Problematic usage of the internet and eating disorder and related psychopathology: A multifaceted, systematic review and meta-analysis

Current Advances in Behavioral Addictions: From Fundamental Research to Clinical Practice

Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. This narrative review summarizes the current state of knowledge regarding these five (potential) disorders due to addictive behaviors. All five (potential) disorders are clinically relevant and prevalent. Behavioral addictions frequently co-occur with other mental and behavioral problems, such as depression, anxiety, and attention deficit hyperactivity disorder. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Given that behavioral addictions are prevalent, frequently co-occur with psychiatric disorders, may often go undiagnosed and untreated, and have been linked to poorer treatment outcomes, active screening and treatment are indicated. Public health considerations should be expanded, and impacts of modern technologies should be investigated more intensively. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation.

Impact of internet addiction and gaming disorder on body weight in children and adolescents: A systematic review

AIM

Internet use and gaming have increased in daily life. Internet addiction has not been recognised in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or 11th Revision of International Classification of Diseases despite gaming addiction having been listed since 2013. Previous studies have shown an association between internet use and weight gain or disordered eating patterns in the general population, however none have addressed this association in a paediatric population. The aim of this study is to investigate the relationship between internet addiction or gaming addiction and weight in children and adolescents under 18 years of age.

METHODS

A systematic search of electronic databases was conducted, and articles were screened for relevance. The Joanna Briggs Institute (JBI) 3 critical appraisal tool was used to assess quality of studies. Due to heterogeneity of the studies, a meta-analysis could not be performed, thus a narrative summary was performed with the results summarised and tabulated.

RESULTS

Of 8114 initial articles identified, we included 14 studies. The review produced inconsistent results, with three of the 14 studies demonstrating no statistically significant relationship between internet and/or gaming addiction and obesity. The remaining 11 studies showed a statistically significant positive association. One study demonstrated that those who are underweight as well as overweight and obese were more likely to have problematic internet use. Four articles demonstrated increased rates of poor nutritional habits, poor eating patterns and weight control behaviour in children and adolescents with internet addiction or gaming disorder. Another study showed no statistically significant association between internet addiction and disordered eating or eating disorder.

CONCLUSION

Most of the available studies revealed increased rates of obesity in children and adolescents with internet addiction or gaming disorder, with poor patterns of eating. Clearer definitions and consistent use of terminology are required to enable more robust research in this field.

Taming the Chimaera-Hydra: disconnecting from the net to fortify our mental health

In our ever digitalising society, our engagement with the online world has significant potential to have a negative impact on our mental health. Although the roles of public health and psychiatry are debated, clinicians are in a strategic position to assess usage and intervene, to prevent harms from problematic engagement with the internet.

Problematic social media use and psychological distress in pregnancy: The mediating role of social comparisons and body dissatisfaction

BACKGROUND

Pregnancy can be experienced as a significant transition for many women with associated body dissatisfaction, depression, pregnancy-related anxiety, and disordered eating attitudes. Problematic Social Media Use (PSMU) creates abundant opportunities for women to compare themselves with others and expose themselves to sociocultural influences which may increase body dissatisfaction and psychological distress.

AIMS

This study examined whether the relationship between PSMU and psychological distress (defined as depression, pregnancy-related anxiety and disordered eating attitudes) was mediated by negative social comparisons and body dissatisfaction.

METHOD

A sample of 225 pregnant Australian women (Mage = 31.91 years, SDage = 4.39) recruited online, completed self-report measures related to the variables of interest.

RESULTS

PSMU was associated with higher levels of depression, pregnancy-related anxiety, and disordered eating attitudes. Negative social comparisons and body dissatisfaction partially mediated the relationship between PSMU and pregnancy-related anxiety and depression, and fully mediated the relationship between PSMU and disordered eating attitudes.

LIMITATIONS

Cross-sectional nature of the study limited our ability to determine the direction of the relationships. Moreover, the recruitment method via social media led to high rates of non-completion.

CONCLUSION

The findings of this study suggest that problematic social media usage during pregnancy may increase depression, pregnancy-related anxiety and disordered eating attitudes. This study identified potential pathways that may explain this relationship, (via social comparisons and body dissatisfaction). This study highlights the potentially negative impact of social media use amongst expectant mothers and the importance of screening for body dissatisfaction in routine antenatal care.

The Bidirectional Association between Internet Use, Sleep Quality and Eating Behavior: A Cross-Sectional Study in Northwestern Thrace Region in Türkiye

OBJECTIVE

This study aimed to examine the complex associations between Internet addiction, sleep disturbances, and disordered eating behaviors.

METHODS

This cross-sectional study included 646 students from 17 high schools in Edirne, Türkiye between December 2023 and May 2024. A face-to-face questionnaire was administered to assess demographic characteristics, Internet addiction (YIAT), sleep quality (PSQI), and eating behavior (TFEQ-R21).

RESULTS

In total, 644 students completed the study. The prevalence of Internet addiction among adolescents was 16.3%, with a similar prevalence among male and female adolescents. The prevalence of poor sleep quality among adolescents was 6.4%, and this trend was more pronounced in male adolescents, with an incidence of 13.0%. A weak positive correlation was observed between Internet addiction and disordered eating behavior. Additionally, a moderate positive correlation was observed between poor sleep quality and disordered eating behavior. Gender, maternal education level, Internet addiction, and poor sleep quality were significant predictors of eating disorders in adolescents.

CONCLUSION

The findings of our study are of significant value in providing insights into the development of programs designed to prevent undesired eating behaviors.

The relationship between problematic Instagram use and eating disorders psychopathology: an explanatory structural equation model

An emerging body of research has evidenced the negative influence of using and being exposed to social networking sites (SNSs) on body image. Furthermore, it has been postulated that SNS use might be related with onset and persistence of eating disorders (EDs) psychopathology. The aim of the present study is to evaluate the complex interplay between problematic Instagram use (PIU) (conceptualized as a potential behavioral addiction comprising withdrawal, conflict, tolerance, salience, mood modification and relapse) and ED psychopathology, by means of an explanatory structural equation model. We hypothesized that PIU would be associated with ED symptoms through the mediating role of appearance comparison, individual psychological investment in physical appearance, and body uneasiness. A sample of 386 young female participants (Mage = 26.04 ± 6.73) was recruited, of which 152 had received a diagnosis of ED. ED patients used Instagram more than the control group and showed higher levels of PIU. Results from structural equation modeling (fit indices: χ2 = 44.54, df = 19, p < 0.001; RMSEA = 0.059; CFI = 0.98; SRMR = 0.02) showed that PIU predicted appearance comparison and psychological investment in physical appearance, which in turn predicted body uneasiness. In turn, body uneasiness predicted ED psychopathology and interpersonal difficulties. Our model provides a useful account of how eating disorder symptoms could be triggered and maintained by an addictive use of Instagram.

Service failure is bound to happen: Unraveling the impact of dissatisfaction, complaint behavior and re-travel intention in travel and tourism industry

Service failure is bound to happen, but dissatisfaction has always been undermined by scholars previously. The present study investigates dissatisfaction factors in travel decision-making leading towards re-travel intention with the help of the expectancy disconfirmation theory (EDT) model. Moreover, complaint behavior mediates the relationship between dissatisfaction and re-travel intention concerning the factors involved in it. For the findings, 434 real-time responses were collected through an offline survey following the lifetime value (LTV) approach. Kaiser-Meyer-Olkin (KMO) and Bartlett's tests were conducted to test the sphericity of the variables one by one. Furthermore, structural equation modeling (SEM) was implied to test the measurement and structural models. All the hypotheses supported and accepted the proposed research questions. The findings reveal that the dissatisfaction factors, with their interaction terms (transaction-based and experience-based), help study the variable dissatisfaction and its multifaceted concept in travel and tourism literature. Moreover, complaint behavior is identified as a key mediating factor in the relationship between dissatisfaction and re-travel intention, suggesting that commuters' response to dissatisfaction, including complaints, shapes their future re-travel intentions. The theoretical implications of the study are substantial, as it advances our understanding of commuter behavior in the context of public transport travel and tourism. Practically, the findings offer actionable insights for public transport authorities and service providers. Understanding the specific dissatisfaction factors influencing re-travel intention allows for targeted interventions to improve service quality and customer experience. Recognizing the importance of effective complaint management systems can help organizations better address customer grievances and mitigate the negative effects of dissatisfaction on re-travel intention.

Is problematic use of the Internet and smartphone predictor of unhealthy eating behaviors and abnormal body weight in Turkish young adults?

With technological progress, the use of the internet and smartphones has become an inseparable part of our lives and their use is increasing. The uncontrolled use of both the internet and smartphones is defined as problematic use. This study examined the effects of problematic internet and smartphone use on dietary behaviors and abnormal body weight status in young adults. Participants were 560 university students. Participants completed measures of demographics, dietary behaviors, internet and smartphone usage habits, Young's Internet Addiction Test and Smartphone Addiction Scale. Negative associations were found between dietary behaviors and problematic internet and smartphone use. Significant inverse associations were also found between these uses and recommended consumption levels of several food groups. For a healthy future generation, it is recommended that policies be developed to prevent or manage these problematic uses, especially in young adults with negative dietary behaviors and abnormal body weight.

Social Media Effects Regarding Eating Disorders and Body Image in Young Adolescents

The following study investigates how eating problems and young people's body image are affected by social media. As social media becomes more pervasive, young teenagers are exposed to many pictures, messages, and influencers encouraging unachievable body and beauty ideals. The study investigates the link between social media usage and the development of binge eating disorder patterns and undesirable body image judgments. It also sheds light on the influence that so-called social media influencers and celebrities have on encouraging disordered eating patterns and forming negative body image perceptions. On websites like Instagram and TikTok, exposure to deliberately selected photographs of "ideal" body types encourages body dissatisfaction and poor self-worth. The research emphasizes social media's possible harm to this vulnerable group's physical and mental health by examining pertinent literature and empirical evidence. It also looks at potential safeguards and methods for fostering good mental and physical health in early adolescents during pervasive social networking site use. Promoting fad diets, weight-loss aids, and the exaltation of extreme thinness aids in the normalization of harmful behaviours. Social media's negative consequences on eating disorders and body image in young teenagers are highlighted by this study in its conclusion. As a critical developmental stage, early adolescence is vulnerable due to the effect of social media, which could normalize unhealthy behaviours and maintain negative body image and insecurities. The findings underscore the need for targeted interventions and educational programs to mitigate the adverse effects of eating problems and young people's body image in light of social media.

Internet addiction and its relationship with food choice motives and the risk of eating disorders among young adults in Malaysia

The COVID-19 lockdown measures have dramatically altered the daily routines of young adults. Therefore, this study aims to elucidate the relationships between internet addiction, food choice motives and the risk of eating disorders in young adults during the transition to the endemic phase of COVID-19. The Internet Addiction Test was utilised to evaluate the presence and severity of internet addiction among young adults. The Food Choice Questionnaire was employed to assess the food choice motives of young adults, while the risk of eating disorders was determined using the Eating Attitude Test-26. The relationships between internet addiction, food choice motives, and the risk of eating disorders were assessed using model 4 of the PROCESS macro for SPSS. The findings indicated that 29.0% of young adults experienced moderate-to-severe internet addiction, whereas 32.6% were at risk of eating disorders. Young adults were highly valued for the price, sensory appeal, and mood when deciding food choices. The relationship between internet addiction and the risk of eating disorders was partially mediated by convenience (b = - 0.211, SE = 0.140, - 0.548 to - 0.016) and familiarity (b = 0.219, SE = 0.122, 0.019 to 0.494). A significant direct effect was also observed between internet addiction and the risk of eating disorders (B = 0.793, p = 0.017). There is an urgent need to implement intervention strategies aimed at reducing problematic internet use, promoting healthier food choices, and fostering healthy eating habits among young adults.

Co-occurrence of habit-forming risk behaviors and their socio-demographic, health status and lifestyle determinants: a population-based cross-sectional study

BACKGROUND

Although habit-forming risk behaviors frequently co-occur, determinants of concurrent risk behaviors have rarely been investigated. The aim of the present study was to investigate socio-demographic, health status, and lifestyle determinants of single versus concurrent risk behaviors in general-population adults.

METHODS

We analyzed data from 32,622 participants (74.5% female; mean age = 57.9 ± 14.2 years) of the NutriNet-Santé cohort who completed the Alcohol Use Disorders Identification Test, the 12-item Cigarette Dependence Scale, the modified Yale Food Addiction Scale 2.0, and the Internet Addiction Test in 2021-2022. Using established cutoffs, participants were first split into 2 groups (presence versus absence) for each risk variable (alcohol use disorders, nicotine dependence, food addiction, Internet addiction) and were then divided into 3 groups (no risk behavior, 1 risk behavior (reference), and ≥ 2 risk behaviors). The association between socio-demographic, health status, and lifestyle exposures and individual/concurrent risk behaviors were investigated with polytomous logistic regression.

RESULTS

Younger age (Odds Ratio (OR) = 2.04; 95% Confidence Interval (CI: 1.62-2.56), current financial difficulties (OR = 1.29; CI: 1.08-1.54), self-perceived poor health (OR = 1.70; CI: 1.32-2.20), overall poor dietary quality (OR = 2.88; CI: 2.06-4.02), being underweight (OR = 1.46; CI: 1.05-2.04), having obesity (OR = 1.62; CI: 1.31-1.99), lack of affection during childhood (OR = 1.41; CI: 1.18-1.69), and a lifetime prevalence or medication use for a mental disorder (OR = 1.46; CI: 1.24-1.73) were positively associated with having ≥ 2 versus 1 risk behavior (all p < 0.05). The comparison of none versus 1 risk behavior revealed the same determinants in addition to having a higher education, being physically active at work, and being overweight.

CONCLUSIONS

We investigated determinants of concurrent habit-forming risk behaviors among adults in a large, population-based study. The findings could serve as impetus for future research in this domain and ultimately help guide addiction prevention efforts.

Disorders of impulsivity in trichotillomania and skin picking disorder

Trichotillomania and skin picking disorder are often classified as body-focused repetitive behaviors (BFRBs) as they are characterized by repetitive hair-pulling and skin picking, respectively. They were initially considered to be impulse control disorders despite little research scrutiny. The objective of this study was to examine the relationship of these two conditions to other disorders with impulsive features. Adults with trichotillomania (n = 104) and skin picking (n = 178) or both (n = 96) were recruited from the general community using advertisements and online support groups and completed an online survey. Participants undertook a structured clinical interview and completion of self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed the Minnesota Impulse Disorders Interview to screen for disorders with impulsive features. Of the 378 adults with BFRBs, 134 (35.4%) screened positive for at least one disorder with features of impulsivity with the most common being compulsive buying (18.3%) and problematic use of the internet (17.5%). Participants with a co-occurring disorder of impulsivity reported significantly worse pulling and picking symptoms (p < .001), were more likely to have co-occurring alcohol problems (p < .001) and PTSD (p < .001), and scored higher regarding dissociative symptoms (p < .001). BFRBs are associated with a range of impulsive disorders and the comorbidity may have important treatment implications.

Effects of the COVID-19 pandemic on youth mental health: a cross-sectional study on eating disorder patients and their unaffected siblings

BACKGROUND

Adolescence has emerged as a particularly vulnerable phase during the COVID-19 pandemic, with eating disorders (EDs) representing a prominent psychopathological challenge linked to the restrictions imposed by the pandemic. Emerging evidence suggests that not only individuals with EDs but also their healthy siblings (HS) may experience unique psychological effects in this context. However, the existing literature on this topic remains limited. This study seeks to examine and compare the effects of the pandemic on adolescents and adults, with a specific focus on the impact of containment measures, disruptions in daily routines, and alterations in life trajectories, for both individuals with EDs and their HS.

METHODS

We enrolled 273 individuals, including those diagnosed with EDs and their HS. Among the participants, 120 were under the age of 19. Multiple self-report questionnaires were administered to assess the psychological impact of 1 year of the COVID-19 pandemic. These assessments covered a range of psychological constructs, including posttraumatic symptoms, general psychopathology, and eating-related concerns.

RESULTS

Notably, adolescent patients with EDs demonstrated the highest psychopathological scores within our sample. They were the sole subgroup to surpass clinical cutoffs, exhibiting more pronounced issues concerning eating-related concerns and general psychological well-being. Our findings also shed light on the unique experiences of HS during the pandemic.

CONCLUSION

Our findings highlight the specific psychological burden endured by adolescents with EDs throughout the COVID-19 pandemic, emphasizing the vulnerability of this demographic. Moreover, the experiences of HS, often overlooked in the literature, warrant increased attention in future health programs and interventions.

Digital Addiction and Related Factors among College Students

(1) Background: Digital addiction has been a global concern, with college students becoming increasingly vulnerable to it. The detrimental psycho-physiological effects of digital addiction have raised concerns regarding college students' health. This descriptive correlational study was conducted to evaluate the prevalence of digital addiction and identify influencing factors among college students, such as body shape satisfaction, time management, and psychological health. (2) Methods: Data were collected from 199 students at a university in Seoul, South Korea, from 30 May to 13 June 2023. The Digital Addiction Scale (DAS), Time Structure Questionnaire (TSQ), General Health Questionnaire (GHQ), and Body Shape Questionnaire (BSQ) were used for the assessment. Data (N = 199) were analyzed using descriptive statistics, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression. (3) Results: The mean score for digital addiction was 54 ± 12, with scores ranging from 23.0 to 89.0. Digital addiction had a significant positive correlation with body shape satisfaction (r = 0.156, p = 0.028) and a negative correlation with time management (r = -0.500, p < 0.001). In the stepwise multiple regression model of digital addiction (adjusted R2 = 0.285, p < 0.001), subfactors of body shape satisfaction (fear of fatness β = -0.280, body dissatisfaction β = 0.401) and time management (effective organization β = -0.211, persistence β = -0.209, past orientation β = -0.165) were statistically significant. (4) Conclusions: Body shape satisfaction and time management are important factors influencing digital addiction among college students. However, it does not establish a direct causal relationship. The findings indicate that there is a statistical association or connection between these factors, but they do not definitively state that body shape satisfaction or time management directly cause digital addiction. To decrease digital addiction in this population, interventions should aim to improve body shape satisfaction and time management.

Smartphone and Instagram use, body dissatisfaction, and eating disorders: investigating the associations using self-report and tracked data

BACKGROUND

Previous research has linked smartphone and Instagram use to higher body dissatisfaction (BD) as well as eating disorder (ED) symptomatology. However, these studies have typically been limited to using self-report measures for technology use which, as shown by scientific literature, might not be reliable. In the present work, we combine self-reported assessments as well as tracked smartphone and Instagram use.

METHODS

The effective sample comprised N = 119 women (34 with ED diagnosis history) who were queried about BD and ED symptomatology, and who provided the data about their smartphone and Instagram use duration for each day of the previous week.

RESULTS

The study results show that women with an ED diagnosis history scored higher on both BD as well as ED scales. Although women with an ED diagnosis history had higher smartphone screen time, there were no statistically significant differences in Instagram screen time. Tracked smartphone use duration was positively correlated with both BD and ED symptomatology, but the role of Instagram use needs to be further elucidated.

CONCLUSIONS

The results of this study show that while BD and ED symptomatology are correlated with smartphone use, it may be that Instagram use is not the main contributor to that relationship.

A Systematic Review of the Association of Internet Gaming Disorder and Excessive Social Media Use With Psychiatric Comorbidities in Children and Adolescents: Is It a Curse or a Blessing?

Internet gaming and social media usage (SMU), particularly among children and teenagers, have witnessed a remarkable surge over the past decade. However, it remains uncertain whether this widespread usage has a positive or negative impact. The primary objective of this systematic review was to investigate the diverse effects of excessive video game playing and extensive SMU, both favorable and detrimental, on the psychological and mental well-being of children and adolescents. To assess the influence of internet gaming disorder (IGD) and disordered SMU on the mental health of children aged 6-12 years and adolescents aged 13-18 years, we conducted a systematic review of 20 studies on the subject. These studies utilized a substantial sample size of 48,652 participants, encompassing online and in-person questionnaires administered to children, teenagers, and their parents in educational institutions, healthcare facilities, and online platforms. Our findings suggest that multiple factors contribute to the intricate relationship between SMU, video game playing, and mental health outcomes. The majority of research indicates that excessive gaming or SMU among children and teenagers leads to adverse consequences on their mental well-being. Furthermore, certain studies have even reported fatal consequences, while others have identified a worsening of preexisting mental health issues. A few studies have explored the potential positive impacts of SMU and gaming on individuals and society at large. In light of this, we have concluded that it is inappropriate to categorize internet gaming and SMU as solely beneficial or detrimental without considering the broader context and the interplay of various factors.

Internet severity and activities addiction questionnaire (ISAAQ): Psychometrics of item response theory and clustering of online activities

BACKGROUND

Problematic usage of the internet (PUI) is an umbrella term, referring to a variety of maladaptive online behaviors linked to functional impairment. There is ongoing need for the development of instruments capturing not only PUI severity, but also the online activity types. The Internet Severity and Activities Questionnaire (ISAAQ), previously developed to address this need, required further refinement and validation.

METHODS

Cross-sectional data was gathered in two separate samples (South Africa n = 3275, USA-UK n = 943) using the Internet Severity and Activities Addiction Questionnaire (ISAAQ). Item Response Theory (IRT) was used to examine the properties of the scale (Part A of the ISAAQ) and differential item functioning against demographic parameters. The severity scale of the ISAAQ was optimized by eliminating the poorest performing items using an iterative approach and examining validity metrics. Cluster analyses was used to examine internet activities and commonalities across samples (Part B of the ISAAQ).

RESULTS

Optimization of ISAAQ using IRT yielded a refined 10-item version (ISAAQ-10), with less differential item functioning and a robust unidimensional factor structure. The ISAAQ-10 severity score correlated strongly with established measures of internet addiction (Compulsive Internet Use Scale [Person's r = 0.86] and the Internet Addiction Test-10 [r = 0.75]). Combined with gaming activity score it correlated moderately strongly with the established Internet Gaming Disorder Test (r = 0.65). Exploratory cluster analyses in both samples identified two groups, one of "low-PUI" [98.1-98.5%], and one of "high-PUI" [1.5-1.9%]. Multiple facets of internet activity appeared elevated in the high-PUI cluster.

DISCUSSION

The ISAAQ-10 supersedes the earlier longer version of the ISAAQ, and provides a useful, psychometrically robust measure of PUI severity (Part A), and captures the extent of engagement in a wide gamut of online specific internet activities (Part B). ISAAQ-10 constitutes a valuable objective measurement tool for future studies.

A predictor of emotional eating in adolescents: Social anxiety

This descriptive, cross-sectional study was conducted to determine the effect of social anxiety on emotional eating in adolescents. The sample consisted of 1027 adolescents between aged 14-18 studying in the 9-12th grades of the high schools in the Central Anatolia Region in the 2018-2019 academic year. Ethics Committee and institutional permission was obtained in this study, data were collected by a questionnaire, the Social Anxiety Scale for Children-Revised (SASC-R), and The Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). Data were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test and simple linear regression analysis. Adolescents had a mean SASC-R and EES-C score of 43.49 ± 16.56 and 61.93 ± 18.68, respectively. It was found that there was a relationship between EES-C mean scores and SASC-R mean scores, and they explained 35.0 % of the scores they got from the EES-C scale (p < 0.05). In conclusion, adolescents had moderate emotional eating and social anxiety. The higher the social anxiety, the higher the emotional eating. School personnel, parents and healthcare professionals need education about social anxiety and eating disorders in adolescents in order to detect symptoms early and intervene to better support adolescents struggling with social anxiety.

Mental health and health behaviours among patients with eating disorders: a case-control study in France

BACKGROUND

Eating disorders (ED) are a public health concern due to their increasing prevalence and severe associated comorbidities. The aim of this study was to identify mental health and health behaviours associated with each form of EDs.

METHODS

A case-control study was performed: cases were patients with EDs managed for the first time in a specialized nutrition department and controls without EDs were matched on age and gender with cases. Participants of this study filled self-administered paper questionnaire (EDs group) or online questionnaire (non-ED group). Collected data explored socio-demographics, mental health including anxiety and depression, body image, life satisfaction, substances and internet use and presence of IBS (Irritable Bowel Syndrome).

RESULTS

248 ED patients (broad categories: 66 Restrictive, 22 Bulimic and 160 Compulsive) and 208 non-ED subjects were included in this study. Mean age was 36.0 (SD 13.0) and 34.8 (SD 11.6) in ED and non-ED groups, respectively. Among patients and non-ED subjects, 86.7% and 83.6% were female, respectively. Body Shape Questionnaire mean score was between 103.8 (SD 46.1) and 125.0 (SD 36.2) for EDs and non-ED group, respectively (p < 0.0001). ED patients had a higher risk of unsatisfactory friendly life, anxiety, depression and IBS than non-ED s (all p < 0.0001) Higher risk of anxiety, depression and IBS was found for the three categories of EDs. Higher risk of smoking was associated only with restrictive ED, while or assault history and alcohol abuse problems were associated only with bulimic ED. The risk of binge drinking was lower in all EDs categories than in non-ED.

CONCLUSION

This study highlights the common comorbidities shared by all EDs patients and also identifies some specific features related to ED categories. These results should contribute to the conception of future screening and prevention programs in at risk young population as well as holistic care pathways for ED patients. This case-control study evaluated mental health and health behaviours associated with the main categories of Eating Disorders (EDs). Cases were patients with EDs initiating care in a specialized nutrition department and controls without ED were matched on age and gender with cases. Self-administered paper questionnaires were filled by ED 248 patients (66 Restrictive, 22 Bulimic and 160 Compulsive) and online questionnaire by 241 non-ED controls. Body image satisfaction was significantly worse in ED patients than in controls. (p < 0.0001). Dissatisfactory life, anxiety, depression and irritable bowel syndrome were more found in patients with all EDs categories than in non-ED (p < 0.0001). Smoking risk was increased only in restrictive patients while and assault history and alcohol abuse was increased only in bulimic patients. These results highlight the global burden of ED and related comorbidities and provide useful information for future screening, prevention and care programs.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

The Effects of Acute Social Media Exposure on Body Dissatisfaction and Eating Behavior of Male and Female Students

Introduction: Experimental research has examined the effect of social media on body dissatisfaction, but little attention has been given to the impact on eating behavior. Across two studies, we tested the causal relationship between acute social media use, body dissatisfaction and eating behavior. Methods: In Study 1, 80 female participants (age: M = 20.75 years; BMI: M = 21.3) viewed their own Facebook account or a news website before completing a portion size selection task. In Study 2 (pre-registered), 148 participants (81 females; age: M = 20.92 years; BMI: M = 22.19), viewed their own or an experimenter-curated Instagram profile before consuming potato chips ad-libitum. Results: In Study 1, body dissatisfaction was significantly higher in participants who viewed Facebook (compared to a news website) and significantly mediated the effect of condition on portion size selection. In Study 2, regardless of condition females reported significantly smaller ideal body sizes and higher body dissatisfaction compared to males. When females reported a thinner body size as ideal, females in the personal Instagram consumed significantly less potato chips than those in the control Instagram condition. When males reported a smaller actual body size, males in the personal Instagram condition consumed significantly less potato chips than males in the control Instagram condition. Discussion: Findings suggest brief bouts of social media use may produce immediate disruptions to body image of both sexes, and restrained snack intake of females endorsing thin ideals.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

Associations between COVID-19 pandemic impact, dimensions of behavior and eating disorders: A longitudinal UK-based study

BACKGROUND

There is growing concern about how people with eating disorders are impacted by the widespread societal restructuring during the COVID-19 crisis.

AIMS

We aimed to examine how factors relating to the impact of the pandemic associate with eating disorders and quantify this relationship while adjusting for concurrent and longitudinal parameters of risk.

METHODS

We gathered demographic, behavioral and clinical data pre- and mid-pandemic as well as childhood trauma history from a longitudinal online survey of 489 adults (mean age 23.4 years) recruited from the Neuroscience in Psychiatry Network (NSPN). Using pre-pandemic (T1) and concurrent (T2) data we aimed to predict eating disorders at mid-pandemic (T2). We deployed hierarchical generalized logistic regression to ascertain the strength of longitudinal and concurrent associations.

RESULTS

Pre-pandemic eating disorder scores strongly associated with concurrent eating disorder (z = 5.93). More conflict at home mid-pandemic (z = 2.03), pre- (lower sensation seeking z = -2.58) and mid-pandemic (higher lack of perseverance z = 2.33) impulsivity traits also associated with mid-pandemic eating disorder.

CONCLUSION

Conflict at home mid-pandemic and specific aspects of impulsiveness significantly associated with concurrent eating disorder when adjusted for pre-pandemic eating disorder symptoms, baseline demographics, behavioral traits, history of traumatic experiences and concurrent psychopathology. These results provide insight into the struggles of those suffering with eating disorders during the COVID-19 pandemic and highlight the importance of impulsiveness traits and the immediate family environment in their experience of illness during the pandemic.

Prospective Association Between Problematic Mobile Phone Use and Eating Disorder Symptoms and the Mediating Effect of Resilience in Chinese College Students: A 1-Year Longitudinal Study

A previous cross-sectional study found that problematic mobile phone use (PMPU) was associated with students' eating disorder symptoms. However, since the cross-sectional study cannot infer the causality and the direction of effect, the longitudinal relationship between the two and the mechanism behind this relationship are unclear. Therefore, the present study explores the prospective association between PMPU and eating disorder symptoms and related mediation mechanisms using a 1-year longitudinal study of 1,181 college students (from December 2019 [T1] to December 2020 [T2]). Survey tools used include the Mobile Phone Addiction Tendency Scale, the 10-item Connor-Davidson resilience scale, and the 12 item Short Form of the Eating Disorder Examination Questionnaire. The longitudinal relationship between PMPU and eating disorder symptoms and the mediating effect of resilience was analyzed using a cross-lagged model. The results showed that PMPU (β = 0.086, P < 0.01) and resilience (β = -0.145, P < 0.01) at T1 predicted eating disorder symptoms at T2, but not vice versa. PMPU was bidirectionally associated with resilience, and the prediction effect of PMPU at T1 to resilience at T2 (β = -0.151, P < 0.001) was higher than the prediction effect of resilience at T1 to PMPU at T2 (β = -0.134, P < 0.001). The standardized indirect effect of PMPU at T1 on eating disorder symptoms at T2 via resilience was significant (β = 0.022, 95% CI = 0.010~0.040, P < 0.001). Therefore, PMPU and resilience were predictive for eating disorder symptoms in college students, and resilience may play a mediating role in the prospective association between PMPU and eating disorder symptoms. This study provides new ideas and higher-level evidence for the development of prevention and intervention measures for college students' eating disorder symptoms.

Online media exposure and weight and fitness management app use correlate with disordered eating symptoms: evidence from the mainland of China

BACKGROUND

The relationship between online media exposure and disordered eating symptoms has been reported in western regions. Though the prevalence of eating disorders and access to the Internet increased substantially in recent years, relevant evidence is rare in mainland China. This study aims to evaluate the association between online media exposure or weight and fitness management app use and disordered eating symptoms in Chinese mainland young adults, and the mediation effect of disordered eating cognition.

METHODS

353 Chinese mainland female and 142 male young adults completed online questionnaires consisting of demographic information, Eating Disorder Examination-Questionnaire 6.0 (EDE-Q 6.0), and items relating to online media exposure and weight and fitness management app use. Through correlation analysis, the relationship between online media exposure or weight and fitness management app use and disordered eating symptoms was examined, separately by sex. The mediation effect of disordered eating cognition on the relationship between online media exposure or weight and fitness management app use on disordered eating behaviors was investigated with two moderated mediation models.

RESULTS

Young female adults in the Chinese mainland presented higher disordered eating symptoms and were more engaged in online media and weight and fitness management app use than males. Online media exposure and weight and fitness management app use showed a significant correlation with disordered eating behaviors in males and females. Disordered eating cognition mediated the relationship between online media exposure or weight and fitness management app use and disordered eating behaviors. This effect was significantly higher in females.

CONCLUSION

Online media exposure and weight and fitness management app use play a crucial role in the generation of disordered eating symptoms in Chinese mainland young adults, especially in females. The mediation analysis suggested the importance of prevention and intervention of disordered eating cognition. Monitoring and scientific guidance of online media are necessary.

Eating disorders symptoms and excessive internet use in adolescents: the role of internalising and externalising problems

BACKGROUND

Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems.

METHODS

A representative sample of 7,083 adolescents (M_age = 13.48 years; SD_age = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling.

RESULTS

There was a partial correlation between EDS and EIU (r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders.

CONCLUSION

The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.

Digital Hazards for Feeding and Eating: What We Know and What We Don't

PURPOSE OF REVIEW

We aimed to accrue recent evidence exploring effects of modern online activities (e.g., Internet use) on feeding and eating disorder symptoms, and related traits. We examined available evidence to ascertain any direct influences from online activities on feeding and eating disorders, thereby shedding light on putative mechanisms by which those influences may occur.

RECENT FINDINGS

Many facets of problematic usage of the Internet correlate cross sectionally with eating disorder and related psychopathology. There is evidence to suggest that significant effects do exist in the direction of specific Internet activities contributing to eating disorder symptoms, viewed dimensionally. Putative mechanisms are discussed. However, a significant number of eating disorder phenotypes and Internet-related activities remain under-researched. Specific facets of engagement with the online environment appear to confer risk for feeding and eating problems, evidence being strongest for non-clinical studies using dimensional measures. More research is required to rigorously confirm causal effects, including in patients meeting formal diagnostic criteria for eating disorders. We also highlight the need for high-quality evidence to explore how eating disorder phenotypes are commonly as well as uniquely affected by different online activities. Such research is needed in order that scientific understanding in this area can be translated to protect those most at risk of disordered eating, including through changes in public health approaches and clinical practice.