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Biological, psychological and social complexities in childhood development
Biological, psychological and social complexities in childhood development

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4.1 The impact of social media on mental health and body image

This section gives a small insight into how social media can affect someone’s perspective on their own body. With the ever-growing use of social media in young people (with at least 3.5 billion people online overall, according to Ortiz-Ospina, 2019), there is a growing emphasis on fitting a beauty standard (characteristics people are believed to need to be ‘ideal’). Smaller waistlines, perfect skin, always looking like society wants you to look – it can be a toxic headspace for both teenage boys and girls.

An image of a woman exposing her abdomen and looking in a full length mirror.

These beauty standards have grown over the last few years, which has made a profound impression on adolescents, who set out to appear the way their favourite celebrities or ‘influencers’ do. However, this can have damaging impacts on their mental health should they feel they don’t look physically attractive or the same as somebody else. While it is important to acknowledge that everybody is beautiful in their own ways, there are some young people who don’t think this applies to them, and feel they need to work harder to be attractive. This was, to some extent, the case for Lola. You will find out more about Lola in the following case study.

A young person’s experience

Lola is 15 years old and for the last two years running she has decided to give up all forms of chocolate for Lent. To her, it’s a big challenge as she loves chocolate – but during the second year of her doing Lent, she considers the health benefits of not eating chocolate. As well as seeing labels on food packaging with information about fat, carbohydrate and sugar content, Lola uses Instagram, where many of her friends and favourite celebrities post photos. Some of these celebrity photos are advertising things to do with fitness or a new way of living and eating. Sometimes, it’s just a photo of that person, and it makes Lola feel self-conscious about her own appearance.

Lola is in Year 10, preparing for her GCSEs. These are the first important exams in her life and will form the basis of her future. The pressure of exams, combined with social media, is causing Lola to feel like she’s losing a bit of control.

During the summer holidays, just before Lola goes into Year 11, she goes on a family holiday; she’s feeling low in confidence about the way she looks. To counter this, she’s restricting her food intake, which doesn’t go unnoticed by her family. Lola wants to have those foods she likes, yet her mind has a way of telling her it isn’t good for her.

By the time Lola has settled into Year 11, she’s weighing herself regularly, thinking constantly about the food she’s eating and being sneaky with the way she exercises. Her fingernails are also beginning to turn blue and the majority of her clothes are beginning to look big on her. She also gets agitated when she’s told to eat something. It’s her way of keeping control in a very stressful time, but to other people her behaviour is becoming extremely dangerous. One of her teachers has raised concerns, as well as two of her friends. By this point, Lola’s mother takes her to the doctor, and she’s assessed.

Activity 12 Lola’s experience

Timing: Allow 30 minutes

Part A

Imagine you are one of the medical professionals assessing Lola. Consider the information above and think about what you would do with Lola to try to help her, as well as what the proposed diagnosis might be. You could do an internet search on the things that Lola may have and put this into a mind map or make some notes below.

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Discussion

You may be considering whether Lola should be diagnosed with an eating disorder. The doctor refers Lola to a CAMHS (child and adolescent mental health services) outpatient unit after checking her weight and blood pressure. Once there, Lola is diagnosed with anorexia nervosa, an eating disorder which can affect 6 per 100,000 young people, with the highest incidence in those aged 15–19 years (National Institute for Health and Care Excellence, 2019). It is very likely, however, that due to the rapid increase in the use of social media since 2003, the figures for young people experiencing anorexia or other eating disorders have increased too.

Part B

What kinds of symptoms may Lola have been showing? You can use the information in the case study, do an internet search or use the following websites:

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Discussion

Hopefully, you will have found symptoms Lola may have (in terms of her behaviour, mental health and physical health). While there are no found causes for why somebody experiences an eating disorder, there are some potential contributing factors, regardless of which eating disorder they have – and it may not surprise you that social media and pressures have a role.

Some potential risk factors for eating disorders include:

  • scrolling through social media, changing beauty standards and the expectation for young people to appear a certain way – in Lola’s case, this is on Instagram
  • desire for perfection and a need to control things to keep them right – for Lola, she wants to do well at school and so the mounting pressure from her GCSEs may have been a risk factor for her developing an eating disorder
  • lacking confidence and being overly critical
  • major life changes – for Lola, this is her GCSEs and what she’ll do afterwards
  • having another mental health problem – Lola sometimes experiences anxiety, which may have contributed to her low self-esteem and need to alter the way she looks.

These are just a few risk factors, but there are other things that could contribute to forming an eating disorder.

Part C

While at the CAMHS unit, Lola is offered several types of treatment – cognitive behavioural therapy (CBT) and family-based treatment (FBT). Both treatments are successful in their own right, but differ slightly in how they are carried out.

Explore the various treatment methods listed in the websites below and consider which treatment could be most beneficial to Lola. (You’ll need to bear in mind that Lola lives with her mother, who is a single parent.)

Make some notes about which treatment you would recommend and your reasons for it.

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Discussion

You have now hopefully considered several types of treatment for Lola, including CBT and FBT. Lola and her mother choose the second of those treatments, which looks into how family members can support, and get support for, the young person who has the eating disorder. Lola stayed with these services for just over a year and a half (the final few months were affected by the Covid-19 pandemic; if this hadn’t happened, Lola might have been able to be discharged sooner).

Lola and her mother chose FBT because they have a close relationship, and because her mother needs support to be able to help Lola recover from her disorder. For Lola and her mother, this involved twice-weekly check-ups (later changed to once weekly, and then once a fortnight) and talks with both Lola and her mother separately, to see how their week had gone and what eating had been like. Lola would be weighed and have her pulse checked, to check her progress. They’d discuss things with their practitioner, such as events during the week, difficult topics, and how Lola was feeling.

To conclude this case study, read the following statement from Lola herself, post-recovery, and think about how Lola’s eating disorder may have been prevented in the first place. You could also think of ways to prevent relapse, by using the an internet search and the websites linked previously.

Lola says:

I know I could have saved myself a lot of problems. In the summer before I got referred to CAMHS, I knew there was a problem, and there were so many times when I could have said something, but I never did. I let things get worse, to the point where I had to take six weeks out of school because it was going to be detrimental to my recovery. I also nearly went to an inpatient unit because I was so ill.

While this time of my life will always be the worst, most stressful situation, I also view it as the biggest challenge I have ever overcome. My recovery was not smooth – it never is for anybody – but to finally leave the CAMHS unit for the final time and know that I was a recovered person is the thing I’m most proud of. I’m now nearly 18, three years on from when I first had problems with my eating, and I could not be further away from the person I was then!

The one piece of advice I would say to anybody, if they feel they’re struggling with food or another mental health problem, is that they should speak to someone. A friend, a family member, a teacher, a medical professional, anybody you can trust. Don’t let it get out of control, like I did, as it can end so dangerously. Just speak out, and it will get better.