Creating communities in cyberspace: pro-anorexia web sites and social capital

Women's perspectives toward their nutritional counseling for eating disorders: a qualitative internet-based study in Israel

Nutritional counseling is a central part of eating disorder (ED) treatment. However, the nature of this treatment has not yet been described from women's perspectives. We conducted two studies exploring views of women regarding their ED nutritional counseling. In the first study, we used content analysis to reveal practices that registered dietitians (RDs) use in ED treatment. In the second study, we used phenomenological analysis to explore the nature of the client-dietitian collaboration. Data included 1,897 posts and 8,673 responses from 414 distinct female users, retrieved from a moderated ED Internet community website in Israel. Content analysis demonstrated six practices used by RDs: meal planning, weight monitoring, health assessment/consultation, establishing rapports, food logs, joint eating. Phenomenological analysis produced four positions demonstrating client-dietitian collaborations: "Silent dialogue," "Cancelation and deception," "Tough love," "Containment." Findings revealed women's efforts to continue treatment despite their ambivalence about goals and recovery, and RDs' efforts to help women, despite the women's ambivalence, to move forward toward recovery.

Analyses of posts written in online eating disorder and depression/anxiety moderated communities: Emotional and informational communication before and during the COVID-19 outbreak

INTRODUCTION

Moderated online health communities (OHCs) are digital platforms that provide a means for patients with similar medical conditions to communicate with each other under the supervision of healthcare professionals.

AIMS

To examine the impact of the COVID-19 outbreak on content and type of posts published in two moderated OHCs - eating disorders and depression/anxiety - by comparing categorizations of posts written before vs. after the lockdown, and about vs. not about the pandemic.

METHODS

Posts were retrieved from Camoni, the first Israeli medical social network (January-June 2017, March-May 2020). A total of 1475 posts were analyzed. Of them, 802 posts were written before and 680 were written during the first lockdown. Posts were divided into two main categories: informational and emotional, and into fourteen subcategories.

RESULTS

Before the pandemic, the eating disorders OHC was characterized as primarily emotional (emotional: 66.7%, informational: 45.4%) and the depression/anxiety OHC as primarily informational (emotional: 49.8%, informational: 65.8%) (χ² = 31.6, p < 0.001). During the lockdown, there was a transition in the eating disorders community, from primarily emotional to primarily informational communication (emotional: 46.1%, informational: 71.7%) (χ² = 30.3, p < 0.001). In both OHCs, only about one in six posts written during the lockdown was related to the pandemic. There were only minimal differences in subcategorization of posts written before vs. after the outbreak (e.g., searching for medical information was more common during the pandemic: χ² = 40.9, p < 0.001), as well as about vs. not about the pandemic (e.g., sharing negative emotions was more common when writing about the pandemic: χ² = 4.1, p = 0.43).

CONCLUSION

During the first lockdown, people with eating disorders have increased their use of OHCs as sources of informational (as opposed to emotional) support, but the overall impact of the pandemic on the content of posts written in the examined OHCs was minimal, suggesting that OHCs have not changed their function as a valuable means of providing emotional and informational support for people with mental difficulties.

Barriers to hospital admission among people with eating disorders: A qualitative internet-based study

We seek to describe the barriers that people with eating disorders (EDs) face when undertaking a decision about whether to be admitted for inpatient treatment. Data were retrieved from a moderated ED Internet community website. A descriptive phenomenological approach was used to explore the shared experiences of community members who posted information about their viewpoints on inpatient admission. Three themes emerged: (i) 'Can I let others help me?' addressed the question of participants' ability to cooperate with hospital staff; (ii) 'Can I give up my daily routine?' focused on participants' meaningful lives outside of their ED (school, work, family, friends); and (iii) 'Can inpatient treatment work?' revealed a general lack of faith in the ability of inpatient treatment to make a substantial positive contribution. Our findings highlight the difficulties associated with making a decision about inpatient admission and suggest implications for mental-health professionals.

Effects of viewing a pro-ana website: an experimental study on body satisfaction, affect, and appearance self-efficacy

Pro-anorexia websites portray an extreme form of thin-ideal. This between-subjects experiment examined the effects of viewing such a website on body satisfaction, affect, and appearance self-efficacy compared to viewing control websites (fashion, home decoration, automutilation). The sample consisted of 124 normal weight, young adult, Dutch women (mean age 21.2, mean body mass index 21.4). Participants did not differ on affect and appearance self-efficacy. One body satisfaction measure showed that pro-anorexia viewers were more satisfied with their bodies than home decoration viewers. Our findings suggest that viewing a pro-anorexia website might not have detrimental effects on body satisfaction and affect among normal weight young women.

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.

Pro-eating disorder communities on social networking sites: a content analysis

The purpose of this study was to assess the number of pro-ana groups on social networking sites and to analyze their content. A general inductive approach was used to analyze the content. Two main themes emerged from the content analysis: social support and eating disorder specific content. Themes were similar across all groups; however, a linguistic analysis indicated differences between groups on the two different networking sites. There was an absence of content typically found on Internet sites. Pro-ana groups on social networking sites are focused on social interactions, and lack eating disorder specific content found on Internet sites.

e-Ana and e-Mia: A content analysis of pro-eating disorder Web sites

OBJECTIVES

The Internet offers Web sites that describe, endorse, and support eating disorders. We examined the features of pro-eating disorder Web sites and the messages to which users may be exposed.

METHODS

We conducted a systematic content analysis of 180 active Web sites, noting site logistics, site accessories, "thinspiration" material (images and prose intended to inspire weight loss), tips and tricks, recovery, themes, and perceived harm.

RESULTS

Practically all (91%) of the Web sites were open to the public, and most (79%) had interactive features. A large majority (84%) offered pro-anorexia content, and 64% provided pro-bulimia content. Few sites focused on eating disorders as a lifestyle choice. Thinspiration material appeared on 85% of the sites, and 83% provided overt suggestions on how to engage in eating-disordered behaviors. Thirty-eight percent of the sites included recovery-oriented information or links. Common themes were success, control, perfection, and solidarity.

CONCLUSIONS

Pro-eating disorder Web sites present graphic material to encourage, support, and motivate site users to continue their efforts with anorexia and bulimia. Continued monitoring will offer a valuable foundation to build a better understanding of the effects of these sites on their users.