"Lean into the Lizzo:" Internet spaces as therapeutic publics in eating disorder recovery

Abstract

Atypical anorexia (AAN) is a restrictive eating disorder (ED) in which “all of the criteria for anorexia nervosa (AN) are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.” (APA, 2013, p. 353). Though rates of AAN are similar to or greater than those of AN, fewer individuals with AAN are referred to or admitted to ED specific treatment due to discrimination based on weight stigma (Harrop et al., 2021). Online spaces, especially social media, have become hugely influential both in general and as part of the context of EDs. Though online spaces have primarily been studied for their roles as risk factors, they contain possibilities for healing (Cohen et al., 2020). As sites where people in larger bodies with EDs can exchange information, receive mutual support, and learn about related movements for cultural change, internet spaces holds significant potential as a therapeutic public in recovery (Fullagar, 2017). However, digital spaces are a largely untapped resource in mainstream treatment contexts where many people, particularly those with less access to traditional treatment such as patients with AAN, are already interacting. This secondary qualitative analysis aimed to highlight the ways that a group of ED patients typically not given access to traditional treatment has engaged online and how that engagement has impacted sense of self and recovery from their EDs.Methods: This study utilized semantic and latent qualitative thematic analysis to explore semi-structured interview data collected as a part of a longitudinal, mixed-methods study conducted by Dr. Erin Harrop (EH) that explored women’s and non-binary assigned female at birth individuals’ experiences of atypical anorexia nervosa (Braun & Clarke, 2006; Harrop, 2020). Results: Study participants discussed five levels of engagement (withdrawing, consuming, interacting, sharing/reposting, contributing) online and described four functions that online spaces served for them (as sites of identifying diet culture, sites of transforming shame, sites of resourcing and resistance, and sites of public pressure). In several ways, these insights position the internet as a powerful therapeutic tool: a space where knowledge and validation are freely exchanged, where cultural norms can be made visible and challenge, where ideas of the “expert” in treatment can be negotiated (Fullagar, 2017). Discussion: Findings from this study frame the internet as a powerful therapeutic tool with implications both for clinicians working with patients with EDs and for ED treatment itself. Insights from participant experiences suggest potential benefits of expanding the clinical lens to explore the systemic and cultural forces at play in client narratives, and invite clinicians to consider the role of advocacy in ED treatment activities. Findings from this study suggest possibilities for self-directed internet-based treatment interventions for patients with EDs who may face barriers to accessing formal treatment. Future studies may build on these insights by investigating current recovery activities online and their specific impact on patients’ ED recovery processes. Further attention to this topic holds potential to expand what is a critical and accessible recovery space for ED patients who have been marginalized due to their body size.