17: Teen Boys, TikTok, and Bigorexia

Today I'm talking with Dr. Scott Griffiths. Scott is a senior lecturer in the School of Psychological Sciences at the University of Melbourne. He leads the Physical Appearance Research Team, a multidisciplinary group of researchers and health professionals who investigate body image, appearance related stigmas and discrimination, appearance enhancing substances, appearance enhancement and appearance related psychological disorders such as eating disorders and body dysmorphic disorder.

I wanted to talk to Scott about the phenomenon of muscle dysmorphia, a disorder that sits somewhere between a body dysmorphic disorder and an eating disorder that tends to impact cis boys and men. It's sometimes characterised as the male anorexia. Of course cis boys and men get anorexia too, but muscle dysmorphia is a bit different. It's sometimes known as Bigorexia. It's when an individual doesn't believe that they're big enough or sufficiently muscular to the point that they devote their lives to gains and progress in the gym. They might follow extremely strict diets which prioritise protein and cut out a lot of carbohydrates, and in some cases men can turn to using anabolic steroids, which have some really serious long-term effects for both physical and mental health as you'll hear us talking about. A lot of Scott's research is about the ways that social media, and particularly TikTok feeds people who are vulnerable to eating disorders or muscle dysmorphia, more and more content that upholds unrealistic body and image based ideals, and actually fuels eating disorders.

It's really interesting research to hear about, but as a parent and as someone who works with eating disorders, it's really terrifying.

Find out more about Scott’s work here.

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Here’s the transcript in full:

Scott: When you're on your feed and TikTok is delivering videos for you to consume, all of the reference points you are getting from content that it’s popular and influential and that people are responding to it. It's so divorced from reality that you've got a greater pool of people comparing and feeling poorly about themselves and now investing in the general necessity of looking better.

INTRO

Laura: Hey, and welcome to Can I Have Another Snack? I'm Laura Thomas, an anti-diet, registered nutritionist, and author of the Can I Have Another Snack newsletter. We're having conversations about how we nourish ourselves and our kids in all senses of the word in the hellscape that is diet culture.

Today I'm talking with Dr. Scott Griffiths. Scott is a senior lecturer in the School of Psychological Sciences at the University of Melbourne. He leads the Physical Appearance Research Team, a multidisciplinary group of researchers and health professionals who investigate body image, appearance related stigmas and discrimination, appearance enhancing substances, appearance enhancement and appearance related psychological disorders such as eating disorders and body dysmorphic disorder.

I wanted to talk to Scott about the phenomenon of muscle dysmorphia, a disorder that sits somewhere between a body dysmorphic disorder and an eating disorder that tends to impact cis boys and men. It's sometimes characterized as the male anorexia, which of course cis boys and men get anorexia too. But muscle dysmorphia is a bit different. It's sometimes known as bigorexia. It's when an individual doesn't believe that they're big enough or sufficiently muscular to the point that they devote their lives to gains and progress in the gym. They might follow extremely strict diets which prioritize protein and cut out a lot of carbohydrates. And in some cases men can turn to using anabolic steroids, which have some really serious long-term effects for both physical and mental health as you'll hear us talking about. A lot of Scott's research is about the ways that social media, and particularly TikTok feeds people who are vulnerable to eating disorders or muscle dysmorphia, more and more content that upholds unrealistic body and image based ideals and actually fuels eating disorders.

It's really interesting research to hear about, but as a parent and as someone who works with eating disorders, it's. Really terrifying. So you'll notice that this episode has a slightly different vibe to some of the other episodes this season. I'm asking Scott more about his research on muscle dysmorphia rather than his, you know, personal story. And I'm curious to hear what you think of this episode and get some feedback from you as to whether you'd like more interviews with academics, researchers and practitioners with a particular kind of expertise or on a particular topic like this, in addition to hearing people's lived experience. So if you want, you can drop me a comment over on Substack underneath this episode, um, which you can find at laurathomas.substack.com.

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Okay, team, I appreciate your support and hopefully one day we can make this work more sustainable, so I can give up my side hustles. Thank you so much for being here. Here is my interview with Scott Griffiths.

MAIN EPISODE

Laura: All right, Scott, I would love it if you could start by telling us a little bit about how you got interested in studying appearance related psychological disorders like body dysmorphic disorder and eating disorders.

Scott: When I was a teenager, I worked at a cinema and someone who worked there who was kind of a friend of mine, a young woman, she had anorexia, and I remember at the time being completely mystified by her ailment and predicament. And it's probably quite stigmatizing in retrospect because it seemed to me as a, you know, kind of a fool, that the solution to her problem was readily at hand.

Like she was really thin and, and just needed to eat. And that kind of set my thinking in motion about the really complex feelings and beliefs that folks can have about their body and their eating, et cetera. And it was when I was in undergraduate doing a, a Bachelor of Psychology that I had a couple of friends, both young men who would say things to me that would remind me of that young woman who had anorexia in the cinema and things they would say were similar, but the manifestations of them were different. The kinds of eating and, and training and the bodies that they wanted for themselves were all different, but it's core, it seemed like the same kind of issue and disorder. So I think that was what got me interested. And it's developed a lot since then.

Laura: Yeah, it's so interesting. I think you know that I work with people with eating disorders and something I often hear from them is like, well, it just, how misunderstood that the disorder is, and from the outside, especially to anyone who knows nothing about eating disorders, it seems like, yeah, it's really simple just to eat more food.

But I think you've been on your own learning journey with that and, and come through the other side and realized it's, it's a lot more complicated than that. These people would, you know, if, if it was just, just as easy as eating food, they would do it. But unfortunately that's, that's not the case.

Sorry, that was a little tangent cuz I think you were touching on something that I know is really important to those with lived experience of eating disorders. And then kind of moving further along, it's really interesting that you saw the parallels between anorexia nervosa and then what I think you would probably characterize as body dysmorphic disorder. Which is the same but different. And maybe the same is too much of a stretch. But it's similar, but also different. So I'm wondering for people who are unfamiliar with body dysmorphic disorder, can you tell us what exactly it is and maybe some of the, the des describing more of the parallels between something like anorexia nervosa or what we would consider to be a more traditional in inverted commas eating disorder versus what we see in the BDD presentation.

Scott: When I was talking with those, those friends, those young men when I was at university the disorder that would best capture what was going on for them is something we call muscle dysmorphia, which is a subtype of body dysmorphia disorder, which kind of sits alongside eating disorders. They are distinct, but they're often comorbid.

They both have body image often as a central element. So body dysmorphic disorder, the cardinal symptom is you believing there is a defect in your appearance. It can be completely imaginary or it can be real, but the severity of it in your head is almost always much more severe than it is in actual objective reality.

And in the context of muscle dysmorphia, which many people, including myself, see more as an eating disorder than body dysmorphic disorder. The defect in appearance is guys, some girls, but often guys who objectively are, are very large and muscular, but when they look in the mirror, what they see reflected back to them is someone who is scrawny, out of shape or overweight.

Just a big difference to how they actually are not at all dissimilar to anorexia where we have people, often young women predominantly, but also some men who look in the mirror and see someone reflected back to them who is very different to how they actually look.

Laura: It's interesting that you said that you characterize muscle dysmorphic disorder as more similar to an eating disorder than to true body dysmorphic disorder, and I'm curious to hear a little bit more about why you feel like it fits more into that category.

Scott: Yeah. To be fair, when people debate about whether muscle dysmorphia ought to be a body dysmorphic disorder as it currently is classified or an eating disorder, it feels a little bit like a semantic exercise.

Laura: Absolutely.

Scott: The real push and importance in research as far as I'm concerned, is trying to understand both disorders and develop better treatments and trying to figure out which, which category where there's so much overlap between these two categories already, it belongs to, feels a little like a moot point, but to, to answer the question. For me, it's because when you look at the central pathology that motivates folks with muscle dysmorphia, the low self-esteem, especially around appearance, the kinds of things they believe with respect to why they have to look a certain way in order to have worth and be loved.

The attention given to dieting and to exercise and the inability to tolerate deviations from that, the need to constantly progress, the perfectionism, it's all there. It all feels like different sides of the same coin. And when I speak to people, including yourself and your audience, it feels to me like explaining away muscle dysmorphia as one manifestation of an eating disorder, kind of like anorexia, or the reverse of it is just an easy way to see how it is that eating disorders are so much more than just thinness, that they can manifest in all sorts of different ways depending on the types of bodies that people feel compelled to achieve for themselves.

Laura: Yeah. Oh, that's so interesting. And I'm, I'm wondering if you could tell us a little bit more about sort of, you know, maybe not with going with, without going into tons and tons of detail that might be upsetting to hear, but just tell us a little bit about, a bit more about you know, how would you know if someone had muscle dysmorphic disorder? You know, I'm thinking about parents who, you know, what are the signs and symptoms that someone might want to look out for that are sort of red flags, if you will.

Scott: Got you. So, when you're trying to identify red flags, some muscle dysmorphia, a useful starting point is to recognize that almost everything that is common in muscle dysmorphia can exist and be benign. So you can train five, six days a week every day of the week if you want. And it's completely fine, as long as it's working for you.

You can diet right, and it can be fine. Not a psychological disorder if it's working for you. It's not encouraging people to go and do it, but it's not a psychological disorder to do it in muscle dysmorphia. It's when there is a preoccupation and that preoccupation is causing impairment. So it could be that your training and dieting have become so strict that when you feel that your training or dieting are about to be compromised in some way, maybe there's an important social occasion that you have to attend, and it means that you don't get to stick to your diet or go to train or something unexpected comes up, and you have to prioritize that other important unexpected thing.

If that brings you anxiety and guilt makes you angry at yourself, then you are in the territory of massive dysmorphia as opposed to just behaviors that are otherwise benign with respect to disorder.

Laura: Yeah, so you're just highlighting here that you know, the behaviors in and of themselves are not pathological. You know, plenty of people go to the gym, you know, they are super careful with their diet. Where it runs into kind of hot water is when, you know, that becomes almost like all encompassing.

It takes over your life. It doesn't allow for any flexibility. It becomes very rigid. You can't go to your mates birthday party or just like, go pick up a pizza after work because it’s a mess. So that flexibility in eating, that flexibility in your social life, but also I suppose kind of the feelings of guilt, remorse, stress, that might come up if you do do those things.

Scott: That's right. And the deteriorations tend to come from many places. They don't just come from one. So maybe you find that on the days where you have to rest where you can't be in gym training, cuz you've gotta have a couple of rest days to recover, you don't feel so good on those days. Maybe every time you don't progress in the gym, so you're not adding on to the weight, you're not getting stronger, it makes you feel like rubbish.

Whereas when you first started out, maybe all of those things made you feel really good. Maybe your relationships are starting to suffer. Maybe your partner has had four or five conversations with you now about how they don't like how it's so challenging to go out to a restaurant, et cetera, etc.

There's going to be no one thing, but the things tend to all come. Together. And what's challenging as you would well know in the eating disorder space is that the person who is in the thick of it is sometimes not the best judge of how extreme and rigid what they are doing is, and not uncommon at all to have folks who've come out the other end of these disorders look back and say, oh man, I can't believe I didn't see just how crazy it was for me at that.

Laura: And that's a really important point, and I'd like to come back and think a little bit about how particularly a parent might address this or raise their concerns with you know, maybe their teen who they know is becoming super fixated on the gym and really rigid around that.

Maybe we could come back to that because I feel I still wanna characterize a little bit more of what might be going on for people with muscle dysmorphic disorder. And a big piece that I feel like we haven't talked about yet is the use of anabolic steroids.

So yeah, could you tell us how that and maybe any other kind of diet aids and things fit into the picture of muscle dysmorphic disorder?

Scott: Yeah, sure. So, if you wanted to be thin and skinny and you were going to abuse drugs to get there, you might use laxatives and diuretics. If you wanna be big and muscular the drug that will typically be abused is anabolic steroids. So the most basic anabolic steroid is just a synthetic form of testosterone, the sex differentiating hormone that men tend to have more of than women, and it helps to synthesize muscle. So if you wanna be bigger muscular, if you've been influenced by, you know, famous fitness influencers, many of whom are using steroids, it may be something you're tempted to turn to and unlike with laxatives and diuretics, where if you take them, they don't have any substantive impact on the calories that you absorb (another way of saying they don't work very well). anabolic steroids, unfortunately do work very well. It's a bit of a public relations disaster, really.

Laura: Can I just put a tiny caveat that for people who abuse laxatives and diuretics, in terms of, I just wanna highlight that they are still really dangerous and they can cause electrolyte imbalances. Just because I know people with eating disorders will listen to this podcast and I've worked with eating disorders for long enough to know that they will hear that and think, oh, okay, that means they're safe

So, I just want to highlight that it can cause problems in terms of your intestines. There can be problems with, I'm forgetting the terminology now, but basically twisting your intestines because it just messes with your digestion so much.

I'm thinking about laxatives here, but also it can cause dangerously low electrolyte levels in the body, which can cause fits and seizures. So they're not benign, and I don't want anyone to walk away with the message that they're benign. But that's aside from what you're talking about, which is that yeah, you know that people with muscle dysmorphic disorder are more likely to abuse steroids.

So, yeah. Could I pass it back to you now?

Scott: Of course, and steroids on top of being effective, which makes them very attractive in terms of, you know, as a temptation they also have rather significant health consequences, especially in the long term. But why I bring up the fact that they are effective for building muscle into such a significant degree that you have outfits like the International Olympics Committee who test for doping.

The use of things like steroids in sports is because once you're on them, you will experience the progress that you've been craving and to a very significant degree. So folks will get on them, they will put on a lot of muscle, they might even lose some body fat at the same time, which is incredibly challenging to do if you are not on these substances.

And of course, they feel. for a time, but they still have the core beliefs and attitudes and thinking so that high doesn't last for very long. But now not only are they not satisfied with their current size often, but to drop in size by coming off would trigger the kinds of intense feelings and distorted thinking that you also see when folks with anorexia are going through recovery and are, you know, weight restoring.

So it's incredibly challenging. And what ends up happening is that you have to then treat both the muscle dysmorphia, which is very much a psychological disorder, and the anabolic steroids and their effects, which is an endocrine impactor. And dealing with these in combos is challenging.

Laura: And, I was just wondering if you could talk a little to the, the longer term side effects of of the steroid use.

Scott: Sure. So the longer term side effects tend to focus on increased mortality and morbidity from, from cardiovascular events, heart attacks, enlarged hearts. The endocrine effects focus predominantly on the capacity of your endocrine system to resume a normal amount of testosterone production endogenously, so from within, subsequent to stopping steroid use.

Because when you flood your system with anabolic steroids or synthetic testosterone, the reason men's testicles shrink is because most of the function of testicles is to make testosterone. So the body says, oh, I'm full of testosterone. Now I'm not gonna make any more myself. But when you doing the injections of the tablets and you don't have that testosterone coming in, the body has to restart that system from scratch. And as we've learned, it is not very reliable at doing that. And it is very unpredictable how well that is gonna happen. And there's many, many, many instances of men as young as 23, 24, who will be on testosterone replacement therapy for their entire life, and who have their fertility are greatly compromised now because their bodies have not resumed normal testosterone production.

Laura: Yeah. What you're describing is really similar to what happens when once this women are taking the contraceptive pill and then they come off of it and they might not restart their period for five or six months after, hopefully all going well. But what you're talking about, I think in muscle dysmorphic disorder, where there's an abuse of these drugs that those, as I understand it, the doses are much higher than a typical physiological dose.

And so the impact, the effect is much, much greater and could last a lot longer, you know, if function is ever fully regained.

Scott: Yeah. To give you some context, a beginner's of anabolic steroids, a beginner steroid cycle, if you will, might prescribe something like 500 milligrams of testosterone enate, a really commonly available steroid. I'd wager a bet that it's most widely available in the UK, certainly is in Australia. That beginner's dose is already five times higher than the maximum that a healthy male would produce on their own. And that much testosterone, flooding a system is beyond the bounds of what the human body is used to dealing with.

Laura: Yeah. And, and you mentioned you know, the UK context there and there were headlines a couple of years ago that suggested that first of all, that predominantly steroid users in the UK were were using steroids as an appearance or an aesthetic related, you know, for aesthetic reasons rather than for purely like bodybuilding lifting reasons.

Although I, I can imagine those things get kind of murky to tease apart and. At that time, I think this was about 2018 the, the reports were that there were about a million steroid users in the UK for, you know, for aesthetic reasons. Is that an accurate reflection? Do you know? Like, is that likely an underestimation, an overestimation, or do we have any, any real sense of what's going on?

Scott: I'd say there's a great chance that's an underestimate. Steroid use is incredibly stigmatized. It's heavily criminalized and users are extremely loath to admit even to health professionals that they use anabolic steroids. And you see these schisms even in fitness communities online. So Instagram, TikTok, where there's this constant accusations that someone is using steroids or is natural or bloody for short. So, it's all very underground and it means that whenever you do get an, an estimate based on data that is credible. So in Australia that would be visits to needle and syringe programs as one example, to get injecting equipment for steroids. You can be almost certain that that's just a fraction of what's actually going on out there. And all the evidence we have, at least in Australia suggests that anabolic steroid use is increasing in prevalence and it's gone from something that used to be the purview of just athletes through to professional weightlifters to now those only being a minority. It's very much an aesthetics driven thing.

Laura: So tell us what we know about who Muscle Dysmorphic Disorder impacts. You've alluded to that it's mostly cis men. But can you elaborate any further on that?

Scott: Sure. So itt's mostly cis men because cis men are the largest pool who would want to be muscular. But you see certain subpopulations of men who are more vulnerable. Gay men are more vulnerable to muscle dysmorphia and to using anabolic steroids because of the heightened appearance pressures in that space. Younger men. So it does tend to be something that has its onset in younger years similar to anorexia.

Laura: Sorry, I was gonna ask you, we know kind of what age do boys start becoming vulnerable? Because we know in anorexia it can be as young as like eight or nine sometimes, and that age is getting younger and younger.

Scott: Yeah. And you see the same thing in muscle dysmorphia. So the first vulnerability factors can appear there. Studies have been done with action figurines and you have young boys asked which one do they prefer more? And they're able to, to, they have their preferences in line with what you'd expect, and they'll expect a preference for their own bodies to look certain ways, as you'd expect, given media messaging.

So the vulnerability factors are there. In terms of muscle dysmorphia on setting tends to take quite a while. You'd be familiar. It's not the case that you hear a couple of messages, you get a mean comment about your appearance, and then suddenly you have it . It's years of internalizing and a bunch of factors that come along, and then it might strike in your teens or your early adulthood.

And we see that in muscle dysmorphia too. Steroids often come into the piece a little later, so early adulthood to mid, and it's because they're expensive and they're hard to access.

Laura: Yeah. You need to be kind of savvy also. Yeah. I can imagine kids who have figured out the whole cryptocurrency thing. I'm sure that they, you know, would get in there if they could, if they had the means. So you're saying gay men are more at risk. What, are there any other sort of subpopulations that you know, you're particularly worried about?

Scott: Men who are in sports for which body weight or some aesthetic element around body weight is a key part. So not uncommon to have guys with muscle dysmorphia say that a lot of some of these thoughts came about because they had to weigh in for their sports. Maybe they were, they were boxes or fighters, something like that. So it just primed them to be in the space of being anxious about the number on the scale and how their fitness was progressing. Things like that.

Laura: Do we know anything about racialized groups and, and who might be most at risk?

Scott: There is some evidence though, it's not great in terms of its quality as of yet, that folks in predominantly white countries who are not white themselves may be at greater risk for both muscle dysmorphia and steroid use. Data we produced in Australia that was specific to gay bisexual men of, of various races suggested for example, that, you know, if you were an Asian gay man in Australia, that you might be more likely to use anabolic steroids and to succumb to muscle dysmorphia.

And in talking with Asian gay men in interviews in qualitative research, part of it is because, you know, if you are an Asian gay man in Australia, then you are often stereotyped as being more feminine. You're not able to be part of the masc for masc subculture, which is still quite dominant and exclusionary and anabolic steroids are a way to compensate for those other aspects of your appearance that are diminishing your masculine capital. You can see something similar happen for men who are shorter. If you go to spaces online where men are complaining about being short to other men, they'll often see, just hit the gym, just get jacked. It's a way to compensate for those other elements that are not helping you to embody that masculine archetypal, conventionally attractive male.

Laura: Hmm. Okay. A while back, you talked about pressures from the media. And that has, you know historically, particularly in anorexia research, been held up as a huge antecedent, I suppose, to eating disorder precipitation, but now there's this whole other layer of social media on top of things. How does, and I'm thinking about the fact that young people in particular hang out on TikTok and Instagram and Facebook and maybe less Facebook these days I don't know. I don't go on Facebook. So what do we know about the influence that social media is having on aesthetic and appearance based pressures?

Scott: Social media makes people more vulnerable to eating disorders, including muscle dysmorphia. And if you are vulnerable, it can make the transition to having one of these disorders shorter. It can intensify it. And I think it can also assist in maintaining them for longer as well. So the reason why media messaging can be so problematic and damaging in terms of vulnerability for and experiencing eating disorders is because you end up with all these idealized reference points and what social media does is expands that limitlessly so that when you're on your feed and TikTok is delivering videos for you to consume, all of the reference points you are getting from content that is popular and influential and that people are responding to. It's so divorced from reality that you've got a greater pool of people comparing and feeling poorly about themselves and now investing in the general necessity of looking better.

Laura: So this is an area that you've been researching. Am I right?

Scott: Yeah, that's right.

Laura: Can you tell us a little bit more about, you know, specific studies or experiments that you've done, that you're excited to share a bit more about?

Scott: So, you know, studies of social media, including of TikTok, generally what they will do is have an experiment and you'll show people some images or videos from social media platforms that you're worried about and see how people respond. Or you have people answer a survey question that will amount to, how often do you use, say, TikTok, Instagram, and you correlate that with some measure like how you feel about your body.

And that's all well and fine. But where the real explanatory power is, in my mind, is in big data and getting access into exactly what people are seeing and viewing so you can map their social media experience. So what we've been able to do is to take a group of people with eating disorders and a group of people who, we call it our healthy controls, that don't have eating disorders. And see their entire TikTok algorithm from the day they installed it to the day we requested the data. And that means we can track exactly every video that's being delivered to them, the comments, the likes, all with their consent, I'll just say, of course not being done without that. And we can see what is happening.

What it means is we can show things like if you are someone with an eating disorder, your TikTok algorithm that decides what videos you see every time you log in is 50% more likely to deliver you an appearance oriented video for each and every video that you see compared to someone without an eating disorder.

And the amount of videos that these folks are seeing, the average is around 2000 a month. So if you are someone in weekly therapy for an eating disorder, If you're a clinician and you have someone who you're

Laura: Oh my God. I'm just sitting here thinking about like some of my clients. I'm like,

Scott: That's 500 videos on average that they are seeing between each session. And when we run studies to compliment these on new phones with fresh TikTok accounts that we manage, it only takes three minutes to get an appearance oriented video.

You get 17 in the first 20 minutes. So it's not that people are seeking this content out. It happens anyway. And when we look at the rate of liking that folks with eating disorders have for this content versus folks without. It's not that the folks with eating disorders are looking for this content, they're liking it at the same rate because what's algorithm is doing is not taking what you like to determine what you want to see. They're interested in engagement, whether it's Facebook or, or Instagram or TikTok. It's what keeps you looking and what keeps you looking isn't just what makes you happy. It's what makes you anxious or what makes you upset. It's what makes you mad. And if you are someone who is really unhappy or worried about the way you look, it knows which videos will make you look more. And that's exactly what happens. And you can see over time how the algorithm becomes more echo chambery as people get sucked into the vortex of this content.

Laura: I think the scariest part for me both as someone who works with eating disorders and as a parent, like my child is obviously not on social media right now, but will be one day I'm sure, is the fact that they know, like the social media companies know exactly what they're doing because wasn't it a couple of years ago, but there was a whistleblower at meta. Who said who, who said, we have all of this information that shows that our algorithms are making body image and eating disorders worse, and yet they're not doing anything about it.

Scott: Yeah. And then they downplayed and discredited their own data generated by the star researchers they themselves hired which is absurd. And the reason that they don't wanna do anything about it is because the..

Laura: It's capitalism.Sorry, go. 

Scott: No, you, you're exactly right. The money is made from engagement. And I think the faint that the social media companies do is to imply that what they're doing is giving people what they want, community connectedness. And when it comes to advertising that they're connecting people with the products that they want to buy. And through being able to like things, you can get the sense that, oh, the social media companies are just sitting back and people are doing what they want in there.

They're getting what they want, but certainly, the controls that you think you have over what your algorithm, especially on TikTok is sending you is less. And it's about engagement. And engagement doesn't care how you feel, if it's positive or negative, it just cares that you spent the time. Whatever it takes to get you to do more time is what it is going to send you. It's worth noting also that when you look at the proportion of appearance honored content that your algorithm sends you, so how big this echo chamber is, that correlates strongly with the eating disorder symptoms. So the more your algorithm becomes, you know, polluted by appearance, honored content, the worse the eating disorder becomes in tandem. And why wouldn't it?

Laura: I have a question, and you might not be able to answer this. One of my clients uses the term recovery porn in eating disorder recovery, which are all of these images of usually women who claim to be in recovery or recovered. Have you looked at the impact that these recovery accounts have on eating disorder recovery?

Scott: I've not looked at that specifically, but I'm well aware of the phenomenon your client has described. And unfortunately, lots of social media phenomena and hashtags, like for example eating disorder recovery, body positivity is another good example.

Laura: Yeah.

Scott: They are not clear paragons, they're not at all as clearly useful as we would like them to be if someone went searching for them. You go looking for ed recovery, you might find an account that is extremely thoughtful in the way that that content is presented right alongside content that is clearly not being very helpful. Just like with body positivity, you might get someone who hearkens back to the, the fat acceptance movement, who's really preaching the fighting the good flight right next to someone who is perhaps well-meaning, but still thin, skinny, and they're pinching a tiny little roll of fat and going body positivity, which as I can tell from your reaction is missing the point.

Laura: Yeah. Okay. Maybe, maybe something for a future research agenda then, Scott.

Scott: Absolutely. It's a great suggestion.

Laura: I'm curious to, because, and I think what it comes, what it comes back to you articulated it there really well. I think something that I tried to unpack with my clients, you know, is thinking about, okay, well, is this image, they might have the message on point, right? But if there's an image that is still highly focused on aesthetics, it's highly focused on their body and, you know, showing off their body in a particular way, then that really completely undermines the message that they might have been sending with the best of intention.

So just a little interesting aside, but you know, you've talked about how social media, you know, there might be some benefits to social media. I think there's definitely some work that has shown that coming out of the center of appearance research, but it's murkier and less clearly defined than, than maybe we would like to think.

So you painted this really dark picture of social media and, and how it contributes to muscle dysmorphic disorder. So I'm wondering what we can do both from maybe a clinical perspective, or maybe a public health perspective as well as maybe a parenting perspective to protect our kids from internalizing these messages because they're gonna be exposed to them. Right. We know that for sure. So how do we buffer the impact, both maybe at the broader public health level, because this is a public health issue clearly, but also maybe in our own parenting in our own homes.

Scott: Yeah. And okay, you're absolutely right. You cannot start from a base of let's not use social media altogether. That's, that's the arena. That's where youth culture is driven in, telling young people not to use it is just not practical. So they're going to use it. Encouraging your child to be a critical consumer of media generally, including on social media, is really useful.

I think if you feel confident enough to talk about it, explaining to them that what they see is delivered to them by algorithms can be useful. That's something we're exploring in our own research where we want young people to have a better understanding that what they're seeing in their feed is not a one-to-one reflection of reality to the world as it actually is.

And that's beyond the, you know, manipulation of photos and self portrayals that go on, but like the algorithm just feeding you with whatever activates your emotions. Part of that is this tool we're developing that can visualize your algorithm for you so that you can know and compare it to others just how biased it's become. And this can be for clinicians too, because if you have a client walk in the door, you need to know if 70% of their feed is appearance oriented, which is not a number I picked out of thin air. That's an actual number from clients we had with anorexia nervosa. And then you can have a productive conversation with that person around, okay, your algorithm is not only not reflective of reality, it's doing you harm and this is how we can work to remediate it.

Laura: I would definitely, like sign me up for that tool. I will test it for you. Whatever you need me to do.

Scott: Lovely.

Laura: So, so yeah, having conversations that, you know, that there's obviously, the images themselves have been highly altered, stylized, potentially photoshopped, all kinds of different things. But then there's this whole machinery and infrastructure behind that feeding you more and more and more of these idealized images.

Scott: Yeah, that's it. And you know, when social media, the way we use it, a lot of the time, like a lot of the time when people are using TikTok, people's guards are down. It's incidental. It's minutes in bed when you first wake up, it's bed when you might be trying to go to sleep. It's when you're on a bus, it's when you're bored, it's when you're tired.

It's not active consumption of content. And before you know it, you can have scrolled through or mindlessly watched tens and tens of videos that have appearance oriented content and, just like with how people think that advertising isn't working on them, but the reason that so much money is pumped into it is because it does have cumulative accumulative impacts on, on purchasing decisions. The same thing happens with social media, so it's about getting people to recognize that and to try to minimize what's happening in those spaces because it all adds up.

Laura: You know, you said kind of towards the top of the interview that people who are deep in their eating disorder, whether it's anorexia, whether it's muscle dysmorphic disorder, bulimia, orthorexia, whatever form that takes, they are, you know, the least clear in what's going on, right? They're the least easily able to see what's going on. They are definitely aware that there's a problem, but they might not be able to identify exactly what that is. So, with that in mind, I'm wondering for, for parents particularly of teen boys, tweens and teens, it sounds like are both vulnerable and kind of heading into adolescence.

If a parent notices more protein powders coming into the house, more you know, concerns about lean protein and less carbohydrates on the plate and more time working out or conversations about being fit, about being healthy, and they're, they're noticing that, that's becoming increasingly rigid and perfectionistic. How might a parent approach this, do you think?

Scott: It's a very common question that has never had an answer come easy to me, as I'm sure it wouldn't for many parents because teenage boys are notoriously challenging to talk to and get to open up to, especially about these,

Laura: Yeah, but you're a psychologist so you ,

Scott: So I'm obliged to have an answer and I I have you. So I think the way we approach folks who we think have muscle dysmorphia, but who are perhaps reluctant to talk about it, is to emphasize those parts of their training and their dieting that aren't working for them. We don't say, “Is it making you sad or anxious?” and, “what's not working for you?” because often whether it's a young boy, a teen, a young adult, they're just thinking about progress. They wanna progress. It's, I want my lifts to get stronger, my body to get better, etc. And the things that we think of as the symptoms of the disorder, the things that we're worried about, they're not worried about them per se. They're worried about their progress. And it's those things on the side that are making it hard, right? So we frame it as, okay. What's, what's getting in the way of you being able to train and diet and be like this and, and that maybe it's, ah, you know, I couldn't, I couldn't train today. I had to go and do this.

It's like, oh, okay. So like, how did it make you feel? It's like, you can try to get them to see that it's the rigidity that is being more unhelpful than helpful. We deliberately keep it above the level of feelings for a while until that is more approachable. Often with our young clients, we'll just pitch it as, look we don't want to change your training and your dieting. We're not gonna tell you not to go to the gym. We just want you to be in a space where you can get back to making the progress that you wanna make. Then you've got your foot in the door and you go from there

Laura: You're getting them on side. You're telling them I'm on your team. Yeah.

Scott: Yeah. Because whilst you can say the term body image to most young women and they intuitively know what you're thinking about, if I try to say, “are you worried about your body image?” to a young man, even if I know they are, it's so super clear as day, a lot of the time they'll say no.

Laura: Yeah,

Scott: Like straight up, they'll say no to you. Because it's just not the language that they speak

Laura: Yeah, yeah. But if you can talk to them in terms of gains and what's getting in the way of their

Scott: What's getting in the way? You know, you're not talking about feelings per se. That's just the best way I can describe it. It's a very tactful and challenging spot to be in, I think.

Laura: Yeah. I mean, my hope is that I never have to broach this conversation with my kid, but fuck parenting is hard, man.

Scott: Yeah, I certainly empathize.

Laura: And I really hope you don't say CBT right now, but what do we know about treatment? What is available to help young people, older people, whoever is impacted by muscle dysmorphia to help them recover?

Scott: The evidence-based for effective treatment for muscle dysmorphia is extremely limited. It's nowhere near what we have for the other eating disorders. There is nothing in the way of an RCT or anything like that. I have a PhD student now who is running the first manualised treatment for muscle dysmorphia, so we'll see how that turns out.

Generally speaking, the approaches that work for eating disorders will also work for muscle dysmorphia, in my opinion, because again, the core maintaining factors of the disorder and precipitating factors are very, very similar. And what has been encouraging as a first port of call, the major eating disorder charities that run helplines, so certainly the Butterfly Foundation in Australia perhaps BEAT over in the UK, they are increasingly cognizant of muscle dysmorphia and the helpline staff are better equipped to, to talk about it, which is perfect.

Laura: I noticed the other day that there's even an NHS page, which, you know, you and I spoke a couple of years ago for Don't Salt My Game, and I'm pretty sure it didn't exist even then. So there is certainly more recognition and awareness, but it sounds like people are more equipped to have these conversations, certainly in the eating disorder space.

I worry more about kind of general practice in terms of medicine because there's even and, and don't get, this is not GP bashing . We all know how much pressure GPs are under, but there is a lack of awareness even about more traditional eating disorders in that space. So yeah, I reckon BEAT would be probably the best first port of call there.

But in terms of treatment, it sounds like we don't exactly know yet. Your sense is that probably some of the modalities that we use for other eating disorders are probably gonna be successful because of, you know, the same underlying maintaining and precipitating factors. But I guess we need to wait for your student to do their research before we have more clear answers on that.

Scott: Yeah. But even then for the really convincing answer that yes, you can confidently send someone for this treatment and there's a great chance they get better years and years away from that. But what I find promising is in talking to eating disorder clinicians, in training them when it comes to muscle dysmorphia, it's not a case of, oh, how am I gonna do this?

It's, oh wow. There's all the parallels are all there, which is great because it means that the tools are there, it's just a matter of education both on the part of the clinician and on on people and young men so that they know they can go and seek help and that help will be there to meet them.

Laura: Absolutely. And I just wanna go back to the TikTok algorithm thing, which is super disturbing to me, but, but just to kind of close out, I wonder, you know, from your perspective as a researcher, what do we need to be doing both in terms of a research agenda, but maybe also like a public health policy agenda in terms of tackling some of these, like really problematic systems, I suppose, that young people are up against. I don't know if that question makes sense, but like, where do we go from here? What do we do with this?

Scott: No, I've thought about this. There's the organizations I'm working with in Singapore, we've been talking about that at length and the broader conversation that needs to be had moving back from TikTok to algorithms and data generally is we need greater oversight and control of how our data is used to deliver us content of all kinds.

Because people cannot bat an eyelid when they think of, alright, I wanna clean my house and I'm on Instagram and I got an ad for a cleaning product, cool. And in your ideal world, advertising connects you seamlessly to the things that can make your life easier. What you don't want is for an algorithm to see and know that a young person has been looking at a lot of videos that are around weight loss and now a targeted ad comes up for a weight loss supplement, cause that is how that data gets used also.

And we need tools, I think like the one we're developing so that people can see what their algorithms are sending that. You should know. You should know if your algorithm is sending you three times more toxic masculinity content than someone else, if it's sending you more eating disorder content, if it's sending you more plastic surgery content.

Because the first step in a battle is knowing what your algorithms are sending to you. And this issue only becomes more important because let's say you or I wanted to find out something factual, we go to Google.

Gen Z uses things like TikTok for search. 40% of Gen Z prefers to use TikTok than Google for search, which means you are down the rabbit hole of the algorithm from day dot.

So you need to know, but of course that information's never released to you. So it's pushing back against the opaqueness of the data that we provide and how that data is used to send us content because it's not in our, in the service of our health and connectedness and community. Again, it's in the service of, of money, and, and engagement. So I think that's the broader conversation, right? The data collected from us is not benign.

Laura: Oh, absolutely. Wow. All right, Scott, on that cherry note, um, at the end of every episode, my guest and I share something that they have been really excited about lately. Um, So something they've been snacking on, either literally or metaphorically. Do you have something picked out?

Scott: I do. So in Singapore, my favorite breakfast to have is kaya toast with some rather runny under soft boiled eggs with soy sauce and white pepper. It's a very common breakfast here, and I love it. It's so, so satisfying. I had it this morning. I'll have it again tomorrow.

Laura: Sorry. What is the kind of toast did you say?

Scott: It's called Kaya Toast. So it's like thick cuts of toast with butter that's called kaya butter. And it's slightly sweet. I think it has a more fun and complex flavour than regular butter. And you can dip that in eggs that are loaded up with white pepper and soy sauce.

Laura: Got it.

Scott: I love it.

Laura: Oh, it sounds like they have a really amazing food culture over there. Like I've heard from people that they have like, you know, lots of different kinds of street food and stuff like that, so yeah. That sounds awesome. Mine is also a food so it's, I mean, it's only February at the time of recording, but like all the Easter stuff is now showing up in the shops and so I demolished a pack of like Doisy and Dam, which is like a brand of chocolate over here, mini eggs the other day. And they were so good. Like, I don't know if you get mini eggs in Australia, they're like solid chocolate eggs with like a candy kind of coating shell around them. And they're like all different kind of pastel kind of colors. Like yellow and pink and green and like eastery kind of spring colors.

Scott: It's possible we do, I can't recall 'em off the top of my head,

Laura: You're gonna tell me like you don't like chocolate or something.

Scott: No, no, no. I love chocolate I'm not silly

Laura: So I think you would like, I know you would recognise them. So maybe you don't have them. You don't have them over there. All right, Scott, it's been really great to chat to you again. Can you let everybody know where they can find out more about you, your research group, or any of your publications? I will link to the study, the TikTok studies if they're published yet? 

Scott: They’re in the process of being, so the best place to follow along with the research my team does, including the TikTok work, is at my Twitter. It's @Scott1Griffiths. Or just search Google. Scott Griffiths, Scott Griffiths Body Image Research or something like that, and it will come up. That's the easiest way.

Laura: I'll link to it so that it saves people the minefield of Googling stuff.

Scott: Yeah.

Laura: But yeah, so that's the best place to follow along on your Twitter and get updates about your research. I can't wait to read that. Well say. I can't wait to read it. I'm really depressed after talking to you about the state of social media.

I mean, I was already bummed out about it, but this has just solidified that for me. So thank you for that. But otherwise, it was really great to talk to you and it's obviously really essential and important research that you're doing. So thank you for taking the time to share it with us.

OUTRO

Laura Thomas: Thank you so much for listening to this week's episode of Can I Have Another Snack? If you enjoyed this episode, please take a moment to rate and review in your podcast player and head over to laurathomas.substack.com for the full transcript of this conversation, plus links we discussed in the episode and how you can find out more about this week's guest. While you're over there, consider signing up for either a free or paid subscription Can I Have Another Snack? newsletter, where I'm exploring topics around bodies, identity and appetite, especially as it relates to parenting. Also, it's totally cool if you're not a parent, you're welcome too. We're building a really awesome community of cool, creative and smart people who are committed to ending the tyranny of body shame and intergenerational transmission of disordered eating. Can I Have Another Snack? is hosted by me, Laura Thomas, edited by Joeli Kelly, our funky artwork is by Caitlin Preyser. And the music is by Jason Barkhouse. And lastly Fiona Bray keeps me on track and makes sure this episode gets out every week. This episode wouldn't be possible without your support. So thank you for being here and valuing my work and I'll catch you next week.

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