An Interpretative Phenomenological Analysis of Participation in a Pro-anorexia Internet Site and Its Relationship with Disordered Eating

Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating

Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants' motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals' motivational stage in breaking the dieting-binging cycle.

Predicting Patient Satisfaction With Medications for Treating Opioid Use Disorder: Case Study Applying Natural Language Processing to Reviews of Methadone and Buprenorphine/Naloxone on Health-Related Social Media

Background

Medication-assisted treatment (MAT) is an effective method for treating opioid use disorder (OUD), which combines behavioral therapies with one of three Food and Drug Administration-approved medications: methadone, buprenorphine, and naloxone. While MAT has been shown to be effective initially, there is a need for more information from the patient perspective about the satisfaction with medications. Existing research focuses on patient satisfaction with the entirety of the treatment, making it difficult to determine the unique role of medication and overlooking the views of those who may lack access to treatment due to being uninsured or concerns over stigma. Studies focusing on patients' perspectives are also limited by the lack of scales that can efficiently collect self-reports across domains of concerns.

Objective

A broad survey of patients' viewpoints can be obtained through social media and drug review forums, which are then assessed using automated methods to discover factors associated with medication satisfaction. Because the text is unstructured, it may contain a mix of formal and informal language. The primary aim of this study was to use natural language processing methods on text posted on health-related social media to detect patients' satisfaction with two well-studied OUD medications: methadone and buprenorphine/naloxone.

Methods

We collected 4353 patient reviews of methadone and buprenorphine/naloxone from 2008 to 2021 posted on WebMD and Drugs.com. To build our predictive models for detecting patient satisfaction, we first employed different analyses to build four input feature sets using the vectorized text, topic models, duration of treatment, and biomedical concepts by applying MetaMap. We then developed six prediction models: logistic regression, Elastic Net, least absolute shrinkage and selection operator, random forest classifier, Ridge classifier, and extreme gradient boosting to predict patients' satisfaction. Lastly, we compared the prediction models' performance over different feature sets.

Results

Topics discovered included oral sensation, side effects, insurance, and doctor visits. Biomedical concepts included symptoms, drugs, and illnesses. The F-score of the predictive models across all methods ranged from 89.9% to 90.8%. The Ridge classifier model, a regression-based method, outperformed the other models.

Conclusions

Assessment of patients' satisfaction with opioid dependency treatment medication can be predicted using automated text analysis. Adding biomedical concepts such as symptoms, drug name, and illness, along with the duration of treatment and topic models, had the most benefits for improving the prediction performance of the Elastic Net model compared to other models. Some of the factors associated with patient satisfaction overlap with domains covered in medication satisfaction scales (eg, side effects) and qualitative patient reports (eg, doctors' visits), while others (insurance) are overlooked, thereby underscoring the value added from processing text on online health forums to better understand patient adherence.

Adolescent and emerging adult perceptions of eating disorder severity and stigma

OBJECTIVE

Eating disorders are one of the deadliest mental health conditions, yet most individuals with eating disorders never receive treatment. Previous research has explored barriers to treatment among individuals diagnosed with eating disorders, but little is known about general adolescent and emerging adult perceptions of eating disorders, as compared to other mental health illnesses, a population at greatest risk for developing an eating disorder, and a population that may be important sources of information or support for peers.

METHOD

A sample of adolescents and emerging adults aged 14-24 years (mean age 19 years) from MyVoice, a national text-message-based cohort (53% female, 38% male, 9% other, race/ethnicity 63% White, 10% Black or African American, 13% Asian, 9% Mixed Race, and 5% Other) provided open-ended responses to questions on the severity of eating disorders as compared to other mental health diagnoses, others' perceptions of eating disorders and potential treatment barriers. Responses were collected using a secure online platform and analyzed using content analysis.

RESULTS

Among respondents (n = 792/1283), 91% felt that eating disorders were a mental health condition and 65% felt that eating disorders were as serious as other mental health conditions, while 21% said they were more serious than other mental health conditions. Responses to questions related to perception and barriers illustrated that beliefs of eating disorders involve blame, stigma, and overall lack of understanding.

DISCUSSION

Findings from this study illustrate that there is a lack of understanding around eating disorders that could be addressed in youth-focused initiatives.

PUBLIC SIGNIFICANCE

Adolescents and emerging adults understand that eating disorders are severe mental illnesses that are not taken seriously by others, especially in comparison with other mental health diagnoses. Adolescents and emerging adults report that individuals with eating disorders are blamed for their condition and face shame and stigma. The lack of understanding around eating disorders should be addressed in youth-focused prevention initiatives.

Misinformation, thin-ideal internalization, and resistance to treatment: an interpretive phenomenological analysis of the experience of orthorexia nervosa

PURPOSE

Orthorexia nervosa (ON) is an emerging pattern of disordered eating which may be driven by a pathological desire to consume only highly nutritious foods, absent concern over body weight, as is noted in anorexia nervosa (AN). This study seeks to clarify the development and progression of ON and add to researchers' understanding of this potential disorder.

METHOD

Utilizing Interpretive Phenomenological Analysis to guide data collection and analysis, interviews were conducted with 18 individuals who self-identified as having ON.

RESULTS

Participants described a clear distinction between orthorexia nervosa and clinically recognized eating disorders, with which they had prior experience. In addition, they demonstrated patterns of inflexible thinking that guided their perceptions of themselves and others. As a result, participants rapidly integrated newly acquired nutritional information, which led to escalations in restriction, social isolation, and physical symptoms of malnutrition. While prior findings on the relationship between ON and weight are conflicting, previously proposed criteria for ON emphasize an absence of weight-related concerns. The results of the present study suggest that weight control is a primary motivating factor in the escalating pattern of restriction.

CONCLUSION

The nuanced results from this work evidence the value of interpretive qualitative approaches to improve understanding of ON. In particular, participants' described inflexible thinking with respect to eating behaviors may help inform or revise screening instruments and provide important insights for treatment of ON.

LEVEL OF EVIDENCE

Level V, qualitative descriptive research.

Challenges and Benefits of an Internet-Based Intervention With a Peer Support Component for Older Adults With Depression: Qualitative Analysis of Textual Data

Background

Technological interventions provide many opportunities for improving the health and quality of life of older adults. However, interaction with new technologies can also cause frustration. Although these themes have been explored in extant research, much remains to be learned with regard to how the challenges of aging and technology use and the experiences of participating in a social and learning environment are interrelated.

Objective

This study aimed to perform a qualitative analysis of data collected from MoodTech, a pilot study of an internet-based intervention with a peer support component for older adults with symptoms of depression, to better understand the participants’ experience of using technological interventions, including the challenges and benefits that they experienced over the course of these interventions.

Methods

We employed an inductive qualitative analysis method based on grounded theory methodology and interpretative phenomenological analysis to analyze participant textual data. These textual data were of 3 main types: (1) assignments in which participants challenged their negative thoughts, (2) status updates, and (3) comments in the peer support component of the intervention.

Results

We have presented the results through 3 main themes: (1) the challenges of aging as seen through the participants’ comments, (2) the difficulties experienced by the participants in using MoodTech, and (3) the benefits they derived from participating.

Conclusions

This paper offers several contributions concerning study participants’ experiences with internet-based cognitive behavioral therapy (iCBT) interventions with a peer support component and design considerations for developing complex technological interventions that support the challenges participants experience due to aging and cognitive difficulties. First, technical issues encountered by older adults within the context of the intervention can interact with and exacerbate the insecurities they experience in life, and it is important to consider how intervention components might be designed to mitigate these issues. Second, peer support can be employed as a mechanism to facilitate communication, support, and collaborative problem solving among participants in an intervention. The insights from this paper can inform the design of iCBT interventions for older adults.

Curation of Mental Health Recovery Narrative Collections: Systematic Review and Qualitative Synthesis

BACKGROUND

Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, which refer to events or actions over a period. They are readily available either individually or in collections of recovery narratives published in books, health service booklets, or on the Web. Collections of recovery narratives have been used in a range of mental health interventions, and organizations or individuals who curate collections can therefore influence how mental health problems are seen and understood. No systematic review has been conducted of research into curatorial decision making.

OBJECTIVE

This study aimed to produce a conceptual framework identifying and categorizing decisions made in the curation of mental health recovery narrative collections.

METHODS

A conceptual framework was produced through a systematic review and qualitative evidence synthesis. Research articles were identified through searching bibliographic databases (n=13), indexes of specific journals (n=3), and gray literature repositories (n=4). Informal documents presenting knowledge about curation were identified from editorial chapters of electronically available books (n=50), public documents provided by Web-based collections (n=50), and prefaces of health service booklets identified through expert consultation (n=3). Narrative summaries of included research articles were produced. A qualitative evidence synthesis was conducted on all included documents through an inductive thematic analysis. Subgroup analyses were conducted to identify differences in curatorial concerns between Web-based and printed collections.

RESULTS

A total of 5410 documents were screened, and 23 documents were included. These comprised 1 research publication and 22 informal documents. Moreover, 9 higher level themes were identified, which considered: the intended purpose and audience of the collection; how to support safety of narrators, recipients, and third parties; the processes of collecting, selecting, organizing, and presenting recovery narratives; ethical and legal issues around collections; and the societal positioning of the collection. Web-based collections placed more emphasis on providing benefits for narrators and providing safety for recipients. Printed collections placed more emphasis on the ordering of narrative within printed material and the political context.

CONCLUSIONS

Only 1 research article was identified despite extensive searches, and hence this review has revealed a lack of peer-reviewed empirical research regarding the curation of recovery narrative collections. The conceptual framework can be used as a preliminary version of reporting guidelines for use when reporting on health care interventions that make use of narrative collections. It provides a theory base to inform the development of new narrative collections for use in complex mental health interventions. Collections can serve as a mechanism for supporting collective rather than individual discourses around mental health.

Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis

OBJECTIVE

Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients.

METHOD

A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel.

RESULTS

In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders.

CONCLUSIONS

Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.

A reliability and content analysis of Italian language anorexia nervosa-related websites

Objective

Internet represents a major source of information related to health issues, increasingly used by providers. Indeed, there are numerous websites concerning eating and weight disorders, such as anorexia nervosa. The aim of the current investigation was to systematically perform a reliability and content analysis of Italian language anorexia nervosa-related websites.

Methods

Reliability of the anorexia nervosa website pages was assessed using the Health on the Net Foundation Code of Conduct Standards (HonCode^®) certification mark. A comprehensive content analysis (thematic cluster analysis, correspondence analysis of emerging themes and topics, density and degree-centrality analysis, and co-word analysis) was performed using the commercial software T-Lab.

Results

402 unique website pages were included and analyzed in the current study. Statistically significant differences related to the accomplishment or less to the items of the HonCode^® certificate mark were found for all items, except for confidentiality and webmaster/additional contact. From the thematic cluster analysis, four clusters were identified: namely, treatment (26.6%), vomiting (24.7%), weight (24.4%) and onset-age (24.3%). Treatment (in particular, cognitive-behavioral psychotherapy) was the most represented theme (with a frequency of 97.76%, recurring in 393 websites). Pro-ana content characterized 147 website pages (with a frequency of 36.57%).

Conclusion

The quality of Italian language anorexia nervosa-related websites was rather moderate-poor, being generally inconsistent with the principles of the HonCode^® certification mark. Therefore, physicians and health authorities should be aware of such findings to provide their patients with proper answers and education.

Estimating Determinants of Attrition in Eating Disorder Communities on Twitter: An Instrumental Variables Approach

BACKGROUND

The use of social media as a key health information source has increased steadily among people affected by eating disorders (EDs). Research has examined characteristics of individuals engaging in online communities, whereas little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities.

OBJECTIVE

This study aimed to investigate the characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors.

METHODS

Using a snowball sampling method, we collected a set of individuals who self-identified with EDs in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals' emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users' following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from February 11, 2016 to August 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. The average levels of attributes among an individual's followees (ie, people who are followed by the individual) are used as instruments for the individual's attributes.

RESULTS

Eating disordered users have relatively short periods of activity on Twitter with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, whereas dropped-out users tend to cluster together. Estimation results suggest that users' emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter lasting periods of activity online than users with negative emotions, whereas central users in a social network have longer lasting participation than peripheral users. Findings on users' tweeting interests further show that users who attempt to recover from EDs are more likely to drop out than those who promote EDs as a lifestyle choice.

CONCLUSIONS

Presence in online communities is strongly determined by the individual's emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled when designing online interventions so as to accurately capture their intended populations.

Improving the Living, Learning, and Thriving of Young Black Men: A Conceptual Framework for Reflection and Projection

Black men experience disproportionate mental health challenges due to their exposure to severe psychosocial stressors. Yet, the mental health challenges of Black men have largely been left out of national conversations. Strong theoretical frameworks are important when generating dialogue about the mental health of Black men, as it helps to validate the work on a larger scale while also grounding the work for more practical use. This paper presents the conceptual framework for a five-year initiative aimed at improving the living, learning, and thriving of young Black men through a social media intervention that improves their mental health, expands their definitions of manhood, and helps them to engage in social support. The Young, Black Men, Masculinities, and Mental Health (YBMen) project is a social media-based, health promotion program that targets mental health (e.g., depressive symptoms), masculine norms (e.g., definitions of manhood), and social support for young Black men using culturally-sensitive, age-appropriate, and gender-specific popular culture. The YBMen project has been successfully implemented with over 150+ Black men since 2014; findings demonstrate improved mental health outcomes, progressive definitions of manhood, and stronger social relationships. Reflections from the past and projections for the future are discussed.

Doing Histor{y/ies} of Health Psycholog{y/ies}

Academic (sub)disciplines develop in time and place when particular ideas/practices are nurtured within social, gendered, cultural, community, economic and political contexts. Different histories employ different analyses, some with external views of scientific outputs describing research and practice, and others with internal, behind-the-scenes examinations of these developments, through oral histories and personal recollections. This collection, written by historians of (social) science, or practitioners or pioneering participants, uses different historiographical methods to contextualize health-related activities within the sub-discipline of health psychology and the evolving critical and/or community approaches. The papers connect the evolving health psycholog{y/ies} with changing socio-political circumstances in different countries.

"It's the Symptom of the Problem, Not the Problem itself": A Qualitative Exploration of the Role of Pro-anorexia Websites in Users' Disordered Eating

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.

Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research

Compared with self-help bibliotherapy, little is known about the efficacy of creative bibliotherapy or the mechanisms of its possible efficacy for eating disorders or any other mental health condition. It is clear, however, that fiction is widely used informally as a therapeutic or antitherapeutic tool and that it has considerable potential in both directions, with a possibly significant distinction between the effects of reading fiction about eating disorders (which may-contrary to theoretical predictions-be broadly negative in effect) or one's preferred genre of other fiction (which may be broadly positive). Research on creative bibliotherapy, especially systematic experimental research, is lacking and requires a medical humanities approach, drawing on knowledge and methods from psychology and cognitive literary studies as well as clinical disciplines to expand our understanding of how the dynamic processes of interpretation mediate between textual structures and characteristics of mental health and illness.

Social interactions in online eating disorder communities: A network perspective

Online health communities facilitate communication among people with health problems. Most prior studies focus on examining characteristics of these communities in sharing content, while limited work has explored social interactions between communities with different stances on a health problem. Here, we analyse a large communication network of individuals affected by eating disorders on Twitter and explore how communities of individuals with different stances on the disease interact online. Based on a large set of tweets posted by individuals who self-identify with eating disorders online, we establish the existence of two communities: a large community reinforcing disordered eating behaviours and a second, smaller community supporting efforts to recover from the disease. We find that individuals tend to mainly interact with others within the same community, with limited interactions across communities and inter-community interactions characterized by more negative emotions than intra-community interactions. Moreover, by studying the associations between individuals' behavioural characteristics and interpersonal connections in the communication network, we present the first large-scale investigation of social norms in online health communities, particularly on how a community approves of individuals' behaviours. Our findings shed new light on how people form online health communities and can have broad clinical implications on disease prevention and online intervention.

Assessing Unmet Information Needs of Breast Cancer Survivors: Exploratory Study of Online Health Forums Using Text Classification and Retrieval

BACKGROUND

Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety of reasons. An automated content analysis of survivors' postings to online health forums can identify expressed information needs over a span of time and be repeated regularly at low cost. Identifying these unmet needs can guide improvements to existing education materials and the creation of new resources.

OBJECTIVE

The primary goals of this project are to assess the unmet information needs of breast cancer survivors from their own perspectives and to identify gaps between information needs and current education materials.

METHODS

This approach employs computational methods for content modeling and supervised text classification to data from online health forums to identify explicit and implicit requests for health-related information. Potential gaps between needs and education materials are identified using techniques from information retrieval.

RESULTS

We provide a new taxonomy for the classification of sentences in online health forum data. 260 postings from two online health forums were selected, yielding 4179 sentences for coding. After annotation of data and training alternative one-versus-others classifiers, a random forest-based approach achieved F1 scores from 66% (Other, dataset2) to 90% (Medical, dataset1) on the primary information types. 136 expressions of need were used to generate queries to indexed education materials. Upon examination of the best two pages retrieved for each query, 12% (17/136) of queries were found to have relevant content by all coders, and 33% (45/136) were judged to have relevant content by at least one.

CONCLUSIONS

Text from online health forums can be analyzed effectively using automated methods. Our analysis confirms that breast cancer survivors have many information needs that are not covered by the written documents they typically receive, as our results suggest that at most a third of breast cancer survivors' questions would be addressed by the materials currently provided to them.

Literary reading and eating disorders: survey evidence of therapeutic help and harm

BACKGROUND

There is growing evidence for the efficacy of self-help bibliotherapy as a treatment for eating disorders, although little understanding of how specific linguistic characteristics may enhance or constrain its effects. Meanwhile, 'creative bibliotherapy' (the therapeutic use of fiction, poetry, or sometimes film, rather than self-help books) is widely practised, but even more poorly understood than the self-help variety: although a range of theoretical models exist, claims of the healing power of literature are far more commonly made than tested.

METHODS

An online survey including quantitative (forced-choice) and qualitative (free-response) items was designed and administered in collaboration with the charity Beat to investigate the connections between respondents' reading habits and their mental health, with a focus on eating disorders, and attracted 885 respondents. Responses to two sequences of questions, exploring the differential effects of fiction about eating disorders versus respondents' preferred genre of other fiction on the dimensions of mood, self-esteem, feelings about one's body, and diet and exercise habits, were analysed using a 2 × 2 repeat measures factorial ANOVA design for each of the four dependent variables.

RESULTS

Surprisingly, fiction about eating disorders was perceived by respondents as broadly detrimental to mood, self-esteem, feelings about their bodies, and diet and exercise habits, while respondents' preferred genre of other fiction was experienced as beneficial to mood and broadly neutral on the other three dimensions. The free-response data added detail to these core findings, as well as suggesting numerous other possible effects and mechanisms, drawing attention to the roles of positive and negative feedback structures and of highly selective interpretive filtering, and highlighting the dangers of 'self-triggering': using books to deliberately exacerbate an eating disorder.

CONCLUSIONS

The findings directly challenge existing theoretical models of creative-bibliotherapeutic mechanisms, which tend to insist on the importance of a close match between the reader's and the protagonist's situations. They point the way forward for a new programme of clinical research and practice by suggesting other ways to conceive of how embodied cognitive acts of textually cued interpretation may intervene in the psychopathology of an eating disorder - for good and for ill.

"I Kinda Feel Like Wonder Woman": An Interpretative Phenomenological Analysis of Pole Fitness and Positive Body Image

The purpose of this research was to describe and interpret the positive body image experiences of women actively engaged in pole fitness. A total of seven women between the ages of 20 and 36 years participated in semistructured one-on-one interviews and follow-up interviews. Participant observation was also used to generate data. Data were analyzed using an interpretative phenomenological analysis approach, and the positive body image experiences of women are represented by five themes: (a) observation and exposure fostering body acceptance, (b) performance promoting self-confidence, (c) personal growth and sexual expression, (d) unconditional community support creates comfort, and (e) body appreciation through physical skill development. Findings suggest that women engaging in pole fitness may experience positive body image, and the words of participants provide insight into the components of pole fitness that may foster positive body image. Pole fitness may provide a unique exercise context whereby women can develop and maintain positive body image.

Interventions to reduce the stigma of eating disorders: A systematic review and meta-analysis

Stigma is a problem for individuals with eating disorders (EDs), forming a barrier to disclosure and help-seeking. Interventions to reduce ED stigma may help remove these barriers; however, it is not known which strategies (e.g., explaining etiology to reduce blame, contact with a person with an ED, or educating about ED) are effective in reducing stigma and related outcomes. This review described effectiveness of intervention strategies, and identified gaps in the literature. A search of four databases was performed using the terms (eating disorder* OR bulimi* OR anorexi* OR binge-eating disorder) AND (stigma* OR stereotyp* OR beliefs OR negative attitudes) AND (program OR experiment OR intervention OR education), with additional texts sought through LISTSERVs. Two raters screened papers, extracted data, and assessed quality. Stigma reduction strategies and study characteristics were examined in critical narrative synthesis. Exploratory meta-analysis compared the effects of biological and sociocultural explanations of EDs on attitudinal stigma. Eighteen papers were eligible for narrative synthesis, with four also eligible for inclusion in a meta-analysis. Biological explanations reduced stigma relative to other explanations, including sociocultural explanations in meta-analysis (g = .47, p < .001). Combined education and contact interventions improved stigma relative to control groups or over time. Most studies examined Anorexia Nervosa (AN) stigma and had mostly female, undergraduate participants. Despite apparent effectiveness, research should verify that biological explanations do not cause unintentional harm. Future research should evaluate in vivo contact, directly compare education and contact strategies, and aim to generalize findings across community populations.

The importance of social identities in the management of and recovery from 'Diabulimia': A qualitative exploration

INTRODUCTION

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort.

METHOD

Transcripts from five online focus groups with 13 members of an online support group for individuals with 'Diabulimia' were thematically analysed.

RESULTS

Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery; these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions.

CONCLUSIONS

While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

Teen Depression Groups on Facebook: A Content Analysis

Major depressive disorder (MDD) is one of the most frequently diagnosed disorders in early adolescence and can lead to a multitude of negative life outcomes, highlighting the need for early and effective intervention to mitigate depressive symptoms. Recognizing the preference of youth to seek informal sources of help for mental health issues, which may include the Internet, the social networking site Facebook was investigated as a potential source of support and help for youth suffering depressive symptoms or disorder. This study examined the content of online Facebook support groups targeting adolescents with depression. A total of 508 posts from six Facebook groups were analyzed. The majority of post content on these Facebook groups consisted of self-disclosure (32.48%), feedback between posters (24.80%), and offers and recommendations of help (24.61%). Posters seem to utilize adolescent Facebook depression groups mainly to connect with those who might share a similar experience and to share information about mental health resources. Future studies should investigate the potential to use the information exchange that occurs in these groups to promote traffic to online and offline evidence-based mental health resources.

'Everyone here wants everyone else to get better': The role of social identity in eating disorder recovery

Retention of a positively valued illness identity contributes to poor outcomes for individuals with eating disorders (EDs). Consequently, dis-identification from the illness identity and the adoption of a recovery identity are vital for successful recovery. While social identity processes have been shown to influence ED maintenance, their role in recovery is rarely considered. This study explores how a sense of shared identity helps individuals with EDs manage their condition and promotes recovery. Transcripts from 18 online support sessions involving 75 participants were thematically analysed. Our findings suggest that the illness identity initially operates as a social identity that forms the basis for connections with similar others. For those wishing to recover, identity-based support is then perceived to be more effective than that found outside the group. Online interactions also facilitate construction of a new shared recovery identity which promotes a shift from the illness identity as a primary source of definition and endorses group norms of illness disclosure and treatment engagement. While in the clinical literature, ED identity is seen as problematic and interventions are targeted at challenging an individual's self-concept, we suggest that interventions could instead harness identity resources to support a transition to a recovery identity.

‘Learning to live your life again’: An interpretative phenomenological analysis of weblogs documenting the inside experience of recovering from anorexia nervosa

This study aimed to explore the construct of recovery from anorexia nervosa through the medium of weblogs, focusing on the benefits and barriers to the recovery process. Data were extracted from female ( n = 7) and male ( n = 1) participants’ textual pro-recovery weblogs, all of which were posted between 2013 and 2015 in the public domain. Data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) barriers to recovery, (2) factors increasing the likelihood of recovery and (3) support. Results suggest supportive relationships, regaining control and recognising the consequences of the eating disorder benefit recovery, whereas public perceptions, the anorexia nervosa voice and time act as barriers to recovery. Out of eight participants, four described seeking professional help as part of their recovery, of which three believed their professional therapy experience helped aid recovery. Implications for anorexia nervosa treatment are discussed in detail.

International Olympic Committee consensus statement: harassment and abuse (non-accidental violence) in sport

Despite the well-recognised benefits of sport, there are also negative influences on athlete health, well-being and integrity caused by non-accidental violence through harassment and abuse. All athletes have a right to engage in ‘safe sport’, defined as an athletic environment that is respectful, equitable and free from all forms of non-accidental violence to athletes. Yet, these issues represent a blind spot for many sport organisations through fear of reputational damage, ignorance, silence or collusion. This consensus statement extends the 2007 IOC Consensus Statement on Sexual Harassment and Abuse in Sport, presenting additional evidence of several other types of harassment and abuse—psychological, physical and neglect. All ages and types of athletes are susceptible to these problems but science confirms that elite, disabled, child and lesbian/gay/bisexual/trans-sexual (LGBT) athletes are at highest risk, that psychological abuse is at the core of all other forms and that athletes can also be perpetrators. Harassment and abuse arise from prejudices expressed through power differences. Perpetrators use a range of interpersonal mechanisms including contact, non-contact/verbal, cyber-based, negligence, bullying and hazing. Attention is paid to the particular risks facing child athletes, athletes with a disability and LGBT athletes. Impacts on the individual athlete and the organisation are discussed. Sport stakeholders are encouraged to consider the wider social parameters of these issues, including cultures of secrecy and deference that too often facilitate abuse, rather than focusing simply on psychopathological causes. The promotion of safe sport is an urgent task and part of the broader international imperative for good governance in sport. A systematic multiagency approach to prevention is most effective, involving athletes, entourage members, sport managers, medical and therapeutic practitioners, educators and criminal justice agencies. Structural and cultural remedies, as well as practical recommendations, are suggested for sport organisations, athletes, sports medicine and allied disciplines, sport scientists and researchers. The successful prevention and eradication of abuse and harassment against athletes rests on the effectiveness of leadership by the major international and national sport organisations.

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.

Young women with a disorder of sex development: learning to share information with health professionals, friends and intimate partners about bodily differences and infertility

AIM

To understand the experiences of young women with a disorder of sex development when sharing information about their body with healthcare professionals, friends and intimate partners.

BACKGROUND

Disorders of sex development are lifelong conditions that create bodily difference such as absence of reproductive organs which can impact on young women's fertility and sexual experiences.

DESIGN

Interpretive phenomenological analysis with thirteen young women (14-19 years old) with a disorder of sex development.

METHODS

The young women chose to participate in either a face-to-face semi-structured interview or to complete a paper diary between 2011-2012.

RESULTS

A superordinate theme focusing on the meaning bodily differences held for these young women is presented through three themes: self-awareness and communicating this to others; actualizing intimacy; and expressing meaning of altered fertility to self or professionals or partners. During early adolescence, the young women were guarded and reticent about sharing personal information about their disorder of sex development but as they moved towards adulthood, some of the young women learnt to engage in conversations with more confidence. Frustrations about their bodily differences and the limitations of their bodies were talked about as factors which limited physical spontaneity, impacted on their perceived sexual fulfilment and challenged the development or sustainability of close friendships or intimate partnerships. The young women wanted empathic, sensitive support from knowledgeable health professionals to help them understand their bodies.

CONCLUSION

Attachment and a 'sense of being' were the concepts that were closely linked to the young women's development of a secure identity.

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.

"I am a waste of breath, of space, of time": metaphors of self in a pro-anorexia group

According to recent research on eating disorders, heavy users of pro-anorexia (pro-ana) sites show higher levels of disordered eating and more severe impairment of quality of life than non-heavy users. A better understanding of how pro-ana members self-present in the virtual world could shed some light on these offline behaviors. Through discourse analysis, I examined the metaphors the members of a pro-ana group invoked in their personal profiles on a popular social networking site, to talk about the self. I applied the Metaphor Identification Procedure to 757 text profiles. I identified four key metaphorical constructions in pro-ana members' self-descriptions: self as space, self as weight, perfecting the self, and the social self. These four main metaphors represented discourse strategies, both to create a collective pro-ana identity and to enact an individual identity as pro-ana. In this article, I discuss the implications of these findings for the treatment of eating disorders.

Things you can learn from books: exploring the therapeutic potential of eating disorder memoirs

This paper explores the potential benefits that books, and specifically memoirs, might offer mental health students, positing that first-person testimonials might make the complex experiences of a mental health challenge, in this case, eating disorders, accessible to learners. The paper presents a pedagogical approach, based on transformative learning, to assist in encouraging the development of a recovery approach in students. Transformative learning is a pedagogy that is interested in problematic practices that keep afflicting an area, such as the imbalanced focus on learning illness, rather than well-being, and in pondering and revising the educational solutions. The paper proposes that forward movement in this area will be based on considering and developing such innovative curricula, and researching its impact. By virtue of their accessibility, memoirs could offer to a large audience the benefits of universality, empathy, hope, and guidance. Teachers and learners could be making use of these books in face-to-face or online activities. This paper explores the groundwork that is needed before eating disorder memoirs can be confidently recommended as a therapeutic tool.

Start, stop, and continue: Preliminary insight into the appeal of self-injury e-communities

Nonsuicidal self-injury e-communication has gained heightened empirical and public interest. This is the first study to examine possible motives for nonsuicidal self-injury e-communication. A total of 68 nonsuicidal self-injury e-community members responded to open-ended questions concerning reasons for starting, temporarily stopping, and continuing nonsuicidal self-injury e-communication. Results from a thematic analysis indicated that being motivated to obtain support, get nonsuicidal self-injury help, help others, and better understand nonsuicidal self-injury represented motives for starting nonsuicidal self-injury e-communication. For some, negative interactions and accessing triggering material contributed to e-communication stoppage; these individuals continued e-communication to get support and help. Implications for research and e-outreach are discussed.

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.

Social support networks and eating disorders: an integrative review of the literature

AIMS

This study aimed to analyze the scientific literature about social networks and social support in eating disorders (ED).

METHODS

By combining keywords, an integrative review was performed. It included publications from 2006-2013, retrieved from the MEDLINE, LILACS, PsycINFO, and CINAHL databases. The selection of articles was based on preestablished inclusion and exclusion criteria.

RESULTS

A total of 24 articles were selected for data extraction. There was a predominance of studies that used nonexperimental and descriptive designs, and which were published in international journals. This review provided evidence of the fact that fully consolidated literature regarding social support and social networks in patients with ED is not available, given the small number of studies dedicated to the subject. We identified evidence that the family social network of patients with ED has been widely explored by the literature, although there is a lack of studies about other networks and sources of social support outside the family.

CONCLUSION

The evidence presented in this study shows the need to include other social networks in health care. This expansion beyond family networks would include significant others - such as friends, colleagues, neighbors, people from religious groups, among others - who could help the individual coping with the disorder. The study also highlights the need for future research on this topic, as well as a need for greater investment in publications on the various dimensions of social support and social networks.

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.

Women's experiences of coping with pregnancy termination for fetal abnormality

Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

Sharing experiences and social support requests in an Internet forum for patients with systemic lupus erythematosus

Internet forums represent a useful but understudied resource to understand psychosocial aspects of living with systemic lupus erythematosus. This study was aimed to describe the demand/supply of social support through the Internet in relation with the description of personal illness experiences. All the posts (118) from an Italian forum for systemic lupus erythematosus patients were collected and analyzed combining qualitative content analysis with statistical textual analysis. The results showed different purposes for posts: starting new relationships, seeking information, receiving emotional support, and giving a contribution. Lexical analysis identified three ways of describing patients' experiences. Discussion focuses on the relationship between the requested/offered support and systemic lupus erythematosus experiences.

Online exchanges among cancer patients and caregivers

Purpose

The meanings attributed to the quality of a person's illness experience result from important processes of co‐construction not only between healthcare professionals and patients but also among patients and caregivers. In the case of advanced cancer, new treatments extend patients’ lives but they raise the problem of the quality of this “renewed time”. Lay contexts of exchanges appear crucial for orienting the attribution of meaning to the time with cancer and for sharing practices to manage it. Furthermore, the internet is becoming an important space in which cancer patients meet and construct knowledge regarding their illness. The aim of this paper is to study knowledge‐ and practice‐construction among advanced cancer patients and caregivers, and to explore the suitability of online forums for analysis of these processes.

Design/methodology/approach

The paper discusses the results of a qualitative study based on one online forum for long‐term cancer patients (second relapse) and one for caregivers. The discussions explored show how patients and caregivers attribute meanings to their time with cancer. Verbatim transcripts of the discussions were analyzed according to the Interpretative Phenomenological Analysis (IPA) procedure.

Findings

The findings suggest the system of medical representations regarding health and illness should take greater account of other (lay) systems of representations and that the internet could be a valuable resource to support the development of spontaneous networks of patient and caregivers through which to organize health interventions and to involve patients and caregivers more closely in the care and cure process.

Research limitations/implications

The study examines the experiences of a particular subset of patients/caregivers who were internet‐literate and might be considered more “active” in their coping with the disease over a fairly limited time span. These potential limitations are being remedied in continuing research projects.

Practical implications

The authors’ experience with this research design suggests qualitative research may be particularly valuable in casting light on emergent phenomena such as spontaneous social networks on the internet, and in encouraging more participative forms of research engagement.

Originality/value

These findings may orient therapeutic interventions to be more closely attuned to the needs of long‐term cancer patients and their caregivers. Online forums enable participants to disclose experiences, share knowledge, and co‐construct “good practices” for illness management.

Pro-anorexia and pro-recovery photo sharing: a tale of two warring tribes

Background

There is widespread use of the Internet to promote anorexia as a lifestyle choice. Pro-anorexia content can be harmful for people affected or at risk of having anorexia. That movement is actively engaged in sharing photos on social networks such as Flickr.

Objective

To study the characteristics of the online communities engaged in disseminating content that encourages eating disorders (known as “pro-anorexia”) and to investigate if the posting of such content is discouraged by the posting of recovery-oriented content.

Methods

The extraction of pro-anorexia and pro-recovery photographs from the photo sharing site Flickr pertaining to 242,710 photos from 491 users and analyzing four separate social networks therein.

Results

Pro-anorexia and pro-recovery communities interact to a much higher degree among themselves than what is expected from the distribution of contacts (only 59-72% of contacts but 74-83% of comments are made to members inside the community). Pro-recovery users employ similar words to those used by pro-anorexia users to describe their photographs, possibly in order to ensure that their content appears when pro-anorexia users search for images. Pro-anorexia users who are exposed to comments from the opposite camp are less likely to cease posting pro-anorexia photographs than those who do not receive such comments (46% versus 61%), and if they cease, they do so approximately three months later. Our observations show two highly active communities, where most interaction is within each community. However, the pro-recovery community takes steps to ensure that their content is visible to the pro-anorexia community, both by using textual descriptions of their photographs that are similar to those used by the pro-anorexia group and by commenting to pro-anorexia content. The latter activity is, however, counterproductive, as it entrenches pro-anorexia users in their stance.

Conclusions

Our results highlight the nature of pro-anorexia and pro-recovery photo sharing and accentuate the need for clinicians to be aware of such content and its effect on their patients. Our findings suggest that some currently used interventions are not useful in helping pro-anorexia users recover. Thus, future work should focus on new intervention methods, possibly tailored to individual characteristics.

Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.

Recommendations for the use of online social support for African American men

African American men face greater psychosocial stressors than African American women and men of other racial and ethnic groups, which place them at higher risk for psychological distress. Yet, research suggests that African Americans are less likely to utilize professional mental health services because of their mistrust of the health care system and their need for more specialized and innovative services. Supplemental resources aimed at positive coping and social support for African American men may reduce the likelihood that they experience psychological distress, which could lead to more severe mental disorders. This article proposes the use of online social support for African American men who are in early, nonsevere stages of psychological distress. We examine the unique experiences of African American men, discuss distress among this underserved group, and finally, offer recommendations for achieving an online community for African American men.

Communicating stigma: the pro-ana paradox

This study explores the personal experience of pro-ana bloggers, members of an online community for people with eating disorders. Using Erving Goffman's work on stigma, this study explores the motivations, benefits, and drawbacks of blogging about a stigmatized mental illness, as taken from the bloggers' own perceptive. We conducted 33 interviews with bloggers from seven different countries via phone, Skype, and e-mail. Participants were motivated to blog because they found social support, a way to cope with a stigmatized illness, and means of self-expression. Participants described blogging as a cathartic experience and perceived the social support they received from other members of the pro-ana community as a benefit. The fear that the eating disorder will be revealed if the blog is exposed and the concern that the blog encourages disordered eating were the perceived negative consequences of maintaining such a blog. Thus, blogging about anorexia serves to both alleviate and trigger anxiety about living with this stigmatized illness. Recommendations for future research are made.