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Social Contagion and Psychopathology

Example illustration of a person's social network.

The possibility of social contagion of psychopathology has been a topic of debate in recent research. Social contagion theory suggests that emotions and behaviours can spread through social networks similarly to the way in which an infectious disease would spread. In this way, mental heath disorders may also spread through groups of people, both in person and online. On the one hand there is some evidence that mood states such as anxiety and depression do spread among social networks. However, on the other hand some researchers suggest that these contagion effects are only small or context dependent at best. Another key typology of mental health disorder which may be affected by social contagion are eating disorders, in particular anorexia nervosa and bulimia nervosa.

Currently most research into the social contagion of different types of psychopathology is focussed on establishing to what extent mental health problems are contagious, however there is also some attempt at explaining the mechanisms behind why these disorders have a contagious aspect such as through social learning theory and social comparison theory.

In relation to specific mental health disorders

Depression

One way of measuring depression in rats is the Forced Swim Test, where depressed rats will stop trying to escape the water and will not move beyond small attempts at keeping their heads above water.

Social contagion of depressive symptoms has been demonstrated in laboratory mice and in laboratory rats, with healthy rats exhibiting depressive like symptoms after 5 weeks of being housed with depressed rats which persisted for the remaining 5 weeks of observation. These researchers suggest that animal studies such as these are important in the developing body of research into contagious depression as they allow a closer look into the underlying mechanisms, which have not received much research attention so far .

The contagion of depressive symptoms in human social networks is more debated than in laboratory animals, however. On the one hand in a study surveying 10,000 college students there were no significant contagion effects for happiness and there was only a significant contagion effect for depression among men and not among women. In this case, the researchers concluded that mental health contagion was lower than the contemporary literature was suggesting. On the other hand, research using 32 years of longitudinal data from the Framingham Heart Study showed that both high and low depression scores in any given period were strongly related to an individuals friends and neighbours, a connection which extended as far as up to 3 degrees of separation. Contagion effects for depression have also been found in non-Western settings such as in rural China , suggesting that these results are applicable to a wide range of people. It has also been identified that these studies are limited to in person interactions, however one study looking at the online depression community in China did find that users emotion was affected by received emotion . Overall, many researchers have concluded that there is a social contagion effect when it comes to depression, even if the effect size is small.

The extent to which depression can be contagious may also be dependent on other individual differences. For example, Eisenberg et al. noted that there were significant gender differences when it came to the social contagion of depression, with depression being better transmitted among men who were already depressed where women with poor mental health fared better mentally when paired with a roommate who also had poor mental health, although it should be noted that the authors view these individual differences results as exploratory. It has also been suggested that female friends are particularly influential over time, possibly due to them being more self-expressive and hence better at communicating their depressed moods to their companions. In addition, spouses have been found to be significantly less influential in transmitting depressive symptoms than friends and it is also possible that people who openly disclose their distress are also more effective at transmitting depressive symptoms .

Anxiety

The emotional contagion of anxiety has also been discussed in the literature. For example, a modest contagion effect for anxiety was found in a study examining mental health in college roommates. Similarly, in a lab setting, higher levels of anxiety were recorded during and immediately after watching a video of a socially anxious presenter in comparison to a control video in which the presenter displayed no signs of social anxiety. Twin studies have also been conducted which found that there was a predictive association between the anxiety levels of same sex twin dyads, particularly when the twins has a better relationship, however this study has many limitations including the fact that twins would also share genetic factors which may also affect their anxiety levels. This suggests that there are social contagion effects when it comes to anxiety as an emotional state, but as this effect is moderate it is unclear how much of a role social contagion would have in the expression of clinical anxiety disorders.

Eating disorders

Early research into social contagion of eating disorders described two cases of teenage girls who developed 'pseudo eating disorders' after being hospitalised for a unconnected health issue and spending time with anorexic patients. Reviewing other cases of 'pseudo-contagiousness', such as that of contagions of eating and weight disturbances in a Dutch psychotherapeutic community in 1981, Vandereycken (2011) suggested that living in close contact with fellow patients is both helpful and detrimental to recovery. Indeed in a study which asked anorexic participants how they felt about other individuals who had a similar disorder to them, responses displayed distress over the comparison and competition between patients as well as the tendency for individuals to learn worse habits such as self-injury from others, although the respondents did also express how they received understanding and support from others. This demonstrates how, particularly in specialised inpatient care and group therapy where there is large amounts of exposure to people with similar eating disorders, social contagion may exacerbate the symptoms of eating disorders, or even introduce symptoms, in vulnerable individuals.

When it comes to the general population there is still a social contagion effect when it comes to body image. In particular, the effect which social media and popular culture has on body image and eating disorders has been a topic of recent research due to the increase in social media usage. Studies conducted using adolescent women in Fiji have shown that the introduction of television, and hence western beauty standards, significantly increased the amount of disordered eating among this group, a result the authors highlight as particularly profound due to the longstanding cultural norms standing against dieting and body dissatisfaction in Fiji . In another study examining social media exposure in Fiji, a significant association was found between eating pathology and media exposure in school-going adolescent ethnic Fijian girls . This demonstrates how social norms can be introduced to certain, previously naive, populations which has led to a contagion of disordered eating behaviour.

Examples of the many social media platforms which may contribute to the spread of eating disorders.

Social media is also implicated in the contagion of eating disorders through certain digital communities, such as 'pro-ana' pages. Corzine and Harrison (2023) suggest that through social media users may seek out communities in order to ground their identity and seek emotional support from others and in this way contagion can spread quickly through online spaces. Once the community has become central to a persons sense of self the messages constantly conveyed by those same media spaces that it is ideal to restrict what you are eating become particularly influential, an idea that is present in person but much exacerbated by the ability of the internet to reach more people. Due to this it has been suggested that there should online guidelines to try and limit the amount of exposure that eating disorders and disordered eating behaviours gets.

Mechanisms

Social Learning Theory

Imitation effects due to identification with an observed model has previously been linked to adolescent suicide and non-suicidal self-injury. When looking at social learning as a mechanism for social contagion in other pathologies, in the case studies of two adolescent girls who developed symptoms of eating disorders after being hospitalised for separate health issues and then spending time with anorexic patients, the observer similarly suggested that these symptoms were modelled by the anorexic patients and then reinforced as the focal girls then got recognition from the anorexic sub-group who they greatly admired. Modelling has also been implicated in the case of the increase in disordered eating among native Fijian adolescent girls, as after the introduction of television and social media the girls had new models with a beauty standard of being thin that they tried to emulate. In this way social learning theory contributes to social contagion of mental health disorders through imitation of models who an individual may interact with either in person or through the internet.

Social Comparison Theory

It has also been suggested that social comparison theory may play a role in the social contagion of both depression and eating disorders. In the case of eating disorders it has been suggested that spending time making upwards social comparisons, particularly to people online who are living unattainable and exaggerated lives, alters the way individuals view their own body image and hence contributes to the maintenance of disordered eating behaviour in order to keep an 'ideal' body shape. Upward comparisons with people we see as more successful than ourselves may also contribute to the contagion of depressive symptoms as they could cause a loss of self-esteem, while downward comparisons could cause guilty feelings or defensiveness. This may lead to the social contagion of depressive symptoms by eliciting negative emotions in an individual over their own social standing.

Emotional expression

Hatfield et al. (1993) suggest that another mechanism for emotional contagion is an unconscious mimicry of facial expressions and vocal tones of those around us, and as a consequence we are more easily able to feel those emotional states . Eisenberg et al. (2012) then picked up on this idea and identify mimicry of emotional expression as one mechanism for the contagion of mental health, as, while most social contagion effects focus primarily on behavioural outcomes, they suggest that emotional contagion effects are equally as important to look at as mental health conditions are not just behavioural. They suggest that mimicry helps individuals feel empathy for one another and that by feeling this empathy and imagining oneself in the position of someone suffering from depression it is possible to feel a small amount of the same negative emotions. However, much more empirical research into this field needs to be conducted in order to gain a greater idea of exactly how emotions can be mimicked and how much mimicked emotion a person can feel themselves.