The Real, Life-Threatening Consequences of Photoshop.

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The Real, Life-Threatening Consequences of Photoshop.

For Theresa, it started with her upper arms.

“I was 12-years-old when I opened up a teen fashion magazine and realized all the models had super-thin upper arms,” she says. “Mine were, in comparison, gigantic.” And she didn’t like what she saw.

Since nine, Theresa had racked up victories in the front crawl and backstroke, so she developed a classic swimmer’s physique: strong arms, trim hips and muscular thighs. She was slender, but not skinny, with a muscular, athletic build.

In the teen fashion magazine, though, she saw herself in a different light. She compares it to “The Wizard of Oz,” when Dorothy enters the technicolor world. “It was like you could see more detail, more clearness, more light,” she says. “In the movie, it’s magical. But in my life, it was the start of a nightmare.”

Years later, she’s recovering from a severe eating disorder that landed her in the hospital multiple times. She gave up swimming, and will spend the rest of her life wondering if she squandered her talent.

All of it began, she says, when she saw a picture in a magazine and realized she could never live up to its ideal of glamour. That ideal is so digitized and increasingly removed from reality that it’s impossible for real life to replicate — though that doesn’t stop girls, such as Theresa, from relating to images as real and trying to recreate them anyway.

Theresa tore out a picture of the thin, glamorous model from the magazine and put it on her closet door. Soon, other images joined it. They all featured girls with a certain body type: the skinny, ropy look of ballerinas, complete with birdlike arms. “I chose them all because I envied their bodies, and the beauty and grace they seemed to get from them,” Theresa says.

The pictures were the first things she saw when she woke up. They were the last things she saw when she fell asleep at night, trying to shut out her parents’ arguing in the other room.

At some point, inspiration turned to aspiration, and Theresa put herself on a diet. As an athlete, she had always been aware of the importance of food as fuel. But losing weight in the way she wanted was an entirely different matter. She began counting calories, keeping rigorous track with an Excel spreadsheet.

No one noticed her new behavior. Theresa’s parents at the time were in the midst of a disintegrating marriage. They chalked up Theresa’s dieting as typical young teen behavior.

Almost every girl at her school was on a diet, and no one questioned why she was dieting as well. Imposing food restrictions — whether it was disguised as avoiding gluten, becoming vegan or some other diet choice — was the norm. “It wasn’t cool to say you were on a diet,” Theresa noted. “Instead, you could say you were vegan, or cutting out dairy and bread, or whatever. I just said I was trying out a new training regimen.”

Theresa found dieting hard. “I would sit in class and my head would swirl, and I would feel light-headed and weak [from hunger],” she said. “And I would curse having the metabolism of an athlete, which dooms you to eating healthy amounts of food pretty much all the time.”

She was plagued with a sense of failure. “I could get As in classes, make friends with the popular girls at school, and win my events in swimming, but I couldn’t lose half an inch around my waist or even just five pounds,” Theresa said. “I was frustrated.”

Looking for help online, she stumbled upon a group of websites that offered “thinspiration” — online communities of girls with anorexia or bulimia who gave each other tips and support in their disorders. “At first I resisted them,” Theresa said. “I didn’t identify myself as an anorexic or bulimic; I just wanted to feel less hungry. But I still tried out their tips.”

In desperation, she tried out one of the trendy juice cleanses advocated by celebrities like Gwyneth Paltrow in an attempt to “kickstart” some weight loss. But she couldn’t make it — her muscular physique and fast metabolism demanded food.

She remembers the night of her one-day cleanse clearly. “I was starved. No one was home. And so I basically gorged,” Theresa said. “I figured I was a failure, so I had nothing to lose. I ate steak, potatoes, cake, ice cream, chips, cookies…I ate it all.”

Theresa finally felt full. But then she was slapped with a sense of shame, humiliation and loathing. “It bubbled up inside me, and I felt like I wanted to throw up,” Theresa says. “So that’s what I did.”

Theresa immediately felt better: she felt lighter, less burdened. And she finally found out a way she could manage to eat and still control her diet.

She went to bed that night, her eyes resting upon the pictures of the models posted onto her closet door. “I felt as if those images of perfection were within my reach,” she says. She drifted off to sleep, feeling at peace for the first time in ages.

With that first night of binging and purging, Theresa joined an estimated 24 million people in the U.S. grappling with an eating disorder, according to the National Association of Anorexia Nervosa and Associated Disorders, or ANAD.

Eating disorders are little understood. The stereotypical eating disorder sufferer is an underweight, skeletal white teenage girl, but this picture ignores the fact that men and women of all ages and races — and all body types — can develop bulimia, binge eating disorders or anorexia. Eating disorders have the highest mortality rate of any mental illness, according to ANAD. Victims die due to related causes such as heart failure, organ failure, malnutrition or suicide.

No one has been able to identify exactly why some people develop eating disorders over others. Cultural norms that emphasize thinness and youth do foster higher instances of disordered eating — several studies show that eating disorders tend to rise the more “Westernized” non-Western cultures become, for instance.

But equally important, people suffering from eating disorders tend to have co-existing psychological issues such as depression, anxiety and personality disorders. Studies show girls with ADHD are more likely to develop eating disorders, as are those who suffer from some kind of post-traumatic stress disorder, particularly after sexual trauma.

The brains of those afflicted with eating disorders also process anxiety and other negative emotions differently. For instance, most people get irritable and anxious when hungry and experience food as a reward and pleasant experience. Anorexics, however, actually feel extreme anxiety anticipating meals or while eating itself, according to a UC San Diego study released last year. As a way to relieve anxiety, they reduce their food intake.

One of the most controversial factors in eating disorders is the role media images play. On one hand, ANAD reports just about half of girls aged 10-18 say they want to lose weight because of magazine pictures, which often are dominated by bodies that only 5 percent of the population naturally have. Not many people would argue against the idea that the media promotes an unhealthy ideal of female health and beauty.

But many argue we must distinguish between disordered eating and genuine eating disorders. Media images of thinness are powerful, but not as powerful as the influence of biology, genetics and psychology. An eating disorder can begin with a desire to change your body and lose weight — a sadly common desire among many young girls. But the development of a diet into a compulsive, uncontrollable need to starve yourself or throw up your food requires much deeper issues.

Theresa admits she probably had a predisposition towards developing an eating disorder. Her home and family life at the time was troubled. Both parents retreated into their own problems, leaving Theresa on her own emotionally. Culturally, her father immigrated from Asia, where thinness is often prized among women, so Theresa grew up listening to her family dissect and judge women’s bodies with clinical detachment. Theresa was also an elite athlete, a demographic whose perfectionism, high self-expectations and keen sense of success and failure make them susceptible to eating disorders.

For Theresa, the binging and purging pattern was so compelling because of the emotional payoff. It gave her a profound sense of control and sovereignty.

“You can’t really get it until you understand just how intense the feeling of self-loathing and hatred you have towards yourself when you eat or do anything with food — and just how peaceful and light and wonderful you feel after you vomit it up,” Theresa says. “It’s feeling calm and in control. I felt weirdly angelic whenever I purged, like I was above anything and everything.”

But Theresa herself doesn’t downplay the role that such images played in her disorder. “I definitely think the media’s unrealistic standards of thinness play a powerful role,” she says. “I don’t think it’s a linear role, like ‘Look at these images and boom, eating disorder.’ But if you’re already feeling doubt about your self-worth, they needle away at you. They raise a kind of standard that you’re constantly falling short of, and that’s a horrible feeling if you’re not gifted with the ability to talk yourself out of that feeling.”

It doesn’t help that media images of extreme thinness are not just more prevalent, but increasingly unrealistic, with rampant use of software like Photoshop. The software, first released in 1988, is now the industry standard in publishing and media, allowing photographers and editors to make adjustments to images after their production.

Some degree of airbrushing always existed, even before the advent of digital photography. Airbrush spray guns allowed users to apply a very precise, tiny amount of pigment onto a photo, allowing artists to smooth out and even remove entire objects from images. But this process was tedious, time-consuming and expensive. Photoshop, however, made the process of retouching cheaper and faster, and offered control over more variables in the image.

But photo retouchers now can alter much more than contrast, saturation, hue and colors. With Photoshop and other photo-editing software, they can swap out faces, change skin tones, shave off inches off a body part, sculpt muscle definition that isn’t there or erase skin folds and puckers.

And it’s not just Photoshop — video editors can use CGI to alter performers’ bodies to perfection, which they’ve done in videos like Britney Spears’ “Work Bitch” video, according to Radar.

Models — as thin and photogenic as they already are — can have their imperfections erased entirely in a form of digital plastic surgery. But such perfection is physically impossible — and that’s an ethical and moral dilemma, according to media critics.

“The more and more we use this editing, the higher and higher the bar goes. They’re creating things that are physically impossible,” Hany Farid, a Dartmouth professor of computer science who specializes in digital forensics and photo manipulation, told ABC News. “We’re seeing really radical digital plastic surgery. It’s moving towards the Barbie doll model of what a woman should look like — big breasts, tiny waist, ridiculously long legs, elongated neck. All the body fat is removed, all the wrinkles are removed, the skin is smoothed out.”

The problem now is that such digitized perfection enabled by Photoshop and other software has become the visual norm, internalized by young girls and women and altering people’s perceptions of reality. They may know intellectually images are being altered, but they’re not sure exactly what is being changed, so they see certain near-impossible attributes as physically possible.

Editors and photographers defend their work practices, saying this is what readers and viewers want to see. Some also argue most people are media-aware enough to know these images aren’t real — that they are fantasy and serve as inspiration.

Others, though, see this argument as a cop-out, saying these images are sold to us as packages of health, glamour, happiness and beauty — and are precisely powerful because they teach us what to aspire to and what is possible.

You can’t underestimate fantasies in shaping how we see reality and ourselves. The human brain can graft together information from the different senses with our imaginings, altering how we perceive reality, according to Psychology Today.

Mindfulness training, visualization and other mental techniques, for example, can alter perceptions of reality at a neuronal level. If that’s the case, then it’s important that the images and stories we use to inspire ourselves be healthy ones.

In a way, Theresa was already adept at this process as an athlete — the night before a meet, she envisioned herself having a top-notch race. When she posted models’ pictures up on her closet door and gazed upon them at night, she would envision what she would and wouldn’t eat the next day.

Now, she thinks back on those images of the super-skinny models on her closet door and wonder if some photo retoucher shaved a few inches off their upper arms. Those images once inspired her quixotic quest for an unattainable thinness — now they haunt her. “Did I really put myself through all that, hating myself for a physical attribute that so few people have?” she asks.

Many now are spearheading a backlash and debate over the use of excessive photo retouching and Photoshop. The American Medical Association, for instance, wants advertisers to work with health organizations to develop photo editing guidelines that discourage unrealistic body standards.

“We must stop exposing impressionable children and teenagers to advertisements portraying models with body types only attainable with the help of photo editing software,” the organization said in its statement.

Some even want to create tech tools to sniff out overzealous Photoshopping. According to the New York Times, Hany Farid and Eric Kee, a Ph.D. student in computer science at Dartmouth, worked on an algorithm that detects the amount of digital manipulation an image undergoes. They want to create a software tool and a labeling system that measures how much fashion and beauty photos are altered, using a 1-to-5 scale ranging from small-scale to fantastical.

And many speak out against companies that indulge in too much photo retouching. Earlier this spring retailer Target came under fire for digitally editing a photo of a model in a bikini, giving the already slender girl a “thigh gap” between her legs, a physical attribute that’s difficult to achieve, even among skinny girls. The Minneapolis-based store apologized and pulled the image from its site, according to ABC News.

Websites like also point out excessively doctored images in magazines like Vogue. The site offered $10,000 for untouched images that accompanied Vogue’s profile of “Girls” writer/director/actress Lena Dunham, convinced the magazine drastically altered Dunham’s voluptuous proportions to fit into its slender ideal. Untouched photos of the Dunham shoot showed photo editors shaved off inches off her hips, thinned out her neck and jaw and removed smile lines.

Jezebel also released untouched photos from a recent Mariah Carey cover for Wonderland magazine, which thinned out her jawline, took in inches on her waist and gave her legs more muscle definition. And recently, Beyonce fans went into a tizzy after some eagle-eyed Instagram viewers noticed tell-tale signs of photo editing on some of her supposedly candid snapshots.

On a more positive end, some celebrities and campaigns seek to “retrain” the consumer eye to see imperfections as normal, acceptable and even beautiful. Singer Colbie Caillat’s video for her single “Try,” for instance, portray her and several other women transforming from fully made-up to completely natural, showing just how much effort and studio trickery goes into supposed images of perfection.

More fashion campaigns have explicitly decided not to retouch images, touting their images as real and healthy. Teen retailer American Eagle, for instance, this spring launched a campaign for its Aerie lingerie line. The images are all of thin models wearing underwear, but none of the images have been retouched. All skin puckers, rolls, dimples and other imperfections have been kept intact. Teen sportswear line Bongo, too, launched its fall campaign with actress Vanessa Hudgens, and a small caption makes clear the fact that the photo has been unedited.

Perhaps the rejection of photo retouching is a PR stunt, a way for brands and companies to stand out in a crowded field. But they’re still garnering praise, especially because they’re aimed at especially vulnerable audiences who are still shaping their standards of beauty and health. “It’s so incredible to be a part of [this campaign] because young girls see these photos and they’re like ‘Oh, wait, this is what I look like’ or ‘I can relate to that, and I can see myself in these clothes,'” Amber Tolliver, one of the models who participated in the Aerie campaign, told Elle.

Of course, the Aerie models and Hudgens are still thin, beautiful girls, and the images still boast good lighting, top-notch photography and pro-level hair and makeup. They are still aspirational, promising fun, glamour and whatever else the brands want to convey. The untouched imperfections are subtle but still notable. But they’re still beautiful, anchored with some basis in reality.

“I think they’re great,” Theresa says of the Aerie photos. “I think it’s important that we see human imperfections in a context of beauty. It’s about training the eye and conditioning the mind. That’s why images like these matter.”

Seven years after her first binge-and-purge session — and many years of suffering after — Theresa now calls herself a “recovering bulimic.” She eats healthy now and doesn’t force herself to vomit anymore, but she still struggles with the desire to control her food intake. “I don’t think I’ll ever have an un-self-conscious relationship to eating anymore,” she says.

Treatments for eating disorders are tricky and often unsuccessful, with several relapses. Doctors treat the physical complications from disorders, but also need to treat the underlying anxiety, depression and psychological issues. Theresa herself went through psychotherapy, in-patient and outpatient treatment and was hospitalized several times for various bulimia-related medical complications, such as damage to her kidneys and esophagus and severe inflammation of her stomach lining.

She and her family went through counseling together, which “unleashed a whole hornet’s nest of issues,” Theresa says. Her parents realized their dysfunctional dynamic affected Theresa, and needed to learn how to support Theresa to fight off her disorder.

She also went on medication to treat anxiety and depression to regulate her moods, so she didn’t need the psychological relief purging once offered her as much.

The journey to recovery is far from over, though. Theresa herself draws an analogy to alcoholism, saying her illness is something she lives with everyday. “It’s hard, because food is a necessity to living,” she says. “But that means that every day, I have to confront my neuroses. I have to choose everyday to be healthy. And some days are harder than others.”

She’s now in college at a small, prestigious liberal arts school in the Midwest, a tricky transition as she learned to take care of herself while being surrounded by unhealthy examples of eating. “So many girls here eat crazy,” she says. “They’re not exactly eating disorder material, but they definitely show signs of disordered eating and exercising.”

She says she continues to see a psychologist, who keeps her on track. She’s also majoring in psychology; she wants to become a counselor to help others like her.

Beyond confronting her depression, dysfunctional family dynamics and regaining a sense of healthy appetite, Theresa says a key part of her recovery was reprogramming herself to see her body as healthy and normal. She learned to avoid women’s magazines and cut herself off from media that encouraged unhealthy body ideals. Instead, she seeks out images that glorify and beautify a wider variety of body shapes.

“There isn’t a lot out there, honestly,” Theresa says. “Not as much as there should be. If images help us imagine and aspire towards beauty, they should at least be healthy ones.”

Theresa thinks back now to those images that once inspired her, and to her credit, she sees them with entirely different eyes. “I see now the models were barely out of childhood, so of course they’d have those twig-like arms,” she says. “I also realize they were probably altered to within an inch of their life. They aren’t real, but I related to them as if they were.”

Recently, Theresa’s gone back to swimming. Her competitive drive fell by the wayside as complications from her bulimia interfered with her health and her life, and while she mourns missing the promise of her full potential, she thinks it’s for the best. “The drive and perfectionism that being an elite athlete wasn’t going to be healthy in the long run,” she says.

But swimming helps her reconnect with her body in a healthier way. “It helps me remember that my body is a source of strength and accomplishment,” she says. “Not a way to torture myself by forcing it into something it’s impossible to become.”

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