Mass Media, Social Networks, and Eating Disorders: Image, Perfection, and Death

Abstract

Eating disorders are complex and have multiple causes, which may be genetic, biological, or psychological. Social factors are also relevant. In today’s societies, mass media and social networks play a fundamental role, acting as risk factors for eating disorders. This chapter analyzes the concept of image, differentiating between certain concepts such as reality, perception, and image. Image and self-image are difficult to differentiate and do not always coincide with the body object; one’s self-image may deteriorate to the point that it no longer coincides with the actual body. The mass media may serve as an instrument for the creation of reality. The images of women that are portrayed, especially in the media, tend to be based on sexist stereotypes that saturate social networks, video games, and movies. Currently, pro-ana and pro-mia websites promote identities based on unhealthy diets, exercise, and purgative practices. Therefore, pro-eating disorder socialization exists on Twitter and thinspiration image share is found on Instagram and other social networks.

1. Introduction

Eating Disorders (hereinafter, ED) are by definition, highly complex entities whose etiology is difficult to explain. Therefore, the explanatory models used to present ED risk factors tend to be based on the following division of these factors: predisposing, precipitating, and perpetuating, based on the 1980s proposal made by Garner and Garfinkel [1]. Certain classifications respond to this model. For example, see [2, 3, 4]. Therefore, explanations should be multi-causal and multidimensional [5, 6].

Dr. Toro [4], Spanish specialist on ED, defends the idea that the major dilemma refers to the importance of genetic factors as opposed to environmental ones. While some studies have demonstrated the importance of genetic factors, the importance of psycho-social factors cannot be underestimated. In fact, the influence of genetics tends to be attributed to a range of 40–60% [7]. Thus, rates of inheritance-based transmission are between 40 and 88% for anorexia, between 28 and 83% for bulimia, and between 40 and 82% for binge eating disorder (BED) [8]. More recently, the heritability of eating disorders such as anorexia nervosa and bulimia nervosa has been quantified at between 22 and 62% [9]. However, if reviewing certain studies performed from a gender perspective, it may be concluded that “In girls, the four variables demonstrate a heritability component of 37.7% for ineffectiveness, 42.8% for perfectionism, 56.9% for the drive for thinness and 65.5% for body dissatisfaction. In boys, genetic influence is discarded for body dissatisfaction, which is influenced exclusively by environmental factors. The other variables demonstrate an inheritance component, although to a lesser degree than in girls [9].”

As mentioned previously, the explanatory models for ED risk factors are multidimensional. In these models, having threefold classifications (predisposing, precipitating, and perpetuating), predisposing factors are those that most clearly respond to the definition of risk, since they appear before the illness presents itself. They correspond to situations, characteristics, etc., which, individually or collectively, make it more likely for the illness to appear. Precipitating factors arise in situations that serve as the spark igniting the flame of the illness. Finally, perpetuating factors are those which, once the individual has the ED, facilitate its presence and prevent improvement or recovery.

In these explanatory models, individual factors may be distinguished: genetic factors, ways of thinking (temperament, perfectionist, and obsessive cognitive style), ways of feeling such as personality, low self-esteem, level of insecurity, the use of avoidance, the use of food as a compensation element, extreme emotional reactions in the face of real threats, and negative emotions. To this, eating habits must be added, as well as diets, excessive physical activity, and the body dissatisfaction felt by the individual. Finally, distinct forms of acting are signaled such as motivation for acting on feelings of lack of worth, the need for approval, and behavioral alterations. Likewise, family factors are proposed, such as a history of mental illness, family environments with high pressure on body image, and family functioning [3].

Individual factors complement other social ones such as the ideal model of thinness, thinness as a social status symbol, the influence of the mass media, social networks, peer groups (difficulties establishing or maintaining social relationships, past history of harassment, bullying, etc.), the reification of the image of the woman, and belonging to certain professional groups: gymnasts, dancers, athletes, models, or similar, the presence of certain environmental stressors (academic, work, or personal problems).

In summary, the following may be stated:

Scientific evidence supports an interactive model of bio-psycho-social influences on the etiology of eating disorders (ED). Novel studies on the association of the complete genome suggest a metabolic dysregulation base in anorexia nervosa. Of the psychological factors, body dissatisfaction (BD) may be considered the most consistent predictor in females. Low self-esteem, negative affect, and interiorizing of the ideal thinness determine BD. Certain personality traits and other individual factors such as a high body mass index, emotional problems, and certain metabolic and digestive illnesses, social factors such as sporting or professional activities focused on body shape pressure, family environment characteristics, and social or peer group pressure to be thin, mediated by the use or abuse of social networks, act as determinants of the risk of ED [10].

This chapter analyzes the etiology of ED from a social perspective focusing specifically on the concept of image. We will begin by establishing some conceptual clarifications regarding reality, perception, and image. Then, we will consider the influence of the mass media on our image of ourselves and of others since the mass media may assume an instrumental role in the creation of reality [11]. And finally, we will briefly analyze the role of social networks in the increase in the prevalence of ED, which has taken place over recent years.

2. Perception, image, and reality

The concept of body image is ever-changing and highly complex. First, there is our body (body object). To this, we must add our self-perception of the same (body-subject). That said, it is also necessary to establish certain distinctions: first, the body object does not necessarily have to coincide with an individual’s perception of the same. In addition, self-perception is influenced by the symbolic universe: social imaginaries, the esthetic canon, etc., that is, by abstract social influences. To this, we must add the fact that the body and the image are influenced by social relations and exchanges established by each person. Moreover, position, role, and social status may influence the body and the images of the same that are created by the individual. Some studies, for example, have concluded that professionals relate a thin body image to an individual’s social success [12]. And finally, perception would have its own individual dimension, in which self-esteem, attitudes, beliefs, opinions, prejudices, and other personal characteristics all play a role.

From a psychological perspective, Raich defined body image as “the representation of the body constructed by the individual in his/her mind [13].” This, however, is an overly simplified definition. It may be more appropriate to consider the limits of this concept mentioned by Rodríguez Testal and Senín when they stated that “Body image is a complex mental representation (with its neural correlate and organization) that is multi-faceted, stable, and constantly being updated with regard to our body and emotional experience [14].” However, this definition can also be considered overly individualistic and focused on the “I,” putting aside the social condition of being human. The body, as the social sciences have noted, is a biological structure in which social discourse is materialized, thus the need to understand that, from a social perspective, it is made up of social imaginaries [15, 16, 17]. In this sense, the body incarnates subjectivity. It is the site of the presence and articulation of practices (social, cultural, and bodily) and of hegemonic social representations that generate the imaginaries of distinct societies [18], so that, ultimately, the body is the source of identity.

In general, four components of body image may be distinguished (see Table 1). Research assumes a level of dissatisfaction with body image that approaches 50% [19, 20, 21] and considers that most women are unsatisfied with their bodies at some time [22]. This level of dissatisfaction is so high that Rodin, Silberstein, and Striegel-Moore established the normative discontent category [23]. In other words, a subclinical phenomenon has been distinguished, and therefore, a nonpathological one, in which the general situation of the population coincides with dissatisfaction with one’s own body. In other words, it is normal to dislike one’s body. Furthermore, some studies have affirmed that in the 6 months prior to the study, 31.06% of the sample recognized the practice of at-risk eating behavior, while 35.23% recognized having engaged in two at-risk eating behaviors, and 6.82% admitted to having engaged in 3 or 4 at-risk eating behaviors [19].

Perceptive	Affective	Cognitive	Behavioral
It ranges from the biological substrate that permits perception, the orientation established by the social imaginary to the esthetic canon. All of the dimensions are important since research has shown that from the time of birth, blind individuals have a lower level of dissatisfaction regarding their image, and fewer symptoms related to their eating behavior [19].	Body image is closely linked to emotions. For example, in the case of women with ED, after eating certain foods, specific thoughts regarding their weight or figure and emotions (shame, disgust, feeling fat, etc.) immediately appeared [20]. In the case of men, concern over image appears to be linked to sedentary habits, concern over body muscle, and the effort made to lose weight [21].	In psychology, the notion of schema is used as a mediator. It may be defined as “assumptions or beliefs about the importance and influence of bodily appearance [14]”. They are made up of incorrect or biased information that reactively activates in response to external influences.	All behavior conducted by an individual influences their body image.

Table 1.

Components of body image.

Source: Adapted from: RodríguezTestal JF, Senín MC. Introducción. In: RodríguezTestal JF, editor. Alteraciones de la imagen corporal. Madrid: Síntesis; 2013, p. 17–56.

The media, especially television and social networks, have been identified as sociocultural risk factors, especially through the influence exerted by advertising [24]. Moreover, reviews of existing research on beauty stereotypes and their influence on the development of ED have concluded that 90% of the documents reviewed hold the media responsible for creating and influencing the esthetic canon and 85% of all adolescents aspire to resemble the socially established beauty prototype in order to be socially accepted [25].

If we introduce the gender perspective in our analysis, for women, dissatisfaction is more focused on weight and results in attempts to reduce it, either by not eating or by using purgative techniques. In the case of men, however, dissatisfaction focuses more on body shape and contour (image) as opposed to weight. Measures would be taken by men, such as excessive physical exercise, attempting to increase muscle mass using steroids (although without losing the slenderness of the figure), and preferring practices such as vomiting over the use of laxatives or diuretics [14]. In Spain, a study conducted by the Ministry of Health, Social Services, and Equality [26] concluded that almost 16% of all adolescents, regardless of their sex, are on some type of diet. And of the other surveyed individuals who are not on a diet, 21% believed that, despite their inaction, they need to lose weight.

3. Image, time, and space: the case of the sexes

Regarding the image, it should be noted that the prototypical image over time does not coincide for men and women. Vernant [27] described how in Greece, the structuring of the image of men and women was influenced by mythology and led to the linking of women to the domestic space, reserving the public space of the agora and the polis for men. The French author interprets a sculptural work by Pausanias in which the Greek sculptor associated the gods in pairs, uniting Hestia and Hermes (two gods who were not originally united in the traditional Greek pantheon). This association is attributed to the fact that Hestia represents the goddess of the home and, by association, the immobile, to that which does not change. Hermes, on the other hand, is the protector god of travelers, representative of what changes quickly, of the unstable, the god of the outdoors. Women would be linked to the inside of homes, remaining immobile and not changing over time. Men would be linked to the outside of the house, to the public space, and even to political areas of representation and defense of their own rights and those of others. This connection of women to the private space and men to the public one has become one of the main battle horses of feminism today. Galán pointed out that in

studies conducted in the field of advertising [women] continue to be represented by the same topics and stereotypes that are often associated with the areas of emotions, passivity, maternity, and sexuality, in private or intimate settings such as the home, while men are overwhelmingly granted attributes such as reasoning, leadership, and action, normally placing them in the public spheres [28].

Miguel Requena [29], analyzing this text by Vernant, argues that a dichotomous model of meanings was established for women, with the corresponding transgressions. The author extends the argument even further, indicating that the panoply of meanings is completed by assigning the characteristic of passivity to the female sex, and the characteristic of activity to the male sex (See Table 2).

Positive models	Negative models
Virgin: immutability	Whore: mobility in space
Mother: stability on the space/time axis	Sterile woman: mobility in time

Table 2.

Models of meaning assigned to the woman in classic Greece.

Source: Adapted from: Requena M. De Hestia to Claudia Shiffer. La mujer inmóvil. In: Alba E, Ginés B, PérezOchando L, editors. De-construyendo identidades. La imagen de la mujer desde la modernidad. Valencia: University of Valencia; 2016. p. 75–92.

Thus, activity and passivity are essential elements of sexual differentiation, even more so than sexual orientation. In Greece, homosexual men who assumed passive roles, as well as homosexual women who assumed active roles, were censored, since they defied the fundamental structure of gender identity at the time. In any case, this type of analysis of female prototypes based on canons such as Virgin, Whore, Mother, etc., extends across all current literature analyzing the image of women, for example, see [30, 31, 32].

In this sense, some research on the female image in movies and video games has concluded that prototypical patterns linking women to passivity continue to be used (see Table 3).

Stereotype	Description
The “damsel in the refrigerator”	The woman is the eternal victim of the killer, and given that she was not protected, the male bears the burden of her vengeance on his shoulders, being interpreted as an active hero-avenger of his lover.
The “euthanized damsel”	In this case, the woman not only dies, but she does so at the hands of her partner and for his benefit. Thus, there is a justification for violence against one’s own partner.
The “damsel in distress”	The woman unable to take care of herself, requiring help due to harassment from certain circumstances or people from whom she cannot escape. Of course, all of this suggests that a man should appear who will take on the role of the girl’s savior-asset.

Table 3.

Stereotypes of the female image in video games and films.

Source: Adapted from: Tur D. La evolución de la imagen de la mujer en los videojuegos. In: Alba E, Ginés B, PérezOchando L, editors. De-construyendo identidades. La imagen de la mujer desde la modernidad. Valencia: University of Valencia; 2016. p. 301–320.

Galán, in his research on two fictional Spanish television series, concluded that the female image presented tends to correspond to a Spanish woman between the ages of 25 and 50. He suggested that these roles may be attributed to having an obsession with beauty [28].

All this leads to the objectification of the feminine image. Seven distinct means of objectifying people have been distinguished [32]:

• Instrumentality: treating others as objects, tools for our service.

• Denial of autonomy: treating others as being incapable, lacking autonomy and self-determination.

• Inert being: treating others as being incapable of exercising motivation and, at times, also activity.

• Fungibility: treating others as being interchangeable with other objects, whether they are the same or another type.

• Violability: treating others as something that can be torn, broken, or violated.

• Property: treating others as something that is possessed by another; and something that can be bought, sold, etc.

• Denial of subjectivity: treating others as something whose experience and feelings (should they exist), need not be considered.

The objectification of the woman may influence the type of image constructed for the other-masculine that looks at her [33]. It is an image that takes on the condition of dependency and de-substantiation, which goes on to be assumed by the one-masculine.

Based on this starting point, we ask ourselves how image is created from a social perspective. In this sense, two of the main instruments for building social images through imaginaries are the mass media and the social networks; the last two sections of this work will be devoted to them.

4. The influence of the mass media

A sequence of images has been established to represent the evolution of the feminine esthetic canon over distinct historical moments. The journey begins with the Venus of Willendorf, goes on to the Venus de Milo, the Portland Vase, the Primavera by Botticelli, Bathsheba at Her Bath by Rembrandt, and finally, the Naked Maja by Goya. Unfortunately, this analysis has not been continued to the present day. However, there is the well-known example of the Barbie doll, a clear exponent of the present-day esthetic canon. The impossibility of her body shape is well known. If the Barbie doll were a real-life person, her measurements (in centimeters) would be: 100-45-80, with a height of 2 meters and a size 34 shoe; clearly, “these measurements are incompatible with real life [34]”.

What is the effect of these canons to which we are all exposed? Over the years, a series of sociological theories have been developed to explain the influence of the mass media (see Table 4).

Theories	Description
Theory of Cultivation [35]	The use of media cultivates a view of reality that is distinct from that of the real world and that associates meanings to thinness such as success, whereby unrealistic models are accepted as real body models without criticism
Theory of Objectification [36]	Women are socialized to be considered as objects, viewed by others. The primary definition of the woman is that of a body-object. The media are the main vehicle for the transmission of this objectification
Theory of Internalization [37]	The media presents the ideal body standard to be achieved and transmits the message that it is important to achieve it

Table 4.

Explanatory sociological theories on the influence of the media on changes in image and eating behavior.

Source: Adapted from: Calado M, Lameiras M. Alteraciones de la imagen corporal, la alimentación y el peso: ¿Son los medios de comunicación tan influyentes? Valencia: Tirant Humanidades; 2014.

All of the research conducted thus far agrees that the current beauty canon is a factor playing a very relevant role in image. This canon is linked to extreme thinness, and, from a very young age, it is internalized by women. In fact, research has suggested that this internalization may occur at only 3 years of age [38]. This internalization initiates the activation of a comparison mechanism, which, in turn, may lead to dissatisfaction with one’s body. In any case, the beauty canon is very important and receives extensive social reinforcement [39], to the point that adolescents may design their body image based on the media, overvaluing their appearance [40]. Moreover, research has also noted that the media presents a distorted female body [35] with all that this may mean, given the ongoing bombarding of images in today’s hyperconnected and information-saturated society. It may be concluded that “Mass media are an extremely important source, if not the principal source, of information, and reinforcement in relation to the nature of the thin beauty ideal, its importance, and how to attain it [36].”

Furthermore, the influence of the media is not the same across the population, with some sectors being more vulnerable to this type of influence. For example, young girls with poor social support are more vulnerable to this type of influence [37, 41]. On the other hand, ethnicity appears to be a protective factor against the risk of dissatisfaction with one’s own image, and of potentially developing an ED [36]. In other words, Afro-American women tend to display a higher degree of satisfaction with their bodies, as compared to Caucasian women. Studies reveal, however, that with the acculturation of the Latin, Afro-American, and Asian populations in Western culture’s white canon of beauty, levels of dissatisfaction have begun to rise [42].

As for men, the influence is based on satisfaction with one’s own body, self-esteem regarding it, the possibility of increasing the risk of developing certain disorders such as depression, and the development of certain behaviors such as excessive exercise patterns. In males, the influence of the media is more pronounced in the university population as compared to the adolescent collective. It may be speculated that slightly older boys are more frequently exposed to the media than younger ones or than boys who have yet to reach puberty, which some research has cited as a biological factor that harms the influence of the media. The displayed image does not need to be especially muscular for the comparison process to begin. And this may stimulate negative emotions and dissatisfaction with one’s image [43]. Moreover, in the case of men, health, and esthetic ideals are more distanced than in females. This may function as a protective factor against ED. This should not suggest that few men suffer from body dissatisfaction, as this is the case for an especially high number of homosexual and single men. However, this perception appears to be determined not so much by an esthetic ideal, but rather, by the need to adjust to biological norms that sustain health, in a strictly biological sense [44].

A series of factors increasing the media’s influence on ED has been determined:

• The media is the tool that allows the beauty ideal to be transmitted to people “Not only do the media glorify a slender ideal, they also emphasize its importance, and the importance of appearances in general [45]”.

• Media exposure appears to increase the typical symptoms of ED, making it one of many risk factors for developing an eating disorder [36, 41, 46].

• The media are instruments that facilitate the so-called normative discontent [47].

• The media would also work not only as a risk factor for suffering some ED but also as a factor that maintains the disorder [48].

At this point, we ask, what view of ED is portrayed in the media? The following aspects may be highlighted [49]:

• Articles related to ED tend to appear in the culture and entertainment sections. In this research, 48% of the articles appeared in the mentioned section.

• 95% of the articles referred to cases of women having some type of ED. And when men appeared, it was presented such that the ED developed in response to certain events, such as drug dependence or sexual abuse.

• 94% of the individual cases presented referred to Caucasians.

• When discussing casual factors, only one tends to be cited. The most frequently mentioned factors are parental influence, verbal abuse, sexual abuse, and emotional distress persisting for an extended period of time.

• Only 21% of the articles discuss treatments. And when they do, simplified solutions are presented. In fact, only 8% of the articles discussed medical treatment or psychological therapy.

• The treatment success percentage that is presented does not correspond to reality, therefore it may lead to a perception of a low severity for this type of disorder.

O’Hara and Clegg concluded that “While the medical community increasingly sees anorexia and bulimia as complex disorders with both biological and environmental roots, public perceptions do not recognize this shift in thinking. The news media both reflect and perpetuate public beliefs about ED that can impede the diagnosis and treatment of these conditions [49].” In other words, the beauty canon establishes an ideal related to the female body, which, when continuously and constantly transmitted by the media, establishes norms for weight and body image that should alarm the population or at least should serve as motivating elements to seek professional help. Some research suggests that even students and health professionals may be affected by the distorted beauty canon since, when shown photos of individuals clearly suffering from an ED, they often fail to recognize the disorder or to censor the image of these individuals, instead describing the image in positive terms, or even linking the photographed individuals with social success and high status [12].

The literature agrees that the most frequently presented image in the media is that of a young, tall, blond, white woman with a tubular (noncurvaceous) body. On the other hand, the image presented in the case of men can be argued to have changed over the past 25 years, and now it is a man with a broad and muscular chest, muscular arms, broad shoulders, and a narrow waist and with a V-shaped or mesomorphic body [46]. In fact, after reviewing different magazines aimed at men for months, it may be affirmed that the accentuation of the musculature is quite evident.

If ignoring the distinction between masculine and feminine images, the media’s fixation and saturation with this iconographic pairing establishes a dichotomy that harshly eliminates any type of heterogeneity. Moreover, it establishes a “body image [that] is timeless, static, and immutable, implying an imbalance or selectivity of certain body forms and exclusion and invisibility of other body forms, relegating them to formal nonexistence [46].” A utopian and, therefore, unreal image (over and above any place) is imposed. But, at the same time, and paradoxically, individuals are responsible for handling this merchandise (in which the body has been converted), since otherwise, they will be burdened with the stigma of obesity and other negative meanings assigned by the current popular consciousness. In this meticulous work, the influence of distinct media has been established, concluding that exposure to magazines can give rise to patterns or symptoms of eating disorders. These possible consequences may be influenced by the level of exposure to the variable under study. It is worth noting that most of the reviewed research was performed on a female university population. In the case of male university students, exposure to this type of stimuli increases concern about muscles and increases the possibility of exercising and using beauty products and dietary supplements. Next, in the case of television, there are two variables to be considered: the time spent watching television and the type of programming being watched. The increase in hours spent watching television correlates with an increased risk of eating disorders. Moreover, watching movies, series, or music videos increases the risk, while watching sports does not. Finally, it is concluded that the increased risk of developing an ED is not caused by the media’s influence, but there is a call to develop complex explanatory models since it is confirmed that more and more, the media’s social influence is being channeled through indirect social influences such as social comparison, shared diet, and avoidance of social disapproval. Therefore, it appears necessary to examine other psychological variables, as well as sociological-structural variables, along with the variables of exposure to the media in changes in body image and eating [46].

Thus, in the case of body image, it is influenced by the series of messages received from the society and culture in which we live and which ultimately shape our body (see Table 5).

Gender stereotypes	Double standard on the body according to gender	Body control	The importance of the body
Socialization (androcentric culture); Subordination and invisibilization of the woman; Woman object vs. Man subject; Exclusion, imbalance, and social fragmentation	Homogenization, objectivation, and body fragmentation; Feminine: thinness, beauty, youth, vulnerability, mental illness; Masculine: athletic, muscular, healthy, actor (moves, acts)	Unreal bodies; Sculpting the body	Simplification (dichotomous messages)
		More invasive behavior to achieve the ideal/unreal	Beauty/success association
		Bodily beauty	Beauty/no failure association

Table 5.

Sociocultural-cultural messages influencing the creation of the body image.

Source: Adapted from: Calado M, Lameiras M. Alteraciones de la imagen corporal, la alimentación y el peso: ¿Son los medios de comunicación tan influyentes? Valencia: Tirant Humanidades; 2014.

Finally, to end this section, we ask the question: What is the role of advertising in this process of construction and dissemination of the ideal body imaginary? A study reviewed advertising created between 1918 and 1940, making projections to the present day [50], and reaching the following conclusions:

• During this time, there was an appropriation of the body that would result in the appearance of a filtered body instead of real bodies in the photo-report model [50]. Since then, the body would continue to be filtered based on the ideals imposed at the time, evolving toward unreal standards.

• Advertising would impose a new form of body semiotization due to the influence of the cinematographic technique. A discourse is imposed on the image: “media-based, persuasive, with multiple connections [50].”

• A process of mediatization of the body takes place in a slow and entangled process, implemented through the change in the form of image production, which goes from being dominated by engravings to the use of photography. This increases the speed of the presentation and its ephemeral nature.

• In contrast to the covered and veiled body, the body is an image, or the naked and revealed body. In contrast to meaningful figuration, representative figuration. In contrast to the body, the mere image. There is a division or distinction between the feminine and masculine image; the same is true for illness in both sexes. Man presents his condition as a worker as the cause of his illness. This is in contrast to women, who are presented as housewives beset by womanly discomforts: anguish, restlessness, nerves, pain, sadness, etc.

• The author also considers how the body medicalization process is reflected in advertising. The body is a field of tension due to the temptations posed by food and the guilt resulting from its consumption.

5. The social networks and pro-ana and pro-mia communities

Cyberspace has facilitated the incorporation of women into certain hyper-masculinized spaces, permitting the appearance of phenomena such as the Geeks movement (women dedicated to developing software, web pages, programming databases, and creating video games) [51]. However, regarding ED, pro-ana and pro-mia phenomena exist. They arose in the form of blogs [52, 53, 54], but their development has not been linear. In the 90s, these terms began to appear in blogs and by 2001–2003, given the growing development of these blogs, the phenomena evolved, assuming the form of web pages [55]. These web pages serve as a relationship context for communities of individuals who support each other in their struggle to continue to starve themselves (pro-ana), or to help each other and share information on how to maintain patterns that prevent them from gaining weight through purging behaviors (pro-mia). At least 400 such websites have been found devoted to the promotion of ED-based lifestyles [56]. And the phenomenon continues to evolve and become more complex, becoming online communities with a subculture based on the promotion of a lifestyle that places an impossible and unreal beauty canon at the center of people’s lives, offering social support to members of these communities. Furthermore, the Internet contains the so-called Thinspiration blogs in which social support is provided, considered a crucial element in the promotion and perpetuation of certain behaviors or decisions, and thus, the use of self-help and therapeutic groups. Thus, the use of self-help groups and therapeutic groups. On the other hand, in the case of the technological phenomena discussed, these types of effects may turn on the vulnerable and the work of professionals treating this disease.

An article offers the following description of a pro-ana site that was studied by the authors:

a community that provided an understandable website and forum, where participants exchanged ideas, provided support, and exchanged experiences, achievements, and perceived failures. The site featured recipes that promoted healthy anorexic eating, advice on nutritional supplements, and “thinspiration”—photographs of skinny celebrities to inspire and sustain anorexic behavior. The participants were from the United States, Great Britain, New Zealand, and Australia, mostly women between the ages of 14 and 42, with the majority being between the ages of 17 and 20 and students [57].

The pro-ana and pro-mia pages promote what these authors defend as a true identity that is sustained by a lifestyle based on a strict diet, purgative practices, and exercise. To this, we can add a caloric intake of approximately 700 calories daily, with the supposed aim of staying alive under these conditions [57].

It is noteworthy that this type of website uses image as its main instrument, rather than the body itself. In this way, “support” techniques are used by the community members, such as [58]:

• Thinspiration (thin + inspiration): presentation of an image of individuals in a situation of enviable weight according to the canons admissible based on the pro-ana or pro-mia subculture.

• Reverse thinspiration: given this scenario, individuals are subjected to images of obese or overweight people who are mocked by demeaning comments, satirical poems, offensive songs, etc.

• Wannabes (want to be): this is the way that they refer to individuals who aspire to be anorexics or bulimics but have yet to become them.

• Princess or Prince: this label is applied to boys or girls whose emaciated bodies serve as models to be achieved by the rest of the web community.

• Monsterland: this is how this type of website refers to obese people.

The study reveals that these websites share the following characteristics [42, 57]:

• They tend to promote an “anorexic” lifestyle and ideals.

• They tend to use typical metaphors from religious language.

• One of the issues that they frequently discuss is perfection, linking it to thinness.

• Another common area discussed is transformation, suggesting that ED can transform an individual from obesity to thin beauty.

• They also talk about success, which is linked to strength and the ability to stay at a low weight.

• Participants adopt “signatures” reflecting the weight, height, and goals achieved.

• Participants tend to situate the etiology of the illness within the social sphere: the beauty industry, the mass media’s obsession with celebrity lifestyles, and the association of thinness with beauty, success, happiness, and health.

It should be considered that some studies declare that 35.5% of those suffering from ED had visited these pages prior to their diagnosis, and of these, 96% learned new practices to maintain or worsen their situation [59]. Therefore, the study states that profiles exist on social networks where it is possible to self-identify with ED practices, serving as tools for the socialization of individuals that support these pro-ED lifestyles, thereby reinforcing their ED identity [60]. These pages, which currently serve as online communities, use their own language, for example, referring to “princesses” when discussing pro-ED girls, and “princes” for pro-ED boys. They adopt shared signs (such as the use of red and purple identification bracelets), and they share a series of discourses and values. Therefore, this is a subculture-generating identity in these individuals [61].

This is clearly a problem if we consider that the Internet Quality Agency (IQUA) and the Association against Anorexia and Bulimia (ACAB) have indicated that between 2006 and 2011, pro-ana and pro-mia pages increased by 470% and 75% of their users are minors [62]. For example, in 2016, 84 million Google results appeared when searching for “how to not eat” [63], while currently, there are 575,000,000 results in this search. Furthermore, hashtags such as #A4Paperchalleger, #iphone6challenge, or #collarbonechallenge, are becoming increasingly successful, proposing challenges in which the goal is to have a waistline that is thinner than a sheet of DIN A4 paper or two knees together that are thinner than an iPhone 6 [63].

Despite institutional attempts to control this situation, the solution appears to be difficult to achieve, since before it is possible to close one of these pages, five new ones are created [64]. They are created without the use of terms such as Ana or AN [61]. Although recent research concludes that more than a million pro-ana and pro-mia entries exist, they are poorly positioned pages with greater dissemination on Facebook and Twitter. Unfortunately, if the search is changed to “anorexia” results are abundant and well-positioned in the searches [65].

This situation has been further complicated by the Covid-19 pandemic since this has increased the prevalence of certain mental disorders. Specifically, ED are some of the disorders that have seen the highest increase [66], rising from 37.5% to 56.2% due to the effect of the pandemic [67]. And furthermore, the way in which these disorders present themselves has also worsened, since a “higher proportion of patients with eating disorders in 2020 had suicidal ideation (hazard ratio HR = 1.30, 1.16–1.47) or attempted suicide (HR = 1.69, 1.21–2.35) [68]”. This has continued until the present day for ED patients who “have a higher risk of exacerbation of symptoms and risk of self-injury and suicide [69].”

To summarize,

social networks have occupied the space of traditional media, assuming their role and perpetuating the problem of existing beauty stereotypes but adding the social factor that the previous media lacked. It may also be concluded that it is impossible to discuss social networks, in general, since these are very heterogeneous, with Facebook and Instagram being the most frequently related to anorexia and bulimia nervosa [70].

6. Conclusions

EDs are disorders having a highly complex etiology. Thus, since the end of the 20th century, the scientific literature has concluded that in order to explain EDs, multi-causal, and multidimensional models must be designed. This has led to the establishment of a series of explanatory factors depending on whether they predispose to this type of disorders, trigger them or help to maintain them. In turn, these factors can be genetic, biological, psychological and social; or they can also be organized as individual or social factors. Of the factors influencing them, in social terms, two related concepts may be distinguished: image and body. Both are affected by gender differences. The media transmits to society the structuring of the interpretive axis of gender in relation to the image of people. This aggravates the level of normative discontent that already pervades society, which ends up enthroning a canon of beauty that does not correspond to reality. That is to say, in reality the notion of normative discontent responds to the social reality that it is normal to dislike our bodies. The literature agrees that the most frequently presented image in the media is that of a young, tall, blond, white woman, with a tubular (noncurvaceous) body. On the other hand, the image presented in the case of men can be argued to have changed over the past 25 years, and now it is a man with a broad and muscular chest, muscular arms, broad shoulders, and a narrow waist and with a V-shaped or mesomorphic body. In fact, after reviewing different magazines aimed at men for months, it may be affirmed that the accentuation of the musculature is quite evident. A single image is imposed, a single body type to which everyone must conform. And it does not change over time, but is very stable.

This may become a risk factor for an increased incidence of ED. This has become a reality after Covid 19. The pandemic caused by this virus has accelerated the digitalization process that had been taking place previously. It has also modified some habits related to entertainment and the media. In this sense, pro-ana and pro-mia communities have emerged.

And the phenomenon continues to evolve and become more complex, becoming online communities with a subculture based on the promotion of a lifestyle that places an impossible and unreal beauty canon at the center of people’s lives, offering social support to members of these communities. Furthermore, the Internet contains the so-called Thinspiration blogs in which social support is provided, considered a crucial element in the promotion and perpetuation of certain behaviors or decisions; and thus, the use of self-help and therapeutic groups. Thus, the use of self-help groups and therapeutic groups. On the other hand, in the case of the technological phenomena discussed, these types of effects may turn on the vulnerable and the work of professionals treating this disease. The pro-ana and pro-mia pages promote a true identity that is sustained by a lifestyle based on a strict diet, purgative practices, and exercise. To this, we can add a caloric intake of approximately seven hundred calories daily, with the supposed aim of staying alive under these conditions. In this regard, these online communities serve as subcultures for socialization through pro-ED identities. So, this is clearly a problem if we consider that the Internet Quality Agency (IQUA) and the Association against Anorexia and Bulimia (ACAB) have indicated that between 2006 and 2011, pro-ana and pro-mia pages increased by 470 and 75% of their users are minors. For example, in 2016, 84 million Google results appeared when searching for “how to not eat,” while currently, there are 575,000,000 results to this search. Furthermore, hashtags such as #A4Paperchalleger, #iphone6challenge, or #collarbonechallenge, are becoming increasingly successful, proposing challenges in which the goal is to have a waistline that is thinner than a sheet of DIN A4 paper or two knees together that are thinner than an iPhone 6.

To summarize, the importance of the media as creators of reality and of the new technologies which make it easier for messages to “flood” society should be considered. Recently, these messages regarding image and the body tend to be linked to food. This practice may ultimately result in the creation of online communities that serve as subcultures for socialization through pro-ED identities. These communities must be halted, with the increased control of social networks and the implementation of public policies, to ultimately prevent an increased prevalence of disorders such as ED that put people’s well-being and lives at risk. Really, we are talking about people, young girls, and young boys, that are dying every day around us.