How Cell Phones are Fueling Anorexia
'Pro Ana' websites and an avalanche of calorie-counting apps are making it even more difficult to treat eating disorders. (And Facebook hasn't helped either.)
Three months after I started therapy with a new patient—let's call her Jane—I finally asked her about her obsessive interest in her cell phone. Jane, a 24-year-old with a long history of Anorexia Nervosa dating back to her early teens. Every week, as soon as she enters my office, she places the device on a chair right next to her, where it vibrates loudly every few minutes. She's constantly on the alert for any activity. We are still getting to know each other, so early on, I try to give her some leeway. But after several distracting sessions, I ask her to put the phone away. She tells me that she can't. She is in a relationship that centers around texting all day, and this alone has been a frequent cause of her anxiety, since she times the intervals between her boyfriend's texts and analyzes his wording.
It wasn't until a few months later, however, that Jane shares that it wasn't just her boyfriend's texts that kept her glued to her cell. She's equally obsessed with the dozens of calorie-conscious apps she has stored on it. One day she tells me she's just eaten an impromptu bite of hummus on pita bread. Hummus is not one of her "safe foods." To make matters worse, none of the 14 calorie-counting apps on her cell phone can agree on the actual number of calories it has. One asserts that hummus carries 25 calories per tablespoon; another puts the calorie count at 35. The discrepancy irritates her. Thanks to one app, she knows the distance and calories burned walking to my office. Over the next few weeks I learn that her bathroom scale automatically transmits her weight to her iPhone, which also tracks her BMI and fat.
While she restricts herself to safe foods—mostly low carb food, steamed white meat chicken, and no salt, sugar or butter—Jane sometimes sublimates her own ever-present hunger by cooking for others. She loves to bake cookies for her office colleagues, and labors mightily to produce elaborate feasts of lasagna and baked ziti for the doormen in her building. She has downloaded a variety of food apps that constantly taunt her with delicious low-cal recipes. The most trusted sources are placed in one folder. The rest—those whose calorie count and exercise apps she considers unreliable— are kept out of sight in a back-up folder. Though she works on Wall Street, diet and exercise are the main topic of conversation at her job. They are also the only subjects she thinks about at home. Technology hasn't helped quell Jane's constant obsession with her weight. In fact it's just made it stronger.
In my patient's case, not only does the information on the app become part of her need to control, but accessing the apps, updating them, comparing them, buying them and organizing them has become an entirely new avenue of obsessive behavior.
The latest generation of smartphone apps can help people do practically anything, from teaching them chess to tuning their guitar. But the proliferation of apps that obsessively quantify eating and fitness—Tap&Track, My Diet Diary, Fitbit Activity, and hundreds of others—have radically transformed the way anorexia afflicts patients. In Jane's case, managing all the information that steadily streams to her phone has come to resemble a new addiction. Buying, updating and organizing all of her apps has become an entirely new avenue of obsessive behavior. For therapists who work with people 10, 20 or 30 years younger than they are, there are multiple challenges from patients who are addicted to using their apps, either because of the appeal of another new way to calculate calories or because they enable them to reach precipitous new levels of detail over the problems that originally drew them to therapy—problems, for example, of body imagery and eating.
Technology plays a growing role in all of our lives. But for patients suffering with eating disorders its impact can be pernicious. It is important to be aware that they have access to apps that they utilize to feed into their anorexia and perpetuate obsessive thinking, as well as drive their constant perfectionism. Can we help our patients to not get on the scale everyday, as well as get them to stop using destructive apps? It's a seemingly impossible task. The scale is left at home in the morning, but now the patient is armed with different apps to measure every function. The apps are in no way a cause of eating disorders, but understanding how an arsenal of diet and exercise apps impacts the behavior of persons with anorexia or bulimia is necessary to clarify triggers and identify how a patient can help to disengage from addictive behavior.
Jane religiously scans the Internet to get the latest information about diet and exercise. Until recently "thinspiration," or "thinspo," bloggers congregated on Tumblr to provide eating-disordered individuals with encouragement and tips on sustaining their starvation. (After enduring lots of criticism, Tumblr recently moved to ban any content that promotes or glamorizes self-destructive behavior like eating disorders, self-injury and even suicide among its users.) But it's not hard to imagine how more recent sensations like Pinterest could pick up where Tumblr left off. In fact, the impact of social media on the lives of my on patients is a frequent topic of discussion with my patients.
Not surprisingly, Facebook posts and photos have an especially powerful impact on people who are compulsively concerned with their image. Jane's biggest nightmare is being tagged in an unflattering picture posted on the site. The idea of thousands of people remotely judging her is more significant to her than most of the real-life interactions she has throughout the day. Many therapists struggle to keep up with this fast-changing media landscape. In my practice, I've been seeing growing numbers of patients like her who messily entangle social media with the intimate problems that bring them to therapy in the first place. Forums such as “tweet what you eat” present a constant temptation to connect food, calories and self image. For people like Jane, that's not very helpful. She finds it hard to conceive of a world where she can enjoy a simple snack without measuring and quantifying its calories. And that's a challenge that neither patients nor therapists faced even a decade ago.
Diana Freed is a therapist specializing in the treatment of eating disorders and addictions. She is a graduate of NYU and Columbia University and completed the William Alanson White Institute Program in Eating Disorders, Compulsions and Addictions. She is also the recently appointed Social Media Chair of the New York Chapter of the International Association of Eating Disorder Professionals (IAEDP). This is her first article for The Fix.