Is Bulimia Contagious?

Lee Daniel Kravetz has written a new book on psychological contagion. He asks and answers the question of whether psychological symptoms and illnesses can be produced by contact with media reports. That is, does enhanced awareness of psychological illnesses produce these illnesses?

For those who believe that the solution to all problems is more awareness and a national conversation, Kravetz’s research should be a cautionary sign. The more you talk about, for example, binge-purge bulimia, the more of it you produce.

I have addressed these issues from time to time on this blog. I referred to Ethan Watters’ book, Crazy Like Us, the first book to address this issue comprehensively through the science of symptom selection theory. I have also expressed concern that our current glorification of transgenderism will very likely persuade vulnerable children to become transgender—with calamitous results. Thus, we are not just working to normalize transgenderism, but our culture is producing it. Since no one is currently discussing this point, I have mentioned it on numerous occasions.

For today’s post I will be quoting from an article Kravetz wrote for New York Magazine’s Science of Us column. He begins by noting that what is called bulimia nervosa was first diagnosed in 1972 in London. Over the years, as the condition became studied and discussed in public, it proliferated, almost becoming an epidemic:

As bulimia gained further diagnostic legitimacy in 1980 with its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, [British psychologist Gerald] Russell ruefully tracked its unexpectedly swift spread across Europe and North America, where it infiltrated college campuses, affecting 15 percent of female students in sororities, all-women dormitories, and female collegiate sports teams. The disease moved through the halls of American high schools, where binging, fasting, diet pill use, and other eating disorder symptoms easily clustered. He chased its dispersion across Egypt, where the number of new cases grew to 400,000. In Canada, it swelled to 600,000. In Russia, 800,000. In India, 6 million. In China, 7 million. In the UK, one out of every one hundred women was now developing the disorder.

Obviously, identifying the condition in the DSM III was not sufficient to produce a true social contagion. For that we needed the influence of women’s magazines:

Mademoiselle and Better Homes and Gardens, among other popular women’s magazines, took the press release and described the effects of a new “binge-purge syndrome” making inroads into American culture. With Russell’s data proliferating among diagnosticians, and the term itself entering the lexicon through trendy magazines with wide distributions, cases of bulimia rose steeply. Once people realized they were able to eat whatever they wanted and as much as they wanted without a weight consequence, binging and purging became the new strategy for weight management. It was no coincidence that these unhealthy and harmful behaviors took hold at the same time that obesity — which the researchers Nicholas Christakis and James Fowler have found to be as contagious as any eating disorder — doubled in the US.

The morale rationale was simple. Women were being told that they could eat whatever they wanted and as much as they wanted, without having to suffer the weighty consequences. Or better, perhaps more importantly, they could do what they wanted and could hide their sinful indulgences. One must mention that bulimia nervosa eventually had its very own celebrity victim, named Diana, Princess of Wales. Surely, she was influenced by the media reports. But, she also was a role model for many, many young girls. And that her glory days, the days when she chose to advertise her bulimia, were in the mid-1990s

Even in a place like Fiji, where there had never been any cases of eating disorders, no less bulimia nervosa, the mid 1990s saw an uptick. What caused it? Was it Princess Diana or was it American television? Studies suggest that American television shows worked their magic and produced bulimia. Since he dates it all to 1995, we cannot ignore the potential influence of Princess Diana . At the time there was no more ubiquitous media figure than Di. Keep in mind Fiji was formerly a British colony and is currently part of the British Commonwealth:

Melrose Place, he says. Xena: Warrior Princess. Beverly Hills, 90210. “That was the year the first television arrived to the island republic.”

After just three years of exposure to American television shows, 11 percent of Fiji’s adolescent girls admitted to Becker that they had purged their food at least once to lose weight. In that time, the risk of developing an eating disorder jumped from 13 percent to 29 percent. More than 80 percent revealed that television influenced them or their friends to be more conscious about body shape or weight. By 2007, 45 percent of girls from the main island reported purging their food.

It is not an accident that Ethan Watters entitled his book, Crazy Like Us. He too was suggesting that American culture, through the mass media, was producing psychological contagion around the world.

In Fiji, Kravetz argues, girls who watched American television shows decided that they want to be like American girls. They were, effectively, emulating their betters:

In one of her studies, 80 percent of the girls said they planned to eschew traditional agrarian jobs for professional careers, specifically those that only wanted thin women. The republic also experienced a rise in the social contagion of emotional strain among teenage girls. Fiji’s society was changing quickly, and psychological problems accompanied these massive cultural shifts as media transmissions carried along even more social contagions.

Following Russell, Kravetz suggests that the problem lies in increasing awareness. I underscore the importance of this point, since we have been told that increased awareness, say of bullying and sexual harassment, is going to help reduce these problems. What if, increased awareness of bullying and sexual harassment produce more bullying and sexual harassment?

Discussing the problem with a California therapist, Kravetz emphasizes the role of the media:

… the cultural fulcrum toward perfect models, the Playboy centerfolds, beauty pageant contestants, and television actresses, as well as the rise of diet products in the seventies and eighties that perpetuated the desire and means to achieve these looks. Not only did the media come to glorify a slender ideal, they also emphasized its importance, and the importance of appearances in general that went into shaping identity, gender roles, values, and beliefs. To treat this perfect storm of catchable body image standards, openness to restrictive eating behaviors, and feelings of despair, pugilists of this pandemic would, in due course, introduce prosocial media campaigns to reinforce healthy body weight, antidepressants, and evidence-based psychotherapies.

I would only question the way he and his interlocutor identify a mania toward slimness. After all, Playboy centerfolds have never been known for their svelte or even skeletal figures. Perhaps women’s fashion magazines emphasized slim models, but magazines pitched to men never did. The Sports Illustrated swimsuit issue is not filled with anorectic models.

I would also add that there is more to life than the media. Surely, we ought to decode the influence of a universally adored goddess like Princess Diana. We have not begun to measure her deleterious influence. 

More than that, we cannot ignore the influence of counterculture forces, the kind that are encouraging sexual liberation, the indulgence of every kind of sexual appetite. If girls are being told to liberate and explore their sexuality aren’t they also being told that temperance is an outmoded social value, and that indulgence is the new order of the day? And that it’s fine to indulge as long as no one else knows you are doing so.