Skip to main content

Advertisement

SpringerLink
Log in

#EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Limited research has evaluated the role of Social Networking Sites (SNS) in eating disorder (ED) recovery. While research has demonstrated the deleterious effects of pro-ED SNS content, less is known regarding SNS content documenting ED recovery. This study evaluates orientation towards help-seeking, ongoing ED warning signs and recovery themes on ED recovery SNS hashtags.

Methods

600 Instagram posts were retrieved from two popular hashtags: #EDrecovery and #EatingDisorderRecovery. They were categorized into four thematic concerns: Food, Quotes, People or Others. Posts were analysed for behavioural and psychological signs of ED based on the Mental Health First Aid Eating Disorders Guidelines, and whether they encouraged seeking professional help. Thematic qualitative analysis to evaluate themes posted on recovery hashtags was conducted.

Results

Of the 600 posts, 405 were used for analysis. The majority of posts were on Food (49.6%), Quotes (24.2%) and People (22.7%). Behavioural and psychological signs suggestive of EDs were present in 18.0% and 22.5% of images, respectively. Only 9.4% of posts encouraged seeking professional help. Important themes that emerged from the qualitative analysis included the recovery journey, increased awareness and stigma for EDs and the development of a supportive community.

Conclusions

Despite identifying with ED recovery, posts had a high prevalence of ongoing ED behaviour and low prevalence of help-seeking. Thematic analysis emphasized the role of recovery as a journey and the role of stigma and community in recovery. These findings suggest that SNSs could potentially be leveraged as a platform to improve help-seeking and encourage recovery for users with eating disorders.

Level of evidence: Level V, descriptive study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ED:

Eating disorder

SNS:

Social networking site

MHFA:

Mental Health First Aid

EDFA Guidelines:

Eating Disorder First Aid Guidelines

References

  1. Holland G, Tiggemann M (2016) A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 17:100–110. https://doi.org/10.1016/j.bodyim.2016.02.008

    Article  PubMed  Google Scholar 

  2. 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(8):1526–1534. https://doi.org/10.2105/ajph.2009.172700

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sowles SJ, McLeary M, Optican A, Cahn E, Krauss MJ, Fitzsimmons-Craft EE et al (2018) A content analysis of an online pro-eating disorder community on Reddit. Body Image 24:137–144. https://doi.org/10.1016/j.bodyim.2018.01.001

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cavazos-Rehg PA, Krauss MJ, Costello SJ, Kaiser N, Cahn ES, Fitzsimmons-Craft EE et al (2019) “I just want to be skinny.”: a content analysis of tweets expressing eating disorder symptoms. PLoS ONE 14(1):e0207506. https://doi.org/10.1371/journal.pone.0207506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Arseniev-Koehler A, Lee H, McCormick T, Moreno MA (2016) #Proana: pro-eating disorder socialization on Twitter. J Adolesc Health 58(6):659–664. https://doi.org/10.1016/j.jadohealth.2016.02.012

    Article  PubMed  Google Scholar 

  6. Tiggemann M, Zaccardo M (2018) ‘Strong is the new skinny’: a content analysis of #fitspiration images on Instagram. J Health Psychol 23(8):1003–1011. https://doi.org/10.1177/2F1359105316639436

    Article  PubMed  Google Scholar 

  7. Tiggemann M, Churches O, Mitchell L, Brown Z (2018) Tweeting weight loss: a comparison of #thinspiration and #fitspiration communities on Twitter. Body Image 25:133–138. https://doi.org/10.1016/j.bodyim.2018.03.002

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Peebles R, Wilson JL, Litt If, Hardy KK, Lock Jd, Mann Jr, Borzekowski L (2012) Disordered eating in a digital age: eating behaviors, 2 health, and quality of life in users of websites with pro-eating disorder content. J Med Internet Res 14(5):e148. PMID: 23099628, PMCD: PMC3510745. https://doi.org/10.1296/jmir.2023

  10. Fitzsimmons-Craft EE, Krauss MJ, Costello SJ, Floyd GM, Wilfley DE, Cavazos-Rehg PA (2020) 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(6):1681–1692. https://doi.org/10.1007/s40519-019-00808-3

    Article  PubMed  Google Scholar 

  11. Wang T, Brede M, Ianni A, Mentzakis E (2018) Social interactions in online eating disorder communities: a network perspective. PLoS ONE 13(7):e0200800. https://doi.org/10.1371/journal.pone.0200800

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Chancellor S, Mitra T, De Choudhury M (2016) Recovery amid pro-anorexia: analysis of recovery in social media. Proc SIGCHI Conf Hum Factor Comput Syst 2016:2111–2123. https://doi.org/10.1145/2F2858036.2858246

    Article  PubMed  PubMed Central  Google Scholar 

  13. Branley DB, Covey J (2017) Pro-ana versus pro-recovery: a content analytic comparison of social media users’ communication about eating disorders on Twitter and Tumblr. Front Psychol 8:1356. https://doi.org/10.3389/2Ffpsyg.2017.01356

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yom-Tov E, Fernandez-Luque L, Weber I, Crain SP (2012) Pro-anorexia and pro-recovery photo sharing: a tale of two warring tribes. J Med Internet Res 14(6):e151. https://doi.org/10.2196/2Fjmir.2239

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lyons EJ, Mehl MR, Pennebaker JW (2006) Pro-anorexics and recovering anorexics differ in their linguistic Internet self-presentation. J Psychosom Res 60(3):253–256. https://doi.org/10.1016/j.jpsychores.2005.07.017

    Article  PubMed  Google Scholar 

  16. Hart LM, Jorm AF, Paxton SJ, Kelly CM, Kitchener BA (2009) First aid for eating disorders. Eat Disord 17(5):357–384. https://doi.org/10.1080/10640260903210156

    Article  Google Scholar 

  17. Ging D, Garvey S (2018) ‘Written in these scars are the stories I can’t explain’: a content analysis of pro-ana and thinspiration image sharing on Instagram. New Media Soc 20(3):1181–1200. https://doi.org/10.1177/2F1461444816687288

    Article  Google Scholar 

  18. LaMarre A, Rice C (2017) Hashtag recovery: #Eating disorder recovery on Instagram. Soc Sci 6(3):68. https://doi.org/10.3390/socsci6030068

    Article  Google Scholar 

  19. Cohen R, Newton-John T, Slater A (2017) The relationship between Facebook and Instagram appearance-focused activities and body image concerns in young women. Body Image 23:183–187. https://doi.org/10.1016/j.bodyim.2017.10.002

    Article  PubMed  Google Scholar 

  20. Turner PG, Lefevre CE (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord 22(2):277–284. https://doi.org/10.1007/s40519-017-0364-2

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pew Research Center (2019) Share of U.S. adults using social media, including Facebook, is mostly unchanged since 2018. https://www.pewresearch.org/fact-tank/2019/04/10/share-of-u-s-adults-using-social-media-including-facebook-is-mostly-unchanged-since-2018/

  22. Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P (2016) Eating disorders: what age at onset? Psychiatry Res 238:225–227. https://doi.org/10.1016/j.psychres.2016.02.048

    Article  PubMed  Google Scholar 

  23. Patriciello G, Monteleone AM, Amodio R, Calvanese M, Volpe U, Monteleone P (2017) Age at onset of eating disorders: a statistical validation of proposed cut-offs. Eur Psychiatry 41:S550–S551. https://doi.org/10.1016/j.eurpsy.2017.01.780

    Article  Google Scholar 

  24. Chancellor S, Pater JA, Clear T, Gilbert E, Choudhury MD (2016) #thyghgapp: Instagram content moderation and lexical variation in pro-eating disorder communities. In: Proceedings of the 19th ACM conference on computer-supported cooperative work & social computing. ACM, San Francisco, California, USA. 2819963. pp 1201–1213. https://doi.org/10.1145/2818048.2819963

  25. Hart LM, Jorm AF, Paxton SJ (2012) Mental health first aid for eating disorders: pilot evaluation of a training program for the public. BMC Psychiatry 12(1):98. https://doi.org/10.1186/2F1471-244X-12-98

    Article  PubMed  PubMed Central  Google Scholar 

  26. Octoparse. Octoparse [Internet]. https://www.octoparse.com

  27. Deighton-Smith N, Bell BT (2018) Objectifying fitness: a content and thematic analysis of #fitspiration images on social media. Psychol Pop Media Cult 7(4):467–483. https://doi.org/10.1037/ppm0000143

    Article  Google Scholar 

  28. Lobstein T, Davies S (2009) Defining and labelling “healthy” and “unhealthy” food. Public Health Nutr 12(3):331–340. https://doi.org/10.1017/s1368980008002541

    Article  CAS  PubMed  Google Scholar 

  29. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. https://doi.org/10.1191/1478088706qp063oa

    Article  Google Scholar 

  30. Eikey EVB, Kayla M (2017) Recovery and maintenance: how women with eating disorders use Instagram. iSchools. pp 227–40. https://doi.org/10.9776/17024

  31. Federici A, Kaplan AS (2008) The patient’s account of relapse and recovery in anorexia nervosa: a qualitative study. Eur Eat Disord Rev 16(1):1–10. https://doi.org/10.1002/erv.813

    Article  PubMed  Google Scholar 

  32. Potterton R, Austin A, Allen K, Lawrence V, Schmidt U (2020) “I’m not a teenager, I’m 22. Why can’t I snap out of it?”: a qualitative exploration of seeking help for a first-episode eating disorder during emerging adulthood. J Eat Disord 8:46. https://doi.org/10.1186/s40337-020-00320-5

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ritchie J, Lewis J, Nicholls CM, Ormston R (2013) Qualitative research practice: a guide for social science students and researchers. Sage Publications, Thousand Oaks

    Google Scholar 

  34. Marcos YQ, Sebastián MQ, Aubalat LP, Ausina JB, Treasure J (2013) Peer and family influence in eating disorders: a meta-analysis. Eur Psychiatry 28(4):199–206. https://doi.org/10.1016/j.eurpsy.2012.03.005

    Article  CAS  Google Scholar 

  35. Linville D, Brown T, Sturm K, McDougal T (2012) Eating disorders and social support: perspectives of recovered individuals. Eat Disord 20(3):216–231. https://doi.org/10.1080/10640266.2012.668480

    Article  PubMed  Google Scholar 

  36. Rubin R (2019) Getting social: physicians can counteract misinformation with an online presence. JAMA 322(7):598–600. https://doi.org/10.1001/jama.2019.10779

    Article  PubMed  Google Scholar 

  37. Ahola Kohut S, LeBlanc C, O’Leary K, McPherson AC, McCarthy E, Nguyen C et al (2018) The internet as a source of support for youth with chronic conditions: a qualitative study. Child Care Health Dev 44(2):212–220. https://doi.org/10.1111/cch.12535

    Article  CAS  PubMed  Google Scholar 

  38. Feuston JLP, A Marie (2019) Everyday experiences: small stories and mental Illness on instagram. In: Proceedings of the 2019 CHI conference on human factors in computing systems. Glasgow, Scotland UK. pp 1–14. https://doi.org/10.1145/3290605.3300495

  39. Ramsey-Wade CE, Williamson H, Meyrick J (2020) Therapeutic writing for disordered eating: a systematic review. J Creat Ment Health. https://doi.org/10.1080/15401383.2020.1760988

    Article  Google Scholar 

  40. Rance N, Clarke V, Moller N (2017) The anorexia nervosa experience: shame, solitude and salvation. Counsell Psychother Res 17(2):127–136. https://doi.org/10.1002/capr.12097

    Article  Google Scholar 

  41. Conti J, Rhodes P, Adams H (2016) Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa. J Eat Disord 4:33. https://doi.org/10.1186/s40337-016-0117-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding to report.

Author information

Authors and Affiliations

  1. Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore, 308232, Singapore

    Aaron Qi Yang Goh & Nicholas Yong Wai Lo

  2. Adolescent Medicine Service, Department of Paediatrics, KK Women & Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore

    Courtney Davis & Elaine Chu Shan Chew

Authors
  1. Aaron Qi Yang Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas Yong Wai Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Courtney Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elaine Chu Shan Chew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elaine Chu Shan Chew.

Ethics declarations

Conflict of interest

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

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Ethics approval and waiver of informed consent were obtained from Nanyang Technological University Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goh, A.Q.Y., Lo, N.Y.W., Davis, C. et al. #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eat Weight Disord 27, 1535–1545 (2022). https://doi.org/10.1007/s40519-021-01279-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-021-01279-1

Keywords

Search

Navigation