guidelines and restrictions

Adolescent Res Rev (2016) 1:121–137
DOI 10.1007/s40894-015-0017-5
QUALITATIVE REVIEW
The Relationship Between Body Image Concerns, Eating

Disorders and Internet Use, Part II: An Integrated
Theoretical Model
Rachel F. Rodgers1,2
Received: 19 June 2015 / Accepted: 29 September 2015 / Published online: 7 October 2015
Springer International Publishing 2015
Abstract The last decade has seen a huge rise in Internet Keywords Internet Social media Body image Eating
use, including social media, particularly among youth, and pathology Theory
preliminary evidence of a relationship between Internet use
and increased body image concerns and eating pathology
has emerged. However, to date, considerations of theoret- Introduction
ical perspectives that might guide this direction of research
are lacking. The aim of the present study was, therefore, to In recent years, Internet usage has increased exponen-
provide an analysis of the different theoretical contexts in tially, with 93 % of teenagers now possessing Internet
which Internet use may be studied, and propose an inte- access at home (Madden et al. 2013). Youth are dispro-
grative framework for research among adolescents. It portionately high Internet and social media users, with up
reviews five important theoretical models of the develop- to 89 % of 18–29 year olds using a social network site
ment of body image concerns and eating pathology and (Brenner and Smith 2013). Furthermore, Internet access is
discusses their usefulness as frameworks within which to virtually unlimited through mobile phones and other
explore the relationships between Internet and social media mobile devices and nearly 50 % of teenagers own a
use and body image concerns and eating pathology. smartphone in the U.S. (Madden et al. 2013). Develop-
Specifically, it critically evaluates sociocultural theory, mentally, this is very relevant in that many of the inter-
feminist and self-objectification theory, impression man- personal processes that are important for social-emotional
agement theory, social identity theory, and gratification development may now be transitioning to the online
theory. Finally, drawing on these five theories, it presents environment, which could result in poorer psychosocial
an integrated model and proposes a framework within wellbeing (Pea et al. 2012). Body image concerns and
which to ground research focusing on the relationships eating pathology also predominantly appear during ado-
between Internet and social media use, and body image lescence, and have been shown to develop within a
concerns and eating pathology. It ends with suggestions for sociocultural context (Levine and Murnen 2009; Von
future research among adolescents within the proposed Soest and Wichstrøm 2009). Together, these factors sug-
framework. gest a putative association between Internet use and body
image and eating concerns.
Consistent with this, an increasing body of research has
documented the relationship between Internet exposure and
& Rachel F. Rodgers use, and body image concerns and eating pathology (e.g.
rodgers.rachel@gmail.com Brown and Bobkowski 2011; de Vries et al. 2015; Rodgers
1 et al. 2013; Tao and Liu 2009; Tiggemann and Miller 2010;
Department of Applied Psychology, Northeastern University,
404 International Village, 360 Huntington Avenue, Boston, Tiggemann and Slater 2013). However, to date, consider-
MA 02115, USA ations of theoretical perspectives that might guide this
2
Laboratoire de Stress Traumatique, Université Paul Sabatier, direction of research are lacking. This is an important
Toulouse, France omission, as the Internet presents several characteristics
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122 Adolescent Res Rev (2016) 1:121–137
that depart from traditional media and may render current $50 billion in North America, promotes products promising
frameworks insufficient, including its interactive nature, an immediate solution to perceived imperfections and
and the combination of being highly visual yet allowing physical transformations through little or no effort
immense control over self-presentation. These character- (Freedhoff and Sharma 2009). A wealth of correlational,
istics limit the usefulness of existing theories, as they prospective and experimental studies has provided support
intensify the interpersonal—and thus personal nature of the for the role of media exposure in the development of body
Internet and social media, and raise questions regarding the image dissatisfaction and eating pathology among adoles-
interplay between identity and self-presentation in ways cents and suggested that media exposure might be a causal
which traditional theories, developed around a uni-direc- risk factor for these concerns (Levine and Murnen 2009).
tional model of media communication, are ill-equipped to Peers represent another important source of sociocul-
address. Thus, the adaptation of existing theoretical models tural influence during adolescence and young adulthood.
and the development of frameworks that are suited to the Adolescents who conform to social ideals of appearance
investigation of the effects of Internet use is a critical need. are typically more popular and provide an example of the
The objective of the present study was, therefore, to rewards of conformity and the pursuit of social ideals
provide an analysis of the different theoretical contexts in (Wertheim et al. 1997). Peer feedback has also been shown
which Internet use may be viewed, and propose an inte- to have an impact on body dissatisfaction (Salafia and
grative framework. The aim was to provide a structure Gondoli 2011). Teasing particularly has revealed an asso-
within which to build future research on the relationship ciation with body dissatisfaction (Lampard et al. 2014;
between Internet use and body image and eating concerns Neumark-Sztainer et al. 2002; Paxton et al. 1999). Fur-
among adolescents, and to call for more work in this area. thermore, fat talk—that is conversations focusing on
weight and appearance and involving explicit self-depre-
cating statements, complaints regarding personal physical
Sociocultural Theory appearance, and weight management tips—is related to
body image and eating concerns (Nichter and Nichter
Sociocultural theory has emerged as one of the primary 2001; Sharpe et al. 2013). From a network perspective,
frameworks within which body image and eating concerns friendship cliques have also been shown to report similar
has been conceptualized. This theory posits that social body image and eating concerns, a phenomenon sometimes
agents such as the media, peers, and parents convey strong referred to as peer contagion (Hutchinson and Rapee 2007;
messages regarding the importance of appearance, and Paxton et al. 1999). Furthermore, appearance-related
pressure to conform to unrealistic body ideals (Brown and comments from friends have been found to reinforce the
Bobkowski 2011; Thompson et al. 1999; Webb and Zim- relationship between body dissatisfaction and disordered
mer-Gembeck 2014). These messages are then internalized eating (Forney et al. 2012). Thus, peers have been shown to
by individuals who adopt societal standards of beauty and constitute an important source of influence on body image
slenderness as their own. The discrepancy perceived and eating concerns among adolescents.
between the ideal and one’s own body often results in body Within sociocultural theory, particular attention is paid
dissatisfaction followed by disordered eating behaviors to physical appearance comparison as one of the mecha-
aiming to bring one’s body closer to the ideal (Thompson nisms proposed to account for the relationship between
et al. 1999). Physical appearance comparison constitutes a sociocultural pressures to achieve appearance ideals and
second mechanism leading to the development and main- body image concerns and eating pathology (Schutz et al.
tenance of body image and eating pathology, as in many 2002; Rodgers et al. 2014; van den Berg et al. 2002).
instances comparisons are not favorable, especially when Consistent with this, media-ideal internalization and
media images are chosen as comparison targets (Levine appearance comparison have emerged as mediators of the
and Murnen 2009). The sociocultural theory of body image relationship between sociocultural influences and body
and eating concerns’ focus on media, peers, and parents as dissatisfaction and eating pathology among adolescent girls
socializing agents has made it developmentally very rele- (Keery et al. 2004). Thus, appearance comparison plays a
vant to adolescents and youth (Borzekowski and Bayer critical role in the impact of sociocultural influences on
2005; Clay et al. 2005; Rodgers et al. 2009; Webb and body image and eating concerns.
Zimmer-Gembeck 2014).
The media, in particular, have been shown to present a The Role of the Internet
relentless stream of images of ideal bodies, almost without
exception carefully digitally modified to create an Having described the sociocultural theory of body image
unattainable image of physical perfection (Hunter 2011). concerns and eating pathology, the aim is to examine how
Furthermore the weight-loss industry, representing over the Internet may fit into sociocultural models (Fig. 1). The
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Adolescent Res Rev (2016) 1:121–137 123
Fig. 1 Internet influences within sociocultural models of body image concerns and eating pathology
Internet, particularly through the use of social media, can contains high levels of appearance-focused content (Fer-
be considered to combine aspects of both media and peer nandes et al. 2013). Regarding direct peer influences,
influences, as the Internet provides a vehicle for images cyberbullying related to appearance occurs frequently on
portraying appearance ideals as well as an interactive the Internet among adolescents (Frisén et al. 2014), and
medium allowing for peer feedback, through applications constitutes an emotionally very impact form of peer
such as Facebook, Twitter and Instagram. As a form of influence. Peers may also amplify the appearance-focus on
media pressure, one of the Internet’s strongest means of the Internet by intensifying the presence of certain pictures,
influence is advertising. A content analysis of advertise- or messages (through generally circulating the content by
ments on popular websites targeting teenagers revealed that ‘‘liking’’ ‘‘retweeting’’ etc.) as well as mediating the effect
advertisements for cosmetic and beauty products were the of Internet content by adding meaning and valence to it.
most represented (Slater et al. 2012). Interestingly, the Similar processes of the mediation of media content by
majority of the websites reviewed targeted girls only. parents have been described in the context of media effects
Furthermore, personalized advertising occurs with of body image and eating concerns (Nathanson and Botta
increasing frequency on the Internet, involving the delivery 2003). Thus, in many ways, the Internet may also represent
of advertisements based on the previous data collected on a a source of peer influence, or perhaps, an intersection
particular user in order to best target their interests (Yu and between media and peer influences.
Cude 2009). This is common-practice and nearly all web- The Internet and social media also offer multiple
sites collect great amounts of personal information from opportunities for social comparison. The images presented
consumers (such as search terms) to create personal profiles on the Internet are often those of other users and, therefore,
(U.S. Federal Trade Commission 2000). As one of the main likely to be considered appropriate targets for appearance
uses of the Internet reported by adolescents is for obtaining comparison. Interactive applications such as allow users to
information regarding diet, fitness and exercise (Borze- post pictures and follow the pictures posted by others. A
kowski and Rickert 2001), searching for this type of large amount of the content on these websites appears to be
information, therefore, results in adolescents’ being tar- devoted to appearance ideals. Instagram and Tumblr, two
geted with weight-loss and fitness advertisements, poten- social networking sites, also host events such as ‘‘trans-
tially exposing them to a narrower and more greatly formation Tuesday’’ encouraging users to post ‘‘before and
appearance-focused range of advertising than would occur, after’’ pictures, frequently focused on weight-loss. Thus,
for example, on television. Thus, the Internet appears to the Internet and social media may promote social com-
constitute an additional source of appearance-focused parison, leading to body dissatisfaction and eating
media. pathology.
In terms of peer influence, the Internet and social media
allow the occurrence of appearance-centered interactions, Usefulness of Sociocultural Theory
negative appearance-related feedback and the modeling of
these behaviors by exposing individuals to examples of The Internet appears to provide an exceptional arena for
weight-based teasing or stigmatization. For example, a sociocultural influences, both through exposure to media
content analysis of videos displaying fat-stigmatization on images and messages as well as peer influences in terms of
YouTube unearthed a sample of 493,000 results, with weight- and shape-focused interaction and feedback. The
certain videos viewed almost 2.5 million times suggesting potential for the online environment to become highly
that this type of media content has an extremely high saturated in appearance-related content based on individ-
potential reach (Hussin et al. 2011). Similarly, Twitter uals’ interests makes sociocultural models very relevant.
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Similarly, the disinhibiting effect of anonymity in online perception of sexist events and disordered eating (Sabik
peer networks may encourage appearance-related teasing and Tylka 2006). Thus, feminist theories of the develop-
and negative feedback (Suler 2004). Thus, the sociocultural ment of body image and eating concerns have received
framework, which considers these influences, might be empirical support.
particularly appropriate. The sociocultural framework also Another important concept developed by feminist the-
presents a number of limitations, however. Firstly, while it ories of body image and eating concerns is the objectifying
may theoretically consider bidirectional relationships male gaze. Objectification can be defined as the tendency
between individuals and their sociocultural environment, to treat bodies as objects as opposed to entities (Fredrick-
the model does not operationalize these in any way. This is son and Roberts 1997). In other words, through objectifi-
a critical shortcoming as the online environment is con- cation, individuals, particularly women but increasingly
stantly changing and shaped by user actions through tar- men as well, are considered and treated ‘‘as bodies’’. Self-
geted advertising, group membership, and user objectification refers to the tendency to join society in
contributions. Secondly, the sociocultural theory fails to viewing oneself as an object. Thus, self-objectification
conceptualize potential differences between exposure to theory posits that Western society socializes its members to
industry created images of appearance ideals, and exposure treat themselves as objects to be evaluated, and in many
to digitally modified images from one’s social circle, and cases, sexual objects (Fredrickson and Roberts 1997). From
their differential effects on body dissatisfaction and eating a theoretical standpoint, self-objectification would con-
pathology. Finally, sociocultural theory fails to incorporate tribute to body dissatisfaction and eating pathology through
the effects of participating in creating Internet appearance- the resulting experiences of increased body-related anxiety,
focused content. Thus, while clearly presenting a number shame and surveillance (McKinley and Hyde 1996). A
of strengths, sociocultural theory is also limited in its robust body of work has supported objectification theory
usefulness as a framework for the investigation of the and the usefulness of considering body image and eating
relationship between Internet use and body image and pathology within this framework, and provided evidence
eating concerns. for the relationship between self-objectification and body
dissatisfaction and disordered eating in women (e.g. Slater
and Tiggemann 2002), as well as muscularity concerns in
Self-Objectification and Feminist Theory early adult males (Daniel and Bridges 2010). Furthermore,
media content analysis has revealed the ubiquitous pres-
In feminist theories of the development of body image and ence of objectifying images of women and men (Rohlinger
eating concerns, the Western focus on female appearance 2002; Stankiewicz and Rosselli 2008). Media and peer
that encompasses both the glorification of thinness and the influences have also been linked with increased levels of
vilification of fatness, is viewed as a form of sexism and self-objectification among adolescents, suggesting that
misogyny, and therefore as a means of maintaining the being exposed to images of ideal figures heightens feelings
patriarchal status quo (Brown 1989). The relentless pro- of objectification (Aubrey and Frisby 2011; Knauss et al.
motion of thinness serves the interests of the diet and 2008; Lindberg et al. 2007). In this way, self objectification
beauty industry as well as hampering women’s empower- theory has emerged as a useful lens through which to
ment and sense of self-efficacy by maintaining an anxious conceptualize body image and eating concerns.
focus on appearance (Gilbert and Thompson 1996). Fur-
thermore, feminist theories of body image and eating The Role of the Internet
concerns highlight the conflicting attitudes surrounding the
increasing social success of women, and suggest that As feminist theory hypothesizes that patriarchal messages
women are motivated to try to conform to societal stan- are conveyed by mainstream society, Internet and social
dards of appearance in order to assuage male anxieties media use could potentially be explored within this
resulting from their growing role in society, and gain male framework (Fig. 2). Early cyberfeminists saw the disem-
approval (Gilbert and Thompson 1996). Consistent with bodied space of the Internet as possessing a high potential
these theories, meta-analytic findings have shown a posi- for combatting gender inequalities (Fahs and Gohr 2012).
tive association between feminist identity and positive Consistent with this, the Internet has been described as a
body image and lower eating pathology among women libratory space in which minority voices can be expressed
(Murnen and Smolak 2009), suggesting that heightened and heard, patriarchal discourse challenged, and where
feminist consciousness may help adolescent girls to engage youth can experience greater freedom of expression (Bosch
in critical appraisal of their cultural environment and resist 2011; Walsh 2008). However, other authors have high-
sociocultural pressures. Furthermore, feminist identity has lighted the tendency for the homogenizing patriarchal
been found to moderate the relationship between the discourse to dominate cyberspace, going so far as to term it
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Fig. 2 Internet influences within self-objectification models of body image concerns and eating pathology
a ‘‘superpatriarchy’’ (Fahs and Gohr 2012). In this way, with their appearance (Pempek et al. 2009). Other forms of
while promising emancipation into an androgynous space, objectifying content can be found through websites and
the Internet replicates and amplifies traditional gender applications that allow users to rate the physical attrac-
scripts (Fahs and Gohr 2012). Social media, in particular, tiveness of other users. It is easy to imagine the increasing
can be seen as providing an illusion of personal expression feelings of self-objectification arising from the awareness
and unconstrained identity while subtlety allowing only a that every member of your peer group is equipped with a
narrow and controlled range of ways in which to express camera-phone and that every moment is susceptible to be
identity. As noted by other authors, Facebook, for example, captured and circulated on the Internet, with or without
offers users the opportunity to ‘‘like’’ content but has no your consent. Consistent with this, Internet use has been
corresponding ‘‘dislike’’ function (Fahs and Gohr 2012). found to be associated with high levels of self-objectifi-
These observations suggest that Internet and social media cation among adolescent girls (e.g. Tiggemann and Slater
use may maintain individuals in a space in which patriar- 2013). Thus, this framework seems to present some use-
chal discourse and capitalism are the dominant voices, and fulness for the examination of the relationship between
that feminist theory might, therefore, be a useful frame- Internet and social media use, and body image concerns
work for conceptualizing the effect of the Internet. and eating pathology among adolescents.
In addition to the previously mentioned content, the
Internet provides access to sexually explicit content with Usefulness of Feminist and Self-Objectification
more ease than ever before. It has been suggested that a Theory
large proportion of youth come into contact with sexually
explicit Internet content, which has been associated with The Internet and social media promote the availability of
the perception of women as sex-objects (Doornwaard et al. sexual content as well as extending the space submitted to
2015; Peter and Valkenburg 2007). Regarding more inter- the objectifying male gaze to cyberspace by creating
active forms of exposure to sexual content, up to 32 % of opportunities for online identities to be judged and evalu-
young adults and 19 % of adolescents have reported ated by others. Internet exposure and new social media
sending nude or semi-nude photos of themselves (The sites provide conditions that might promote self-objectifi-
National Campaign to Prevent Teen and Unplanned Preg- cation both through the invitation to constantly update
nancy 2008). Furthermore, themes of objectification and one’s profiles, resulting in the perception of being in the
body display were found in over 25 % of the female profile gaze of others, and through the presence of readily avail-
photos posted on MySpace (Hall et al. 2012). These find- able explicitly objectifying content. Thus, feminist and
ings suggest that the Internet may promote both the sexual self-objectification theory seem to contribute a valuable
objectification of others and self-objectification. lens through which to explore the relationships between the
While it could be considered that the anonymity of Internet and body image and eating pathology.
computer-mediated communication might allow individu- Similarly to sociocultural theory, however, the useful-
als to remove themselves from society’s objectifying gaze, ness of this framework is limited by its lack of consider-
the opposite has also been argued: ‘‘one enters the online ation of the contributions of users to the Internet and social
world very aware that he/she is being observed, monitored, media, as well as online gratifications. Thus, the degree to
judged… The assumed male gaze is ubiquitous’’ (Donnelly which individuals contribute images of themselves to
2011, p. 174. This assumed male gaze is well-illustrated by online profiles, sometimes with the specific intention of
‘‘attractiveness’’ being the most frequently cited motivation them being appraised (and objectified), may result in dif-
reported by Facebook users regarding their choice of pro- ferent psychological effects compared to the sensation of
file photo (Strano 2008). Facebook also offers the option of being objectified in a manner that is out of one’s control.
being ‘‘tagged’’ in a photo—that is creating a link between Furthermore, traditionally, when considering the impact of
an individual in a photo and their personal profile. While media, objectification theory has considered that individ-
women report engaging in this more than men, they have uals, and particularly girls, are socialized within an envi-
also been suggested to ‘‘untag’’ photos of themselves more ronment rich in objectifying but impersonal images, rather
frequently, the most common reason being dissatisfaction than experiencing their own image being circulated and
123
objectified as may occur on the Internet. The usefulness of and behavioral difficulties, and judging oneself by exter-
feminist and self-objectification theory is therefore also nal standards (Rogers 1951; Zaitsoff et al. 2002), while
tempered by a number of limitations. expression of one’s true self is associated with psycho-
logical well-being (Schlegel and Hicks 2011). In the
context of eating disorders, the inability to express and
Impression Management: Self-Discrepancy the suppression of the true self have been suggested to
and True Self Theories lead to over-reliance on external standards of appearance
and others’ expectations, which result in high levels of
Theories of self-presentation and impression management body image concerns and eating pathology (Striegel-
posit that in social situations individuals attempt to control Moore et al. 1993; Zaitsoff et al. 2002). Consistent with
their image and identity-relevant information (Cialdini and this, experiencing the public self as a fraudulent repre-
de Nicholas 1989; Schlenker 1980). Thus, motivated by the sentation of one’s real self has been associated with eat-
desire to gain social acceptance or approval, individuals ing disorder symptoms among adolescent girls (Norwood
will try to portray themselves in the way that they consider et al. 2011). Similarly, self-silencing and the perception of
to be the most attractive or desirable and selectively pre- not being really known by others has been associated with
sent information about themselves in order to convey this body dissatisfaction and eating pathology in female ado-
image. In addition, however, individuals are also motivated lescents (Buchholz et al. 2007). These findings support
to present themselves in a way that is congruent with their the usefulness of the true self theories as an explanatory
perception of their true selves, and obtain acceptance. Self- framework for the development of body image and eating
presentation is therefore guided by the tension between concerns.
creating a desirable impression and painting an authentic
picture. The Role of the Internet
Higgins’ (1987) self-discrepancy theory posits that the
discrepancy between multiple selves is related to emo- While the Internet is by definition a disembodied space, it
tional and behavioral consequences. Specifically, it dis- has been argued that adolescents are particularly likely to
tinguishes between an ideal, an ought, and an actual self. use the Internet for self-presentation purposes and that
The perceived failure of the actual self to live up to the through most online activities users create some form of
ideal and ought selves, is hypothesized to result in nega- presented body image and embodied self, and that (Mazur
tive affect and anxiety and to lead to behaviors aiming to and Kozarian 2010; Young and Whitty 2011). This
decrease the discrepancy (Higgins 1987). Within the field embodied self is often closer to the desired or ideal self that
of eating disorders, perceived discrepancies, both in terms might be achieved offline (Young and Whitty 2011). In this
of physical appearance and personal characteristics and way, for example, profiles on online dating sites frequently
achievements, have been hypothesized to result in body include minor deceptions regarding users’ physical attrac-
image concerns and eating pathology (Forston and Stanton tiveness (Toma and Hancock 2010), and an analysis of
1992; Szymanski and Cash 1995). Consistent with this, these websites revealed that 86 % of participants thought
self-discrepancies have been shown to be associated with that other users were likely to misrepresent their physical
eating disorder symptoms among college women (Snyder appearance (Gibbs et al. 2006). However, even in other
1998). In addition, among individuals suffering from eat- contexts of online presentations, users have a tendency to
ing disorders, greater actual/ideal and actual/ought dis- present an ideal self. Profile photos on social media sites
crepancies have been found to be associated with greater are frequently digitally manipulated to enhance the
severity of psychopathology (Lavender et al. 2013). Fur- appearance of users (Reich 2010). Furthermore, success-
thermore, discrepancies between actual and ideal body fully enhancing one’s appearance on social media is con-
images have been shown to be associated with disordered sidered by adolescents to be one of the most important
eating and body dissatisfaction among young women skills for achieving popularity online (Siibak 2009). Overly
(Anton et al. 2000; Szymanski and Cash 1995). These enhancing one’s appearance is associated with social con-
findings therefore provide support for self-discrepancy sequences, however, and may be perceived as deceptive
theory. (Sessions 2009), highlighting the importance of portraying
Other theories have highlighted the presence of a true a self that is perceived as not unreasonably discrepant from
self consisting of existing characteristics that are not fully the real self. Therefore self-presentation on the Internet is
expressed in one’s present social life (Rogers 1951). Here an important but delicate task.
the distinction lies between a self fully known only to the In the context of body image and eating disorders, the
individual, and the public self. Perceived pressures to construction of an online self that is felt to be closer to
silence the true self are theorized to result in emotional one’s ideal self, as compared to one’s offline actual self,
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may lead to increased dissatisfaction with the actual body image and eating concerns from this viewpoint is
physical self. Thus, constructing an online embodied self illustrated in Fig. 3.
that one may never be able to achieve could result in higher
body image concerns and, potentially, eating disorder Usefulness of Impression Management Theory
behaviors aiming to bridge the gap between one’s offline
and online presentations. Furthermore, other authors have Through its highly visual nature as well as the opportunity
suggested that rather than an ideal self, which suggests for very high levels of control of self-presentation, the
something perfect and therefore unlikely to be obtained, Internet is an important outlet for impression management.
online presentations might present a promised self, or the Correspondingly, impression management theory offers an
true self yet to emerge (Ellison et al. 2012). Thus, the interesting framework within which to conceptualize the
enhanced online self is perceived more as a future self to be effects of the Internet and social media use, which takes
achieved shortly through self-improvement. Given how the into account many of the distinctive features of Internet use
present social discourse offers extreme weight control (Fig. 3). Thus, impression management theory helps to
strategies as a principal means of self-improvement conceptualize the creation of online selves and how their
(Hesse-Biber et al. 2006), efforts to achieve this promised perceived distance from actual offline selves might result in
self might easily lead to eating pathology. In this way, body image concerns and eating pathology.
presenting an enhanced version of oneself in the online Impression management theory also presents some limi-
world might be associated with body image and eating tations in the framing of the relationships between Internet
concerns in the offline world. and social media use, and body image concerns and eating
In addition, the Internet is a space in which aspects of pathology in that it fails to account for the sociocultural
the self that are not readily communicated through face-to- pressures shaping the ideal or promised self that individuals
face communication may be more easily portrayed, try to present. Furthermore, it lacks a description of the
allowing individuals to express their true selves, particu- psychological processes and individual differences
larly aspects which may be perceived as less socially accounting for the existence of discrepancies between online
desirable (Bargh et al. 2002). Furthermore, online rela- and offline presentations. Finally, it would be useful to pro-
tionships built upon disclosure of the true self are more vide an understanding of how online and offline presenta-
likely to successfully transition to offline (McKenna et al. tions may reciprocally influence each other. It may be, for
2002), suggesting that they possess an increased degree of example, that, as an individual successfully modifies their
authenticity and reciprocity. Within the context of eating offline appearance to more closely resemble the online self,
disorders, the Internet might allow for greater expression of the online self shifts a little closer to the ideal, thus remaining
the true self, emotions and personal characteristics that are out of reach. In sum, despite its advantages, impression
perceived as needing to be silenced in the offline world. management theory is also limited in its usefulness as a
Being able to express these aspects of the true self in the framework within which to explore the relationship between
anonymity of the online environment, and potentially Internet use and body image and eating concerns.
transition relationships based on the true self, offline, might
constitute a protective factor for eating disorders. In addi-
tion, it has been suggested that adolescents frequently use Social Identity Theory
the Internet to aid them in their quest for clarity of self-
concept, therefore these theories might be particularly Social identity theory proposes that one’s sense of personal
relevant to this developmental period (Valkenburg and identity is drawn from knowledge of social group mem-
Peter 2011). The relationship between Internet use and bership (Tajfel 1982). As a result, individuals are likely to
Fig. 3 Internet influences within impression management models of body image concerns and eating pathology
123
engage in social categorization (perceiving the social individuals to be virtually connected and to form online
environment in terms of in-group and out-group), rely of groups that do not require physical proximity. Thus, mar-
stereotypic characteristics of groups, and use social com- ginal interests or behaviors, which may have once repre-
parison processes as a means of preserving a positive sented a peripheral part of an individual’s identity, are now
identity (Tajfel 1982). Body image concerns and eating able to take a more central role through the creation of
pathology have both been described within a social identity online groups of like-minded people. Similarly, individuals
framework (Ison and Kent 2010). As previously described, who experience ostracism or stigma are able to form sup-
physical appearance plays a central role in identity. Con- portive communities. One example of this is pro-eating
sistent with social identity theory, in order to maintain a disorders groups. While individuals with eating disorders
positive identity individuals need to experience feelings of who view their concerns as part of their identity might seek
membership to a desirable group in terms of appearance to connect with others with similar concerns offline (Rich
and to sustain this with positive social comparisons. In 2006), the prevalence of these disorders is relatively low
Western society, in which there is an emphasis on a gen- (Hudson et al. 2007), and these diseases are associated with
erally unachievable body shape, it is likely that individuals high levels of social ostracism and stigma (Stewart et al.
may experience difficulties trying to maintain their identity 2008), rendering the creation of physical pro-eating dis-
as part of this ingroup, and finding targets for positive order groups very difficult. On the Internet, however, the
social comparisons. The ingroup can be defined in various creation of groups supporting eating disorders as an iden-
ways such as, for example, the peer group. Thus, adoles- tity choice is much more readily achieved, and a number of
cent girls have been reported to associate body satisfaction authors have reported on ‘‘Pro-eating disorder’’ websites
with the recognition that certain members of their peer (Sharpe et al. 2011).
group are more attractive than them while others are less so Pro-eating disorder websites advocate for disorder eat-
(Krayer et al. 2008). Gender group and gender role identity ing behaviors and extremely low body-weight as a life-
has also been hypothesized to be associated with body choice (Rodgers et al. 2012). The typical content of such
dissatisfaction and disordered eating in that investment in web pages includes pictures of very thin celebrities,
appearance is considered to be a feminine trait, therefore, ‘‘thinspirations’’ (sometimes digitally modified so as to
women for whom gender is a salient identity trait will be appear even thinner) (Borzekowski et al. 2010). They also
more likely to invest in their appearance (Cash et al. 2004). include advice or tips on how to maintain disordered eating
Consistent with this, stress resulting from adherence to symptomatology, including extremely unhealthy weight-
rigid traditional feminine roles has been associated with loss methods or techniques for concealing symptoms
disordered eating (Mussap 2007). Thus, social identity (Borzekowski et al. 2010). Most importantly, however,
theory has received support as a framework for examining they often include some means of interactive communi-
body image and eating concerns. cation, via noticeboard, blog, or instant messaging.
Severe eating disorders such as in Anorexia Nervosa Through this interactive component, members provide each
and Bulimia Nervosa have also been described as central other with encouragement and support, and co-construct
elements of an individual’s identity. In this way, the their eating disordered identity. Content analyses of these
disorder becomes one of the primary characteristics interactions have highlighted the importance of shared
around with the self is constructed and relationships with deception-through hiding ingroup practices from the out-
others are formed (Rich 2006). Here, the disorder is group. Thus, while eating pathology is a central aspect of
viewed as a salient characteristic for social categorization, identity for the users, it must remain hidden from friends
to be shared with other members of the ingroup. One of and family for fear of stigma or imposed treatment (Bor-
the particularities of these disorders is the wish to retain zekowski et al. 2010; Sharpe et al. 2011). Importantly,
the symptoms, and the refusal to view them as problem- exposure to these websites has been suggested to contribute
atic but rather as egosyntonic (Vitousek and Hollon to the development or exacerbation of eating disorder
1990). Social identity theory may, therefore, be particu- symptomatology among female adolescents (Custers and
larly useful when considering the clinically severe forms van den Bulck 2009).
of eating disorders. Despite the incentives to maintain or intensify symp-
tomatology found on pro-eating disorder websites, many
The Role of the Internet studies have found the provision of social support to be one
of the main motivations for online community members
The Internet allows access to a much wider variety of and bloggers (Rodgers et al. 2012). A number of online
social groups than are included in an individuals’ offline support groups for eating disorders that are pro-recovery
network and is therefore interesting to consider within a also exist, and have been shown to provide both informa-
social identity theory framework. The Internet has allowed tion and emotional support (Eichhorn 2008). Furthermore,
123
online groups may fulfill needs that face-to-face groups consensus obtained in online groups, and those in the off-
have more difficulty meeting, such as being available late line world. Furthermore, this theory places little emphasis
at night (Winzelberg 1997). In this way, pro-eating disor- on the visual nature of the Internet and how images of the
der online communities may also have benefits for their self and others dominate the online world. Finally, it
members. neglects that much of Internet and social media content is
Pro-eating disorder online communities are an extreme corporate—produced rather than individually produced,
example of appearance-centered online groups. As public and how this might influence online identity construction.
policies become stricter, these websites are banned by an Therefore, similarly to the other frameworks reviewed
increasing number social media such as Pinterest and above, social identity theory presents both strengths and
Tumblr. These groups are not the only type of body shape limitations as a framework within which to conceptualize
and eating related groups found online, however. More the relationship between Internet use and body image and
positive forms of these groups include activists forums, eating concerns.
such as the Body Positive movement, the Beautiful Body
Project, or the Every Day Sexism Project, and other groups
aiming to promote positive body image and healthy eating Gratifications Theory
practices. These websites and groups use the Internet as a
medium of drawing together individuals who do not Gratifications theory has also been used to conceptualize
endorse the promotion of the social beauty ideal. In sum, body image concerns and eating pathology (Fitzsimmons-
while pro-eating disorder online groups may be the most Craft 2011). Contrary to sociocultural theory, gratifications
salient due to their extreme beliefs and behaviors, other theory restores the agency of the individual in seeking out
types of online communities may be associated with media exposure and selectively tailoring their media
decreased body image and eating concerns (Fig. 4). environment to their choices (Hesse-Biber et al. 2006).
According to this theory, individuals are motivated to
Usefulness of Social Identity Theory selectively expose themselves to cultural messages as a
source of information on appearance standards (Tiggemann
The Internet and social media offer many opportunities for 2003). Such active and deliberate exposure to social mes-
online group membership, and social identity theory pro- sages regarding thinness may then produce different out-
vides a useful framework within which to explore the comes compared to passive exposure (Fitzsimmons-Craft
creation of groups capitalizing on the egosyntonic nature of 2011). Consistent with this theory, it has been shown that
eating disorder symptoms, as well as focusing more general exposure to fashion magazines and television thin-ideal
on appearance, weight, and shape, and therefore seems a content has differential associations with body image and
useful perspective for the study of the effects of the Internet eating variables, suggesting that individuals may seek out
and social media (Fig. 4). One of the valuable contribu- these media for different reasons and report different
tions of social identity theory is the consideration of online impacts among college women (Lin and Reid 2009;
interactions, not just in terms of feedback regarding online Tiggemann 2003). Furthermore, individual characteristics
presentation, but also in terms of relationships and social and motivations to select media are thought to interact with
support. Adolescents have been suggested to be most likely exposure, thereby producing differential effects in different
to use the Internet for self-disclosing to their peers around individuals (Hesse-Biber et al. 2006). Consistent with this,
the age of 15 (Valkenburg and Peter 2007), suggesting that the magnitude of the deleterious effects of media exposure
these aspects are very relevant to this age group. This on body satisfaction among college women has been shown
theory highlights the relational aspect of the Internet and to be associated with initial levels of trait body dissatis-
the importance of the bonds formed online. However, faction (Posavac et al. 1998; Rodgers and Chabrol 2009).
social identity theory also presents a number of limitations Thus, individuals with higher initial concerns seem more
including the lack of conceptualization of the differences greatly affected by exposure to ideal images. Gratifications
between online and offline identities and relationships, and theory, therefore, offers a more active account of media
the consequences of the clash between norms and social influences on body image and eating concerns.
Fig. 4 Internet influences within social identity models of body image concerns and eating pathology
123
The Role of the Internet networking behavior. In addition, the emphasis on the
selection of different contents based on motivations, as
It has been argued that gratifications theory is uniquely well as the modulation of the effects of exposure to these
suited to exploring online communication and behaviors, contents depending on user characteristics is particularly
particularly among adolescents, and it has been used to useful. Gratifications theory thus contributes to clarifying
explain traditional Internet use and well as social media use why individuals engage in various online activities, and
(LaRose and Eastin 2004; Peter et al. 2005; Raacke and how this might moderate the impact of the Internet and
Bonds-Raacke 2008). Contrary to traditional theories of social media on body image and eating pathology.
media use, gratifications theory adopts a user-level per- Gratifications theory, however, also presents a number
spective and considers how users are motivated to use the of limitations in that it focuses very much on individual
Internet and social media for personal satisfaction. Thus, differences to the exclusion of differences in the types of
the Internet is satisfying both in the user-directedness and content and activities as explanatory factors for the variable
control of the process, the scope of the available content, effects of Internet use. Furthermore, it fails to capture
and the social aspect (Stafford et al. 2004). In the context of online interactions with others and the important part they
body image concerns and eating pathology, this may play in the relationship between Internet and social media
translate to the Internet being appealing through control of use and body image concerns and eating pathology. Taken
self-presentation, the availability of appearance, diet, and alone, therefore, gratifications theory is insufficient as an
weight and shape-related content, and the capacity for explanatory framework for examining the relationship
social interaction. Furthermore, within gratifications the- between Internet use and body image and eating concerns.
ory, user characteristics modify the relationship between
media use and outcomes. Thus, characteristics such as trait
body image, self-esteem, need for belonging and media An Integrated Theory
literacy might moderate the relationship between Internet
and social media use and body dissatisfaction. Gratifica- Presentation of the Model
tions theory therefore brings together many of the aspects
highlighted separately in sociocultural theory, impression Five different theoretical frameworks have previously been
management theory, and social identity theory. It offers a described to consider the relationship between Internet and
more integrative view of the ways in which Internet and social media use and body image and eating pathology. All
social media use are related to body image and eating five theories present different aspects of particular useful-
disorders (Fig. 5). ness as a framework to consider these relationships, how-
ever, taken separately, they also present limitations. This
Usefulness of Gratification Theory article proposes an integrative framework based upon these
(Fig. 6).
Gratifications theory possesses a number of important The integrated theory proposes that individuals may use
assets as a framework within which to conceptualize and the Internet and social media in three main ways with
explore the relationships between Internet and social media increasing levels of interaction. First, the Internet may be
use and body image and eating pathology. Firstly, the used as an impersonal tool, without interaction with others
emphasis on the active and gratifying nature of Internet and through it. Importantly, this is not a unidirectional use,
social media use seems to capture well the nature of social since, as previously described, a user’s online environment
Fig. 5 Internet influences within gratifications models of body image concerns and eating pathology
123
is modeled by previous uses through saved searches and to body dissatisfaction and eating disorder symptoms,
personalized marketing. However, this mode of use does through the mediated pathway of social comparison
not incorporate any peer feedback, which constitutes and (Rodgers et al. 2015).
important distinction from the next two, and can therefore Second, the Internet may be used as a general social
be referred to as ‘‘non-participatory’’ (as a note, as social platform through friend-network websites such as Facebook
media becomes increasingly popular, and given that social or MySpace, and social media applications such as Twitter
interaction is one of the main gratifications of Internet use, and Instagram. Through this mode of use, individuals
it is likely that fewer and fewer users engage exclusively in contribute content to the Internet, and create one or several
this type of Internet use). This type of engagement with the online presentations. Others may comment on these con-
Internet resembles traditional sociocultural theory, and tributions (posts, photos, etc.) resulting in the shaping and
would result in increased thin-ideal internalization, leading modeling of one’s online presentation in response to this
Fig. 6 An integrated model of the influence of Internet on body image concerns and eating pathology
123
feedback. Furthermore, peer feedback is likely to heighten eating disorders, but may also be associated with the
thin-ideal internalization and body-surveillance as one’s life greatest protective factors among online communities pro-
(and appearance) is increasingly viewed from the perspec- moting positive body image and healthy eating attitudes.
tive of other Internet users. Both of these factors might then
lead to body shame, body dissatisfaction and eating disorder Usefulness and Future Directions
symptoms, as described in self-objectification theory. Of
note, both positive and negative peer feedback would likely The integrated model brings together aspects of the theo-
reinforce this pathway. In addition, the increased reliance retical frameworks discussed above, and integrates them in
on external standards of self-evaluation might lead to more a manner that aims to capture the different aspects of
frequent online contributions in search of reassurance, and Internet and social media use. One of the main contribu-
the gratifications obtained by positive peer feedback. tions of the model is that it accounts for interactions with
Importantly, the online presentation(s) modeled by peer others through the Internet as well as the central aspect of
feedback and enhanced through digital modification, might control of self-presentation. Furthermore, the hypothesized
differ from reality as individuals seek to present their ideal feedback loop considers how certain gratifications obtained
or real selves, thus creating an online version of themselves from the Internet and social media might prompt an indi-
that is impossible to live up to in the offline world, as pre- vidual to continue to engage with the online world despite
dicted by impression management theory. Social compar- negative feedback or outcomes. Thus, the model brings
ison with this unattainable version of the self might lead to together the strengths of the frameworks described above
increased dissatisfaction with the real self, and the anxiety and aims to overcome the limitations associated with each
that the real self might disappoint others. This dissatisfac- framework when considered in isolation.
tion and anxiety could lead to increased efforts to ‘‘im- Grounded in this model, future research should aim to
prove’’ the real self through excessive dieting and exercise increase our understanding of the relationship between
resulting in eating disorder symptoms. This type of Internet and social media use and body image and eating
engagement with the Internet is likely to be the most fre- concerns. First, greater attention needs to be paid to the role
quent and pervasive, and therefore these types of pathways of different types of Internet use. In particular, it is critical
deserve increased research attention. to examine how ‘‘engagement’’ with the internet, such as
Third, the Internet and social media may also be used to through contributions and postings, might reveal a different
participate in weight and shape focused peer groups and relationship with body image and eating concerns as
communities. Here, the content of social interactions is opposed to ‘‘exposure.’’ It is important to understand to
centered on weight and shape concerns, sometimes to what extent, and how, the interactive aspects of the Internet
extreme extents such as in pro-eating disorder communities. as well as the creation and curating of an online persona are
Unlike in the second pathway, in online communities such related to body image and eating concerns. Specifically, the
as these, individuals may never interact offline. The aim is proposed model hypothesizes that peer feedback would
not to move online relationships offline, but rather to use the emerge as a moderator of this relationship, but also that it
Internet as a means of bringing together people who share a would influence future online participation. These rela-
common interest. Thus, concerns about the correspondence tionships need to be tested. In addition, the integrated
between one’s online and offline selves may not be a central model suggests that perceived discrepancy between the
issue. In contrast, the online self is felt to correspond online and the actual self, resulting from social compar-
strongly to the real self, and aspects of identity that may ison, would increase feelings of body dissatisfaction and
lead to marginalization or stigmatization in the offline eating pathology. This relationship should also be empiri-
world are reinforced as central aspects of identity. Percep- cally investigated. Relatedly, research should aim to clarify
tions of the prevalence or pathological nature of certain whether the relationship between Internet use and body
behaviors or attitudes may also become skewed through image and eating concerns is dose-dependent or whether
interactions with similar minded individuals. Thus, adolescents need to engage with the Internet to a certain
involvement in weight and shape centered communities extent for these relationships to appear. These lines of
may reinforce the centrality of appearance or eating disor- research should aim to clarify whether certain ways of
ders to identity and lead to a perception of false consensus using the Internet confer greater risk for increased body
regarding the extreme nature of these beliefs or behaviors image and eating concerns.
that could act as a barrier to recovery or treatment seeking. Second, the mediators of the effects of Internet and social
This type of Internet engagement is the most active, in that media use on body image and eating concerns should be
others are sought out, and the emotional investment in the identified. The proposed model suggests that media-ideal
online group is greatest. For these reasons, this type of internalization, body surveillance and self-objectification,
Internet use may be related to the most severe forms of and social comparison mediate the effects of Internet and
123
social media use on body image and eating concerns. presented an integrated theory that builds upon the most
Research testing these mediated pathways would contribute useful aspects of each of these theories in order to provide a
to our understanding of the mechanisms through which the framework within which to clarify the relationships
Internet impacts body image and eating concerns. between body image concerns and eating pathology among
Third, it is important to identify the variables that might act adolescents. The Internet and social media may likely
as moderators of the relationships represented in the model. become one of the most important sociocultural influences
Such variables might include demographic characteristics on body image concerns and eating pathology within the
such as age and gender, as well as psychological dimensions next decades, and increasing our understanding of the ways
such as trait body image related variables, self-esteem, and in which engaging with the online world can be helpful or
motivations for Internet use including social support, need for detrimental is critical. In addition, adolescents constitute
belonging, or appearance feedback/information. Clarifying one of the most important developmental groups among
these moderators will help to identify individuals who might which to examine these effects given their heightened risk
be most vulnerable to the effect of Internet and social media for developing body image and eating concerns (Levine and
use on body image and eating concerns. Murnen 2009) as well as their likelihood to use the Internet
Fourth, there is a need to explore how participation in as a context for engaging in the processes identified here as
online communities with a focus on weight and shape putative mechanisms of the deleterious effects of Internet
might influence the centrality of weight, shape, and eating use on body image and eating behaviors (Peter et al. 2005;
behavior to identity, and may therefore maintain eating Valkenburg and Peter 2007, 2011). The present framework
pathology. Increasing our understanding of the ways in aims to contribute to moving forward in this research
which these communities provide support for individuals direction and developing empirically supported models that
will augment our capacity to help individuals find appro- may then guide and inform prevention and treatment.
priate offline resources that may be less deleterious, or use
the online resources in ways that are less harmful. Research Acknowledgments Many thanks to Professor Susan Paxton for her
thoughtful comments on an earlier version of the manuscript.
on these communities should aim to clarify the processes
through which individuals create, become integrated into, Compliance with Ethical Standards
but also leave such communities. The distal results of this
work will contribute to increasing early identification and Conflict of interest The authors report no conflict of interests.
treatment-seeking among adolescents suffering from clin-
ical eating disorders.
Finally, and importantly, the integrated model does not
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Adolescent Res Rev (2016) 1:121–137

The Relationship Between Body Image Concerns, Eating

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