Presented by Dr. Wendy Oliver-Pyatt, Co-Founder, CEO, and Chief Medical Officer at Within Health
In the wake of the COVID-19 pandemic and the social media revolution, which has granted us access to billions of people worldwide, we live in unprecedented times. Not only has the pandemic been traumatic for countless people, but social media now inundates us with traumatic videos on a daily basis. The stressors and trauma of the pandemic, exposure to violence, trauma, and triggers online, living in a diet culture society, and vulnerabilities due to epigenetics and intergenerational trauma create a perfect storm for significant mental health issues, including eating disorders.
It’s no secret that the pandemic has significantly impacted mental health. In fact, prior to the pandemic, about 10% of adults in the U.S. reported anxiety and depression, but post-pandemic, approximately 40% of adults are experiencing depression and anxiety. This is a 300% increase in mental health symptoms.1
Research also has shown the following post-pandemic:1
While social media undoubtedly has many benefits, such as allowing us to connect to others, find community, and learn new information, it can also be harmful. This is especially true for marginalized communities like Black and Indigenous folks, other people of color, immigrants, transgender and queer people, and beyond.
This is because social media sites like Twitter, TikTok, Instagram, and Facebook make it easy for traumatic videos, such as police killings and hate crimes, to go viral, generating millions of views and shares, which can make them difficult to avoid—that and the algorithm literally feeds these videos to users. Viewing distressing and traumatic news directed at members of one’s own racial-ethnic group or those with a similar immigration status is related to poor mental health outcomes.
A study of Black and Latinx youth found that more frequent viewings of traumatic events online were associated with increased symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). The effect was more significant in girls than in boys.2
Social media is a social environment in our pockets. Research indicates that humans tend to thrive in a social structure of about 150 people. Yet, social media has made it possible to connect with the entire world—billions of people are available to us 24/7, and we are also available to them. We aren’t hardwired to have so much incoming data and to connect with so many people.
However, social media taps into the reward system of our brains, and the intermittent reinforcement schedule of receiving notifications and likes from these platforms takes advantage of our dopamine-driven design for social validation. Every time we get a like or comment, we get a small hit of dopamine, which reinforces social media use moving forward and can lead to smartphone addiction.
About 73% of phone users experience a unique form of anxiety when they misplace their phones.3 University students are at the highest risk for problematic or compulsive internet usage, which can cause a range of effects, including social isolation, neglect of self-care, and lack of routines. This type of internet use is linked to disordered eating behaviors like dieting, loss of control eating, hypervigilance related to the body, and food preoccupation, as well as full-blown eating disorders like anorexia, bulimia, and binge eating disorder.4
Adverse childhood experiences (ACEs) refer to traumatic or stressful events that occur during childhood, such as physical, emotional, or sexual abuse, neglect, household dysfunction, caregiver substance use and mental health problems, racism, transphobia, homophobia, or exposure to violence. ACEs can be acute, such as a single traumatic event, or chronic, such as ongoing exposure to abuse or violence. These experiences can significantly impact a person’s development, mental and physical health, and well-being.5
ACEs can make important changes to genes and how they function, known as epigenetics. Epigenetics refers to the study of changes in gene expression that aren’t caused by changes to the DNA itself. Epigenetic changes can occur due to behavioral and environmental factors like stress, nutrition, trauma, and exposure to toxins, and these changes can be passed down through generations. This is the mechanism behind intergenerational trauma and its far-reaching consequences.6
As such, traumatic events like adverse childhood experiences can lead to epigenetic modifications, such as:7
These epigenetics changes can then lead to health disparities, such as:7
ACEs and trauma can overload our biological systems and lead to long-term consequences, such as inflammatory and immune dysfunction and disruptions to the cardiometabolic and endocrine systems. When we consider the added and ongoing trauma of the pandemic and access to social media and the internet, children and teens are even more vulnerable to mental and physical health complications.
There are various types of stress that we experience, some of which are considered normal and even essential to healthy development. Typical types of stress may include:
Normal stress leads to brief increases in heart rate and mild elevations in stress hormone levels. Then, there is tolerable stress, which encompasses non-normative experiences that are essential to healthy development and may include:
During tolerable stress, the body’s alert system may be turned up higher and for longer periods. If a child has supportive adult relationships, the brain and body can recover from this type of stress.
On the other hand, toxic stress is intense, frequent, and prolonged adversity. Examples may include ACES like:5
Toxic stress can disrupt the development of the brain and other organ systems, leading to many different problems.
There is a strong link between trauma and eating disorder development, and in recent years, professionals have expanded the definition of trauma to include more experiences, such as:
Trauma affects everyone differently, but some effects it can have on the mind and body include:
A history of trauma, especially ACEs, can also increase the risk of disordered eating behaviors and eating disorder development. However, it’s important to remember that eating disorders don’t have one case—instead, they are caused by a myriad of intersecting risk factors and vulnerabilities, with trauma being just one.
Research has shown that there are higher rates of PTSD in people with eating disorders than in the general population. The prevalence estimate varies, but one study found that of those with anorexia, about 14% had co-occurring PTSD.8
One study estimated the prevalence of co-occurring PTSD and eating disorders to be as high as 52%, while another approximated it to be between 9% and 24%.9,10
PTSD can lead to avoidance symptoms, such as emotional numbing, detachment, lack of interest in usual activities, less expression of moods, and staying away from people, places, and situations that remind people of the trauma. Likewise, eating disorders can mimic these avoidance symptoms, such as restricting in anorexia and disconnection from food, appetite, and hunger.
PTSD arousal symptoms, such as trouble concentrating, exaggerated startle response, hypervigilance, irritability or outbursts of anger, and sleeping problems, can extend to eating disorder presentation. For example, those with an ED might experience an exaggerated response to feeling fullness in the body. They might also have extreme anger and irritability around eating and the need to eat.
Lastly, PTSD re-living symptoms, such as flashbacks, recurrent memories, repeated dreams, and physical reactions to situations that remind them of the event, can present in eating disorders. Symptoms may include thinking and obsessing over food and eating and avoiding eating to mask other disturbing memories.
Intergenerational trauma is a collective experience that affects groups of people because of cultural identity (e.g., ethnicity, nationality, or religion). The trauma creates psychological effects on subsequent generations of that group. Examples of intergenerational trauma may include The Holocaust and the slavery of African Americans in the United States.
The mechanism for transmission of trauma may be socially transmitted (through learned behaviors), through the effects of stress before birth, or perhaps through stress-induced epigenetic modification (which is then passed down to children, grandchildren, etc.).
Research indicates that constant coping with systemic racism and individual racism is a potent activator of the stress response. People of color have less access to high-quality education and health services, economic opportunities, and pathways to wealth accumulation. On average, Black, Indigenous, and other people of color in the U.S. have more chronic health problems and shorter lifespans than white people at all income levels.11
Research on children of Holocaust survivors has demonstrated many different changes in cognition and affect, including:
There are several modes of trauma transmission, including:12,13,14
In an analysis of 14,000 genes in blood samples of people with PTSD, researchers found markers indicating the presence of epigenetic transmission. Compared to people without PTSD, those with PTSD were found to have 6-7 times more dysfunctional genes, many of which had to do with the immune system.15
The pandemic has caused personal and collective trauma worldwide, whether due to loved ones dying, learning about traumatic deaths on social media, financial hardship, or social isolation. During the pandemic, many of us were unable to get our needs met, and this lack can be exacerbated by smartphone use, diet culture, and epigenetic changes—all of these factors are tied into how we aren’t getting our needs met.
However, there are ways to build resilience, fulfill our needs, heal, and connect with others. Some ways to build resilience may include:
Overall, the intersection of the COVID-19 pandemic, trauma, social media, mental health, epigenetics, and eating disorders is complex and unique to each person. Understanding these connections can help individuals and communities develop strategies to support mental health and promote resilience during this challenging time.