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Section 2
Social Comparison

Question 2 | Answer Booklet | Table of Contents

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In the last section, we discussed three components of narrative therapy as it relates to anorexia.  These three components of narrative therapy included:  creating a story; opening the thought window; and anorexia as a con-man.

In this section, we will examine three social implications related to anorexia nervosa.  These three social implications include:  economic demographics; the diet fad; and conflicting media images.

3 Social Implications of Anorexia Nervosa

♦ Implication #1 - Economic Demographics
The first social implication is the demographics of anorexia disorder. Although it is widely known that most clients diagnosed with anorexia are female, the trends in economic class and race are sometimes ignored. Eating disorders such as anorexia are most prevalent in middle class to upper middle class communities. The comfort that this standard of living provides also comes with certain image requirements.

The social status for females and males in this economic class requires the manifestation of control and perfection. Conformity runs rampant in these communities, and this demand for uniformity often materializes in appearance in order to confirm one’s status. Without the required image, social status may be linked to this standard of perfection. Kelly, age 16, attended a private high school that was predominately white and affluent.  Before entering this school at 15, Kelly weighed a healthy 115 pounds. 

She stated, "At my public school, everyone was kind of full bodied. Your standing was based on attitude and brains. If people thought you were getting snobby or stuck-up, you’d have a hard time making or keeping friends. But when I started at this prep school, everyone looked the same. There was no more diversity. Attitude got you nowhere, but being really thin did. I started to notice that the really cute and popular girls all weighed under 100 pounds. I didn’t know anybody and wanted to make friends so I watched the other girls!  I started talking like them; walking like them; and eating like them! Now, I weigh about 62, and I still think I’m fat. I got popular though." 

Although this is not the norm for private school attendees, the social pressures of class and status took part in Kelly’s eating disorder. In order to feel closer to a community which was of a different economical standing than her last community, Kelly conformed to their habits and standards of appearance. 

Think of your Kelly.  How does his or her economic demographic affect his or her anorexia?

♦ Implication #2 - The Diet Fad
The second social implication is the diet fad that has swept the nation. Although the demand for a certain standard of appearance is one of the largest motivating factors in clients diagnosed with anorexia, another leading cause is the idealization of diets. The business of producing diets has become so lucrative that many health practitioners jump at the chance of being the next doctor to create the ultimate diet. Do you agree? 

After the flurry of success generated by Dr. Atkins and his assault on carbohydrates, the media and other publications wish to capitalize on this sensitive market. Every week, new revelations arise about the best way to lost and keep off weight. This barrage of information causes those who harbor the potential to become anorexic to reconsider their weight. They see celebrities and peers fluctuating from diet to diet and believe that without a specified eating regimen they may lose their social standing. In other words, it has become fashionable to be dieting most of the year.

Sylvia, age 20, had jumped from one diet to the next almost every month for the past five years.  This obsession with diet had led her to become even more self-conscious about her weight which subsequently induced her anorexia. Sylvia stated, "I kept seeing these ‘before’ and ‘after’ pictures, thinking that the ‘before’ looked just like me! So I’d try the diet for a while and move on to the next big thing that week. I’ve been on South Beach Diet three times and Atkins seven times! But they all look the same to me. I just keep eating less and less until I only take in about 500 calories a day." 

Although Sylvia believed she had followed normal dieting restrictions, she had taken it even further beyond the normal requirements of a diet.  She had gotten so caught up in the idea of what she could not eat that she forgot about what she could eat.  Think of your Sylvia.  Has he or she been caught up in the diet fad?

♦ Implication #3 - Conflicting Media Images
In addition to economic demographics and the diet fad, the third social implication of anorexia is conflicting media images. Despite the many Oprah episodes and Datelines targeting the dangers of eating disorders, the media becomes one of the major enemies of clients with eating disorders. Although much information is distributed about the deadly nature of anorexia, the actual images produced by magazines, television shows, and movies contradict this other more positive message.

For every article against under-eating, there are about twenty advertisements featuring an underweight model in scanty clothes. These mixed messages quickly confuse a client. Generally, they will follow the example of the lifestyle with the most coverage, which is the underweight models. 

Brittany, age 15, described her idols to me. She stated, "Kate Moss is absolutely beautiful and I would love to look like Nicole Richie one day!" Both of these high-profile celebrities are known for their thin physiques.  I asked Brittany if she thought they looked healthy. She stated, "Nicole absolutely glows in all her pictures. And Kate’s face is just radiant! There is not one flaw on them." I asked Brittany if she had ever read any articles about anorexia before. She stated, "Yea I read them. They don’t apply to me, though. I’m just looking like everyone else." 

♦ 3-Step Technique:  Tear Out Hypocrisy
To help Brittany to become more aware of the mixed media signals, I asked her to try the "Tear Out Hypocrisy" exercise.
Step 1 - I asked Brittany to find an article about anorexia in a fashion magazine, tear it out, and set it aside. 
Step 2 - I then asked her to look through the rest of the article and tear out any pictures of models that she finds beautiful and lay them next to the article. 
Step 3 - After she did, I then asked her to read the article and to keep the pictures of the models in mind. 

The next week, Brittany stated, "It was so thorough! The article described exactly how anorexic people look and those models all fit the description." Through this exercise, Brittany became more aware of how the media subconsciously places images in her mind. Think of your Brittany.  Would she benefit from the "Tear Out Hypocrisy" exercise?

In this section, we discussed three social implications related to anorexia nervosa.  These three social implications included:  economic demographics; the diet fad; and conflicting media images.

In the next section, we will examine three aspects of early development in clients diagnosed with anorexia nervosa.  These three aspects of early development in anorexic clients include:  prematurely matured; identity development; and parental messages.

Peer-Reviewed Journal Article References:
Corning, A. F., Krumm, A. J., & Smitham, L. A. (2006). Differential social comparison processes in women with and without eating disorder symptoms. Journal of Counseling Psychology, 53(3), 338–349.

Homan, K. J., & Lemmon, V. A. (2014). Attachment to God and eating disorder tendencies: The mediating role of social comparison. Psychology of Religion and Spirituality, 6(4), 349–357. 

Pila, E., Murray, S. B., Le Grange, D., Sawyer, S. M., & Hughes, E. K. (2019). Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa. Journal of Abnormal Psychology, 128(2), 129–139.

Raykos, B. C., Erceg-Hurn, D. M., McEvoy, P. M., Fursland, A., & Waller, G. (2018). Severe and enduring anorexia nervosa? Illness severity and duration are unrelated to outcomes from cognitive behaviour therapy. Journal of Consulting and Clinical Psychology, 86(8), 702–709.

Romano, K. A., & Lipson, S. K. (2021). Weight misperception and thin-ideal overvaluation relative to the positive functioning and eating disorder pathology of transgender and nonbinary young adults. Psychology of Sexual Orientation and Gender Diversity. 

What are social implications related to anorexia nervosa? To select and enter your answer go to Answer Booklet

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