A pair of hands with darker skin tone holds an iPhone. One thumb is poised to click on the TIkTok app.

15 Seconds to Illness: How TikTok is Contributing to an Eating Disorder Epidemic

Today, the idea that social media has a great effect on mental health is hardly a revelation. As more individuals join these social networks and harmful content becomes easier and easier to disguise, the number of affected children and teens continues to grow. In particular, new social media networks such as TikTok have contributed to a higher, and still growing, number of eating disorders than ever before – globally. Eating disorders (EDs), mental health problems affecting an individual’s relationship with food and body image, have more than doubled in prevalence over the last twenty years. In fact, they affect thirty million Americans and are the second most lethal mental illness after opioid overdose.

While eating disorders are arguably one of the most commonly known mental illnesses, their recognized history is very recent. Descriptions of ED-like behaviors date back to the Middle Ages, but it wasn’t until 1980 that bulimia and anorexia were listed, albeit as childhood disorders, in the DSM-III.[1] It took almost two decades for anorexia and bulimia to be recognized as their own diagnostic grouping in the DSM-IV (1994) and an additional seventeen years for binge-eating disorder to be distinguished, in the DSM-5 (2013).

Of course, along with these changes in recognition came changes in societal view and treatment. During the early 1900s, EDs were largely regarded as issues of the endocrine system, specifically having to do with the pituitary gland. In the 1940s, however, the psychiatric community began to realize that these disorders were associated with mental illness. As a result, the 1970s saw work from both psychiatric and psychoanalytical professionals as well as an increase in rates of anorexia and bulimia (or perhaps greater rates of diagnosis).

The first attempts at appropriate treatment were introduced in the 1980s coinciding with increased awareness in the public eye towards eating disorders. Methods included cognitive-behavioral, meal, group, and exposure therapies. Additionally, colleges began to offer ED counseling, allowing for greater treatment accessibility. The 2000s brought about the treatments we know today. These include comprehensive methods that combine medicine, psychology, and dietetics, emphasizing personal healing, family, and group therapy. In addition, in-patient care through residential treatment centers has become increasingly available, along with in-hospital treatment for severe cases. Novel treatment options continue to be studied, sparking hope for innovative methods like repetitive transcranial stimulation in the future.

One would think that today’s seemingly successful body positivity movements would have led to a decrease in eating disorder prevalence, but this is simply not the case. It seems as though social media is still split: one side is focused on self-acceptance, while the other portrays unrealistic ideals of beauty and body image.

With 689 million monthly users and 33 million app store downloads, making it Apple’s 2019 most downloaded app, it’s no wonder that TikTok is one of the fastest-growing social media networks. The app is full of challenges, dance videos, funny clips, and eating disorder content disguised as health advice and body positivity. An enormous number of videos on the platform feature diet, exercise, weight-loss advice, and dramatic body transformations. While these matters are extremely individualized, it doesn’t stop millions of young TikTok users from comparing themselves to those they see on screen. One popular trend is the “what I eat in a day” video, which showcases a (usually fit) TikToker’s every meal, snack, and sometimes even calorie count for a given day. Individuals who post seem relatable because they appear to be everyday people, in their home kitchens, eating after-school meals instead of celebrities with personal chefs. This makes it exceptionally simple for young users to directly compare their bodies and meals, or perhaps lack thereof, to the person on screen.

A woman sits in the dark and looks at her phone. Her face is lit up in the light of the phone screen.
Millions of young TikTok users compare themselves to those they see on screen. (Courtesy Pexels)

Psychologists warn that this comparison game encourages negative body image, disordered thoughts, and the desire to change one’s appearance to fit a perceived ideal. In fact, eating disorder specialist Dr. Alix Timko explains that this exposure alone can cause the development of, or lead to the perpetuation of, an existing ED. Another expert, Melissa Harrison, confirms these fears after working with twelve-year-old clients who gained knowledge on limiting their eating through TikTok. Harrison says that some of her patients are so young that they don’t understand why purging after a meal is harmful.

When these are the possible effects of benevolent “inspiration” videos, it is frightening to consider the consequences of videos featuring ED supportive content either explicitly or under the guise of “ED recovery.” It is easy to find videos outwardly promoting anorexic, bulimic, and binge behaviors with comment sections congratulating users on “achievements” like getting through the day on just 300 calories. Needless to say, those watching and attempting to recover themselves or desiring a certain body image are put in great danger. Moreover, once one takes an interest, such content is almost impossible to escape. TikTok’s algorithm ensures that users consistently see what they are most interested in; interacting with a video by leaving a comment, like, or viewing the user’s page ensures they’re consistently shown similar videos. While TikTok has addressed and attempted to filter for such content, little has changed.

Ultimately, the responsibility of preventing children and teens from being exposed to such harmful content must be shared. TikTok and other social platforms must be more vigilant in removing and filtering for possibly triggering or suggestive ED content. Additionally, parents must play an active role in their children’s social media consumption paying special attention to the types of creators and subject matter their children watch. However, simply banning such videos or stopping children from watching certain creators is not enough. One 2015 study showed that prohibiting ED content on social media without providing support or educational resources in their place is ineffective.[2] Social media platforms, parents, schools, and physicians must work together to put an end to the idea of the unrealistic, ideal body and instead encourage a healthy, balanced lifestyle as beautiful no matter one’s appearance. After all, a meager 15 seconds should never be enough to make someone hate themselves.

Notes

  1. Liliana Dell’Osso, Marianna Abelli, Barbara Carpita, Stefano Pini, Giovanni Castellini, Claudia Carmassi, and Valdo Ricca, “Historical Evolution of the Concept of Anorexia Nervosa and Relationships with Orthorexia Nervosa, Autism, and Obsessive-Compulsive Spectrum,” Neuropsychiatric Disease and Treatment 12, 2016, 1651–1660. https://doi.org/10.2147/NDT.S108912
  2. M.D. Choudhury, “Anorexia on Tumblr: A Characterization Study.” Digital Health (2015).

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