Body image and social media

One thing that characterises people with eating disorders is comparing their body with that of other people of the same sex. These comparisons tend to be quite distorted for several reasons:

1. Because the patient usually starts from a distorted body image (meaning she sees herself as fatter than she really is).
2. Because the reference points patients use when comparing themselves are usually models of women quite far removed from reality and/or “unhealthy ideals”.
3. Because many of these comparisons are based on edited photos and videos (or very carefully staged ones, at best).

This last point is the one I want to talk to you about today, and more specifically its relationship with social media.

A couple of days ago I had a session with a patient I’ve been seeing for a few months. She has very low self-esteem and focuses her problems on her body. She shows quite a marked body image distortion even though her weight is normal according to WHO standards (bordering on underweight). Thanks to the good rapport between us from the start and the fact that she’s quite receptive, we’ve gradually achieved small improvements, including stopping the vomiting, some regularity in her meals and an end to self-harm… among others. Even so, the body image distortion is still very present, as you’d expect in these cases, since it’s usually one of the most resistant aspects.

We devoted this latest session to talking about her reference points and, of course, Instagram came up. It causes headaches for more than a few people (and surely not just in my practice). Social media has been a real boom and has many strengths, but there’s also the other side of the coin. We looked through one of the profiles she considered the ideal of beauty. Our first observation was that it was in the style of pro-ana and pro-mia (websites that promote anorexia and bulimia), just in a more modern version. An unhealthy ideal of beauty. The photos didn’t just show extreme thinness: the poses (the way the ribs and collarbones were displayed…) were carefully studied to achieve that effect.

Another observation was that those photos were probably edited and, if they were real (which is even worse), the person had probably taken dozens of shots to get “the perfect one”, something that frustrates my patient when she takes a couple of photos and doesn’t achieve the “perfection” the influencer seems to get with the first flash.

Another point we discussed was that, even if that body were real, the person isn’t going to show the days of starvation she goes through to look like that; she isn’t going to photograph herself with her head in the toilet throwing up after a binge, or show the wounds from self-harm; nor is she going to write in her caption about her loneliness, her despair or how much she hates herself on any given day. She’ll only show what she wants her followers to see, so the reality my patient compares herself with is manipulated, and she will always come off worse precisely for that reason: because she’s comparing herself with a pseudo-reality. It’s not a fair game.

We also talked about the link between happiness and thinness. We searched online (looking for articles and the like) for examples of well-known influencers who showed what looked like a perfect life and fitted society’s beauty standards, but who had ended up closing their accounts because of the anxiety caused by the pressure of likes, admitting that their lives had nothing to do with what they showed in their pictures.

All of this is worked on in session without trying to convince the patient. Family, friends, partners… have already tried to convince her (this person or anyone else who comes to therapy), and obviously it hasn’t worked.

In cognitive discussions, the psychologist’s job is not to convince the patient but to make them think, to get them to reflect on points of view or ideas they firmly believe without questioning, even though they’re harmful to them. To open a crack in the wall. If at some point during the session the patient says “I’d never thought of it that way” or something similar, that’s already a step forward, because in the next session she’ll probably come back with “I was thinking about what we talked about the other day and…”. And that’s where small reflections come in, which will lead to small changes over time, both in how she thinks and in how she acts. Obviously we’re talking about work over several sessions; it’s a drip-by-drip process, wearing down the wall session after session…

In this particular case, even though this patient is moving very slowly, I can see the change taking shape.