Mirror, mirror on my screen: Focus on self-presentation on social media is associated with perfectionism and eating disturbance among adolescents. Results from the “LifeOnSome”-study.

doi:10.21203/rs.3.rs-3140320/v1

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Research Article

Mirror, mirror on my screen: Focus on self-presentation on social media is associated with perfectionism and eating disturbance among adolescents. Results from the “LifeOnSome”-study.

https://doi.org/10.21203/rs.3.rs-3140320/v1

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published 10 Sep, 2024

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Background

Social media use, perfectionism, and eating disturbances have all increased over the last decades. Some studied indicate that there is a relationship between being exposed to others self-presentation on social media and eating disturbances. Studies also show that the relationship between focus on self-presentation and highly visual social media is stronger than for non-visual social media, hence facilitating upward social comparison. Nevertheless, no previous studies have investigated the link between adolescents focus on their own self-presentation and upward social comparison on social media, and perfectionism and eating disturbances, which is the aim of the present study.

Method

The present study is based on a cross-sectional survey from the “LifeOnSoMe”-study (N = 3725), conducted in 2020 and 2021. Respondents were high school students (mean age 17.3 years, 55% females) in Bergen, Norway. Multiple regression analysis was performed where SPAUSCIS, a measure of self-presentation and upward social comparison, was the independent variable. Perfectionism, eating disturbance and self-reported eating disorder were dependent variables. Self-reported age, gender, and subjective socioeconomic status were used as covariates, as well as frequency and duration of social media use. Regression models were performed to compare proportions across the median split of SPAUSCIS, and potential gender-moderation were assessed for the associations with perfectionism and eating disturbance.

Results

The multiple regression analysis showed that increased focus on self-presentation and upward social comparison on social media were positively associated with both perfectionism (standardised coefficient 0.28) and eating disturbance. A stronger association for girls than boys was found for eating disturbance (standardised coefficient 0.39 for girls and 0.29 for boys). There was no gender moderation for perfectionism.

Conclusions

Findings suggest that focus on self-presentation and upward social comparison on social media is associated with perfectionism, eating disturbance and eating disorder. We recommend promoting a healthy use of social media. This could be established through increasing adolescents’ ability to reflect on and think critically about self-presentation and upward social comparison on social media.

adolescents

self-presentation

upward social comparison

social media

perfectionism

eating disturbance

eating disorders

Growing up today means growing up in a highly digitalized world where social media and online communication plays an important role in adolescents' life. Social media can be defined as “highly interactive platforms via which individuals and communities share, co-create, discuss, and modify user-generated content” {1, pp. 241}. Previous studies have overwhelmingly focused on the temporal aspects of social media use, and some studies indicate that social media use is associated with more mental health problems and decreased well-being {2}. For example, there are reports that more time spent on social media is associated with symptoms of depression and anxiety {3,4}, sleep issues {3,5}, and body dissatisfaction {6}. However, not all research confirms these associations {7,8}, and recent studies have indicated that the observed link between time spent on social media and mental health is too small to be of practical importance {9}. A recent longitudinal study found for instance time spent on social media to be the least important factor in relation to adolescent mental health {10}. Still, there is an ongoing and almost ubiquitous concern regarding social media’s potential negative effect on mental health. Considering this, it is increasingly recognized that it is important to investigate more than adolescents’ time spent on social media, such as their usage patterns. After all, social media offers a range of opportunities such as seeking out like-minded others or specific topics and inspiration, for example, for food, fitness, and a healthy lifestyle. Although inspirational hashtags and pictures may be positive to many adolescents, they also frequently present a “perfect” lifestyle and some of them could even be considered unhealthy inspiration.

Self-presentation

Self-presentation on social media has been highlighted as potentially important in connection with mental health and well-being among adolescents {11,12}. Baumeister & Hutton {13} defined self-presentation as an individual practice related to how one presents oneself to others and is thought to be motivated by a wish to make a socially desirable impression on others, and at the same time, stay true to one’s beliefs and ideals. On social media, self-presentation may include presenting and sharing self-made content, posting of personal opinions, and sharing online content of interest to the person {14}. An American report noted that adolescents are more engaged in self-presentation activities on social media than any other age group {15}. As increased independence from parents is an important developmental task for adolescents, external validation from others may be particularly important for this age group {16}. Feedback on social media posts through likes and comments, may as such be an important source of external validation. Considering this, it is likely that many adolescents put great importance on how they present themselves on social media. Besides, social media is a suitable arena for self-presenting activities, as it gives the adolescent control over what, when and how to present themselves on the platform of their choosing {12}. Functions such as likes, comments, followers {17}, and other measures of engagement, which are implemented on many social media platforms in one form or another, gives ample opportunity of immediate feedback on posted content. Hence, this provides cues of social desirability and direction to align future social media posts with how the adolescents prefer to present themselves on these platforms {12}. These features of social media, in addition to the ability to reach a various audience, may serve to facilitate self-presentation {18}.

Self-presentation activities on social media are closely connected to focus on self-presentation. This consist of caring about how you present yourself on social media, e.g., retouching pictures before posting them, having a nice social media feed or concerns about receiving feedback on your social media posts {19}. A study showed that many adolescents have a desire to focus less on their self-presentation on social media, but that they think is hard to resist the pressure of having a good feed and receive positive feedbacks as likes, comments, and followers {19}. A higher focus on self-presentation has been linked to more use of highly visual social media platforms like Instagram, TikTok and Facebook, and not as much use of less visual platforms {12}.

Likewise, use of social media have been linked to more social comparison, and in particular upward social comparison {20,21}. Social comparison is the propensity to compare one’s characteristics to other people to obtain information about how we are doing relative to others {22}. Upward social comparison occurs when one compares oneself to someone perceived as better or with higher status than oneself, which may be especially prevailing on social media. One study found for example that social media users mostly presume that other users have better lives than themselves {23}. Moreover, following a large number of people on social media increases the reference group to which adolescents compare themselves and may include high-status people like “influencers” and celebrities {24}. Upward social comparison has been reported to be associated with more negative feelings such as depression and lower life satisfaction {11,25}, and more body dissatisfaction {26}. Hawes et al. {27} also found that preoccupation with appearance comparison on social media was linked to symptoms of anxiety and depression among adolescents. Thus, while self-presentation on social media may not itself be harmful, feedback-seeking and social comparison may be harmful to mental health.

Perfectionism

In addition to being a prime period for self-presentation activities, adolescence seems to be a particularly susceptible period for the development of perfectionism. Perfectionism is a personality disposition that may be defined as the tendency to set unrealistically high performance standards and striving for flawlessness {28}. Perfectionism is thought to be a disposition largely consolidated in adolescence as a part of a general identity formation {16}.

Over the last 30 years, there has been an increase in perfectionistic personality traits among young adults {29}. Curran & Hill {29} hypothesized that this might be a consequence of the rise of a competitive cultural trend, and also the advent of social media in young people's lives. Since social media gives adolescents control over how they self-present, social media also allows them to create a (highly) specific and “ideal” image of themselves. Considering these perspectives, Curran & Hill {29} suggest that young people perceive their social context as more demanding and subsequently believe others will evaluate them more harshly. Thus, adolescents of today may to a larger extern strive to self-present themselves in a perfectionistic manner in order to secure acceptance among peers than older generations. Hewitt et al. {30} suggested the concept of perfectionistic self-presentation and argued that this is a maladaptive self-presentation style. One facet of perfectionistic self-presentation is perfectionistic self-promotion, which includes proclaiming and displaying one’s self-perfection {30}. Through features such as likes, comments and followers, social media may be a fertile arena for perfectionistic self-presentation and self-promotion, and hence a way of seeking external validation and approval in a socially acceptable way among adolescents.

A study found that perfectionistic concerns predicted longitudinal change in self-presentation and that perfectionistic self-presentation elevated the risk for decreased well-being {31}. Hence, perfectionistic concerns indirectly affected subjective well-being through self-presentation {31}. Perfectionistic self-presentation also predicted change in both positive and negative affect {31}. In a meta-analysis, perfectionism was found to be positively associated to different psychological disorders and symptoms, including body dissatisfaction, and eating disorders {32}.

Eating disturbance

Previous research has linked eating disturbance to both self-presentation {21} and perfectionism {32,33,34}. A person with eating disturbance will be obsessed with food and have constant thoughts about eating, body shape, weight, and food. Symptoms of eating disturbance above a certain level may constitute an eating disorder according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5th Ed.){35} and the International Classification of Mental and Behavioral Disorders (ICD-10) {36}. A meta-analysis reported that over the last 20 years, there has been an increase in the weighted means of point eating disorder prevalence from 3.5% for the years 2000–2006 to 7.5% for the years 2013–2018 {37}. The prevalence for eating disorder was consistently higher among women compared to men regardless of timeframe (lifetime, 12-months, point prevalence). In the same meta-analysis, the authors also stressed the finding that eating disorders are highly prevalent in adolescence, with an estimated point prevalence between 6% and 8% {37}.

As a great deal of content on social media promotes pictures of healthy food, diets, exercise, and appearance-focused images and idealized bodies, concerns have been raised that social media may contribute to body image concerns and eating disturbances, especially among adolescents {38,39}. A systematic review, conducted by Holland & Tiggemann {39} showed that exposure to content on Facebook, in particular photo-based activity, was positively associated with negative body image and disturbed eating behaviours in children, adolescents, and young adults. Another study found similar results; more exposure to appearance-related pictures on Facebook was associated with self-objectification, weight dissatisfaction, thin ideal internalization, and drive for thinness for girls {40}.

Similarly, research indicates that exposure to others’ “perfect” self-presentations on social media may reinforce one’s own body image concerns and eating disturbance {20,21}. Fardouly et al. {20} investigated women’s appearance comparison in different contexts in young adult women’s everyday life. They found that most of the comparisons were made in-person and on social media, and that the participants made relatively more upward comparisons on social media than in-person. They also found that upward comparison made on social media were associated with more body dissatisfaction than in-person. In addition, upward comparison on social media yielded more thoughts about dieting than in-person comparison, but no difference in the likelihood of dieting-behaviours {20}.

Furthermore, Rodgers et al. {21} found that social media use was positively correlated with higher internalization of appearance ideals, including a higher tendency to engage in appearance comparison, body dissatisfaction, muscle change behaviours and dietary restraints among both boys and girls. In addition, the internalization of social media ideals, the muscular ideals and appearance comparison, were positively associated with body dissatisfaction, muscle change behaviours and dietary restraints. Other research has reported similar results {6,41}. Mclean et al. {41} found for instance, that self-presentation on social media was associated with an internalization of social media ideals, and that the internalization mediated the effect of social media on appearance upward comparison and body dissatisfaction. A scoping review conducted by Dane & Bhatia {42} also reported that in cases were social media use led to eating disorder, the thin/fit body ideal internalization and social comparison often functioned as mediating pathways.

Summary and the current study

As the research on adolescents’ use of social media is increasingly turning away from looking merely at time spent, it has become clear that we should investigate the potential consequences of specific aspects of adolescents’ social media usage patterns. The use of social media, perfectionism, and eating disturbances have all increased over the last decades. Studies indicate a relationship between being exposed to how other present themselves on social media and eating disturbances {20,21}. Some studies also show that the relationship between preoccupation with self-presentation and highly visual social media is stronger than for non-visual social media {12}, hence facilitating upward social comparison.

To our knowledge no studies have investigated the link between one’s own focus on self-presentation on social media and upward social comparison, perfectionism, and eating disturbances, which is the aim of the present study. Based on previous studies we hypothesised that focus on self-presentation and upward social comparison is positively associated with i) perfectionism and ii) eating disturbance, and iii) self-reported diagnosis of eating disorder.

2.1. Study Design, Setting, and Participants

2.1.1. Study sample

This study is based on data from the “LifeOnSoMe” study carried out at public senior high schools in Bergen, Norway. Pupils aged 16 or over were invited to participate. Information about the survey was conveyed both by the teacher and digitally, and the survey itself was conducted digitally. One school hour was set aside for carrying out the survey. The total number of participants was 3,725 (Mean age was 17.3 years (standard deviation 1.0)), and 55% of the participants were girls. This study uses data from two waves of the survey, conducted in September-October 2020 and June-September 2021. For those who responded in both of these two rounds, the response sets from 2020 have been used here. In 2020 the response rate was 53% and in 2021 the response rate was 35%. The study was approved by the Regional Ethical Committee, and is in accordance with the General Data Protection Regulation. Additional information about the study is available elsewhere {19,43}.

2.2 Included variables

2.2.1. Self-reported sociodemographics

The participants reported their age, gender, and subjective socioeconomic status. A small proportion of the participants did not state their age (n = 157). For gender, participants could choose between three options: “girl”, “boy”, and “other/non-binary”. Because too few participants (< 50) answered other/non-binary, these were excluded from the data set due to privacy concerns. Relative socioeconomic status was assessed by asking the participants to estimate how economically well off their family are compared to others, ranging from «Very poor» (scored 0) to «Very well off» (scored 10).

2.2.2. Amount of social media use

Two questions were included related to social media use in general: “How often do you use social media?” and “On the days that you use social media, approximately how much time do you spend on social media?”, giving an estimate of the frequency and duration of their usage, respectively. For frequency, the response alternatives were “almost never”, “several times a month, but rarer than once a week”, “1–2 times per week”, “3–4 times per week”, “5–6 times per week”, “every day”, “several times each day”, and “almost constantly”. In the present study, we differentiated between “daily or less”, “many times a day”, and “almost constantly”. For duration, seven response alternatives ranging from “less than 30 min” to “more than 5 h” were available. In the present study, we differentiate between “<2 h” (28%), “2–4 h” (36%), “>4–5 h” (21%), and “>5 h” (14%).

2.2.3. Independent Variable: Self-Presentation and Upward Social Comparison Inclination Scale (SPAUSCIS)

The items used to assess upward social comparison and aspects of self-presentation were developed based on focus group interviews with senior high school pupils {19}, and have been shown to have adequate psychometric properties in both this sample {44} and elsewhere {12}. Cronbach’s \(\alpha\)was 0.87, indicating a very good internal consistency.

The items included in the SPAUSCIS are:

I use a lot of time and energy on the content I post on social media

It is important to me that my posts receive many likes and/or comments

It is important to me to have many followers on social media

I delete posts on social media that do not receive enough likes and/or comments

I retouch images of myself to look better before I post them on social media

What others post on social media (images/status updates/stories) makes me feel less content with myself and my life

The response I get for what I post (images/status updates/stories) impacts how I feel

The response categories were “not at all”, “very little”, “sometimes/partly true”, “a lot”, and “very much”, coded 1–5, and the mean summed score thus ranges from 1 to 5, with higher scores indicating a higher focus on self-presentation and upward social comparison on social media.

2.2.4. Dependent variables: Perfectionism and eating disturbance

Perfectionism (EDI-P)

Perfectionism was assessed by the 6-item perfectionism scale in the Eating Disorders Inventory (EDI) for children and adolescents {45}. The perfectionism items (EDI-P) are usually rated on a 6-point Likert scale. In the present study, however, the response options were “not true” (scored 0) “sometimes true” (scored 1), and “true” (scored 2) in accordance with the version employed in the youth@hordaland study {46}. This yields a potential score of 0–12 when the items are summed. Previous research has found that the EDI {47} and EDI-P {48} have satisfactory psychometric properties in similar populations. Cronbach’s \(\alpha\) was 0.72 in the present study, indicating acceptable internal consistency.

Eating disturbance (EDS-5)

Symptoms of eating disturbance was assessed using the Eating Disorders Scale (EDS-5) {49}. EDS-5 consists of five questions specifically related to eating, such as comfort eating (item 2) and strict dieting in order to control ones eating habits (item 4). The response options are “not true” (scored 0) “sometimes true” (scored 1), and “true” (scored 2), and the summed scored ranges between 0 and 10. The questionnaire have shown adequate psychiatric properties and convergent validity in previous research {49,50}. Cronbach’s \(\alpha\) was 0.78 in the present study, indicating an acceptable internal consistency.

Operationalization of EDI-P and EDS-5

For the purposes of the present study, both EDI-P and EDS-5 were used as continuous measures, as well as dichotomous variables, differentiating between low and high scores based on the 90th percentile. The chosen cut-off point is informed by previous research which suggest this to be an adequate delineation for mental health problems {46,51}.

Diagnosis of eating disorder

For the participants participating in the study in 2020, self-reported psychiatric diagnoses were available (n = 1978) using a pre-defined list adapted to fit this age-group. Initially, the participants had to answer yes or no to the question “Have you ever received a diagnosis for a mental health problem?”, followed up by a list of possible 11 different diagnoses for those who endorsed the initial question. The list was based on a similar operationalization used in a large population-based studies {52,53}. The list contained no definition of the included disorders or conditions. For this study, the participants who chose “Eating disorder” (n = 36; 1.8%) from the list were identified as having been diagnosed with the condition, and all others were designated as not having received the diagnosis.

2.3 Statistical procedure

First, summary statistics of the included variables for the whole sample were estimated across the median-split of SPAUSCIS and presented in Table 1. For categorical variables, the number and proportions were estimated, and the mean and standard deviation (SD) was estimated for continuous variables. Comparisons across the median-split of SPAUSCIS was done using Pearson’s chi-squared tests for categorical variables, and Wilcoxon rank sum tests were used for continuous variables. Then, two simple linear regression models were estimated using SPAUSCIS as an independent variable and a) score on perfectionism (EDI-P) and b) score on eating disturbance (EDS-5) as dependent variables, respectively. The scores were of the dependent variables were standardized (Z-scored) to ease interpretation of the resulting coefficients. Potential gender-moderation were in both models investigated by entering genderxSPAUSCIS as an interaction term into the model. The interaction term was considered statistically significant with a p-value of < 0.05, and if significant, results from the linear regression model where then presented separately for girls and boys. Linearity of the association between SPAUSCIS and the dependent variables were investigated using restricted cubic splines with four knots. Next, two gender-specific multiple logistic regression models were estimated using the median-split of SPAUSCIS as the main independent variable, and the 90th percentile score on a) perfectionism (EDI-P) and b) eating disturbance (EDS-5) as dependent variables, respectively. Both models were adjusted for usual amount of social media use and socioeconomic status, and the results are presented as odds ratios with corresponding 95% confidence intervals. Finally, we investigated the association between the median-split of SPAUSCIS and self-reported eating disorder using simple logistic regression. No adjustments or investigation of potential gender-moderation was included for the latter analyses as the number reporting eating disorder (n = 36) limited the statistical precision.

Descriptive statistics of the included variables are presented across the median split of score on SPAUSCIS in Table 1. For all of the included variables, there were significant differences between the SPAUSCIS-groups (all p-values < 0.001). The group with median or above scores on SPAUSCIS were more likely to be girls, more likely to use social media more often and for a longer duration but reported a slightly lower subjective socioeconomic status. Furthermore, they were more likely to report higher scores on perfectionism (EDI-P) and eating disturbance (EDS-5).

Table 1

Characteristics of included variables across focus on self-presentation (SPAUSCIS; median split).
	Self-Presentation and Upward Social Comparison Inclination Scale (SPAUSCIS)
Characteristic	Below median, n = 1,752¹	Median or above, n = 1,672¹	p-value²
Gender			< 0.001
Boys	1,095 (62%)	413 (25%)
Girls	657 (38%)	1,259 (75%)
Frequency of social media use			< 0.001
Every day or less	574 (33%)	250 (15%)
Many times a day	844 (48%)	856 (51%)
Almost constantly	332 (19%)	566 (34%)
Duration of social media use			< 0.001
Less than 2 hours	647 (37%)	366 (22%)
2–4 hours	637 (37%)	658 (39%)
> 4–5 hours	254 (15%)	360 (22%)
More than 5 hours	205 (12%)	282 (17%)
Subjective socioeconomic status (0–10)	7.29 (1.77)	7.01 (1.78)	< 0.001
Eating Disorders Inventory, perfectionism (EDI-P)	4.92 (2.61)	5.87 (2.65)	< 0.001
EDI-P, 90th percentile			< 0.001
Below 90th	1,661 (95%)	1,507 (90%)
90th or above	87 (5.0%)	163 (9.8%)
Eating Disturbance Screening (EDS-5) questionnaire	2.17 (2.22)	3.81 (2.77)	< 0.001
EDS-5, 90th percentile			< 0.001
Below 90th	1,637 (94%)	1,328 (80%)
90th or above	110 (6.3%)	342 (20%)
¹n (%); Mean (SD)
²Pearson's Chi-squared test; Wilcoxon rank sum test

Results from gender-specific multiple logistic regression models with median-split of SPAUSCIS as dependent variable, and the 90th percentile score on a) perfectionism (EDI-P) and b) eating disturbance (EDS-5) as dependent variables is presented in Table 2. For boys and girls, scoring on or above the median on SPAUSCIS was associated with increased odds for both dependent variables. For both perfectionism and eating disturbance, the models are adjusted for social media use and socioeconomic status.

Table 2

Association between SPAUSCIS (median-split) and EDI-P and EDS-5. Logistic regression, stratified by gender.
		Boys				Girls
Group	Characteristic	n	OR¹	95% CI¹	p-value	n	OR¹	95% CI¹	p-value
EDI-P, 90th percentile	SPAUSCIS, median split	1,478				1,892
	Below median		—	—			—	—
	Median or above		2.27	1.46, 3.50	< 0.001		1.71	1.16, 2.57	0.008
EDS-5, 90th percentile	SPAUSCIS, median split	1,477				1,892
	Below median		—	—			—	—
	Median or above		2.58	1.51, 4.42	< 0.001		2.14	1.64, 2.84	< 0.001
¹OR = Odds Ratio, CI = Confidence Interval
Note: Adjusted for usual amount of social media use and socioeconomic status; SPAUSCIS: Self-Presentation and Upward Social Comparison Inclination Scale; EDI-P: Perfectionism; EDS-5: Eating disturbance.

There was a significantly higher odds of reporting being diagnosed with an eating disorder among those scoring median or above on SPAUSCIS (crude odds ratio (OR) 3.32; 95% CI 1.58–7.84; p = 0.003).

Figure 1: Association between SPAUSCIS and EDI-P and EDS-5. Linear regressions with cubic splines.

– Insert Fig. 1 here –

Note, Fig. 1: SPAUSCIS: Self-Presentation and Upward Social Comparison Inclination Scale; EDI-P: Perfectionism; EDS-5: Eating disturbance.

Figure 1 presents findings from linear regression models with mean score on SPAUSCIS as the independent variable and the standardized (Z-scored) score on a) perfectionism (EDI-P) and b) eating disturbance (EDS-5) as dependent variables. For both dependent variables, a potential gender moderation of the association with SPAUSCIS was investigated, and potential non-linearity was investigated using cubic splines with four knots. For eating disturbance, a significant gender moderation was found, and the association was stronger for girls than boys. For perfectionism, no evidence for a gender moderation was found. For both dependent variables there was a significant linear association with self-presentation equal to a low-to-moderate effect size.

In the present study we investigated the potential association between focus on self-presentation and upward social comparison on social media, and perfectionism and eating disturbance. As hypothesized, we found evidence for consistent positive associations. That is, increased focus on self-presentation and upward social comparison was associated with increased levels of both perfectionism and eating disturbance, and the effect size was small-to-medium. For perfectionism, the associations were similar for both boys and girls, while we found evidence of a gender moderation for eating disturbance. Specifically, the association with eating disturbance was somewhat stronger for girls compared to boys. For self-diagnosed eating disorder, we also found a positive association with focus on self-presentation and upward social comparison.

The positive association between focus on self-presentation on social media and perfectionism may have several explanations. Curran & Hill {29} argue that the increase in perfectionistic traits among young adults may be due to a response to cultural changes towards a more individualistic and competitive culture in Western societies. As social media is an important part of adolescents’ and young people’s lives, it is likely that the perfectionistic tendencies will affect self-presentation on these platforms as well. Curran & Hill {29} also suggested that the increase in perfectionism among young adults can be due to their perception of increased demands from the social environment. Self-presenting in a socially desirable way in general, and on social media specifically, may be a way to ensure social acceptance from peers. They further hypothesized that the fear of losing acceptance may increase the perfectionistic traits {29}. Hence, increased perfectionism may be the reason for stronger focus on self-presentation on social media. However, since we cannot interpret the direction of the association from this study, focus on self-presentation may also increase adolescents’ perfectionistic tendency. As perfectionism is a personality trait that largely establishes during adolescence, it may be that the constant opportunity to self-present on social media, and thus focus on self-presentation, makes adolescents more susceptible for developing perfectionistic traits.

There is a lack of research on the relationship between one’s own self-presentation on social media and eating disturbance and eating disorder. Most of the research investigating this relationship have looked at being exposed to appearance-related self-presentation on social media and body dissatisfaction and eating disturbance {20,21,39}, not the relationship between a person’s focus on their own self-presentation on social media and eating disturbance. Our results indicate a positive relationship between focus on one’s own self-presentation on social media and eating disturbance. Highly visual social media platforms that exposes adolescents to “perfect” bodies through others self-presentation may constitute an important source for such exposure. In directly support of this notion are previous findings that being exposed to body ideals, may lead to internalization of these ideals among adolescents {21,41,42}. Other research also shows that upward social comparison is a potential consequence of the exposure to others “perfect” appearance related self-presentation {20,27,54}, with body dissatisfaction as one result {26}. Subsequently, some adolescents may be more preoccupied with eating, weight, body shape, and muscularity. This preoccupation could serve as a mitigation strategy to reduce the discrepancy between the adolescent’s perceived appearance, and the ideal body and the appearance of the reference person. Hence reducing the negative body image and negative feelings produced from the upward social comparison.

Another explanation may be that adolescents with eating disturbance already are more preoccupied than other adolescents with how they appear to others. Social media is an apt arena to self-present in an appearance-related and desired way, and could elicit wanted feedback from others through likes and comments, hence reinforcing the focus on self-presentation. A third potential explanation for this relationship is perfectionism as a conceivable mediating factor. As perfectionistic self-presentation can be understood as a maladaptive self-presentation style {30}, perfectionism may lead to a strict view of what constitute a good-enough self-presentation. This may as well include the adolescent’s expectations and demands to their own body as thin or muscular, hence increase the standards of flawlessness in their own appearance-related self-presentation on social media. If these expectations are too rigid, it might for some adolescents be a contributing cause in the development of an eating disturbance.

In relation to the association between focus on self-presentation on social media and eating disturbance we found a stronger association for girls than boys. Hjetland et al. {55} found significant gender differences in how adolescents related to self-presentation on social media. Girls reported that they invested more time and energy on the content of their own social media posts, using more filters to look better at least some times and reporting feeling less satisfied with themselves because of other peoples’ social media posts. Girls also tended to ascribe more importance to the feedback they got on social media than boys. In general, the report showed that social media played a bigger part in the girls’ life than the boys, and that the girls put more importance on what is happening on social media {55}. Hence, more importance put on self-presentation on social media among girls, and social media playing a more important role in girls’ lives, may be stronger underlying causes in development of eating disorders for girls than for boys.

There may as well be other explanations for the gender difference we found. The objectification theory {56}, suggests that women’s bodies are always looked at, evaluated and potentially sexually objectified. Fredricksson & Roberts {56} further argue that these views make women internalize the observer’s perspective of themselves, and socialize women to treat themselves, to a certain level, as objects for the pleasure of others. The emphasis put on girls’ and women’s physical appearance, in particular, is well established in our culture {54}, and through social media’s feedback mechanisms, girls may be more encouraged than boys to self-present in an objectifying way.

Social comparison theory {22}, and especially upward social comparison, is another possible explanation for the gender difference between focus on self-presentation on social media and eating disturbance. Strahan et al. {54} found that when describing their physical appearance, women did significantly more upward social comparisons than downward social comparisons (occurs when one compare oneself to someone with perceived lower status or as less good than oneself), while men made more downward comparisons than upward. This tendency was not seen when women and men described other personal characteristics like social skills. For women, they also found that the more upward social comparison they did, the more negative statements they made about their body {54}. They proposed that ubiquitous appearance norms, mostly applying to women, disrupted strong self-enhancement behaviors {54}. Fardouly et al. {20} also found that women relied on upward social comparison when appearance comparing, and that doing this on social media was associated with more body dissatisfaction than in-person. An explanation for this could be that women experience a stronger discrepancy between themselves and other women they see on social media, than the women they see in-person {20}.

Previous research has primarily focused on appearance-related self-presentation and upward social comparison {e.g. 20} and associated risk among girls, such as body dissatisfaction {26} and eating disturbance {40}. However, it is important to recognize that boys may also be affected by these issues, and a study showed that body dissatisfaction affected boys’ risk of engaging in eating disordered behaviors {57}. The current body ideals for boys emphasize muscularity {58}, and Eisenberg et al. {59} found that muscle-enhancing behaviors are common among American adolescents, including both boys and girls. This were behaviors like dieting, exercising, and taking protein supplements or steroids, with the aim of increasing muscle size or tone. However, most of the behaviors measured were significantly more common among boys {59}, and Compte et al.’s {58} investigation of muscle dysmorphia among young adult men indicated a prevalence of almost 7%. Hence, another explanation for the gender difference we found, may be that the EDS-5-questionnaire does not identify symptoms of drive for muscularity or muscle dysmorphia. In fact, muscle dysmorphia and the likes seem to be more of a concern than thinness and weight loss among boys {58}. The EDS-5 measures of symptoms of eating disturbance are linked to preoccupation about weight loss, body shape and drive for thinness {49}. This is important and needs to be borne in mind, as it suggests that the EDS-5 questionnaire may not fully capture the range of body image concerns among both boys and girls.

Implications

The present results demonstrate the need to address focus on self-presentation and upward social comparison on social media as a potentially important factor for adolescents’ mental health. As such, promoting a healthy use of social media could be established through a focus on increasing adolescents’ ability to reflect on and think critically about self-presentation and upward social comparison on social media. Educational programs and social media literacy programs in school have been suggested to increase adolescents’ reflections about their own and others social media use {38,60,61}. Gordon et al. {38,61} introduced a four-lesson social media literacy program in a junior high school, that aimed to decrease body dissatisfaction, dietary restraints and focus on increased muscles among young adolescents. They found only a small effect of the intervention. The intervention did not focus on self-presentation and based on results from this study and previous research {e.g. 12,23}, this would be an important topic to address for future interventions. Also, previous results suggest that interventions given by someone who already has an established relationship with the adolescents and is familiar with their needs help facilitate discussions among the adolescents {38}, and improve intervention outcomes. This could be done by a teacher by integrating social media literacies in already existing school subjects.

A study of university students showed that women who had a higher internalization of the thin-ideal, were more vulnerable to body image disturbance and hence to appearance exposure in media {62}. They also found that body appreciation protected women from negative effects of the exposure {62}. Thus, developing social media literacy programs specifically focusing on the effects of self-presentation and upward social comparison could be an important target for interventions. Research {63} also suggest that increasing self-compassion is a useful strategy to prevent perfectionistic self-presentation on social media. As perfectionistic self-presentation is related to lower subjective well-being {31}, this may also be a topic to address in an intervention aiming to reduce focus on self-presentation and upward social comparison on social media.

Future research should investigate the concept of self-presentation on social media more closely. It will be important to examine if different ways of self-presentation vary from each other. Previous research has been studying how people self-present, especially selfies as one way of self-presenting {e.g. 64,65}, and further research should investigate if taking pictures of oneself and posting them is dissimilar from other ways of self-presentation on social media when considering its association to mental health among adolescents. SPAUSCIS consist of only one item asking about ways of self-presenting (“I retouch images of myself to look better before I post them on social media”), thus future research on other ways of self-presenting should include self-presentation for example through pictures of other aspect of the adolescents’ life, like friends or hobbies, or through text only. Investigating self-presentation on social media, perfectionism and eating disturbance among younger adolescents than we included in our study will be important as the use of social media starts early and as eating disturbances often makes its onset in adolescence {66}. Understanding at what age focus on self-presentation becomes more prominent for adolescents’ and potential gender differences regarding this, may also be important to pinpoint intervention opportunities.

Strengths and limitations

A major strength of the present study is that it is the first study to investigate the relationship between focus on self-presentation on social media, perfectionism and eating disturbance. So far, the research on this has focused on being exposed to others (perfect) self-presentations and the prevailing body ideals {e.g. 20,21,26,41}. To our knowledge no previous study has examined the association of one’s own focus on self-presentation and perfectionism and eating disturbance before. In addition, the scales used in this study are well-established {48,49,50}. Also, the items of SPAUSCIS were derived from focus-groups interviews with adolescents {19}, which make them relevant for adolescents’ experiences related to self-presentation and social comparison on social media. Some limitations are also worth mentioning. The study is cross-sectional, thus we cannot determine causality between the investigated factors and mental health. Despite the sample being large, it is limited to high schools in Bergen, Norway. Consequently, the results may not be generalized to other countries or cultures. Also, the participate rate was moderate (54% and 35%), which may impact the validity of our findings. However, associations are less vulnerable to bias caused by low participation rates than prevalence estimates {67}. And finally, although EDS-5 is a well-established and validated measurement, the questionnaire does not cover specific symptoms of drive for muscularity and muscle dysmorphia.

To our knowledge this is the first study to examine the association between self-presentation among adolescents on social media, upward social comparison and perfectionism, and eating disturbances. As we hypothesized, our findings suggest that focus on self-presentation and upward social comparison on social media is positively associated with both perfectionism and eating disturbance, as well as self-reported eating disorder among adolescents. Focusing on how the adolescents relate to self-presentation on social media, the study gives new insight into important aspects of usage patterns of social media, and potential gender differences in self-presentation and upward social comparison on social media’s potential role in development of eating disturbances. As such, promoting a healthy use of social media could be established through a focus on increasing adolescents’ ability to reflect on and think critically about self-presentation and upward social comparison on social media.

Ethics approval and consent to participate:

Institutional Review Board Statement

The study was conducted in accordance to the guidelines of the Declaration of Helsinki, and approved by the Regional Ethical Committee (REK) in Norway (REK#65611). All participants gave informed consent prior to participation, and was informed about the general purpose of the study and the opportunity to withdraw from the study at any point. As all the adolescents invited were 16 years or older, they were considered competent to consent on their own behalf, and additional consent from parents or guardians was not prerequisite.

Consent for publication: not applicable.

Availability of data and material: Explicit consent from the participant is required by the Norwegian Health research legislation and the Norwegian Ethics committees in order to transfer health research data outside of Norway. Ethics approval for this was also dependent on storing the research data on secure storage facilities located at the Norwegian Institute of Public Health, which prevent the authors from providing the data as supplementary information. Request to access these datasets should be directed to [email protected].

Competing interests: The authors declare that they have no competing interests.

Funding: The work of GH was supported by Dam Foundation (grant number 2021/FO347287) while the work of JCS, AIOA, and TRF was supported by The Research Council of Norway (grant number 319845).

Author’s contributions: JCS analyzed the participants’ data regarding the LifeOnSome-study. All authors contributed to interpretation of the results. HED and JCS wrote the first draft of the manuscript. Additional contributions and revisions to the manuscript were made by TRF, AIOA, GJH, VW, JCS, and HED. All authors read and approved the final manuscript.

Acknowledgment: We are grateful to Bergen municipality and Vestland County Council for their collaboration on this study. The present study is linked to a larger innovation-project lead by Bergen municipality in Western Norway related to the use of social media and mental health and well-being. The innovation-project is funded by a program initiated by the Norwegian Directorate of Health and aims to explore social media as platforms for health promotion among adolescents. Above all, we are very thankful for the students who participated in this study.

Authors’ information: Not applicable.

Footnotes: Not applicable.

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04 Jul, 2023

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Mirror, mirror on my screen: Focus on self-presentation on social media is associated with perfectionism and eating disturbance among adolescents. Results from the “LifeOnSome”-study.

Status:

Journal Publication

Version 1

Abstract

Figures

1. Introduction

2. Materials and methods

2.1. Study Design, Setting, and Participants

2.1.1. Study sample

2.2 Included variables

2.2.1. Self-reported sociodemographics

2.2.2. Amount of social media use

2.2.3. Independent Variable: Self-Presentation and Upward Social Comparison Inclination Scale (SPAUSCIS)

2.2.4. Dependent variables: Perfectionism and eating disturbance

2.3 Statistical procedure

3. Results

4. Discussion

5. Conclusions

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1