Familiar Faces, Risky Choices: Parasocial Relationships and Health

Social media has made it easier than ever to “feel” connected. But it has also made it easier for one-sided relationships, also known as parasocial relationships, with online personalities, celebrities, and even fictional characters, to shape people’s thoughts and behaviors. Due to the monetization of online engagement, parasocial relationships are now a defining feature of modern media use as influencers and celebrities post frequently and interact directly with their followers. Around 51% of Americans report engaging in a parasocial relationship at some point in their lives. The one-sided bond can feel personal and trustworthy, even though the relationship is not reciprocal.

While the relationship isn’t mutual, parasocial relationships can have positive effects. People struggling with self-esteem can feel an increase in closeness and self-worth when thinking about their parasocial pals. But this perception of closeness can lead to unhealthy lifestyle choices, buying habits, and self-image decisions. When information comes from someone you view as familiar, credible, or emotionally meaningful, it may be accepted with less scrutiny. Polished aesthetics, repeated exposure, and large followings can create a sense of intimacy and authority, allowing misinformation and detrimental lifestyle choices to spread easily, including unsafe supplement use or misleading wellness claims.

Today’s digital influencers may play a powerful role in shaping everyday health decisions.

A recent example highlights these risks. Popular “looksmaxxing” TikTokker Clavicular has leveraged striking before-and-after images to build a sense of legitimacy around his advice on physical appearance. He is known for promoting harmful practices, including substance use and “bone smashing,” a method that involves intentionally striking facial bones to alter their shape. Although these practices carry significant health risks, many young followers are persuaded by his results. His audience now exceeds 600,000 followers, and he has expanded his reach by launching a “looksmaxxing” course.

While parasocial relationships are commonplace, we still have a limited understanding of how parasocial bonds amplify their influence.

To better understand these dynamics, Austin T. Boyd and colleagues developed the Parasocial Relationships in Social Media (PRISM) survey to measure the quality and strength of parasocial relationships with online celebrities. Using a cross-sectional design, they surveyed over 600 adult followers across platforms. The survey assessed four dimensions: interest, knowledge, identification, and interaction. The researchers analyzed the data to ensure the PRISM survey produced reliable, valid results across media formats.

Trust and perceived closeness can form quickly through repeated exposure.

Results showed that engaging in parasocial relationships was driven more by frequency of engagement with the account than by how long someone followed a creator. In other words, trust and perceived closeness can form quickly through repeated exposure. Cross-referencing the survey results with existing data highlights the potential for influence. Individuals who formed perceived deeper connections due to frequent interactions were more likely to adopt the influencer’s recommendations, whether related to diet, fitness, substance use, or other health practices. This builds on earlier evidence that celebrities can sway public health behaviors, suggesting that today’s digital influencers may play a powerful role in shaping everyday health decisions. Research shows that influencers today promote dangerous diets, dodgy supplements, and harmful ideals with a wider reach than ever before.

The survey further enables comparisons across platforms, helping identify how different types of content (e.g., live-streamed versus recorded media) may affect users differently. YouTube and Twitch demonstrated a strong potential for influence across platforms regardless of format. High engagement levels (often multiple interactions per week) suggest repeated exposure to a creator’s messages, increasing the likelihood that opinions or claims are absorbed without fact-checking.

Overall, while the study primarily validates the PRISM as a tool, it underscores its value for future research, public health monitoring, and media literacy efforts aimed at understanding and managing the growing influence of online personalities on individual and collective health outcomes. This is especially relevant in the wake of the COVID-19 pandemic, a time when digital connection became central, highlighting the urgency of improving media literacy and implementing policies that hold platforms accountable for health misinformation.