By Shruti Ram, B.S.
In today’s culture, people in the United States live in a media-saturated environment, and over 92% of American adolescents report going online every single day (Elmore, Scull & Kupersmidt, 2018). Social media allows us exchange and develop ideas and stay connected with each other, but it also allows us to monitor others’ social lives, compare ourselves to others, and quantify our friendships. It may not come as a surprise, but increased media exposure has been associated with increased anxiety, depression, drug abuse and eating disorder symptoms (Mabe, Forney, Keel, 2014; Elmore, Scull & Kupersmidt, 2018), leading researchers to label social media as “super peer” to adolescents.
So how exactly does social media influence the development of disordered eating?
Social media use has been found to be a risk factor for adolescents with eating disorders, and increased engagement in image-centric social media platforms such as Instagram, Facebook and Snapchat have been associated with increased body satisfaction, drive for thinness, perfectionism, and social comparison across different genders and races (Mabe, Forney, Keel, 2014; Howard et al., 2017; Griffiths, Murray, Krug & McLean, 2018). Individuals with disordered eating are more likely to spend time on image-centric social media, place increased importance in receiving likes and comments, spend more time editing photos, and compare their own photos to other individuals on social media (Bennett, 2018).
One reason this might be the case is that existing eating disorder symptoms might drive maladaptive uses of social media. The terms “thinspiration” and “fitspiration” are increasingly being used in order to reference something serving as motivation for a person seeking to maintain a very low body weight. The abundance of “thinspiration”, “fitspiration” and other pro-anorexia blogs and social media accounts can be used to disseminate information about harmful eating disorder behaviors, such as extreme restriction, exercise, and laxative use. These communities normalize these harmful behaviors, and often romanticize eating disorders and mental illnesses, contributing towards the development of worsening of symptoms (Branley & Covey, 2017). Social support, typically seen as a prosocial aspect of social media, can thus become harmful.
Censorship of these pro-anorexia sites and forums may have a minimal effect on disordered eating, considering the pervasiveness of the thin ideal in our everyday lives, which is present even in generic messages. Whether it is celebrities endorsing laxative “flat-tummy tea” or the increased popularity of photoshop and facetune to erase everyday imperfections, individuals have reported being less satisfied with their lives and bodies (Griffiths, Murray, Krug & McLean, 2018). Moreover, censorship would discount the positive effects of social media, such as the use of social media for pro-recovery and relapse prevention groups.
As social media continues to become a bigger part of our daily lives, it is important to consider its role in contributing towards eating disorder symptoms and the harmful idealization of the thin ideal. One way to combat the negative messages represented in the media is through media literacy.
What is social media literacy?
Media literacy, and specifically social media literacy, could be a promising form of eating disorder prevention. Media literacy is the ability to access, analyze, evaluate, and create media in a variety of forms (McLean, & Paxton, 2018). The idea behind media literacy is that individuals should be educated on informed interpretations of the media, and be able to critique images and to make an assessment about how realistic or otherwise images are. Social media literacy is a novel approach to media literacy (McLean et al., 2017; McLean, & Paxton, 2018) that includes two perspectives:
Social media literacy allows us to see the motivations for messages we are fed. Commercial messages have idealized images in order to sell us a product. Brands like Victoria’s Secret attempt to sell us a heavily edited fantasy in order to increase sales for their lingerie, profiting off of women’s body dissatisfaction. On the other hand, messages from our peers may lead us to believe that their lives are perfect, but your friend’s perfectly curated Instagram feed does not show the hidden insecurities we all may have about our appearance, career, or relationships.
One popular message that has been circulating in social media recently has been to ask yourself “who profits off this emotion?” in response to body/appearance dissatisfaction – this question is an excellent way to challenge appearance ideal norms in social media. The reality is that no one is perfect, despite what the smiling, filtered images on social media may be telling you. Holding yourself to an unrealistic standard benefits no one but the corporations that are profiting from it.
Pilot tests of social media literacy as a prevention program for eating disorders have proven successful (McLean et al., 2017; Tamplin), however, everyone can benefit from it. Through social media literacy, we can begin to understand that social media is not a healthy scenario for social comparison. We are less likely to post about our personal failings, or images that show our imperfections, and the same is true for celebrities and magazines. Becoming social media literate allows us to realize the discrepancy between social media and “real life”. It shows us that comparison on social media is unrealistic – we are comparing our “real” selves with others’ “best” selves, whether it be on Instagram or the pages of Cosmopolitan.
Another idea related to social media literacy is evaluating the time you spend on social media altogether. The number of social media networks you are active on is associated with increased negative outcomes, and reduced time on social media has been associated with a variety of positive outcomes for mental health (Primack et al., 2017). If you find yourself spending more time on social media rather than enjoying experiences with your loved ones, or engaging in other hobbies, you may find yourself more at risk for social media’s negative influences. There are many benefits to social media, but if you find yourself obsessing over getting the perfect picture or looking at other people’s achievements, you may run the risk of not living in the moment, and hence feeling less satisfied with your own life.
We might not have the power to regulate standards in the beauty and entertainment industries, but we can make changes in our own lives to minimize the negative impact the appearance ideal has in our daily lives. Social media literacy has the potential to reduce disordered eating symptoms, as well as increase satisfaction in our lives and appearances. However, you might be doing yourself a favor by just logging off.
Bennett, M. (2018). Factors contributing to eating disorders in pre-adolescents. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning. Retrieved from http://echo.louisville.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-43829-143&site=ehost-live
Branley, D. B., & Covey, J. (2017). Pro-ana versus pro-recovery: A content analytic comparison of social media users’ communication about eating disorders on Twitter and Tumblr. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01356
Elmore, K. C., Scull, T. M., & Kupersmidt, J. B. (2016). Media as a "Super Peer": How Adolescents Interpret Media Messages Predicts Their Perception of Alcohol and Tobacco Use Norms. Journal of youth and adolescence, 46(2), 376-387.
Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in human behavior, 69, 1-9.
Griffiths, S., Murray, S.B., Krug, I., McLean, S.A. (2018) The contribution of social media to body dissatisfaction, eating disorder symptoms, and anabolic steroid use among sexual minority men. Cyberpsychology, Behavior, and Social Networking. 21(3):149-156. doi:10.1089/cyber.2017.0375.
Howard, L. M., Heron, K. E., MacIntyre, R. I., Myers, T. A., & Everhart, R. S. (2017). Is use of social networking sites associated with young women’s body dissatisfaction and disordered eating? A look at Black–White racial differences. Body image, 23, 109-113.
Mabe, A. G., Forney, K. J., & Keel, P. K. (2014). Do you “like” my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders, 47(5), 516–523. https://doi.org/10.1002/eat.22254
McLean, S. A., Wertheim, E. H., Masters, J., & Paxton, S. J. (2017). A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders. International Journal of Eating Disorders, 50(7), 847–851. https://doi.org/10.1002/eat.22708
Powers, K. L. (2018). Social media use and media literacy in relation to adolescents’ understanding of the internet. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning. Retrieved from http://echo.louisville.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018-00726-191&site=ehost-live
Tamplin, N. C., McLean, S. A., & Paxton, S. J. (2018). Social media literacy protects against the negative impact of exposure to appearance ideal social media images in young adult women but not men. Body Image, 26, 29–37. https://doi.org/10.1016/j.bodyim.2018.05.003
Teo, N. S. Y., & Collinson, S. L. (2018). Instagram and risk of rumination and eating disorders: An Asian perspective. Psychology of Popular Media Culture. https://doi.org/10.1037/ppm0000205
By: Caroline Christian, B.S.
Eating disorders affect approximately 10% of the population (Stice, Marti, & Rhode, 2013). Despite this, effective treatments for eating disorders are extremely limited. The empirically supported treatments for binge eating disorder and bulimia nervosa have relapse rates estimated to be as high as 50% (Olmstead, Kaplan, & Rockert, 2005). Additionally, the only empirically supported treatment for anorexia nervosa is for adolescents, meaning there are no effective treatments for adults with anorexia nervosa. Our lab is working hard to try to fill this need by researching new interventions for treating eating disorders, such as imaginal exposure therapy and personalized treatment for eating disorders.
Because treatment interventions for eating disorders are currently not as advanced as we would like them to be, eating disorder prevention is even more critical. Prevention and early detection of eating disorders has the potential to drastically reduce the high prevalence of eating disorders, and thus, reduce the number of individuals who struggle with treatment-resistant eating disorders. Our lab has recently been trained in the Body Project, which is a dissonance-based eating disorder prevention program. We are very excited to disseminate this program around Louisville and on University of Louisville’s campus to help reduce the burden of eating disorders on our community.
What is the Body Project?
The Body Project was first developed by Dr. Carolyn Becker, a professor at Trinity University in San Antonio. She first implemented the college version of the Body Project in collaboration with Delta Delta Delta Sorority, and the program quickly expanded to several colleges around the nation. The purpose of the Body Project is to inform young women about the “appearance ideal,” which is the “perfect” appearance, as promoted by society, which is often unrealistic and unattainable. After discussing this ideal, participants then brainstorm the costs of pursuing this unattainable ideal and learn skills and activities they can do to act and speak against this ideal. This intervention has shown to be effective in reducing eating disorder symptoms, thin ideal internalization, and body dissatisfaction in young women (Stice et al., 2013; Stice, Rohde, Gau, & Shaw, 2009). Additionally, individuals at the Body Project are also working on developing and validating new versions of this intervention for different groups, including cultural minorities, non-English speakers, males, and middle school students. This could allow for the Body Project to reach more people across the world and prevent eating disorders in more individuals! Two versions of the intervention that we currently have in Louisville are the 4-session high school version and the 2-session peer lead version for college students.
High School Version
The high school version in Louisville is conducted in four one-hour sessions and takes place during the school day as part of the health class curriculum. So far, the Body Project has been conducted at Mercy and Presentation Academy in Louisville. In an investigation of the effectiveness of the Body Project in these Louisville high schools, we found that the Body Project reduced eating disorder symptoms, body dissatisfaction, as well as many other eating disorder risk factors and comorbidities, including anxiety, depression, and maladaptive perfectionism (Christian et al., 2018). This upcoming year we are planning to expand this program even more, and there is currently a call for interested individuals to become a trained facilitator of the high school version of the Body Project. If you are interested in attending a training event, please reach out to email@example.com for more details on the training and the Body Project.
This January, a group of students and professionals from the Eating Anxiety Treatment (EAT) lab, the Louisville Center of Eating Disorders, and the Psychological Services Center underwent a training for the peer-led version of the Body Project, so that we can start disseminating it to college students at the University of Louisville. We have already done a few sessions of the Body Project on campus in collaboration with the Women’s Center, and they were very successful. This semester, we are planning on expanding the reach of the Body Project at UofL by turning it into a Registered Student Organization (RSO). We hope that this RSO will allow for students who are passionate about eating disorder prevention or spreading body positivity on UofL’s campus to get more involved, as well as create a sustainable model of disseminating the Body Project on campus. In addition to doing the peer-led Body Project with interested groups, we also hope to spread a body positive message that could change the campus culture around body image by partnering with other groups to promote external events and initiatives. If you are interested in being part of this new RSO, please contact firstname.lastname@example.org to learn more about the RSO or to RSVP for the peer-led Body Project facilitator training.
We are very excited to bring the Body Project to Louisville to help increase awareness and prevention of eating disorders in our community and on the University of Louisville campus! We hope that through disseminating this intervention, we will spread a body positive message to more individuals and decrease the number of friends, family members, and neighbors that struggle with eating disorders in our community.
Christian, C., Brosof, L. C., Vanzhula I.A., Williams, B. M., Shankar Ram, S., Levinson, C. A. (2018). The Efficacy of a Dissonance-Based Eating Disorder Prevention Program in the Reduction of Eating Disorder Comorbidities and Risk Factors in High School Students. Manuscript submitted for publication.
Olmsted, M. P., Kaplan, A. S., & Rockert, W. (2005). Defining remission and relapse in bulimia nervosa. International Journal of Eating Disorders, 38(1), 1-6. DOI: 10.1002/eat.20144
Stice, E., Butryn, M. L., Rohde, P., Shaw, H., & Marti, C. N. (2013). An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behaviour Research and Therapy, 51(12), 862-871. DOI: 10.1016/j.brat.2013.10.003
Stice, E., Marti, C., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology. 122(2), 445. DOI: 10.1037/a0030679.
Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825. DOI: 10.1037/a0016132
By: Leigh C. Brosof
This year’s fifth-annual Louisville National Eating Disorder Association (NEDA) Walk was held a few weeks ago on September 15 at Bellarmine University. From the speakers to the attendance (497 people registered!), it is clear that the community rallying around eating disorder awareness and advocacy only continues to grow in Louisville. This growing sense of community is imperative in Louisville to increase resources devoted to eating disorder treatment, decrease stigma, and letting individuals in recovery or recovering from eating disorders know that they are supported and that there is hope.
Ken Fleming, a Kentucky State Representative, who helped spearhead legislation recognizing an eating disorder awareness week in Kentucky, spoke about the steps being taken in Frankfort to help address legislation surrounding eating disorders. I was lucky enough to attend one of these meetings in Frankfort and got to see the legislative process in action!
Dr. Andrea Krause, a pediatrician in Louisville, spoke about the seriousness of eating disorders and how professionals work with families and individuals with eating disorders to treat these disorders and work toward recovery.
Megan Ward gave an inspiring speech about her personal struggles with an eating disorder and how she ultimately was able to get the help she needed to reach recovery. She also spoke powerfully about how eating disorders come in all shapes and sizes and do not discriminate based on age, race, ethnicity, gender, or anything else.
This message was echoed by the last speaker of the day, former MLB catcher and NEDA Ambassador Mike Marjama, who battled with an eating disorder while playing professional baseball and now works to increase awareness about eating disorders in all individuals. This was truly an important message for everyone to know that eating disorders do not “look” a certain away, that they can affect anyone, and that everyone is worthy of treatment.
Ultimately, all of the money raised through NEDA goes directly back to clinical resources, awareness about eating disorders, research endeavors, and to help our local community continue to fight eating disorders. Fundraising efforts for the Louisville NEDA Walk continue through October 15.
To donate, go to: https://nedawalk.org/louisville2018. It was a powerful day to remind our community that we continue to get stronger in the fight against eating disorders, and that if you struggle, there are others around you to support you, and there is help and hope available for a full recovery.
If you or a love one is struggling with disordered eating, there is help available. NEDA offers a helpline to speak to someone about seeking help, and a screening tool to help identify if any eating concerns you are having may be an eating disorder.
NEDA Helpline to speak to someone over the phone:
By: Lisa Michelson, M.A
Upon hearing about the experiences my lab had at the 2018 International Conference on Eating Disorders in Chicago, Illinois, we discussed the controversial nature that exists when researchers use “triggering,” terminology. Audience members became upset with certain researchers who used words such as “overweight,” and “obese,” which were used to describe study participants. These words have been part of the terminology present in fat-shaming, fat discrimination, and micro aggression towards a population that society has deemed to have above average weight. Furthermore, these words become associated with individuals that society has frequently labeled as “lazy” or “incapable” as dictated by their portrayals in films, television, and other media outlets. However, this begs the question: Should researchers use these words if they are so triggering in the public domain? The answer is complicated.
“Obese,” comes from the latin “obesus,” which means “fat, stout, plump.” It was believed that Hippocrates recognized obesity as a medical condition as it gave rise to the onset of other diseases (Christopoulou-Aletra & Papavramidou, 2004). The modern term “obesity,” one that became stigmatized by society today, took shape in 1942, when The Metropolitan Life Insurance Company began to determine mortality rates based off of age and weight. For the first time, individuals were standardized and the notion of what an individual “should” weigh was popularized (Statistical bulletin of the Metropolitan Life Insurance Company). While initially designed to determine “desirable weight” dependent on age, height and mortality values, the insurance company changed the medical term into one that society was able to pass medical judgment on, completely discounting the innate nature in which all bodies are different.
Researchers Meadows and Danielsdottir (2016) said it best, “Part of the problem is that the very act of labeling is a process of othering, one that creates a distinction between us and them; which raises the question: who is entitled to do the labeling and why, and in what conditions is such a distinction needed?” Within research, othering is needed in order to determine differences between two groups of individuals. However, when presenting research, the two groups must be labeled in order for other researchers to understand what populations the research is being done on. The questions Meadows and Danielsdottir (2016) raise are both legitimate and further contemplation could give rise to an ethics paper worth developing.
However, I argue, researchers ought to be allowed to use the triggering word, upon critical consideration, as long as its intent is to use the word as it originally appeared in the dictionary and not one that was shaped from societal norms. I recognize this statement contains many caveats, like “what if the word in the dictionary was created offensively in the first place?” It is the responsibility of researchers to develop a common word that can be used for research purposes.
Let’s say for instance, researchers were to change the word of a specific demographic every time social norms dictate it as “triggering.” Not only would this be a disservice to the population in which the research was presented on, but also could have a negative impact on the research itself. For example, if researchers cannot come up with a common language for the subject in which they are communicating, then the ability to share research will be dependent on how long the terminology within that research is deemed “acceptable.” For this reason, when reporting on demographics, researchers ought to be careful in the first place of the terms they do use.
In the end, I believe that “obese” as a research term ought to continue to be used, reporting results unbiased without regard to social norms. Further, if new information comes to light, for example if it was discovered that Hippocrates used “obese” as a derogatory term, then it is the ethical responsibility of researchers to utilize different terminology for this demographic.
By: Shruti Shankar Ram
While the culture in the United States has come a long way in terms of normalizing and destigmatizing mental illness, particularly with respect to depression and anxiety, there are still a lot of misconceptions and stereotypes surrounding other mental illnesses, such as eating disorders and obsessive-compulsive disorder. Eating disorders, and mental illness in general, is still a taboo topic in a lot of communities, specifically among people of color.
As an Indian-American, I have witnessed the culture surrounding mental illness within my community. Rather than being seen as a real illness that warrants the same attention and level of care as a physical ailment, mental illness is often dismissed and not legitimized. Even when one’s mental illness is acknowledged, their family might try to explain it by giving it a biological cause, such as rationalizing it as a thyroid dysfunction. Due to a myriad of sociocultural factors, South-Asians face unique barriers to seeking treatment for eating disorders.
One issue is that eating disorders are still stereotyped as an issue that only affects young, affluent, White women. In reality, eating disorders affect people of all genders, ethnic groups and ages (Marques et al., 2011).
While extensive research on eating disorders has been conducted in European-American populations, and some research has been conducted in African, Latin-American, and Hispanic populations, eating disorder research has been historically sparse in Asian populations (Soh & Walter, 2013). Research has suggested that referrals to eating disorder services from South-Asian populations are under-represented (Abbas et al., 2010), despite evidence suggesting that rates of disordered-eating behaviors are similar to the rest of the population (Wales et al., 2017). Studies have also shown that there is a high prevalence of disordered eating behaviors in minority populations in general (Solmi et al., 2014), and research in South-Asian populations have suggested that the incidence of certain eating disorders, specifically bulimia nervosa, is higher in South-Asian populations than White populations (Mumford et al., 1991).
Eating disorders are particularly relevant in the South-Asian community due to role that food plays in the culture. Any large gathering of family or friends usually involves a lot of sugary, fatty food, and people are encouraged to socialize and eat, and those that do not partake are seen as asocial. However, it is also a common occurrence in the South-Asian community to have various relatives or family friends comment on various aspects of one’s life, including one’s physical appearance. In the Indian community, being light-skinned and thin are seen as not just sufficient, but necessary to be considered attractive, if you are a woman. Societal pressure in the form of comments or suggestions are often made if a woman does not match this ideal body type, conditioning individuals to go to extremes pursuing this ideal. Research has found that this is a common theme in the South-Asian community that can prime individuals to develop disordered eating habits and behaviors (Wales et al., 2017). Much of this pressure is faced by young women and adolescent girls, as patriarchal norms dictate that they are expected to look attractive to find an ideal husband. Men in the South-Asian community also face the same societal pressures, but generally to a lesser extent. Older women often note that they do not face the same pressures after marriage, though some pressures still exist. This dual pressure to eat in social settings and yet maintain a thin figure may be one reason why there is a higher than average prevalence of bulimia nervosa in South-Asian women, and why anorexia nervosa might not be as common (Mumford et al., 1991; Abbas et al., 2010). Klump and Keel (2003) also provide other explanations on cultural differences in eating disorders, and their research has found that bulimia nervosa has greater variability cross-culturally than other eating disorders, such as anorexia nervosa.
Additionally, women who are part of the South-Asian diaspora, but who live in the Western world face experience many conflicting messages about food and weight, as they are exposed to more traditional South-Asian influences from their family, as well as being exposed to various Western disordered eating triggers such as peer pressure, pictures of thin celebrities and pro-anorexia websites.
Not only do South-Asians face unique sociocultural pressures that may contribute towards disordered eating, but they also face barriers to seeking treatment. One of the biggest barriers to accessing services is lack of knowledge – while younger South-Asians tend to be more aware and exposed to ideas about mental illness, they may be dismissed by elder family members or friends. The lack of communication and understanding of the seriousness of eating disorders can keep younger South-Asians from accessing care, particularly if they are dependent on family members to assist with paying for treatment (Wales et al., 2017). This goes along with the general stigma surrounding mental illness in the South-Asian community – seeking treatment involves acknowledging the mental illness, and many South-Asians do not want to admit that there is a “problem” in their family or community.
While South Asian populations face these unique barriers to accessing care for eating disorders, progress is still being made. Mental health is being discussed in a serious way in South-Asian media, such as in Bollywood movies, reshaping the way it is viewed by the general population. However, increasing eating disorder research on this understudied population is important, as it could contribute towards reducing barriers to treatment and improving quality of care to the South-Asian population. Moreover, eating disorders may present differently in Eastern populations versus Western populations, so more research needs to be done to parse out if such differences exist. Additionally, normalizing topics within these communities is essential, as stigma can keep South-Asians from accessing mental health services, even when readily available.
Abbas, S., Damani, S., Malik, I., Button, E., Aldridge, S., & Palmer, R. L. (2010). A comparative study of South Asian and non‐Asian referrals to an eating disorders service in Leicester, UK. European Eating Disorders Review, 18(5), 404-409.
Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological bulletin, 129(5), 747.
Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420.
Mumford, D.B., Whitehouse, A.M., & Platts, M. (1991), Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. The British Journal of Psychiatry, 158(2), 222-228.
Soh, N.L. & Walter, G. (2013), Publications on cross-cultural aspects of eating disorders. Journal of Eating Disorders, 1(1), 1-4.
Solmi, F., Hatch, S.L., Hotopf, M., Treasure, J. and Micali, N. (2014), Prevalence and correlates of disordered eating in a general population sample: the South East London community (SELCoH) study. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1335-1346.
Wales, J., Brewin, N., Raghavan, R., & Arcelus, J. (2017). Exploring barriers to South Asian help-seeking for eating disorders. Mental Health Review Journal, 22(1), 40-50. doi:10.1108/MHRJ-09-2016-001
By Irina Vanzhula, M.S
Everyone experiences shame and guilt at times. While these emotions can be helpful in guiding our social behavior, they can also bring a lot of discomfort and even trigger depression and other psychological disorders, such as eating disorders. Let’s differentiate between shame and guilt, describe in which situations they can be useful or harmful, and discuss how to cope with them.
Guilt is an unpleasant emotion about something we have done. It is often used synonymously to remorse, meaning that we regret the action, and guilt may involve sadness and empathy towards the person harmed. Guilt is generally seen as a useful emotion that encourages us to follow moral and societal norms. For example, we may feel guilty about lying to a friend or skipping a volunteering shift at the local shelter. Guilt may also occur if we act inconsistently with our personal values. For example, someone who values family above all else may feel particularly guilty about skipping a family holiday dinner.
In contrast to guilt that involves feelings about an act one has done, shame involves negative feelings about oneself. Shame encompasses a feeling of inferiority and perceiving oneself as a small, lesser person, worthless, and a failure. Another way to differentiate guilt and shame is by what the emotion urges us to do: guilt usually triggers a desire to apologize and redeem oneself, while shame may lead to a desire to hide or escape. Although shame can be helpful in some situations (i.e. serious wrongdoing) and is used in programs redeeming violent offenders (Loeffler, 2009), it generally is associated with increased distress and may lead to depression, self-harm, and disordered eating (Muris, 2015).
Feelings of guilt can also be harmful if it is based on an irrational belief, such as feeling guilty for something that was not our fault. For example, if we witness an injustice, we may feel guilty because we think we could have done something to prevent it. Guilt can also transform into shame if a “bad” action is interpreted as having occurred because one is a “bad” person. Example: “I feel guilty that I didn’t visit my family this month” can lead to two different outcomes: 1) Call or visit the family to release the guilt or 2) Feelings of shame because “I am a bad son.” The problem with feeling shame in the second scenario is that it may lead the individual to further avoid visiting family and feeling even more shame.
How then can we cope with guilt and shame? First, check your guilt or shame statement for accuracy. Was it really your fault? Can you think of anyone or anything else that may have contributed to the situation? Make a list of any other possible causes and state how much you think each cause contributed in percentage. Then add up all the percentages and subtract from 100%: How much is left? You may want to do this exercise with someone else who can help you see all the perspectives.
To cope with shame, it can be very helpful to examine the evidence and rewrite shame statements into statements of guilt. For example, if you got frustrated and yelled at your child, does it really mean that you are a bad parent? Generally, we want to change the statement from “There is something wrong with me” to “I have done something wrong.” Most of the time, a guilt reaction is more accurate than shame.
Statement of shame: I yelled at my child again! I am a terrible parent.
Statement of guilt: I feel guilty about yelling at my child.
What if you truly have done something bad and can’t shake the regret or shame? Think back to the situation and answer these questions: What purpose did this action serve to you at the time? What did it help you accomplish? What would have happened if you didn’t make that choice in the moment? It’s easy to see what we did wrong looking back and knowing what we know now; it’s called hindsight bias. Most often, we make the best decision based on what we knew at the time.
Finally, if logic and reason are not helpful in dealing with guilt and shame, practice self-compassion. Most of us are very good at being compassionate towards others, but find it hard to be compassionate to ourselves. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or beating ourselves up with self-criticism. Imagine that your close friend or a loved one tells you about their guilt or shame, what would you say to them? Say those words to yourself. You can also find many useful self-compassion exercises on Cristin Neff’s website http://self-compassion.org.
By Shruti Shankar Ram
Consider this: a friend or peer of yours has developed a particular obsession with food – to the point where they count the number of bites they take from their meal, or arrange their food in a specific way every time they eat. They might also have to eat their food in a methodical way and refuse to eat certain foods.
This information alone might make you suspect that they have an eating disorder, but these symptoms could also be seen in another mental illness – obsessive compulsive disorder (OCD).
Obsessive-compulsive disorder is characterized by repetitive, intrusive thoughts, feelings or sensations that cause anxiety, often accompanied by the need to engage in a repeated habit or ritual that serves to reduce this anxiety in the short-term. Similar to eating disorders, there are also various types of OCD, and the obsessions and compulsions can range from a variety of different things – from health to religion and sexual orientation.
Eating disorders and OCD are often heavily stereotyped in the media. While you may immediately think of a teenage girl with anorexia nervosa when thinking of an eating disorder, or a person excessively washing their hands when thinking of OCD, the reality is that both these disorders affect individuals from both genders from a wide variety of different backgrounds and across all ages. Unfortunately, these stereotypes could keep individuals with both these disorders from realizing that they even have the disorder or recognizing the signs in their peers, and this keeps people from getting the treatment that they need.
Stereotyping aside, OCD and eating disorders actually share a lot of commonalities. There are several parallels that can be drawn between these two mental illnesses. An example of an obsessive behavior that is seen across both these illnesses is checking. While someone with OCD may constantly check their stove or locks in their house, a person with an eating disorder may constantly check themselves in the mirror or weigh themselves frequently.
This is no coincidence, eating disorders and OCD actually co-occur quite frequently (Rubenstein et. al., 1993; Halmi et. al., 2005; Swinbourne and Touyz, 2007) and eating disorder pathology has been shown to be positively associated with obsessive-compulsive symptoms (Davies et. al., 2009; Naylor et. al., 2011). In fact, obsessive-compulsive symptoms have also been associated with higher relapse rates in eating disorders (Carter, et. al., 2012).
Individuals with OCD and eating disorders typically also share two traits in common – high levels of anxiety and perfectionism. In fact, it is quite common for individuals with these disorders to excel in various other areas of their life while silently suffering from the illness. Perfectionism may be seen as a positive trait by some, but it has been shown to mediate the relationship between OCD and eating disorders, and individuals with either or both of these illnesses typically have high levels of trait perfectionism (Bernert et. al., 2013).
Additionally, obsessional anxiety could help maintain both OCD and eating disorder symptoms. This anxiety surrounds possible catastrophic outcomes that may occur if the ritualistic behaviors is not completed – in the case of an eating disorder, this could mean that an individual believes that, unless they heavily restrict, they will gain large amounts of weight and become overweight. In the case of obsessive-compulsive disorder, this could mean that an individual believes that they will die unless they are constantly avoiding germs and washing their hands. This anxiety leads to drawing associations between certain rituals and outcomes – even if they appear irrational to others.
Not only are there common symptoms between eating disorders and OCD, but the treatment can also look similar. Specifically, exposure and response prevention therapy (ERP) is an evidence-based treatment that has been well established as the most effective treatment for OCD (Koskina et. al., 1996), and research is beginning to show that ERP may be effective in treating eating disorders as well (Ambramowtz et. al., 2013). Combining exposure therapy with cognitive-behavioral therapy (CBT) is effective in breaking up these irrational associations between ritualistic behaviors and the reduction of anxiety.
It is important to note that, of course, eating disorders and OCD, are two very different illnesses. The obsessions and compulsions of an individual with OCD can extend far beyond food, and individuals with eating disorders often experience symptoms that are not typically present in OCD, such as body dysmorphia and drive for thinness. However, it is important to understand the relationship between these disorders, particularly as the comorbidity rate is so high. So, if you do question whether a friend or peer has an eating disorder or OCD – consider the possibility that it could be both!
Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27(4), 583-600. doi:10.1016/S0005-7894(96)80045-1
Bernert, R. A., Timpano, K. R., Peterson, C. B., Crow, S. J., Bardone-Cone, A. M., le Grange, D., & ... Joiner, T. E. (2013). Eating disorder and obsessive–compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor. Personality And Individual Differences, 54(2), 231-235. doi:10.1016/j.paid.2012.08.042
Davies, H., Liao, P., Campbell, I. C., & Tchanturia, K. (2009). Multidimensional self reports as a measure of characteristics in people with eating disorders.Eating And Weight
Disorders,14(2-3), e84-e91. doi:10.1007/BF03327804
Halmi, K. A., Tozzi, F., Thornton, L. M., Crow, S., Fichter, M. M., Kaplan, A. S., et al. (2005). The relation among perfectionism, obsessive–compulsive personality disorder and obsessive–compulsive disorder in individuals with eating disorders. International Journal of Eating Disorders, 38, 371–374.
Koskina, A., Campbell, I. C., & Schmidt, U. (2013). Exposure therapy in eating disorders revisited. Neuroscience And Biobehavioral Reviews, 37(2), 193-208. doi:10.1016/j.neubiorev.2012.11.010
Naylor, H. et. al. (2011) Beliefs about excessive exercise in eating disorders: the role of
obsessions and compulsions. European Eating Disorders Review, 19, 226–236, DOI:
Rubenstein, C. S., Pigott, T. A., Altemus, M., L'Heureux, F., Gray, J. J., & Murphy, D. L. (1993). High rates of comorbid OCD in patients with bulimia nervosa. Eating Disorders: The Journal Of Treatment & Prevention, 1(2), 147-155. doi:10.1080/10640269308248282
Swinbourne, J., & Touyz, S. (2007) The co‐morbidity of eating disorders and anxiety disorders: a review. European Eating Disorder Review, 15, 253–274. https://doi.org/10.1002/erv.784
Does this dress make me look fat? - The Importance of Rejecting Fat Talk
By Caroline Christian
“Does this dress make me look fat?” “Oh my, you look so good! Have you lost weight?” “I need to lose a few pounds before spring break if I am going to wear a bikini on the beach.” These are all statements I have heard just within this past week. With the extreme pressure and focus around body shape and weight in our society, conversations like these are extremely common. Most women will hear at least one statement like these every single day. These statements are called fat talk. Below is a short list of fat talk statements that we may hear, or even say, on a daily basis.
Fat talk statements:
“Your arms look so skinny today!”
“If I were her size, I would not want to leave my house.”
“I need to go to the gym so my boyfriend won’t feel my love handles.”
“I could never pull off jeans that tight with my thunder thighs.”
“Why is he with her? She is a whale!”
“If I was that fat, I just wouldn’t eat.”
“I wish I could be as thin as you.”
“If you think you are fat, I must be a cow!”
“I wish I had a bikini body.”
“That dress is cute, but it isn’t very flattering on you.”
“I need to lose weight before we vacation.”
“Oh my gosh, you look amazing! Have you lost weight?”
“Be honest, do I look fat in this?”
“She probably shouldn’t have been wearing that dress, it was way too revealing.”
The important thing to recognize about fat talk is that it isn’t necessarily malicious. In fact, looking at this list of fat talk statements, you can see that many of the more common examples are actually meant to be complimentary. However, regardless of intention, fat talk statements that equate weight and shape with value or beauty, can be very harmful to you and to the people around you.
Fat talk is extremely prevalent in young women, especially around high school and college years, with around 93% of college-aged women admitting to engaging in fat talk (Salk & Engeln-Maddox, 2012). Other studies have shown the impact negative body talk can have on the people around you. In one study by Gapinski, Brownell, and LaFrance (2003), women who listened to another woman saying negative things about her own body reported higher body dissatisfaction than women who listened to the woman speak about a neutral topic. In addition to increases in body dissatisfaction, exposure to fat talk also increases the likelihood of listeners engaging in fat talk (Tucker et al., 2007). Because of this, fat talk tends to have a cascading effect (i.e., if one friend engages in fat talk around 2 friends, those friends may engage in fat talk around 2 more friends, those 4 friends may engage in fat talk around 2 more friends, and so on.)
Given the huge prevalence and negative mental health impacts of fat talk, there is a clear need for change. But because fat talk is so inundating, change can be really difficult. Some universities and organizations around the country have started challenging this societal norm by hosting a Fat Talk-Free Week. This movement was started at Trinity University in 2008, as a part of the Reflections Body Image Program, which was started by Dr. Carolyn Becker and the national sorority Delta Delta Delta. Now Fat Talk-Free Weeks are hosted at universities all across the country. In addition to challenging students not to engage in fat talk and to shut down fat talk when they hear it, many other events happen during this week that promote healthy body image, like smashing a scale or writing a letter to a younger girl about body image. Another common exercise promoted at these events is challenging women to look in a mirror and write down only positive things they like about themself, both internally and externally. Dr. Becker said in reference to this activity, “It's really hard for women to do. Women are used to standing in front of the mirror and trashing themselves.”
Additionally, beyond participating in these big events, there are lots of small ways you can challenge fat talk in your everyday life. One way I commonly like to challenge fat talk is when I hear a friend say something negative about her own body, (instead of joining in with another fat talk comment about myself) I tell her to say three things she likes about her body. At first this may be brushed off with a snide laugh, but actually make them say those three things. Saying things out loud has been shown to have a reinforcing effect on ideas and beliefs. So verbalizing positive self-affirmations may help reinforce a body positive attitude. Another great way to challenge fat talk is to just speak kindly about your own body and others. The same way fat talk can have a cascading effect, positive body talk can also spread like wild fire among young women. Instead of saying things like, “Oh my gosh you look so skinny, I would kill to look like that!” practice saying compliments that are not dependent on weight or shape. Try some on this list for example:
“The color of your shirt matches your bright personality.”
“You have a great sense of style.”
“Your laugh is so contagious!”
“I love how down-to-earth you are.”
“You are so warm and fun to be around.”
“Your positive attitude brings out the best in me.”
“I love that dress! You look so confident in it!”
“That thing you don't like about yourself is what makes you so interesting.”
“I am proud to be your friend.”
“Your confidence is contagious!”
At first these changes can be uncomfortable and difficult. But after implementing them in my own life, I have seen a huge boost in confidence and self-love among my close friends and family members. Thinking consciously about the way we talk about others and ourselves in front of our sisters, daughters, mothers, and friends makes a huge difference in the way they see themselves and other women. So next time you face fat talk try to be more conscious about the way you respond, and don’t be afraid to fight back with positive compliments!
Gapinski, K. D., Brownell, K. D., & LaFrance, M. (2003). Body objectification and “fat talk”: Effects on emotion, motivation, and cognitive performance. Sex Roles, 48(9-10), 377-388.
Rochman, B. (2010, October 13). Do I Look Fat? Don't Ask. A Campaign to Ban 'Fat Talk'. Retrieved from http://content.time.com/time/nation/article/0,8599,2025345,00.html
Salk, R. H., & Engeln-Maddox, R. (2011). “If you’re fat, then I’m humongous!” Frequency, content, and impact of fat talk among college women. Psychology of Women Quarterly, 35(1), 18-28.
Tucker, K. L., Martz, D. M., Curtin, L. A., & Bazzini, D. G. (2007). Examining “fat talk” experimentally in a female dyad: How are women influenced by another woman's body presentation style?. Body Image, 4(2), 157-164.
Virtual Reality and Eating Disorders: Why Should We Bring VR Therapy to Kentucky?
By: Lisa Michelson
Within recent years, virtual reality has gained popularity in the entertainment industry. This new domain, where entertainment and technology intersect, has transformed games and television, making a whole new experience for the user. Healthcare providers have also noticed, and have begun to take advantage of this whole new world of possibilities for treating their patients.
Here are a few examples of how health professionals, specifically mental health professionals have begun using virtual reality (VR). VR has been used to treat phobias, anxieties, and fears (Garcia-Palacios et al., 2002). In the United States, Duke University has used VR as a form of cognitive behavioral therapy (CBT) for individuals with anxiety disorders (Zielinski et al., 2006). At the University of Southern California, a VR exposure therapy has been developed in order to address PTSD symptoms for individuals returning from military service in Iraq and Afghanistan (Rizzo & Hartholt, 2005). There are VR medical centers, VR clinical trials, and therapies that continue to be developed. In the eating disorder field, virtual reality is being used to implement CBT for individuals who suffer from eating disorder (ED) behaviors and symptoms. The kinds of VR experiences can range from a full body emersion (wearing sensors all over one’s body) to wearing goggles (for the user to see the VR world they have been placed in). Below is a list of some VR scenarios that participants have been placed in for treatment in Bulimia Nervosa (BN) and Binge Eating Disorder (BED) (Regine de Carvalho et al., 2017):
Furthermore, below is a list of some outcomes that have been observed in utilizing VR in ED treatment (Regine de Carvalho et al., 2017):
Although Regine de Carvalho et al. (2017) did a systematic review of VR in the assessment and treatment of BN and BED, the number of studies that utilized VR in the treatment of BN and BED is few. In researching the use of VR in treating Anorexia Nervosa (AN), the number of studies that used VR within the United States was practically non-existent; most of AN and VR research being conducted in Europe, specifically Spain and Italy (Riva et al., 1999; Perpina et al., 1999).
In the previously mentioned studies, utilizing VR in ED treatment has been shown to improve behaviors and symptoms in participants. In other words, what is being done in these treatments IS working. However, the use of VR as exposure therapy for eating disorder treatment is still not only infrequently used, but underutilized and underdeveloped in the United States.
Here, at the EAT Lab, one of my jobs has been to find collaborators and programmers to develop such technology. While it has been a steep learning curve in understanding what technology would be most user-friendly, financially reasonable, and the best for therapy, we continue to learn more about this technology every week. In our own research into VR software development, it has become apparent why this form of therapy rarely exists in the United States; the combination of technology/entertainment and mental health therapy is still an unchartered (yet exciting!) territory. Communicating the wants/needs of what we, the therapists, want in the VR technology to the software development is like talking between two languages. However, through talking with multiple resources, we have hope that we are closer to brining this technology to Louisville and being amongst the first ED research facilities here to provide this cutting edge therapy to our clients.
To address the question that was posed in the title of this article (Why Should We Bring VR Therapy to Kentucky?), we know it can work to improve health outcomes for our clients and we hope that future advancements will provide more insight to our exposure therapy research.
Fighting the Stigma, Increasing Awareness and Education: Advocating for Eating Disorders in Kentucky
Fighting the stigma, increasing awareness and education: Advocating for eating disorders in Kentucky
By Leigh C. Brosof
Fighting stigma, increasing awareness, and educating our communities about eating disorders are essential for early detection and treatment of these disorders; and we know that the earlier we catch an eating disorder, the more likely an individual is likely to recover. In the state of Kentucky, there is no officially recognized awareness efforts or state-sponsored educational programs about eating disorders. That is why today (February 5, 2018), myself, Dr. Levinson, and Melissa Cahill, an eating disorder advocate in Louisville, traveled to Frankfort, KY to meet with our legislators to discuss how we can get the state involved in the fight against eating disorders.
We had meetings with Representative Ken Fleming, who is also the executive director of the Kilgore Counseling Center, and Senator Ernie Harris about sponsoring a resolution in the Kentucky House of Representatives and Senate, respectively, to officially recognize February 26-March 4th as Eating Disorder Awareness Week in the state of Kentucky.
We also spoke with them about what other states have done to further the cause of supporting eating disorder awareness. In Missouri, the local government created an eating disorder coalition dedicated to awareness and providing education to health providers about treatment standards. In Pennsylvania, the legislature passed a bill requiring all middle and high schools to provide a fact sheet on eating disorder detection and what to do if you think someone has an eating disorder. These efforts show that state support really can make a difference in the fight against eating disorders, and we hope that Kentucky will follow these examples.
Indeed, in addition to meeting with Representative Fleming and Senator Harris about the resolution, we also asked about longer-term plans to get legislation passed in order to increase awareness and education about eating disorders in Kentucky. Both were immensely supportive in helping us understand the steps in order to get such a bill developed. We were briefly introduced to Representative Kimberly Moser and Senator Julie Raque Adams, who both serve on the Health and Welfare Committee, through which the legislation would be drafted.
Our ultimate goal is to see a coalition created similar to the one in Missouri: one that spreads awareness and education, provides training to health care providers in eating disorder care, and establishes treatment recommendation guidelines for best care. In the meantime, we are thrilled to see that our legislators are listening to the need for state support of eating disorders in Kentucky and to recognize Eating Disorder Awareness Week, which will be the first piece of legislation including eating disorders ever passed (hopefully) in the state. We are also excited to continue to advocate for eating disorder awareness in Kentucky.
Overall, it was a fun and encouraging day, and we are grateful to our legislators for taking the time out of their day to meet with us. This was my first experience with formal advocacy work with legislators, and I look forward to continuing to work toward our goals. But it’s also important to remember that advocacy takes many forms, and it doesn’t always take a trip to Frankfort to make a real difference.
Post on social media. Attend a walk. Put posters up around a school or work building. Bring in a speaker or attend a lecture. That’s all it takes to start advocating for eating disorder awareness in our community. Louisville has come such a long way in the short time I’ve been here, and I’m excited to see how we can advocate for a better future for every individual with a diagnosis of an eating disorder.