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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



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.


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.


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.


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.

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  1. 1.

    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.


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

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Correspondence to Ellen E. Fitzsimmons-Craft.

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

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

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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).

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