Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services

'You Are Not Alone, We've Got You': Power Plays, Devotion, and Punishment on Healthy Eating and Pro-Eating Disorder Websites

Healthy eating (HE) and pro-eating disorder (pro-ED) websites are popular sources of dietary and weight loss information, social support, and lifestyle inspiration. However, the discursive styles and language used by authors/moderators and users of these two site genres have not been widely studied or compared. Forty-three HE websites and twenty-four pro-ED websites were analysed using Fairclough's model of critical discourse analysis. Findings indicate that sites share common characteristics in terms of power relations played out by authors, 'successful' dieters, and those attending these sites. These power plays encourage moral and spiritual commitment to the care of one's body, with authoritative language used to support readers' loyalty and adherence to dietary plans. On HE sites, medicinal properties were attributed to 'clean' or 'pure' foods, whereas pro-ED sites conveyed their importance for weight reduction. Healthy eating sites were largely entrepreneurial, promoting products or themselves. Pro-eating disorder sites typically featured discussions of bodily disgust, the chastisement of others, and self-discipline in the name of 'Ana', such that dieting came to be framed as part of a devotional, often punitive, body project. On both sites, morality discourses were gendered around the thin female body and the 'ideal mother', with occasional praise for muscular male bodies. Our findings indicate how transitioning from healthy eating preoccupations to eating disorders may be facilitated by normalising discussions about restrictive dieting and the shaming of bodies, overseen by self-appointed diet 'experts' and 'buddies' online.

The contribution of social media addiction to adolescent LIFE: Social appearance anxiety

The use of social media by adolescents, who spend about 3 hours a day on social media, is dominated by visual communication. Nowadays, appearance ideals are presented through social media platforms. Exposure to these popular ideals of appearance could cause appearance-based anxiety and adolescents to develop binge-eating behavior. This cross-sectional study was conducted to determine social appearance anxiety, social media addictions, and emotional eating behaviors of adolescents. 1363 adolescents, living in the Central Anatolian Region of Turkey, were included in the study. Data were collected with a Questionnaire form, the Social Appearance Anxiety Scale (SAAS), Social Media Addiction Scale (SMAS), and Emotional Eating Scale (EES-C). 24.4% of adolescents are social media addicts. No relationship was found between adolescents' social appearance anxiety, social media addictions, and emotional eating behaviors. However, social appearance anxiety and social media addictions of girls, those who perceive their family income as low and who think that they are influenced by social media influencers have higher anxiety. The value of this study is that it shows that gender, low income perception, time spent on social media, being influenced by influencers, following influencers who share diet and nutrition content, and social media addiction are associated with social appearance anxiety. As a result, it is thought that social media addiction and being affected by social media influencers increase social appearance anxiety in adolescents and pose a risk in terms of adolescents' mental health.

Self-disclosure in public and private groups of people with mental illnesses in Facebook

Purpose

The Internet enables various voices and opinions that previously did not participate in the community discourse to express themselves. People with mental illnesses make use of social networks to advance their special needs in varied ways. The study aims to examine the nature of the discourse that takes place in public and private groups of people with mental illnesses.

Design/methodology/approach

The research corpus consisted of the content of 615 messages taken from public and private groups of people with mental illnesses in Facebook. Linguistic parameters (the total number of words, the number of words in the first person) were examined for each message. Two skilled judges classified the messages on a self-disclosure scale to determine the degree of disclosure of personal information, thoughts and emotions.

Findings

The results of the study indicate that the messages published in public groups are longer than the messages in private groups; however, the level of personal disclosure in messages written in private groups is deeper than in messages written in public groups. In addition, the level of self-disclosure in opening posts was found to be greater than the level of self-disclosure in comments.

Practical implications

In the study, the authors focus on the ways people in excluded populations make use of virtual tools to advance both their personal and social needs.

Originality/value

The study is innovative, as it explores the discourse of people with mental illnesses in public and private groups on Facebook.

Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals

BACKGROUND

An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed.

OBJECTIVE

Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach.

METHOD

To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis.

RESULTS

In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were 'recognizing and addressing' by close others, 'waiting times and availability' and 'recommendations and referrals' by health care professionals. 'Positive role models for treatment' were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability.

CONCLUSION

Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03713541 .

Psychological Impact of Pro-Anorexia and Pro-Eating Disorder Websites on Adolescent Females: A Systematic Review

(1) Background: Teenagers (in particular, females) suffering from eating disorders report being not satisfied with their physical aspect and they often perceive their body image in a wrong way; they report an excessive use of websites, defined as PRO-ANA and PRO-MIA, that promote an ideal of thinness, providing advice and suggestions about how to obtain super slim bodies. (2) Aim: The aim of this review is to explore the psychological impact of pro-ana and pro-mia websites on female teenagers. (3) Methods: We have carried out a systematic review of the literature on PubMed. The search terms that have been used are: "Pro" AND "Ana" OR "Blogging" AND "Mia". Initially, 161 publications were identified, but in total, in compliance with inclusion and exclusion criteria, 12 studies have been analyzed. (4) Results: The recent scientific literature has identified a growing number of Pro Ana and Pro Mia blogs which play an important role in the etiology of anorexia and bulimia, above all in female teenagers. The feelings of discomfort and dissatisfaction with their physical aspect, therefore, reduce their self-esteem. (5) Conclusion: These websites encourage anorexic and bulimic behaviors, in particular in female teenagers. Attention to healthy eating guidelines and policies during adolescence, focused on correcting eating behavioral aspects, is very important to prevent severe forms of psychopathology with more vulnerability in the perception of body image, social desirability, and negative emotional feedback.

Profiling Commenters on Mental Health-Related Online Forums: A Methodological Example Focusing on Eating Disorder-Related Commenters

BACKGROUND

Understanding the characteristics of commenters on mental health-related online forums is vital for the development of effective psychological interventions in these communities. The way in which commenters interact can enhance our understanding of their characteristics.

OBJECTIVE

Using eating disorder-related (EDR) forums as an example, this study detailed a methodology that aimed to determine subtypes of mental health-related forums and profile their commenters based on the other forums to which they contributed.

METHODS

The researchers identified all public EDR forums (with ≥500 contributing commenters between March 2017 and February 2018) on a large Web-based discussion platform (Reddit). A mixed-methods approach comprising network analysis with community detection, text mining, and manual review identified subtypes of EDR forums. For each subtype, another network analysis with community detection was conducted using the EDR forum commenter overlap between 50 forums on which the commenters also commented. The topics of forums in each detected community were then manually reviewed to identify the shared interests of each subtype of EDR forum commenters.

RESULTS

Six subtypes of EDR forums were identified, to which 14,024 commenters had contributed. The results focus on 2 subtypes-proeating disorder and thinspiration-and communities of commenters within both subtypes. Within the proeating disorder subtype, 3 communities of commenters were detected that related to the body and eating, mental health, and women, appearance, and mixed topics. With regard to the thinspiration group, 78.17% (849/1086) of commenters had also commented on pornographic forums and 16.66% (181/1086) had contributed to proeating disorder forums.

CONCLUSIONS

The article exemplifies a methodology that provides insight into subtypes of mental health-related forums and the characteristics of their commenters. The findings have implications for future research and Web-based psychological interventions. With the publicly available data and code provided, researchers can easily reproduce the analyses or utilize the methodology to investigate other mental health-related forums.

Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12-30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen's d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen's d = 0.65), had a higher online-offline friend ratio (t = 3.7, p < 0.0001, Cohen's d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen's d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63-0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their "real life" social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

Cue reactivity towards bodies in anorexia nervosa - common and differential effects in adolescents and adults

BACKGROUND

Aberrant reward mechanisms with regard to slim body shapes are discussed in patients with anorexia nervosa (AN). The aim of the present study was to examine of cue reactivity toward body shapes in AN via the late positive potential (LPP), an event-related electroencephalography (EEG) component. By including adolescents and adults, aspects of development and chronification could be studied (2 × 2 design).

METHODS

Thirty-two female AN patients (19 adolescents and 13 adults) and 37 control participants (16 adolescents and 21 adults) were included. Standardized photographic stimuli showing women's bodies in underwear from five body mass index (BMI) categories (extremely underweight to extremely overweight) were presented. During picture evaluation, EEG activity was recorded (10-20 system). The LPP was measured in two time windows characterized by different topographies (450-700 ms: posterior; 1000-1300 ms: central).

RESULTS

Regarding the posterior component, LPP amplitudes were clearly reduced in adult but not in adolescent patients; for both time windows the LPP showed differential patterns over BMI categories for patients and controls. Regarding the central component, a highly significant linear decrease from extremely underweight to extremely overweight body shapes was revealed in patients and no significant modulation in control participants.

CONCLUSIONS

Adolescent and adult patients show increased sustained attention toward extremely underweight bodies. In chronically ill patients, this bias appears to be accompanied by generally reduced automatic attention. The LPP findings provide a differentiated picture of aberrant cue reactivity which could be interpreted as motivated attention toward body shapes in AN.