Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts

Abstract

Background A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19–related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings. Objective The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)–related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior. Methods Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis. Results Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability. Conclusions Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access.

The impact of COVID‐19 on body‐dissatisfied female university students

“…This study investigated the impact of COVID‐19 on young women's risk of developing an eating disorder and the effectiveness of active interventions during COVID‐19. Findings suggest that during COVID, disordered eating behaviors and negative affect were significantly higher than pre‐COVID levels, which echoed findings from qualitative research (Brown et al, 2021; Nutley et al, 2021; Richardson et al, 2020). Significant difference in disordered eating pre‐versus during COVID remained when adjusting for negative affect.…”

“…Using retrospective reporting, Phillipou et al (2020) found that a general population in Australia increased their restricting and binge eating behaviors during COVID‐19, whereas those who had an ED history increased not only their restricting, binge eating but also purging and exercise behaviors. Qualitative retrospective research has found that those who experienced disordered eating tend to report similar themes; an increase in ED symptoms, need for help and support, limited access to services during COVID‐19 (Brown et al, 2021; Nutley et al, 2021; Richardson, Patton, Phillips, & Paslakis, 2020). To date only one study has used a prospective design to report on the impact of COVID on disordered eating, where college students in the US recorded no significant change in weight, BMI, or BMI category, between January and April 2020, but over this time the subjective descriptions of weight changed to significantly be more likely to fall into a higher category (Keel et al, 2020).…”

Changes in Language Style and Topics in an Online Eating Disorder Community at the Beginning of the COVID-19 Pandemic: Observational Study

“…However, it could also reflect a genuine effort by users to learn about ED treatments or exchange views on recovery from EDs. A willingness among users of ED communities on Reddit to foster healthier habits and attempt recovery from EDs during the first months of the pandemic was also noted in another study [28]. The increase in discussions could have also been caused by users debating or inquiring about alternatives for their interrupted ED treatments such as self-management of recovery or anonymous helplines [9,17].…”

“…As a consequence, people with EDs, or those at-risk for developing an ED, could be reaching out to these communities during the COVID-19 pandemic to receive the social support they are lacking in their everyday life. A qualitative study on three ED communities on the social media website Reddit during the first months of the COVID-19 pandemic uncovered themes such as increased ED symptomatology, changes in daily routine, and treatment interruptions [ 28 ], which echo issues that were also found in survey studies.…”

Perceived Weight Gain and Eating Disorder Symptoms among LGBTQ+ Adults during the COVID-19 Pandemic: A Convergent Mixed-Method Study

“…While several studies suggest differential outcomes based on eating disorder (ED) type (e.g, anorexia nervosa vs binge eating), 6 persons with histories of (ED) may be particularly affected by pandemicrelated stressors, exacerbating risk for recurrence or elevated severity of their ED and worsening symptoms. [6][7][8][9][10][11][12] Preliminary studies examining disordered eating behaviors (DEB) during the COVID-19 pandemic cautioned how lockdown may exacerbate problematic eating behaviors, [13][14][15] and that ED may shape COVID-19 risk. 16 In an Italian community sample collected at two different phases of Italy's pandemic lockdown, Cecchetto et al 17 found that depression and anxiety were associated with emotional eating, and that stress was associated with binge eating.…”