The pressure of ‘perfectionism’ on body image from social media

Schoolchildren airbrush photos of themselves to achieve myth of flawlessness – and avoid cyber bullies

Priory consultant Dr Pippa Hugo said the vast majority of pupils feel compelled to digitally enhance their images before posting them on social media because they are unhappy with their appearance - and desperate to avoid cyber criticism.

It means many young people are no longer comfortable in their own skin, with ‘retouched’ pictures becoming their ‘new normal’.

“Young people want to put their best possible appearance out there, but it is a false one,” says Dr Hugo, child and adolescent psychiatrist from Priory’s hospital in Roehampton, south-west London, who specialise in eating disorders.

“Schools have told us that as many as 80-90% of girls feel they must improve their photograph before it can be seen on screen.

“So how can these young people feel normal and accepted in real life if they feel compelled to change themselves in this way?”

Photo manipulation tutorials are commonplace on the internet, including ones that specialise in making people look skinny, and there are hundreds of apps which allow pictures to be manipulated so people achieve a flawless skin and can lose weight from their faces and bodies.

Dr Hugo said that in some cases social media, bullying and the pressure to look slim and attractive, and exam pressures, were combining to make children’s lives unmanageable.

Raising awareness of eating disorders in schools

She is among a number of our consultants now visiting schools to raise awareness of eating disorders like anorexia and bulimia in a bid to help teachers and pupils recognise the problem and get help.

The consultants talk to secondary school pupils about body image, and the airbrushing of celebrity photographs, to encourage young girls to have a healthier attitude to real-life differences in their shapes and sizes and avoid a distorted and damaged relationship with food. They say that an eating disorder is not a choice but a serious mental health illness, and that many people can suffer in secret as they feel so ashamed.

They also give pupils tips on building up resilience, to help lower stress levels. Dr Hugo said those most susceptible to eating disorders often suffered extreme anxiety, low self-esteem and depression. Many are perfectionists, who drive themselves to achieve their unrealistic expectations, including reaching the “thin ideal”.

Her comments follow remarks by the chairwoman of a group of MPs who said Britain should adopt a law banning very thin models from the catwalk.

Perfect girl syndrome

At the start of London Fashion Week, Caroline Noakes MP, who heads the All-Parliamentary Group on Body Image, said legislation should be considered if a voluntary code of conduct was not effective.

Several countries are demanding models should have a Body Mass Index (BMI) of at least 18 - 18.5 to take part in shows.

The Priory’s schools initiative also comes as so-called “Perfect girl syndrome” in secondary schools is understood to be fuelling a rise in eating disorders among high-achieving girls as they strive to be “perfectly” underweight.

Some of the schoolgirls who develop eating disorders turn their academic perfectionism to their diets, trying to control every aspect of their food intake to manipulate their body shape in the same way as they aim for perfect ‘A’ and ‘A*’ grades.

Dr Hugo said the “narcissistic world” of social media was making children feel inadequate and believe they could never look good enough.

“Cyber scrutiny and bullying is not an unusual experience in our patients and it presents a dilemma for them as many feel they need to use Facebook and other social media channels to feel part of their peer group,” she said.

“Eating disorders commonly occur around puberty as a child’s body is changing. At the same time they are facing other pressures such as school changes, exams, difficulties in peer relationships. And it’s not just girls; boys also develop eating disorders and are increasingly concerned with their appearance. Indeed 10% of those with eating disorders are male but they seek help infrequently as it is seen as a girl’s disorder.  Some schools are very switched on about eating disorders, while others deny the issue is even present in their school which is nonsense. Some of my patients cite the healthy eating teaching in school as the trigger for their eating disorder.  Of course the healthy eating message is important as obesity is a major concern, but this needs to be presented in a balanced way to include the topic of eating disorders. Sometimes children only hear how fat everyone is, and how bad fat is and this is the only message they are taking in.”

Rise in eating disorder cases

NHS figures show that the number of 14-year-old girls ending up in hospital because of an eating disorder jumped from 74 in 2003-04 to 336 a decade later, with a similarly steep rise – from 87 to 336 – among 15-year-olds.

While 658 under-19s in England needed a spell in hospital in 2003-04 to treat an eating disorder, by 2013-14 that number had increased to 1,791, up 172%. More than 90% of them were girls and young women, with teenage girls among the likeliest to become an inpatient, usually because they were suffering from anorexia nervosa. The NHS figures are said to be the tip of an iceberg because many eating disorder sufferers are on waiting lists or never hospitalised. Community care is currently limited, although NHS England has distributed £30m of funding to improve eating disorder services aiming to achieve 95 per cent of patients being seen within four weeks or one week for urgent cases by 2020.

The funding is the first stage of a new programme to improve children and young people’s mental health and will be used to improve community based eating disorder services so patients are helped earlier.

The Priory - the largest independent provider of treatment for eating disorders - has seen its own increase in eating disorders. Since 2010 there has been a rise of 85% in eating disorder patients aged 12-17. Anorexia, one of a number of eating disorders, has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide.

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