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.
Similar content being viewed by others
Notes
We compared survey completers (n = 598) to survey non-completers (n = 334) on items appearing early in the survey, including (1) percent of individuals reporting use of specific social media platforms several times a day; (2) average minutes spent on specific social media platforms when logging in; (3) percent of individuals reporting seeing peers posting thin ideal content on specific social media platforms in the past month; and (4) percent of individuals reporting posting thin ideal content on specific social media platforms in the past month. For these items, we queried the social media platforms of Twitter, Facebook, Snapchat, Instagram, Tumblr, YouTube, and Reddit. Groups generally did not differ with just a few exceptions to this pattern of findings. More non-completers reported using Instagram several times a day relative to completers (p = 0.003), whereas more completers reported using Reddit several times a day relative to non-completers (p < 0.001). Completers reported using Snapchat more minutes per day on average (M = 30, SD= 104) relative to non-completers (M = 24, SD= 37) (p = 0.007). More completers reported seeing thin ideal content on Tumbler (p = 0.037) and Reddit (p < 0.001) relative to non-completers, whereas more non-completers reported seeing thin ideal content on Instagram relative to completers (p = 0.020). Finally, more completers reported posting thin ideal content on Reddit relative to non-completers (p = 0.002). Overall, completers and non-completers reported similar social media use patterns, with just a few minor differences, as noted above.
References
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
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
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
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
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
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
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
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
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
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
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
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
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
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 Online
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
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
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
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
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
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
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
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
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
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
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
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
PewResearchCenter (2018) Social media fact sheet. http://www.pewinternet.org/fact-sheet/social-media/. Accessed 03 July 2019
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
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
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
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
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
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
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
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
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
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
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613
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
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
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 29:227–234a
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
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
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
Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1:43–46. https://doi.org/10.1097/00001648-199001000-00010
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
Casper RC (1998) Depression and eating disorders. Depress Anxiety 8:96–104
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
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
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
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
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
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
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
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
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
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
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
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
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
Acknowledgements
This study was funded by the National Institute of Mental Health [Grant Numbers R21 MH112331 and K08 MH120341].
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Fitzsimmons-Craft, E.E., Krauss, M.J., Costello, S.J. et al. 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. Eat Weight Disord 25, 1681–1692 (2020). https://doi.org/10.1007/s40519-019-00808-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-019-00808-3