By: Vanessa Cecchini, Carissa Green, and Taylor Westbury

Eating disorders are a widespread issue. Social media has helped to accelerate and increase ideas of poor self-thought and/or dysmorphia. Social media can also create a safe space for challenging triggering content and normalizing recovery. Our study covered 36 posts under 5 separate hashtags to examine how conversations around eating disorder recovery were being held on Instagram. Our findings illuminate how the media shapes discourse, narratives, and beliefs surrounding eating disorders.

Eating disorders are commonplace and those suffering often don’t receive treatment. Only 1/3 of those diagnosed with eating disorders sought treatment (National Institute of Mental Health). Positive emphasis and prevalence of recovery are crucial in destigmatizing to encourage those who need help to receive it. While social media can perpetuate negative ideas about one’s self, Instagram, alongside users are working to challenge this discourse and change the narrative around eating disorders. Instagram has introduced a feature which redirects users to sources that encourage recovery and outside help. Therefore, when attempting to research under #ProED, our search was redirected. Additionally, users have pushed back on pro-eating disorder content through a combination of 10.3 million posts through the 4 hashtags examined.

Our analysis of the 36 posts uncovered an overwhelming push of positive messages for recovery. Our research showed that women were most predominantly represented. Women posted individual stories of recovery. Rarely were men included in the content analyzed, although at times they were present in posts advocating for a more diverse representation of those with eating disorders. This is to be expected as most research and assumptions about body dissatisfaction and or self-objectification do pertain to women. It should be noted this contributes further to the stigma regarding men with eating disorders. This difference in gender participation contributes to the normalization of what is considered acceptable and demonstrates societal norms.

To expand upon the gender challenges boundaries only eight (22%) of them contained images of females or female-presenting individuals. Of those eight posts, two (0.05%) contained images of males or male presenting individuals, although again through an infographic for representation. Upon further analysis, posts demonstrating themes of hope and combat (47%) occurred significantly more than posts demonstrating peril (0.03%). Additionally, many posts contained positive and uplifting messages. Emphasizing the positive rhetoric around rehabilitation.

This research has helped contribute a foundation for further research into the importance of hashtags and posts in guiding conversations around eating disorders and specifically the role of Instagram when conceptualizing the portrayal of eating disorders. This research can be effectively implemented into meaningful real-world actions that are impactful. Non-profits and mental health advocates can collaborate with social media platforms to help promote resources and steps for eating disorder recovery, additionally elevating the stories of people with eating disorders who do not fit the normalized standard imagery.

 

Research Report

By: Vanessa Cecchini, Carissa Green, and Taylor Westbury

Eating disorders are an often-overlooked issue, social media provides a platform for discussion, which can work to reduce or increase stigmas and stereotypes. Platforms like Instagram can create communities that facilitate conversations around mental health issues, more specifically eating disorders. Our study will examine 36 stagnant Instagram posts that use #EatingDisorder, #EDrecovery, #anarecovery, and #anorexia recovery to understand how Instagram creates communities, how they help to regulate and facilitate these spaces, and conversations around eating disorders. Findings suggested that females are more heavily represented than males, that food and food acceptance play an integral role in recovery, challenge cues, especially hope and combat, were more common than stigma cues, quotes were used in 58% of the posts, indicating that quotes may be used as a way to inspire and motivate individuals in recovery or attempting to recovery. This study holds theoretical value, rooted in Framing, Cultivation, and stigma communication theories. Additionally, it provides insight into how healthcare and community organizations can utilize social media to create effective campaigns that raise awareness of this issue and support those living with or recovering from eating disorders.

Literature Review

Although mental health has been a topic of research for some time, specifically the link between social media and mental illness has been strengthening thus building a larger field of research which delves into this unique topic (Valle, M. K., & Wade, 2022). For our research article, we will be accessing two individual communications theories. The first we will call upon is Framing Theory (Entman, 1993), which connects a medium’s presentation of information and its influence on understanding. As our research is focused on the manifestation of mental illness in the form of eating disorders, it is important to note that these disorders are implicitly linked to sociocultural factors in which social media platforms thrive (Padin, Gonzalez-Rodriguez, Verde-Diego, & Vazquez-Perez, 2021). This theory associated with our content-driven society which our current generation is being raised within has had an increase in poor self-thought and/or dysmorphia (Leone, Sedory & Gray, 2005). This concept can be connected back to the second theory we will impose; Cultivation Theory (Gerbner, 1969). A notion that examines the consumption of media on one’s perception of themselves and others. Using these theories as a baseline for analysis we will extract meaning from the content of the social media posts, for example, the photo, the caption, and the hashtags. Two major research articles have previously highlighted these segments of posts and their roles within eating disorders. Talbot, Campbell, and Greville-Harris (2023) in their study ‘Your struggles are valid, you are worthy of help and deserve to recover’: narratives of recovery from orthorexia nervosa” and Goh, Lo, Davis, and Chew (2023) in their study “#EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram”. These articles have built a foundation for further research into the importance of hashtags in guiding conversations around eating disorders and specifically the role of Instagram when conceptualizing the portrayal of eating disorders.

Method

Instagram was chosen as the social media platform we would be focusing on for this study. We selected four of the most popular recovery-based hashtags and one pro-ED hashtag to facilitate our data collection. These hashtags were chosen based on previous studies looking at the portrayal of eating disorders and eating disorder recovery on Instagram (Goh, Lo, Davis, and Chew, 2021; LaMarre and Rice, 2017; and Talbot, Campbell, and Greville-Harris, 2023). Between the four chosen recovery hashtags there were a total of 10.3 million posts. We then decided we would review a total of 36 posts divided between the chosen hashtags and a random number generator was used to select the posts for review. This study involved the analysis of publicly available posts containing photos, not videos. As we used posts from public accounts, the content was therefore in the public domain, preventing any potential privacy concerns, the review process did not involve any interaction between the researchers and content creators, therefore a formal ethics review was not deemed necessary.

Each post in the study was coded for demographic details (post ID, posting date, presenting gender, and age), framing of eating disorder (positive, negative, neutral), role of food (negative perception of food, positive perception of food, includes images of healthy foods, includes images of unhealthy/indulgent foods, not applicable), hashtag utilized (recovery hashtags: #edrecovery, #eatingdisorderrecovery, #anarecovery, #anorexiarecovery; anti-recovery hashtag: #proED), emotion in caption (happy, sad/sadness, not applicable, unspecified emotion), quotes (positive, potentially negative, factual, acceptance, not applicable), and challenge and stigma cues (challenge cues: hope, social inclusion, combat; stigma cues: social exclusion, responsibility, peril, labelling).  Two coders coded all 36 posts in the sample to ensure intercoder reliability, 75% was achieved.

Results

This study analyzed how living with and recovering from an eating disorder is portrayed on the social media platform Instagram. Of the 36 posts analyzed, eight (22%) of them contained images of females or female-presenting individuals. Of those eight posts, two (0.05%) also contained images of male or male-presenting individuals. Approximately 39% of the posts featured images of food, and 100% of the posts containing images of food included images of foods that one would typically avoid while living with an eating disorder. Challenge cues occurred more frequently (47%) than stigma cues (0.03%). Hope (75%) and combat (50%) were the commonly used challenge cues in the posts. Of the 36 posts, 21 (58%) utilized quotes to convey messages of positivity (36%) and acceptance (13%).

Discussion

Out of the posts containing imagery of people, the majority contained real-life photos of females or female-presenting individuals. Males only being present in artistic imagery, continually with them being represented in posts captured under 1% of the time. The majority of posts attempted to convey positive messages about eating disorders. Framing Theory assists in conveying that the content consumed influences understanding. Imagery on social media platforms has led to an increase in poor self-thought and/or dysmorphia (Leone, Sedory & Gray, 2005). Positive messages are critical in helping change the narrative to support those who struggle and assist in normalizing recovery. Framing Theory connects to Cultivation Theory. One’s consumption influences perception (Gerbner, 1969). A lack of diverse representation can lead to inadvertently excluding members who do not fit into the stereotype. Diversity is crucial for challenging narratives of who meets the criteria for inclusion.

Limitations

Our study is not without limitations. The study’s focus on one common eating disorder, anorexia, may minimize or overlook the many other eating disorders that exist and the experiences of those living with and/or recovering from them. Although we strived to ensure strong intercoder reliability, there may be variations in the interpretation by coders which could impact the consistency of the analysis. While we did base some of our coding categories on what other studies looked at, we created the definitions ourselves as they were not available which could lead to variations in meaning between different studies. Instagram has created rules around the sharing, accessing, and engaging with content related to eating disorders and as such may lead to overestimating the impact of this content. One of the changes Instagram has made from previous research publications is that you can no longer search for content related to #proED which meant we could not include this in our study. Including research on the pro-eating disorder community could provide additional insights into the role Instagram plays in facilitating conversations about and representations of eating disorders. While our study looks at the role Instagram plays in the portrayal/discussion of eating disorders and eating disorder recoveries it cannot establish causality. Due to time restraints and the complexity of gathering the required information from Instagram posts our sample size is on the small side. Due to a small sample size and targeted eating disorder, the findings may not be generalizable to all anorexia recovery content or eating disorder content more broadly. Future research could mitigate these limitations through expanded sampling size, a more comprehensive list of hashtags, analyzing data from more than one social media platform, and utilizing established coding protocols to improve the validity and applicability of the research.

Implications, Recommendations, Conclusion

This research supports Framing Theory by examining the presentation of eating disorders on social media. One can see this with the top challenge cues of hope and combat in congruence with the 100% of posts containing typical fear foods. This leads to the notion that Instagram specifically can be used to expose those with eating disorders and recovery to positive mindsets regarding food and their relationship to specific items. As seen within the research, 58% of these posts include quotes which suggest a direct link towards implicit messaging and move towards more direct communication of motivation or support. As previously mentioned within the limitations Instagram has introduced a feature which redirects users to sources that encourage recovery and outside help; suggesting users will see more positive and recovery-inclined posts than detrimental ones. This shows the site acknowledges its influential power and is moving in the direction of recovery with posts that will be boosted within the algorithm. This concept links back to Cultivation Theory, as the platform is moving to emphasize posts that positively support its users. This thought is supported again by the frequency of challenge cues of both hope (75%) and combat (50%). Using this information public servants, advocates, health care and media professionals can start to identify online trends to tailor their content to reach and assist a larger audience. For example; one may want to use the trend of general food exposure alongside the growing trend of positive quotes to work within the social media platform algorithm. Alternatively one can use different imaging and communication methods to stand out against other content. We hope more research can explore these specific trends possibly involving focus groups of users who access this content to determine their effectiveness. Additionally, it should be noted that prior research has been done examining the prominent role video content plays in influencing one’s self-image and body dissatisfaction (Allen & Mulgrew). As technology continues to evolve, experts in the field of Mental Health, Healthcare and media professionals must remain vigilant in their communication and modes of outreach to be successful.

 

References

Allen, A., & Mulgrew, K. E. (2020). Differential media effects on male body satisfaction and mood. Australian Journal of Psychology, 72(1), 3–10. https://doi.org/10.1111/ajpy.12254

Entman, R. M. (1993). Framing: Toward Clarification of a Fractured Paradigm. Journal of Communication, 43(4), 51-58.

Goh, A. Q. Y., Lo, N. Y. W., Davis, C., & Chew, E. C. S. (2022). #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eating and Weight Disorders, 27(4), 1535–1545.

Gerbner, G. (1969). Toward “Cultural Indicators”: The Analysis of Mass Mediated Public Message Systems. AV Communication Review, 17(2), 137–148. http://www.jstor.org/stable/30217499

Guarda, A. (2023). What are Eating Disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders#section_8

LaMarre, A., & Rice, C. (2017). Hashtag Recovery: #Eating Disorder Recovery on Instagram. Social Sciences (Basel), 6(3), 68-.

Lash, B. N. (2014). I can’t hear you but I’m not sure I’m going to tell you: Perceptions of stigma and disclsoure for individuals who are deaf or hard of hearing.  ProQuest Dissertations Publishing.

Leone, J. E., Sedory, E. J., & Gray, K. A. (2005). Recognition and treatment of muscle dysmorphia and related body image disorders. Journal of athletic training, 40(4), 352.

O’Gorman, B., Sheffield, J., Clarke, R., & Griffiths, S. (2021). “Guys don’t talk about their bodies”: A qualitative investigation of male body dissatisfaction and sociocultural influences in a sample of 40 Australian males. Clinical Psychologist, 24, 123–132.

Padin, P. F., Gonzalez-Rodriguez, R., Verde-Diego, C., & Vazquez-Perez, R. (2021). Social Media and Eating Disorder Psychopathology: A Systematic Review. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 15(3), Article 6.

Perera, A. (2023). Cultivation Theory in Media. SimplyPsychology. https://www.simplypsychology.org/cultivation-theory.html

Public Health Agency of Canada (2020). About mental health. Government of Canada. https://www.canada.ca/en/public-health/services/about-mental-health.html

Scheufele, D. A. (1999). Framing as a theory of media effects. Journal of Communication, 49(1), 103-122.

Talbot, C. V., Campbell, C. E. R., & Greville-Harris, M. (2023). “Your struggles are valid, you are worthy of help and you deserve to recover”: narratives of recovery from orthorexia nervosa. Eating and Weight Disorders, 28(1), 25–25.

U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders

Valle, M. K., & Wade, T. D. (2022). Targeting the link between social media and eating disorder risk: A randomized controlled pilot study. The International Journal of Eating Disorders, 55(8), 1066–1078.

 

Appendix 1

Definitions

Cultivation Theory: Communication framework that implies that those exposed to media interpret social realities according to how such realities are portrayed in the media (Perera, 2023).

Framing Theory: Communication theory that demonstrates how “media have a strong impact by constructing social reality” (Scheufele, 1999), the way something is framed or presented by media effects the way people come to understand it.

Mental Health: Mental health refers to one’s psychological and emotional well-being (Public Health Agency of Canada, 2020, para.1).

Eating Disorders: Are complex conditions characterized by “severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions” (American Psychiatric Association, 2023, para.1).

Stigma Communication Theory: Explores how stigma results from society’s categorization of an individual, leading to an internalization of these societal stigmas (Lash, 2014; Goffman, 1963).

 

Appendix 2

Code Definitions and Categories
		Description
1. Demographic Details	A. Post ID	Unique identifier for each post.
	B. Posting Date	Date when the post was published.
	C. Presenting Gender	What gender does the individual present as in the photo: i. Female ii. Male iii. Other/unclear iv. Not applicable
	D. Age	i. child/adolescent (<18 years) ii. Young adult (18 to 35 years) iii. Other/unclear iv. Not applicable
Variable	Category	Description
2. Framing of Eating Disorder		0 = No and 1 = Yes for each option
	A. Positive	Recovery is a process, ultimately leading to a better and healthier, journey that has challenges, but it is worth it, describes/discusses the benefits to their health
	B. Negative	Recovery is an unnecessary, inapplicable, unattractive idea and “a failure”
	C. Neutral	References facts and takes an objective stance on the matter. No sense of a personal connection to the topic at all.
3. Role of Food		0 = No and 1 = Yes for each option
	A. Negative perception of food	Food contributes to body fat percentage and weight gain is deemed as ‘unattractive’ or scary (fear foods further explained at D. Includes Images of unhealthy/indulgent foods) Food is not to be enjoyed, food is to be restricted and or the consumption/digestive process is to be altered by emotional/mental barriers.
	B. Positive perception of food	Describes food as necessary to maintain a healthy lifestyle. Does not criticize having unhealthy/indulgent foods. Food is needed to live a healthy and fulfilling life, food is enjoyable, discusses eating a diverse variety of foods not just “healthy foods”
	C. Includes images of healthy foods	Images include foods that are typically associated as healthy. This includes foods in their raw state (raw state foods are those that have not been processed, they are in their natural state), fresh produce, low-carb alternative, vegetables, and fruit.
	D. Includes Images of unhealthy/indulgent foods	Image includes foods typically associated as being unhealthy or indulgent. This includes foods such as cake, cupcakes, chocolate, milkshake, fast food, processed food, candy, soda, high-sugar snacks, and bread.
	E. Not applicable	Post does not contain images of food or discuss or mention foods
4. Hashtag utilized		0 = No and 1 = Yes for each option
	Recovery Hashtag	Utilizes a hashtag such as #EDRecovery, #EatingDisorderRecovery, #AnorexiaRecovery, #anarecovery to show support for the recovery process whether they themselves are going through or supporting the recovery of others. Using this hashtag frames eating disorders as something you do not have to live with but can recover from.
	A. Uses #edrecovery
	B. Uses #eatingdisorderrecovery
	C. Uses #anarecovery
	D. Uses #anorexiarecovery
	Anti-recovery Hashtag	Utilizes a hashtag such as #proED to show support for the continuation of living with an eating disorder. Using this hashtag frames eating disorders as a positive thing versus negative.
	E. Pro Eating Disorder Hashtag
5. Emotion		0 = No and 1 = Yes for each option
	A. Happy	Look for adjectives that describe feelings of contentment, fulfillment and a sense of satisfaction/joy. If unsure, see if the post has one of the following emojis (if applicable): smiley face, sun, celebration, rainbow.
	B. Sad/Sadness	Look for adjectives that describe feelings of discontentment, loss and a sense of yearning/ incompleteness. If unsure, see if the post has one of the following emojis (if applicable): heartbreak, sad face, crying face.
	C. Not applicable	References facts and takes out personalization or relation to eating disorders.
	D. Unspecified emotion	Substantial use of adjectives that cross a spectrum of emotional responses. Does show an emotional response but it is not specifically linked to only happy or sad.
6. Quotes		0 = No and 1 = Yes for each option
	A. Positive	Internal motivation to change, promotes the benefits of recovery
	B. Potentially Negative	Ambivalent about recovery, does not acknowledge the need to recover
	C. Factual	Increase awareness and stigma of ED
	D. Acceptance	Focused on accepting themselves for who they are and where they are at in their journey
	E. Not applicable	Post does not contain any quotes
7. Challenge and Stigma Cues	Challenge Cues	0 = No and 1 = Yes for each option
	A. Hope	Messages emphasizing success in overcoming an eating disorder.
	B. Social Inclusion	Integrating the topic or discussion of eating disorders into society
	C. Combat	Highlighting how individuals combat their eating disorder
	Stigma Cues
	D. Social Exclusion	Depiction of people with eating disorders as isolated and marginalized. OR Placing value over one disorder rather than another.
	E. Responsibility	Blaming those suffering from an eating disorder for their condition.
	F. Peril	Expression of concerns about the dangers posed by the eating disorder.
	G. Labelling	Those in recovery are viewed negatively or as the opposition to those living with a disorder OR Those living with a disorder need help and rehabilitation OR All people with anorexia should fit a specific body type to be labeled as anorexic