What's Photoshop got to do with it?

Last week, the American Medical Association released a policy statement about Photoshopping models and eating disorder prevention.

The statement:

Advertisers commonly alter photographs to enhance the appearance of models' bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems.

The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

"The appearance of advertisements with extremely altered models can create unrealistic expectations of appropriate body image. In one image, a model's waist was slimmed so severely, her head appeared to be wider than her waist," said Dr. McAneny. "We must stop exposing impressionable children and teenagers to advertisements portraying models with body types only attainable with the help of photo editing software."

And if the AMA had left out the mention of "eating disorders" at the end of the first paragraph, I wouldn't have had anything to say except to nod my head in agreement.  Because the alteration of images is appalling and imappropriate and, indeed, harmful.  The problem is the link to eating disorders.  The AMA said there was a "large body of research" linking media exposure to eating disorders.

So I went looking to see if I could find this large body of research.  I went to PubMed and searched for "eating disorders media" and indeed, I pulled up 264 studies on the subject.  But if you read the studies more closely, you'll see that there's lots of links between "disordered eating" and "eating pathology" and "body image dissatisfaction" and media exposure, but there's very little mention of linkage to outright, diagnosable eating disorders as spelled out by the DSM-IV.  One study did actually say that "media contributes to the development of eating disorders," but when I looked at the studies cited, all I saw were examples that linked media exposure to disordered eating.

A lot of the media coverage of the story has said that Photoshopped images "promote anorexia."  I'm not entirely sure I understand what that means.  I think I know what they're getting at--that looking at these images make you more likely to develop anorexia--but there's no actual evidence that this is true (at least, none that I could find).  We don't think ads for disinfectant somehow promote OCD.  We also don't think that those Bluetooth headsets promote schizophrenia because it looks like you're talking to yourself.

I think the big difference is that people don't think they know what it's like to have schizophrenia because they've been paranoid at one time or another, or that they've had a rather animated conversation with themselves.  But people do think they know what it's like to have an eating disorder because they've dieted and asked their husbands if these jeans make their butts look big. 

It's a common mistake, confusing disordered eating and eating disorders.  Many men and women are unhappy with their bodies and are on a diet.  People with eating disorders also often express extreme body dysmorphia and restrict their food intake.  They do look alike on the outside, but the internal experience is very different.  Dr. Sarah Ravin summarizes the difference between disordered eating and eating disorders as follows:

Disordered eating is very widespread in our country, especially among women. I define disordered eating as a persistent pattern of unhealthy or overly rigid eating behavior – chronic dieting, yo-yo dieting, binge-restrict cycles, eliminating essential nutrients such as fat or carbohydrates, obsession with organic or “healthy” eating – coupled with a preoccupation with food, weight, or body shape.

By this definition, I think well over half of the women in America (and many men as well) are disordered eaters.

The way I see it, disordered eating “comes from the outside” whereas eating disorders “come from the inside.” What I mean is this: environment plays a huge role in the onset of disordered eating, such that the majority of people who live in our disordered culture (where thinness is overvalued, dieting is the norm, portion sizes are huge, etc) will develop some degree of disordered eating, regardless of their underlying biology or psychopathology.

In contrast, the development of an eating disorder is influenced very heavily by genetics, neurobiology, individual personality traits, and co-morbid disorders. Environment clearly plays a role in the development of eating disorders, but environment alone is not sufficient to cause them. The majority of American women will develop disordered eating at some point, but less than 1% will fall into anorexia nervosa and 3% into bulimia nervosa.

I think it's great that the AMA is trying to protect children and adolescents from companies that would turn actual women into bobblehead models (the woman in the Ralph Lauren ad looks a bit like a bobblehead since her head is so disproportionately large compared to her body).  Our ideas of what "normal" and "healthy" look like are disorted and it is harmful.  On that subject, the research is clear.


hm said...

It's amazing how interchanging 2 words could make such a difference- saying:

"A large body of literature links exposure to media-propagated images of unrealistic body image to DISORDERED EATING and other child and adolescent health problems."

- would make all the difference in the world. It would be scientifically accurate.

Why does it matter? It matters b/c when they say that the media causes eating disorders, it redefines a serious mental illness into something that can be caused by pictures. Is there any other serious mental illness that would be defined like this? "He developed bipolar from thumbing through his father's hunting magazines." or "She developed schizophrenia from reading all the different peoples' stories in Reader's Digest." ??? People would call that diminishing and silly. But they would still claim someone can develop anorexia from seeing models in magazines. It isn't fair- it is diminishing.

Kendra (Voice in Recovery) said...

Yes yes yes yes yes. I have been asked a LOT on studies with regards to media and eating disorders and when you really dig in the language is way more complex. This matters because we need to broaden the language. We need to be precise when we are talking about research and tying new initiatives and movements. Besides these issues are larger - the disordered behavior is a concern on a more global scale. It just further feeds the myths that media "causes" eating disorders when in actuality the research shows more links to body image, disordered eating, disordered behavior.

Cathy (UK) said...

Well said Carrie :) I like this post, alongside your article in 'Psychology Today' very much!

One currently 'hip' phrase I love to hate, and which is commonly applied to EDs is 'internalisation of the thin ideal'. Ugh.

I support everything you write in this post. It's what I have been arguing for years. In addition I will add:

* A person can have a severe ED and little or absent body dissatisfaction or body dysmorphia. I had severe and longstanding AN and I never had body image issues.

* A clinical ED is accompanied by severe mental health issues - including extreme anxiety, depression, self harm, mood swings, OCD, and accompanying social isolation. It's not just a case of not liking your body, being obsessed with physical appearance, or dieting. I would actually argue that not liking your body, being obsessed with physical appearance, or dieting are normal behaviour in our society!

Thank you for this.

Anonymous said...

"I think the big difference is that people don't think they know what it's like to have schizophrenia because they've been paranoid at one time or another, or that they've had a rather animated conversation with themselves. But people do think they know what it's like to have an eating disorder because they've dieted and asked their husbands if these jeans make their butts look big." - You said it brilliantly!

Anonymous said...

This sort of thing drives me nuts. Maybe I'm just the eternal devil's advocate, but I roll my eyes when photoshopping, diet food ads, and the chlothing industry's size 0 and 00 are blamed as the cause for eating disorders. Yes, it's a warped world that we live in where dieting and body dissatisfaction seems to be the norm, but I don't think advertisements are causing eating disorders.

The recent Yoplait ad that was pulled and the celebration by the ED community that followed seemed a little strange to me. Sure it could be considered triggering to those with an established eating disorder, but then so much of the world is triggering. To be fair to all, we'd need to ban just about everything from beer commercials that could trigger alcoholics to the use of short-shorts clad leggy ladies in Nair ads that may trigger sex addicts if we blame ads for causing disorders.

I'm not any way in favor of photoshopping models to promote unrealistic ideals, but to condemn the modeling and advertising industry for causing eating disorders seems like a step in the wrong direction.

NS said...

I get this, and I agree. Good post.

I get it because, I have seen “disordered eating” all of my life (hasn’t every American woman?), but when my daughter’s mind got trapped in the torture of AN it was clear to me that this was another animal altogether. I understand that media encouragement to diet and be thin cannot change the percentage of people with ED-prone brain chemistry. I understand that AN pushes susceptible individuals over the edge following malnourishment; I understand that long before Twiggy and Photoshop, people were brought to the precipice by other influences, including religious fasting and illness.

And yet…..
Media is still a problem in our time. Photoshopped images won’t bring about AN in someone not wired for it, but these persistent messages do encourage a whole lot of f&cked up* behavior, and that the pervasive drive to be thin produces more malnourishment, which brings more people to the edge of that cliff – where those who are prone to do so, will fall off. Gaunt models and food ads which equate “fitness and health” with “skinny” are not the problems which cause AN, but they are sure not part of the solution.

*I wish there was a different popular term for “disordered eating” to use in discussing the difference between this and “eating disorders”. I believe it would help clarify and educate. Alas, right now I can’t think of a phrase other than “f&cked up eating”, but I don’t think this has a future in the popular press…..

petersmith said...

Good sharing, thanks for it.
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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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