Advertisement

Adolescents and young adults engaged with pro-eating disorder social media: eating disorder and comorbid psychopathology, health care utilization, treatment barriers, and opinions on harnessing technology for treatment

  • Ellen E. Fitzsimmons-CraftEmail author
  • Melissa J. Krauss
  • Shaina J. Costello
  • Glennon M. Floyd
  • Denise E. Wilfley
  • Patricia A. Cavazos-Rehg
Original Article
  • 106 Downloads

Abstract

Purpose

The purpose of this study was to examine exposure (i.e., seeing, following, posting) to body image content emphasizing a thin ideal on various social media platforms and probable eating disorder (ED) diagnoses, ED-related quality of life, and psychiatric comorbidities (i.e., depression, anxiety) among adolescents and young adult females recruited via social media who endorsed viewing and/or posting pro-ED online content. We also investigated health care utilization, treatment barriers, and opinions on harnessing technology for treatment.

Methods

Participants were 405 adolescent and young adult females engaged with pro-ED social media. We reported on study constructs for the sample as a whole, as well as on differences between age groups.

Results

Eighty-four percent of participants’ self-reported symptoms were consistent with a clinical/subclinical ED, and this was slightly more common among young adults. Participants endorsed reduced ED-related quality of life, as well as comorbid depression and anxiety. Among those with clinical/subclinical EDs, only 14% had received treatment. The most common treatment barriers were believing the problem was not serious enough and believing one should help themselves. The majority of participants approved of harnessing technology for treatment.

Conclusions

Results provide support for engagement with pro-ED online content serving as a potential indicator of ED symptoms and suggest promise for facilitating linkage from social media to technology-enhanced interventions.

Level of evidence

V, cross-sectional descriptive study.

Keywords

Feeding and eating disorders Adolescent Young adult Social media Cross-sectional studies 

Notes

Acknowledgements

This study was funded by the National Institute of Mental Health [Grant Numbers R21 MH112331 and K08 MH120341].

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was reviewed and approved by the Washington University Institutional Review Board.

Informed consent

Participants consented to participate online.

References

  1. 1.
    Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E (2009) Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 42:97–103.  https://doi.org/10.1002/eat.20589 CrossRefPubMedGoogle Scholar
  2. 2.
    Micali N, Hagberg KW, Petersen I, Treasure JL (2013) The incidence of eating disorders in the UK in 2000–2009: findings from the general practice research database. BMJ Open 3:e002646.  https://doi.org/10.1136/bmjopen-2013-002646 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Stice E, Marti CN, Rohde P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. J Abnorm Psychol 122:445–457.  https://doi.org/10.1037/a0030679 CrossRefPubMedGoogle Scholar
  4. 4.
    Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P (2016) Eating disorders: what age at onset? Psychiatr Res 238:225–227.  https://doi.org/10.1016/j.psychres.2016.02.048 CrossRefGoogle Scholar
  5. 5.
    Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE (2017) Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord 50:170–189.  https://doi.org/10.1002/eat.22670 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Eisenberg D, Nicklett EJ, Roeder K, Kirz NE (2011) Eating disorder symptoms among college students: prevalence, persistence, correlates, and treatment-seeking. J Am Coll Health 59:700–707.  https://doi.org/10.1080/07448481.2010.546461 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Borzekowski DL, Schenk S, Wilson JL, Peebles R (2010) e-Ana and e-Mia: a content analysis of pro-eating disorder web sites. Am J Public Health 100:1526–1534.  https://doi.org/10.2105/ajph.2009.172700 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Custers K, Van den Bulck J (2009) Viewership of pro-anorexia websites in seventh, ninth and eleventh graders. Eur Eat Disord Rev 17:214–219.  https://doi.org/10.1002/erv.910 CrossRefPubMedGoogle Scholar
  9. 9.
    Harper K, Sperry S, Thompson JK (2008) Viewership of pro-eating disorder websites: association with body image and eating disturbances. Int J Eat Disord 41:92–95.  https://doi.org/10.1002/eat.20408 CrossRefPubMedGoogle Scholar
  10. 10.
    Juarez L, Soto E, Pritchard ME (2012) Drive for muscularity and drive for thinness: the impact of pro-anorexia websites. Eat Disord 20:99–112.  https://doi.org/10.1080/10640266.2012.653944 CrossRefPubMedGoogle Scholar
  11. 11.
    Peebles R, Wilson JL, Litt IF, Hardy KK, Lock JD, Mann JR, Borzekowski DL (2012) Disordered eating in a digital age: eating behaviors, health, and quality of life in users of websites with pro-eating disorder content. JMIR 14:e148.  https://doi.org/10.2196/jmir.2023 CrossRefPubMedGoogle Scholar
  12. 12.
    Rodgers RF, Skowron S, Chabrol H (2012) Disordered eating and group membership among members of a pro-anorexic online community. Eur Eat Disord Rev 20(1):9–12.  https://doi.org/10.1002/erv.1096 CrossRefPubMedGoogle Scholar
  13. 13.
    Lewis SP, Arbuthnott AE (2012) Searching for thinspiration: the nature of Internet searches for pro-eating disorder websites. Cyberpsychol Behav Soc Netw 15(4):200–204.  https://doi.org/10.1089/cyber.2011.0453 CrossRefPubMedGoogle Scholar
  14. 14.
    Livingstone S, Haddon L, Görzig A, Ólafsson K (2010) Risks and safety on the Internet: the perspective of European children: key findings from the EU Kids Online survey of 9 to 16-year-old and their parents in 25 countries. EU Kids OnlineGoogle Scholar
  15. 15.
    Ghaznavi J, Taylor LD (2015) Bones, body parts, and sex appeal: an analysis of # thinspiration images on popular social media. Body Image 14:54–61.  https://doi.org/10.1016/j.bodyim.2015.03.006 CrossRefPubMedGoogle Scholar
  16. 16.
    Juarascio AS, Shoaib A, Timko CA (2010) Pro-eating disorder communities on social networking sites: a content analysis. Eat Disord 18:393–407.  https://doi.org/10.1080/10640266.2010.511918 CrossRefPubMedGoogle Scholar
  17. 17.
    Pater JA, Haimson OL, Andalibi N, Mynatt ED (2016) “Hunger hurts but starving works:” characterizing the presentation of eating disorders online. In: Paper presented at the Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing, San Francisco, California, USA. https://dl.acm.org/citation.cfm?id=2820030
  18. 18.
    Syed-Abdul S, Fernandez-Luque L, Jian WS, Li YC, Crain S, Hsu MH et al (2013) Misleading health-related information promoted through video-based social media: anorexia on YouTube. JMIR 15:e30.  https://doi.org/10.2196/jmir.2237 CrossRefPubMedGoogle Scholar
  19. 19.
    Cornelius T, Blanton H (2016) The limits to pride: a test of the pro-anorexia hypothesis. Eat Disord 24:138–147.  https://doi.org/10.1080/10640266.2014.1000102 CrossRefPubMedGoogle Scholar
  20. 20.
    Holland G, Tiggemann M (2017) “Strong beats skinny every time”: disordered eating and compulsive exercise in women who post fitspiration on Instagram. Int J Eat Disord 50:76–79.  https://doi.org/10.1002/eat.22559 CrossRefPubMedGoogle Scholar
  21. 21.
    Hefner V, Dorros SM, Jourdain N, Liu C, Tortomasi A, Greene MP et al (2016) Mobile exercising and tweeting the pounds away: the use of digital applications and microblogging and their association with disordered eating and compulsive exercise. Cogent Soc Sci 2:1.  https://doi.org/10.1080/23311886.2016.1176304 CrossRefGoogle Scholar
  22. 22.
    Ali K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM (2017) Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord 50:9–21.  https://doi.org/10.1002/eat.22598 CrossRefPubMedGoogle Scholar
  23. 23.
    Bauer S, Moessner M (2013) Harnessing the power of technology for the treatment and prevention of eating disorders. Int J Eat Disord 46:508–515.  https://doi.org/10.1002/eat.22109 CrossRefPubMedGoogle Scholar
  24. 24.
    Arnett JJ (2007) Emerging adulthood: what is it, and what is it good for? Child Dev Perspect 1:68–73.  https://doi.org/10.1111/j.1750-8606.2007.00016.x CrossRefGoogle Scholar
  25. 25.
    Common Sense (2015) The common sense census: media use by tweens and teens. https://www.commonsensemedia.org/sites/default/files/uploads/research/census_researchreport.pdf. Accessed 03 July 2019
  26. 26.
    Lenhart A (2015) Teens, social media & technology overview 2015. Pew research center. http://www.pewinternet.org/2015/04/09/teens-social-media-technology-2015/. Accessed 03 July 2019
  27. 27.
    PewResearchCenter (2018) Social media fact sheet. http://www.pewinternet.org/fact-sheet/social-media/. Accessed 03 July 2019
  28. 28.
    Bauermeister JA, Pingel E, Zimmerman M, Couper M, Carballo-Diéguez A, Strecher VJ (2012) Data quality in HIV/AIDS web-based surveys. Field Methods 24:272–291.  https://doi.org/10.1177/1525822X12443097 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Godinho A, Kushnir V, Cunningham JA (2016) Unfaithful findings: identifying careless responding in addictions research. Addiction 111:955–956.  https://doi.org/10.1111/add.13221 CrossRefPubMedGoogle Scholar
  30. 30.
    Leiner DJ (2013) Too fast, too straight, too weird: post-hoc identification of meaningless data in internet surveys. SSRN Electron J.  https://doi.org/10.2139/ssrn.2361661 CrossRefGoogle Scholar
  31. 31.
    Murray SB, Griffiths S, Mond JM (2016) Evolving eating disorder psychopathology: conceptualising muscularity-oriented disordered eating. Br J Psychiatr 208:414–415.  https://doi.org/10.1192/bjp.bp.115.168427 CrossRefGoogle Scholar
  32. 32.
    Hepp U, Milos G (2002) Gender identity disorder and eating disorders. Int J Eat Disord 32:473–478.  https://doi.org/10.1002/eat.10090 CrossRefPubMedGoogle Scholar
  33. 33.
    McClain Z, Peebles R (2016) Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin N Am 63:1079–1090.  https://doi.org/10.1016/j.pcl.2016.07.008 CrossRefGoogle Scholar
  34. 34.
    Winston AP, Acharya S, Chaudhuri S, Fellowes L (2004) Anorexia nervosa and gender identity disorder in biologic males: a report of two cases. Int J Eat Disord 36:109–113.  https://doi.org/10.1002/eat.20013 CrossRefPubMedGoogle Scholar
  35. 35.
    Graham AK, Trockel M, Weisman H, Fitzsimmons-Craft EE, Balantekin KN, Wilfley DE, Taylor CB (2019) A screening tool for detecting eating disorder risk and diagnostic symptoms among college-age women. J Am Coll Health 67:357–366.  https://doi.org/10.1080/07448481.2018.1483936 CrossRefPubMedGoogle Scholar
  36. 36.
    Engel SG, Wittrock DA, Crosby RD, Wonderlich SA, Mitchell JE, Kolotkin RL (2006) Development and psychometric validation of an eating disorder-specific health-related quality of life instrument. Int J Eat Disord 39:62–71.  https://doi.org/10.1002/eat.20200 CrossRefPubMedGoogle Scholar
  37. 37.
    Ackard DM, Richter S, Egan A, Engel S, Cronemeyer CL (2014) The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome. Int J Eat Disord 47:259–267.  https://doi.org/10.1002/eat.22193 CrossRefPubMedGoogle Scholar
  38. 38.
    Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613CrossRefGoogle Scholar
  39. 39.
    Spitzer RL, Kroenke K, Williams JW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the gad-7. Arch Intern Med 166:1092–1097.  https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle Scholar
  40. 40.
    Kroenke K, Spitzer RL, Williams JW, Monahan PO, Löwe B (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 146:317–325.  https://doi.org/10.7326/0003-4819-146-5-200703060-00004 CrossRefPubMedGoogle Scholar
  41. 41.
    Mossman SA, Luft MJ, Schroeder HK, Varney ST, Fleck DE, Barzman DH et al (2017) The generalize anxiety disorder 7-item scale in adolescents with generalized anxiety disorder: signal detection and validation. Ann Clin Psychiatr 29:227–234aGoogle Scholar
  42. 42.
    Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE et al (2010) Evaluation of the Patient Health Questionnaire-9 item for detecting major depression among adolescents. Pediatrics 126:1117–1123.  https://doi.org/10.1542/peds.2010-0852 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Cachelin FM, Striegel-Moore RH (2006) Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. Int J Eat Disord 39:154–161.  https://doi.org/10.1002/eat.20213 CrossRefPubMedGoogle Scholar
  44. 44.
    Althouse AD (2016) Adjust for multiple comparisons? It’s not that simple. Ann Thorac Surg 101:1644–1645.  https://doi.org/10.1016/j.athoracsur.2015.11.024 CrossRefPubMedGoogle Scholar
  45. 45.
    Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1:43–46.  https://doi.org/10.1097/00001648-199001000-00010 CrossRefPubMedGoogle Scholar
  46. 46.
    Rubin M (2017) Do p values lose their meaning in exploratory analyses? It depends how you define the familywise error rate. Rev Gen Psychol 21:269–275.  https://doi.org/10.1037/gpr0000123 CrossRefGoogle Scholar
  47. 47.
    Casper RC (1998) Depression and eating disorders. Depress Anxiety 8:96–104CrossRefGoogle Scholar
  48. 48.
    Giovanni AD, Carla G, Enrica M, Federico A, Maria Z, Secondo F (2011) Eating disorders and major depression: role of anger and personality. Depress Res Treat.  https://doi.org/10.1155/2011/194732 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Hudson JI, Hiripi E, Pope HG, Kessler RC (2007) The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatr 61:348–358.  https://doi.org/10.1016/j.biopsych.2006.03.040 CrossRefGoogle Scholar
  50. 50.
    Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K (2004) Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatr 161:2215–2221.  https://doi.org/10.1176/appi.ajp.161.12.2215 CrossRefPubMedGoogle Scholar
  51. 51.
    Ziobrowski H, Brewerton TD, Duncan AE (2018) Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample. Psychiatr Res 260:53–59.  https://doi.org/10.1016/j.psychres.2017.11.026 CrossRefGoogle Scholar
  52. 52.
    Lin LY, Sidani JE, Shensa A, Radovic A, Miller E, Colditz JB et al (2016) Association between social media use and depression among U.S. young adults. Depress Anxiety 33:323–331.  https://doi.org/10.1002/da.22466 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Zagorski N (2017) Using many social media platforms linked with depression, anxiety risk. https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2017.1b16. Accessed 03 July 2019
  54. 54.
    Housman LT (2017) “I’m home(screen)!”: social media in health care has arrived. Clin Ther 39:2189–2195.  https://doi.org/10.1016/j.clinthera.2017.10.007 CrossRefPubMedGoogle Scholar
  55. 55.
    Melioli T, Bauer S, Franko DL, Moessner M, Ozer F, Chabrol H, Rodgers RF (2016) Reducing eating disorder symptoms and risk factors using the internet: a meta-analytic review. Int J Eat Disord 49:19–31.  https://doi.org/10.1002/eat.22477 CrossRefPubMedGoogle Scholar
  56. 56.
    Saffran K, Fitzsimmons-Craft EE, Kass AE, Wilfley DE, Taylor CB, Trockel M (2016) Facebook usage among those who have received treatment for an eating disorder in a group setting. Int J Eat Disord 49:764–777.  https://doi.org/10.1002/eat.22567 CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Sadeh-Sharvit S (2019) Use of technology in the assessment and treatment of eating disorders in youth. Child Adolesc Psychiatr 28:653–661.  https://doi.org/10.1016/j.chc.2019.05.011 CrossRefGoogle Scholar
  58. 58.
    Chéileachair CN (2017) Instagram and the regulation of eating disorder communities [internet]. Bill of health: examining the intersection of health law, biotechnology, and bioethics. http://blog.petrieflom.law.harvard.edu/2017/10/20/instagram-and-the-regulation-of-eating-disorder-communities/. Accessed 24 Sept 2019
  59. 59.
    Alexander A (2019) Instagram will restrict who can see posts about cosmetic procedures, weight loss products [internet]. The Verge. https://www.theverge.com/2019/9/18/20872711/instagram-weight-loss-cosmetic-procedures-restrictions-policy-wellness-influencer-marketing. Accessed 24 Sept 2019
  60. 60.
    Austin SB, Hutcheson R, Wickramatilake-Templeman S, Velasquez K (2019) The second wave of public policy advocacy for eating disorders: charting the course to maximize population impact. Psychiatr Clin 42:319–336.  https://doi.org/10.1016/j.psc.2019.01.013 CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychiatryWashington University School of MedicineSt. LouisUSA

Personalised recommendations