Communicating stigma: the pro-ana paradox

'You Are Not Alone, We've Got You': Power Plays, Devotion, and Punishment on Healthy Eating and Pro-Eating Disorder Websites

Healthy eating (HE) and pro-eating disorder (pro-ED) websites are popular sources of dietary and weight loss information, social support, and lifestyle inspiration. However, the discursive styles and language used by authors/moderators and users of these two site genres have not been widely studied or compared. Forty-three HE websites and twenty-four pro-ED websites were analysed using Fairclough's model of critical discourse analysis. Findings indicate that sites share common characteristics in terms of power relations played out by authors, 'successful' dieters, and those attending these sites. These power plays encourage moral and spiritual commitment to the care of one's body, with authoritative language used to support readers' loyalty and adherence to dietary plans. On HE sites, medicinal properties were attributed to 'clean' or 'pure' foods, whereas pro-ED sites conveyed their importance for weight reduction. Healthy eating sites were largely entrepreneurial, promoting products or themselves. Pro-eating disorder sites typically featured discussions of bodily disgust, the chastisement of others, and self-discipline in the name of 'Ana', such that dieting came to be framed as part of a devotional, often punitive, body project. On both sites, morality discourses were gendered around the thin female body and the 'ideal mother', with occasional praise for muscular male bodies. Our findings indicate how transitioning from healthy eating preoccupations to eating disorders may be facilitated by normalising discussions about restrictive dieting and the shaming of bodies, overseen by self-appointed diet 'experts' and 'buddies' online.

"Anxiety is not cute" analysis of twitter users' discourses on romanticizing mental illness

BACKGROUND

The proliferation of social media platforms has provided a unique space for discourse on mental health, originally intended to destigmatize mental illness. However, recent discourses on these platforms have shown a concerning shift towards the romanticization of mental health issues. This research focuses on Twitter (now called X) users' authentic discussions on the phenomenon of romanticizing mental health, aiming to uncover unique perspectives, themes, and language used by users when engaging with this complex topic.

METHODS

A comprehensive content analysis was conducted on 600 relevant tweets, with the application of topic modeling techniques. This methodology allowed for the identification and exploration of six primary themes that emerged from Twitter users' discussions. Statistical tests were not applied in this qualitative analysis.

RESULTS

The study identified six primary themes resulting from Twitter users' discussions on the romanticization of mental health. These themes include rejecting/critiquing the glamorization of mental health, monetization of mental health by corporate organizations, societal misconceptions of mental health, the role of traditional media and social media, unfiltered realities of depression, and the emphasis on not romanticizing mental health.

CONCLUSIONS

This study provides valuable insights into the multifaceted discourses surrounding the romanticization of mental health on Twitter. It highlights users' critiques, concerns, and calls for change, emphasizing the potential harm caused by romanticizing mental illness. The findings underscore the importance of fostering responsible and empathetic discussions about mental health on social media platforms. By examining how Twitter users interact with and respond to the romanticization of mental health, this research advances our understanding of emerging perspectives on mental health issues among social media users, particularly young adolescents. The study also underscores the effects of this phenomenon on individuals, society, and the mental health community. Overall, this research emphasizes the need for more responsible and knowledgeable discussions around mental health in the digital age.

"Follow to *actually* heal binge eating": A mixed methods textual content analysis of #BEDrecovery on TikTok

Binge eating disorder (BED) has been relatively overlooked in research on eating disorders and social media. Existing literature suggests that time spent on social media may be associated with increased binge eating. However, more granular details of social media experiences such as the consumption of pro-recovery content have not received sufficient scholarly attention. The present study begins to address this gap through analysis of 1074 captions from public posts on TikTok, a video-based social media platform, tagged with #BEDrecovery between July 2021-2022. We generated six themes by examining word frequencies in the data and engaging in reflexive categorization of commonly used words within the context of different posts. These themes were: (1) diets and eating approaches, (2) help and support, (3) mental health, (4) diet culture critique, (5) body monitoring, and (6) fitness. To understand which videos in the BED recovery community had the broadest reach, we also examined how themes were associated with user engagement - concretely, the number plays (times the post was watched) and shares (times users shared a link to the post with other TikTok users). Notably, we found that the number of shares was significantly lower in posts that included diet culture critique than in those that did not. By contrast plays and shares were higher in posts with body monitoring than in those without. Our findings suggest that highly engaged with #BEDrecovery TikTok content may include the promotion of diet culture and potentially create an unproductive environment for individuals seeking BED recovery support.

Visions of recovery: a cross-diagnostic examination of eating disorder pro-recovery communities on TikTok

Individuals seeking support or inspiration for eating disorder recovery may turn to pro-recovery content on social media sites such as TikTok. While research has thus far treated pro-recovery social media as a fairly homogeneous space, many pro-recovery hashtags single out particular eating disorder diagnoses. This exploratory study used codebook thematic analysis of 241 popular pro-recovery videos on TikTok to compare the presentation of eating disorders and eating disorder recovery across five different diagnosis-specific hashtags: #anarecovery, #arfidrecovery, #bedrecovery, #miarecovery, and #orthorexiarecovery. These hashtags refer to the following eating disorder diagnoses respectively: anorexia nervosa, avoidant restrictive food intake disorder, binge eating disorder, bulimia nervosa, and orthorexia nervosa. Our analysis generated the following qualitative themes across the entire dataset: (1) centrality of food to eating disorders and recovery, (2) what eating disorders look and feel like, (3) recovery as a process, (4) getting and giving help, and (5) negotiating diet culture in recovery. To supplement our qualitative findings and facilitate cross-diagnostic comparisons, we also conducted one-way ANOVAs and chi-square tests to probe for statistically significant differences in audience engagement and code prevalence across the different hashtags. Our results indicate that there are clear differences in how recovery is envisioned on TikTok based on which diagnostic hashtags are employed. Such variations in how different eating disorders are imagined on popular social media demand further investigation and clinical consideration.

Bio-citizens online: A content analysis of pro-ana and weight loss blogs

Current neoliberal ideology in Western society encourages individuals to self-monitor their body to control population health. The resulting self-surveillance includes weight management, promoted as a marker of health. Disordered eating, like anorexia, is framed as a health disorder. However, weight loss is framed as a health initiative; we argue that these framings are engaging with the same body project, encouraging thinness as a marker of health and good bio-citizenry. Using content analysis to compare online blog context created by individuals engaged in weight loss and individuals who identify as pro-anorexia, we argue and evidence that both groups are engaged in body projects with shared parameters. Findings suggest each group is striving to embody a thin ideal through weight management. Specifically, weight loss bloggers and pro-ana bloggers demonstrate similar diet and exercise behaviours in online diaries detailing their weight loss experiences. Thus, weight loss and anorexia exist on the same spectrum of responsible bio-citizenry.

Men have eating disorders too: an analysis of online narratives posted by men with eating disorders on YouTube

Eating Disorders (ED) among men are still surrounded by stigma and gender stereotypes, with a common misconception that ED are an exclusively female condition. This study employed a gender-sensitive approach to uncover males' critical needs for effective treatment and recovery. We qualitatively analyzed a sample of twenty-five videos posted on YouTube by men with ED, presenting personal stories of recovery and recovery in-progress. Through thematic analysis of the narratives, we identified three common factors increasing disordered eating behaviors in men: 1) bullying, 2) drive for muscularity, and 3) self-regulation. In addition, we found three major themes related to barriers preventing men from help-seeking: 1) shame and stigma, 2) lack of knowledge and information, and 3) low level of perceived doctor-patient communication. The findings of this study can contribute to the conceptualization of future interventions and recovery programs designed to prevent and treat ED in men.

Evaluation of Web-Based Health Information From the Perspective of Women With Eating Disorders: Thematic Analysis

Background

Users with experience of eating disorders use the internet as a source of information, whether for prorecovery activities (such as web-based treatment, looking for information, support, and sharing) or activities that promote eating disorder behavior as a desirable lifestyle choice (such as pro–eating disorder communities and reading and creating pro–eating disorder posts). Their assessment of web-based eating disorder–related information is crucial for understanding the context of the illness and for health professionals and their web-based interventions.

Objective

This study aimed to understand the criteria young women with the experience of eating disorders use in evaluating eating disorder–related web-based information and what eating disorder–related characteristics of these women are involved in their evaluation.

Methods

We analyzed 30 semistructured individual interviews with Czech women aged 16 to 28 years with past or present eating disorder experience using a qualitative approach. Thematic analysis was adopted as an analytical tool.

Results

The specifics of eating disorder phases (the disorder stage and the treatment process) emerged as important aspects in the process of information assessment. Other specific characteristics of respondents (eg, motivation, abilities, and resources) addressed how the respondents arrived at certain web-based information and how they evaluated it. In addition, the respondents described some content cues as features of information (eg, novelty and social information pooling). Another finding is that other users’ attitudes, experiences, activities, and personal features are involved in the information evaluation of these users and the information presented by them. Finally, the respondents evaluated the websites’ visual look and graphic components.

Conclusions

This study shows that web-based information evaluation reported by women with experience of eating disorders is a complex process. The assessment is influenced by current personal characteristics related to the illness (mainly the motivation for maintaining or curing the eating disorder) using cues associated with information content, other users, and website look. The study findings have important implications for health professionals, who should ask their clients questions about web-based communities and their needs to understand what information and sources they choose.

Exploring the Benefits of Proactive Participation among Adults and Older People by Writing Blogs

The use of Information and Communication Technologies (ICTs) for information-seeking, social contact and leisure activities is increasing in adults and older people. However, little is known about adults and older people who are already actively using ICTs to write a blog. The aim of this paper is to describe the benefits adults and older people gain from having a blog. Twenty-three older adult bloggers (aged 60-83 years; most of them with college degrees and retired) from Spain who, at the time of the study had an active blog were interviewed. A thematic analysis identified four different benefits related to blogging: (1) a general sense of satisfaction from producing the blog; (2) relational benefits; (3) cognitive benefits; and (4) identity benefits. Results showed that adults and older people experienced a variety of benefits that broadens the distinction between personal and social benefits found in previous research. Blogging in later life challenges the traditional passive/consumer and online user experience view of adults and older people and seems to be a good example of proactive participation through websites.

"Do You Know How Much I Suffer?": How Young People Negotiate the Tellability of Their Mental Health Disruption in Anonymous Distress Narratives on Social Media

The emergence of mental distress presents significant difficulties and dilemmas for adolescents and early adults about being open with their troubles and emotions. To better understand the communication practices and challenges that reflect the lived realities of marginalized youth struggling with mental health disruption, this study examines 136 anonymous personal stories disclosing self-harm behaviors or suicidal thoughts on a Facebook "secrets" page for Hong Kong students. The narrative analysis unveils young people's anecdotal accounts of hidden grievances and struggles around their mental distress, hitherto untold not because they are too difficult to tell but because they are too negative to be heard. Extending the concept of tellability, this study illustrates how anonymous distress storytelling on social media enables silenced and isolated distressed youth to resist the denial - invisibility, discredit, and mischaracterization - of their suffering by turning their disruptive experiences into stories worth telling through disclosure, clarification, and testimony. This study further clarifies the salient interpretive frameworks that shape young people's experience and communication of mental distress: the tyranny of happiness depicted to engender distress and languages of suffering used to resist culpability and plead for social respite. It highlights the disconnection in interpretations regarding the transitory nature of distress and its controllability as a major source of communication gap and interpersonal communication breakdowns. The findings call on health communication practices around mental health promotion to refrain from highlighting individual deficiencies or messages of positivity and speak out on the structural inconsistencies and communication denial that perpetuate and silence youth distress.

Behind the Hashtag: Online Disclosure of Mental Illness and Community Response on Tumblr

The present study examined personal disclosures about mental illness and the responses of online community members on the social media platform, Tumblr. We sampled public blog posts of 14,626 Tumblr users disclosing ten different mental health diagnoses using hashtags (e.g., #depression, #anxiety, and #anorexia). We examined the content of users' disclosures, predictors of disclosure frequency, and predictors of online community response. The content of most disclosures was related to users' emotions and cognitions about their mental health and their feelings of interpersonal loss and change over time. Content varied with users' disclosure frequency and with self-identified mental health diagnoses. Predictors of disclosure frequency included the "self effects" of writing about oneself or one's opinions, such as self-concept formation, and "reception effects" of receiving responses to one's writing. User disclosures generally increased with frequency of community response (reception effects), and the degree of this effect differed depending on the disclosed diagnosis (self effects). The responses of online community members also varied significantly across disclosed diagnoses. The implications of our findings for community research and action are discussed.

The Role of Communication Affordances in Post-Traumatic Stress Disorder Facebook and WhatsApp Support Groups

(1) Background: Digital health research has indicated that people with stigmatized health problems are drawn to online support groups (OSGs) because these groups help them to manage such conditions. However, little is known about how media affordances-interactions between the technology and the user-reconfigure the ways in which stigmatized individuals use OSGs and interact with others like themselves. (2) Method: The current study applied an affordance framework to evaluate how Facebook and WhatsApp support groups can help military veterans and their partners cope with post-traumatic stress disorder (PTSD) and was based on interviews with 34 PTSD-OSG members in Israel. (3) Findings: This research identified five affordances that members appraised as enhancing their coping efforts in the digital world: visibility, availability, multimediality, surveillance, and synchronicity. (4) Conclusions: This study reveals the connection between a specific stigmatized mental health disorder (i.e., PTSD) and perceptions of communication technologies (i.e., affordances), and specifies the uses of technologies for coping with this mental health disorder. Moreover, this study may inform digital intervention designers about which communication affordances can potentially lead to better health outcomes.

Digital public health surveillance: a systematic scoping review

The ubiquitous and openly accessible information produced by the public on the Internet has sparked an increasing interest in developing digital public health surveillance (DPHS) systems. We conducted a systematic scoping review in accordance with the PRISMA extension for scoping reviews to consolidate and characterize the existing research on DPHS and identify areas for further research. We used Natural Language Processing and content analysis to define the search strings and searched Global Health, Web of Science, PubMed, and Google Scholar from 2005 to January 2020 for peer-reviewed articles on DPHS, with extensive hand searching. Seven hundred fifty-five articles were included in this review. The studies were from 54 countries and utilized 26 digital platforms to study 208 sub-categories of 49 categories associated with 16 public health surveillance (PHS) themes. Most studies were conducted by researchers from the United States (56%, 426) and dominated by communicable diseases-related topics (25%, 187), followed by behavioural risk factors (17%, 131). While this review discusses the potentials of using Internet-based data as an affordable and instantaneous resource for DPHS, it highlights the paucity of longitudinal studies and the methodological and inherent practical limitations underpinning the successful implementation of a DPHS system. Little work studied Internet users' demographics when developing DPHS systems, and 39% (291) of studies did not stratify their results by geographic region. A clear methodology by which the results of DPHS can be linked to public health action has yet to be established, as only six (0.8%) studies deployed their system into a PHS context.

Social Support for Active Substance Users: A Content Analysis of r/Drugs

Substance abuse remains an important and dangerous societal issue. In this study, we build on previous literature that identified online social support communities that encouraged unhealthy behaviors, by investigating a platform that provides social support related to engaging in illicit drug use. Three days' worth of posts, amounting to almost 400 pages of written data, was collected and analyzed to identify what types of support were being requested and provided by users. The analysis identified 19 total topics for support, with 14 of those topics relating to action-facilitating support, and five of them relating to nurturant support. The results show that the website is primarily used to discuss topics like drug effects and drug dosages. This raises questions as to whether these discussions increase safety by allowing users to dose accurately, or whether they give users a false sense of security related to their continued substance use.

How do people with eating disorders experience the stigma associated with their condition? A mixed-methods systematic review

BACKGROUND

Public opinion research shows that eating disorders (EDs) are a major target of stigmatisation. To understand the implications of this stigma, research investigating how stigma is experienced by individuals with EDs is critical.

AIM

This paper aims to collate, evaluate and synthesise the extant empirical research illuminating how people with EDs experience the stigma associated with their condition.

METHOD

A systematic mixed-methods literature search was performed. Articles that met a specified set of inclusion criteria underwent a quality assessment and thematic synthesis.

RESULTS

Twenty-nine articles were included in the review. Studies were mostly qualitative and of reasonable methodological quality. The literature was characterised by five research themes, illuminating (i) the nature and prevalence of stigma experienced, (ii) stigma in families, (iii) stigma in healthcare contexts, (iv) self-stigmatisation and illness concealment, and (v) stigma resistance.

CONCLUSIONS

The reviewed research showed that people with EDs have extensive experience of stigma in diverse settings. They report that stigma has negative implications for their psychological wellbeing and likelihood of help-seeking. However, research also shows that people with EDs actively seek to resist and challenge stigma. The review identifies the outstanding gaps and weaknesses in this literature.

Information Sharing to Promote Risky Health Behavior on Social Media

A large number of posts promoting risky health behavior are posted on social media, but not all posts are widely disseminated. Disseminated information is more likely to influence social media users as users may not be exposed to non-disseminated posts. Thus, this study focuses on principal characteristics of disseminated Twitter posts that attract individuals who promote smoking behavior. After collecting 6,432 tweets and analyzing highly disseminated and non-disseminated Tweets, this study found that Tweets expressing emotional support were observed more than expected among the pro-smoking group and less than expected among the anti-smoking group. Affective tone was also found to be an important factor in Tweet dissemination both in pro- and anti-smoking groups. Interestingly, in the pro-smoking group, Tweets having a negative tone were disseminated more than those having a positive tone. This paper concludes with the discussion of theoretical and practical implications of the current findings.

Is it Important to Talk About Technologies with Eating Disorder Clients? The Health-Care Professional Perspective

Nowadays, the use of digital technology is an important issue that should be addressed during the treatment of people who have eating disorders. The involvement or absence of this issue reflects the understanding, experience, and atttude of health-care professionals toward their clients' use of technology. The aim of the present study was to investigate the perceptions of health-care professionals and their assessment of their clients' usage of digital technology while developing strategies for treatment. Semistructured interviews with 30 professionals were performed from October 2015 to June 2016 and a thematic analysis was used to analyze the data. The health-care professionals' views could be summarized in three thematic groups: (1) technology use is not relevant for the cooperation; (2) technology use is relevant for the cooperation and addressed generally; and (3) technology use is relevant for the cooperation and addressed specifically. The results are discussed in relation to the theoretical model presented by Rodgers about the impact of technology on disordered eating behaviors and the implications for practice.

"You See Yourself Like in a Mirror": The Effects of Internet-Mediated Personal Networks on Body Image and Eating Disorders

Body image issues associated with eating disorders involve attitudinal and perceptual components: individuals' dissatisfaction with body shape or weight, and inability to assess body size correctly. While prior research has mainly explored social pressures produced by the media, fashion, and advertising industries, this paper focuses on the effects of personal networks on body image, particularly in the context of internet communities. We use data collected on a sample of participants to websites on eating disorders, and map their personal networks. We specify and estimate a model for the joint distribution of attitudinal and perceptual components of body image as a function of network-related characteristics and attributional factors. Supported by information gathered through in-depth interviews, the empirical estimates provide evidence that personal networks can be conducive to positive body image development, and that the influence of personal networks varies significantly by body size. We situate our discussion in current debates about the effects of computer-mediated and face-to-face communication networks on eating disorders and related behaviors.

Internet use among young people with and without mental health difficulties

OBJECTIVES

Research regarding adolescent internet use and mental health is sparse. However, awareness of a young person's internet use is becoming increasingly recognised as an important element of clinical assessment and intervention, and requires the development of an evidence base. The aim of the present study was to better understand the internet use of young people experiencing mental health difficulties and to contrast it with those who currently report no concerns.

METHOD

In total, 299 young people aged 12-19 years, across a continuum of mental health difficulties, completed an online survey measuring internet use and related experiences. Young people were assigned to four groups: (a) attending inpatient services; (b) attending outpatient services; (c) a community group with mental health concerns and no clinical support; and (d) a regular community group.

RESULTS

Those in the inpatient and outpatient groups visited more potentially harmful websites. Young people attending inpatient and outpatient services showed aspects of both more risky and less risky use. The community group reporting no mental health difficulties showed least risky use. The group experiencing difficulties but not receiving support showed consistently high risky use, suggesting this is a particularly vulnerable group.

CONCLUSIONS

Despite methodological limitations, findings suggest that those with mental health difficulties may experience more of the risks and fewer of the benefits offered by the internet. Though further research is needed to clarify these findings, clinicians should consider routine assessment of Internet use when planning interventions for young people experiencing mental health difficulties.

Social Media Propagation of Content Promoting Risky Health Behavior

While social media have been found useful in providing social support and health information, they have also been home to content advocating risky health behavior. This study focused on how content defending and even celebrating anorexia as a lifestyle are circulated among social media users, and investigates the characteristics that promote wide propagation of such messages. We captured anorexia-related content on Tumblr, a popular blog for talking about eating disorders, during a one-month period. Among the 35,432 posts collected, we examined the most highly propagated posts and coded them for message characteristics. Our findings revealed that posts in which the source of a narrative ("testimony") was identified (was either from an anorexic poster or about another's anorexia) and which were positive toward the pro-anorexia perspective were more likely to be propagated on Tumblr. In addition, posts containing content that references an anorexic person and contains an affective tone were more likely to be propagated. We also found that underweight bodies and bodies with a high degree of exposure were associated with propagation of posts. The present study suggested practical implications by focusing on the characteristics of highly propagated but potentially harmful content in social media.

Writing About the Body and the Body of Writing: The Girl’s Body in Israeli Teenage Girls’ Blogs

This qualitative study focuses on blogs written by Israeli girls, aged 14 to 18, concerning their body and the developmental process of identity construction. Using a sociocultural approach, the study examined the ways in which the girls write about their bodies, what issues they raise in their blogs concerning their body and identity, and what blog writing about the body offers to them in the process of identity construction. A combination of thematic-categorical analysis and structural-linguistic analysis was used to analyze 27 blogs (86 posts) written by Israeli girls. The findings reveal a complex picture about the ways in which girls experience their bodies and perceive societal norms concerning their appearance. The blogs included the girls’ feelings of insecurity, stress, and confusion about their body and at the same time served as a place where girls were able to voice resistance to the current ideal of beauty and of social conventions. Findings also reveal the ways in which the girls presented their body to their girl peers. The study concludes that writing blogs is an important channel for Israeli girls to engage in discourse about the body as part of the process of identity formation.

Uncovering Factors Influencing Interpersonal Health Communication

Talking to friends, family, or peers about health issues might, among other things, increase knowledge of social norms and feelings of self-efficacy in adopting a healthier lifestyle. We often see interpersonal health communication as an important mediating factor in the effects of health campaigns on health behavior. No research has been done so far, however, on factors that influence whether and how people talk about health issues without being exposed to a health campaign first. In this exploratory study, we interviewed 12 participants about their communication behavior concerning six different health themes, like smoking and exercising. The results suggest that at least four types of interpersonal health communication can be distinguished, each influenced by different factors, like conversational partner and objective of the conversation. Future research should take this diversity of interpersonal health communication into account, and focus on designing health campaigns that aim to trigger dialogue within target populations.

Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services

PURPOSE

Previous research into the impact of pro-eating disorder (pro-ED) websites has predominantly been undertaken using experimental and survey designs. Studies have used both clinical and non-clinical (college student) samples. The present study aimed to explore the underlying functions and processes related to the access and continued use of pro-ED websites within a clinical eating disorder population using a qualitative research design.

METHODS

Participants were recruited through NHS community mental health teams and specialist eating disorder services within South Wales, UK. Face-to-face semi-structured interviews were conducted with seven adult women in treatment for an eating disorder who had disclosed current or historic use of pro-ED websites. Interviewees ranged in age from 20 to 40 years (M = 31.2; SD = 7.8). Constructivist Grounded Theory was used to analyse interview transcripts.

RESULTS

Five key themes were identified within the data, namely fear; ambivalence; social comparisons; shame; and pro-ED websites maintaining eating disordered behaviour. The pro-ED websites appeared to offer a sense of support, validation and reassurance to those in the midst of an eating disorder, whilst simultaneously reinforcing and maintaining eating disordered behaviour.

CONCLUSION

Themes are discussed in relation to implications and recommendations for clinical practice. Limitations of the present study and suggestions for future research are also outlined.

Differences in physical status, mental state and online behavior of people in pro-anorexia web communities

BACKGROUND

There is a debate about the effects of pro-anorexia (colloquially referred to as pro-ana) websites. Research suggests that the effect of these websites is not straightforward. Indeed, the actual function of these sites is disputed, with studies indicating both negative and positive effects.

AIM

This is the first study which systematically examined the differences between pro-anorexia web communities in four main aspects: web language used (posts); web interests/search behaviors (queries); users' self-reported weight status and weight goals; and associated self-reported mood/pathology.

METHODS

We collected three primary sources of data, including messages posed on three pro-ana websites, a survey completed by over 1000 participants of a pro-ana website, and the searches made on the Bing search engine of pro-anorexia users. These data were analyzed for content, reported demographics and pathology, and behavior over time.

RESULTS

Although members of the main pro-ana website investigated appear to be depressed, with high rates of self-harm and suicide attempts, users are significantly more interested in treatment, have wishes of procreation and reported the highest goal weights among the investigated sites. In contrast, users of other pro-ana websites investigated, are more interested in morbid themes including depression, self-harm and suicide. The percentage of severely malnourished website users, in general, appears to be small (20%).

CONCLUSIONS

Our results indicate that a new strategy is required to facilitate the communication between mental health specialists and pro-ana web users, recognizing the differences in harm associated with different websites.

Tweeting and Trivializing

A quick search of social media websites demonstrates that users often describe their benign behaviors (e.g., organizing drawers or color-coding) as related to obsessive–compulsive disorder (OCD). Yet, the actual disease is complex and often much more severe than suggested by Twitter users who employ the term #OCD. The present experiment examines the effects of such disease trivialization on social media users’ perceptions of the disease, emotional reactions, and intentions to take action related to the disease. To do so, it first explicates the concept of disease trivialization as a three-part phenomenon involving oversimplification, decreased severity, and mockery. Findings from an experiment ( N = 574) indicate that different patterns of emotional reactions can be found in response to framing of OCD as either trivial, clinical, or both trivial and clinical. Moreover, significant interactions between independent variables were found. Participant gender and preexisting familiarity with OCD also shaped participant perceptions and behavioral intentions. Directions for future work are discussed.

The changing face(book) of psychiatry: can we justify 'following' patients' social media activity?

Individuals with mental health issues may post information on social networking sites that can provide an insight into their mental health status. It could be argued that doctors (and specifically psychiatrists) should understand the way in which social media is used by their patients to gain a better insight into their illnesses. However, choosing to actively monitor a patient's social media activity raises important questions about the way in which medical students, qualified clinicians and other healthcare professionals obtain information about patients. While this may be framed as a mere form of 'collateral history-taking', there are obvious practical and ethical problems with doing so. Here, a case is made against monitoring the social media activity of patients involved with psychiatric services.

Online Stigma Resistance in the Pro-Ana Community

Media scholars often use concepts from Goffman's dramaturgical approach to study online communities of stigmatized individuals as "backstages," spaces where members take refuge from social disapproval. In this study, I extend this view through an examination of in-depth interviews with bloggers from the "pro-ana" community, an online community for people with eating disorders. To explore how this community uses an online environment that is both anonymous and public, I fuse Goffman's ideas about identity performance and stigma with more recent theories about boundary maintenance. In-depth interviews with "pro-ana" bloggers reveal that to protect this virtual group and resist stigmas associated both with their illness and with their online presence, they construct their own norms and rules in the online realm, and discipline and eject members deemed to be out-group.

Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites

Pro-anorexic websites are a popular online venue for individuals with anorexia, but recent research suggests that they play a role of "online negative enabling support groups" because they can undermine recovery and encourage negative behaviors by validating pro-anorexic views. By analyzing 22,811 messages from 5,590 conversations from the Pro-Ana Nation online discussion board forum, this study examines communicative mechanisms of online negative enabling support through language analysis of disclosure-response sequences, changes in the language of the initial discloser within an interaction exchange, and the role of responses in eliciting those changes. The findings show that initiating disclosures containing stigma-related emotion words, anorexia-specific content, and sociorelational content are typically met with negatively valenced responses from other members of the pro-anorexic community. Moreover, although the act of revealing stigmatized information has some cathartic effects, disclosers use more, not fewer, stigma-related emotion words when they receive negatively valenced responses. These results provide insight into communicative dynamics and effects of online negative enabling support through validation of the pro-anorexic identity and the dangerous cycle of stigma escalation in disclosure-response exchanges on pro-anorexic online communities.

The urgent matter of online pro-eating disorder content and children: clinical practice

During the last decade, much concern has been expressed about online pro-eating disorder communities (e.g., pro-anorexia websites and blogs) which encourage their users to engage in disordered eating behavior. The aim of the current paper is to reemphasize the importance of pro-eating disorder communities in light of the recent changes in the media landscape. With the increase of social networking sites, pro-anorexia messages have transplanted to more volatile and constantly changing media, such as Snapchat, Twitter, Facebook, Instagram, Pinterest, and many others. Most parents, educators, and health professionals are unaware of the sheer scope and nature of such pro-anorexia messages in these new contexts. The current paper will provide a review of pro-eating disorder websites, overview the effects of such websites on young people's health, examine the emergence of these messages on social media platforms, and highlight a number of guidelines for clinicians and parents.

CONCLUSION

The dissemination of online pro-eating disorder content to different types of social networking sites is becoming an urgent issue.

WHAT IS KNOWN

• Existing research on pro-eating disorder websites examines the prevalence and the content of these websites, and the effects of pro-eating disorder content on both clinical (eating disordered individuals) and non-clinical samples (non-eating disordered individuals). • The scope and nature of such anorexia messages is unknown to most adults, and many people (including parents and medical professionals) are insufficiently aware of the ease with which young people access, navigate, and use a wide range of online platforms.

WHAT IS NEW

• Pro-anorexia messages are no longer limited to websites that can be easily monitored, but instead have been transplanted to more volatile and constantly changing media such as Snapchat, Twitter, Facebook, Pinterest, and Tumblr which makes pro-eating disorder content much more easily accessible. • This paper wants to emphasize the implications of the presence of pro-eating disorder content on websites and social media. A number of guidelines for parents and clinicians are provided.

Beyond prevention: containment rhetoric in the case of bug chasing

Bug chasing, the practice of pursuing HIV positive sexual partners in order to acquire HIV, presents multiple dilemmas for health affiliates in terms of how to address discourses and practices that challenge widely held beliefs about health and medicine. In order to examine how researchers respond to controversial counterpublic rhetorics, this essay chronicles the construction of "bug chasing" in published social science literature. Guided by a theory of containment rhetoric, I analyze how bug chasers are configured in the language of social science used to describe and explain them. I find that social scientific coverage of bug chasing often addresses the behavior using a recipe of rhetorical containment: first, authors gaze upon bug chasers via distanced descriptions of the community; second, authors characterize the behavior as exhibiting an idealistic naiveté; and, third, authors stress the inconceivable, and therefore reproachable, sacrifice that bug chasing ultimately demands of its onlookers and participants. In closing, I evaluate the consequences of this containment rhetoric and offer three rhetorical maneuvers to aid future scholarship that examines the discourses and communities that counter dominant health ideologies.

Sociability and support in online eating disorder communities: Evidence from personal networks

We study how people select their health support ties from their broader personal networks, taking into account the interplay of web-based and face-to-face interactions. We focus on users of self-styled Internet communities on eating disorders, often dubbed “pro-ana” and “pro-mia” and widely feared to contribute to maintaining and spreading these disorders. Despite the controversial anti-medical stances of some of them, “ana-mia” websites may channel mutual assistance, advice, and psychological and emotional support, with ultimate benefits for health.

In 2011–12 we fielded an online survey of users of French- and English-language “ana-mia” websites, mapping the composition and structure of their personal networks both online and face-to-face, and their health and eating-related support networks, for two types of health issues. We estimate binary choice models for these data and find that different health needs call for different types of support, embedded in different parts of personal networks. Specifically, online groups provide distinctive sources of help, which partly compensate for perceived shortcomings in healthcare services, although members do not overwhelmingly reject standard health systems and norms. We discuss how web-based groups constitute an important source of social support, and a potential resource for enhanced public health services provision.

Content analysis of male participation in pro-eating disorder web sites

The pro-anorexia community has emerged as a powerful cultural movement that takes an at least partially positive attitude toward anorexia nervosa and other eating disorders. A systematic review of the literature on pro-ana forums focused specifically on females with eating disorders. However, epidemiological data suggest that as much as 25% of the eating disorders population is male. In our review of pro-anorexia web sites, we found a substantial number of participants were male. We conducted a qualitative content analysis of male participation in pro-ana forums in an effort to learn more about male participation in these forums. In this article, we present the results of this analysis, highlighting themes of social support, community appreciation, and ambivalence, as well as themes that appear to be particular to the male experience of eating disorders, such as alienation and teasing.

A comparative analysis of anorexia nervosa groups on Facebook

PURPOSE

To analyze the content and culture of anorexia nervosa (AN)-related communication on the current major social network site (SNS) Facebook.

METHODS

We searched for groups and sites related to AN on Facebook by means of a faux profile of a young female. Identified groups/sites were analyzed with respect to (1) category (education, self-help, professional help, pro-ana, anti pro-ana), (2) activity, (3) motivational aspects (prose, pictures), and (4) social support.

RESULTS

Numerous relevant groups were found in all categories except that professional help was almost nonexistent. Pro-ana groups were found to be the most active, best organized, and offered the highest levels of social support. Prose motivation was distinctly offered in all categories. Motivation with pictures was particularly evident in pro-ana groups. The most functional motivation was found in self-help groups.

CONCLUSIONS

SNS appears to be a relevant way for young females suffering from AN to communicate and exchange disease and health-related ideas. Caregivers, researchers, and institutions in the field of eating disorders should be aware of the existence, possibilities, dysfunctions, and influence of SNS. Whether SNS can help persons with AN to get therapeutic assistance as well as whether it can be integrated into psychotherapeutic strategies should be examined in future studies.