10 - Social Media Use and Body Image Disorders, Association between Frequency of Comparing One's Own Physical Appearance to That of People Being Followed on Social Media and Body Dissatisfaction and Drive for Thinness.pdf

International Journal of Environmental Research and Public Health Article Social Media Use and Body Image Disorders: Association between Frequency of Comparing One’s Own Physical Appearance to That of People Being Followed on Social Media and Body Dissat...

International Journal of Environmental Research and Public Health Article Social Media Use and Body Image Disorders: Association between Frequency of Comparing One’s Own Physical Appearance to That of People Being Followed on Social Media and Body Dissatisfaction and Drive for Thinness Barbara Jiotsa 1 , Benjamin Naccache 1 , Mélanie Duval 2 , Bruno Rocher 1 and Marie Grall-Bronnec 1,3, * 1 Addictology and Liaison Psychiatry Department, Nantes University Hospital, 44000 Nantes, France; [email protected] (B.J.); [email protected] (B.N.); [email protected] (B.R.) 2 Public Health Department, Nantes University Hospital, 44000 Nantes, France; [email protected] 3 Inserm UMR 1246, Nantes and Tours Universities, 44200 Nantes, France * Correspondence: [email protected] Abstract: (1) Summary: Many studies have evaluated the association between traditional media exposure and the presence of body dissatisfaction and body image disorders. The last decade has


borne witness to the rise of social media, predominantly used by teenagers and young adults. This
 study’s main objective was to investigate the association between how often one compares their Citation: Jiotsa, B.; Naccache, B.; physical appearance to that of the people they follow on social media, and one’s body dissatisfaction Duval, M.; Rocher, B.; Grall-Bronnec, and drive for thinness. (2) Method: A sample composed of 1331 subjects aged 15 to 35 (mean M. Social Media Use and Body Image age = 24.2), including 1138 subjects recruited from the general population and 193 patients suffering Disorders: Association between from eating disorders, completed an online questionnaire assessing social media use (followed Frequency of Comparing One’s Own accounts, selfies posted, image comparison frequency). This questionnaire incorporated two items Physical Appearance to That of originating from the Eating Disorder Inventory Scale (Body Dissatisfaction: EDI-BD and Drive for People Being Followed on Social Media and Body Dissatisfaction and Thinness: EDI-DT). (3) Results: We found an association between the frequency of comparing one’s Drive for Thinness. Int. J. Environ. own physical appearance to that of people followed on social media and body dissatisfaction and Res. Public Health 2021, 18, 2880. drive for thinness. Interestingly, the level of education was a confounding factor in this relationship, https://doi.org/10.3390/ while BMI was not. (4) Discussion: The widespread use of social media in teenagers and young ijerph18062880 adults could increase body dissatisfaction as well as their drive for thinness, therefore rendering them more vulnerable to eating disorders. We should consequently take this social evolution into account, Academic Editors: Jon-Patrick Alle including it in general population prevention programs and in patients’ specific treatment plans. and Anuja Majmundar Keywords: body image disorders; teenagers; social media; eating disorders; selfies; social compar- Received: 30 January 2021 isons; body dissatisfaction; drive for thinness Accepted: 9 March 2021 Published: 11 March 2021 Publisher’s Note: MDPI stays neutral 1. Introduction with regard to jurisdictional claims in published maps and institutional affil- Body image is defined as one’s perception, thoughts, and emotions revolving around iations. one’s own body. It is the depiction of one’s body representation, including their mirror reflection, and it reflects social constructs, which depend on a society’s culture and norms. This conception is created using body ideals, substantially communicated via media, family, and peers. Copyright: © 2021 by the authors. For the last 30 years, media have been over-exposing people to thinness ideals, starting Licensee MDPI, Basel, Switzerland. from a young age , turning this ideal into a new reference standard. Young women, This article is an open access article who are most sensitive to thinness ideals, tend to liken them to beauty and success. distributed under the terms and Thus, etiologic models incorporating environmental factors consider social pressure about conditions of the Creative Commons physical appearance to be a determining factor in developing eating disorders (EDs) [4,5]. Attribution (CC BY) license (https:// However, even though this social pressure is indisputable, not all people are vulnera- creativecommons.org/licenses/by/ ble to it. It is the degree with which they will relate to these thinness standards, namely how 4.0/). they internalize this ideal, that will help to predict the risk of developing an ED. Indeed, Int. J. Environ. Res. Public Health 2021, 18, 2880. https://doi.org/10.3390/ijerph18062880 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 2880 2 of 14 internalizing thinness standards can lead to an alteration in body image, resulting in body dissatisfaction and exaggerated concerns about body and weight. Body dissatisfaction is characterized by an inconsistency between one’s real body and the idealized body. It is one of the most studied psychological constructs in body image disorders literature [4,7–9]. According to the literature, it is often linked to psychological distress [10,11] and is a proven risk factor for developing an ED [12,13], through, in particular, the implementation of food restriction that can lead to anorexia nervosa (AN) [14,15] or to the onset of binge eating episodes (with or without compensatory behaviors to prevent weight gain). According to several authors, body dissatisfaction found in AN patients differs from that of control subjects by a greater feeling of inconsistency between their actual body and the desired body. Indeed, in addition to overestimating the size of their actual shape, AN patients seek to resemble an ideal significantly thinner than subjects without EDs do. People with AN and bulimia nervosa share the same body image obsession, with the pervasive fear of gaining weight. Finally, subjects with binge eating disorders tend to be overweight, or even obese, which can reinforce body dissatisfaction. Social comparison, combined with the internalization of ideals, is one of the main mechanisms participating in one’s body image perception. These two mechanisms are instrumental in developing body dissatisfaction [1,18,19]. Several studies have shown that individuals who compare their physical appearance to that of others they considered to be more attractive than them, such as models or celebrities, had a higher chance of being dissatisfied with their body image and developing an ED [20–23]. Although historically speaking, body norms have been mainly conveyed through traditional media (TV, radio, newspaper, magazines), the last few years have borne witness to the rise and expansion of social media use. The term “social media” refers to every website and online mobile app with user-generated content. They enable their users to participate in online exchanges, broadcast self-made content, and join virtual communities. They are mostly used by teenagers and young adults, and the most common ones are Facebook, Instagram, Snapchat, and Twitter. Several studies have suggested that social media exposure could foster body dissatisfaction and result in risky eating behaviors by broadcasting thinness ideals individuals thus long for [18,24,25]. Among the identified mechanisms that explain this outcome, the most common ones are social comparison based on physical appearance and thinness ideals’ internalization through daily exposure to idealized bodies. Indeed, physical appearance holds a central place in social media today. There is, to this day, a lack of scientific data, and in particular French data, about the association between the use of social media and risky eating behaviors. In this context, this study’s main objective was to study the association between, on one hand, daily exposure to idealized bodies through social media and, on the other hand, the presence of two dimensions fostering body image disorders: body dissatisfaction and drive for thinness. A secondary objective was to compare two populations, one with a risk of suffering from ED, and the other one free of that risk, using different variables. The hypothesis was that at-risk participants were more dissatisfied with their physical appearance, had a higher drive for thinness, and compared themselves more often to social-media-conveyed images. 2. Materials and Methods 2.1. Study Design and Ethics Statements This is a transversal observational study. Participants had to answer a questionnaire available online. Since it was an investigation involving the health field, but with an objective that did not involve the developing of biological or medical knowledge, it not fit in the French Jardé legal framework (and thus, approval from an ethics committee was not required). Data collection was made anonymously, was digitalized, and was realized outside of a care setting. Answering the questionnaire was interpreted as consent for data use, as it displayed that the results would be used in a survey, but that the participation would be anonymous, and that there were no data that would lead them to be recognized should they decide to participate. Int. J. Environ. Res. Public Health 2021, 18, 2880 3 of 14 2.2. Participants Recruitment The study’s general population participants were enlisted via a social media publica- tion (Facebook, Instagram, Twitter) and via posters in gyms. These posters were also sent to health workers with a practice in Nantes and in different French cities (psychiatrists, GPs, psychologists, etc.), who were tasked with informing their ED patients about this study. The Fédération Française Anorexie Boulimie (FFAB, French Federation for Anorexia and Bulimia), which is an association regrouping professionals working in the ED field, helped to broadcast the questionnaire using mailing lists, social media, and websites. Recruitment occurred between September 2019 and December 2019. The inclusion criteria were as follows: using their Facebook and/or Instagram account daily and being 15 to 35 years old. This age range was chosen in light of the current literature, which shows that use of social media and body image concerns involved mainly teenagers and young people [28,29]. Moreover, participants recruited via a health profes- sional had to register their ED diagnosis for which they were treated. 2.3. Evaluation 2.3.1. General Data The questionnaire’s first part was designed to register sex, age, degrees, and current height and weight to measure body mass index (BMI). 2.3.2. Social Media Use The questionnaire’s second part interrogated the participants about their use of social media: platform, frequency (number of uses per day), time spent (hours per day), frequency of comparing one’s physical appearance to that of people followed on social media, and the frequency of posting “selfies” (a photograph that you take of yourself). 2.3.3. Body Image The questionnaire’s third part evaluated body image perception, using the Eating Disorder Inventory-2 (EDI-2) scale, translated and adapted in French [30,31]. It is a self- rated questionnaire evaluating psychological characteristics and symptoms associated with ED, using 11 subscales. We used the “Drive for Thinness” subscale (EDI-DT), composed of 7 questions (score of 0 to 21), and “Body Dissatisfaction” subscale (EDI-BD), composed of 9 questions (score of 0 to 27). The subscales are presented in Table 1. Table 1. Drive for Thinness and Body Dissatisfaction subscales of Eating Disorder Inventory-2. Always Usually Often Sometimes Seldom Never Drive for Thinness (=3) (=2) (=1) (=0) (=0) (=0) 1—I eat sweets and carbohydrates without feeling nervous       2—I think about dieting       3—I feel extremely guilty after overeating       4—I am terrified of gaining weight       5—I exaggerate or magnify the importance of weight       6—I am preoccupied with the desire to be thinner       7—If I gain a pound, I worry that I will keep gaining       Body Dissatisfaction Always Usually Often Sometimes Seldom Never 1—I think that my stomach is too big (+)       2—I think that my thighs are too large (+)       3—I think that my stomach is just the right size (−)       4—I feel satisfied with the shape of my body (−)       5—I like the shape of my buttocks (−)       6—I think my hips are too big (+)       7—I think that my thighs are just the right size (−)       8—I think my buttocks are too large (+)       9—I think that my hips are just the right size (−)       Int. J. Environ. Res. Public Health 2021, 18, 2880 4 of 14 2.3.4. ED Screening The questionnaire’s last part aimed at screening ED, using the Sick-Control-One Stone-Fat-Food (SCOFF) self-questionnaire. It is a simple survey of 5 questions used to screen eating disorders in general population. The French validation depicted this questionnaire to be as efficient and relatable as the original, with a great sensitivity and specificity in diagnosing ED when a patient has a score of 2 or over. It enabled us to sort the population sample into two groups depending on their risk of having an ED: when their score was ≥2, they were sorted in the “SCOFF positive” group, and when their score was