracts only or that the subjects of the study
weren't age appropriate according to this systematic
review. The 25 articles that remained were included in this
systematic review. Inclusion Criteria was Articles from the
year 2014-2021 and the articles which correlated social
media with eating disorders and body dysmorphia.
Exclusion Criteria was the articles published prior to 2014,
Review articles, meta-analysis, articles that weren't
accessible beyond the abstract and the articles that were
not in English language.
The data collected as demonstrated in following tables
depicts a clear co-relation between social media and boy
dysmorphia/ eating disorders. The 25 articles that were
chosen for the purposes of the review, through a myriad of
ways established that social media and its growing
inuence on the society especially amongst youth in
different population is a pivotal catalyst in the formation of
body dissatisfaction, unhealthy ideals and eventually
seriously detrimental eating disorders.
Figure 2: PRIMA owcharts for study selection
Identification of records via searching
the database
(n = 500)
I n c l u d e d
y
t
i
l
i
b
i
g
i
l
E
Identification of additional records via
other sources
(n = 0)
Excluded records
(n = 150)
Reason of exclusion:
· Articles were not within the
selected time period (2014 -
2021)
· Articles weren’t in English
;
;
Eligibility check of articles
(n = 75)
Excluded articles
(n =50)
Reason of exclusion:
· Subjects were not the
appropriate age group.
· Review articles, meta-analysis,
etc. were excluded.
· The abstract only articles were
excluded
Studies included in
qualitative synthesis
(n= 25)
(n = 9 )
n
o
i
t
a
c
i
f
i
t
n
e
d
I
g
n
i
n
e
e
r
c
S
Removal of duplicates
(n = 250)
Records screened
(n =100)
Study Design
Study Population
Study
Duratio
n
Body Image/ Eating
Disorder Mea sure
Evidence Based
Research Stu dies
Outcomes/ R esults
Ecological
momentary
assessment
[6]
30 college go ing
women.
Mean age:18.52
years
Five
days
Body dissatisfa ction
Asses the resu lt of social
media consum ption on
body disappo intment.
The amount o f social media s ites
stayed was an important
interpreter of body
disappointme nt although tim e
spent using so cial media was not.
Cross
sectional
study design
[7]
Age ranges f rom
18 to 78 years.
4
consec
utive
days for
1 month
Body dislike a nd
eating disorde r
symptoms, he ight and
body fat
disappointme nt.
To assess the
relationship b etween
body dissatisfa ction and
social media.
Positive co-relation betwee n the
intake of anab olic steroids an d
disordered ea ting and the use of
social media w as discovere d.
Snowball
sampling
method [8]
208,063 twitte r
users
1.5 year
Eating disorde r and
personal emo tions.
To estimation the
determining fa ctor of
dropout while addressing
the endogene ity issues
by via an instrume ntal
adjustable ap proach in
an online ED pu blic.
Estimations re sults suggests that
user’s reaction s and system
significances have effects o n their
dropout perfo rmances on T witter.
Experimental
study design
[9]
112 female fro m
the age of 17 to 25
years.
1 month
Negative moo d,
weight and sha pe
discrepancy.
To investigate the result
of Facebooks tradition
on ladies’ bod y image and
attitude.
Members who spent time on
regulator web sites have bette r
mood than wo men who con sumed
more time on F acebook.
Quantitative,
descriptive
and cross
sectional
stud design
[10]
337 women
between the a ge
of 15 and 30 ye ar.
4
months
Eating disorde r
To examine th e
relationship b etween the
risk of the use of
community ne tworks and
eating disorde r.
Entire of 143 cases with a risk of
Eating Disorde rs were recog nized.
639
Individuals
Younger
adults [11]
About:639
Individuals
Younger adul ts
1 year
Eating
disappointme nt
Examining spread of
illness globall y.
Internet is play ing an
important role on betterme nt of
eating disorde rs
Survey
Based
Study [12]
Adolescents
1 day
Hunger
Malnourishm ent
Examining the clear
factors relate d to food
insecurity.
Adolescents w ho were not in the
school have increase num ber of
food insecurity
Cross-
sectional
study [13]
1765 early
grownups age s 19-
32 years, of a ge.
One
month
bulimia nervo sa,
anorexia nerv osa,
binge eating d isorder .
Inspect relatio ns
between soc ial media
use, and eatin g
concerns.
There were im portant pos itive
general direc t links betwee n the
social media u se variables a nd
eating conce rns.
Sampling
Study [14]
An over-all of 268
sexual
undergroun d
young people and
mature men,
extending fro m
fourteen to th irty
five years ol d
Two to
four
months
Body dysmo rphic
illness, Body
disappointme nt,
Minority pres sure,
Sexual mino rity
Inspect relatio ns
between min ority
stressors and bo dy
dysmorphia.
Higher incide nce of body
dysmorphia in sexual mino rity
men.
qualitative,
correlational
and
experimenta l
studies [15]
Studies were
mainly condu cted
among child ren /
adolescents
6-
7month
s
Pro-eating Disorde rs
Investigative the
connection a mong the
usage of so cial media
,Internet and e ating
concerns, bo dy image.
67 empirical s tudies discov ering
the bond amo ng the body im age,
eating conce rns and Interne t.
Rizwan B et al Increase In Body Dysmorphia and Eating Disorders Among Adolescents Due to Social Media
PBMJ VOL. 5, Issue. 3 March 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
DOI: https://doi.org/10.54393/pbmj.v5i3.205
144144
145

D I S C U S S I O N
social media and inuenced by it. This type of studies can
be also done in large population therefore giving a wide
array of explanations about the ways of how social media
exposure directly correlates with body image issues. Other
common type of study designs used was experimental
study and snowball study which brought a much-needed
diversity in the types of research methods for this issue.
Griths et al, 2018, Oshana et al, 2020 dealt with body
image issue in sexual minority men due to social media. It
was discovered by both that men of alternate sexuality are
more at risk of developing body image problems leading to
body dysmorphic and eating disorders as compared to
heteronormative men. The increased use of anabolic
steroids due to social media inuence was also observed
[7,14].Similarly, women present an increased risk of facing
bodily image issues as eight of the studies chosen,
selected women as their prime subjects. As seen in Bennet
2019, Fardouly 2014, Restrepo 2018, Wayles 2020 amongst
others, women who spent more time on social media
across multiple platforms such as Facebook, Instagram,
Pinterest etc., were more likely to develop body image
concerns or some type of dissatisfaction with one's self
[6,9]. Young adults and adolescents were also the majority
demographics of the selected studies suggesting that
younger demographic is shown to be more affected by
social networking and the health concerns it presents.
Fourteen of the selected studies chose young people as
their subjects while 11 studies chose subjects from varied
age groups including adolescents and young adults.
Bennet 2019, Fardouly 2014, Restrepro 2018, Ioannidis 2021,
etc., established rm relationship between use of social
networking and the rise of bodily image concerns the youth
of today face [6,9,10,11].Studies like Wang 2019, Wayles
2020, Branley 2017, etc. examined posts from across
different social media websites including Instagram,
Twitter, Tumblr, Facebook etc. to discover that many of
these platforms host groups or pages that support pro
anorexic lifestyle and inuence users of these platforms to
engage in disordered eating [8,21,4]. Another common
thread seen being promoted on social media with similar
repercussions is 'Thinspiration' which promotes rapid and
unhealthy weight loss by demonstrating 'success stories'
and give the impression of 'ideal' body. This type of
'inspiring' content creates insecurity amongst the users
about their body and gure even when they are perfectly
healthy [19,27]. A subset of 'thinspiration' is 'tspiration'
which similarly portrays muscular and bulky body type as
easily achievable and desirable. Without proper knowledge
of healthy weight loss or muscle gain, users try to achieve
this by using short cuts of disorder eating such as
starvation and induced vomiting. As well as indulging in
products like 'detox' tea and diet pills which are just
Table 1: Summary of literature review
observationa
l quantitative
and
qualitative
studies [16]
Young adulthoo d
(18-30 years)
4 years
Calorie countin g, self-
induced nause a
fasting, and bin ge
eating.
To assessed th e
influence in he althy
young adults. A nd body
image of habitu al social
media appointm ent or
contact to ima ge-related
contented on f ood
choices.
Social media a ppointment wa s
related with se lecting health y
foods, dieting/ restricting foo d, eat
too much, and high body
displeasure.
Cross
sectional
study [17]
approximately
79% of adults
11
months
Fitspiration
Thinspiration B ody
image Disordered
eating
Compare Thins piration n
Fitspiration gro ups on
Twitter.
Exposure of tw itter user to suc h
tweets lead to disordered eatin g.
Data analysis
[18]
Teenagers age d
between 14 an d 18
years, by sexu al
category. Girl s
15.6% and boy s
15.7%
eating disorders;
body dissatisfac tion
To examine th e effect of
the social med ia on body
dissatisfaction Eating
disorders and bo dy
displeasure in
adolescents. re lating
genders.
As a result, we find
The conseque nce of the bod y
mass index and social media a re
predictors of bo dy displeasure in
both sexual c ategory; and Bo dy
Displeasure is a n interpreter o f
Eating Disorde r risk in both girl s
and boys.
Sampling
Study [19]
About 128
undergraduate-
students both M en
and women
1
Week
Thinspiration
And
Fitspiration
Inspect fitspira tion and
thinspiration in everyday
lives of femal es and men.
The body satisf action was high er
than that of bad affect and
positive affec t signifying bod y
fulfillment ma ybe more stabl e
crossways time .
Present
Study [20]
Sample of
Adolescence .
Age: 6-11
About 523
students.
1 day
Overweight
And
Underweight
Use of comm unity media
is connected to body
image concern s and poor
emotional hea lth in
youth.
Female had hig her body
Concerns and
Internalizing p roblems even after
counting bod y image worries .
Empirical
Study [5]
College aged
women with
Instagram
account.
About 187 peo ple.
Age:19-24
1 day
Low self-esteem and
Poor body imag e.
The relationsh ip
between soc ial media
use and body
dissatisfaction .
Social media is a contributing
factor to almo st every compo nent
of young peop le’s lives.
Present
Study [4]
Premedical
Students: 186
Mean age:
16-18 years
1 day
Body Dysmorp hia
Body dysmorp hic
between youth s and
young grown-ups
There is an incre asing urgenc y of
body dysmorphia in y oung people.
Experimental
Ecological
Momentary
Design [21]
85 women
Six
times
daily for
seven
days
Disordered eatin g
And
Body dissatisfa ction.
Belongings of temper,
eating disorder a nd
fitspiration pic tures on
body appearan ce.
There were no important effe cts
on disordered eating or moo d.
Content
Analysis
And
Network
Analysis [22]
Data set of
Users: 3029
3 years
Social structu re
And commun ication
patternresearch in
eating disorders
Communal me dia plays
an indispensab le role in
daily life of young peo ple.
Recognized n ine topics conn ected
to eating sickn ess specific
content and c ommunal suppo rt
Cross-
sectional
study [23]
147 young adu lt
university
students
3
months
Self-esteem ,social
networking site s,
youth, eating
behaviors.
Analysis of iss ues
pertaining bod y image
and existing ea ting
disorders that a re being
aggravated by social
media.
Most young ad ults are expos ed to
unhealthy be auty standards th at
affects their bo dy image and s elf-
esteem issues which might le ad to
eating disorders.
Cross-
sectional
study [24]
118 women in U SA
between the a ges
of 18 to 64 yea rs
6 years
Social assessm ent
theory.
Women’s med ia use
and body
Social media’s
contribution in the rise of
women comp aring
themselves an d dealing
with body image
problems
It was seen tha t those wome n who
regularly follo w and show inte rest
in fitness relate d content on
Pinterest, follo wed a much stric t
dietary regime .
Thematic
analysis [25]
706 posts fro m
twitter (353) a nd
Tumblr (356) w ere
considered
3
months
Eating disorder
,anorexia, bulim ia
,thinspiration.
Eating disorde rs
prevalent in twit ter and
Tumblr users
pro anorexia related content was
clearly visible on twitter
Snowball
sampling
method [26]
252,970 twee ts
were taken into
consideration
2 weeks
Eating disorde r:
anorexia, bul imia,
binge eating
Eating disorde rs
prevalent in twit ter users
Increased inte raction betwee n
twitter users w ith the same ea ting
disorder.
Experimental
design [27]
220 female
undergraduate
students
2 years
Body dissatisfaction
Eating disorde rs
prevalent in so cial media
users
Thin ideal imag es were seen to be
a major contrib ution factor in
increased bod y dissatisfaction
Cross-
sectional
study [28]
168 female
students betwe en
1 month
Eating behavior
Establishing a l ink
between low s elf-
About 93% of all subjects were in
some shape or form not satisfied
with their bodies.
This review is to establish the potentially detrimental effect
social media can have on the youth in regards to body image
dissatisfaction also how it eventually leads to disordered
eating and body dysmorphia. Twenty-ve research studies
were selected and the data they provided was analyzed in
order to understand the extent to which this problem exists
and how social media is directly contributing to eating
diso rders /bo dy d iss atis facti on a cr oss d if fer en t
demographics. While most of the studies that were taken
into account proved that social media indeed have a direct
relation in body dissatisfaction and can lead to sever
consequences, different methods and demographics were
used across these st udies to derive this common
conclusion. The most commonly used method was cross-
sectional study, which was employed in 9 of the 25 selected
studies. The purpose of this type of research design to ask
the subjects about their perspective and gure out the root
of the problem and to get a clear idea about the extent of
the issue. In aforementioned studies the subjects were
often young and therefore more likely to be exposed to
Rizwan B et al Increase In Body Dysmorphia and Eating Disorders Among Adolescents Due to Social Media
PBMJ VOL. 5, Issue. 3 March 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
DOI: https://doi.org/10.54393/pbmj.v5i3.205
146

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PBMJ VOL. 5, Issue. 3 March 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
DOI: https://doi.org/10.54393/pbmj.v5i3.205
148