ALL IN YOUR HEAD:

When teaching freshman composition in New York colleges in the mid-Eighties, I picked up a peculiar pattern in one-on-one conferences with my female students. With improbable frequency, they'd confide that they were anorexic. The term had only entered the popular lexicon about 10 years earlier, and public awareness of the perturbing derangement had been given a huge boost by the pop singer Karen Carpenter's death in 1983. Yet not all these 18-year-old students were disturbingly underweight. It took me a minute to get it. They aspired to be anorexic. Anorexia was a prestige diagnosis.

While some of those students may have been merely flirting with the condition, they were canaries in a very dark coal mine. All too many of their peers were undertaking life-threatening calorie restriction in great earnest. Anorexia was already known to be the very deadliest of all psychiatric ailments. (Wanting to be anorexic, then, is like pining to contract necrosis.) In the Nineties, my natural ghoulish voyeurism inspired me to read several books about obsessive self-starvation, the best of which was Jenefer Shute's harrowing novel Life Size.

So surely this month I jumped at the chance to read Hadley Freeman's Good Girls: A Story and Study of Anorexia? Beginning in 1992, the columnist struggled for many years with the eating disorder, for which she was repeatedly hospitalised for months on end. Yet before diving into what proved a compelling and forthright memoir, I resisted. Honestly? The topic felt dated. Because as a prestige diagnosis, anorexia has been replaced. With trans.

Although Freeman spends half a chapter on the overlap between the two afflictions -- both are "rooted in the belief that if you change your body, you will no longer hate yourself" -- throughout her account I began to notice other intersections.

Both neuroses are clearly communicable.

Social contagion in several adolescent behaviours (e.g., mood and emotion, eating disorders, drug use, self-harm, and suicide) has been well established empirically. For example, Madelyn Gould  concluded that

... the existence of suicide contagion no longer needs to be questioned. We should refocus our research efforts on identifying which particular story components promote contagion under which circumstances and which components are useful for preventive programming.

Four mechanisms that may be involved in the social contagion of these behaviours and gender dysphoria are:

Peer contagion: Peer contagion is a process of reciprocal influence to engage in behaviours occurring in a peer dyad/group.  By middle childhood, gender is the most important factor in the formation of peer associations, highlighting the significance of gender as the organizing principle of the norms and values associated with gender identity.

Deviancy training as a mechanism of social contagion: A process whereby deviant attitudes and behaviours are rewarded by the peer group. Young people are particularly vulnerable to peer contagion if they have experienced peer rejection, hostility, and/or social isolation from the peer group.

Co-rumination as a form of social contagion: A process of repetitive discussion, rehearsal, and speculation about a problematic issue within the peer dyad or peer group that underlies peer influence. It is more common among adolescent girls. Being in a friendship that engages in perseverative discussions on deviant topics has been associated with increased problem behaviour over the course of adolescence.

Social media: Nathan and Kristina have argued that: "...[u]nlike the broadcasts of traditional media, which are passively consumed, social media depends on users to deliberately propagate the information they receive to their social contacts. This process can amplify the spread of information in a social network."

Targeted marketing campaigns on and offline generate additional influence. Peer influence and homophily (intrinsic peer similarity) are major factors influencing the behaviour of those embedded in social networks. Peer influence is more likely to trigger positive, self-reinforcing feedback loops, where the imitation of the target individual's behaviour by peers enhances that behaviour in the target individual so that s/he does more of the behaviour which becomes more extreme over time, creating a social multiplier effect.

This effect also occurs in online communities which is enhanced by introducing certain features into the market design of products, such as, in this case, puberty blockade, cross sex hormones, and sex reassignment surgery, and identifying the influential and susceptible users.

Online activity enables, enhances, or triggers potential risks of "copycat" behaviours such as self-harm, suicide, and eating disorders through the normalization of pathological behaviours, or vicarious and social reinforcement of these behaviours.

Is gender dysphoria socially contagious?

Given the strong evidence of social contagion in suicide, self-harm, substance abuse, eating disorders, and emotion/mood, especially among adolescents, the role of social contagion in gender dysphoria demands urgent attention. 

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