From tics to fainting, strange behaviours can spread through social contagion. Eating disorders are not exempt. How can we combat the spread?

In 2011, a cheerleader at a small high school in the small town of Le Roy, New York starting twitching and spasming on and off. A few weeks later, the captain of the cheerleading squad began stuttering and jerking her arms and legs randomly. Over the following weeks, 18 students came down with this mystery illness of tics, that seemed to mimic Tourette’s Syndrome.

Camera crews descended, environmental tests were conducted, but no cause was found. As the case sparked national media interest and the girls’ parents became increasingly desperate, something very curious started to happen. The girls in the spotlight got worse, whilst the girls being treated away from the cameras, isolated from their friends with the same ailments, started to get better. There were accusations that some of the girls were faking it…

Diagnosis? Mass hysteria spread through social contagion

It’s not that the girls were faking their symptoms. The brain is a very powerful thing and the symptoms were very much real. Doctors and researchers think it’s like when someone next to you yawns, and then you yawn, too. There’s a drive in the amygdala region of the brain to belong to the group around you, to fit in. And adolescent girls are particularly vulnerable as their survival has historically depended so heavily on being part of a group. They seem to be especially vulnerable if they’re going through a hard time and don’t have many supports outside of that group.

I often see a kind of social contagion like this on a smaller scale with disordered eating. It starts with one girl going through a rough patch, perhaps her parents are getting divorced, or a half-sibling has been born, or she’s just really anxious about upcoming exams… (these examples are far more common than you might think), and she starts to rigidly control her food in order to feel some control over her life. It’s a coping mechanism.

Her food struggles are met with love, sympathy and increased attention. And then it starts to spread to her friends, peers, sports group… Just like the Le Roy girls, the more time they spend together and the more their food struggles take the spotlight, the worse the symptoms are and the quicker they spread.

Often it’s not even on that big of a scale. All it takes it for one popular girl to skip lunch because it makes her feel ‘lighter’ for dance class after school… And now that behaviour spreads through the rest of the dance group.

What can health professionals do?

Your mind may jump to helping your clients understand that a culture that promotes disordered eating behaviours is to be resisted, not leaned into, or working with schools and sports groups to support a culture shift… And those things are definitely worthwhile.

But, in my experience, the thing that makes the most difference to our clients is building their identity outside of food, sport and their friend group. Encouraging them to see themselves as a multi-faceted person, to explore their interests, to slowly build up who they are. They’re not just Jane, the slim dancer that everyone admires for their physique. They are Jane, the girl who loves to paint, who listens to music, who enjoys hot days at the beach and walks in the rain, who reads sci-fi novels, etc., etc. She is more than this one area of her life.

I do this with my clients from the very first session, where I encourage them to tell me about themselves. It’s not a simple rapport-building exercise for me. It’s laying a foundation that will be vital to their recovery from disordered eating.

What about social media?

Social media is a breeding ground for social contagion. “TikTok tics” is remarkably similar to the Le Roy case, only this time the tics spread through TikTok instead of the school hallways.

Diet culture content on social media can overtly promote disordered eating (such as in the case of Skinny Tok content), or more subtly promote dieting behaviours (like “What I eat in a day” videos). Because the algorithm feeds users increasingly extreme content based on their past engagement, it gets worse the more you interact with it.

I’ve had clients come to me convinced they only need 1200 calories per day, can never touch a carbohydrate, need to religiously drink litres of water despite peeing every 5 minutes, and tracking every single thing they consume in an app…

How can we combat hours of social media use in our limited time with our clients?

It’s a great idea to audit their social media feed, get them to unfollow toxic accounts, follow accounts that promote recovery (like mine! @eattypelive) and hit “not interested” on diet posts.

But even more powerful than curating their feed is cultivating their offline life. Their hobbies, their in-person friendships – more time in the real world and less time online always seems to be a good thing. It builds their sense of self and their self-worth, so the online world has less influence over them.

What about toxic sports clubs and workplaces?

Certain environments foster unspoken rules about what you should and shouldn’t look like, and what you should and shouldn’t eat. In these settings, disordered eating is too often explained away as ‘normal’ or even rewarded.

I was once asked to run a seminar for a group of young athletes, but after I shared my support for the idea “you shouldn’t train more hours than your age”, the organizers told me that would need pre-approve my slides to ensure I wasn’t “promoting eating things they shouldn’t have”. Needless to say, I backed out.

Advocating for change within the system is always a good thing, but it isn’t always easy to pull off. Sometimes you need to play the long game. If one sports club seems to be the issue, can you work with peripheral clubs and slowly find your way in?

On an individual level, simply validating your client’s experiences goes a long way. Letting them know, “It’s not okay that your coach/colleague said that, that is out of line” can make a world of difference. As one of my clients said to me, “I knew on some level it was wrong, but hearing you say it aloud made something click into place for me”.

And of course, helping your client to separate themselves from their appearance or sporting performance is the ultimate goal. Can you see the theme here? They are more than how they look, they are more than their sport, they are a multi-faceted, complex, amazing individual. I’ve literally made some of my clients write down a list of all the things they like about themselves and then read it to themselves when needed!

Healing from disordered eating isn’t just about what you eat. It’s about building your self-worth and finding out who you are beyond what you eat and what you look like.